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Background: People with kidney failure receiving dialysis (CKD‐G5D) are more likely to undergo surgery and experience poorer postoperative outcomes than those without kidney failure. In this scoping review, we aimed to systematically identify and summarize perioperative strategies, protocols, pathways, and interventions that have been studied or implemented for people with CKD‐G5D. Methods: We searched MEDLINE, EMBASE, CINAHL Plus, Cochrane Database of Systematic Reviews, and Cochrane Controlled Trials registry (inception to February 2020), in addition to an extensive grey literature search, for sources that reported on a perioperative strategy to guide management for people with CKD‐G5D. We summarized the overall study characteristics and perioperative management strategies and identified evidence gaps based on surgery type and perioperative domain. Publication trends over time were assessed, stratified by surgery type and study design. Results: We included 183 studies; the most common study design was a randomized controlled trial (27%), with 67% of publications focused on either kidney transplantation or dialysis vascular access. Transplant‐related studies often focused on fluid and volume management strategies and risk stratification, whereas dialysis vascular access studies focused most often on imaging. The number of publications increased over time, across all surgery types, though driven by non‐randomized study designs. Conclusions: Despite many current gaps in perioperative research for patients with CKD‐G5D, evidence generation supporting perioperative management is increasing, with recent growth driven primarily by non‐randomized studies. Our review may inform organization of evidence‐based strategies into perioperative care pathways where evidence is available while also highlighting gaps that future perioperative research can address. [ABSTRACT FROM AUTHOR]

A small pilot study was conducted to test whether the technique of in vivo neutron activation analysis could measure bone aluminum levels in 15 miners who had been exposed to McIntyre Powder over 40 years prior. All miners were over 60 years of age, had worked in mines that used McIntyre Powder, and were sufficiently healthy to travel from northern to southern Ontario for the measurements. Individual aluminum levels were found to be significantly greater than zero with 95% confidence (p < 0.05) in 7 out of the 15 miners. The inverse variance weighted mean of the 15 participants was 21.77 ± 2.27µgAl/gCa. This was significantly higher (p < 0.001) than in a group of 15 non-occupationally exposed subjects of a comparable age from Southern Ontario who had been measured in a previous study. The inverse variance weighted mean bone aluminum content in the non-occupationally exposed group was 3.51 ± 0.85µgAl/gCa. Since the use of McIntyre Powder ceased in 1979, these subjects had not been exposed for more than 40 years. Calculations of potential levels at the cessation of exposure in the 1970s, using a biological half-life of aluminum in bone of 10 to 20 years predicted levels of bone aluminum comparable with studies performed in dialysis patients in the 1970s and 1980s. This pilot study has shown that the neutron activation analysis technique can determine differences in bone aluminum between McIntyre Powder exposed and non-exposed populations even though 40 years have passed since exposure ceased. The technique has potential application as a biomarker of exposure in cross-sectional studies of the health consequences of exposure to McIntyre Powder. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Patients can be used as a resource to enter their own pertinent medical information. This study will evaluate the feasibility of an intelligent computer medical history-taking device directed at patients in the emergency department (ED). Methods: Two of the authors (MB, RE) developed an expert system that can take patient-directed medical histories. Patients interacted with the computer in the ED waiting room while it gathered a medical history based on chief complaint (CC). A survey was completed post history. A sub-study assessed the computer''s ability to take an adequate history for an index CC. We compared the computer and emergency physician histories for the presence or absence of important historical elements. Results: Sixty-seven patients used the interactive computer system. The mean time to complete the history was 5min and 32s±1min and 21s. The patient response rate was 97%. Over 83% felt that the computer was very easy to use and over 92% would very much use the computer again. A total of 15 patients with abdominal pain (index CC) were evaluated for the sub-study. The computer history asked 90±7%, and the emergency physician asked 55±18%, of the important historical elements. These groups were statistically different with a p-value of <0.00001. Conclusion: This feasibility study has shown that the computer history-taking device is well accepted by patients and that such a system can be integrated into the normal process of patient triage without delaying patient care. Such a system can serve as an initial mode for documentation and data acquisition directly from the patient. [Copyright &y& Elsevier]

• Hospital mortality was higher in patients within the lower psoas cross sectional area quartiles. • The development of pneumonia and/or acute respiratory distress syndrome was not significantly different across quartiles. • Patients who died had a significantly lower psoas cross sectional area compared to all others. Sarcopenia is associated with increased morbidity and mortality in the trauma patient. The primary objective of this study was to determine the relationship of psoas cross sectional area with hospital mortality in patients with rib fractures over the age of 55 years. We retrospectively reviewed 1223 patients presenting to a Level 1 Trauma Center between 1/1/2002 and 1/31/2019. Psoas cross sectional area was measured using a polygonal tracing tool. Patients were stratified into four quartiles based on sex-specific values. There was increased in-hospital mortality for patients with a lower psoas cross sectional area (10 %, 8%, 6%, and 4%, Q1-Q4 respectively; P =0.021). The logistic regression model determined for every increase in psoas cross sectional area by 1 cm2 the odds of in-hospital mortality decreased by 4%. In-hospital mortality is multifactorial; however, psoas cross sectional area may provide a clue in predicting adverse outcomes after traumatic rib fractures. [ABSTRACT FROM AUTHOR]

Perioperative medicine is changing rapidly, and with this change comes the opportunity to improve upon current models of care delivery and integration within the health care system. Perioperative models of care are structured or conceptual arrangements for surgical patients before, during and after their surgery. Models of care such as the Perioperative Surgical Home and Enhanced Recovery After Surgery pathways are increasingly used to guide the structure of perioperative care delivery with an aim to improve patient outcomes and experience in Canadian settings. In this narrative review, we summarize the origins of these perioperative models of care. They are fundamentally different in scope and level of evidence. Both models have potential benefits and limitations to their broad implementation in our health care system. As currently developed, both models are limited in their application to patients with chronic disease. We discuss how these models of care can be used to develop integrated horizontal and vertical perioperative pathways in a Canadian setting. Such integration is a potential solution that will improve their applicability to patients with medically complex conditions and in times when health care systems are under pressure. We describe this approach using the example of patients with kidney failure receiving dialysis. [ABSTRACT FROM AUTHOR]

Somatic cell hybrid systems generated by combining cancerous with non-cancerous cells provide useful model systems to study neoplastic transformation. Combined with recent advances in omics-based technologies, novel molecular signatures that drive radiation-induced carcinogenesis can be analyzed at an exceptional global level. Here, we present a complete whole-transcriptome analysis of gamma-induced mutants (GIM) and gamma irradiated control (CON) segregants isolated from the CGL1 (HeLa x normal fibroblast) human hybrid cell-system exposed to high doses of radiation. Using the Human Transcriptome Array 2.0 microarray technology and conservative discrimination parameters, we have elucidated 1067 differentially expressed genes (DEGs) between tumorigenic and non-tumorigenic cells. Gene ontology enrichment analysis revealed that tumorigenic cells demonstrated shifts in extracellular matrix (ECM) and cellular adhesion profiles, dysregulation of cyclic AMP (cAMP) signaling, and alterations in nutrient transport and cellular energetics. Furthermore, putative upstream master regulator analysis demonstrated that loss of TGFβ1 signaling due to reduced SMAD3 expression is involved in radiation-induced carcinogenesis. Taken together, this study presents novel insights into specific gene expression and pathway level differences that contribute to radiation-induced carcinogenesis in a human cell-based model. This global transcriptomic analysis and our published tumor suppressor gene deletion loci analyses will allow us to identify and functionally test candidate nexus upstream tumor suppressor genes that are deleted or silenced after exposure to radiation. Image 1 • Whole transcriptome and gene ontology enrichment analysis was performed on independently isolated radiation-induced tumorigenic segregants of CGL1 human hybrid cells (GIMs) versus irradiated but nontumorigenic CONs. Radiation-induced carcinogenesis resulted in: • Shifts in extracellular matrix, cellular adhesion, cyclic AMP signaling, nutrient transport and cellular energetics now classified as hallmarks of cancer. • Loss of TGF-β1 signaling due to reduced SMAD3 expression. • Changes in gene expression that agreed with extensive published phenotypic alterations observed in these radiation-induced tumorigenic GIM segregants. • Identification specific gene expression and pathway level differences that contribute to radiation-induced carcinogenesis in a human cell-based model. • Global transcriptomic and tumor suppressor gene deletion loci analyses will allow us to functionally test candidate nexus upstream tumor suppressor genes involved in radiation carcinogenesis. [ABSTRACT FROM AUTHOR]

Background. Acute kidney injury (AKI) is a serious complication of major noncardiac surgery. Risk prediction models for AKI following noncardiac surgery may be useful for identifying high-risk patients to target with prevention strategies. Methods. We conducted a systematic review of risk prediction models for AKI following major noncardiac surgery. MEDLINE, EMBASE, BIOSIS Previews and Web of Science were searched for articles that (i) developed or validated a prediction model for AKI following major noncardiac surgery or (ii) assessed the impact of a model for predicting AKI following major noncardiac surgery that has been implemented in a clinical setting. Results. We identified seven models from six articles that described a risk prediction model for AKI following major noncardiac surgeries. Three studies developed prediction models for AKI requiring renal replacement therapy following liver transplantation, three derived prediction models for AKI based on the Risk, Injury, Failure, Loss of kidney function, End-stage kidney disease (RIFLE) criteria following liver resection and one study developed a prediction model for AKI following major noncardiac surgical procedures. The final models included between 4 and 11 independent variables, and c-statistics ranged from 0.79 to 0.90. None of the models were externally validated. Conclusions. Risk prediction models for AKI after major noncardiac surgery are available; however, these models lack validation, studies of clinical implementation and impact analyses. Further research is needed to develop, validate and study the clinical impact of such models before broad clinical uptake. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Continuity of care is composed of provider and information continuity and can change value over time. Most studies that have quantitatively associated continuity of care and outcomes have ignored these characteristics. This study is a detailed examination of continuity of care in patients discharged from hospital that simultaneously measured separate components of continuity over time or determined the factors with which they are associated. Design Setting: Multicenter, prospective cohort study of patients discharged to the community after elective or emergent hospitalization. For all physician visits during 6 months after discharge, we identified the physician and the availability of particular information (including hospital discharge summary and any information from previous physician visits). Four physician continuity scores (preadmission; hospital admitting; hospital consultant; and postdischarge) and two information continuity scores (discharge summary and postdischarge visit information) were calculated for all patients (range: 0–1, where 0 is perfect discontinuity and 1 is perfect continuity). Results: Four thousand five hundred fifty-three people were followed for a median of 175 days. Both provider (range of median values: 0–0.410) and information (range: 0.220–0.427) continuity scores were low and varied extensively over time. With a few exceptions, continuity measures were independent of each other. The influence of patient factors on continuity varied extensively between the continuity measures with the most influential factors being admission urgency, admitting service, and the number of physicians who regularly treated the patient. Conclusion: Both provider and information continuity was low in patients discharged from hospital. Continuity measures can change extensively over time, which are usually independent of each other, and are associated with patient and admission characteristics. Future studies should measure multiple components of provider and information continuity over time to completely capture continuity of care. [Copyright &y& Elsevier]

To date, there are no data available on the population genetics of Trichinella due to the lack of genetic markers and the difficulty of working with such small parasites. In the Arctic region of North America and along the Rocky Mountains, there exist two genotypes of Trichinella, Trichinella nativa and Trichinella T6, respectively, which are well differentiated by biochemical and molecular characters. However, both are resistant to freezing, show other common biological characters (e.g. low or no infectivity to rodents and swine) and produce fertile F1 offspring upon interbreeding. To data, these two genotypes have been considered allopatric. In this study, we detected both genotypes in wolves of the same wolf packs in Alaska, suggesting sympatry. A single GTT trinucleotide present in the ITS-2 sequence of T. nativa but not in Trichinella T6 was used as a genetic marker to study gene flow for this character in both a murine infection model and in larvae from naturally-infected Alaskan wolves. Only F1 larvae originating from a cross between T. nativa male and Trichinella T6 female were able to produce F2 offspring. Larvae (F1) originating from a cross between Trichinella T6 male and T. nativa female were not reproductively viable. As expected, all F1 larvae showed a heterozygote pattern for the GTT character upon heteroduplex analysis; however, within the F2 population, the number of observed heterozygotes (n=52) was substantially higher than expected (n=39.08), as supported by the Fis index, and was not in the Hardy–Weinberg equilibrium. Larvae from two of the 16 Trichinella positive Alaskan wolves, showed the Trichinella T6 pattern or the T. nativa/Trichinella T6 hybrid pattern. Our data demonstrate that T. nativa and Trichinella T6 live in sympatry at least in Alaskan wolves, where T. nativa occurs more frequently (69%) than Trichinella T6 (31%). One explanation for this phenomenon is that glacial periods may have caused a geographical relocation, colonisation and independent evolution of T. nativa within the Rocky Mountains, resulting in a bifurcation of the freeze-resistant genotype. Additional studies will be required to test this hypothesis. [Copyright &y& Elsevier]

Extensive research has been conducted investigating the effects of ionizing radiation on biological systems, including specific focus at low doses. However, at the surface of the planet, there is the ubiquitous presence of ionizing natural background radiation (NBR) from sources both terrestrial and cosmic. We are currently conducting radiobiological experiments examining the impacts of sub-NBR exposure within SNOLAB. SNOLAB is a deep underground research laboratory in Sudbury, Ontario, Canada located 2 km beneath the surface of the planet. At this depth, significant shielding of NBR components is provided by the rock overburden. Here, we describe a Specialized Tissue Culture Incubator (STCI) that was engineered to significantly reduce background ionizing radiation levels. The STCI was installed 2 km deep underground within SNOLAB. It was designed to allow precise control of experimental variables such as temperature, atmospheric gas composition and humidity. More importantly, the STCI was designed to reduce radiological contaminants present within the underground laboratory. Quantitative measurements validated the STCI is capable of maintaining an appropriate experimental environment for sub-NBR experiments. This included reduction of sub-surface radiological contaminants, most notably radon gas. The STCI presents a truly novel piece of infrastructure enabling future research into the effects of sub-NBR exposure in a highly unique laboratory setting. • Living systems are exposed to natural background radiation at the planet's surface. • The biological significance of ionizing background radiation is not well understood. • A sub-natural background radiation research study is only possible deep underground. • A novel Specialized Tissue Culture Incubator has been designed and engineered. • Instrument commissioning reveals a sub-natural background radiation environment. [ABSTRACT FROM AUTHOR]

Background: A retrospective cohort study was conducted to estimate associations between an ultrafine aluminum powder, McIntyre Powder (MP), and cardiovascular disease incidence in a cohort of mine workers from Ontario, Canada. Disease outcomes included ischemic heart disease (IHD), acute myocardial infarction (AMI), congestive heart failure (CHF), and strokes and transient ischemic attacks (STIA)., Methods: Using work history records from the Ontario Mining Master File (MMF) mine workers were followed for disease incidence in administrative health records. The analysis included 25,813 mine workers who were exposed to MP between 1943 and 1979 and followed for cardiovascular disease (CVD) diagnoses between 2006 and 2018. Cardiovascular disease cases were ascertained using physician, hospital, and ambulatory care records. Poisson regression models were used to estimate age and birth-year adjusted incidence rate ratios (RR) and 95% confidence intervals (CI) for associations between MP exposure and CVD outcomes., Results: Ever-exposure to MP was positively associated with modest increases in the incidence rate of IHD, AMI, and CHF, but not STIA, using both assessment approaches. Duration of self-reported MP exposure was positively associated with monotonically increasing rates of IHD and AMI compared to never-exposed miners, with the greatest association observed among miners with >20 years of exposure (for IHD: RR 1.24, 95% CI: 0.91-1.68; and for AMI: RR 1.52, 95% CI 1.01-2.28)., Conclusion: Mine workers ever-exposed to MP had modestly elevated rates of CVD. The rate of CVD diagnoses appeared to increase with longer duration of exposure when assessed by both self-reported exposure and through historical records., (© 2024 The Authors. Journal of Cellular Physiology published by Wiley Periodicals LLC.)

McIntyre Powder (MP) is a fine aluminum powder that was developed to prevent silicosis in gold and uranium mine workers in Ontario, Canada, and was administered to miners there from 1943 to 1979. Mine workers were exposed to high concentrations (35.6 mg/m 3 ) of MP for approximately 10 min before every work shift. Contemporary physical and chemical characterizations of this powder have revealed that 12% of the powder is in the ultrafine particle size-range (nanoparticles); and the remaining 88%, in the fine particulate size range (below 2.5 µm in diameter). The confluence of ultrafine particulate (UFP) composition and high airborne concentration of MP would be expected to overwhelm the defense mechanisms of the lung and increase the lung dust burden of the mine worker exposed to respirable dust in the mine. Published studies revealing associations between air pollution particulates and increased risk for cardiovascular disease (CVD) shown a dose-response relationship with ambient PM 2.5 and UFP and suggest that miners exposed to MP may also be at increased risk of CVD. The historical perspective of the use of MP in northern Ontario hard-rock mines and its potential implications for CVD in exposed mine workers are discussed., (© 2021 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals LLC.)

McIntyre Powder (MP) is a finely ground aluminum powder that was used between 1943 and 1979 as a prophylaxis for silicosis. Silicosis is a chronic lung disease caused by the inhalation of crystalline silica dust and was prevalent in the Canadian mining industry during this time period. The McIntyre Research Foundation developed, patented, and produced the MP and distributed it to licensees in Canada, the United States, Mexico, Chile, Belgian Congo, and Western Australia. In the province of Ontario, Canada it is estimated that at least 27,500 miners between 1943 and 1979 were exposed to MP. The present study was undertaken to examine the chemical and physical characteristics of two variations of MP (light grey and black). Chemical analyses (using X-ray Fluorescence and Inductively Coupled Plasma approaches) indicate that the black MP contains significantly higher concentrations of aluminum and metal impurities than the light grey MP ( p  < 0.001). X-ray diffractometry shows that while aluminum hydroxide dominates the aluminum speciation in both variations, the higher total aluminum content in the black MP is attributable to a greater proportion of elemental aluminum. Physical characterization (using electron microscopy, light microscopy, and dynamic light scattering) indicates that the light grey MP consists of particles ranging from 5 nm to 5 µm in diameter. Atomic Force Microscopy shows that the light grey MP particles in the nanoparticle range (<100 nm) have a mode between 5 and 10 nm. Consequently, it is possible that inhaled smaller MP nanoparticles may be transported via blood and lymph fluid circulation to many different organs including the brain. It is also possible for inhaled larger MP particles to deposit onto lung tissue and for potential health effects to arise from inflammatory responses through immune activation. This MP characterization will provide crucial data to help inform future toxicological, epidemiological, and biological studies of any long-term effects related to the inhalation of aluminum dust and nanomaterials.