Using microglia-derived extracellular vesicles to capture diversity of microglial activation phenotypes following neurological injury

Microglia are one of the three glial cell populations in the central nervous system(CNS),along with astrocytes and oligodendrocytes.While microglia are unique among brain cells due to their hematologic origin and perform immune functions similar to peripheral macrophages,they are not simply macrophages of the CNS.

Habitual physical activity levels and sedentary time of children in different childcare arrangements from a nationally representative sample of Canadian preschoolers

Background:Children spend substantial time in childcare,and the reasons parents choose a particular childcare type may differ by family.However,little is known about how childcare type influences habitual(full day)activity levels among children.Therefore,exploring patterns between childcare type and habitual physical activity(PA)(i.e.,light,moderate-to-vigorous PA(MVPA),and total PA)and sedentary time(ST)in young Canadian children is needed.Methods:A nationally representative sample of preschoolers from Cycles 3 and 4 of the Canadian Health Measures Survey was used in this cross-sectional study.Childcare type(e.g.,center-based childcare,home-based childcare,home with parent,kindergarten)was reported by parents.Preschoolers wore an Actical accelerometer for 7 days.Device and population-spcific cut-points were applied to delineate PA intensities and ST.Population means and sample totals were calculated to examine average daily and hourly rates of activity.Results:Preschoolers’rates of MVPA and total PA from the 4 childcare arrangements ranged from 65.99 min/day to 74.62 min/day(5.48-6.18 min/h)and 274.20 min/day to 281.66 min/day (22.69-23.21 min/h),respectively,while ST ranged from 443.13 min/day to 460.57 min/day(36.80-37.31 min/h).No significant differences were observed in daily or hourly rates of activity.Conclusion:This study provides a snapshot of the levels of PA and ST among preschoolers in various childcare settings at a national level,with no differences observed in habitual activity levels based on childcare enrollment.Additional research is needed to clarify the relationship between young children’s PA and childcare type,with consideration given to the quality of the childcare settings.

Flexible ureteroscopy:Technological advancements,current indications and outcomes in the treatment of urolithiasis

The last 3 decades have witnessed great improvements in the technology and clinical applications of many minimally invasive procedures in the urological field.Flexible ureteroscopy(fURS)has advanced considerably to become a widely utilized diagnostic and therapeutic tool for multiple upper urinary tract pathologies.The most common indication for fURS is the treatment of upper urinary tract stones with the aid of Holmium:Yttrium Aluminium Garnet(YAG)laser lithotripsy.Advancements in endoscope technologies and operative techniques have lead to a broader application of fURS in the management of urolithiasis to include larger and more complex stones.fURS has proved to be an effective and safe procedure with few contraindications.Continued progression in fURS may increase its clinical applicability and supplant other procedures as the first line treatment option for urolithiasis.

Dystrophic calcification and heterotopic ossification in fibrocartilaginous tissues of the spine in diffuse idiopathic skeletal hyperostosis(DISH)

Diffuse idiopathic skeletal hyperostosis(DISH) is a prevalent noninflammatory spondyloarthropathy characterized by ectopic mineral formation along the anterolateral aspect of the vertebral column, yet little is known about its underlying pathogenesis. Our objective was to evaluate the histopathological features and composition of ectopic mineral within spinal tissues affected by DISH in humans. Thoracic spine segments from six embalmed cadaveric donors(one female and five males;median age 82 years)meeting the radiographic diagnostic criteria for DISH were evaluated using radiological, histological, and physical analyses. Overall,the histological features of ectopic mineralization at individual motion segments were heterogeneous, including regions of heterotopic ossification and dystrophic calcification. Heterotopic ossifications were characterized by woven and lamellar bone,multifocal areas of metaplastic cartilage, and bony bridges along the anterior aspect of the intervertebral disc space. Dystrophic calcifications were characterized by an amorphous appearance, a high content of calcium and phosphorus, an X-ray diffraction pattern matching that of hydroxyapatite, and radiodensities exceeding that of cortical bone. Dystrophic calcifications were found within the anterior longitudinal ligament and annulus fibrosus in motion segments both meeting and not meeting the radiographic criteria for DISH. In summary, our findings indicate that in DISH, ectopic mineral forms along the anterior aspect of the spine by both heterotopic ossification and dystrophic calcification of fibrocartilaginous tissues. Although both types of ectopic mineralization are captured by current radiographic criteria for DISH, dystrophic calcification may reflect a distinct disease process or an early stage in the pathogenesis of DISH.

Evaluating implicit gender bias at Canadian otolaryngology meetings through use of professional title

Objectives:Increasing numbers of women enter medical school annually.The number of female physicians in leadership positions has been much slower to equalize.There are also well‐documented differences in the treatment of women as compared to men in professional settings.Female presenters are less likely to be introduced by their professional title(“Doctor”)for grand rounds and conferences,especially with a man performing the introduction.This study reviewed the Canadian Society of Otolaryngology–Head and Neck Surgery(CSOHNS)meetings from 2017 to 2020 to determine the proportion of presenters introduced by their professional title and whether this varied by gender.Methods:Recordings from CSOHNS meetings were reviewed and coded for introducer and presenter demographics,including leadership positions and gender.Chi‐squared tests of proportion and multivariate logistic regression was used to compare genders and identify factors associated with professional versus unprofessional forms of address.Results:No significant association was found between professional title use and introducer or presenter gender.Female presenters were introduced with professional title 69.6%of the time,while male presenters were introduced with professional title 67.6%of the time(P=0.69).Residents were introduced with a professional title with the most frequency(75.8%),while attending staff were introduced with a professional title with the least frequency(63.0%)(P=0.02).Conclusions:The lack of gender bias in speaker introductions at recent CSOHNS meetings demonstrates progress in achieving gender equity in medicine.Research efforts should continue to define additional forms of unconscious bias that may be contributing to gender inequity in leadership positions.

Biopsy of Canada’s family physician shortage

Family physicians provide comprehensive care for the community and are an integral part of the healthcare system.Canada is experiencing a shortage of family physicians,driven in part by overbearing expectations of family physicians,limited support and resources,antiquated physician compensation,and high clinic operating costs.An additional factor contributing to this scarcity is the shortage of medical school and family medicine residency spots,which have not kept pace with population demand.We analysed and compared data on provincial populations and numbers of physicians,residency spots and medical school seats across Canada.Family physician shortages are the highest in the territories(>55%),Quebec(21.5%)and British Columbia(17.7%).Among the provinces,Ontario,Manitoba,Saskatchewan and British Columbia have the fewest family physicians per 100000 persons in the population.Among the provinces that offer medical education,British Columbia and Ontario have the fewest medical school seats per population,while Quebec has the most.British Columbia has the smallest medical class size and the least number of family medicine residency spots as a function of population,and one of the highest percentages of provincial residents without family doctors.Paradoxically,Quebec has a relatively large medical class size and a high number of family medicine residency spots as a function of population,but also one of the highest percentages of provincial residents without family doctors.Possible strategies to improve the current shortage include encouraging Canadian medical students and international medical graduates to consider family medicine,and reducing administrative burdens for current physicians.Other steps include creating a national data framework,understanding physician needs to guide effective policy changes,increasing seats in medical schools and family residency programmes,providing financial incentives and facilitating entry into family medicine for international medical graduates.

Exercise for stroke prevention

We review evidence concerning exercise for stroke prevention.Plausible biological reasons suggest that exercise would be important in preventing stroke.While definitive randomised controlled trials evaluating the impact of physical activity(PA)and exercise on preventing stroke and mortality are lacking,observational studies,small randomised controlled trials and meta-analyses have provided evidence that PA and exercise favourably modify stroke risk factors,including hypertension,dyslipidaemia,diabetes,sedentary lifestyle,obesity,excessive alcohol consumption and tobacco use.It is,therefore,important to understand the factors associated with poststroke PA/exercise and cardiorespiratory fitness.Positively associated factors include self-efficacy,social support and quality of patients’relationships with health professionals.Negatively associated factors include logistical barriers,medical comorbidities,stroke-related deficits,negative exercise beliefs,fear of falling,poststroke fatigue,arthropathy/pain and depression.Definitive research is needed to specify efficacious behavioural approaches to increase poststroke exercise.Effective techniques probably include physician endorsement of exercise programmesto patients,enhancement of patient-professional relationships,providing patients an exercise rationale,motivational interviewing,collaborative goal-setting with patients,addressing logistical concerns,social support in programsmes,structured exercise programming,individualised behavioural instruction,behavioural diary recording,reviewing behavioural consequences of exercise efforts,reinforcing successful exercise performance.Exercise programming without counselling may increase short-term activity;simple advice or information-giving is probably ineffective.Older patients or those with cognitive impairment may need increased structure,with emphasis on behaviour per se,versus self-regulation skills.We support the latest American Heart Association/American Stroke Association guidelines(2014)recommending PA and exercise for stroke prevention,and referral to behaviourally oriented programmes to improve PA and exercise.

Associations between partial foot amputation level,gait parameters,and minimum impairment criteria in para-sport:A research study protocol

Altered biomechanics due to amputation can contribute to substantial limitations,influencing sporting activities.Individuals with lower extremity amputations or congenital lower limb deficiency are encouraged to participate in para-sports.However,to compete in Paralympic sports,the candidate must have an impairment that results in lower extremity loss of function and meets or exceeds the sport's minimum impairment criteria(MIC).This review will focus on the MIC for competitive wheelchair tennis.Limb deficiency is known as one of the MIC used to regulate participation in competitive para-sports since it impacts gait,kinematics,and biomechanics of both the upper and lower body.Notwithstanding,it is questionable whether the MIC concerning limb deficiency is set at the correct level for determining eligibility for participating in Paralympic sports.This study aims to provide an overview of the evidence examining the impact of different partial foot amputation(PFA)levels on gait as a proxy for sporting performance.This scoping review will be based on a 6-step methodological framework and Preferred Reporting Items for Systematic Reviews and Meta-Analysis,extension for scoping reviews(PRISMA-ScR).Studies will be selected from PubMed,Embase,CINAHL,and SPORTDiscus.Two authors will screen the titles/abstracts independently.Selected studies will be scrutinised,and the same authors will extract data.Findings will be relevant to informing the evidence-based development of MIC for lower limb impairment after PFA and may be extrapolated to specific Paralympic sports,including wheelchair tennis.Results will be disseminated through scientific publications and conferences to audiences interested in Paralympic sports.