Magnetic resonance imaging (MRI) is a powerful tool that doctors use to visualize organs and tissues in three dimensions. While the images can provide key insights, the high cost and low availability of MRI systems has led to long wait times for patients.
Dr. Masoom Haider, an Affiliate Scientist with the Techna Institute and a Clinician Scientist in the Joint Department of Medical Imaging, has devised a method for reducing MRI demand by avoiding unnecessary scans for patients at risk of prostate cancer. He says the new strategies, “may support clinical decisions for a more judicious application of MRI to further improve the cost-benefit ratio.”
Dr. Haider, along with his research fellow Dr. Dominik Deniffel and research team, sought to find alternatives to MRI scans among other more readily available and inexpensive clinical parameters. They wondered whether factors such as age, prostate size or the presence of molecular markers could predict MRI results.
The team began by collecting data from hundreds of patients who were at risk of prostate cancer and who had undergone MRI screening. The researchers then built a statistical model for finding patterns and making predictions—to categorize patient risk. The model was then used to predict whether an MRI scan would reveal prostate cancer.
The researchers found that if doctors were to implement this model, 29% fewer patients would need MRI scans. Skipping MRI for these patients would rarely lead to missed prostate cancer diagnosis.
As part of the model building, the researchers discovered that one patient factor was particularly informative in predicting risk: the density of a molecular marker known as prostate specific antigen (PSA). Dr. Haider’s team found that by applying a patient cut-off for this factor alone, the number of patients perceived as needing MRI scans could be reduced by 25%.
Although the predictive power of PSA density is slightly weaker than that of the full model, a cut-off for PSA density could be easily implemented as a low-cost and routine filter for MRI testing.
This work was supported by the Ontario Institute for Cancer Research, a Deutsche Forschungsgemeinschaft (DFG) Fellowship and Sinai Health Foundation.
Deniffel D, Zhang Y, Salinas E, Satkunasivam R, Khalvati F, Haider MA. Reducing Unnecessary Prostate Multiparametric Magnetic Resonance Imaging by Using Clinical Parameters to Predict Negative and Indeterminate Findings. J Urol. 2020 Feb. doi: 10.1097/JU.0000000000000518.
Hospital intensive care units attend to patients with life-threatening or critical conditions. A stay there can be devastating, and patients who are released are often severely weakened and may experience long-term disabilities.
“Identifying patients who will have serious difficulties recovering from illness is a challenge,” says Dr. Ewan Goligher, a Scientist with Toronto General Hospital Research Institute.
Prompted by this challenge, Dr. Goligher and his team initiated a study that focused on patients being aided by a breathing machine—a procedure also known as invasive ventilation. In this procedure, a breathing tube is inserted into the throat so that air can be mechanically pumped into and out of the lungs to help the patient breathe.
In their study, the researchers examined patients who had received invasive ventilation at hospitals in Toronto and tracked their recovery. The researchers measured the thickness of patients’ diaphragms—the primary muscle used for breathing—using ultrasound imaging.
The study results revealed that the patients with more muscle mass in their diaphragms when first admitted had a lower risk of death in hospital. As well, they were less likely to develop complications and recovered from respiratory assistance significantly faster.
While the results may help identify the patients who are at risk for poor recovery, they could also enable the development of new, proactive approaches to reducing these risks. In cases where doctors can foresee a patient needing ventilation, such as following organ transplant or for serious illnesses like cancer, exercises aimed at strengthening the diaphragm could be prescribed.
This work was supported by the Canadian Institutes of Health Research and Toronto General & Western Hospital Foundation.
Sklar MC, Dres M, Fan E, Rubenfeld GD, Scales DC, Herridge MS, Rittayamai N, Harhay MO, Reid WD, Tomlinson G, Rozenberg D, McClelland W, Riegler S, Slutsky AS, Brochard L, Ferguson ND, Goligher EC. Association of Low Baseline Diaphragm Muscle Mass with Prolonged Mechanical Ventilation and Mortality Among Critically Ill Adults. JAMA Network Open. 2020 Feb 19. doi:10.1001/jamanetworkopen.2019.21520.
The CenteR for Advancing Neurotechnological Innovation to Application (CRANIA) is hosting its inaugural workshop as part of an Industry Partnership Day Workshop Series.
The half-day workshop is on February 21, 2020; and registration is open to all staff and researchers involved in neuromodulation research (maximum 70 registrants, first-come-first-served). The workshop will highlight state-of-the-art neural implants—with a focus on Novela Neurotech’s new Open Source Wireless Neuromodulation Research Kit (OpenKit).
The workshop is also a call for collaboration to further develop OpenKit. All research teams that employ electrophysiological techniques/protocols or are interested in learning about the future of neuromodulation therapies are invited to participate.
Ten event registrants will be selected to receive a complimentary OpenKit system, which features a state-of-the-art wireless and flexible neural implant, bluetooth communication module and a software suite with smartphone integration. The kit is open-sourced to promote collaboration and greatly advances multi-channel recording, data processing and sharing capabilities.
Event details are listed below:
● Date and Time: Friday, February 21, 2020 from 12:30 to 4:30 pm
● Venue: Room GB303, Galbraith Building, 35 St. George Street, University of Toronto [map]
● Speakers: Dr. Milos Popovic, Co-Director, CRANIA; Ray Iskander, CEO, Novela Neurotech; and Prof. Yiannos Manoli, Director, Hahn Schickard.
● Registration: https://www.eventbrite.com/e/open-source-wireless-neuromodulation-research-kit-workshop-tickets-92971669767
The immune system is the body’s defense against infectious invaders like bacteria and viruses. However, in autoimmune diseases, the immune system dysfunctions and attacks the body itself.
In her latest study, Dr. Joan Wither, a Senior Scientist at Krembil Research Institute, examined whether tiredness is a harbinger of disease progression in a family of autoimmune diseases known as systemic autoimmune rheumatic diseases (SARDs). SARDs occur when the immune system mistakenly attacks the body’s joints and connective tissues, and can lead to debilitating inflammation, pain and tiredness.
The first sign of a SARD is the presence of a specific type of antibody, which is a protein produced by the immune system. Doctors have worried that people with these antibodies who are also experiencing profound tiredness are at an increased risk of progressing to a more severe stage of disease.
As part of the study, Dr. Wither and her team analyzed a combination of questionnaires administered to SARD patients, as well as their blood test results and medical records. The researchers found that individuals with the antibodies and tiredness did not have a greater likelihood of progressing to a SARD.
Instead, they found that approximately one third of patients who participated in the study might be affected by a different disease with similar symptoms: fibromyalgia. Fibromyalgia is a condition with heightened sensitivities to pain and tiredness and is thought to stem from a disorder in the nervous system.
“Based on our findings, clinicians can now reassure their patients that fatigue is not necessarily a sign that their condition is progressing,” says Dr. Wither.
These findings will also improve the diagnosis and treatment of people with elevated tiredness.
This work was supported by the Krembil Foundation, the Canadian Institutes of Health Research, the Oscar and Eleanor Markovitz Fund for Scleroderma Research, the Freda Fejer Fund for Scleroderma Research, the Autoimmunity Research Centre of the University Health Network, The Arthritis Centre of Excellence and the Department of Medicine of the University of Toronto, The Arthritis Society of Canada and the Toronto General & Western Hospital Foundation.
Hafiz W, Nori R, Bregasi A, Noamani B, Bonilla D, Lisnevskaia L, Silverman E, Bookman AAM, Johnson SR, Landolt-Marticorena C, Wither J. Fatigue severity in anti-nuclear antibody-positive individuals does not correlate with pro-inflammatory cytokine levels or predict imminent progression to symptomatic disease. Arthritis Res Ther. 2019 Nov 4. doi: 10.1186/s13075-019-2013-9.
The UHN Office of Research Trainees (ORT) is proud to announce the release of the latest issue of The ORT Times!
The ORT Times is UHN's monthly trainee-focused newsletter. It highlights news and editorials about trainee life, articles to help developing researchers get the most out of their training experience at UHN, tips on career development, and research training opportunities within and outside of UHN.
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