Clinical and Investigative Medicine最新文献

Over the past year, the leadership of the Clinician Investigator Trainee Association of Canada (CITAC), alongside our MD+ trainees, had the opportunity to further develop and implement our strategic plan in response to the evolving medical landscape. We have dedicated our efforts to the progression towards a post-pandemic environment, have taken advantage of the lessons learned during the coronavirus disease 2019 (COVID-19) health crisis and have focused on enhancing in-person career development opportunities for our members.

Purpose: There is a need for effective and affordable treatments that achieve hepatitis B virus (HBV) functional cure and prevent long-term complications. The use of immune-modulators combined with HBV antivirals is a promising therapeutic strategy to achieve these goals. Based on ribavirin (RBV) monotherapy data, we hypothesized that RBV could improve virological responses when used in combination with tenofovir.  Methods: In this randomized, open label, controlled pilot trial, we evaluated RBV (n=4) dosed for the initial 24 weeks of treatment versus no RBV (n=4) in tenofovir recipients dosed over 48 weeks.  Results: Although well tolerated and safe in combination with tenofovir, RBV demonstrated no beneficial effects on virologic, biochemical or immunological markers of chronic HBV infection over 48 weeks of serial evaluation.  Conclusions: Our data does not suggest a HBV-specific immunomodulatory effect or an impact of RBV on HBV virological and antigen suppression.

For over 40 years the journal of Clinical and Investigative Medicine (CIM) has published articles of interest to clinician investigators in Canada and elsewhere. We strive for the highest standards and to remain relevant to our readers, but we cannot achieve this goal without the help of our reviewers, all of whom play a vital role in maintaining the integrity of the scientific process. Without their efforts, academic excellence would falter.

The Canadian Society of Transplantation (CST) annual scientific meeting was held in Banff Alberta September 19-23, 2022. It provided a forum for the transplantation community to share ideas, leading practices, innovative science and educational content in transplant care. The meeting brought together members of the Banff Foundation for Allograft Pathology and the CST for a hybrid event, combining both in-person and virtual experiences, and helping the two societies reach a wider audience. With over 600 Canadian and International delegates attending, the 2022 Banff-CST Meeting received outstanding educational programming, but also rare opportunities to connect with transplantation professionals from all over the world.

Purpose: To measure interleukin (IL)-17 serum levels in thoracic trauma patients and to correlate these levels with other cytokines and with patient prognosis.  Methods: This prospective observational study recruited 130 thoracic trauma patients who were admitted to the Zhoupu Hospital Affiliated to Shanghai Medical College of Health June 2020 to April 2022 and 100 healthy volunteers. Patients were divided into two groups based on Injury Severity Score (ISS): ISS<16 (mild/moderate trauma) and ISS ≥16 (severe trauma). Serum IL-17, tumor necrosis factor α (TNF-α), IL-6, IL-1β and C-reactive protein (CRP) levels were measured by enzyme-linked immunosorbent assay. Patients with poor prognosis were defined as those who developed serious complications or died during hospitalization or follow-up.  Results: Serum levels of IL-17, TNF-α, IL-6 and IL-1β were significantly elevated in patients with ISS ≥16 (p<0.05). Serum cytokines levels increased within 48 h in both groups and then gradually decreased during subsequent treatment and rehabilitation. Pearson's analysis indicated a positive correlation among IL-17, TNF-α and IL-1β. Serum IL-17 levels in patients with poor prognoses were higher than the patients with good prognoses at all time points (p<0.05). Furthermore, for patients with poor prognoses, the serum IL-17 levels had highest diagnostic value among all the cytokines measured. Logistic regression analysis showed that IL-17 was the risk factor for thoracic trauma patients with poor prognoses.  Conclusion: Serum IL-17 levels were significantly elevated in thoracic trauma patients and decreased gradually with rehabilitation. IL-17 was a risk factor for thoracic trauma patients with poor prognoses. This study suggests a new diagnostic and therapeutic target for thoracic trauma patients.

Purpose: Clinician-investigators have an important role in the development and implantation of new therapies and treatment modalities; however, there have been several reports highlighting a pending shortage in the clinician-investigators' workforce. In Canada, the Royal College has promoted the development of clinician-investigators programs (CIP) to facilitate the training of these individuals. There is currently a paucity of data regarding the outcomes of such programs. This study aims to identify the strengths and areas of improvement of the Montreal University CIP.  Methods: An internet-based 51-question survey was distributed to all the alumni from the University of Montreal CIP. Participation was voluntary and no incentives were provided. The response rate was 64%.  Results: Among respondents, 50% (n=16) had completed their clinical residency and all CIP requirements. The majority of these individuals (63%) had become independent investigators and had secured provincial and national funding. Satisfaction of the respondents was high regarding the overall program (85%), the research skills developed during the CIP (84%) and the financial support obtained during the program (72%). The satisfaction rate regarding career planning was lower (63%).  Conclusion: This survey demonstrates that, while indicators are favorable, some areas still require improvement. Several steps to improve the CIP have been identified; notably, the transition from the CIP to early independent career has been identified as critical in the development of clinician-investigators and steps have been taken to improve this progression.

Purpose: To investigate the value of anteroposterior-to-transverse ratio (ATR) and the effect on features of nodules in ultrasound (US) diagnosis of thyroid nodules in different locations.  Methods: The nodules were divided into three groups according to the different nodule location: isthmus group; upper and lower poles of bilobed thyroid group; and the middle of the bilobed thyroid group. The diameters of the nodules were recorded, and ATR of the nodule was calculated on the transverse and longitudinal sections. The transverse and the longitudinal sections of ATR of thyroid nodules in different groups were compared.  Result: The transverse section of ATR was significantly different among the three groups (p = 0.001). In addition, there are significant differences in many US features among three groups, including nodule composition, thyroid parenchyma, morphology, echogenicity, shape, calcifications, vascularity, nodule ACR TI-RADS and histopathologic (all p < 0.05). In the group of upper and lower poles of bilobed thyroid, significant difference was found between the transverse and the longitudinal section of ATR (p = 0.019). The cut-off values of transverse section and longitudinal section of ATR were 0.967 and 0.750, respectively.  Conclusion: The transverse section of ATR at different location of thyroid may be a predictor for malignancy with clinical diagnostic significance.

Purpose: To determine correlation between genetic susceptibility of type 2 diabetes mellitus (T2DM) and Src homology 2 B adapter protein 1 (SH2B1) gene polymorphism in a diabetic population.  Methods: A total of 111 T2DM patients (DM group) and 34 healthy controls (NC group) from Shanxi Provincial People's Hospital were included in this study. Exon 9 of the SH2B1 gene was detected using the Sanger sequencing method, and the relationship between SH2B1 gene polymorphism and diabetes was analyzed.  Results: Comparison of the data between the two groups showed that the values of TG, the updated HOMA of insulin resistance (HOMA2-IR), weight, body mass index, waist circumference, fasting blood glucose and fasting insulin levels of the DM group were higher than those of the NC group (P < 0.05). The HOMA2 insulin sensitivity (%S) of the DM group was lower than that of the NC group (P < 0.05). Sequencing analysis revealed that the following five single nucleotide polymorphisms in exon 9 of SH2B1 may be related to T2DM: rs181578610, rs550079240, chr16.28884655, chr16.28884659 and chr16.28884831. Among them, chr16.28884655 was found to be significantly related to diabetes; this site, located on the NM_015503 exon, was related to TG, LDL-C and waist circumference.

Conclusion: The SH2B1 gene locus chr16.28884655 was found to be significantly related to genetic susceptibility to T2DM.

Purpose: To investigate vector and refractive astigmatism changes after superotemporal versus temporal clear corneal incision cataract surgery.

Methods: Patients were diagnosed with age-related cataract with corneal astigmatism < 1.5 diopters (D) and were divided into two groups: superotemporal incision (R group) and temporal incision (L group). Uncorrected visual acuity, manifest refraction, corneal topography, anterior segment optical coherence tomography was performed pre- and six months postoperatively. Total ocular astigmatism, corneal astigmatism, vector of surgically induced corneal astigmatism (SICA), non-corneal ocular residual astigmatism (N-CORA), postoperative intraocular lens decentration and tilt were analyzed.  Results: Thirty-eight subjects were included: 21, R group; 17, L group. After surgery, the N-CORA decreased significantly from 1.17±0.72 D to 0.73±0.47 D in all patients (P=0.001), 1.03±0.52 D to 0.70±0.40 D in the R group (P=0.005) and 1.35±0.90 D to 0.78±0.55 D in the L group (P=0.033). Significant differences between t:he R and L groups were found in the postoperative meridian of anterior corneal astigmatism (75.95±52.50 vs 116.79±47.29; P=0.017), total corneal astigmatism (51.65±42.75 vs 95.20±57.32; P=0.011), J45 change vector of SICA in the anterior cornea (-0.10±0.18 vs 0.00±0.11; P=0.048) and total cornea surface (-0.14±0.17 vs 0.03±0.12; P=0.001).  Conclusion: The N-CORA decreased significantly after cataract surgery. Superotemporal and temporal incisions caused differences in the meridian components of oblique astigmatism in some patients but did not have a significant effect on the magnitude of corneal astigmatism.