BANNATYNE CAMPUS THEATRE A
RESEARCH DAY SPONSORS The Surgery Research Day 2020 Planning Committee gratefully recognizes
the contributions of the sponsors for the Annual Surgery Research Day.
Research Program:
The Wayne Beecroft Western Surgical Lectureship Fund Awards Dinner:
Thorlakson Chair in Surgical Research
American College of Surgeons—Manitoba Chapter
Department of Surgery GFT Surgeons
ACKNOWLEDGEMENTS
The Surgery Research Day 2020 Planning Committee greatly appreciates
the support from the Pan Am Clinic Foundation and Department of Surgery
Research Advisory Committee members in the planning of our Annual
Surgery Research Day 2020.
Giuseppe Retrosi, Co-Chair
Ryan Mitchell, Co-Chair
Megan Delisle, Resident Representative
Rachel Eikelboom, Resident Representative
Charity Pascual, Research Coordinator
WELCOME MESSAGE
Dear Colleagues,
On behalf of the Planning Committee, it is with great pleasure that we welcome you to the Department of Surgery’s Annual Research Day, 2020.
Over the past 19 years, surgeons, residents, medical students and fellows have made major contributions to research, teaching and clinical practice in all of our surgical specialties, resulting in a positive impact on patient care and education. Today, we wish to recognize the extensive accomplishments in research and innovation achieved within our Department, and we seek to share and exchange these ideas in a collaborative, interdisciplinary research environment.
On behalf of the members of the Surgery Research Day 2020 Planning Committee, we would like to extend our thanks to all those who have submitted an abstract, to our sponsors and to those attending this exciting department-wide event.
We hope you find this day enriching, with new concepts to implement in your practice, teachings and future research aspirations.
Sincerely,
Co-Chairs, Surgery Research Day 2020 Planning Committee
TABLE OF CONTENTS
General Information
Judges ................................................................................................. 6
Continuing Professional Development .............................................. 7
History of Surgery Research Days ............................................................ 49
Surgery Research Day 2019 Presentation Award Winners ...................... 50
Presenter’s Abstract Index ...................................................................... 51-52
4
NIHR Professor of Paediatric Surgery Nuffield Professor of Paediatric Surgery Head of Stem Cells & Regenerative Medicine Section Developmental Biology& Cancer Programme Consultant Paediatric Surgeon Great Ormond Street Hospital Surgery Offices UCL Institute of Child Health
Paolo De Coppi is a Consultant Paediatric Surgeon at Great Ormond Street Hospital (GOSH), and
Reader and Head of Stem Cells and Regenerative Medicine at the UCL Institute of Child Health in
London.
He has been an Honorary Professor at the Katholieke Universiteit Leuven, Belgium, since 2013,
an Adjunct Assistant Professor at the Wake Forest Institute for Regenerative Medicine, Wake
Forest University in Winston-Salem, North Carolina, since 2009 and an Honorary Assistant
Professor in Paediatric Surgery at the University of Padua, Italy, since 2005. He co-ordinates
the EU Horizon2020 funded stem cell research consortium - INTENS which aims to aims to make
a functional reconstructed bowel for people with Short Bowel Syndrome.
DR. PAOLO DE COPPI
5
UPMC Endowed Professor and Chair of Plastic Surgery Chair of Plastic Surgery Director, UPMC Wound Healing Services Professor of Bioengineering
Peter Rubin, MD, is Chair of the Department of Plastic Surgery, the UPMC Endowed Professor of Plastic Surgery, Director of UPMC Wound Healing Services, and Professor of Bioengineering at the University of Pittsburgh. He earned his undergraduate degree in biology from Grinnell College and his M.D. degree from Tufts University School of Medicine. He completed a residency training program in general surgery at Boston University/Boston City Hospital. He took time away from the clinic to pursue a two-year fellowship in surgical basic science at Massachusetts General Hospital/Harvard Medical School. He completed a three-year residency in plastic surgery at Harvard Medical School and joined the plastic surgery faculty at the University of Pittsburgh. He is a core faculty member in the McGowan Institute of Regenerative Medicine (MIRM).
Dr. Rubin is well-recognized for his surgical skills and innovative solutions to complex aesthetic and reconstructive problems. He is Founder and Director if the Life After Wright Loss Surgical Body Contouring Program at the University of Pittsburgh. In addition to his active clinical program, Dr. Rubin directs a basic science research program in the biology of adipose derived stem cells and serves as Co-Director of the Adipose Stem Cell Center at the University of Pittsburgh. He is the principal investigator in an NIH funded line of research aimed at developing cell based methods for clinical soft tissue reconstruction after cancer therapy. He directs a related line of research aimed at soft tissue reconstruction for injured military personnel as an investigator for the Department of Defense Armed Forces Institute for Regenerative Medicine (AFIRM). To facilitate the rapid translation of new technology, he founded the Center for Innovation in Restorative Medicine (CIRM) at the University of Pittsburgh.
His many scientific leadership positions include current Director, American Board of Plastic Surgery; Co-Chair of the American Society of Plastic Surgeons (ASPS) Task Force on Regenerative Medicine; Regulatory Chair for ASPS; Vice President of Finance for ASPS, past president of the International Society of Adipose Therapeutics and Science (IFATS), Board Chair of IFATS, and past Chairman of the Plastic Surgery Research Council. Dr. Rubin is the recipient of a Presidential Early Career Award for Scientists and Engineers (PECASE). The Presidential Award is the highest honor bestowed by the United States government on outstanding scientists and engineers early in their research careers. It is intended to recognize some of the finest scientists who show exceptional potential for leadership at the frontiers of scientific knowledge during the twenty- first century. He has served as editor for four textbooks, published over 180 peer reviewed articles, and presented over 500 invited lectures.
DR. J. PETER RUBIN
University of Pittsburgh
Dr Rachel Eikelboom
Cardiac Surgery Resident
Dr Giuseppe Retrosi
Dr Ryan Mitchell
RESEARCH DAY 2020 OBJECTIVES
At the end of the Department of Surgery Annual Research Day, participants will be able to:
Present and evaluate current clinical, educational and basic science research being conducted in the Department of Surgery; and learn and discuss innovative advanced techniques and technology in a collaborative surgery research environment.
Summarize concepts of regenerative medicine for clinicians, present the recent advancement in the field of regenerative medicine in paediatrics, discuss the limitation of regenerative medicine and Reflect on the full potentials offered by stem cell research
To appreciate the Biology of adipose stem cells; understand current therapeutic applications and comprehend the limitations and also future application of these therapies
7
CONFLICT OF INTEREST DISCLOSURE
Before each presentation, speakers will disclose on their first slide any
significant relationships that may be a perceived or apparent conflict of
interest to the subject of the proposed CME/CPD activity.
Each member of the Research Day 2020 Planning Committee were asked to
disclose any significant relationships with the manufacturer of any
commercial product that may have a direct or indirect conflict of interest in
the program content. All members reported no conflicts.
CONTINUING PROFESSIONAL DEVELOPMENT
This event is an Accredited Group Learning Activity (Section 1) as defined by
the Maintenance of Certification Program of The Royal College of Physicians
and Surgeons of Canada and approved by the CPD Medicine Program,
University of Manitoba for a maximum of 5.5 credits.
Participants should only claim credit for the actual number of hours
attended.
The University of Manitoba CPD Medicine Program is fully accredited by the
Committee on Accreditation of Continuing Medical Education (CACME).
8
Joe Doupe Atrium—Basic Medical Sciences
8:00 DR PAOLO DE COPPI, UNIVERSITY OF COLLEGE OF LONDON Regenerative Medicine in Paediatrics: advantages for translation Introduction—Dr Giuseppe Retrosi (Research Day 2020 Planning Committee)
9:00 OPENING REMARKS - Dr Ryan Mitchell and Dr Megan Delisle (Research Day 2020 Planning Committee)
PROGRAM — MORNING
Time Abstract Title Presenter
Orthopaedics Surgery
Systemic Environments: Results of a Prospective Cohort Study
*Allan Bruinooge
Thoracic Surgery
9:15 Medical versus surgical NEC – a 25-year retrospective review *Michael Cowap Pediatric Surgery
9:20 A survey of primary care physician referral to bariatric surgery in Manitoba: access, perceptions and barriers
*Felicia Daeninck General Surgery
*Gabrielle Derraugh Pediatric Surgery
9:30 A Retrospective Review of Postoperative Prophylactic Antibiotic Use in Breast Reduction Surgery: Are they actually necessary?
*Veronique Doucet Plastic Surgery
9:35 The Impact of a Virtual Clinic for Thoracic Aortic Disease in Manitoba *Bakhtiari Fatemah
Cardiac Surgery
*Marta Zmudzinski General Surgery
*Norah Alarifi Neurosurgery
9:50 Accuracy of optic nerve sheath diameter measurements in pocketsized ultrasound devices on a new simulation model
*Garrett Johnson General Surgery
Sheila McRae Orthopaedics Surgery
Moderator: Dr. Premal Patel (Urology) & Dr. Scott Hurton (General Surgery)
Time Abstract Title Presenter
10:20 The Incidence of Hearing loss in Children with Congenital Diaphragmatic Hernia: A Population-Based Case-Control Study
*Abdullah Alenazi Pediatric Surgery
10:30 Enhancing Communication and Reducing the Need for Repeat Endoscopy between Gastroenterologists and Surgeons, A Mixed-Methods Analysis
*Olivia Hershorn
General Surgery
10:40 Social Determinants Associated With Paediatric Burn Injury: A Population Based, Case-Control Study
*Adam Padalko General Surgery
10:50 Exploring the role of miR-200b in vascular changes due to pulmonary hypertension in miR-200b knockout mice
*Samira Seif Pediatric Surgery
11:00 Tibial tunnel widening in ACL reconstruction: Randomized controlled trial comparing bioabsorbable versus biocomposite interference screws
Greg Stranges Orthopaedic Surgery
11:10 Oncological outcomes of patients with non-metastatic renal cell carcinoma
with renal vein or inferior vena cava tumor thrombus
*Benjamin Shiff
*Stephanie Lim General Surgery
11:30 The Aryl Hydrocarbon Receptor is involved in the pathogenesis of Congenital Diaphragmatic Hernia
*Landon Falk Pediatric Surgery
11:40 Effectiveness of bosentan treatment in miR-200b null mice as a model for pulmonary hypertension in Congenital Diaphragmatic Hernia
*Chelsea Day Pediatric Surgery
11:50 Fabrication of Immunomodulatory Hydrogels for Cardiac Repair after Acute Myocardial Infarction
*Weiang Yan Cardiac Surgery
12:00 PM—1:00 PM
1:00 DR J. PETER RUBIN, UNIVERSITY OF PITTSBURGH
The healing power of fat: adipose stem cells and therapeutic applications
Introduction—Dr Ryan Mitchell
BRIEF (E-POSTER) SESSION Moderator: Dr. Gregory Hawryluk (Neurosurgery)
Time Abstract Title Presenter
2:05 Mobile Virtual Collaborating - Realizing the Future of Surgical Education *Bryce Lowry General Surgery
2:10 Does Shielding reduce ionizing radiation exposure during retrograde fluoroscopic guided ureteral stent insertion in the pregnant patient?
*Zack Li Urology
2:15 Do initial radiographic results of atherectomy predict requirement for reintervention?
*Rikesh Parekh Vascular Surgery
2:20 Trajectory of health-related quality of life in thoracic surgery patients *Eagan Peters Thoracic Surgery
2:25
Cryptorchidism at the Children’s Hospital of Winnipeg Prevents the
Performance of Unnecessary Scrotal Ultrasounds
Karen Psooy
2:30 Anterior interosseous-to-ulnar motor nerve transfers: a single centre’s
experience in restoring intrinsic hand function
*Tanis Quaife
Plastic Surgery
2:35 Prognostic impact of paraneoplastic syndromes on patients with non- metastatic renal cell carcinoma undergoing surgery: Results from Canadian Kidney Cancer information system collaborative
*Ryan Sun Urology
2:40 Conical Vs Cylindrical Pedicle Screw Design Sara Parashin Orthopaedic Surgery
2:45 Does ultrasound in clinic without formal training change the management of patients with rotator cuff tears?
Jarret Woodmass Orthopaedic Surgery
2:50 Medial plating of pilon fractures predicts post-operative soft tissue complications requiring subsequent surgery
*Mark Xu Orthopaedic Surgery
2:55 PM –3:20 PM
Moderator: Dr. Megan Delisle (General Surgery) & Dr. Rachel Eikelboom (Cardiac Surgery)
3:20 Human Papillomavirus is Associated with Improved Survival in Hypopharyngeal Head and Neck Cancer
*Ciaran Lane Head and Neck Surgery
3:26 Biceps Tenodesis Versus Tenotomy in the Treatment of Lesions of the Long Head of Biceps Tendon in Patients Undergoing Arthroscopic Shoulder Surgery: A Randomized Controlled Trial
Peter MacDonald Orthopaedic Surgery
3:32 Association between socioeconomic status and treatment for prostate cancer in a universal healthcare system: A population-based analysis
*Justin Oake Urology
3:38 Impact of a Limited Movement Strategy and an External Chest Support Device For Patients at High-Risk for Sternal Complications after Cardiac Surgery
*Janessa Siemens Cardiac Surgery
3:44 Transplacental delivery of IgG-modified nanoparticles as a novel prenatal therapy
*Wai Hei Tse Pediatric Surgery
4:00 CLOSING REMARKS - Dr Giuseppe Retrosi
(Co-Chair, Research Day 2020 Planning Committee)
SURGERY RESEARCH DAY AWARDS DINNER
Canadian Museum for Human Rights | 85 Israel Asper Way
Garden of Contemplation (3rd floor)
6:30 PM
12
Arthroscopic Skill Acquisition in Medical Professionals
Introduction
Knee arthroscopy is one of the most commonly performed orthopedic procedures and
is a difficult technical skill to acquire. The aim of this study was to compare traditional
master-apprentice style of learning (TL) to a self-guided module-based training (MBT)
program on an arthroscopic surgery simulator.
Hypothesis
We hypothesize that performance scores will improve significantly in both training
groups in comparison to the control group (C).
Methods
Health Sciences students where recruited and randomized into one of the three
groups: MBT, TL, or C (1:1:1 ratio). Participants in MBT were required to practice on
the simulator by themselves a minimum of two hours per week, while TL received one
-on-one coaching by a senior resident for fifteen minutes per week. The control group
received no training. All groups were assessed at baseline and at four weeks using
objective measures from the surgical simulator (procedure time [PT], camera path
length [CPL], meniscus cutting score [MCS], detailed visualization [DV], safety score
[SS] and total score [TS]), and subjective ratings scales (OAAS global assessment form,
and Competency Based Assessment form [CBA]). Improvement after intervention was
tested using repeated measures ANOVAs and post-hoc comparisons with Bonferroni
correction.
Results
Thirty participants were recruited. There was significant Group X Time interaction for
PT (p = 0.006), CPL (p=0.008), SS (p=0.013), TS (p=0.003), OAAS form (p<0.001) and
CBA form (p<0.001). MBT group was superior to C group for PT (p=0.02), CPL
(p=0.003), TS (p=0.004) and OAAS form (p=0.021), but there was no significant post-
hoc differences between MBT and TL groups, or TL and C groups.
Conclusion
Knee arthroscopy simulation training with self-learning modules can improve skill in
untrained participants in comparison to a control group. Incorporating module-based
simulation training into a junior resident’s curriculum could provide additional time
and practice to improve arthroscopic skills.
13
Lung Surgery Induces Inflammatory Changes In Local and Systemic Environments: Results of a Prospective Cohort Study
Introduction
Mechanical ventilation can induce lung injury. Patients undergoing lung surgery are at
higher risk from ventilator-induced lung injury (VILI) due to the use of one-lung
ventilation. Such patients can potentially be at risk for respiratory complications due
to VILI but also due to the surgical trauma on the operated lung. We aimed to
characterize the local and systemic immunological changes that are induced by the
operative and ventilator stresses in patients undergoing lung surgery. We also aimed
to assess if these changes could predict complications.
Methods
A prospective study of 12 high-risk patients undergoing lung surgery was conducted.
Arterial plasma and bronchoalveolar lavage fluid of both ventilated and operated
lungs were collected before and after one-lung ventilation. Multiplex ELISA assays
were performed on the samples quantifying 68 markers. Data was analyzed using the
R package mixOmics.
Results
The analytes with the greatest change in both ventilated and operated lung were CRP
and VCAM-1. TNF-â and bFGF had the third largest response in the ventilated and
operated lung respectively. In the plasma TGF-b3, IL-1â, and IL-17A/F had the most
significant change. TARC, IL-13, and Eotaxin-3 had changes in concentration in the
ventilated lung orders of magnitude greater than the operated lung. Patients were
relatively homogenous in pre-ventilation marker levels, but had notably
heterogeneous responses to ventilation and surgery. The local environments of the
ventilated and operated lung responded differently to the course of ventilation.
The change in cytokines IL-1â, IL-5, and IL-23 best classified patients with
complications versus those without. These were more predictive of complications than
established clinical predictors (eg pre-operative FEV1).
Conclusion
Lung surgery induces inflammatory changes in both the local airway and systemic
environments. These are driven both by surgical trauma and VILI in unique ways.
These immunological changes were more predictive of complications than established
clinical predictors.
Medical versus surgical NEC – a 25-year retrospective review
Introduction
Necrotizing enterocolitis (NEC) is one of the most common and devastating
gastrointestinal diseases affecting newborns. However, surgeons and neonatologist
continue to struggle to improve care and outcomes for these babies. The purpose of
this project was to compare the short term outcomes for babies treated surgically
versus babies treated medically for NEC.
Methods
We conducted a retrospective chart review of infants diagnosed with NEC at HSC from
1991 to 2016. We abstracted demographic, maternal, perinatal and NEC management
details into NEMO. The outcomes compared between medical and surgical babies
were: mortality, length of stay (LOS), and times to full enteral (FEF) and full oral feeds
(FOF). We used chi squared and student t-test with a p-value <0.05.
Results
A total of 367 charts were reviewed. 290 (79.0%) patients were managed medically
and 77 (21.0%) were managed surgically. The 30-day mortality was 9(3.1%) for
medical and 18 (23.38%) for surgical patients, (p<0.0001; RR=0.79; 95% CI [0.70-0.90])
The 60-day mortality was 13 (4.48%) for medical and 30 (38.96%) for surgical patients
(p<0.0001; RR=0.63; 95% CI [0.53-0.77]). The 180-day mortality was 18 (6.21%) for
medical and 34 (44.16%) for surgical (p<0.0001; RR=0.59; 95% CI [0.49-0.73]). The
mean LOS in days was 61.39 (± 43.92) for medical patients and 103.44 (±53.02) for
surgical patients (p<0.0001). Days to reach FEF after diagnosis was 20.68 (±15.72) and
47.05 (±32.47) for medical and surgical patients respectively (p<0.0001). Days to reach
FOF after diagnosis was 35.36(±28.43) and 74.1(±37.65) for medical and surgical
patients respectively (p<0.0001).
Conclusions
We found that surgically managed NEC patients had worse short-term outcomes than
medically managed NEC patients. This is consistent with other literature. The next
step is to compare long term outcomes for both these cohorts.
15
FELICIA DAENINCK E-Poster and Brief Session (9:20—9:24 AM)
A survey of primary care physician referral to bariatric surgery in Manitoba: access, perceptions and barriers
Introduction Despite the wide body of evidence demonstrating bariatric surgery as an effective means of long term health modification, there is an important disconnect between surgical programs and primary care physicians (PCP) in the delivery of bariatric care. The objective of this study is to assess PCP knowledge and perception of a provincial bariatric surgery program. Methods A 32-question, IRB approved, survey was developed by experts in bariatric surgery and vetted by local PCPs. A single round of paper surveys was administered to 1000 PCPs between July and September 2015. Continuous variables were assessed by t-test and categorical variables by Chi-square test. Results There were 131 survey responses (13.1%). A majority (54.2%) of respondents did not feel well equipped to counsel their patients on operative management strategies. PCPs counseled on average 11.6 ± 17% of their obese patients on bariatric surgery. Many respondents (58.3%) thought excess weight loss from gastric bypass was less than 40% and most believed there was less than 50% resolution of diabetes (62.4%), hypertension (72.3%), dyslipidemia (77.8%) and obstructive sleep apnea (60.6%). PCPs who referred patients to the bariatric program (71.8%) were more comfortable counseling their patients on bariatric surgery options (56.8% vs 17.1%, p<0.001) and were more comfortable with post-operative care (67.4% vs 38.2%, p=0.003). Additionally, these PCPs were more likely to estimate a higher rate of diabetes (54.4 ± 22.6% vs 39.0 ± 20.1%, p=0.003) and hypertension (49.4 ± 21.0% vs 38.8 ± 19.6%, p=0.03) resolution post-bariatric surgery. The predominant perceived barrier to accessing bariatric surgery was wait times (33.3%). Conclusion PCPs appear to underestimate the efficacy of bariatric surgery in the treatment of obesity and feel ill-equipped to counsel patients. Further education related to bariatric surgery may improve PCP comfort in counseling and long-term follow-up. Provincial advocacy is required to reduce access barriers.
16
Introduction
Improvements in surgical and perioperative care have led to an increase in survival for
children born with congenital diaphragmatic hernia (CDH). Consequently, how these
children do later in life is unknown. The purpose of this study was to determine if
children with CDH have different long-term health, socioeconomic, and educational
outcomes compared to controls.
Methods
We performed a cohort study of CDH children born between 1991-2015. CDH cases
were obtained from the Winnipeg Surgical Database of Outcomes and Management
(WiSDOM) and a 10:1 date-of-birth matched control population was selected using
the Manitoba Centre For Health Policy (MCHP) data repository. Hospital admission
frequency, International Classification of Disease (ICD) codes, Socioeconomic Factor
Index (SEFI) and grade 3, 7, 8 standardized assessments were used to assess
outcomes.
Results
Ninety CDH children and 898 controls were used. We found that CDH children were
admitted to hospital more frequently than controls (OR=2.58, 95% C.I. = 2.17-3.08,
p<0.001). However, the rate of admissions was found to decrease over time (r=-0.21,
p<0.001). Respiratory admissions (OR=4.95, 95% C.I. = 3.39-7.23, p<0.001),
gastrointestinal admissions (OR=4.23, 95% C.I. = 2.59-6.92, p<0.001) and admissions
due to other causes (OR=2.29, 95% C.I. = 1.68-3.11, p<0.001) were all found to be
significantly different. We also found that the presence of CDH is associated with
hearing loss (OR=4.0[1.51 – 9.62], p = 0.0027). No difference in SEFI at birth or a
change in SEFI over time was found (p=0.839). Lastly, we found no difference in
performance on the grade assessments between cases and controls (p=0.678).
Conclusion
CDH children have more hospital admissions, higher rates of hearing loss and do not differ in SEFI or grade assessment performance.
17
A Retrospective Review of Postoperative Prophylactic Antibiotic Use in Breast Reduction Surgery: Are they actually necessary?
Introduction
Breast reduction mammoplasty is a common procedure performed amongst plastic
surgeons in treating patients suffering from hypermastia. Complications associated
with this procedure include surgical site infection, hematoma, seroma formation, and
wound dehiscence. It is popular amongst surgeons to prescribe postoperative
prophylactic antibiotics in addition to preoperative prophylactic antibiotics following
breast reduction mammoplasty, despite the lack of evidence of their effectiveness in
preventing surgical site infections (SSIs). The purpose of this study is to determine if
post-operative antibiotics in addition to preoperative antibiotics are more effective in
preventing surgical site infections in comparison to preoperative prophylactic
antibiotics alone in breast reduction surgery.
Methods
A retrospective analysis of breast reduction cases by a single senior surgeon was
completed. Healthy female patients between the age of 18 to 65 undergoing primary
breast reduction mammoplasty electively for breast hypertrophy were included. Two
study groups of 62 patients were reviewed, based on location of surgery at one of two
surgical centers. Two pre- and post-operative antibiotic regimens were adopted
between the two groups of patients. The first regimen consisted of a single
intravenous dose of antibiotics, while the second regimen consisted of the pre-
operative intravenous dose followed by a 7-day course of oral antibiotics. Primary
outcome measures were incidence of SSIs. Secondary outcome measures included
incidence of complications such as delayed healing, cellulitis, wound dehiscence, and
antibiotic-related complications.
Results
Overall surgical site infection rate was 3.2% for the 124 patients. For the group
receiving only pre-operative intravenous antibiotics, infection rate was 4.8% in
comparison to 1.6% for the group receiving pre-operative and post-operative
antibiotics prophylactically. The was no statistical significant difference between both
groups (p value 0.31).
Study results demonstrated that the use of postoperative prophylactic antibiotics for
breast reduction mammoplasty had no significant effect on rate of surgical site
infections.
18
FATEMAH BAKHTIARI E-Poster and Brief Session (9:35—9:39 AM
The Impact of a Virtual Clinic for Thoracic Aortic Disease in Manitoba
Introduction
With the prevalence of thoracic aortic disease on the rise in Manitoba, methods such
as the Manitoba Thoracic Aortic Diseases (MATD) Virtual Clinic (VC) have been
established to accommodate an increasing number of patients. After their initial
consultation visit, many patients are monitored with serial CT imaging performed in
their community and answering nurse administered questionnaires. This information
forms the basis for plans of care involving the VC, decreasing time and travel
commitments for patients and facilitating the assessment of new consults by freeing
up resources. In this study, we explored the patient’s satisfaction and personal
monetary savings with the use of the VC.
Methods
This was a single center, prospective study. Our primary outcome was patient
satisfaction with the VC using a mixed-method survey that was administered by
phone. A secondary outcome was an evaluation of the patient’s monetary savings by
using the VC.
Results
There were 65 study participants, 68% were male and 32% were female. The majority
were between the ages of 55-74. 97% of patients were satisfied with the care that
they received, while only 17% responded that they would have rather come into the
clinic. 95% of patients felt that the quality of care provided by the VC was satisfactory
or better. Furthermore, patients traveling one hour or more expressed the strongest
preference for the VC. A cost evaluation demonstrated that the MTAD VC saved
patients on average $86.14 compared to a visit to the in-person clinic.
Conclusion
Patient satisfaction with the MTAD VC was high and the VC resulted in monetary
savings for the patients. As the demand for cardiac surgery consultations increases in
Manitoba, novel healthcare delivery models such as the VC will need to be developed
to provide high quality and safe healthcare in an efficient manner.
19
Facilitating Indigenous Surgical Research Through A Permission-To-Contact Process
Introduction
Indigenous surgical research in a culturally sensitive and decolonized manner. It is
imperative that we understand the influences of Indigenous culture on perspectives of
surgery, process of care and outcomes in order to improve perioperative care for the
Indigenous population.
We sought to develop a self-identification process to facilitate Indigenous bariatric
surgical research. A Permission-to-Contact form was developed with an option to
voluntarily self-identify as Indigenous. Institutional ethics was obtained. All current
and waitlist patients registered with the WRHA Centre for Metabolic and Bariatric
Surgery program were contacted by a single mail-out in the spring of 2019. Going
forward, a Permission-to-Contact form is mailed to newly referred patients when they
are accepted on the bariatric surgery waitlist.
Results
There were 2301 patients contacted in the initial mail-out. In total, 648 (28.2%)
patients gave permission to contact and 98 (15.1%) of respondents self-identified as
Indigenous. This patient identification process has subsequently been used to
facilitate recruitment for two Indigenous bariatric surgery studies.
Conclusion
We developed a successful process to identify Indigenous bariatric surgery patients
that will facilitate research on Indigenous aspects of bariatric surgical care. There is
potential for our research team to extend this process to non-bariatric patients in
order to further address the gaps in Indigenous surgical research.
20
Predictors of Shunt-dependent Hydrocephalus Following Intraventricular Hemorrhage in Premature Infants; Introducing a Novel Scoring System
Introduction
complication after intraventricular hemorrhage (IVH) in premature infants, and
negatively impacts outcomes among survivors. The objective of this study is to
investigate the associated risk factors for ventriuloperitoneal shunting (VPS) in
infantile hydrocephalus following intraventricular hemorrhage in premature infants.
Methods
A cohort study was conducted to include premature infants in whom the diagnosis of
intraventricular hemorrhage with hydrocephalus was made by cranial ultrasound and
the pediatric neurosurgery service was consulted about in the Health Sciences Center
in Winnipeg, Canada, from January 2013 to January 2018. The patients who were
followed up for at least one year after the diagnosis of IVH were included in the study,
and data regarding pregnancy, delivery, hospital course, imaging (cranial ultrasound
and MRI), non-surgical treatment (including cerebrospinal fluid drainage and analysis),
and shunt requirement were collected.
Results
A total of 32 premature infants with intraventricular hemorrhage and hydrocephalus
were included in the study. All the patients were followed up for at least one year
after diagnosis. The univariate and multivariate analysis showed association between
certain factors and the development of shunt-dependent hydrocephalus among the
pregnancy, delivery, hospital course, imaging, and the non-surgical treatment factors.
On univariate analysis, factors associated with shunt insertion after IVH were
gestational age (p-value 0.046), gender (p-value 0.017), geriatric pregnancy (p-value
0.04), birth weight (p-value 0.0169), CSF glucose (p-value 0.007), First ventricular
index (p-value 0.005), CSF neutrophils (p-value 0.04), and Apgar score at 5 mins (p-
value 0.04).A scoring system was proposed accordingly. Of these, only CSF glucose (p-
value 0.016), First VI (p-value 0.03), Gender (p-value 0.04), Gestational age (p-value
0.03), and Apgar score (5 min) (p-value 0.04) were associated with shunt insertion on
multivariate analysis. Scoring system was designed accordingly which was able to
predict up to 83% of infants with shunt-dependent hydrocephalus.
Conclusion
Shunt-dependent hydrocephalus is a major complication after intraventricular
hemorrhage in premature infants. Predictors found in this study can help identify
highrisk
Accuracy of optic nerve sheath diameter measurements in pocketsized ultrasound devices on a new simulation model
Introduction
Transorbital sonographic measurement of optic nerve sheath diameter (ONSD) is an
emerging non-invasive technique for identification and monitoring of elevated
intracranial pressure (ICP). New smaller handheld ultrasound units have hit the
market and it is uncertain if they have the resolution to measure such a small
structure appropriately as compared to their predecessors. We measure the
performance of three ultrasound units on a new simulation model of the ONS.
Methods
ONSD was measured by three expert point-of-care sonographers using three
machines a total of three times each on of a variety of ONS sizes ranging from 3.5 to
7.9mm. Two pocket ultrasounds (IVIZ, Sonosite, and Lumify, Philips) and one standard
sized portable ultrasound (M-Turbo, Sonosite) were used to measure the models.
Measurements were analyzed for mean error and variance, and tested for significance
using blocked covariance matrix regression analyses using a series of F-tests based
upon maximum likelihood.
The devices differed in their variances (Philips Lumify: 0.1906, Sonosite M-Turbo:
0.2598, Sonosite IVIZ: 0.3424) and their mean error (Philips Lumify: -0.0524mm,
Sonosite MTurbo: 0.1048mm, Sonosite IVIZ: -0.1016mm). The difference in mean
error between users is not significantly different (p=0.4528), but there is a significant
difference in mean error between devices (p=0.0174).
Conclusion
Accurate ONSD measurement is possible utilizing pocket-sized ultrasound with the
Phillips Lumify device having both the least measurement error and variance. While
the differences in theses devices were statistically significant, they are likely not
clinically significant indicating that all three could potentially be used for ONSD
measurement. Further study in human subjects should be conducted prior to using
pocket ultrasounds for in vivo diagnosis of elevated ICP.
22
year follow up
There is increasing evidence that patients with ACL reconstruction using ipsilateral
graft harvest are at greater risk of rupture (12.5%) on their contralateral compared to
their surgical side (7.9%). The purpose of this study is to re-evaluate patients from a
previous study comparing ipsi- versus contralateral graft harvest to compare ACL
rupture rate at a minimum 10 year follow-up.
Methods
An attempt to contact all participants from a previously published study was made to
invite them to return for a follow-up. The assessment included an International Knee
Documentation Committee Knee Clinical Assessment (IKDC), isokinetic concentric
knee flexion and extension strength testing, as well as the ACL-Quality of life (ACL-
QOL). A chart review was conducted to identify or confirm subsequent ipsi- or
contralateral knee surgeries.
Results
In patients with ipsilateral graft, 3/34 (8.8%) re-ruptured and 3/34 (8.8%) had
contralateral rupture. In the contralateral group, 1/28 (3.6%) re-ruptured and 2/28
(7.1%) had contralateral rupture. The relative risk (RR) of re-rupture with ipsilateral
graft was 2.47 compared to using the contralateral site (p=0.42). RR of rupture on the
contralateral side when ipsilateral graft was used was 1.23 compared to the alternate
approach. Current contact information was unavailable for 21 patients. Of the 47
remaining, 37 were consented (79%). No difference in the ACL-QOL between groups
(ipsilateral 68.4±24.4, contralateral 80.1±16.0, p=0.17) was observed. There were no
differences in knee flexion strength between groups (peak torque flexion affected leg:
ipsilateral 77.8nm/kg±27.4, contralateral: 90.0 nm/kg±35.1; p=0.32; Unaffected leg:
ipsilateral: 83.3 nm/kg±30.2 contralateral 81.7 nm/kg±24.4; p= 0.89).
Conclusion
This study suggests that using the contralateral hamstring in ACL rupture is not
associated with an increase in ACL rupture on either side. The risk of ACL injury was
low in all limbs; therefore, a larger study would be required to definitively state that
graft side had no impact.
23
ABDULLAH ALENAZI Plenary Session (10:20—10:30 AM)
The Incidence of Hearing loss in Children with Congenital Diaphragmatic Hernia: A Population-Based Case-Control Study
Introduction
The true incidence of hearing loss among children with congenital diaphragmatic
hernia (CDH) is unknown, with some studies reporting an incidence of up to 62%.
Children may not be diagnosed with hearing loss until later in childhood and miss
opportunities for early intervention and support. The aims of this study were to
determine the incidence of hearing loss in children with CDH, then compare it to age-
matched controls and another cohort requiring neonatal surgery and long hospital
admissions.
Methods
We performed a population-based case-control study of children older than 10 years-
of-age, born between 1991 and 2016 with CDH. A control group was established using
date-of-birth matched peers. A second control comparison was performed for
children born with gastroschisis between 1991 and 2016, and their date-of-birth
matched controls. Data analysis was performed using R statistical software. The
incidences of hearing loss was compared using Chi-square tests. Statistical significance
was considered p<0.05.
Results
A total of 934 children (31 CDH cases and their 380 date-of-birth matched controls; 46
gastroschisis cases and their 477 date-of-birth matched controls) met the inclusion
criteria. Hearing loss was found in 22% of children with CDH (p<0.0004), with a
relative risk of 4. Hearing loss was infrequent in patients with gastroschisis (p=0.5),
with a relative risk of 0.6.
Conclusion
CDH patients are 4 times more likely to develop hearing loss compared with their date
-of-birth matched controls. A similar risk of hearing loss was not found in children with
gastroschisis. Congenital factors may contribute to hearing loss in CDH more than
perinatal exposures.
Enhancing Communication and Reducing the Need for Repeat Endoscopy
Introduction
Despite limited endoscopy resources in Canada, repeat preoperative lower endoscopy
is commonly practiced. Our aim is to determine repeat preoperative endoscopy rates
and factors influencing this practice at a high volume tertiary care centre.
Methods
A retrospective chart review was conducted on all patients undergoing elective
colorectal resection for benign and malignant neoplasms between 2007 to 2017.
Patient demographics, endoscopic, and tumour related characteristics were collected.
Multivariable logistic regression analysis was used to identify predictors of repeat
preoperative endoscopy.
Results
Of the 1, 062 patients identified, mean age was 68 years and 56% were male.
Laparoscopic approach occurred in 59% of patients. We identified a repeat
preoperative endoscopy rate of 29%. Index endoscopy was performed by a General
Surgeon in 53% of cases. A total of 57% of patients underwent tattooing for tumour
localization at index endoscopy. Median time to surgery differed amongst those who
underwent repeat endoscopy compared to those who did not (159 days versus 64
days).
On multivariate analysis, male sex (OR: 1.68, p= 0.003), left colon (OR: 2.73, p=
<0.001), rectosigmoid (OR: 9.11, p= 0.003) and rectal lesions (OR: 4.06, p= <0.001)
were at increased odds of undergoing repeat endoscopy prior to surgery. Patients
who had a tattoo placed at index endoscopy were at lower odds of undergoing repeat
endoscopy (OR: 0.48, p= <0.001). Predictors of tattoo placement at index endoscopy
included lesions located in the transverse colon (OR: 1.93, p= 0.04) and planned
laparoscopic surgery (OR: 1.69, p=0.001).
Conclusion
Repeat preoperative endoscopy may be unnecessary if appropriate identification and
documentation of lesions has been achieved. Tattooing of suspicious lesions is a
modifiable factor associated with reduced likelihood of repeat endoscopy prior to
surgery. This study highlights the need for standardizing endoscopic approaches given
the delays that repeat preoperative endoscopy is associated with.
25
Social Determinants Associated With Paediatric Burn Injury: A Population Based, Case-Control Study
Introduction
Colonoscopies are an effective means of detecting and removing precancerous
adenomatous polyps. The adenoma detection rate (ADR) is a marker of colonoscopy
quality and an independent predictor of colorectal cancer incidence. Focused training
interventions may improve an endoscopist’s ADR, but the supporting research is
limited. This systematic review and meta-analysis identified, critically appraised, and
meta-analyzed data from randomized trials (RCTs) evaluating the effect of training
interventions on ADRs.
Methods
Ovid Medline, EMBASE, CENTRAL, Eric, CINAHL, Scopus, Web of Science, and
ClinicalTrials.gov were searched for RCTs investigating the effect of an educational
intervention on ADRs. Two reviewers independently screened, identified, and
extracted trial-level data. Internal validity was assessed in duplicate using the Risk of
Bias tool. Our primary outcome was the ADR. Secondary outcomes were advanced
adenoma detection rate, adenocarcinoma detection rate, polyp detection rate, and
withdrawal times. Safety outcomes were post-polypectomy bleeding rate and
colonoscopy-related perforation rate.
Results
From 2,837 screened citations, we identified 3 trials (119 endoscopists) meeting our
inclusion criteria. Training interventions were associated with increased ADRs (odds
ratio 1.16, 95% confidence interval (CI) 1.00-1.34; I2 83%; 3 trials; 119 endoscopists).
When limited to screening colonoscopies, the odds ratio for ADRs associated with
training interventions was 1.17 (95% CI 1.00-1.36; I2 80%; 3 trials; 119 endoscopists).
There was a high level of heterogeneity between the trials’ training interventions.
Training intervention improved the advanced adenoma detection rate,
adenocarcinoma detection rate, polyp detection rate, and withdrawal times. Safety
outcomes were not reported.
associated with increased ADRs compared to no training interventions. These finding
support focused, well developed continued professional development activities to
improve ADRs even among certified endoscopists.
26
SAMIRA SEIF PLENARY SESSION (10:50— 11:00 AM)
Exploring the role of miR-200b in vascular changes due to pulmonary
Introduction
Pulmonary hypertension (PH) is one the main causes of death in congenital
diaphragmatic hernia. It results from thickening of the medial and adventitial layers in
the lung vessels leading to increased vessel resistance and ultimately heart failure. The
underlying pathogenesis of PH is poorly understood. We hypothesized that microRNA-
200b (miR-200b) plays a role in vascular remodeling associated with PH. To better
understand the role of miR-200b we created miR-200b knockout (KO) mice and aimed
to 1) evaluate the morphological pulmonary vasculature changes in miR-200b KO mice
and 2) to determine the role of miR-200b in PH by targeting of the vascular endothelial
(VEGF) signaling pathway.
Methods
Verhoeff-van Gieson (VVG) staining (n=4) was used to measure the medial, arterial
and adventitial thickness of the lung vessels. VEGFR-1 and VEGF-A expression were
assessed using immunohistochemistry (IHC). Micro-computed tomography (micro CT)
was applied to demonstrate the complexity of the pulmonary vasculature at the
microlevel with high resolution, quantitative, three -dimensional images.
Results
Vascular remodeling assessment showed that miR-200b KO lungs have 35% increased
arterial wall thickness, 47% medial wall thickness and 32% adventitial wall thickness in
pulmonary vessels compared to normal lung (p<0.05). The most noticeable structural
changes were observed in arterioles with an external diameter less than 20 or 40 µm
in the KO group. IHC results showed downregulation of VEGF-A and upregulation of
VEGFR1 in miR-200b KO lungs. Preliminary micro CT data did not show any difference
between miR-200b null mice and wild type.
Conclusion
PH in miR-200b KO mice is associated with changes in vascular morphology. Our
results suggest that the absence of miR-200b results in PH by vascular remodeling of
the pulmonary vessels especially in arterioles and alteration of the VEGF signaling
pathway in KO mice.
Tibial tunnel widening in ACL reconstruction: Randomized controlled trial comparing bioabsorbable versus biocomposite interference screws
Introduction
Bioabsorbable interference screws made with a ceramic component were designed to
improve bone ingrowth, reduce reactive responses during the degradation process,
and possibly reduce bone tunnel widening. The purpose of this study was to compare
tibial tunnel widening, function, and quality of life between a bioabsorbable
interference screw composed of poly-L-lactic acid (PLLA) alone to a biocomposite
interference screw composed of poly-L-lactic acid embedded with beta tri-calcium
phosphate (β-TCP/PLLA) in patients undergoing ACL reconstruction with hamstring
autograft.
Methods
This was a two group, 1:1 randomized controlled trial with consented participants
allocated to undergo ACL reconstruction using either the PLLA or β-TCP/PLLA
interference screw for tibial fixation. Study time points were pre-surgery, 3-, 6-, and
12-months post-operative. Participants underwent standardized x-rays with a 25 mm
calibration ball, an IKDC knee assessment, and completed the ACL quality of life at
each visit. Tibial tunnel diameter was quantified at tunnel exit of the medial tibial
cortex, proximally at the level of the joint line, and the widest point within the tunnel
and tunnel widening was expressed as a percentage of actual screw size. Tibial tunnels
were also rated dichotomously as either ‘widened’ or ‘normal’ based on tunnel shape.
Results
Forty participants were randomized to each group (mean age (SD) of 29.7 (7.6) and
29.8 (9.1), for PLLA and β-TCP/PLLA, respectively). The greatest difference between
groups was noted at the widest point on lateral x-ray view with a mean difference of
11%. Based on subjective evaluation of tunnel shape, three participants had visible
widening in the PLLA group, and two in the β-TCP/PLLA group (p=NS). These were not
associated with any differences in ACL-QOL or clinical findings.
Conclusions
The PLLA bioabsorbable screw and β-TCP/PLLA biocomposite interference screw do
not differ in degree of tunnel widening, patient-reported outcomes, knee function, or
complications at 12 months post ACL reconstruction.
28
Oncological outcomes of patients with non-metastatic renal cell carcinoma with renal vein or inferior vena cava tumor thrombus
Introduction
Tumour extension into the venous circulation is a well-described feature of renal cell
carcinoma (RCC). Current TNM staging guidelines distinguish between various degrees
of venous tumour thrombus (VTT) extent, implying well-defined prognostic
significance to this feature. In reality, there has been a dichotomy within the literature
regarding the association of VTT extent and survival, and this issue remains highly
controversial. We aimed to investigate the impact of VTT extent on survival in non-
metastatic RCC patients using a prospectively-collected multi-institutional database.
Methods
The Canadian Kidney Cancer information system (CKCis) database was used to identify
a historical cohort of patients who underwent radical nephrectomy and renal vein or
inferior vena cava (IVC) tumour thrombectomy for non-metastatic pathological T3 RCC
from 2011 to 2018. Association of level of tumour thrombus was examined with
disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS).
Univariate and multivariate analyses were performed.
Results
Of the 175 patients identified from the database who satisfied the study criteria, 111,
39, and 25 patients had level 0-1, 2, and 3-4 thrombus, respectively. Mean age was
65.3 (standard deviation [SD] 10.9) years. On multivariate analysis, only tumour
Fuhrman grade was significantly associated with each survival metric. Thrombus level
did not impact DFS, CSS, or OS. Predicted 5-year OS rates were 58.3%, 61.0%, and
63.3% for tumour thrombus level 0-1, 2, and 3-4, respectively, with no significant
difference between them (log-rank test p-value 0.25).
Conclusions
According to our data, level of venous tumour thrombus is not associated with survival
metrics in patients undergoing surgery for non-metastatic RCC with renal vein or IVC
thrombus. Higher tumour grade was associated with worse survival in all metrics.
Given inconsistency in available evidence, TNM staging for RCC may require revision.
29
Training Interventions to Improve Adenoma Detection Rates During Colonoscopy: A Systematic Review and Meta-Analysis
Introduction
Colonoscopies are an effective means of detecting and removing precancerous
adenomatous polyps. The adenoma detection rate (ADR) is a marker of colonoscopy
quality and an independent predictor of colorectal cancer incidence. Focused training
interventions may improve an endoscopist’s ADR, but the supporting research is
limited. This systematic review and meta-analysis identified, critically appraised, and
meta-analyzed data from randomized trials (RCTs) evaluating the effect of training
interventions on ADRs.
Methods
Ovid Medline, EMBASE, CENTRAL, Eric, CINAHL, Scopus, Web of Science, and
ClinicalTrials.gov were searched for RCTs investigating the effect of an educational
intervention on ADRs. Two reviewers independently screened, identified, and
extracted trial-level data. Internal validity was assessed in duplicate using the Risk of
Bias tool. Our primary outcome was the ADR. Secondary outcomes were advanced
adenoma detection rate, adenocarcinoma detection rate, polyp detection rate, and
withdrawal times. Safety outcomes were post-polypectomy bleeding rate and
colonoscopy-related perforation rate.
Results
From 2,837 screened citations, we identified 3 trials (119 endoscopists) meeting
our inclusion criteria. Training interventions were associated with increased ADRs
(odds ratio 1.16, 95% confidence interval (CI) 1.00-1.34; I2 83%; 3 trials; 119
endoscopists). When limited to screening colonoscopies, the odds ratio for ADRs
associated with training interventions was 1.17 (95% CI 1.00-1.36; I2 80%; 3 trials;
119 endoscopists). There was a high level of heterogeneity between the trials’
training interventions. Training intervention improved the advanced adenoma
detection rate, adenocarcinoma detection rate, polyp detection rate, and
withdrawal times. Safety outcomes were not reported.
Conclusions
associated with increased ADRs compared to no training interventions. These finding
support focused, well developed continued professional development activities to
improve ADRs even among certified endoscopists.
30
LANDON FALK PLENARY SESSION (11:30—11:40 AM)
The Aryl Hydrocarbon Receptor is involved in the pathogenesis of Congenital Diaphragmatic Hernia
Introduction
Environmental factors may contribute to 70% of CDH cases. A specific class of
environmental chemicals can activate the transcription factor aryl hydrocarbon
receptor (AHR) to change gene expression. We hypothesize that activation of AHR by
these chemicals is involved in the pathogenesis of CDH.
Methods
Ethical approval was obtained prior to experiments (19-010 (AC11436)). We compared
the response of AHR to nitrofen to known ligands - benzo[α]pyrene and resveratrol -
in the BEAS-2B human epithelial cell line (n=3). AHR activity within a 24 hour exposure
period was assessed with immunocytochemistry (ICC/IF). We compared the
abundance of AHR in saccular lung sections (n=3) from human CDH patients (Week 39-
40) and nitrofen-treated rat pups (E21) to age-matched controls using
immunofluorescence.
Results
AHR activation was induced in BEAS-2B cells within six hours of treatment. We
observed all ligands to induce the translocation of AHR fluorescence signal from the
cytoplasm (inactive) to nucleus (active), suggesting nitrofen activates AHR. After 24
hours of treatment, the AHR signal was strictly cytoplasmic and diminished. CDH
patients and rat lung sections have increased AHR abundance in the mesenchyme and
airways compared to controls.
Conclusions
We observed nuclear translocation of AHR indicating activation of the receptor. We
saw similar changes in AHR abundance in both human CDH and nitrofen rat lungs;
suggesting that similar pathological mechanisms are involved. This dysregulated
expression of AHR may contribute to abnormal lung development in babies born with
CDH. The results suggest that environmental chemicals structurally similar to nitrofen
may activate AHR to induce CDH.
31
CHELSEA DAY Plenary Session (11:40—11:50 AM)
Effectiveness of bosentan treatment in miR-200b null mice as a model for
pulmonary hypertension in Congenital Diaphragmatic Hernia
Introduction
Congenital diaphragmatic hernia (CDH) is a complex condition where patients suffer
from pulmonary hypertension due to abnormal lung development. Effectiveness of
current treatments for pulmonary hypertension in CDH patients are unknown. We
determined that CDH patients with poor outcomes have decreased levels of a
microRNA known as miR-200b, and created a miR-200b null mouse. miR-200b null
mice have pulmonary hypertension, abnormal lung development, and up regulation of
endothelin receptor-A in their lungs similar to that of CDH patients. Our aim is to
determine the effectiveness of the drug bosentan, an endothelin receptor antagonist,
in miR-200b null mice.
Methods
Following ethical approval, miR-200b null and wild type mice were treadmill trained
then underwent baseline graded maximal exercise tests and echocardiographs at 8
weeks of age. Bosentan was administered via gavage at 100mg/kg of body weight/day
for three weeks. Weekly graded maximal exercise tests and end of study
echocardiographs were performed to evaluate pulmonary hypertension. After three-
week treatment lungs were formalin fixed and paraffin embedded. Embedded lungs
were then serial sectioned and Verhoeff-van Gieson stained to evaluate vasculature.
Results
Preliminary results show that miR-200b null mice have improved VO2 max after
bosentan treatment (p=0.053, n=2) and increased run time to exhaustion. At this time
no difference in artery thickness measurements is seen between WT and miR-200b
null mice after three week bosentan treatment. We are currently analyzing
echocardiographs to determine changes in pulmonary acceleration time.
Conclusions
These results suggest that Bosentan increases VO2 max and prevents worsening of
pulmonary hypertension. In conclusion, determination of the effectiveness of
bosentan in the treatment of pulmonary hypertension could lead to better treatment
options for patients suffering from pulmonary hypertension in CDH.
32
Fabrication of Immunomodulatory Hydrogels for Cardiac Repair after Acute Myocardial Infarction
Introduction
The balance of pro- and anti-inflammatory processes is tightly linked to left ventricular
remodeling after myocardial infarction. Immune activation also plays a key role in the
rejection of transplanted allogeneic stem cells and consequently reduces the long-
term efficacy of allogeneic stem cell therapies. In this study, we present the design,
fabrication and in vitro characterization of immunomodulatory chitosan-based
hydrogels for cardiac repair after myocardial infarction.
Methods
process. The resultant hydrogels were lyophilized and characterized using scanning
electron microscopy (SEM) and Fourier-transformed infrared spectroscopy (FTIR).
Human mesenchymal stem cells (hMSCs) were encapsulated into the hydrogels and
biocompatibility was assessed after one week using fluorescence microscopy and a
colorimetric LDH assay. Immunomodulatory activity was assessed after co-culture with
human T-lymphocytes using flow cytometry for CD4+IFN-γ+ pro-inflammatory T-
lymphocytes and CD4+CD25+FoxP3+ regulatory T-lymphocytes.
Results
hydrogels. Physico-chemical characterization revealed no significant changes to the 3D
structure and porosity of the hydrogels. The addition of either 10µM atorvastatin or
10µM rosuvastatin did not result in significant cytotoxicity to encapsulated
mesenchymal stem cells at 3 or 7 days. Addition of statins resulted in a marked
suppression of CD4+ T-lymphocyte proliferation (Control 25.1 Fold, Atorvastatin 1.0
Fold, Rosuvastatin 2.3 Fold, p<0.001) and activation (CD4+IFN-γ+ Population: Control
87.1%, Rosuvastatin 23.7%, p<0.001) after in vitro stimulation. No differences were
seen in the percentage of CD4+CD25+FoxP3+ regulatory T-lymphocytes (Control 5.5%,
Rosuvastatin 5.7%, not significant).
A biocompatible immunomodulatory hydrogel was created through integration of
atorvastatin and rosuvastatin into a chitosan hydrogel. This hydrogel may be useful for
stem cell delivery and reducing adverse left ventricular remodeling after myocardial
infarction.
33
Introduction
progressively challenging the contemporary paradigms of technical skills training (1).
Concurrently, new high-fidelity simulation platforms have been developed that
merge virtual-reality video streams to allow for remote instruction and collaboration
(2). The purpose of this study was to validate the use of one such platform
(HelpLightning™) for the instruction and assessment of the fundamentals of
laparoscopic surgery (FLS) skills (3,4).
Methods
participants were enrolled and randomized between three groups: the control group
who received no instruction or feedback, the standard group who received in-person
instruction and expert summary feedback, and the experimental group who received
remote standard instruction and feedback via merged virtual reality. All underwent
pre-testing to ensure baseline homogeneity, post-testing immediately following
instruction, and a retention test one-month later. Standard FLS metrics were
obtained for the five FLS tasks: peg transfer, pattern cutting, ligating loop, extra-
corporeal suture, and intra-corporeal suture (4). Ordinary one-way analysis-of-
variance was used to evaluate the effects of time, group, and time-on-group, with
significance set at a P-value <0.05.
Results
The pre-test confirmed homogeneity between the groups. There was no significant
difference between the groups for task one, peg transfer, however statistically
significant improvements in all four of the remaining tasks were identified between
the control and standard groups, and the control and experimental groups, with no
significant differences between the standard and experimental groups. The
improvements were seen immediately following the instruction and feedback on the
post-test and remained significant one month later on the retention test.
Conclusion
The current study has shown non-inferiority of a merged virtual-reality platform. This
method of teaching and assessing the FLS skills establishes a foundation on which
future work in remote, virtual instruction and collaboration for surgical skills can be
built.
34
Introduction
Of pregnant women who develop symptomatic renal stone disease, 20 to 30% will
require intervention. One treatment that continues to be utilized is retrograde
ureteric stent insertion under fluoroscopic guidance. Unfortunately, X-ray is a known
teratogen. Protecting the fetus with lead shields has been recommended but not well
studied.We devised a series of experiments to investigate this.
Methods
A phantom was constructed using methyl methacrylate to mimic a pregnant patient
undergoing a fluoroscopic procedure. A phantom kidney model containing 15 cc of
Omnipaque contrast agent at 50% concentration, was used to mimic the renal
collecting system. Radiation Dose measurements using dosimeters were carried out
in a variety of scenarios involving different levels of shielding, beam culmination and
both. An experiment with no shielding and no culmination was performed as the
control. Measurements were taken using a variety of different fluoroscopy settings.
Measured Radiation exposure are reported in relation to the control.
Results
Minimum fetal dose is obtained when the beam is collimated such that the fetus is
completely outside of the irradiated field of view, with a reduction in fetal dose of as
much as 76% relative to the situation where the fetus is within the field of view.
Shielding the fetus with thyroid shields reduced fetal dose by a maximum of 75%,
while increasing radiation to the mother by 53%.Using Low Dose instead of Normal
fluoroscopy, and Pulsed instead of Continuous fluoroscopy, provides significant
radiation sparing. Additionally, the fluoroscopy unit output increases with increasing
the size of Shielded area in the X-ray beam.
Conclusion
Using pulsed low dose fluoroscopy with collimation is the most effective fluoroscopy
setting to minimize radiation exposure to the fetus. Shielding with thyroid collars and
collimation both reduce dose to the shielded area. However, shielding doesthis while
increasing exposure to the surrounding tissues of the mother.
35
Introduction
Atherectomy is a transluminal procedure for removing atheromatous plaque. The
ideal target lesion and how to gauge success is currently unclear in the literature. Our
objective was to report single centre short-term outcomes of lower extremity
atherectomy.
Methods
A single centre retrospective review was performed on 22 patients undergoing
rotational atherectomy (TurboHawkTM) in Winnipeg, Manitoba, between July 2017
to October 2018. All patients were heparinized, had filter devices (SpiderFXTM), and
had paclitaxel-coated balloon angioplasty post-atherectomy.
Results
The majority of patients were Rutherford Class 5 (minor tissue loss, 10/22). Average
lesion length was 9.3 cm ± 8 cm (mean ± standard deviation)). Eleven of 28 lesions
were chronic total occlusions, 13 were severe (70-99% stenosis), and 4 were
moderate (50-69% stenosis). Fourteen patients had superficial femoral artery (SFA)
lesions only, 3 in the SFA and popliteal arteries, 3 in the popliteal artery only, and 2 in
the peroneal artery only. Five patients had complications (intimal flap, thrombosis
requiring lysis, vasospasm, etc.). Twenty-three lesions had an excellent radiographic
result (residual stenosis 0-49%). Three lesions had residual stenosis between 50-69%.
Two lesions were impassable – one patient underwent bypass and one underwent
below knee amputation. No lesions were stented. Fourteen patients had resolution
of symptoms. Non-resolution of symptoms demonstrated re-occlusion in 3 patients.
At follow-up, 7 patients required repeat interventions - 3 bypasses, 1 atherectomy,
and 3 major amputations. In patients requiring reintervention, 4 of 8 lesions had an
initially excellent (0-49%) angiographic result. Patients requiring reintervention had
higher rates of coronary disease, congestive heart failure, and chronic kidney disease.
Conclusion
Lower rates of re-intervention post-atherectomy appear to be associated with initial
post-treatment lesion appearance. In selected patients, atherectomy appears to be a
promising treatment. Longer term follow-up is required to identify patients for whom
this treatment can be utilized to maximal benefit.
36
Trajectory of health-related quality of life in thoracic surgery patients
Introduction
Health-related quality of life (HRQOL) affects both physical and mental health.
Studying relationships between HRQOL, waiting periods, and treatment outcomes
could afford insight into the burden of poor HRQOL, identify higher risk groups for
poor HRQOL, and possibly target interventions for high-risk groups. We assessed
HRQOL measure trajectory between first consultation with thoracic surgery and
definitive treatment, along with factors associated with worsening HRQOL.
Methods
This is a retrospective cohort study of consecutive patients seen at a tertiary thoracic
clinic between January 2018 and January 2019. Patients performed assessment of
HRQOL including a 100-point Visual Analog Scale (VAS) at each visit (0 and 100 being
the worst and best possible health states, respectively). Demographic, diagnostic, and
treatment information were collected. Time-trend and univariable analyses were
performed.
Results
Of 937 patients included, 445 (47.4%) were female and mean age was 66.5 years
(SD = 15.0). Number of clinic visits ranged from 1-5 for most patients. Half of patients
visited only once and completed 1 VAS. Of remaining patients, 418 performed 2 VAS
assessments, 144 patients performed 3 VAS assessments, and 36 patients performed
4 VAS assessments. Mean VAS score at consultation was 65.8+21.0. Mean VAS scores
over several visits demonstrated a stable plateau phenomenon and were not
significantly different from each other (Visit 1 = 65.6+21.4, Visit 2 = 67.4+21.2, Visit
3 = 66.9+21.0). Individually, change in VAS score between visits was not significantly
associated with age or sex (p>0.2). Change in VAS score between visits may be
associated with type of treatment received (surgical, endoscopic, pharmacologic).
However, this data has not yet been finalized.
Conclusion
Overall, HRQOL based on VAS appears to exhibit a stable plateau phenomenon.
However, subsets of patients may experience worsening HRQOL. Work is ongoing to
help identify factors or subsets of patients that may benefit from targeted supportive
interventions.
37
Performance of Unnecessary Scrotal Ultrasounds
Introduction
Choosing Wisely Canada™ 2014 recommends against the routine ordering of scrotal
ultrasounds (US) for boys with undescended testicles (UDT). In 2016, the Dept. of
Radiology at the Children's Hospital of Winnipeg sent a letter to all local pediatricians,
informing them of the recommendation, and providing recommendations regarding
the timing of referrals for the surgical management of UDT. Thereafter, any requisition
for an outpatient scrotal US for UDT from a pediatrician or a family physician was
returned to the ordering physician along with a copy of the original letter. We aimed
to determine if the implementation of this change resulted in a significant reduction in
the performance of scrotal US for UDT.
Methods
This was a quality assurance study. We retrospectively identified all scrotal US
performed for boys aged <11 years during years 2014 & 2015 (pre-implementation)
and 2017 & 2018 (post-implementation). Of these, we identified those performed for
UDT and then identified their ordering physician as: pediatrician; family physician; or
surgeon (pediatric surgeon or urologist).
Results
Following implementation of this practice change, the following was noted: 1) an
observed 20% reduction in the total number of scrotal US performed annually (148
vs.118.5; data does not allow for statistical analysis); 2) a significant reduction in the
proportion of scrotal US being performed for UDT (38.9% vs. 22.8%; p<0.0001); and 3)
no significant increase in the proportion of scrotal US being ordered by surgeons
(16.6% vs. 19%; p=0.4639).
Conclusion
A simple practice change resulted in a significant reduction in the proportion of scrotal
US being performed for UDT and did NOT lead to a significant increase in the
proportion of scrotal US being ordered by the surgeons being consulted. This study
affirms that the Choosing Wisely Canada™ recommendations, when directed toward
primary care physicians, effectively prevents unnecessary scrotal US from being
performed.
38
Introduction
Patients with high ulnar motor nerve injury and poor intrinsic hand function can
benefit from terminal branch of anterior interosseous nerve (AIN) transfer to deep
ulnar motor nerve by providing stimulation closer to the motor end plates, and
therefore improved intrinsic muscle function. We report outcome measurements
of this nerve transfer in patients with compressive ulnar neuropathy and
hypothesize that any improvement in intrinsic hand function is beneficial to
patients.
Methods
A retrospective review was conducted of all AIN to ulnar motor nerve transfers,
including end-to-side (ETS) and end-to-end (ETE) transfers, from January 2011 to
October 2018 performed by 2 surgeons. All adults that underwent nerve transfer for
compressive ulnar neuropathy with >6 month follow-up and completed charts were
included. Primary outcomes were motor function using the British Medical Research
Council (BMRC) grading system. Secondary outcomes included complications and
donor site deficits. Preoperative nerve conduction studies were also reviewed.
Results
Of 65 patients (mean age 56.1, 68% male), 32 patients met inclusion criteria. Average
follow-up was 12 months. Average time to surgery from motor symptom onset was
14.1 months. Overall average BMRC was 2.94/5 with statistically significant improved
recovery in patients receiving earlier surgery (<12months =BMRC 3.73, >12months
=BMRC 2.24, p-value <0.01). Patients with an ETS had better motor function than ETE
(ETS = BMRC 3.24, ETE =2.6). Recovery of intrinsic function was measured by the
ability to abduct/adduct fingers and loss of Wartenburg’s sign at final follow-up. There
were no donor deficits post-operation. One patient developed CRPS post-operation.
Conclusion
Patients with earlier surgery (within 12 months symptom onset) and ETS transfer had
improved recovery and BMRC grade compared to late surgery and ETE. Even patients
with low BMRC scores reported improved hand dexterity in follow up. We
recommend this surgery for patients with chronic compressive ulnar neuropathy for
functional improvement.
Prognostic impact of paraneoplastic syndromes on patients with non- metastatic renal cell carcinoma undergoing surgery: Results from Canadian
Kidney Cancer information system collaborative
Introduction
The impact of paraneoplastic syndromes (PNS) on survival in patients with renal cell
carcinoma (RCC) is uncertain. This study was conducted to analyze the association of
PNS with recurrence free survival (RFS) and overall survival (OS) in patients with non-
metastatic RCC undergoing nephrectomy.
From the Canadian Kidney Cancer information system (CKCis) database, historical
cohort of patients who underwent nephrectomy for non-metastatic RCC from year
2011 to 2018 was identified. Patients with PNS were identified and compared to
patients without PNS. PNS identified were one or more of anaemia, polycythemia,
hypercalcemia and weight loss. Association of PNS with RFS and OS was examined.
Univariate and multivariate analysis were performed.
Results
Out of 2724 patients, 1004 (36.86%) had evidence of one or more PNS. There was no
significant difference in PNS with regards to gender, race or family history of kidney
cancer. Patients with PNS were of advanced age, had higher Charlson comorbidity
index (CCI) score and advanced clinical tumor stage as compared to patients without
PNS. On univariate analysis presence of PNS adversely affected RFS (HR 1.68, 95% CI
1.47-1.92, p<0.0001) and OS (HR 1.90, 95% CI 1.38-2.63, p<0.0001). On multivariate
analysis; PNS did not predict RFS or OS when adjusted for age, CCI score, tumor size,
grade, pathological stage and tumor margin. Main limitations are retrospective design,
selection bias and possible reporting bias.
Conclusion
PNS are associated with advanced age, higher CCI score and tumor stage but not with
poor RFS or OS.
CONICAL VS CYLINDRICAL PEDICLE SCREW DESIGN
Introduction
Pedicle screws can have a conical (tapered) or cylindrical (uniform) diameter. Screw
back-out of one or two revolutions is common intraoperatively. The literature has
conflicting results on whether there is a significant difference in screw purchase for
conical versus cylindrical screws after back-out. Since conical screws have a tapered
diameter, they may be more likely to lose pullout strength than cylindrical screws
after backing out.
Pullout strength and displacement of conical and cylindrical screws were assessed
following 37,800 cycles of 150 N of force. Three screws of each type were tested in
accordance with ASTM standard F543-13, using normal and osteoporotic synthetic
bone models validated to cadaver lumbar spines. Second, the screws were backed out
one and two revolutions, and pullout strength and displacement were recorded.
Results
Screw back-out increased screw toggle and pullout strength in both conical and
cylindrical screws. Cylindrical screws displaced more than conical screws in normal
and mild osteopenic bone (p < 0.05 for all values). Average screw toggle after cyclic
loading in the normal bone mode was 0.61 mm, 1.45 mm, and 2.64 mm for cylindrical
screws backed out zero, one, and two revolutions respectively. Conical screws had
0.12 mm, 0.16 mm, and 0.22 mm of screw toggle. Pullout strength was reduced less in
cylindrical screws than conical screws, but conical screws had greater pullout strength
compared to cylindrical screws (p < 0.05). Pullout strength was 3585 N, 3333 N, and
3260 N for cylindrical screws and 4751 N, 4511 N, and 4340 N for conical screws.
Results were similar in the mild osteopenic bone model.
Conclusion
Screw back-out causes more screw toggling and decreased pullout strength.
Counterintuitively, conical screws had equivalent or stronger screw purchase
compared to cylindrical screws after screw back-out in normal and mild osteopenic
bone models.
JARRET WOODMASS E-Poster and Brief Session (2:45—2:49 PM)
Does ultrasound in clinic without formal training change the management of patients with rotator cuff tears?
Introduction
When compared to magnetic resonance imaging (MRI), ultrasound (US) performed by
experienced users is an inexpensive tool that has good sensitivity and specificity for
diagnosing rotator cuff (RC) tears. However, many practitioners are now utilizing in-
office US with little to no formal training as an adjunct to clinical evaluation in the
management of RC pathology. The purpose of our study was to determine if US
without formal training is effective in managing patients with a suspected RC tear.
Methods
This was a single centre prospective observational study. Five fellowship-trained
surgeons each examined 50 participants referred for a suspected RC tear (n= 250).
After routine clinical exam, surgeons recorded their treatment plan (“No Surgery”,
“Uncertain”, or “Surgery”). Surgeons then performed an in-office diagnostic US
followed by an MRI and documented their treatment plan after each imaging study.
Results
Following clinical assessment, the treatment plan was recorded as “No Surgery” in 90
(36%), “Uncertain” in 96 (39%) of cases, “Surgery” in 61 (25%) cases, and incomplete
in 3 (2%). In-office US allowed resolution of 68 (71%) of uncertain cases with 227
(88%) of patients having a definitive treatment plan. No patients in the “No Surgery”
group had a change in treatment plan. After MRI, 16 (6%) patients in the “No Surgery”
crossed-over to the “Surgery” group after identification of full-thickness tears, larger
than expected tears or alternate pathology (e.g., labral tear).
Conclusion
The combination of clinical examination and in-office US may be an effective method
in the initial management of patients with suspected rotator cuff pathology. Using this
method, the diagnosis and treatment remained uncertain in 12% of patients who
required MRI to generate a definitive plan. A small percentage (6%) of patients with
full-thickness rotator cuff tears and/or alternate glenohumeral pathology (e.g., labral
tear) would be missed at initial evaluation.
42
Introduction
Pilon fractures are associated with significant soft tissue injury and complications.
The medial border of the distal tibia is subcutaneous and often the site of soft tissue
injury. The objective of this study was to assess the link between the application of
distal tibial medial plates for pilon fracture fixation and soft tissue complications
requiring either non-operative medical management or surgical management.
Methods
This was a retrospective analysis of prospectively collected data on patients with a
pilon fracture treated with open reduction and internal fixation at HSC Winnipeg
(2011-2017). Logistic regression was performed to determine the association
between medial plating and: 1) the incidence of soft tissue complications and 2) the
incidence of soft tissue complications requiring surgical intervention. We controlled
for other independent variables by introducing them into the regression model. Other
independent variables introduced into the model included: presence of open fracture,
smoking status, diagnosis of diabetes, and radiological injury classification. We
calculated the Cox and Snell r2 as a measure of the percentage of the explained
variation.
Results
The study included 168 patients, 165 of whom had full data. The incidence of soft
tissue complications was 29% (n=48), while 23% (n=39) required surgical treatment.
Predictors of soft tissue complications were 1) presence of open fracture (OR 4.750,
95%CI 2.060-10.950, p<0.001), 2) smoking (OR 2.866, 95%CI 1.224-6.713, p=0.015),
and 3) medial plating (OR 2.619, 95%CI 1.033-6.641, p=0.042). The r2 value was 0.18.
Predictors of soft tissue complications requiring surgical intervention were 1)
presence of open fracture (OR 2.879, 95%CI 1.212-6.838, p=0.017) and 2) medial
plating (OR 4.167, 95%CI 1.401-12.389, p=0.010). The r2 value was 0.14.
Conclusion
Both the use of medial plating and the presence of an open pilon fracture were
associated with increased incidence of soft tissue complications requiring surgical
intervention. Although smoking was linked to increased risk of post-operative soft
tissue complications, it did not predict a higher re-operation rate. Surgeons should
consider the value of using a distal tibia medial plate, particularly when treating open
pilon fractures.
Human Papillomavirus is Associated with Improved Survival in Hypopharyngeal Head and Neck Cancer
Introduction
HPV related oropharyngeal carcinoma is a unique disease process and increasing in
prevalence. The prognostic value of HPV in non-oropharyngeal head and neck cancer
has not been clearly established. Our objective is to determine the association
between HPV status and survival in patients with head and neck cancer originating
from each subsite of the pharynx.
Methods
Population-based retrospective cohort study from the Surveillance Epidemiology and
End Results (SEER) Database. Data was collected from patients with head and neck
cancer and known HPV status between the 2010 and 2016. 5-year overall survival was
calculated using the Kaplan-Meier method for HPV positive and HPV negative patients
for each subsite of the pharynx. Overall 5-year survival was compared using logrank
and Breslow methods for each subsite. Multivariate cox-regression analysis was
completed for each subsite to determine the effect of HPV on survival.
Results
A total of 15,394 patients with HPV status were identified from the SEER database;
4,941 HPV negative and 10,453 HPV positive patients. Primary sites were distributed:
929 in nasopharynx, 13, 294 in oropharynx, and 844 in hypopharynx. 5-year overall
survival was improved by 24.1% and 23.6% in HPV positive oropharyngeal and
hypopharyngeal cancer respectively. Univariate analysis reveals an association
between survival and HPV positivity for oropharyngeal and hypopharyngeal subsites
using the logrank (p<0.00001, p=0.00003) and Breslow (p<0.00001, p=0.00032)
methods. Similary, multivariate cox-regression showed an association between HPV
status and overall survival in oropharyngeal (hazard ratio [HR]= 2.13,95%CI=1.96-2.30)
and hypopharyngeal subsites (HR=1.64,95%CI=1.23-2.19), but not nasopharyngeal
subsite (HR=0.84,95%CI=0.62-1.13).
Conclusion
and hypopharyngeal subsites. The nasopharynx subsite shows no association with
overall survival. Given our evolving understanding of HPV and the prognostic value of
HPV in the oropharynx, testing should be considered in patients hypopharyngeal
cancer.
44
PETER MACDONALD Surgeon’s Den Session (3:26—3:31 PM)
Biceps Tenodesis Versus Tenotomy in the Treatment of Lesions of the Long Head of Biceps Tendon in Patients Undergoing Arthroscopic Shoulder
Surgery: A Randomized Controlled Trial
Introduction
The biceps tendon is a known source of shoulder pain. Few high level studies have
attempted to determine whether biceps tenotomy or tenodesis is the optimal
approach in the treatment of biceps pathology, and most literature is of lesser
scientific quality with varying results.The aim of this study was to compare patient-
reported and clinical results between tenotomy and tenodesis for the treatment of
lesions of the long head of the biceps brachii.
Methods
Patients 18 years or older undergoing arthroscopic surgery with intraoperative
confirmation of a lesion of the long head of the biceps tendon were randomized. The
primary outcome measure was the ASES score while secondary outcomes included
WORC score, isometric elbow and shoulder strength, operative time, complications,
and the incidence of revision surgery. Study visits were conducted at pre-, 3-, 6-, 12-,
and 24-months post-operative. Magnetic resonance imaging (MRI) was performed at
one year to evaluate the integrity of the procedure in the tenodesis group.
Results
One hundred fourteen participants were randomized to undergo either biceps
tenodesis or tenotomy. ASES and WORC scores improved significantly from pre- to
post-operative time points with a mean difference of 32.3% (p<0.001) and 37.3%
(p<0.001), respectively, with no difference between groups in either outcome from
pre- to 24-months. The relative risk of cosmetic deformity in the tenotomy group
relative to the tenodesis group was 3.5 (p=0.016). Pain improved (p<0.001) while
cramping remained unchanged from 3- to 24-months post-operative with no
difference between groups. There were no differences between groups in elbow
flexion strength or supination strength. Follow up MRI at 12-months post-operative
showed that the tenodesis was intact for all patients.
Conclusion
Tenotomy and tenodesis as treatment for lesions of the long head of biceps tendon
result in good subjective outcomes but there is a higher rate of popeye deformity in
those undergoing tenotomy.
JUSTIN OAKE Surgeon’s Den Session (3:32—3:37 PM)
Association between socioeconomic status and treatment for prostate cancer in a universal healthcare system: A population-based analysis
Introduction
A large body of research has shown that there are strong socioeconomic disparities in
access to cancer treatment. However, whether these inequalities persist among men
with prostate cancer has not been previously explored in the equal-access, universal
Canadian health care system The aim of this study is to compare whether
socioeconomic status is associated with the type of treatment received (radical
prosta