Monitoring mental health reform in a Canadian inner city

This ecological study investigated whether the relationship between social disadvantage and hospitalization for psychoses changed during a time of social and economic stressors in an urban setting. Hospital separation rates were compared in the census years 1991 and 1996. Rates were 66% higher in the lowest income areas compared to the richest areas; but this relationship did not change over time. Instead, rates for psychoses increased by about 15% over time. These findings may be due to an increase in the need, a change in the level of resources or in coding practices. As hospital separation data are collected systematically in many countries, they can be used to monitor the progress of mental health reform. Variations in an area may signify that resources need to be redistributed more equitably and/or at a faster pace.     

Neighbourhood recent immigration and hospitalization in Toronto, Canada

Recent immigrants to Canada tend to initially settle in low-income urban core areas. The relationships among immigration, neighbourhood effects and health are poorly understood. This study explored the risk of hospitalization in high recent-immigration areas in Toronto compared to other Toronto neighbourhoods. The study used 1996 hospitalization and census data. Regression was used to examine the effects of recent immigration on neighbourhood hospitalization rates. Most hospitalization categories showed significantly higher rates of admission as the proportion of recent immigrants increased. Income was also significantly associated with all categories of hospitalization except surgical admissions. Average household income was almost 60% lower (dollar 36,122) in the highest versus the lowest immigration areas (dollar 82,641) suggesting that, at the neighbourhood level, the effects of immigration and income may be difficult to disentangle. These findings have important implications for health care planning, delivery, and policy.     

Incidence trends and projections for childhood cancer in Ontario

Studies of cancer incidence patterns and trends can provide useful measures of health burden and possible disease etiology, which can aid the planning of cancer care services. This report aims to characterize trends in incidence of childhood cancer, and to assess the implications of these trends by generating incidence projections to 2015. Cancer incidence data were obtained from the database of the Pediatric Oncology Group of Ontario (POGO), which has registered all cancer cases in Ontario since 1985. Annual incidence rates were calculated with census-based population estimates for the 1986-2001 period. Poisson regression models were used to analyze trends, and to calculate projected numbers of cases up to the year 2015. From 1986 to 2001, 5,163 cancer cases occurred among children aged 0-14. Leukemia, CNS tumors and lymphomas were the most common cancers. The number of incident cases increased by 14%, from 296 in 1986 to 336 in 2001. For all cancers, average annual age-standardized rates increased from 147 per million in 1991 to 157 per million in 2001. Over the next 15 years, the 0-14 year population is expected to decrease from 2.28 million in 2000 to 2.13 million in 2015. A marginally statistically significant trend in incidence was projected for all cancers combined (0.5% increase per year p < 0.10) and a statistically significant increase for lymphomas, (1.2% per year 95% CI = 0.0-3.9%). During this period, the number of cases of leukemia and CNS tumors is expected to remain relatively stable. The number of cases of all cancers is expected to increase by 8%, from the average of 320 in 1995 to approximately 347 in 2015. Understanding of these projections will facilitate health care resource planning.     

Outcome of conditioning intensity in acute myeloid leukemia with monosomal karyotype in patients over 45 year‐old: A study from the acute leukemia working party (ALWP) of the European group of blood and marrow transplantation (EBMT)

Acute myeloid leukemia with monosomal karyotype (MK AML) carries a very poor prognosis, even after allogeneic stem cell transplantation (SCT). However, SCT remains the only curative option in this high‐risk population. Because myeloablative conditioning regimen (MAC) is associated with less relapse, we hypothesized that more intensive conditioning regimen might be beneficial for MK AML patients. We reviewed 303 patients over age 45 diagnosed with either de novo or secondary MK AML. One hundred and five patients received a MAC and 198 a reduced‐intensity conditioning (RIC). The median age at SCT was 57‐year‐old, significantly lower in the MAC (53‐year‐old) than in the RIC group (59‐year‐old). The median follow‐up was 42 months (range, 3 ? 156 months). The 3‐year overall survival (OS), leukemia‐free survival (LFS), and relapse rate (RR) were not significantly different between both groups with overall values of 34%, 29%, and 51%, respectively. On the contrary, the 3‐year nonrelapse mortality (NRM) was significantly higher in MAC recipients (28%) compared with RIC patients (16%, P = 0.004). The incidence of Grades II to IV acute graft‐versus‐host disease (GvHD) was significantly higher after a MAC (30.5%) than after a RIC (19.3%, P = 0.02). That of chronic GvHD was comparable between both groups (35%) and did not impact on LFS. Interestingly, within our MK AML cohort, hypodiploidy was significantly associated with worse outcomes. Due to reduced toxicity and comparable OS, LFS, and RR, RIC appears as a good transplant option in the very high‐risk population, including older patients, diagnosed with MK AML. Am. J. Hematol. 90:719–724, 2015. © 2015 Wiley Periodicals, Inc.     

In vitro isolation of stem cells derived from human dental pulp

Agha‐Hosseini F, Jahani M‐A, Jahani M, Mirzaii‐Dizgah I, Ali‐Moghaddam K. In vitro isolation of stem cells derived from human dental pulp.
Clin Transplant 2009: DOI: 10.1111/j.1399‐0012.2009.01137.x.
© 2009 John Wiley & Sons A/S. Abstract: Stem cells are characterized by the ability to differentiate and to self‐renew. Stem cells derived from human dental pulp have been shown to differentiate into osteoblasts serving as a potential source of autologous bone produced in vitro. The purpose of the present study was to isolate mesenchymal stem cells from dental pulp. Dental pulp was gently extracted from 27 intact human permanent third molars of patients aged 18–25. Cow horn forceps were used to isolate intact dental pulp in sterilized condition. The pulps were cultured in a medium containing Dulbecco’s modified Eagle’s medium‐low glucose (DMEM)‐LG and Amphotericin 1%. The cells were subsequently expanded by passages, two passages were performed before they were stored in liquid nitrogen for further examination. DMEM + fetal bovine serum (FBS) 10% L‐Glutamin 0.1% + Trypsin 2.5% + ethylene diamine tetraacetic acid (EDTA) were used for passage. Light microscope and flow cytometry were used to study the cells. The isolated dental pulp cells expressed mesenchymal stem cell markers. The cells were negative for CD34 and CD31 and CD45 but were positive for CD13, CD44, CD90, CD166, and CD105. These results indicate that dental pulp can be use as a source of stem cells that we can isolate and culture.     

The esophagus after endoscopic pneumatic balloon dilatation for achalasia

The changes seen on contrast esophagrams after endoscopic pneumatic balloon dilation for the treatment of achalasia are described and illustrated. Sixteen patients had esophagrams within 24 hr after dilation and follow-up esophagrams were obtained 6-24 months later. The radiographic features evaluated in the early postdilation period included detection of esophageal perforation, diameter of the esophagogastric channel, proximal esophageal dilatation, mucosal integrity, and emptying dynamics of the esophagus. Fourteen patients (88%) had immediate symptomatic improvement of dysphagia. The mean increase in diameter of the esophagogastric channel was 6.5 mm (range, 4.8-9 mm) relative to a pretreatment esophagram. Emptying dynamics of the esophagus improved significantly in 12 patients (75%). One patient developed esophageal perforation requiring surgery. On the follow-up esophagrams obtained 6-24 months later, the evaluation was for sustained dilatation of esophagogastric channel, decrease in esophageal dilatation, and improved emptying dynamics of the esophagus. The effective esophagogastric channel diameter of 8-10 mm correlated well with improved clinical response in 88% of the patients.     

Duplex ventral pancreas

Complete duplication of the ventral pancreatic ductal system in 2 patients is reported. Both patients, during evaluation for recurrent abdominal pain, underwent endoscopic retrograde cholangiopancreatography that revealed typical changes of chronic pancreatitis and pseudocysts confined to 1 ductal system with the other ductal system completely normal. Both ductal systems filled with contrast medium via a common opening at the major papilla. A rudimentary minor papilla was present, but cannulations were unsuccessful. This unusual anomaly of the ventral pancreas with its embryologic basis, diagnosis, and clinical implications is discussed.     

Secondary neoplasms of the esophagus

A review of 62 cases of esophageal involvement by secondary neoplasms is reported. The common routes of esophageal involvement are by direct extension of the tumor from the contiguous or adjacent organs (45.2%), via mediastinal nodes (35.5%), and hematogenous spread from a distant primary (19.3%). In the first 2 modes of esophageal involvement, the diagnosis is usually obvious but hematogenous metastases to the esophagus usually pose a diagnostic challenge. Radiologically, hematogenous metastases show a spectrum of features consisting of a short segment of progressive stricture with normal to minimally irregular mucosa, a submucosal mass with or without ulceration, a polypoid mass or masses, and defects in esophageal motility including secondary achalasia. Since endoscopy and biopsy have limited diagnostic yield, radiologic diagnosis plays a key role in the diagnosis of secondary neoplasms of the esophagus irrespective of their mode of spread to the esophagus.