That’s what some Sunnybrook scientists are questioning, and now investigating in a clinical research study to enhance bone fracture repair.

The “magic pill” in this case is a daily medication already scientifically tested and well established in clinical use known as lithium carbonate.

With timed administration at very low doses, lithium carbonate has been shown to enhance bone repair, and now, orthopaedic clinical researchers are testing it in injured patients with fractures.

The Sunnybrook-led study – Lithium for Fracture Treatment (LiFT) – is a randomized controlled multi-centre clinical trial investigating if lithium can improve long bone fracture healing in healthy patients from 18 to 55 years of age, who have a shaft fracture of the femur, tibia/fibula, humerus or clavicle. Participants take the medication for just two weeks starting 14 days after the fracture or surgery.

“Fracture healing in adults typically takes several weeks to months to heal – and in up to 10 per cent of cases, it can fail to heal completely despite appropriate treatment,” says Dr. Diane Nam, an associate scientist with the Holland Bone and Joint Research Program and orthopaedic trauma surgeon at Sunnybrook.

Dr. Diane Nam, Principal Investigator on the LiFT trial.

“Sustaining a fracture significantly impacts an individual’s function, such as the ability to work, drive or physically parent young children. We’re talking not only about the long time to heal bones, but don’t forget the pain and negative impact on a patient’s quality of life and mental health. If we can show that this safe and inexpensive ($1/a day) therapy works, it can potentially have a huge impact to globally change how we manage fractures.”

Dr. Nam was involved in the scientific research from “lab bench to patient bedside”. She led the team as its principal investigator in conducting the pre-clinical work and in translating the research through to the current clinical trial.

The first few patients in the initial pilot clinical trial showed a reduction in pain with the use of lithium, with no impact on mental activity or mood. In order to keep the highest standards for clinical research, the current study is blinded, meaning that patients and the research team who will analyze the data do not know who is receiving the actual drug or a placebo pill in order to control for potential bias. 120 patients have been enrolled in the study to date.

The trial has sites at Sunnybrook, St. Michael’s Hospital, McMaster University Medical Centre, Ottawa Hospital and Royal Victoria Regional Health Centre, and is supported through Sunnybrook’s Centre for Clinical Trial Support (CCTS) and the Canadian Institutes for Health Research.

A research participant from the LiFT trial comes in for one of his check-in visits at the fracture clinic and to have x-rays taken.

The research team will analyze and compare X-ray result scores assessing for bone union where three of the four outer layers at the fracture site are bridged. They will also factor in how the research participants are functioning in their day-to-day life, including accounting for pain levels.

The research is also considering potential barriers to the acceptance of lithium therapy for the purpose of fracture healing, from both the perspective of patients and care providers. Of note, the dose of lithium being used in the study is so low (300 mg or one-quarter of the dose amount used for other applications) that it’s not detectable in blood work at 12 hours after taking it.

“This important clinical trial is one of many promising investigations that have resulted from collaborations between surgeons and scientists in the Holland Bone and Joint Program,” says Dr. Cari Whyne, senior investigator involved in the trial and the Susanne and William Holland Chair in Musculoskeletal Research at Sunnybrook Research Institute and University of Toronto. “This aligns with my research focus in clinically-translational bioengineering research aimed at maximizing function among those who develop musculoskeletal disease or disability.”

For more information about participating in the LiFT trial, contact lift@sunnybrook.ca

The post Igniting Discovery: Can we speed up bone healing? appeared first on Your Health Matters.

“We’re here to support our Sunnybrook investigators in their leadership of clinical trials,” says Gail Klein, operations director for the CCTS. “We’re their right-hand people; providing internal supports and a full-service package to make things easier for them, while also acting as a partner to the partners – that is, other trial sites worldwide.”

Sunnybrook has a strong history of leading clinical trials locally, nationally, and globally. CCTS has expertise in the management and coordination of single-centre, multicentre, national and international clinical trials and research projects across any therapeutic area at Sunnybrook.

“This is an incredibly exciting time to be part of the clinical trials team at Sunnybrook,” says Dr. Paul Karanicolas, medical and scientific director for the CCTS. “Across our institution, there is a renewed and growing focus on innovation leading us to the forefront of inventing the future of healthcare. Our work is not only advancing medical science—it’s directly impacting patient lives in meaningful ways.”

Have a Sunnybrook-led clinical research project in mind (or in the works)?

Contact the CCTS at: ccts@sunnybrook.ca

The post Igniting Discovery: Where researchers go to get their research projects off the ground appeared first on Your Health Matters.

Big sister Debbie has always been there for Cindy; this time, as they scurry through hospital corridors, a little late for their first appointment of the day.

Together, the siblings navigate traffic, banter over the long drive from Brantford, and keep on top of appointments. Debbie is a little on edge, given the circumstances. She takes her support role seriously, as she – more than most, due to her career in nursing – understands its importance to patients; her sister, in this case. Cindy, as a result, comes across as laid back and has an energetic spring in her step.

Despite having left early as they always do, the heavy fog and wet morning meant road conditions were heavier than usual. But nothing was going to get in their way…

Cindy is part of a clinical trial, or research study, that is testing an investigative drug therapy for the prevention of Alzheimer’s disease. It is one of many dementia research trials from the Brain Lab in the Dr. Sandra Black Centre for Brain Resilience and Recovery at Sunnybrook Health Sciences Centre.

A volunteer participant for the study, Cindy is required to come in to hospital for regular visits – twice a month in her case, for now. This trip marked a year of visits; expected to continue another four years, for the duration of the five-year study.

Why would someone like Cindy – who shows no symptoms of Alzheimer’s disease – need or want to take that time to participate in such a research study?

When I first heard about this study, I knew right away I wanted to be a part of it. My mother had dementia, Alzheimer’s disease (AD). Seeing mom deteriorate mentally, it was difficult. She would have been in her late sixties, when she started manifesting confusion. She deteriorated; it was tough to see her go downhill. I wanted to learn what my risk was, to see if I could get more information, and what I could do about it”

Cindy Greatex,
clinical trial research participant,
68 years old 

Dementia is a term for several diseases that affect memory, thinking, and the ability to perform daily activities, with Alzheimer’s being the most common, contributing to about 60 to 70 per cent of dementia cases.

According to the World Health Organization, the illness gets worse over time and mainly affects older people. Having a family history of Alzheimer’s disease – in particular, if a biological parent or sibling has the disease – increases the risk of developing it.

As a part of the study, Cindy had the option to have her genes tested; she didn’t hesitate. The results showed that she has the strongest genetic risk factor for AD – which means she has a 15 times higher risk of developing the brain disorder than the average person.

As a medical doctor, Sunnybrook cognitive neurologist and brain scientist Dr. Sandra Black knows too well the devastating effects that diseases of the brain can have on patients, their quality and length of life, and their impact to families and loved ones.

Recognized internationally for her contributions to the diagnosis and treatment of vascular dementia, Alzheimer’s disease and stroke, Dr. Black has been compassionately providing care to patients and their families for most of her career, while working to advance research into what we know about the brain. This includes leading 88 clinical trials and training 110 trainees – new generations of clinicians and brain scientists, who have gone on to be leaders in cognition, stroke and dementia across the country.

While there are drug therapies available to help treat some of the symptoms of AD or other dementias (once those symptoms have already developed), there are limited medical options to address prevention, before the disease takes hold.

Yet Dr. Black has never been more optimistic.

Never before did we have the option or possibility of altering the pathway in which dementia develops. Now we’re actually looking at the pathology itself that leads to brain cell damage and cognitive decline. This is an emerging field and we’ve learned the sweet spot in preventing or slowing down Alzheimer’s disease is well before symptoms start.

Sandra Black,
Scientific Director, Dr. Sandra Black Centre for Brain Resilience and Recovery,
Sunnybrook Research Institute (SRI) and
Officer of the Order of Canada

She explains how the focus of therapies in their clinical trial research now is to intervene before the toxic processes behind the disease begin to form – a minimum of 10 to 15 years before symptoms kick in and “have a life of their own”, spreading in the brain.

“If we can do that, then you’re going to avoid it (dementia developing). It’s like stroke prevention: you get worked up, and put on prevention therapies, so you don’t have a stroke.”

The comparison should not go unnoticed, considering that she and her colleagues at Sunnybrook’s stroke clinic were one of the first to provide stroke prevention therapies in Canada in the 1990’s.

For the time being, volunteering to participate in a clinical trial is often the best option for patients like Cindy to access therapies that are not yet available “clinically”; in this case, a drug therapy in an effort to prevent or offset the very start of the disease process.

Receiving the drug, however, is not a guarantee as clinical trials are often randomized and blinded, which means volunteer participants are either selected for the drug therapy itself, or a “placebo” instead – the latter usually is just a saline solution – so Cindy and the research team don’t know which group she falls in.

“There has to be this placebo comparison in order for the study to be controlled, in order to validly test for any effects and differences – good or bad – of a drug being studied,” explains Halil Akbulut, clinical research coordinator in the Hurvitz Brain Sciences Program at Sunnybrook.

Without people like Cindy and her study support partner, we wouldn’t make any progress at all. They’re contributing to our understanding.

Cindy will continue to be closely monitored and tested for the duration of the study. Her sister Debbie is her “study partner”. In addition to providing a supportive role to Cindy, Debbie is part of her “team”, sharing any cognitive, physical or emotional changes she observes while outside the hospital setting. Changes to cognition can include thinking processes such as attention, learning and memory, language, remembering, reasoning, and problem solving.

If Cindy’s cognition or overall health declines, she will be pulled from the study. If it’s found that she was on the placebo, she will be offered the drug therapy as part of the agreement as a participant of the study. If she was on the drug arm of the study, she will continue to be offered it, for as long as she and her care team decide to use it.

I’m learning so much through this study, I’m learning how to eat better, how to sleep better, interacting more with people; so it’s giving me a lot of tools that I can put into place now while I’m going through the study, and I know it will make a difference in my life, to a better quality of life.

When asked if she had any advice to offer others who may be considering a clinical trial, Cindy added:

“If there are clinical studies available, sign up. It helps to find out as well genetically whether you have a predisposition – a higher probability of getting the disease – so there’s so many good points about being part of a study. I encourage people to find out if anything is happening in your community – I’m commuting myself – it’s worth the while to do that.”

The post Igniting Discovery: Can we stop dementia in its tracks, before it starts? appeared first on Your Health Matters.

Now, clinical researchers at Sunnybrook think they have a living example to support this theory.

A patient case study with brain network mapping, reported by University of Toronto Psychiatry resident and lead author Dr. Saarah Haque and colleagues, was recently published in the journal Communications Medicine.

The findings from this study provide additional understanding of the causes of substance use disorders and could be helpful for developing new treatments in the future.

Sunnybrook cognitive neurologist and senior author of the paper, Dr. Matt Burke, provides for us a summary of his patient’s case, and helps us to make sense of what it could potentially mean for the direction of research and the treatment of chronic, debilitating, and otherwise “treatment-resistant” alcohol use disorder (AUD).

Dr. Matthew Burke, cognitive neurologist and associate scientist in the Hurvitz Brain Sciences Program at Sunnybrook.

Can you provide for us an overview of the events that led to this case study?

A few years ago, a 42-year-old Toronto woman with chronic AUD (since her early twenties), experienced a traumatic brain injury (TBI) as a result of falling down stairs while intoxicated. She struck her head and lost consciousness, with no memory of the incident.

While in intensive care, brain imaging showed bleeding in in the left frontal lobe of her brain.

A few weeks after her injury, I first met with this patient through my work at Sunnybrook’s Traumatic Brain Injury (TBI) Clinic. She reported a good recovery in many symptoms but still had some insomnia, mild short-term memory difficulties, and loss of smell and taste. Interestingly, she also independently reported a dramatic reduction in her cravings and interest in drinking alcohol – leading to her being abstinent from alcohol for the first time in years.

Keep in mind that before the incident, she didn’t respond well to any treatments. Previous attempts to reduce her alcohol consumption went unsuccessful, despite trying multiple approaches including psychosocial treatments – such as individual counselling and group supports, and pharmacological treatments – where she participated in clinical trials testing medications aimed at minimizing symptoms, such as cravings and a strong urge to drink. But they didn’t work for her.

So, this patient had tried a number of other treatments for her alcohol addiction – with little to no success – and was now suddenly showing signs of remission, after her fall?

That’s correct. You could say her addictive behaviour stopped becoming as much of a problem for her – in a way that was not seen before with clinical treatment.

At a one-year follow-up appointment, she had reported one relapse a few months after the TBI that was triggered by increased workplace stressors, in the context of the COVID pandemic.

After the relapse, she had successfully abstained from alcohol in the four months preceding her one-year follow-up appointment in our clinic (early remission), and she was discharged from the TBI clinic.

How did this incident lead to a research study?

We were obviously fascinated and very happy to learn about the relief she was experiencing from her addiction, albeit it was unfortunately in the context of a TBI with other consequences that can come with such an injury.

We were curious as to whether the damage to the specific brain region seen on the CT scan could be the reason for her marked reduction in cravings and interest in alcohol. In order to do so, we knew we would need to collaborate with previous colleagues at Harvard Medical School to map the brain region and see if it overlapped with regions/circuits previously implicated in remission from addiction.

What did you find?

We were able to trace a focal lesion – damage to tissue created when an object penetrates the skull and directly injures the area. In this case, the location of the lesion was in the orbitofrontal cortex – a part of the brain’s frontal lobe.

This is the same area that previous research in pre-clinical models and humans has been telling us plays a role in addictive behaviour – including the regulation of urges, compulsions, and reward decision-making processes.

We then looked to see what parts of the brain this lesion is connected to in a process called lesion network mapping. This map revealed that the lesion overlapped with previously identified circuits implicated in addiction remission.

What does this tell us?

This case study provides us with information that we normally would never be able to ethically do – in that you would never intentionally disrupt or create injury to one’s brain – for obvious reasons, unless there is very specific evidence indicating a measured controlled way for healthcare practitioners to do so that is proven to show therapeutic benefit with minimal risk.

An example of this includes some of the proven therapies offered in medicine and research for some other brain conditions, where non-invasive or minimally-invasive brain therapies have shown to carefully and precisely create either some form of connection disruption, or in some cases, produce a controlled lesion or “injury” to very specific parts deep within the brain to create a therapeutic effect.

In this case, this unintentional TBI appeared to somehow, by fluke, disrupt a brain connection in perhaps a specific way and/or in a critical spot, that contributes to, or is responsible for, this patient’s AUD.

To the best of our knowledge, there have been no published reports of focal lesions resulting in remission of isolated alcohol use disorder (without the use of more than one drug).

What is the take home message?

We describe a patient with longstanding alcohol use disorder who reported reduced cravings and stopped drinking alcohol following a traumatic brain injury that damaged part of her left frontal lobe.

We performed analyses on this damaged brain region and found that this area overlaps with previously-identified brain connections involved in substance use disorders.

Our findings provide additional understanding of the causes of substance use disorders and could be helpful for developing new treatment strategies.

How unusual is this case?

This is a fairly extraordinary situation. I would say there are probably a handful of other cases I have seen where patients report a paradoxical improvement of pre-existing symptoms (e.g. low mood) after a major head injury.

When I was previously working down at Harvard Medical School, I was involved in research that collected such rare lesion cases from the medical literature and combined them with brain network mapping – and they garnered unexpected media attention, probably in part due to the unusualness of these cases.

Does this mean a potential treatment for alcohol addiction? What are the next steps?

Not yet. But it does shine a new light in this area of research and highlights how changes to brain circuits may impact complex behaviours (the crux of neuropsychiatry).

Our findings suggest that potentially just disrupting this brain network could possibly facilitate remission, however, the intersection of brain injury and AUD is complicated and requires more study.

Importantly, we couldn’t control for other possible factors that could have been potential contributors to alcohol remission in our patient. This includes negative psychological associations with alcohol (given that the trauma occurred in the context of alcohol intoxication), less social interaction, the role of psychiatric factors, such as depression or post-traumatic stress disorder, or reduced exposure to triggers for alcohol use in the context of a recovery from TBI.

We therefore need to do more research and proceed with caution in further investigating any potential treatment looking to modulate the brain circuit implicated in our article.

The post Brain injury paradoxically alleviates alcohol addiction in Toronto woman: Q&A with Sunnybrook neurologist Dr. Matthew Burke appeared first on Your Health Matters.

It’s this highly-specialized setting within an academic health sciences centre that lays the foundation for clinical research – the study of health and illness in people – that drives discovery, innovation and learning in the field of critical care, at home and around the globe.

According to the Canadian Clinical Research Network, for the second year in a row, Sunnybrook has enrolled the highest number of patients in Canada in critical care-related trials funded by the Canadian Institutes of Health Research (CIHR).

Two current Sunnybrook-led clinical trials – on the cusp of discovery – are expected to produce evidence that will change the way critical care is practiced, and impact outcomes for critically-ill patients:

The world’s largest clinical trial in critical care:

Using antibiotics to prevent hospital-acquired infections before they happen.

Dr. Brian Cuthbertston, senior scientist in the Evaluative Clinical Sciences, Tory Trauma Research Program at SRI, is the international principal investigator for a number of global critical care studies and collaborations, including the SuDDICU trial.

Critically-ill patients who receive mechanical ventilation (assisted breathing) in an intensive care unit (ICU) are particularly at risk for hospital-acquired infections – these are infections that can develop while patients are in hospital receiving care, and are a major cause of illness, sometimes death, and increases to the costs of care.

While the evidence supporting the preventative use of antibiotics is strong, many health care professionals around the world don’t use this approach, out of a concern of the effects of antibiotic resistance – when antibiotics are no longer effective.

Led by SRI in Canada and the U.K., and by The George Institute in Australia, the SuDDICU  study – Selective Decontamination of the Digestive tract in Intensive Care Unit patients – is a large, randomized controlled trial and international research collaboration, that was first established in 2009.

The researchers wanted to test:

• whether using antibiotics to prevent infections increases the number of patients who get better and go home after being critically unwell, and
• whether using antibiotics in this way affects patterns of antibiotic resistance – when antibiotics are no longer effective – in the ICU.

“The preliminary results are not only promising, but also came as a bit of a surprise,” says Dr. Brian Cuthbertson, international principal investigator of the trial, critical care physician and senior scientist at Sunnybrook.

This research aims to give health care professionals and patients data on the benefits so they can make informed decisions about providing preventive antibiotics as part of care.”

Publication of the study results are expected in the near future – stay tuned to SRI Research News.

The clinical trial ranked #1 out of hundreds of thousands of Health Canada pandemic study grant applications:

Swapping intravenous (IV) sedative for inhaled sedative for patients on a ventilator in the ICU.

This trial is homegrown within Canada (and includes a single U.S. site), but its potential for global impact is not any less significant.

A dose of isoflurane is prepared, as part of the SAVE-ICU trial designed and led by Sunnybrook. The inhaled sedative – known for its use in surgeries – has been tested for use with patients in the intensive care unit, versus traditional sedatives given through an intravenous (IV) line.

The SAVE-ICU study – SedAting with Volatile Anesthetics Critically Ill COVID-19 Patients in the Intensive Care Unit – is a collaborative, multi-hospital, randomized clinical trial testing:

• whether inhaled volatile sedatives – a more widely available anesthetic commonly used in operating rooms – can replace sedative drugs that are typically delivered intravenously (by IV) for patients in the ICU with respiratory distress requiring ventilation; and
• whether patients recover faster with this form of sedation.

“In order to tolerate the uncomfortable procedure of being put on a breathing machine, patients require sedation or sleep-inducing medications,” explains Dr. Angela Jerath, lead principal investigator of the study, anesthesiologist, and a scientist in Evaluative Clinical Sciences at Sunnybrook. “At the beginning of the COVID-19 pandemic, these drugs were in short supply due to the high number of patients needing ventilators.”

The investigators will compare the impact that inhaled versus IV sedation has on outcomes important to patients with respiratory failure, their ICU clinical teams, and health resource use; this includes ICU and ventilator-free days, quality of life, delirium and hospital mortality.

Adds Dr. Jerath: “There has been some evidence to suggest that these (inhaled volatile) drugs may also have properties that reduce lung inflammation, which may speed up recovery and reduce the time patients spend on a ventilator.”

The investigators are also continuing to look for any elevation in risk between the two methods of sedation, but there has been no indication to stop in the last few years, with no adverse events showing.

“As the inhaled sedative doesn’t have to be filtered through the body like the IV sedation does, there are benefits for the lungs, liver and kidneys, for cancer patients, and with no particular concerns over IV sedation seen,” explains Eily Shaw, the research coordinator on the trial.

“When you turn the dose up/down with an IV drip, you need to wait for the body to process it first, and there’s also a considerable ‘wash out’ period after with patients coming off the effects from the sedative days or even weeks later. It can be a long time before they feel themselves again which can be confusing and sometimes scary.”

Although volatile (inhaled) anesthetics are not new (as a standard of care for surgeries), “their use still had to be studied in the context of the ICU because the type of person coming in for surgery is different than the patient who is ventilated due to respiratory distress in critical care,” says Eily.

At the study start in 2021, it was initially aimed at patients with a COVID diagnosis, but has since expanded to include any patient in the ICU with any kind of respiratory distress (lung failure) requiring sedation on a ventilator.

Dr. Angela Jerath, scientist and anesthesiologist in the Schulich Heart Program, is the lead principal investigator of the SAVE-ICU study.

The goal of this study is to determine if inhaled sedation should be a standard of care in the ICU as well,” says Dr. Jerath. “This can be done differently between hospitals (with different tiers of care), and would also ease the pressure on IV sedation stock, in particular during heightened times of need, such as a pandemic.”

With over 750 research participants over the four-year study period, it will take another year or two to assess the data. In the meantime, members of the research team like Eily are left humbled with their own anecdotal personal observations and sense of what it means:

I’m always buoyed by how thankful our participants and their families are to be involved in our research. For me, the human component is what makes the work we do particularly special. Our team certainly can’t take all the credit but it’s so massively rewarding to see patients when they get better and they look totally different at follow ups and are so grateful, we understand the importance of doing this.”

The post Igniting Discovery: Clinical trials changing the trajectory for the critically ill appeared first on Your Health Matters.

But researchers may have a whole new treatment therapy technique to target and treat hypertension that may be an option in the future.

Newly-published pre-clinical research from scientists at Sunnybrook Research Institute suggests that focused ultrasound – a breakthrough non-invasive surgical technique – when targeted to a specific location in the midbrain, can inhibit neuron activity to reduce blood pressure for potential long-lasting treatment.

When left untreated, hypertension (or high blood pressure) is a fatal condition. Currently, it is treated with diet and lifestyle changes, and systemically-delivered medications that act on the central nervous system to lower the heart rate, relax and open up the blood vessels, help rid the body of excess salt and water, or alter enzyme secretion.

For patients with drug-resistant hypertension, or for those who are pregnant, many treatment options are ineffective and unsafe.

Previous research looked at an alternative approach using deep brain stimulation – an invasive neurosurgical procedure – to stimulate a specific region of the midbrain in a handful of patients. The results were promising, but the procedure has been associated with potential infections and hemorrhage.

That’s where focused ultrasound comes in.

Acclaimed in the medical and scientific world as “scalpel-free brain surgery”, FUS has crossed over from research into successful clinical treatment of some brain conditions, non-invasively.

With its additional ability to safely open the blood-brain barrier (BBB) non-invasively – a world-first research breakthrough – scientists continue to plough forward in their investigations of FUS as a treatment option for other health conditions controlled by the brain, such as is the case in this new study published recently in the journal Brain Stimulation.

“We’ve shown in pre-clinical work that by targeting the periaqueductal grey (PAG) region of the brain we can cause direct neuromodulation of central brain activity, which reduces blood pressure for six hours following a single 10-minute ultrasound sonication,” says Dr. Harriet Lea-Banks, lead author of the study, and junior scientist in the Hurvitz Brain Sciences Program at Sunnybrook Research Institute.

“Lowering high blood pressure into the normal range was extended to nine days with the addition of a second component: introducing nanodroplets – tiny liquid droplets – containing anesthetic medication that are injected into the bloodstream, and triggered with five daily treatments of ultrasound to the brain,” adds Dr. Lea-Banks, also an assistant professor in the Department of Medical Imaging at University of Toronto.

Ultrasound causes the nanodroplets to evaporate, locally releasing the anesthetic drug in a time-controlled fashion, within that specific area of the brain. This approach was shown to extend the time that neuron activity was modified and blood pressure was reduced, and prevent off-target effects, such as general sedation; increasing its reliability.

“This work builds on our previous success with FUS and out of a need for a new alternative strategy for hypertension management,” says Dr. Kullervo Hynynen, senior author of the study, VP of Research at Sunnybrook Research Institute, and a pioneer of focused ultrasound.

This study has shown that transcranial FUS offers a non-invasive tool to stimulate the VLPAG and trigger the delivery of an anesthetic agent; both approaches show the ability to modify central brain activity to achieve sustained reduction of hypertensive blood pressure into the healthy range, while offering the potential for real-time treatment monitoring.”

Based on the results of the research, the authors suggest it may be feasible to develop a FUS device that would allow the control of hypertension initially in a hospital setting, and eventually in the patient’s home for cost-effective, long-lasting treatment.    

“This work has implications for developing a new non-invasive and long-lasting treatment for hypertension that has greater safety and broader applicability than current treatment options for vulnerable patient populations,” adds Dr. Hynynen, also a professor in the Department of Medical Biophysics at University of Toronto.

“We’re looking forward to investigating this option further, and are optimistic the results will add another tool to the clinical toolbox for controlling and reducing hypertension.”

The post A new option for hypertension treatment, on the horizon appeared first on Your Health Matters.

As it progressed from the research lab to clinical trials, and in some cases, for approved use with patients in clinical care, perhaps what’s even more exciting is where its potential lies in the future for many therapeutic treatments for a multitude of conditions and diseases.

At its very core are basic (bench research or foundation) scientists like Dr. Meaghan O’Reilly, one of several scientists pioneering therapeutic ultrasound at Sunnybrook Research Institute (SRI).

“Investigations of FUS therapies in the brain have seen a particularly high level of research interest,” says Dr. O’Reilly, Canada Research Chair in Biomedical Ultrasound at SRI and University of Toronto. “The next generation of ultrasound-mediated therapies are currently under development.”

A patient undergoes a FUS procedure at Sunnybrook.

In a new paper she authored – published in the September 13, 2024 issue of the journal Science, Dr. O’Reilly provides an overview of the roots of FUS, its advances, and future outlook; highlighting four areas that have seen growth and sustained research interest in non-thermal therapeutic applications of the technology in and outside the brain.

These non-thermal applications instead rely on mechanical effects from sound waves – creating negligible temperature rise – as opposed to the higher-intensity applications that have been used to create a therapeutic burn to tissue.

She explains these technologies seek to leverage the non-thermal mechanisms of action of ultrasound to:

1. Enable drug delivery to the brain (opening of the blood-brain barrier);
2. Stimulate neurons (neuromodulation);
3. Focally destroy tissue with high spatial precision; and
4. Engage the endogenous immune system (activating immune response within cells like cancer cells) to fight disease.

“The resulting therapeutic approaches have clinical applications in cancer, neurodegenerative disease, vascular and cardiac disease, musculoskeletal health and more,” she pens in the article. “More researchers are joining the field, bringing together expertise from fields such as oncology, neuroscience and immunology, fuelling a surge in clinical translation and novel methods in ultrasound therapy.”

See article in Science

The post The future of non-invasive focused ultrasound therapies appeared first on Your Health Matters.

To spread the word that our Toronto-area hospital collaborations are open for business – with an approximate four-to-six week wait for patients to see a specialist for their hip or knee arthritis – we recently caught up with Dr. James (Jim) Vavougios, a family physician in East York, before an appointment with one of our mutual patients. Here’s what he had to share.

How long have you been practicing family medicine in the community?

40 years, but not yet ready to retire! I don’t want to give up all my skills, I diagnose now better than ever before. 32 years here on the Danforth, along with my colleague James; we were buddies since grade 7, and opened this practice together.

We’re here today to chat a bit about your experiences as a family doctor who refers your patients in to the Toronto Region Rapid Access Clinic for Hip and Knees – but we understand you have a unique perspective as you’ve also been a patient yourself for knee replacement and rehabilitation?

That’s correct. I’ve had lots of experience as a patient, too. I’ve had a knee replacement at Sunnybrook’s Holland Orthopaedic & Arthritic Centre. I went on to have my rotator cuff done and both shoulders repaired there. The service was great for me and for my patients, too. I like that the people there specialize in their area.

Referring patients through the centralized intake for the Rapid Access Clinic, they get a quick assessment and the process is streamlined, which is nice. The Rapid Access Clinic’s model works well, as for a lot of patients, they may just want an opinion and some of the patients aren’t ready for surgery yet. Some will go through the GLA:D exercise program, delay the progression or worsening of their arthritis symptoms for a few years, and then they’re ready for surgery. When they know their doctor had it done too, they feel more comfortable.

It’s like anything, when you believe in something yourself, you give off positivity. If you have had a negative experience, then you won’t talk about it.

Is there a situation or recollection that stands out of your experiences referring your patients for hip and knee surgery?

Sometimes it’s a surprise how the patient is going to react. I’m always a little nervous for my patients, and with new doctors on board, you ask yourself “Are they going to do a great job?” It’s always excellent. It’s satisfying when a patient comes back, you think a particular patient may have a harder time than others, but they’re like ‘No, everything is great.’

You’ve asked one of your patients if we could come in today to meet her and take a few photos. Can you give us a little background on her situation?

Georgia had her first knee done in June 2023, and then her second knee replacement in March 2024. She’s only 42, but she’s had terrible arthritis. We were pleased to see her go through the system and have both her surgeries within a nine-month period and I’m so pleased to see how well she is doing.

Dr. James Vavougios and Georgia. Photos: Kevin Van Paassen/Sunnybrook

What do you think would be helpful information to share with other primary care practitioners in the community, and their patients?

We still hear in the news of some long waits for hip or knee arthroplasty surgeries. I would encourage other primary care practitioners to look into the Toronto Region Rapid Access Clinic as their model has always been efficient and leading in the industry.

And now, with the addition of the “weekend surgery” dates over the past year, I understand they have been able to process through more than 1,000 additional surgeries that wouldn’t have been able to be completed on weekdays alone, which is part of the reason why my patients, like Georgia, have received their specialist appointments and surgery dates much sooner than we anticipated.

 To learn more or to get a referral for your patients, please visit ReduceMyHipandKneeWait.ca.

The post A primary care practitioner’s experiences with getting his patients through for hip and knee assessments/surgery smoothly and efficiently appeared first on Your Health Matters.

She went to her family doctor, followed by x-rays, and a bronchoscopy to look inside her airways. By January 2022, Karen was formally diagnosed with grade 2 neuroendocrine cancer.

While neuroendocrine tumours can occur anywhere in the body, in Karen’s case, hers were in her lymph nodes and gastrointestinal tract.

“I hadn’t had any symptoms, I didn’t even know,” says Karen, who was 48 years old at the time; a sports mom with two teenagers in the house. “I was shocked, I didn’t experience anything, and still haven’t (besides that chest cold discomfort feeling). It never crossed my mind that I may have cancer.”

A clinical trial testing radioligand therapy (RLT)

Upon speaking to her radiation oncologist, Dr. Sten Myrehaug, Karen signed up for a clinical trial to receive radioligand therapy (RLT) as the first course of treatment.

Although neuroendocrine cancer is uncommon, its incidence is rising rapidly and few treatments exist for these patients as this kind of cancer is resistant to most therapies; making it challenging to treat.

RLT involves injecting radioactive isotopes through an IV – in this case, with the drug Lutathera – in order to target specific cancer cell receptors, and deliver more targeted and precise radiation to kill cancer cells while preserving healthy tissue.

While RLT has been used in the treatment of some other cancers in later stages of a patient’s care path, this study evaluated for the first time the use of RLT earlier as a first-line (or “up front”) treatment for patients newly diagnosed with grade 2 or 3 advanced gastrointestinal neuroendocrine tumours.

Karen started off on the “standard arm” of the trial with two intramuscular injections – one in each hip – of high-dose long-acting release (LAR) octreotide.  This is used to in order to stop or slow down the progression of tumours.

When one of her tumours started to grow in size, she was then switched to the treatment arm of the trial that offered infusions of the radioactive medication Lutathera.

Treatment took up to 30 minutes, with an IV in each arm, with the rest of the day with anti-nausea medications.

“Besides the nausea, I didn’t have any other side effects, except having to be isolated from my family for a week. I locked myself in my bedroom with my own bathroom. I had my own dishes, everything had to be washed separately, I equipped myself with my laptop and some trash magazines for the week.”

The nausea got better after each treatment and she continued working full time in healthcare administration right through without any symptoms. She finally took six months off last year to “concentrate on me” and has been back to work since October.

Asked if anything has changed for her, Karen says: “I try to walk more than I did in the past, to keep up with healthy living, getting better. Other than that, nothing has changed.”

The results: a game changer in the practice of cancer treatment

Since the multi-site trial closed, the researchers assessed the data and the results were recently published in the journal The Lancet: the RLT that Karen and other participants received showed a reduction of the risk of advanced neuroendocrine tumour progression by 72 per cent.

Karen’s response upon hearing these results? “I couldn’t be happier.”

“The results confirm the clinical benefit of earlier use of RLT for newly-diagnosed patients with these types of aggressive and life-threatening tumours,” says Dr. Simron Singh, global principal investigator of the trial, and medical oncologist and cofounder of the Susan Leslie Clinic for Neuroendocrine Tumours at Sunnybrook’s Odette Cancer Centre.

“Cancer care has traditionally been treated by surgery, drugs or radiation; RLT is a game changer in the practice of cancer treatment. While it’s technically radiation, it is given via a chemotherapy route through the blood until it reaches the precise location of the tumour. This is the next step in personalized targeted cancer therapy for patients, focused on more effectively killing cancer cells, while limiting the damage to surrounding healthy tissues.”

This past March, once she knew it was safe to do so, Karen decided to get a tattoo of boxing gloves with a zebra pattern. The zebra is the awareness symbol for uncommon or rare diseases including neuroendocrine cancers.

“This was about me fighting my cancer. It symbolized for me my strength and just knowing I’m going to beat this and fight through this. It gives me strength.”

Photo credit: Kevin Van Paassen/Sunnybrook

The post The growing fight against rare but challenging cancers appeared first on Your Health Matters.

Margo Mingay was hard at work breaking up boxes while talking with fellow volunteers Omar and Dallas.

They were shocked to learn that, just 10 weeks ago, Margo had hip replacement surgery, as she scurried along and proceeded to push a cart stacked high with crates of produce. Little did they know, it was her second hip replacement in eight months.

A year ago, Margo was experiencing pain in her arthritic hip joints. “My legs were very sore, I couldn’t walk very far,” she says. “I’d get out of the car, and my hip would lock. I couldn’t move, I’d just stand there for a few minutes and shake my leg or hips around. Bending over was difficult; overall, life was challenging.”

Margo tried different therapies, but the pain progressed. “The pain would radiate; my lower leg was really tight. I’d go to exercise, went to physiotherapy; nothing got better.”

X-rays showed osteoarthritis in her hip joints, which went from medium to severe over only a few years’ time.

“The actual hip joint itself wasn’t so bad; it was the inability to do a lot of things,” explains Margo. “Every day was something different. But I thought ‘Oh the wait list for surgery is so long’, so I thought ‘may as well get on it’.”

It was early 2023 and there were over 4,000 patients waiting for a hip or knee arthroplasty – total joint replacement surgery – in the Toronto region. 20 per cent of those patients were considered “long waiters” – some of whom had severe and painful osteoarthritis as they waited to see an orthopaedic specialist and get a surgery date.

A solution to long wait times

Around this time, a partnership between Sunnybrook Health Sciences Centre and Michael Garron Hospital – the Toronto Regional Arthroplasty Collaborative (TRAC) – was preparing to launch the start of weekend surgeries for hip and knee replacement to increase the number of patients treated. The goal? Help tackle long waits across Ontario.

When Margo had her first consultation with orthopaedic surgeon Dr. Markku Nousiainen at Sunnybrook’s Holland Orthopaedic & Arthritic Centre in March 2023, the centre was preparing to open its operating room on the weekends for the first time. In the months that followed, Sinai Health and Unity Health joined the collaboration.

Participating orthopaedic surgeons were scheduling patients into the weekend surgery dates. Margo was offered a Saturday surgery appointment and quickly accepted. “You’re one of my first Saturday patients,” Dr. Nousiainen told her.

“I was surprised I got in so quickly,” says Margo.

On the road to recovery, Margo was adjusting to her new hip joint. After seeing Dr. Nousiainen again in early November 2023 to assess her other hip, and decide upon surgery again, she made herself available any time for her other hip replacement. “I received a call back with the option of surgery on December 19,” she says. “Despite Christmas being six days out, I jumped at the opportunity.”

“As we celebrate the one-year mark for this initiative, our current wait is less than four weeks for a patient to see a specialist from the time that their referral comes in from their primary care provider.”
– Dr. Markku Nousiainen

For her part, Margo is intent on following through on doctor’s orders to keep active, as evidenced by her weekly shift at the food bank, as well as resuming her volunteer work driving cancer patients to and from their hospital appointments. She’s also doing regular walking, going to the gym and riding her stationary bike.

“I feel great,” she says. “Bending over can be a bit tough, but 10 weeks in, no major problems, I’m getting back in to it, getting stronger. Now it’s my other joint arthritis problems that bother me!”

As of March 31, 2024, TRAC had completed 1,120 additional arthroplasty surgeries. “These are surgeries that wouldn’t have otherwise been completed in that time period, and our patients are seeing the results with more accessible and earlier surgical dates,” says Dr. Nousiainen.

Would you like to be seen for your hip or knee arthritis in under four weeks?

Learn more about the referral process at ReduceMyHipandKneeWait.ca

Photo: Kevin Van Paassen/Sunnybrook

The post How weekend surgery got patient Margo back to health faster and helping the community again appeared first on Your Health Matters.