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Thursday, November 29, 2007

Prescribing heroin to help heroin addicts

Preliminary results from a British harm reduction clinical trial on heroin users show that prescribing heroin to addicts reduces drug use and increases treatment program enrollment, reports the BBC.

The news is a positive sign for Canada's government-funded NAOMI Study -- the North American Opiate Medication Initiative -- which is still recruiting patients in Vancouver and Montreal.

The 150-person British trial is ongoing, but the results to this point sound promising:
Trial leader Professor John Strang, of the National Addiction Centre, based at London's Institute of Psychiatry, told BBC News that about 40% of users had "quit their involvement with the street scene completely". "Of those who have continued, which obviously is a disappointment, it goes down from every day to about four days per month," he added. "Their crimes, for example, have gone from 40 a month to perhaps four crimes per month."


The study is being conducted in three locations: in London, Brighton and Darlington. And it's completely government funded, with the full ₤2.5 million kicked in by the Department of Health and the Home Office.

As for NAOMI, which costs $8.1 million, there's been little mention of the project in the news as of late.

But the current government's disdain for Vancouver's safe-injection site, Insite, doesn't bode well for NAOMI; both projects rely on exemptions from Section 56 of the federal Controlled Drugs and Substances Act in order to remain in operation. That's the exemption the Conservative government has been so reluctant to extend for very long in the case of Insite.

Giving them permanent status would violate Article Four of the 1961 UN Single Convention on Narcotic Drugs (PDF), which reads:
The parties shall take such legislative and administrative measures as may be necessary:

a) To give effect to and carry out the provisions of this Convention within their own
territories;
b) To co-operate with other States in the execution of the provisions of this Convention; and
c) Subject to the provisions of this Convention, to limit exclusively to medical and
scientific purposes the production, manufacture, export, import, distribution of, trade in, use and possession of drugs.

Therefore, federal exemptions are required to run projects like Insite and NAOMI. But given the Conservative government's history and comments on harm reduction, and the veiled threats to close Insite, the prospects for these studies' futures aren't as bright as they once were. (NRM reported on this in September.)

And that's despite the fact that the evidence -- including the recent British report -- continues to show such initiatives are beneficial.

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Medical Hypotheses's far-out ideas

The journal Medical Hypotheses (right) is almost certainly the strangest, most unpredictable medical journal in existence. (Closely followed by the ever-fascinating Annals of Improbable Research.)

Their recently published January-February 2008 contains some real bafflers.

The issue's editorial, "Crick’s gossip test and Watson’s boredom principle: A pseudo-mathematical analysis of effort in scientific research," by editor-in-chief Bruce G Charlton, reports a
"bogus, but superficially-impressive" equation composed of "phony-variables":

Percentage likelihood of career success CS=(CP/G)–BQ×PoS×PS

where CP is the time spent gossiping about current project; G is the time spent gossiping about favourite topic; BQ is percentage of boring activities in CP; PoS is probability of solution of the problem; and PS is the percentage professional status of that branch of science as reflected in the proportionate funding, journal impact factors, number of jobs compared with the trendiest area.
And if that's not crazy enough for you, two Spanish researchers attempt to calculate the correlation between the rates of mental illness and sunspots, based on data collected from Canada, the US and the UK.
In a hand, one can appreciate that the partial trends for insane person rate of Canada, USA and Ireland and the partial trend for group sunspot number are very similar during the period 1910–1960. However, the partial trend for insane person rate of England and Wales during the same period is very different (and it is decreasing in fact although we must point out a jump in the series around 1915). On the other hand, the partial trend for the group sunspot number during the period 1837–1910 was decreasing while the partial trend for insane person rate in all geographical sites was increasing.
Seems to me their hypothesis was wrong. But their assessment is more equivocal:
This result suggests that the mechanism that could relates [sic] the solar activity with mental illness is very complex and non-linear in the physical sense.
Another compelling paper was recently published online ahead of print. The abstract of "Adapted cold shower as a potential treatment for depression," by an American molecular radiobiologist, is worth reading in full:
Depression is a debilitating mood disorder that is among the top causes of disability worldwide. It can be characterized by a set of somatic, emotional, and behavioral symptoms, one of which is a high risk of suicide. This work presents a hypothesis that depression may be caused by the convergence of two factors: (A) A lifestyle that lacks certain physiological stressors that have been experienced by primates through millions of years of evolution, such as brief changes in body temperature (e.g. cold swim), and this lack of “thermal exercise” may cause inadequate functioning of the brain. (B) Genetic makeup that predisposes an individual to be affected by the above condition more seriously than other people.

To test the hypothesis, an approach to treating depression is proposed that consists of adapted cold showers (20 °C, 2–3 min, preceded by a 5-min gradual adaptation to make the procedure less shocking) performed once or twice daily. The proposed duration of treatment is several weeks to several months.

The following evidence appears to support the hypothesis: Exposure to cold is known to activate the sympathetic nervous system and increase the blood level of beta-endorphin and noradrenaline and to increase synaptic release of noradrenaline in the brain as well. Additionally, due to the high density of cold receptors in the skin, a cold shower is expected to send an overwhelming amount of electrical impulses from peripheral nerve endings to the brain, which could result in an anti-depressive effect. Practical testing by a statistically insignificant number of people, who did not have sufficient symptoms to be diagnosed with depression, showed that the cold hydrotherapy can relieve depressive symptoms rather effectively. The therapy was also found to have a significant analgesic effect and it does not appear to have noticeable side effects or cause dependence. In conclusion, wider and more rigorous studies would be needed to test the validity of the hypothesis.
Of course, these psuedo-studies aren't meant to be taken entirely seriously. But, as I wrote in early September, not everyone is amused -- particularly when articles appear that purport to find links between Down syndrome patients and Asians.

Canada has some responsibility, for better or worse, for the genesis of Medical Hypotheses, as it turns out. The journal's founder, David F Horrobin, who is described in his Lancet obituary as "an outspoken critic of the scientific process," began his crusade against the peer-review system in 1975 when he was a researcher and professor at the University of Montreal.

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Wednesday, November 28, 2007

Hep B and C found in exposed Alberta patients

An undisclosed number of patients exposed to improperly sterilized medical instruments at a rural Alberta hospital earlier this year have tested positive.

But local medical officials say the rate of blood-borne infections among the exposed population are lower than the average rate in the general population, though they've refused to disclose details about the results of their testing -- including the actual number of patients who have been found to be infected, reports the Canadian Press.

The St Joseph's General Hospital in Vegreville, Alberta failed to clean medical equipment sufficiently over a period of four years, leading to a public health scared in March that has since sparked a government crackdown. The provincial government's latest efforts to improve infection-control accountability have included the introduction of Bill 41, which would give the Minister of Health the power to handpick administrators and rewrite the standards of practice and codes of ethics of health professionals' regulatory bodies like the College of Physicians and Surgeons of Alberta. (NRM wrote about Bill 41 in our November 15-30 issue.)

An initial estimate pegged the number of exposed patients at St Joseph's at 2,980; that number was later revised to 2,872. Nearly all of those patients -- 2,820, or 98% -- were contacted and offered testing, reports the Edmonton Journal. Just 1,850 agreed. But Dr Gerhard Benade, local medical officer, refused to divulge the number of positive test results. The cases are currently under review in Edmonton and definitive results of the testing likely won't be available until Dr Benade's final report, which is supposed to be published in February or March.

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Wonks and rounds

Grand Rounds, the weekly collection of the best of the medical blogs, is online at Prudence, MD.

And the latest edition of the Health Wonk Review, a collection of the best health policy writing from blogs, is also online, at Health Care Renewal.

This week Canadian Medicine appears in both. In the former, our piece on London, Ontario's poisonous pita problem is cited; in the latter, our entry on the privacy law issues of outsourcing the collection of uninsured billings.

Thanks to Dr Tess Termulo and Dr Roy Poses for hosting the anthologies.

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Canada's greatest medical research

Canada has produced a disproportionately large number of major biomedical breakthroughs, and a new report released today exhaustively catalogues the best of the best.

The Association of Canadian Academic Healthcare Organizations new report, called "Moving at the Speed of Discovery" (PDF), includes a (very long) list of the top medical discoveries made in Canadian academic hospitals.

You probably knew about Dr Frederick Banting's discovery of insulin, but you're sure to be surprised at some of the high-profile research mentioned in the report, like robot surgeons, music therapy for the physically disabled, induced hypothermia for heart surgery patients and "cobalt bombs," to name a few of the most interesting items.

Download the PDF above or click 'Read more' to check out the list.

1877 Introduction of sterilized cotton wool swabs in test tubes, which reduces contamination. (McGill University Health Centre Research Institute — Montreal, Quebec)

1907 First bronchoscopy performed. (McGill University Health Centre Research Institute — Montreal, Quebec)

1908 Installation of the first milk pasteurization plant in Canada, 30 years before it becomes mandatory. This all but eliminates diseases transmitted by unpasteurized milk like tuberculosis, salmonella, and e.coli. Pasteurization dramatically decreases infant mortality in Canada. (The Hospital for Sick Children — Toronto, Ontario)

1912 First surgical treatment of tuberculosis. (McGill University Health Centre Research Institute — Montreal, Quebec)

1922 First clinical use of insulin for diabetes in human patients. (University Health Network — Toronto, Ontario)

1930 Development of a new infant cereal that later becomes famous internationally as “pablum.” This fortified cereal (the first of its kind) significantly reduces death from malnutrition. (The Hospital for Sick Children — Toronto, Ontario)

1933 First excision of the entire lung performed (pneumonectomy). (McGill University Health Centre Research Institute — Montreal, Quebec)

1939 Invention of the corneal splitting knife (still standard in surgery to reduce pressure in glaucoma). (McGill University Health Centre Research Institute — Montreal, Quebec)

1948 Development of the first artificial kidney machine. (Lawson Health Research Institute — London, Ontario)

1948 First 25 million electron-volt beta-tron to be established in any university or hospital — calibration takes nine months. The electron-volt beta-tron is used for cancer research and to improve treatment accuracy. (Saskatoon Health Region — Saskatoon, Saskatchewan)

1950 Introduction of lumpectomy for treatment of breast cancer. Lumpectomy is a surgical procedure designed to remove a discrete lump (usually a tumour, benign or otherwise) from an affected woman or man’s breast. (University Health Network — Toronto, Ontario)

1950 Use of total body cooling as a method of making heart surgery safer. (University Health Network — Toronto, Ontario)

1950 First neuro-surgical treatment of epilepsy performed. (McGill University Health Centre Research Institute — Montreal, Quebec)

1951 First use worldwide of calibrated cobalt-60 for cancer radiotherapy treatment. (Saskatoon Health Region — Saskatoon, Saskatchewan)

1951 First “cobalt bomb” in the world used to deliver radiation therapy to cancer patients. (Lawson Health Research Institute — London, Ontario)

1952 First use of a device that determines whether or not a patient’s thyroid is cancerous through the use of radioactive iodine. (Saskatoon Health Region — Saskatoon, Saskatchewan)

1956 Major breakthrough in virology by discovering that positive strand Ribonucleic Acid (RNA) could be infectious. (Capital Health/University of Alberta — Edmonton, Alberta)

1957 Invention of the artificial cell for application in medicine and biotechnology. It was thought that artificial cells could one day be used as a partial substitute for human cells and organs. (McGill University Health Centre Research Institute — Montreal, Quebec)

1958 World first surgical treatment on cerebral aneurysms. (Lawson Health Research Institute — London, Ontario)

1960 Implementation of genetic screening programs for hereditary metabolic diseases in newborns. (McGill University Health Centre Research Institute — Montreal, Quebec)

1960 First implanted mammary artery into the heart wall in order to restore functionality of the heart. (McGill University Health Centre Research Institute — Montreal, Quebec)

1961 Discovery of blood-forming stem cells enabling bone marrow transplants. (University Health Network — Toronto, Ontario)

1963 The first widely successful surgery to correct the birth defect known as “Blue Babies” is performed. Before this procedure, this condition used to kill 9 out of 10 patients in their first year. (The Hospital for Sick Children — Toronto, Ontario)

1965 First artificial knee joint in the world created. (McGill University Health Centre Research Institute — Montreal, Quebec)

1969 Discovery of a carcino-embryonic antigen, a tumour marker for cancer. (McGill University Health Centre Research Institute — Montreal, Quebec)

1970 Discovery that hereditary metabolic diseases could be treated with vitamins. (McGill University Health Centre Research Institute — Montreal, Quebec)

1971 Developed the world’s first paediatric electric prosthetic arm. (Bloorview Kids Rehab – Toronto, Ontario)

1975 Development of software used worldwide for 20 years to control radiation therapy. (University Health Network—Toronto, Ontario)

1976 Identification of P-glycoprotein as a major cause of cancer drug resistance. (University Health Network — Toronto, Ontario)

1978 Developed the internationally-recognized AeroChamber, a medical device used to administer aerosolized medication for patients with asthma. This device continues to be used in practice around the world. (St. Joseph’s Healthcare – Hamilton, Ontario)

1979 Invention of a radically different ventilator (now used worldwide) that gently “shakes” oxygen into the lungs of children with severe lung disease, sparing many of them painful lung bypass procedures. (The Hospital for Sick Children — Toronto, Ontario)

1979 Development of “Continuous Passive Motion” (CPM), a revolutionary treatment for injured or diseased joints. Before this treatment, patients with damaged cartilage had to be totally immobilized. CPM is such an improvement that it is now being used in 17,500 hospitals in more than 77 countries worldwide. (The Hospital for Sick Children — Toronto, Ontario)

1980 Initial studies using real time ultrasounds and detailing biological factors affecting human fetal behavioral activity and breathing movements. (Lawson Health Research Institute — London, Ontario)

1981 World-first heart operation to correct a life-threatening heart condition known as right ventricular dysphasia. (Lawson Health Research Institute — London, Ontario)

1983 Successful single lung transplant. Lung transplants extend life expectancy and enhance the quality of life for end-stage pulmonary patients. (University Health Network — Toronto, Ontario)

1983 The Department of Nuclear Medicine becomes first to use a special imaging agent to diagnose Parkinson’s disease. Called [18] F6-fluorodopa PET, the chemical was produced by Hamilton Health Sciences and is now used worldwide. (Hamilton Health Sciences/McMaster University – Hamilton, Ontario)

1984 Discovery and cloning of the T-Cell receptor genes, significant in the field of immunology. (University Health Network — Toronto, Ontario)

1986 Discovery of the SH2 domain, which controls the ability of proteins to interact with other SH2 containing proteins and thereby direct the function of enzymes involved in transmitting cellular signals. This finding has revolutionized our understanding of how proteins form, signaling pathways inside cells. It is already informing research to control these pathways in diseased cells — the basis for novel therapies. (Mount Sinai Hospital — Toronto, Ontario)

1986 Developed first predictive testing for late onset genetic diseases (Huntington Disease). (Provincial Health Services Authority – Vancouver, British Columbia)

1987 First aortic valve replacement in the world using the Toronto Heart Valve, which is now used worldwide. (University Health Network — Toronto, Ontario)

1987 World’s first pacemaker cardioverter defibrillator is implanted. (Lawson Health Research Institute — London, Ontario)

1988 Researchers solve the structure of rennin, a key enzyme in the kidney that plays a role in the development of high blood pressure. (Capital Health/University of Alberta — Edmonton, Alberta)

1988 World’s first successful liver/small bowel transplant is performed. (Lawson Health Research Institute — London, Ontario)

1989 Researchers develop sputum induction techniques and sputum cell analysis. Research on nasal mucosa suggested ways in which the cellular response to antigen challenge might be studied in bronchial mucosa and sputum. (Firestone Institute for Respiratory at St. Joseph’s Healthcare – Hamilton, Ontario)

1989 Development of the first oral treatment for hepatitis B, resulting in the drug Lamivudine. (Capital Health/University of Alberta — Edmonton, Alberta)

1989 Discovery of the gene which, when defective, causes cystic fibrosis, the most fatal genetic disease of Canadian children today. (The Hospital for Sick Children — Toronto, Ontario)

1990 First measure of neurotransmitter concentration in schizophrenics by Magnetic Resonance Spectroscopy (MRS). MRS allows scientists and doctors to measure chemicals within the body and brain without removing tissue or blood samples and without using dangerous radioactive “tracers.” It is therefore safe and can be used repeatedly on the patient without any ill effects. (Lawson Health Research Institute — London, Ontario)

1991 Publication of the first paper demonstrating that treatment of obstructive sleep apnea by nasal continuous positive airway pressure (CPAP) in patients with congestive heart failure improves cardiac function and symptoms of heart failure. This discovery has major implications because it suggests that obstructive sleep apnea contributes to the development and progression of congestive heart failure. (Toronto Rehabilitation Institute — Toronto, Ontario)

1992 Discovery of the first gene responsible for Fanconi anemia. Fanconi anemia (FA) is a rare genetic disease that affects children and adults from all ethnic backgrounds. FA is characterized by short stature, skeletal anomalies, increased incidence of solid tumors and leukemias, bone marrow failure (aplastic anemia), and cellular sensitivity to DNA-damaging agents such as mitomycin C. (Hospital for Sick Children — Toronto, Ontario)

1993 Researchers demonstrate that mouse embryonic stem cells are capable of supporting the entire embryonic development and in fact creating completely cell cultured derived mice. (Mount Sinai Hospital — Toronto, Ontario)

1993 Discovery of a novel gene associated with Lou-Gehrig’s disease. (McGill University Health Centre Research Institute — Montreal, Quebec)

1994 World’s first three-dimensional (3-D) ultrasound-guided cryosurgery. (Lawson Health Research Institute – London, Ontario)

1994 Solved the 30-year old puzzle of why so many people suffer an allergic reaction when they receive a blood transfusion. (Hamilton Health Sciences/McMaster University – Hamilton, Ontario)

1995 First physical map of the human genome created. (McGill University Health Centre Research Institute — Montreal, Quebec)

1995 Discovery of the gene associated with localized muscular dystrophy. (McGill University Health Centre Research Institute — Montreal, Quebec)

1996 Identification of a human blood cell that regenerates the entire blood system. This discovery enabled the development of new treatments for blood diseases such as leukemia, thalassemia and sickle cell anemia. (Hospital for Sick Children — Toronto, Ontario)

1996 Identification of a gene that causes colon cancer. Colorectal cancer is the second leading cause of cancer-related deaths among Canadians. (Hospital for Sick Children — Toronto, Ontario)

1998 Developed the first trophoblast stem cells – the precursors of cells that form the placenta. Since the placenta is critical for a successful pregnancy, this discovery will have a major impact on research to understand and ultimately prevent pregnancy complications resulting from a failure in normal placental function. (Mount Sinai Hospital — Toronto, Ontario)

1998 Discovery of the first gene that causes Lafora disease, one of the most severe forms of teenageonset epilepsy. (Hospital for Sick Children — Toronto, Ontario)

1999 First islet transplant under the Edmonton protocol for Type I diabetes. Islet transplantation had been performed under other protocols; however, the Edmonton protocol produced unprecedented levels of success in the field of islet transplantation. (Capital Health/University of Alberta — Edmonton, Alberta)

1999 World’s first closed chest robotic-assisted beating heart coronary artery bypass graft conducted. (Lawson Health Research Institute — London, Ontario)

1999 Identification of ABCA-1 gene – key regulator of HDL concentrations in humans. (Provincial Health Services Authority/BC Children’s Hospital – Vancouver, British Columbia)

2000 Discovery of the mechanism of formation of amyloid, the basis of Alzheimer’s and other diseases, and the subsequent development of drugs to treat this. (Kingston General Hospital — Kingston, Ontario)

2001 Discovery of a clinical rule that may reduce use of unnecessary x-rays for low-risk neck injuries and could aid in reducing use of imaging tests in alert and stable patients. (Ottawa Health Research Institute — Ottawa, Ontario)

2001 Development of the first animal model for Hepatitis C in mice, using transplanted human cells, providing a convenient way to test new treatments for Hepatitis C. (Capital Health/University of Alberta — Edmonton, Alberta)

2001 Tissue factor is a cell surface membrane protein involved in the initiation of blood clotting. Overexpression or increased activation of tissue factor can increase the risk of cardiovascular disease. The research group demonstrated that overexpression of GRP78 (a protein), can block the coagulant activity of tissue factor in human cells. These studies are important because they have identified a relevant cellular factor that can mediate tissue factor activity. (Hamilton Health Sciences Centre — Hamilton, Ontario)

2001 Identified the emerging role that albuminuria as an important risk factor for both kidney and heart disease. (Hamilton Health Sciences/McMaster University – Hamilton, Ontario)

2002 Introduction of revolutionary medication doses for depression and schizophrenia through positron emission tomography (PET) technology. (Centre for Addiction and Mental Health — Toronto, Ontario)

2002 Creation of a simple system to generate T-cells in a Petri dish. T-cells are a vital component of the immune system that orchestrate, regulate and coordinate the overall immune response. This discovery provided a method to create model systems to study the genetics and molecular biology of T-cell development and points to future clinical therapies for people whose immune systems have been destroyed, for example, by HIV or toxic cancer therapies. (Sunnybrook & Women’s Research Institute — Toronto, Ontario)

2002 Discovery that a type of self-destructing “suicide cell” activity, previously believed to only be detrimental, is in fact necessary for the proper formation of muscle tissue. (Ottawa Health Research Institute — Ottawa, Ontario)

2002 Pioneered the use of Botulinum Toxin A to reduce upper limb spasticity in children with cerebral palsy. (Bloorview Kids Rehab – Toronto, Ontario)

2003 Discovery of a molecular marker to diagnose hepatocellular carcinoma (HCC), the most common type of liver cancer. HCC is usually asymptomatic at early stages, and has great propensity for invasion, making it difficult to treat. A test was developed for the early diagnosis of HCC, which could also be useful for the screening of individuals that are at high risk for developing this disease, such as people chronically infected with Hepatitis B and C. (Sunnybrook & Women’s Research Institute — Toronto, Ontario)

2003 Researchers discover a way to make the immune system specifically recognize infectious prions, proteins that cause brain-wasting diseases like mad cow disease and Creutzfeldt–Jakob disease, its human equivalent. This discovery paves the way for the development of diagnostic tools, immunotherapy and a vaccine. (Sunnybrook & Women’s Research Institute — Toronto, Ontario)

2003 Major international clinical trial provides first alternative treatment to taxol for preventing breast cancer recurrence in survivors five years post diagnosis. (University Health Network — Toronto, Ontario)

2003 Compilation of the complete DNA sequence of chromosome 7. Researchers decode nearly all of the genes on this medically important portion of the human genome. Chromosome 7 contains 1,455 genes, some of which, when altered, cause diseases such as cystic fibrosis, leukemia and autism. (Hospital for Sick Children — Toronto, Ontario)

2003 Study makes it easier to identify patients with deep vein thrombosis (DVT), providing faster diagnosis and significant savings to the health care system. (Ottawa Health Research Institute — Ottawa, Ontario)

2003 Performed the world’s first deep brain stimulation for depression, causing depression that was previously treatment-resistant to go into remission. (University Health Network — Toronto, Ontario)

2003 Identification of a cancer stem cell responsible for brain tumors. This discovery may change how this deadly condition is studied and treated in the future. (Hospital for Sick Children — Toronto, Ontario)

2003 Linkage of maternal folic acid intake to a decrease in neuroblastoma, a deadly childhood cancer. (Hospital for Sick Children — Toronto, Ontario)

2003 Performed the world’s first hospital-to-hospital telerobotic assisted surgery on a patient more than 400 kilometres away. During the procedure, they completed a Nissen Fundoplication on a 66-year old patient located at North Bay General Hospital from St. Joseph’s telerobotics suite in Hamilton, Ontario. (St. Joseph’s Healthcare – Hamilton, Ontario).

2003 Developed a genetically modified vaccine that can completely prevent the recurrence of metastatic breast cancer through genetically altered cells that only destroy cancer cells. (Hamilton Health Sciences/McMaster University – Hamilton, Ontario)

2003 Developed first draft DNA sequence for coronavirus implicated as cause of SARS (Provincial Health Services Authority/BC Cancer Agency, Genome Sciences Centre – Vancouver, British Columbia)

2003 Found that the vast majority of heart attacks can be predicted by nine easily measurable factors that are the same in virtually every region and ethnic group worldwide. (Hamilton Health Sciences/McMaster University – Hamilton, Ontario)

2004 Performed the world’s first simulated underwater surgery during the NASA Extreme Environment Mission Operation (NEEMO 7). During the 10-day NEEMO 7 Mission, they successfully telementored the NEEMO7 crew through various surgical simulations from their base in the underwater Aquarius habitat located 19 metres below the surface off the coast of Key largo, Florida. (St. Joseph’s Healthcare – Hamilton, Ontario)

2004 Development of StemBase, a database of gene expression data from DNA micro array experiments on samples from human and mouse stem cells and their derivatives. This growing resource is used to find genes whose activity is related to stem cells. (Ottawa Health Research Institute — Ottawa, Ontario)

2004 Discovery of the apelin receptor and design of an analogue that can interfere with and block the actions of apelin, in order to decipher its role in the brain. (Centre for Addiction and Mental Health — Toronto, Ontario)

2004 Discovery of over 70 novel human receptor genes; many of which, together with their chemical activators, mediate unique functions in the brain and are being targeted for drug design. (Centre for Addiction and Mental Health — Toronto, Ontario)

2004 In the first large, multi-centre clinical trial of its kind, researchers provided evidence to suggest that artery grafts from the forearm should be used in place of vein grafts from the leg in heart bypass surgery because radial arteries have significantly higher graft patency over one year. Graft patency, a measure of whether the bypass remains open enough to permit efficient blood flow, is critical to success after surgery. (Sunnybrook & Women’s Research Institute — Toronto, Ontario)

2004 A research team finds magnetic resonance imaging detects more breast cancer tumors, earlier, compared with mammography, ultrasound or clinical examination in women with the BRCA1 and BRCA2 genes. This finding offers hope to genetically at-risk women, and gives them an alternative to removing both breasts. (Sunnybrook & Women’s Research Institute — Toronto, Ontario)

2004 World’s first use of beads of palladium, a low-dose radioactive material, to treat women with breast cancer on an outpatient basis. This therapy holds the promise of eliminating anguishing side effects and considerably enhancing the women’s quality of life. (Sunnybrook & Women’s Research Institute — Toronto, Ontario)

2004 Demonstration of an association between pediatric multiple sclerosis (MS) and the Epstein-Barr virus, indicating that exposure to the virus at a certain time in childhood may be an important environmental trigger for the development of MS. (Hospital for Sick Children — Toronto, Ontario)

2004 Developed a virtual instrument that allows children with physical disabilities to make music (both therapeutic and recreational applications of the software – which is licensed in 7 countries around the world). (Bloorview Kids Rehab – Toronto, Ontario)

2005 Developed the world’s first upper respiratory viral panel test that can accurately identify all respiratory viruses including various flu strains including H5N1 and the SARS Coronavirus. (St. Joseph’s Healthcare – Hamilton, Ontario)

2005 In the first trial of its kind in the world, researchers begin treating prostate cancer using a 3-D image-guided radiation therapy device that was developed in Canada. This non-surgical technique allows oncologists to visualize the exact position of the target and deliver precise external beam radiation therapy. (Sunnybrook & Women’s Research Institute — Toronto, Ontario)

2005 Key discovery in Type-1 Diabetes proves the repair process is present within the pancreas during disease development. Understanding the repair process could be the key to successful treatment. (Ottawa Health Research Institute — Ottawa, Ontario)

2005 Study determines that a specific enzyme, known as pro-protein convertase 4 (PC4) may be responsible for fetal growth restriction, the second leading cause of infant mortality in the developed world. Knowledge may lead to screening for the defective enzyme early in the pregnancy and provide the ability to monitor the pregnancy more closely. (Ottawa Health Research Institute — Ottawa, Ontario)

2005 Scientists show that early surgical removal of the spleen combined with antiangiogenic therapy, which arrests the growth of tumour-feeding blood vessels, may stop the progression of leukemia. (Sunnybrook & Women’s Research Institute — Toronto, Ontario)

2005 Using neuropsychological testing, researchers accurately predict which study participants will develop Alzheimer’s disease within five and 10 years. Previous studies were able to predict Alzheimer’s only for shorter periods of time; other studies showed predictions for 10 and even 15 years, but these did not indicate the predictive accuracy of the tests. (Sunnybrook & Women’s Research Institute — Toronto, Ontario)

2005 Identified novel mutations in the gene that causes Rett Syndrome. The discovery is now licenced as a test for the disorder and is available to the public. (Centre for Addiction and Mental Health — Toronto, Ontario)

2005 Initiation of first human clinical gene therapy trials for lipoprotein lipase deficiency. (Provincial Health Services Authority/BC Children’s Hospital – Vancouver, British Columbia)

2006 Discovery of the precise molecular chain of events that initiates the wide-scale immune destruction of “super bug” infections such as flesh-eating disease, toxic shock syndrome and severe food poisoning. (Robarts Research Institute — London, Ontario)

2006 Implantation of an antibody-coated stent into the first human patient. The invention of the antibody-coated stent reduces restenosis and prevents blood clots from occurring. (St. Michael’s Hospital — Toronto, Ontario)

2006 World’s first clinical trial to combine gene and cell therapy to treat a cardiovascular disorder. The PHACeT (Pulmonary Hypertension: Assessment of Cell Therapy) trial will assess the use of adult stem-like cells called endothelial progenitor cells (EPC) for the treatment of pulmonary hypertension. (St. Michael’s Hospital — Toronto, Ontario)

2006 First demonstration that children with cystic fibrosis have choline deficiency. Provision of choline improves redox balance and methyl transfer capacity in humans. (Provincial Health Services Authority/BC Children’s Hospital – Vancouver, British Columbia)

2006 First demonstration that dietary omega-3 fatty acid deficiency impairs neurogenesis in vivo (Provincial Health Services Authority/BC Children’s Hospital – Vancouver, British Columbia)

2006 First curative therapy for Huntington Disease in a mouse model (Provincial Health Services Authority/BC Children’s Hospital, Vancouver, British Columbia)

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