Foothills Medical Centre (FMC) is the largest hospital in the province of Alberta and is located in the city of Calgary. It is one of Canada's most recognized medical facilities and one of the leading research and teaching hospitals. Foothills Medical Centre provides advanced healthcare services to over two million people from Calgary, and surrounding regions including southern Alberta, southeastern British Columbia, and southern Saskatchewan. Formerly operated by the Calgary Health Region, it is now under the authority of Alberta Health Services and part of the University of Calgary Medical Centre.The main building of the hospital was opened in June 1966. It was originally named Foothills Provincial General Hospital and later known simply as Foothills Hospital. With the addition of other medical facilities, it became known by its present name.
BACKGROUND:SURF was a prospective, multicenter, single-arm, observational study with core lab adjudication of radiographic data, assessing embolization of intracranial aneurysms (IAs) using WAVE Extra Soft Coils as part of SMART Coil System. METHODS:Adults undergoing IA embolization with the SMART Coil System (Penumbra, Inc.) comprising >75% of implanted coils and WAVE as the final finishing coil were enrolled at 43 global centers. Primary outcomes were adequate occlusion (Raymond-Roy Occlusion Classification, RROC I/II) at 1 year, serious adverse events (SAEs) within 24 hours, and device-related SAEs up to 7 days (or discharge). RESULTS:A total of 572 patients (mean age 59.5 years, 72.6% female) were enrolled between November 2019 and August 2022. Among target IAs, 39.9% were ruptured, 78.7% saccular, 54.1% wide-necked, and 11.2% previously treated, with 37.1% located in the internal carotid artery and 30.6% in the anterior cerebral artery. The mean size was 6.6±3.45 mm. Unassisted coiling was used in 50.7% of cases. Adjunctive therapy included stent-assisted coiling (28.8%), balloon-assisted coiling (17.7%), and flow diverters or medications (5.6%). The mean packing density was 34%. RROC I/II was 87.4% immediately post-procedure and 92.4% at 1 year. The retreatment rate was 9.8%, and recanalization was 12.7% at 1 year. SAEs rate within 24 hours was 9.3%. Device-related SAEs occurred in 1.1% of patients. The rate of major ipsilateral stroke was 1.7%. CONCLUSION:Penumbra's WAVE coils resulted in high packing density and effective and durable embolization of IAs in a diverse, real-world population, supporting coiling as the standard of care for IA treatment. TRIAL REGISTRATION NUMBER:NCT04106583.
In Canada, endoscopies are typically performed with endoscopist-led, nurse-administered conscious sedation using fentanyl and midazolam. However, some patients cannot tolerate these procedures and require anesthetist-administered deeper sedation, an approach limited by resource constraints in most hospitals. Target-controlled infusion (TCI) of propofol allows precise, semi-automated titration of IV sedation. This study assessed the feasibility and effectiveness of a nurse-led TCI propofol–remifentanil protocol for patients who have had incomplete endoscopies under conscious sedation. From June 2024 to September 2025, 83 patients underwent endoscopy using a nurse-led TCI sedation protocol, including 64 had colonoscopies, 9 upper endoscopies, and 11 had combined procedures. The protocol, developed by the lead anesthetist and initially supervised by a senior anesthetist, began with remifentanil at 1.0 ng/mL, followed by propofol at 1.5 µg/mL once remifentanil reached 0.7 ng/mL effect site concentration. Thereafter, an anesthetist was nearby in the hospital and immediately available if needed. Medications were titrated every two minutes to achieve light to moderate sedation, defined as an Observer’s Assessment of Alertness and Sedation (OAAS) scale of 3–4. Time to sedation, total in-room time, safety outcomes, and clinician and patient satisfaction evaluated by qualitative questionnaires were recorded. Mean time from remifentanil start to endoscope insertion was 11.5 ± 4.5 minutes for colonoscopy and 13.4 ± 5.6 minutes for EGD. In-room time was 53.2 ± 12.4 minutes for colonoscopy and 40.9 ± 9.4 for EGD. Most patients achieved the targeted OAAS score of 3–4; 4 colonoscopy patients reached deeper sedation with OAAS scale of 2. Two patients developed transient hypoxia managed with airway repositioning; one experienced hypotension treated with IV fluids; one required anesthesiology guidance for titration of propofol above the maximum protocol rate. Two patients presented to acute care within 30 days for minor, self-limited issues not related to sedation. Clinician and patient feedback indicated overall satisfaction as shown in Table 1. Nurse-led TCI propofol-remifentanil is a feasible, effective, and safe approach for patients requiring deeper sedation for difficult endoscopy. It may expand access to advanced sedation while maintaining safety under structured supervision; however, some patients may still benefit from general anesthesia. Individualized protocols and direct anesthetist oversight are essential during initial implementation. None A111 Table 1: Clinician and patient satisfaction with sedation instrument (by number).
Acute appendicitis is the most common abdominal surgical emergency worldwide and a leading cause of emergency hospital admissions and operations. Despite its frequency, substantial variability persists in diagnosis and management across patient populations and health care settings. To provide updated, evidence-based recommendations for the diagnosis and treatment of acute appendicitis in adults, children, pregnant women, older patients (aged ≥65 years), immunocompromised individuals, and patients with obesity (body mass index ≥30), developed by the World Society of Emergency Surgery (WSES) using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. A systematic literature search was performed in MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library to identify relevant studies published until May 2025. Eligible designs included randomized clinical trials, observational studies, systematic reviews, and meta-analyses. Risk of bias was assessed with design-appropriate tools (RoB-2, ROBINS-I, QUADAS-2). Evidence profiles and evidence-to-decision frameworks were generated for each of 19 key clinical questions. The certainty of evidence was rated as high, moderate, low, or very low. Recommendations were classified as strong or conditional (weak) according to GRADE. Six key clinical domains were addressed across 19 questions. Thirty-five recommendations were formulated. Key findings include: (1) clinical risk scores and imaging improve diagnostic accuracy and reduce negative appendectomy rates; (2) nonoperative management with antibiotics is safe and effective in selected patients with uncomplicated appendicitis, with recommendations tailored for specific populations; (3) appendectomy for uncomplicated appendicitis may be safely delayed within 24 hours without increased risk of adverse outcomes; (4) laparoscopic appendectomy remains the standard surgical approach; (5) postoperative antibiotic therapy should be limited to short courses (2-3 days) in complicated disease; and (6) follow-up strategies are essential after nonoperative management of complicated appendicitis with abscess to detect neoplasms. The 2025 WSES Jerusalem Guidelines provide updated, evidence-based recommendations for the diagnosis and treatment of acute appendicitis with the aim to standardize practice, reduce unwarranted variability, and support safe, effective, and patient-centered care across diverse populations and health care systems. Their implementation should be adapted to local resources.
Objective The cortex is the primary source of blood-oxygenation-level dependent (BOLD) signals, and it is often believed that the brain structural modules serve as the cornerstones of the functional networks. Although a great deal of work had been done in the past to map the white matter fiber connections among various cortical regions in order to clarify the functional connectivity, it is still unclear how the diffusion property of the inner cortex's microstructure relates to the functional brain networks. This study aims to investigate the connection between the canonical brain functional networks and the complexity of cortical microstructural diffusion. Methods Kurtosis diffusion (DK) and resting state functional MRI data from 30 healthy volunteers were collected. The group level networks of default mode network (DMN), executive control network (ECN), dorsal attention network (DAN), salience network (SN), sensorimotor network (SMN) and visual network (VN) were extracted, and network masks were made on the T1 gray matter images after segmentation. Then, the diffusion parameter maps with kurtosis and tensor properties were calculated from the DK data, and co-registrated with the cortical T1 images. These diffusion kurtosis parameters of AK, RK, MK, KFA, and tensor parameters of AD, RD, MD, FA values in each individual were extracted based on each of the function network mask. The diffusion parameter values of above networks were analyzed by ANOVA method of non-parametric test. Results Statistical analysis showed that the values of AK, RK, MK and KFA in low-order networks (SMN, VN) were significantly higher than those in high-order networks (DMN, ECN, DAN and SN), and no significant differences were observed within either the low-order or high-order networks respectively. The values of RD in SN were significantly lower than those in VN and SMN. The values of FA in SN and ECN were significantly lower than those in SMN. Conclusions Our knowledge of the foundations of brain networks has advanced as a result of the findings, which suggested that the kurtosis diffusion of microstructure within the human cerebral cortex is topologically distributed and corresponds to the hierarchy between low-order and high-order functional networks. The DKI-specific diffusion model is suitable for mapping the networks of structural inner cortices.
