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Every year, approximately 62,000 people with stroke and transient ischemic attack are treated in Canadian hospitals. The 2016 update of the Canadian Stroke Best Practice Recommendations Telestroke guideline is a comprehensive summary of current evidence-based and consensus-based recommendations appropriate for use by all healthcare providers and system planners who organize and provide care to patients following stroke across a broad range of settings. These recommendations focus on the use of telemedicine technologies to rapidly identify and treat appropriate patients with acute thrombolytic therapies in hospitals without stroke specialized expertise; select patients who require to immediate transfer to stroke centers for Endovascular Therapy; and for the patients who remain in community hospitals to facilitate their care on a stroke unit and provide remote access to stroke prevention and rehabilitation services. While these latter areas of Telestroke application are newer, they are rapidly developing, with new opportunities that are yet unrealized. Virtual rehabilitation therapies offer patients the opportunity to participate in rehabilitation therapies, supervised by physical and occupational therapists. While not without its limitations (e.g., access to telecommunications in remote areas, fragmentation of care), the evidence-to-date sets the foundation for improving access to care and management for patients during both the acute phase and now through post stroke recovery.

Cardiovascular disease (CVD) is still virtually absent in those rare populations with minimal Western dietary influence. To date, exercise, altered fats, fibre, anti-oxidants or Mediterranean diet do not appear to overcome the discrepancy in CVD between hunter-gatherer and Western populations. The CVD risk factors of obesity and diabetes are driven by increased caloric intake, with carbohydrates potentially implicated. Paradoxically, non-Westernized diets vary widely in macronutrients, glycemic and insulinemic indices, yet apparently produce no obesity or CVD regardless, even with abundant food. 'Ancestral' grain-free whole-food diet may represent the best lifestyle intervention for obesity and CVD. Such diets are composed of the cells of living organisms, while Western grains, flour and sugar are dense, acellular powders. Bacterial inflammation of the small intestine and vagal afferents appears a crucial step in leptin-resistance and obesity. Therefore it may be important that the Western diet resembles a bacterial growth medium.

One of the challenges in natural orifice transluminal endoscopic surgery (NOTES) is spatial orientation. The Queen's NOTES group has devised a novel method of orientation by using a magnetic device that passes within an endoscope channel allowing for 3-dimensional imaging of the shape and orientation of the endoscope.To assess the feasibility and utility of a novel orientation device.Randomized, controlled trial.Animal research laboratory study on four 25-kg pigs.The device was tested by 6 endoscopists and 6 laparoscopic surgeons. Starting at the gastrotomy, the time to identify 4 targets was recorded. Participants were required to identify and touch the gallbladder, the fallopian tube, a clip on the abdominal wall, and the liver edge. Use of the orientation device was randomized for each session.Time to identify targets with and without the device. Secondary analysis assessed differences between medical specialties and level of training.The mean time to identify all 4 targets with the device was 75.08 ± 42.68 seconds versus 100.20 ± 60.70 seconds without the device (P.001). The mean time to identify all 4 targets on the first attempt was 102.29 ± 61.36 seconds versus 72.99 ± 40.19 seconds on the second attempt (P.001). No differences based on specialty or level of training were identified.Small sample size and simplicity of tasks.Regardless of randomization order, both groups were faster with the device. These encouraging results warrant further study using more complex scenarios.

The Spanier Award, presented for the 2nd best oral presentation by a resident, is named in memory of Allen Howard Spanier who died on April 27th, 1999, at the age of 52. He was Associate Professor in Surgery, Medicine and Anesthesia, McGill University and Senior Surgeon and Chairman, Department of Adult Critical Care, Sir MB Davis Jewish General Hospital (Montreal, Quebec). He was President of the CCCS from 1992–1994.

The use of a skin-stretching device to close radial forearm donor-site defects in patients being treated for intraoral cancer is described. Intraoperative application of the device achieved primary closure of the donor site during the time course of the reconstructive procedure with no requirement for additional operative time. The device was used successfully in seven patients with two instances of marginal skin necrosis and delayed healing but good long-term functional and cosmetic outcomes in all cases.

During the final 10 d of a 22-d subchronic exposure of bluegills Lepomis macrochirus to a pentachlorophenol (PCP) concentration of 173 μg/L, bluegill growth rate significantly decreased by 75% when compared with untreated controls, and food intake declined significantly (29%). At a PCP concentration of 48 μg/L, growth rate was significantly reduced by 26%, but food intake showed a nonsignificant decline. Pentachlorophenol-induced decreases in food intake make this species especially vulnerable to the growth-perturbing effects of the toxicant.

Bluegill sunfish ( Lepomis macrochirus ), exposed to a 22-day subchronic exposure of pentachlorophenol at concentrations of approximately 20 and 75% of the 96-h median lethal concentration (96 h LC 50 ), showed significant reductions in food conversion efficiency measured during the last 10 days of exposure. Bluegills exposed to a 3-day acute spill-mimicking exposure of pentachlorophenol at a concentration of approximately 100% of the 96 h LC 50 failed to show a significant reduction in food conversion efficiency measured during the 10 days following exposure. Bluegill sunfish exposed to pentachlorophenol at continuous low-level concentrations are at a greater risk for decreased growth than those exposed to a more concentrated short-term pulse of toxicant.