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Objective: To evaluate the association between amyotrophic lateral sclerosis (ALS) and potential environmental risk factors, especially head traumas and pesticides, in two populations from Canada and France. Methods: A case–control study was performed in tertiary-care centers. Consecutive ALS cases were recruited along with a control group from the same age distribution and region. Participants answered a phone-administered questionnaire. Head trauma exposure was censored at age of symptom onset, and a sensitivity analysis considering old head traumas that occurred more than 3 years before onset was performed. Univariate and multivariate logistic regression were used to estimate odds ratios (ORs) and their 95% confidence intervals (CIs). Results: A total of 404 ALS cases and 381 controls completed the questionnaire. Previous head trauma was more frequently reported by cases (adjusted OR 1.50 (1.05–2.18)) with a dose-response relationship. This association was driven by a strong effect in men (adjusted OR 2.06 (1.22–3.55)) and was consistent for old traumas, but there was no association in women. For pesticides, a previous high-risk occupation was associated with ALS (adjusted OR 2.08 (1.36–3.24)), although reported occupational exposure to pesticides was not statistically significant in the multivariate model (adjusted OR 1.67 (0.97–2.97)). Past electrocution was associated with ALS (adjusted OR 1.79 (CI 1.13–2.87)), especially spinal-onset ALS. Residential exposure to pesticides, neck trauma, and welding were not associated with ALS. Conclusions: Head trauma is a risk factor for ALS in men only. Previous occupation at high risk for pesticides exposure and electrocution are also risk factors for ALS. [ABSTRACT FROM AUTHOR]

Background: Minor head trauma in young children is a major cause of emergency department visits. Conflicting guidelines exist regarding radiologie evaluation in such cases. Objective: To determine the practice pattern among Canadian emergency physicians for ordering skull radiographs in young children suffering from minor head trauma. Physicians were also surveyed on their willingness to use a clinical decision rule in such cases. Design/Methods: A self-administered email questionnaire was sent to all members of the Pediatric Emergency Research Canada (PERC) group. It consisted of clinical vignettes followed by multiple-option answers on the management plan. The study was conducted using the principles of the Dillman Tailored Design method and included multiple emailings to maximize the response rate. The research protocol received Institutional Review Board approval. Results: A total of 158 of 295 (54%) PERC members responded. Most participants were trained in pediatric emergency medicine and assessed more than 500 children per year. Imaging management for the vignettes was highly variable: 6 of the 11 case scenarios had a proportion of radiograph ordering between 20 and 80%. Ninety-five percent of respondents stated that they would apply a validated clinical decision rule for the detection of skull fracture in young children with minor head trauma. The minimum sensitivity deemed acceptable for such a rule was 98%. Conclusion: Canadian emergency physicians have a wide variation in skull radiography ordering in young children with minor head trauma. This variation, along with the need expressed by physicians, suggests that further research to develop a clinical decision rule is warranted. [ABSTRACT FROM AUTHOR]

Background: Cranioplasty is a commonly performed neurosurgical procedure used to repair defects of the cranial vault. For large defects, 3D printing allows for the creation of patient-specific synthetic cranioplasties. Although these implants provide excellent cosmetic results for patients, costs are quite high. This makes their routine use challenging in the current Canadian healthcare environment. The purpose of this study is to report our experience with a novel, cost-effective method for cranioplasty using desktop 3D printers to manufacture patient-specific molds to aid in the shaping of polymethyl methacrylate (PMMA) cranioplasty intraoperatively., Methods: A retrospective review of patients who underwent cranioplasty utilizing 3D printed custom molds was conducted at a single center between 2018 and 2020. Either a two-piece self-align or open-air mold was utilized. Material cost, as well as demographic, clinical, and radiologic data, was reviewed. A five-point ordinance scale was used to evaluate patient satisfaction with cosmesis., Results: Four patients had previous craniectomies with infected bone flaps, 2 patients had significant bony destruction from tumor invasion, and 1 patient had bone flap resorption. Three patients underwent an open-air mold technique with a Ti-mesh/PMMA-combined implant. The remaining 4 patients underwent two-piece mold with PMMA-only implant. All patients had 'Good' to 'Excellent' cosmetic outcome with one post-operative acute subdural hematoma and one post-operative infection. Two-piece mold resulted in improved cosmetic outcome and cost savings., Conclusions: 3D printing can be used in a cost-effective manner to deliver good cranioplasty cosmesis. Wider adoption of this technique can result in significant healthcare cost savings without compromising patient outcome.