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Norman Bethune (1890-1939) was a man who had everything, and yet had nothing. Although he had achieved international prominence as a surgeon, he was unhappy in his personal life and deeply frustrated by a failed attempt to introduce medicare to Canada. An uncompromising humanitarian in search of a cause, Bethune became immersed in the Spanish Civil War. In Bethune in Spain, Roderick Stewart and Jesús Majada recount Bethune's achievements in Spain and the events that led to his decision to assist the Loyalist forces. The narrative contains Bethune's letters and reports, some of them reproduced here for the first time, as well as newspaper articles, and interviews with him. It covers his creation and operation of a mobile blood transfusion unit, his rescue of fleeing Loyalist civilians during the Malaga-Almeria road tragedy, and his efforts to aid children orphaned by the War. It also deals with the gruelling public-speaking tour Bethune undertook on his return to Canada in 1937 to plead for intervention in support of democracy in Spain and to raise awareness of atrocities committed against civilians by the fascist-backed Spanish Nationalists. Illustrated with photographs from Bethune's seven months in Spain, Bethune in Spain is a poignant portrait of an early advocate for universal health care, an unwavering communist, and a crusader for the Spanish Republican cause.

In response to the COVID-19 pandemic, organizations used virtual platforms to host academic meetings. This includes the Canadian Network for International Surgery and the Centre for Global Surgery at the McGill University Health Centre, who were tasked with organizing the Bethune Round Table (BRT), held May 28–31, 2021. With 496 registrants and 300 attendees representing 50 countries, the BRT 2021 was the most trafficked BRT conference in its 20-year history. One month after the conference’s conclusion, attendees were continuing to view the recorded sessions. Here we describe the successes of the virtual BRT 2021 conference and the plan to continue offering a digital mode of delivery for future BRT conferences.

Fibroblast growth factor 21 (FGF-21) is a metabolic regulator with multiple beneficial effects on glucose homeostasis and lipid metabolism in animal models. The relationship between plasma levels of FGF-21 and coronary heart disease (CHD) in unknown. This study aimed to investigate the correlation of serum FGF-21 levels and lipid metabolism in the patients with coronary heart disease. We performed a logistic regression analysis of the relation between serum levels of FGF-21 and CHD patients with and without diabetes and hypertension. This study was conducted in the Departments of Endocrinology and Cardiovascular Diseases at two University Hospitals. Participants consisted of one hundred and thirty-five patients who have been diagnosed to have CHD and sixty-one control subjects. Serum FGF-21 level and levels of fasting blood glucose; triglyceride; apolipoprotein B100; HOMA-IR; insulin; total cholesterol; HDL-cholesterol; LDL-cholesterol; and C-reactive protein were measured. We found that median serum FGF-21 levels were significantly higher in CHD than that of control subjects (P<0.0001). Serum FGF-21 levels in CHD patients with diabetes, hypertension, or both were higher than that of patients without these comorbidities. Serum FGF-21 levels correlated positively with triglycerides, fasting blood glucose, apolipoprotein B100, insulin and HOMA-IR but negatively with HDL-C and apolipoprotein A1 after adjusting for BMI, diabetes and hypertension. Logistic regression analysis demonstrated that FGF-21 showed an independent association with triglyceride and apolipoprotein A1. High levels of FGF-21 are associated with adverse lipid profiles in CHD patients. The paradoxical increase of serum FGF-21 in CHD patients may indicate a compensatory response or resistance to FGF-21.

Introduction Guillain-Barré syndrome (GBS) is an immune-mediated disorder of the peripheral nervous system. Respiratory failure requiring mechanical ventilation (MV) is a serious complication of GBS. Identification of modifiable risk factors for MV and poor short-term prognosis in mechanically ventilated patients with GBS may contribute to the individualized management and may help improve the outcome of the patients. Methods We retrospectively analyzed the clinical data of 541 patients who were diagnosed with GBS from 2003 to 2014. Independent predictors for MV and short-term prognosis in mechanically ventilated patients were identified via multivariate logistic regression analysis. Results The mean age was 41.6 years with a male predilection (61.2 %). Eighty patients (14.8 %) required MV. Multivariate analysis revealed that shorter interval from onset to admission ( p  < 0.05), facial nerve palsy ( p  < 0.01), glossopharyngeal and vagal nerve deficits ( p  < 0.01) and lower Medical Research Council (MRC) sum score at nadir ( p  < 0.01) were risk factors for MV; disease occurrence in summer ( p  < 0.01) was a protective factor. As to prognostic factors, absence of antecedent infections ( p  < 0.01) and lower MRC sum score at nadir ( p  < 0.01) were predictors of poor short-term prognosis in mechanically ventilated patients regardless of treatment modality. We further investigated the predictors of poor short-term prognosis in patients requiring MV with different nadir MRC sum scores. Combined use of intravenous corticosteroids with intravenous immunoglobulin (odds ratio 10.200, 95 % confidence interval 1.068–97.407, p  < 0.05) was an independent predictor of poor short-term prognosis in mechanically ventilated patients with a nadir MRC sum score from 0 to 12 points, regardless of existence of antecedent infection. Conclusions Clinical predictors of MV and poor short-term prognosis in mechanically ventilated GBS patients were distinct. Add-on use of intravenous corticosteroids was a risk factor for poor short-term prognosis in mechanically ventilated patients with a nadir MRC sum score from 0 to 12 points.

Background This study explored the interrelationships among vascular endothelial growth factor A (VEGF-A), microRNA-210 (miR-210), and EphrinA3 in the plasma of patients with coronary heart disease (CHD), and their collective influence on coronary collateral circulation (CCC) development. Methods We enrolled 253 patients with ≥ 90% stenosis in at least one coronary artery, stratified into good CCC ( n  = 99) and poor CCC ( n  = 154) groups according to the Rentrop grading system. Plasma concentrations of miR-210, VEGF-A, and EphrinA3 were quantified via qRT-PCR and ELISA. The associations between these biomarkers and CCC status were evaluated through correlation analysis, multivariate regression, and mediation analysis. Results Good CCC patients demonstrated significantly elevated plasma miR-210 (1.936 [1.099–4.118] vs. 1.272 [0.792–2.081], p  < 0.001) and VEGF-A levels (3119.655 ± 850.995 vs. 2910.440 ± 713.218 pg/mL, p  = 0.038), alongside reduced EphrinA3 levels (529.594 ± 143.037 vs. 584.657 ± 127.182 pg/mL, p  = 0.002) compared to poor CCC patients. ROC analysis revealed AUCs of 0.656 (95% CI: 0.589–0.724) for miR-210, 0.563 (95% CI: 0.489–0.638) for VEGF-A, and 0.632 (95% CI: 0.560–0.705) for EphrinA3, which improved to 0.747, 0.696, and 0.744 respectively after adjustment for confounders. In fully adjusted multivariate models, miR-210 maintained a robust positive association with good CCC (OR: 1.558, 95% CI: 1.257–1.931, p  < 0.001), with its highest tertile conferring 4.58-fold increased odds compared to the lowest tertile. Conversely, EphrinA3 exhibited a significant negative association (OR: 0.993, 95% CI: 0.990–0.997, p  < 0.001), with its highest tertile linked to 79.4% reduced odds of good CCC. VEGF-A showed a modest association (OR: 1.001, p  = 0.043). Notably, mediation analysis revealed that miR-210 functions as a pivotal intermediary in pathways connecting both VEGF-A and EphrinA3 to CCC formation, mediating 77.18% and 49.90% of their respective effects. Conclusions Plasma miR-210 levels exhibit a strong association with coronary collateral circulation development and represent a promising biomarker for CCC formation in patients with severe coronary stenosis. The influence of VEGF-A and EphrinA3 on CCC formation appears to be predominantly mediated through miR-210, highlighting its central role in coronary collateralization pathways.

Henry Norman Bethune was a prominent Canadian thoracic surgeon who came to fame during the 1930s. After being made a Fellow of the Royal College of Surgeons of Edinburgh, Bethune became head of thoracic surgery in a hospital in Cartierville, Canada. During this time, he pioneered surgical techniques, published research findings, and invented surgical instruments. Not content with being only a physician, innovator, and humanitarian, Bethune also found himself in medical services on the frontlines of wars in both Spain and China. In Spain, Bethune emphasized the need for prompt blood transfusions and developed mobile blood transfusion services. After the start of the Second Sino-Japanese War, Bethune traveled to China and quickly organized a mobile operating unit. Following discussions with Chinese leaders, Bethune performed surgeries on the frontlines of conflict in northern China, where his exceptional loyalty to duty became famous throughout the region. Although he met his end at an early age due to septicemia in 1939, his medical legacy carries on in multiple countries and serves to inspire a future generation of medical practitioners.

The relationship between right-to-left shunts (RLS) and migraine and cryptogenic stroke is not well understood. In this study, we investigated whether RLS are associated with impairment of dynamic cerebral autoregulation (dCA), which may play a role in migraine and cryptogenic stroke. Sixty-six migraineurs were enrolled in the study, including 36 non-RLS patients and 30 RLS patients. Non-invasive continuous cerebral blood flow velocity and arterial blood pressure were recorded simultaneously from each patient by using transcranial Doppler and servo-controlled plethysmograph, respectively. Transfer function analysis was applied to derive autoregulatory parameters of gain, phase difference (PD), and autoregulation index. The PD in migraineurs with RLS was 50.6 ± 22.9 degrees, which was significantly lower than that observed in the non-RLS group (67.2 ± 18.2 degrees, P<0.001). The PD in the large RLS group (45.4 ± 22.6 degrees) was significantly lower than that of the small RLS group (64.9 ± 17.1 degrees, P<0.01) and non-RLS group (P<0.001); however, the PD in the small RLS group was similar to that of the non-RLS group. The PD in the permanent group (48.8 ± 19.9 degrees) was similar to that of the latent group (52.6 ± 26.1 degrees), and both were significantly lower than that of the non-RLS group (P<0.05). The autoregulation index results were similar to the PD findings. dCA is impaired in migraineurs with large RLS, and this may represent a potential mechanism linking RLS, migraine, and cryptogenic stroke.

A potential association between diabetes and Guillain-Barré syndrome (GBS) has been indicated by a few case studies. We retrospectively analyzed the clinical features of a large cohort of GBS patients to explore the relationship between the level of fasting plasma glucose (FPG) obtained in the acute phase at admission and the severity of GBS. Three hundred and four GBS patients were divided into two groups, one with normal FPG and the other with high FPG levels according to the international standards of FPG. The GBS disability scale score was positively, the Medical Research Council (MRC) sum score was negatively correlated to the level of FPG, but not to blood HBA1c or CSF glucose concentrations. A relatively higher FPG level was observed in older and younger GBS patients, and more often in those with cranial nerve involvement, autonomic deficit, dyspnea and ventilator dependence than in patients without these clinical characteristics. Importantly, higher levels of FPG at admission were associated with poorer short-term prognosis measured by the MRC sum score and the GBS disability scale at discharge. Our data demonstrates that FPG in the acute phase of GBS correlates with the severity of GBS and may predict the short-term prognosis of GBS.

Blood tests revealed elevated CA125 and C-reactive protein levels, an increased erythrocyte sedimentation rate, and a normal leukocyte count. Under light microscopy, multiple eosinophilic granules are seen in the tumor cells, and neurosecretory granules are seen under electron microscopy. [...]the cells are rich in bulky cytoplasmic mitochondria, and positive for neuron specific enolase, synapse, pheochromin A, and cytokeratin on immunohistochemistry. [1,5] Among the reported cases treated with surgical resection, no metastasis or death occurred during follow-up. Because the prognosis of controlled TB is good, our patient was advised to receive TB treatment first and then treatment of OCTL once the TB was controlled.