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Vesal M, Roohafza H, Feizi A, Asgari K, Shahoon H, Ani A, Adibi P. Pressure algometry in the general adult population: Age and sex differences. Medicine (Baltimore) 2024; 103:e39418. [PMID: 39183389 PMCID: PMC11346871 DOI: 10.1097/md.0000000000039418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 07/31/2024] [Accepted: 08/02/2024] [Indexed: 08/27/2024] Open
Abstract
Experimental pain studies have revealed inter-individual variations in pain perception that are influenced by age, sex, and country of origin. This study aimed to explore the age and sex differences in pressure pain thresholds within the Iranian general population. To assess the pressure pain thresholds, a handheld pressure algometer was applied bilaterally to the middle fingers of both hands. The participants also completed the short form of the McGill Pain Questionnaire to provide a clinical pain rating. This cross-sectional study included 1610 adult subjects (54.96% female, mean age 40.13 ± 10.18 years). The findings indicated that females generally exhibited lower pain thresholds than males when assessing pain detection and tolerance parameters (P < .001). Females also demonstrated a significant lower pressure thresholds and clinical pain ratings compared with men (P < .001). Additionally, significant differences were observed between age groups in terms of pain detection and tolerance thresholds (P = .02 and P = .03, respectively). However, the interaction between sex and age was not significant. No significant differences in pain detection thresholds were observed between the right and left hand (P = .11). This study underscores the potential utility of algometry as a valuable tool for objectifying pain in the Iranian population.
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Affiliation(s)
- Mina Vesal
- Department of Psychology, University of Isfahan, Isfahan, Iran
| | - Hamidreza Roohafza
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Epidemiology and Biostatistics Department, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Karim Asgari
- Department of Psychology, University of Isfahan, Isfahan, Iran
| | - Hassan Shahoon
- Gastroenterology and Hepatology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Ani
- Department of Bioinformatics, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peyman Adibi
- Gastroenterology and Hepatology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Potvin S, Vincenot M, Haroune L, Giguère CÉ, Gendron L, Léonard G, Marchand S. Data-driven dynamic profiles of tonic heat pain perception in pain-free volunteers are associated with differences in anandamide levels. Sci Rep 2024; 14:17238. [PMID: 39060336 PMCID: PMC11282288 DOI: 10.1038/s41598-024-67401-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Our laboratory previously developed a method for assessing experimentally induced pain perception through a 2-min constant heat pain stimulation. However, the traditional analysis relying on group means struggles to interpret the considerable inter-individual variability due to the dynamic nature of the response. Recently, trajectory analysis techniques based on extended mixed models have emerged, providing insights into distinct response profiles. Notably, these methods have never been applied to pain paradigms before. Furthermore, various socio-demographic and neurobiological factors, including endocannabinoids, may account for these inter-individual differences. This study aims to apply the novel analysis to dynamic pain responses and investigate variations in response profiles concerning socio-demographic, psychological, and blood endocannabinoid concentrations. 346 pain-free participants were enrolled in a psychophysical test involving a continuous painful heat stimulation lasting for 2 min at a moderate intensity. Pain perception was continuously recorded using a computerized visual scale. Dynamic pain response analyses were conducted using the innovative extended mixed model approach. In contrast to the traditional group-mean analysis, the extended mixed model revealed three pain response trajectories. Trajectory 1 is characterized by a delay peak pain. Trajectory 2 is equivalent to the classic approach (peak pain follow by a constant and moderate increase of pain perception). Trajectory 3 is characterized by extreme responses (steep peak pain, decrease, and increase of pain perception), Furthermore, age and blood anandamide levels exhibited significant variations among these three trajectories. Using an innovative statistical approach, we found that a large proportion of our sample had a response significantly different from the average expected response. Endocannabinoid system seems to play a role in pain response profile.
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Affiliation(s)
- Stéphane Potvin
- Centre de recherche, Institut Universitaire en Santé Mentale de Montréal, Montreal (Qc), Canada.
- Department of Psychiatry and Addiction, University of Montreal, Montreal (Qc), Canada.
| | - Matthieu Vincenot
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke (Qc), Canada
- Centre de Recherche sur le Vieillissement, CUISSS de l'Estrie-CHUS, Sherbrooke, Canada
| | - Lounès Haroune
- Pharmacology Institute of Sherbrooke, Université de Sherbrooke, Sherbrooke (Qc), Canada
| | - Charles-Édouard Giguère
- Centre de recherche, Institut Universitaire en Santé Mentale de Montréal, Montreal (Qc), Canada
| | - Louis Gendron
- Pharmacology Institute of Sherbrooke, Université de Sherbrooke, Sherbrooke (Qc), Canada
- Department of Pharmacology and Physiology, Université de Sherbrooke, Sherbrooke (Qc), Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke (Qc), Canada
| | - Guillaume Léonard
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke (Qc), Canada
- Centre de Recherche sur le Vieillissement, CUISSS de l'Estrie-CHUS, Sherbrooke, Canada
| | - Serge Marchand
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke (Qc), Canada
- Department of Surgery, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke (Qc), Canada
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Kitada M, Yamamura S, Hori E. Subcutaneous edema as a potential cause of catheter failure in older inpatients receiving peripheral parenteral nutrition. Drug Discov Ther 2024; 18:160-166. [PMID: 38880602 DOI: 10.5582/ddt.2024.01029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Malnutrition is a common problem among hospitalized older patients. Peripheral parenteral nutrition (PN) can improve patient outcomes but can also lead to complications that affect future treatment. Older inpatients, in particular, are expected to be prone to these catheter-related complications. However, the impact of peripheral PN on older inpatients has been rarely investigated. In the current study, the impact of PN on short peripheral catheters (SPCs) was evaluated by comparing signs and symptoms at the time of catheter removal between 22 patients with PN and 27 without. In addition to external clinical assessment, sonographic investigations of the SPC site were performed. The prevalence of external signs and symptoms of complications was similar between the patients (all P > 0.05). However, subcutaneous edema was found by ultrasound in > 80% of patients with PN, compared with 55.6% of those without PN (P = 0.051). Unlike cases without PN, all patients with PN who presented with external signs and symptoms developed subcutaneous edema (P = 0.022). Multivariate analysis demonstrated that administration of PN was independently associated with subcutaneous edema (adjusted odds ratio = 6.88, 95% confidence interval = 1.083-75.486, P = 0.040). For several decades, phlebitis has been the primary focus of complications related to peripheral PN in clinical settings. However, our results imply that peripheral PN causes subcutaneous edema, which can lead to catheter failure in older inpatients. This study contributes to understanding the etiology of catheter failure during peripheral PN in this population.
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Affiliation(s)
- Motoko Kitada
- Faculty of Nursing, Department of Nursing, Josai International University, Chiba, Japan
| | - Shigeo Yamamura
- Faculty of Pharmaceutical Sciences, Department of Medical Pharmacy, Josai International University, Chiba, Japan
| | - Etsuro Hori
- Behavioral Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
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Kim JH, Sohn JH, Lee JJ, Kwon YS. Age-Related Variations in Postoperative Pain Intensity across 10 Surgical Procedures: A Retrospective Study of Five Hospitals in South Korea. J Clin Med 2023; 12:5912. [PMID: 37762853 PMCID: PMC10532067 DOI: 10.3390/jcm12185912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/08/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Age-related differences in pain perception have been reported in various contexts; however, their impact on postoperative pain intensity remains poorly understood, especially across different surgical procedures. Data from five hospitals were retrospectively analyzed, encompassing patients who underwent 10 distinct surgical procedures. Numeric rating scale scores were used to assess the worst postoperative pain intensity during the 24 h after surgery. The multivariate linear regression model analyzed the relationship between age and pain intensity. Subgroup analyses were performed according to sex and patient-controlled analgesia (PCA). This study included 41,187 patients. Among the surgeries studied, lumbar spine fusion (β = -0.155, p < 0.001) consistently and significantly exhibited a decrease in worst postoperative pain with increasing age. Similar trends were observed in cholecystectomy (β = -0.029, p < 0.001) and several other surgeries; however, the results were inconsistent across all analyses. Surgeries with higher percentages of PCA administration had lower median worst-pain scores. In conclusion, age may affect postoperative pain intensity after specific surgeries; however, a comprehensive understanding of the complex interplay between age, surgical intervention, and pain intensity is required. Pain management strategies should consider various factors, including age-related variations.
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Affiliation(s)
- Jong-Ho Kim
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si 24253, Republic of Korea; (J.-H.K.); (J.-J.L.)
- Institute of New Frontier Research Team, Hallym University College of Medicine, Chuncheon-si 24252, Republic of Korea;
| | - Jong-Hee Sohn
- Institute of New Frontier Research Team, Hallym University College of Medicine, Chuncheon-si 24252, Republic of Korea;
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea
| | - Jae-Jun Lee
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si 24253, Republic of Korea; (J.-H.K.); (J.-J.L.)
- Institute of New Frontier Research Team, Hallym University College of Medicine, Chuncheon-si 24252, Republic of Korea;
| | - Young-Suk Kwon
- Department of Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si 24253, Republic of Korea; (J.-H.K.); (J.-J.L.)
- Institute of New Frontier Research Team, Hallym University College of Medicine, Chuncheon-si 24252, Republic of Korea;
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Sempere-Bigorra M, Julián-Rochina I, Pérez-Ros P, Navarro-Flores E, Martínez-Arnau FM, Cauli O. Relationship between Cognitive Impairment and Depressive Symptoms with Somatosensory Functions in Diabetic and Non-Diabetic Older Adults and Its Impact on Quality of Life. Life (Basel) 2023; 13:1790. [PMID: 37763194 PMCID: PMC10532541 DOI: 10.3390/life13091790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/01/2023] [Accepted: 08/19/2023] [Indexed: 09/29/2023] Open
Abstract
Aging is an inevitable process that impacts the peripheral and central nervous systems and is considered one of the strongest risk factors for neurodegenerative diseases. In addition, when it also presents with diabetes mellitus, the risk of neurological damage may be further increased. This current study aimed to explore the relationships between peripheral sensory system decline and cognitive functions, the symptoms of depression, and quality of life (QoL) as metrics of central nervous system impairment in institutionalized older adults. A total of 95 individuals participated in this case-control study, which included diabetics and non-diabetics. The superficial sensory pathway was assessed in terms of thermal sensation, nociception, and non-discriminative touch, and the deep sensory pathway was evaluated by assessing vibration and light touch-pressure sensations. To assess function at the intellectual level, the Mini-Mental State Examination (MMSE) and Trail Making Test (TMT) cognitive functional tests were used, while the symptoms of depression and QoL were explored by employing the Yesavage Geriatric Depression Scale and EuroQol 5D questionnaire (EQ-5D), respectively. In the overall population analyses, altered thermal sensation was significantly associated with cognitive impairment (CI; p < 0.05). In turn, bivariate analyses and a binary logistic regression showed that the symptoms of depression and QoL were significantly related to altered vibratory sensation when assessed using a medical tuning fork (p < 0.05). In the group of diabetic patients, those with CI also had significantly lower thermal sensation (p < 0.05) and non-discriminative touch sensation, although this was only a trend (p = 0.055). Diabetics with depression had a significantly worse non-discriminative touch (p < 0.05) and vibratory sensation when tested with a tuning fork (p < 0.05). In addition, poorer QoL was associated with reduced sensitivity to heat (p < 0.05), light touch pressure (p < 0.05), and vibrations when assessed either with a tuning fork (p < 0.05) or a biothesiometer (p < 0.05). In contrast, no relationships were found between sensory functions and cognitive assessments in non-diabetic patients. These findings indicate that superficial sensitivity damage was related to CI, while deep sensation alterations were related to depression and poor QoL, with diabetes apparently further strengthening these relationships.
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Affiliation(s)
- Mar Sempere-Bigorra
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, 46010 Valencia, Spain; (M.S.-B.); (I.J.-R.); (P.P.-R.); (E.N.-F.)
- Frailty Research Organized Group (FROG), Department of Nursing, University of Valencia, 46010 Valencia, Spain;
| | - Iván Julián-Rochina
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, 46010 Valencia, Spain; (M.S.-B.); (I.J.-R.); (P.P.-R.); (E.N.-F.)
- Frailty Research Organized Group (FROG), Department of Nursing, University of Valencia, 46010 Valencia, Spain;
| | - Pilar Pérez-Ros
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, 46010 Valencia, Spain; (M.S.-B.); (I.J.-R.); (P.P.-R.); (E.N.-F.)
- Frailty Research Organized Group (FROG), Department of Nursing, University of Valencia, 46010 Valencia, Spain;
| | - Emmanuel Navarro-Flores
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, 46010 Valencia, Spain; (M.S.-B.); (I.J.-R.); (P.P.-R.); (E.N.-F.)
- Frailty Research Organized Group (FROG), Department of Nursing, University of Valencia, 46010 Valencia, Spain;
| | - Francisco Miguel Martínez-Arnau
- Frailty Research Organized Group (FROG), Department of Nursing, University of Valencia, 46010 Valencia, Spain;
- Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | - Omar Cauli
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, 46010 Valencia, Spain; (M.S.-B.); (I.J.-R.); (P.P.-R.); (E.N.-F.)
- Frailty Research Organized Group (FROG), Department of Nursing, University of Valencia, 46010 Valencia, Spain;
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Ohashi Y, Uchida K, Fukushima K, Satoh M, Koyama T, Tsuchiya M, Saito H, Uchiyama K, Takahira N, Inoue G, Takaso M. Increased Synovial CD14 mRNA Expression and Proportion of CD14 high Subsets in Early-Stage Hip Osteoarthritis: Propensity Matched Score Analysis. Int J Mol Sci 2022; 23:13622. [PMID: 36362408 PMCID: PMC9658156 DOI: 10.3390/ijms232113622] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/31/2022] [Accepted: 11/05/2022] [Indexed: 11/26/2023] Open
Abstract
The pathophysiology of early-stage hip osteoarthritis (EOA) is not fully understood. Although a previous study in an age-unmatched cohort reported that the number of macrophages was increased in knee EOA compared to late OA (LOA), it remained unclear whether increased macrophages in EOA accurately reflect EOA pathology. We investigated the differences in CD14 expression levels between EOA and LOA using age-unmatched and -matched cohorts. Synovial tissues were obtained from 34 EOA (Tönnis grades 0 and 1) and 80 LOA (Tönnis grades 2 and 3) patients. To correct for differences in demographics between patients with LOA and EOA, we also created propensity score-matched cohorts (16 EOA and 16 LOA). CD14 expression and its association with pain was estimated in LOA and EOA before and after propensity matching. We performed flow cytometry on tissues from the 16 patients, with 8 from each group, to assess for CD14+ subsets in the cells. The CD14 expression in EOA was higher than that in LOA both before and after propensity matching. The proportion of CD14high subsets in EOA was higher than that in LOA. The CD14 expression was associated with pain in EOA before matching. However, no difference was observed between the pain and CD14 expression after matching in EOA. The increased CD14 expression and the proportion of CD14high subsets may be important features associated with hip EOA pathology. To accurately compare early and late OA, the analysis of a propensity score-matched cohort is necessary.
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Affiliation(s)
- Yoshihisa Ohashi
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Minami-ku Kitasato, Sagamihara City 252-0374, Japan
| | - Kentaro Uchida
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Minami-ku Kitasato, Sagamihara City 252-0374, Japan
| | - Kensuke Fukushima
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Minami-ku Kitasato, Sagamihara City 252-0374, Japan
| | - Masashi Satoh
- Department of Immunology, Kitasato University School of Medicine, 1-15-1 Minami-ku Kitasato, Sagamihara City 252-0374, Japan
| | - Tomohisa Koyama
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Minami-ku Kitasato, Sagamihara City 252-0374, Japan
| | - Maho Tsuchiya
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Minami-ku Kitasato, Sagamihara City 252-0374, Japan
| | - Hiroki Saito
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Minami-ku Kitasato, Sagamihara City 252-0374, Japan
| | - Katsufumi Uchiyama
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Minami-ku Kitasato, Sagamihara City 252-0374, Japan
| | - Naonobu Takahira
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, 1-15-1 Minami-ku Kitasato, Sagamihara City 252-0375, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Minami-ku Kitasato, Sagamihara City 252-0374, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Minami-ku Kitasato, Sagamihara City 252-0374, Japan
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Oto T, Urata K, Hayashi Y, Hitomi S, Shibuta I, Iwata K, Iinuma T, Shinoda M. Age-Related Differences in Transient Receptor Potential Vanilloid 1 and 2 Expression Patterns in the Trigeminal Ganglion Neurons Contribute to Changes in the Palatal Mucosal Heat Pain Sensitivity. TOHOKU J EXP MED 2022; 256:283-290. [PMID: 35296569 DOI: 10.1620/tjem.2022.j004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Tatsuki Oto
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry
| | - Kentaro Urata
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry
| | | | - Suzuro Hitomi
- Department of Physiology, Nihon University School of Dentistry
| | - Ikuko Shibuta
- Department of Physiology, Nihon University School of Dentistry
| | - Koichi Iwata
- Department of Physiology, Nihon University School of Dentistry
| | - Toshimitsu Iinuma
- Department of Complete Denture Prosthodontics, Nihon University School of Dentistry
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Hiroki CH, Sarden N, Hassanabad MF, Yipp BG. Innate Receptors Expression by Lung Nociceptors: Impact on COVID-19 and Aging. Front Immunol 2021; 12:785355. [PMID: 34975876 PMCID: PMC8716370 DOI: 10.3389/fimmu.2021.785355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/16/2021] [Indexed: 12/14/2022] Open
Abstract
The lungs are constantly exposed to non-sterile air which carries harmful threats, such as particles and pathogens. Nonetheless, this organ is equipped with fast and efficient mechanisms to eliminate these threats from the airways as well as prevent pathogen invasion. The respiratory tract is densely innervated by sensory neurons, also known as nociceptors, which are responsible for the detection of external stimuli and initiation of physiological and immunological responses. Furthermore, expression of functional innate receptors by nociceptors have been reported; however, the influence of these receptors to the lung function and local immune response is poorly described. The COVID-19 pandemic has shown the importance of coordinated and competent pulmonary immunity for the prevention of pathogen spread as well as prevention of excessive tissue injury. New findings suggest that lung nociceptors can be a target of SARS-CoV-2 infection; what remains unclear is whether innate receptor trigger sensory neuron activation during SARS-CoV-2 infection and what is the relevance for the outcomes. Moreover, elderly individuals often present with respiratory, neurological and immunological dysfunction. Whether aging in the context of sensory nerve function and innate receptors contributes to the disorders of these systems is currently unknown. Here we discuss the expression of innate receptors by nociceptors, particularly in the lungs, and the possible impact of their activation on pulmonary immunity. We then demonstrate recent evidence that suggests lung sensory neurons as reservoirs for SARS-CoV-2 and possible viral recognition via innate receptors. Lastly, we explore the mechanisms by which lung nociceptors might contribute to disturbance in respiratory and immunological responses during the aging process.
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Affiliation(s)
- Carlos H. Hiroki
- Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Critical Care, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nicole Sarden
- Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Critical Care, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mortaza F. Hassanabad
- Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Critical Care, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Bryan G. Yipp
- Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Critical Care, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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