Medicine and Health Sciences Commons^™

Striatum In Stimulus-Response Learning Via Feedback And In Decision Making., Nole M Hiebert, Andrew Vo, Adam Hampshire, Adrian M Owen, Ken N Seergobin, Penny A Macdonald

Brain and Mind Institute Researchers' Publications

Cognitive deficits are recognized in Parkinson's disease. Understanding cognitive functions mediated by the striatum can clarify some of these impairments and inform treatment strategies. The dorsal striatum, a region impaired in Parkinson's disease, has been implicated in stimulus-response learning. However, most investigations combine acquisition of associations between stimuli, responses, or outcomes (i.e., learning) and expression of learning through response selection and decision enactment, confounding these separate processes. Using neuroimaging, we provide evidence that dorsal striatum does not mediate stimulus-response learning from feedback but rather underlies decision making once associations between stimuli and responses are learned. In the experiment, 11 males …

Localized, Non-Random Differences In Chromatin Accessibility Between Homologous Metaphase Chromosomes, Wahab A Khan, Peter K Rogan, Joan H.M. Knoll

Department of Medicine Publications

BACKGROUND: Condensation differences along the lengths of homologous, mitotic metaphase chromosomes are well known. This study reports molecular cytogenetic data showing quantifiable localized differences in condensation between homologs that are related to differences in accessibility (DA) of associated DNA probe targets. Reproducible DA was observed for ~10% of locus-specific, short (1.5-5 kb) single copy DNA probes used in fluorescence in situ hybridization.

RESULTS: Fourteen probes (from chromosomes 1, 5, 9, 11, 15, 17, 22) targeting genic and intergenic regions were developed and hybridized to cells from 10 individuals with cytogenetically-distinguishable homologs. Differences in hybridization between homologs were non-random for 8 …

Bmp4 And Lgl1 Are Down Regulated In An Ovine Model Of Congenital Diaphragmatic Hernia, Heather M A Emmerton-Coughlin, K Kathryn Martin, Jacky S S Chiu, Lin Zhao, Leslie A Scott, Timothy R H Regnault, Andreana Bütter

Surgery Publications

BACKGROUND/PURPOSE: The molecular pathophysiology of lung hypoplasia in congenital diaphragmatic hernia (CDH) remains poorly understood. The Wnt signaling pathway and downstream targets, such as bone morphogenetic proteins (BMP) 4 and other factors such as late gestation lung protein 1 (LGL1), are essential to normal lung development. Nitrofen-induced hypoplastic CDH rodent lungs demonstrate down regulation of the Wnt pathway including BMP4 and reduced LGL1 expression. The aim of the current study was to examine the molecular pathophysiology associated with a surgically induced CDH in an ovine model.

METHODS: Left thoracotomy was performed at 80 days in 14 fetal sheep; CDH was …

Transcranial Magnetic Stimulation Of The Prefrontal Cortex In Awake Nonhuman Primates Evokes A Polysynaptic Neck Muscle Response That Reflects Oculomotor Activity At The Time Of Stimulation., Chao Gu, Brian D Corneil

Brain and Mind Institute Researchers' Publications

Transcranial magnetic stimulation (TMS) has emerged as an important technique in cognitive neuroscience, permitting causal inferences about the contribution of a given brain area to behavior. Despite widespread use, exactly how TMS influences neural activity throughout an interconnected network, and how such influences ultimately change behavior, remain unclear. The oculomotor system of nonhuman primates (NHPs) offers a potential animal model to bridge this gap. Here, based on results suggesting that neck muscle activity provides a sensitive indicator of oculomotor activation, we show that single pulses of TMS over the frontal eye fields (FEFs) in awake NHPs evoked rapid (within ∼25 …

Euvolemia In Hemodialysis Patients: A Potentially Dangerous Goal?, Shih-Han S Huang, Guido Filler, Robert Lindsay, Chris W Mcintyre

Medical Biophysics Publications

Dialysis patients have high mortality rate and the leading cause of death is cardiovascular disease. Uremic cardiomyopathy differs from that due to conventional atherosclerosis, where cardiovascular changes result in ineffective circulation and lead to tissue ischemia. Modern dialysis has significant limitations with fluid management probably the most challenging. Current evidence suggests that both volume overload and aggressive fluid removal can induce circulatory stress and multi-organ injury. Furthermore, we do not have accurate volume assessment tools. As a result, targeting euvolemia might result in more harm than benefit with conventional hemodialysis therapy. Therefore, it might be time to consider a degree …

Burning Pain Secondary To Clozapine Use: A Case Report., Bradley Linton, Rachel Fu, Penny A Macdonald, Hooman Ganjavi

Brain and Mind Institute Researchers' Publications

BACKGROUND: The first of the atypical antipsychotics introduced in the 1970s, clozapine remains the most efficacious neuroleptic to this day. However, serious and potentially fatal side effects have necessitated careful regular monitoring among prescribing clinicians. Some adverse effects (e.g. ischaemic bowel) remain under recognized, while newly identified adverse effects continue to be described in the literature.

CASE PRESENTATION: In this report, we describe a healthy 43-year old Caucasian male who experienced onset of a full body deep burning pain several months after the onset of treatment with clozapine. The pain worsened over time, ceased with cessation of treatment, and returned …

The Cost Of Moving Optimally: Kinematic Path Selection., Dinant A Kistemaker, Jeremy D Wong, Paul L Gribble

Brain and Mind Institute Researchers' Publications

It is currently unclear whether the brain plans movement kinematics explicitly or whether movement paths arise implicitly through optimization of a cost function that takes into account control and/or dynamic variables. Several cost functions are proposed in the literature that are very different in nature (e.g., control effort, torque change, and jerk), yet each can predict common movement characteristics. We set out to disentangle predictions of the different variables using a combination of modeling and empirical studies. Subjects performed goal-directed arm movements in a force field (FF) in combination with visual perturbations of seen hand position. This FF was designed …

Induction Of Acute Lung Inflammation In Mice With Hemorrhagic Shock And Resuscitation: Role Of Hmgb1, Raymond L. C. Kao, Xuemei Xu, Anargyros Xenocostas, Neil Parry, Tina Mele, Claudio M. Martin, Tao Rui

Anatomy and Cell Biology Publications

Background: Hemorrhagic shock and resuscitation (HS/R) can induce multiple organ failure which is associated with high mortality. The lung is an organ commonly affected by the HS/R. Acute lung injury is a major cause of dysfunction in other organ systems. The objective of this study is to test the hypothesis that HS/R causes increased gut permeability which results in induction of high mobility group box1 protein (HMGB1) and further leads to the development of acute lung inflammation. Materials and methods: A mouse model of HS/R was employed in this study. Gut permeability and bacterial translocation were assessed with circulating FD4 …

Mirror Reversal And Visual Rotation Are Learned And Consolidated Via Separate Mechanisms: Recalibrating Or Learning De Novo?, Sebastian Telgen, Darius Parvin, Jörn Diedrichsen

Brain and Mind Institute Researchers' Publications

Motor learning tasks are often classified into adaptation tasks, which involve the recalibration of an existing control policy (the mapping that determines both feedforward and feedback commands), and skill-learning tasks, requiring the acquisition of new control policies. We show here that this distinction also applies to two different visuomotor transformations during reaching in humans: Mirror-reversal (left-right reversal over a mid-sagittal axis) of visual feedback versus rotation of visual feedback around the movement origin. During mirror-reversal learning, correct movement initiation (feedforward commands) and online corrections (feedback responses) were only generated at longer latencies. The earliest responses were directed into a nonmirrored …

Ct Perfusion Imaging As An Early Biomarker Of Differential Response To Stereotactic Radiosurgery In C6 Rat Gliomas, Timothy Pok Chi Yeung, Maher Kurdi, Yong Wang, Baraa Al-Khazraji, Laura Morrison, Lisa Hoffman, Dwayne Jackson, Cathie Crukley, Ting-Yim Lee, Glenn Bauman, Slav Yartsev

Medical Biophysics Publications

BACKGROUND: The therapeutic efficacy of stereotactic radiosurgery for glioblastoma is not well understood, and there needs to be an effective biomarker to identify patients who might benefit from this treatment. This study investigated the efficacy of computed tomography (CT) perfusion imaging as an early imaging biomarker of response to stereotactic radiosurgery in a malignant rat glioma model.

METHODS: Rats with orthotopic C6 glioma tumors received either mock irradiation (controls, N = 8) or stereotactic radiosurgery (N = 25, 12 Gy in one fraction) delivered by Helical Tomotherapy. Twelve irradiated animals were sacrificed four days after stereotactic radiosurgery to assess acute …

Factors Affecting Transfusion Requirement After Hip Fracture: Can We Reduce The Need For Blood?, Sagar J. Desai, Kristi S. Wood, Jackie Marsh, Dianne Bryant, Hussein Abdo, Abdel Rahman Lawendy, David W. Sanders

Bone and Joint Institute

© 2014 Association médicale canadienne. Background: Hip fractures are common injuries that result in blood loss and frequently require the transfusion of blood products. We sought to identify risk factors leading to increased blood transfusion in patients presenting with hip fractures, especially those factors that are modifiable. Methods: We retrospectively reviewed the cases of all patients who had fixation of their hip fractures between October 2005 and February 2010. The need for transfusion was correlated with potential risk factors, including age, sex, preoperative hemoglobin, fracture type, fixation method and more. Results: A total of 835 patients had fixation of their …

Dopaminergic Therapy Affects Learning And Impulsivity In Parkinson's Disease., Nole M Hiebert, Ken N Seergobin, Andrew Vo, Hooman Ganjavi, Penny A Macdonald

Brain and Mind Institute Researchers' Publications

OBJECTIVE: The aim was to examine the effect of dopaminergic medication on stimulus-response learning versus performing decisions based on learning.

METHOD: To see the effect of dopaminergic therapy on stimulus-response learning and response selection, participants with Parkinson's disease (PD) were either tested on and/or off their prescribed dose of dopaminergic therapy during different testing days. Forty participants with PD and 34 healthy controls completed the experiment on consecutive days. On Day 1, participants learned to associate abstract images with spoken, "right" or "left" responses via feedback (Session 1). On Day 2, participants recalled these responses (Session 2) and indicated the …

Developmental Stress, Condition, And Birdsong: A Case Study In Song Sparrows., Kim L Schmidt, Elizabeth A Macdougall-Shackleton, Shawn P Kubli, Scott A Macdougall-Shackleton

Brain and Mind Institute Researchers' Publications

Sexual-selection theory posits that ornaments and displays can reflect a signaler's condition, which in turn is affected both by recent and developmental conditions. Moreover, developmental conditions can induce correlations between sexually selected and other traits if both types of traits exhibit developmental phenotypic plasticity in response to stressors. Thus, sexually selected traits may reflect recent and/or developmental characteristics of signalers. Here, we review data on the relationships between birdsong, a sexually selected trait, and developmental and current condition of birds from a long-term study of a population of song sparrows (Melospiza melodia). Field studies of free-living birds indicate that the …

Unique Functional Abnormalities In Youth With Combined Marijuana Use And Depression: An Fmri Study, Kristen A. Ford, Michael Wammes, Richard W. Neufeld, Derek Mitchell, Jean Theberge, Peter Williamson, Elizabeth A. Osuch

Anatomy and Cell Biology Publications

Prior research has shown a relationship between early onset marijuana (MJ) use and depression; however, this relationship is complex and poorly understood. Here, we utilized passive music listening and fMRI to examine functional brain activation to a rewarding stimulus in 75 participants [healthy controls (HC), patients with major depressive disorder (MDD), frequent MJ users, and the combination of MDD and MJ (MDD?+?MJ)]. For each participant, a preferred and neutral piece of instrumental music was determined (utilizing ratings on a standardized scale), and each completed two 6-min fMRI scans of a passive music listening task. Data underwent pre-processing and 61 participants …

Longitudinal Computed Tomography And Magnetic Resonance Imaging Of Copd: Thoracic Imaging Network Of Canada (Tincan) Study Objectives, Miranda Kirby, Damien Pike, David G Mccormack, Stephen Lam, Harvey O Coxson, Grace Parraga

Medical Biophysics Publications

Although the human and societal burden and cost of COPD is staggering, there are few clinical tools that provide earlier diagnoses or a means to regionally monitor disease in a way that might lead to improved therapies and outcomes. In acknowledgement of the current gaps in COPD therapy, the objective of the Thoracic Imaging Network of Canada (TINCan) is to improve COPD patient phenotyping through imaging, to provide methods and imaging-based intermediate endpoints for the development of new treatments, and to evaluate disease progression and patient-based outcomes in COPD patients and those at risk of COPD. Here we summarize and …

Use Of Protoporphyrin Fluorescence To Determine Clinical Target Volume For Non-Melanotic Skin Cancers Treated With Primary Radiotherapy, Stephanie Casey, Lara Best, Olga Vujovic, Kevin Jordan, Barbara Fisher, Deborah Carey, Deborah Bourdeau, Edward Yu

Data and Test Instruments

Purpose: This study prospectively investigated Protoporphyrin (PpIX) fluorescence as a means of determining the clinical target volume (CTV) necessary to encompass subclinical disease for non-melanotic skin cancers.Methods and Materials: PpIX photo-delineation was performed on 30 patients by applying δ-aminolevulinic acid (ALA) or Metvix™ (MAL) cream to the lesions to be treated, in order to delineate a CTV prior to treatment with radiotherapy. This CTV was then compared to conventional margins for subclinical disease (10 mm for poorly demarcated tumors).Conclusions: PpIX photo-delineation suggests that conventional 10 mm margins may be inadequately covering areas of subclinical disease in poorly demarcated skin tumors. …

The Epidemic Of Mental And Neurological Health, Mohsyn I. Malik

Psychology Publications

This paper composes an image of modern mental and neurological health issues and looks to draw links to the current epidemic based on research and studies found online the internet and off-line. The goal is to examine what may be the underlying problem for a lot of these increases in mental health issues and neurodegenerative diseases and what are some promising clinical and sociocultural advances that may help. It explores problems such as the negative impact of the pharmaceutical giants, the increase in apathy in the work place and the general stigma towards mental disease. Through current research, the use …

Cardiac Fibroblasts Contribute To Myocardial Dysfunction In Mice With Sepsis: The Role Of Nlrp3 Inflammasome Activation, Wenbo Zhang, Xuemei Xu, Raymond Kao, Tina Mele, Peter Kvietys, Claudio M. Martin, Tao Rui

Anatomy and Cell Biology Publications

Myocardial contractile dysfunction in sepsis is associated with the increased morbidity and mortality. Although the underlying mechanisms of the cardiac depression have not been fully elucidated, an exaggerated inflammatory response is believed to be responsible. Nucleotide-binding oligomerization domain-like receptor containing pyrin domain 3 (NLRP3) inflammasome is an intracellular platform that is involved in the maturation and release of interleukin (IL)-1 beta. The aim of the present study is to evaluate whether sepsis activates NLRP3 inflammasome/caspase-1/IL-1 beta pathway in cardiac fibroblasts (CFs) and whether this cytokine can subsequently impact the function of cardiomyocytes (cardiac fibroblast-myocyte crosstalk). We show that treatment of …

Closing Treatment Gaps: Clinical Psychiatry Of Suicide Prevention, Amresh Srivastava

Data and Test Instruments

TBC

Comparing Moral Judgments Of Patients With Frontotemporal Dementia And Frontal Stroke, Sandra Baez, Blas Couto, Teresa Torralva, Luciano A. Sposato, David Huepe, Patricia Montañes, Pablo Reyes, Diana Matallana, Nora S. Vigliecca, Andrea Slachevsky, Facundo Manes, Agustin Ibanez

Anatomy and Cell Biology Publications

Importance Several clinical reports have stated that patients with prefrontal lesions or patients with the behavioral variant of frontotemporal dementia share social cognition impairments. Moral reasoning is impaired in both conditions but there have been few investigations that directly compare this domain in the 2 groups.

Observations This work compared the moral judgments of these patient groups using a task designed to disentangle the contributions of intentions and outcomes in moral judgment. For both disorders, patients judged scenarios where the protagonists believed that they would cause harm but did not as being more permissible than the control group. Moreover, patients …

Olanzapine-Induced Methylation Alters Cadherin Gene Families And Associated Pathways Implicated In Psychosis, Melkaye G. Melka, Christina A Castellani, Nagalingam Rajakumar, Richard O'Reilly, Shiva M Singh

Biology Publications

BACKGROUND: The complex aetiology of most mental disorders involves gene-environment interactions that may operate using epigenetic mechanisms particularly DNA methylation. It may explain many of the features seen in mental disorders including transmission, expression and antipsychotic treatment responses. This report deals with the assessment of DNA methylation in response to an antipsychotic drug (olanzapine) on brain (cerebellum and hippocampus), and liver as a non-neural reference in a rat model. The study focuses on the Cadherin/protocadherins encoded by a multi-gene family that serve as adhesion molecules and are involved in cell-cell communication in the mammalian brain. A number of these molecules …

Sharp Emergence Of Feature-Selective Sustained Activity Along The Dorsal Visual Pathway., Diego Mendoza-Halliday, Santiago Torres, Julio C Martinez-Trujillo

Brain and Mind Institute Researchers' Publications

Sustained activity encoding visual working memory representations has been observed in several cortical areas of primates. Where along the visual pathways this activity emerges remains unknown. Here we show in macaques that sustained spiking activity encoding memorized visual motion directions is absent in direction-selective neurons in early visual area middle temporal (MT). However, it is robustly present immediately downstream, in multimodal association area medial superior temporal (MST), as well as and in the lateral prefrontal cortex (LPFC). This sharp emergence of sustained activity along the dorsal visual pathway suggests a functional boundary between early visual areas, which encode sensory inputs, …

Motoric Cognitive Risk Syndrome: Multicountry Prevalence And Dementia Risk, Joe Verghese, Cedric Annweiler, Emmeline Ayers, Nir Barzilai, Olivier Beauchet, David A Bennett, Stephanie A Bridenbaugh, Aron S Buchman, Michele L Callisaya, Richard Camicioli, Benjamin Capistrant, Somnath Chatterji, Anne-Marie De Cock, Luigi Ferrucci, Nir Giladi, Jack M Guralnik, Jeffrey M Hausdorff, Roee Holtzer, Ki Woong Kim, Paul Kowal, Reto W Kressig, Jae-Young Lim, Susan Lord, Kenichi Meguro, Manuel Montero-Odasso, Susan W. Hunter, Mohan L Noone, Lynn Rochester, Velandai Srikanth, Cuiling Wang

Physical Therapy Publications

OBJECTIVES: Our objective is to report prevalence of motoric cognitive risk syndrome (MCR), a newly described predementia syndrome characterized by slow gait and cognitive complaints, in multiple countries, and its association with dementia risk.

METHODS: Pooled MCR prevalence analysis of individual data from 26,802 adults without dementia and disability aged 60 years and older from 22 cohorts from 17 countries. We also examined risk of incident cognitive impairment (Mini-Mental State Examination decline ≥4 points) and dementia associated with MCR in 4,812 individuals without dementia with baseline Mini-Mental State Examination scores ≥25 from 4 prospective cohort studies using Cox models adjusted …

Human Premotor Areas Parse Sequences Into Their Spatial And Temporal Features., Katja Kornysheva, Jörn Diedrichsen

Brain and Mind Institute Researchers' Publications

Skilled performance is characterized by precise and flexible control of movement sequences in space and time. Recent theories suggest that integrated spatio-temporal trajectories are generated by intrinsic dynamics of motor and premotor networks. This contrasts with behavioural advantages that emerge when a trained spatial or temporal feature of sequences is transferred to a new spatio-temporal combination arguing for independent neural representations of these sequence features. We used a new fMRI pattern classification approach to identify brain regions with independent vs integrated representations. A distinct regional dissociation within motor areas was revealed: whereas only the contralateral primary motor cortex exhibited unique …

Treatment Of Rectal War Wounds, O Van Waes, J Halm, J Vermeulen, Vivian Mcalister

Data and Test Instruments

Treatment strategies for penetrating rectal injuries (PRI) in civilian settings are still not uniformly agreed, in part since high-energy transfer PRI, such as is frequently seen in military settings, are not taken into account. Here, we describe three cases of PRI, treated in a deployed combat environment, and outline the management strategies successfully employed. We also discuss the literature regarding PRI management. Where there is a major soft tissue component, repetitive debridement and vacuum therapy is useful. A loop or end colostomy should be used, depending on the degree of damage to the anal sphincter complex.

Complexity And Familiarity Enhance Single-Trial Detectability Of Imagined Movements With Electroencephalography, Raechelle M. Gibson, Srivas Chennu, Adrian M. Owen, Damian Cruse

Anatomy and Cell Biology Publications

Objective: We sought to determine whether the sensorimotor rhythms (SMR) elicited during motor imagery (MI) of complex and familiar actions could be more reliably detected with electroencephalography (EEG), and subsequently classified on a single-trial basis, than those elicited during relatively simpler imagined actions. Methods: Groups of healthy volunteers, including experienced pianists and ice hockey players, performed MI of varying complexity and familiarity. Their electroencephalograms were recorded and compared using brain-computer interface (BCI) approaches and spectral analyses. Results: Relative to simple MI, significantly more participants produced classifiable SMR for complex MI. During MI of performance of a complex musical piece, the …

Implantation Failure In Female Kiss1-/- Mice Is Independent Of Their Hypogonadic State And Can Be Partially Rescued By Leukemia Inhibitory Factor., Michele Calder, Yee-Ming Chan, Renju Raj, Macarena Pampillo, Adrienne Elbert, Michelle Noonan, Carolina Gillio-Meina, Claudia Caligioni, Nathalie G Bérubé, Moshmi Bhattacharya, Andrew J Watson, Stephanie B Seminara, Andy V Babwah

Obstetrics & Gynaecology Publications

The hypothalamic kisspeptin signaling system is a major positive regulator of the reproductive neuroendocrine axis, and loss of Kiss1 in the mouse results in infertility, a condition generally attributed to its hypogonadotropic hypogonadism. We demonstrate that in Kiss1(-/-) female mice, acute replacement of gonadotropins and estradiol restores ovulation, mating, and fertilization; however, these mice are still unable to achieve pregnancy because embryos fail to implant. Progesterone treatment did not overcome this defect. Kiss1(+/-) embryos transferred to a wild-type female mouse can successfully implant, demonstrating the defect is due to maternal factors. Kisspeptin and its receptor are expressed in the mouse …

The Co-Occurrence Of Ptsd And Dissociation: Differentiating Severe Ptsd From Dissociative Ptsd, Cherie Amour, Karen-Inge Karstoft, Don Richardson

MacDonald Franklin OSI Research Centre

Purpose

A dissociative-posttraumatic stress disorder (PTSD) subtype has been included in the DSM-5. However, it is not yet clear whether certain socio-demographic characteristics or psychological/clinical constructs such as comorbid psychopathology differentiate between severe PTSD and dissociative-PTSD. The current study investigated the existence of a dissociative-PTSD subtype and explored whether a number of trauma and clinical covariates could differentiate between severe PTSD alone and dissociative-PTSD.

Methods

The current study utilized a sample of 432 treatment seeking Canadian military veterans. Participants were assessed with the Clinician Administered PTSD Scale (CAPS) and self-report measures of traumatic life events, depression, and anxiety. CAPS severity …

Pulmonary Ventilation Defects In Older Never-Smokers, Khadija Sheikh, Gregory A Paulin, Sarah Svenningsen, Miranda Kirby, Nigel A M Paterson, David G Mccormack, Grace Parraga

Medical Biophysics Publications

Hyperpolarized (3)He MRI previously revealed spatially persistent ventilation defects in healthy, older compared with healthy, younger never-smokers. To understand better the physiological consequences and potential relevance of (3)He MRI ventilation defects, we evaluated (3)He-MRI ventilation-defect percent (VDP) and the effect of deep inspiration (DI) and salbutamol on VDP in older never-smokers. To identify the potential determinants of ventilation defects in these subjects, we evaluated dyspnea, pulmonary function, and cardiopulmonary exercise test (CPET) measurements, as well as occupational and second-hand smoke exposure. Fifty-two never-smokers (71 ± 6 yr) with no history of chronic respiratory disease were evaluated. During a single visit, …

Practice Patterns And Trends In The Use Of Medical Therapy In Patients Undergoing Percutaneous Coronary Intervention In Ontario, Pallav Garg, Harindra C. Wijeysundera, Lingsong Yun, Warren J. Cantor, Dennis T. Ko

Department of Medicine Publications

Background

Clinical guidelines emphasize medical therapy as the initial approach to the management of patients with stable coronary artery disease (CAD). However, the extent to which medical therapy is applied before and after percutaneous coronary intervention (PCI) in contemporary clinical practice is uncertain. We evaluated medication use for patients with stable CAD undergoing PCI, and assessed whether the COURAGE study altered medication use in the Canadian healthcare system.

Methods and Results

A population‐based cohort of 23 680 older patients >65 years old) with stable CAD undergoing PCI in Ontario between 2003 and 2010 was assembled. Optimal medical therapy (OMT) was …