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Rochester, MN, United States

Roger V.L.,00 First St SW | Roger V.L.,Mayo Medical School
Circulation: Cardiovascular Quality and Outcomes

As illustrated by these few examples, outcomes research and epidemiology are complementary disciplinesWhen applied in synergy, they can provide unique and powerful insights into the effectiveness of care and the response to interventions designed to improve the quality of care in populationsAs defined by the Institute of Medicine, quality of care is "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge."23 Outcomes research and epidemiology are the compass and roadmap to guide us across the quality chasm. © 2011 American Heart Association, Inc. Source

Werner B.,Max Planck Institute for Evolutionary Biology | Gallagher R.E.,Montefiore Medical Center | Paietta E.M.,Montefiore Medical Center | Litzow M.R.,00 First St SW | And 7 more authors.
Cancer Research

Many tumors are believed to be maintained by a small number of cancer stem-like cells, where cure is thought to require eradication of this cell population. In this study, we investigated the dynamics of acute promyelocytic leukemia (APL) before and during therapy with regard to disease initiation, progression, and therapeutic response. This investigation used a mathematical model of hematopoiesis and a dataset derived from the North American Intergroup Study INT0129. The known phenotypic constraints of APL could be explained by a combination of differentiation blockade of PML-RARa-positive cells and suppression of normal hematopoiesis. All-trans retinoic acid (ATRA) neutralizes the differentiation block and decreases the proliferation rate of leukemic stem cells in vivo. Prolonged ATRA treatment after chemotherapy can cure patients with APL by eliminating the stem-like cell population over the course of approximately one year. To our knowledge, this study offers the first estimate of the average duration of therapy that is required to eliminate stem-like cancer cells from a human tumor, with the potential for the refinement of treatment strategies to better manage human malignancy. © 2014 American Association for Cancer Research. Source

Blancas-Mejia L.M.,00 First St SW | Hammernik J.,Urbana University | Marin-Argany M.,00 First St SW | Ramirez-Alvarado M.,00 First St SW | Ramirez-Alvarado M.,Mayo Medical School
Journal of Biological Chemistry

Background: Extracellular amyloid deposits involve glycosaminoglycans (GAGs). Results: Fibrillation of AL proteins was accelerated by heparan sulfate and inhibited by chondroitin sulfate A. Conclusion: Endogenous GAGs can modulate amyloid formation, and their effect is determined by the amyloidogenic properties of AL proteins studied. Significance: Biologically relevant molecules like GAGs play a major role in the amyloidogenicity of AL proteins. © 2015 by The American Society for Biochemistry and Molecular Biology, Inc. Source

Bennett C.J.,00 First St SW | Maleszewski J.J.,Mayo Medical School | Araoz P.A.,00 First St SW

Valvular disease is estimated to account for as many as 20% of cardiac surgical procedures performed in the United States. It may be congenital in origin or secondary to another disease process. One congenital anomaly, bicuspid aortic valve, is associated with increased incidence of stenosis, regurgitation, endocarditis, and aneurysmal dilatation of the aorta. A bicuspid valve has two cusps instead of the normal three; resultant fusion or poor excursion of the valve leaflets may lead to aortic stenosis, the presence of which is signaled by dephasing jets on magnetic resonance (MR) images. Surgery is generally recommended for patients with severe stenosis who are symptomatic or who have significant ventricular dysfunction; transcatheter aortic valve implantation (TAVI) is an emerging therapeutic option for patients who are not eligible for surgical treatment. Computed tomography (CT) is an essential component of preoperative planning for TAVI; it is used to determine the aortic root dimensions, severity of peripheral vascular disease, and status of the coronary arteries. Aortic regurgitation, which is caused by incompetent closure of the aortic valve, likewise leads to the appearance of jets on MR images. The severity of regurgitation is graded on the basis of valvular morphologic parameters; qualitative assessment of dephasing jets at Doppler ultrasonography; or measurements of the regurgitant fraction, volume, and orifice area. Mild regurgitation is managed conservatively, whereas severe or symptomatic regurgitation usually leads to valve replacement surgery, especially in the presence of substantial left ventricular enlargement or dysfunction. Bacterial endocarditis, although less common than aortic stenosis and regurgitation, is associated with substantial morbidity and mortality. Electrocardiographically gated CT reliably demonstrates infectious vegetations and benign excrescences of 1 cm or more on the valve surface, allowing the assessment of any embolic complications. © RSNA, 2012. Source

Sundsted K.K.,00 First St SW | Burton M.C.,00 First St SW | Shah R.,00 First St SW | Lapid M.I.,Mayo Medical School
Journal of ECT

OBJECTIVE: Electroconvulsive therapy (ECT) is widely used for the treatment of psychiatric disorders, yet there is few published literature to guide the practitioner in the preprocedural evaluation of patients. Based on a review of the literature, we sought to develop a concise, algorithmic approach to be used when evaluating patients for ECT, including those with underlying conditions, such as cardiovascular and neurological disorders. METHODS: The databases of Ovid MEDLINE, PubMed, the Web of Knowledge, and PsychINFO were searched from January 2000 through December 2011. All abstracts were reviewed for relevancy to preprocedural ECT evaluation, and full articles of selected abstracts were reviewed in full, along with bibliographies of each. Algorithms were then constructed using the clinical information obtained from the selected articles. RESULTS: Our review of the literature located 275 articles using the search criteria. After review, 38 articles were selected. A total of 167 articles were excluded because they did not pertain to medical comorbidities in patients undergoing ECT, and an additional 70 were excluded because they did not pertain to ECT. Bibliography review of the selected articles located an additional 10 articles. CONCLUSIONS: Although ECT is generally a safe and effective therapy, some patient subgroups, such as those with certain cardiac conditions or history of cerebrovascular disease, require additional evaluation or, rarely, postponement of ECT. Chronic medical conditions should be optimized before undergoing ECT. Most patient populations are able to undergo ECT safely and effectively. Copyright © 2014 by Lippincott Williams & Wilkins. Source

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