Holtan S.G.,00 First Street SW
Frontiers in Bioscience - Scholar | Year: 2011
Failure of the immune system to recognize and eradicate tumor cells has deadly consequences. It is possible that the normal host response to the inflammatory environment created by many cancers - the body's natural attempt at wound repair and restoration of tissue integrity - is one of counter-regulation that paradoxically favors tumor growth. A physiologic condition where this situation is favorable (and even required) is that of normal pregnancy, where blastocyst implantation creates endometrial inflammation, and the maternal response in turn supports angiogenesis and tolerance required for placentation. Lack of such inflammation and resultant maternal immunologic engagement can lead to serious pregnancy complications including fetal loss, highlighting how important the fetomaternal immunologic dialogue is for survival. Here, we describe how the dynamics of fetomaternal tolerance can help disentangle complex cancer/host immunologic interactions and provide new avenues for immunologic reconstitution in patients with cancer.
Sohail M.R.,00 First Street SW |
Sultan O.W.,Mayo Medical School |
Raza S.S.,Mayo Medical School
Expert Review of Anti-Infective Therapy | Year: 2010
Cardiovascular implantable electronic device (CIED) implantation rate has substantially risen in the foregoing decades. Unfortunately, this upsurge in CIED implantation rate has been accompanied by a disproportionate rise in the rate of CIED infections. Device infection is a major complication of CIED implantation, necessitating removal of an infected device followed by systemic antimicrobial therapy and reimplantation of a new system. In this article, we review the current epidemiology, risk factors, diagnostic strategy and contemporary management of CIED infection. In addition, we address the vexing question of how to best manage patients with Staphylococcus aureus bacteremia, in the setting of an implanted device, but no overt clinical signs of CIED infection. Lastly, we discuss the preventive strategies to minimize risk of CIED infection. © 2010 Expert Reviews Ltd.
Rooney J.W.,00 First Street SW |
Laack N.N.,00 First Street SW
CNS oncology | Year: 2013
After surgery, radiation is the most effective treatment for the majority of brain tumors in both children and adults. Although improvements in radiotherapy delivery and targeting have resulted in reduction in neurologic morbidity, radiotherapy is still associated with acute and late toxicities that are dependent on a variety of treatment- and patient-specific variables. Variables of treatment include radiation dose, fractionation, volume, technique, photons or protons, and concomitant or adjuvant chemotherapy. Patient- and tumor-specific variables include tumor type, location and patient age. Side effects of treatment are also variable and can range from mild fatigue to significant memory difficulties and even death. This review will focus on the hypothesized mechanisms of cognitive dysfunction after radiation therapy and will discuss possible intervention strategies including behavioral and pharmacological prevention and treatment.
Medina-Inojosa J.,00 First Street S.W. |
Jean N.,00 First Street S.W. |
Cortes-Bergoderi M.,Mount Sinai Medical Center |
Lopez-Jimenez F.,00 First Street S.W.
Progress in Cardiovascular Diseases | Year: 2014
Health statistics and epidemiologic studies have shown that Hispanics live longer than Non Hispanic Whites, despite a high prevalence of cardiovascular disease (CVD) risk factors and an average low socioeconomic status, both strong predictors of CVD and mortality. This phenomenon has been dubbed "The Hispanic paradox" and has been demonstrated in old and contemporary cohorts. To date, no factor has been identified that could explain this phenomenon, but socio demographic factors, dietary intake and genetic predisposition have been proposed as possible explanations for the Hispanic paradox. As with the French paradox, where French were found to have a lower rate of coronary heart disease (CHD), helped to identify the role of the Mediterranean diet and wine consumption in the prevention of CHD, the Hispanic paradox could help identify protective factors against CHD. This article describes the current evidence supporting the existence of the Hispanic paradox and provides a brief review on the possible explanations. © 2014.
Melduni R.M.,00 First Street SW |
Koshino Y.,00 First Street SW |
Shen W.-K.,Mayo Medical School
Clinics in Geriatric Medicine | Year: 2012
Perioperative arrhythmias are a common complication of surgery, with incidence ranging from 4% to 20% for noncardiothoracic procedures, depending on the type of surgery performed. The immediate postoperative period is a dynamic time and is associated with many conditions conducive to the development of postoperative arrhythmias. The presence of postoperative atrial fibrillation is associated with increased morbidity, ICU stay, length of hospitalization, and hospital costs. The associated burdens are expected to rise in the future, given that the population undergoing cardiac surgery is getting older and sicker. Thousands of patients undergo major surgery each year and a major complication of these procedures is the occurrence of perioperative arrhythmia. It is imperative for clinicians to be up-to-date on current management of these arrhythmias. © 2012 Elsevier Inc.
Kapoor P.,00 First Street SW |
Kapoor P.,Mayo Medical School |
Paludo J.,Mayo Medical School |
Vallumsetla N.,00 First Street SW |
And 2 more authors.
Blood Reviews | Year: 2015
Waldenström macroglobulinemia (WM) is a distinct hematologic malignancy characterized by a lymphoplasmacytic bone marrow infiltration and the presence of immunoglobulin (Ig)M monoclonal protein. Patients typically present at an advanced age, and a substantial proportion are asymptomatic at diagnosis. A unifying diagnosis of WM may be missed by an unsuspecting hematologist, as symptomatic patients present with a multitude of non-specific manifestations. Although constitutional and neuropathy-related symptoms predominate, concomitant IgM-induced hyperviscosity-associated features can provide useful diagnostic clues. There are specific indications for initiation of therapy. This review focuses on the most up-to-date management strategies of WM, in addition to highlighting the recent discoveries of MYD88 and CXCR4 mutations that have shed unprecedented light on the complex signaling pathways, and opened avenues for novel therapeutic targeting. Although WM remains incurable, with the rapid emergence and integration of effective novel therapies, its clinical course appears poised to improve in the foreseeable future. © 2015 Elsevier Ltd.
Wilcox R.A.,00 First Street SW |
Wilcox R.A.,Mayo Medical School
Frontiers in Bioscience - Elite | Year: 2012
Improved understanding of the cellular and molecular basis of adaptive immunity has been realized over the past few decades, leading to the development of novel immunotherapeutic strategies capable of promoting host anti-tumor immunity. In order to achieve clinically meaningful results, further understanding of the mechanisms by which tumors suppress host immunity, and the development of therapeutic strategies which overcome tumor-associated immune suppression, will be necessary. Myeloid-derived cells with potent immunosuppressive properties are ubiquitous in human cancers. Improved mechanistic understanding of factors promoting their development, activation and mechanisms of immune suppression are being translated into novel therapeutic approaches, and will be summarized herein.
Kung S.,00 First Street SW |
Alarcon R.D.,00 First Street SW |
Williams M.D.,00 First Street SW |
Poppe K.A.,00 First Street SW |
And 2 more authors.
Journal of Affective Disorders | Year: 2013
Background: Patient self-assessment instruments are useful in screening, tracking, and documenting the course of depressive symptoms with minimal clinician time. Two popular instruments are the Beck Depression Inventory (BDI-II) and the Patient Health Questionnaire (PHQ-9). We compared the performance of these two instruments in a mood disorders setting. Methods: A retrospective study of 625 patients who completed a PHQ-9 and BDI-II as part of routine clinical care (1) during initial outpatient evaluation between 2008 and 2009, and (2) on admission to an inpatient mood disorders unit between 2006 and 2009. Pearson correlation coefficients for total PHQ-9 and BDI-II scores were calculated for all patients, the outpatients, and the inpatients. Results: Overall r=0.77, indicating strong correlation, more in the outpatients (n=287, r=0.81) than the inpatients (n=338, r=0.67). Mean PHQ-9 and BDI-II scores for the outpatients were 15.1 (SD 7.4) and 27.8 (SD 14.1) corresponding to moderately severe and moderate categories respectively; for inpatients, 18.9 (SD 5.7) and 33.8 (SD 11.5) corresponding to moderately severe and severe. Limitations: Retrospective design and no monitoring of which instrument was completed first in case that influenced patient response to the second instrument Conclusions: PHQ-9 and BDI-II scores, as continuous but not categorical variables, in a mood disorders subspeciality setting are closely correlated and essentially interchangeable. There are practical applications to our findings, as the PHQ-9 is shorter and free. © 2012 Elsevier B.V.
Kendrick M.L.,00 First Street SW |
Sclabas G.M.,00 First Street SW
HPB | Year: 2011
Background: The feasibility of total laparoscopic pancreaticoduodenectomy (TLPD) has been established. Laparoscopic major venous resection during TLPD has not been reported. The aim of the present study was to describe the technique and outcomes of patients undergoing TLPD with major venous resection. Methods: Retrospective review of all consecutive patients undergoing TLPD and major venous resection from July 2007 to December 2010 was performed. Patient demographics and peri-operative outcomes were retrieved. Data are presented as mean ± standard deviation (SD) or median with range. Results: Out of 129 patients undergoing TLPD, major venous resection was performed in 11 patients with a mean age of 71 years. Median operative time and blood loss was 413 (301-666) min and 500 (75-2800) ml, respectively. Venous resection included tangential (n= 10) and segmental resection (n= 1). Venous reconstruction included patch (n= 4), suture (n= 4), stapled (n= 2) and a left renal vein interposition graft (n= 1). Median mesoportal clamp time was 35 (10-82) min. There was no 30-day or in-hospital mortality. Post-operative imaging was available in 10 patients with 100% patency at the venous reconstruction site. Conclusions: Laparoscopic major venous resection during TLPD is feasible in selected patients. Extensive experience with complex laparoscopic pancreatic resection and reconstruction is advocated before attempting this procedure. © 2011 International Hepato-Pancreato-Biliary Association.
Ernste F.C.,00 First Street SW |
Reed A.M.,Rochester College
Current Opinion in Rheumatology | Year: 2014
Purpose of review: Ongoing research continues to advance our understanding of the juvenile idiopathic inflammatory myopathies (JIIMs). We review the recent contributions from the published literature about the classification, pathogenesis, assessment, and treatment of JIIMs in basic and translational science and clinical research in 2013 through early 2014. Recent findings: Large registries, such as the Childhood Arthritis and Rheumatology Research Alliance registry, are conducting trials to enhance our understanding of JIIMs. Ultraviolet radiation exposure 1 month prior to juvenile dermatomyositis (JDM) may trigger the onset of disease. Myositis-specific autoantibodies define clinical phenotypes in JIIMs. MRI is useful in diagnosing JDM and may be used as a disease assessment tool. Type 1 interferon genes and proteins are increasing in use as disease assessment tools, but larger, prospective, validation studies are needed. Moderate-to-intense physical activity is effective in increasing the aerobic capacity of JDM patients in remission. New criteria developed by the Paediatric Rheumatology International Trials Organization for classifying inactive disease in JDM have practical applicability to the current clinical practice and clinical trials as even after 16.8 years of symptom onset, over half of JDM patients still have active disease. Summary: There has been significant progress in understanding the clinical characteristics, diagnostic workup, treatment, disease assessment, and prognosis of JIIM patients, but more prospective treatment trials are needed, especially in light of the paucity of the current biologic treatment agents available. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.