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Jacksonville Beach, FL, United States

Nguyen J.H.,Mayo Clinic in Florida
Neurochemistry International | Year: 2010

Vasogenic mechanism of brain edema in acute liver failure (ALF) remains poorly understood. Recent work demonstrates that matrix metalloproteinase-9 (MMP-9) contributes to the development of brain edema in experimental ALF (J Hepatol 44:1105, 2006). Importantly, MMP-9 blockage with specific monoclonal antibodies and/or synthetic inhibitor, the edema is attenuated. Specifically, utrastructural evaluations demonstrate intact blood-brain barrier and its tight junction. These results suggest that subtle alterations in BBB are likely to involve in the brain edema associated with ALF. © 2009 Elsevier Ltd. All rights reserved.

Liesegang T.J.,Mayo Clinic in Florida
American Journal of Ophthalmology | Year: 2013

Purpose: To provide a current overview of the movement for open access to the peer review literature. Design: Perspective. Methods: Literature review of recent advances in the open access movement with a personal viewpoint of the nuances of the movement. Results: The open access movement is complex, with many different constituents. The idealists for the open access movement are seeking open access to the literature but also to the data that constitute the research within the manuscript. The business model of the traditional subscription journal is being scrutinized in relation to the surge in the number of open access journals. Within this environment authors should beware predatory practices. More government and funding agencies are mandating open access to their funded research. This open access movement will continue to be disruptive until a business model ensures continuity of the scientific record. A flood of open access articles that might enrich, but also might pollute or confuse, the medical literature has altered the filtering mechanism provided by the traditional peer review system. At some point there may be a shake-out, with some literature being lost in cyberspace. Conclusions: The open access movement is maturing and must be embraced in some format. The challenge is to establish a sustainable financial business model that will permit the use of digital technology but yet not endanger the decades-old traditional publication model and peer review system. Authors seem to be slower in adopting open access than the idealists in the movement. © 2013 by Elsevier Inc. All rights reserved.

Ogawa E.,Kyoto University | Hori T.,Mayo Clinic in Florida | Doi H.,Kyoto University | Segawa H.,Kyoto University | Uemoto S.,Kyoto University
Journal of Hepato-Biliary-Pancreatic Sciences | Year: 2012

Background Candidates for orthotopic liver transplantation (OLT) often have porto-pulmonary hypertension (PPHTN) with pulmonary arterial hypertension (PAH). Poor outcomes of PPHTN contraindicate OLT. There are no guidelines for living-donor liver transplantation (LDLT) in PPHTN patients. Methods We present our experiences of LDLT in six patients with moderate or severe PPHTN, along with our institutional guidelines. Three had liver cirrhosis and three were non-cirrhotic. Catheterization studies were undertaken before, during and after LDLT, and the mean pulmonary arterial pressure (mPAP), cardiac output (CO), pulmonary vascular resistance and total peripheral resistance (TPR) were monitored. Results The results showed significant differences in CO and TPR between cirrhotic and non-cirrhotic patients before, during and after LDLT. Cirrhotic patients showed systemic hyperdynamic state. Two cirrhotic patients showed poor responses to pre-transplant treatment, and continued to have increased PAH and poor clinical courses after LDLT. LDLT has an advantage of flexible timing of LT. Currently in our institution, PPHTN patients with mPAP<40 mmHg are registered for LDLT after treatment and catheterization. However, LDLT is performed when mPAP is ≤35 mmHg, leading to improved outcomes. Conclusion PPHTN patients with well-controlled PAH, or secondary PAH resulting from porto-systemic shunts, may be appropriate candidates for LDLT after careful considerations. © Japanese Society of Hepato-Biliary- Pancreatic Surgery and Springer 2011.

Thompson K.M.,Mayo Clinic Florida | Oldenburg W.A.,Mayo Clinic Florida | Deschamps C.,Mayo Medical School | Rupp W.C.,Mayo Clinic in Florida | Smith C.D.,Mayo Clinic Florida
Annals of Surgery | Year: 2011

Objectives: It is estimated that healthcare associated infections (HAI) account for 1.7 million infections and 99,000 associated deaths each year, with annual direct medical costs of up to $45 billion. Surgical Site Infections (SSI) account for 17% of HAIs, an estimated annual cost of $3.5 to 10 billion for our country alone. This project was designed to pursue elimination of SSIs and document results. Methods: Starting in 2009 a program to eliminate SSIs was undertaken at a nationally recognized academic health center. Interventions already outlined by CMS and IHI were utilized, along with additional interventions based on literature showing relationships with SSI reduction and best practices. Rapid deployment of multiple interventions (SSI Bundle) was undertaken. Tactics included standardized order sets, a centralized preoperative evaluation (POE) clinic, high compliance with intraoperative interventions, and widespread monthly reporting of compliance and results. Data from 2008 to 2010 were collected and analyzed. Results: Between May 1, 2008 and June 30, 2010, all patients with Class I and Class II wounds were tracked for SSIs. Baseline data (May-June 2008) was obtained showing a Class I surgical site infection rate of 1.78%, Class II of 2.82% (total surgical volume: 4160 cases). As of the second quarter 2010, those rates have dropped to 0.51% and 1.44%, respectively (P < 0.001 and P = 0.013; total surgical cases: 2826). This represents a 57% decrease in the SSI rate with an estimated institution specific cost savings of nearly $1 million during the study period. Conclusion: Committed leadership, aggressive assurance of high compliance with multiple known interventions (SSI Bundle), transparency to achieve high levels of staff engagement, and centralization of critical surgical activities result in significant declines in SSIs with resulting substantial cost savings. © 2011 by Lippincott Williams & Wilkins.

Short K.D.,Mayo Medical School | Rajkumar S.V.,Mayo Medical School | Larson D.,Mayo Medical School | Buadi F.,Mayo Medical School | And 7 more authors.
Leukemia | Year: 2011

We studied 174 consecutive patients with relapsed refractory multiple myeloma (MM) enrolled on a phase II clinical trial of pomalidomide plus low-dose dexamethasone at Mayo Clinic. Extramedullary disease (EMD) was present at the time of trial entry in 7.5% (13 of 174 patients). The rate of EMD in the first 3 years following diagnosis of MM was 3%. The response of EMD to pomalidomide plus low-dose dexamethasone included two complete and two partial responses among the 13 patients (response rate, 31%). Overall survival measured from trial entry was significantly shorter for patients with treatment-emergent EMD compared with those who did not have EMD, (median 16 months versus not reached, P0.002). © 2011 Macmillan Publishers Limited All rights reserved.

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