Ochsner Medical Center

About: Ochsner Medical Center is a healthcare organization based out in New Orleans, Louisiana, United States. It is known for research contribution in the topics: Population & Medicine. The organization has 980 authors who have published 1159 publications receiving 49961 citations. The organization is also known as: Ochsner Hospital & Ochsner Foundation Hospital.

Efficacy and safety of iGlarLixi versus IDegLira in adults with type 2 diabetes inadequately controlled by glucagon-like peptide-1 receptor agonists: a systematic literature review and indirect treatment comparison

Abstract: AIMS To estimate the relative treatment effect between the fixed-ratio combinations iGlarLixi and IDegLira (glucagon-like peptide 1 receptor agonist with basal insulin) in people with type 2 diabetes inadequately controlled on a glucagon-like peptide 1 receptor agonist MATERIALS AND METHODS A systematic literature review of randomized controlled trials followed by an indirect treatment comparison was performed to compare the efficacy and safety of the available fixed-ratio combinations Main outcomes were glycated haemoglobin (HbA1c) change and target achievement [<65% and <70% (<48 and <53 mmol/mol)], fasting plasma glucose, self-monitored plasma glucose, body weight, and incidence and rate of hypoglycaemia RESULTS From 4850 abstracts screened, 78 qualified for full-text article review and two randomized controlled trials were included Baseline characteristics were similar in the two studies The mean difference at 26 weeks between IDegLira and iGlarLixi was -036 (95% credible intervals -058, -014) % [-39 (-63, -15) mmol/mol] for HbA1c and -10 (-16, -04) mmol/L for fasting plasma glucose No significant differences were found in HbA1c target attainment, preprandial or postprandial self-monitored plasma glucose, or body weight change Formal comparisons of hypoglycaemia were limited by differences in definitions between the studies: in non-sulphonylurea users, incidence was 28% for IDegLira ('confirmed' at ≤31 mmol/L); for iGlarLixi, incidence was 9% ('documented symptomatic' at <30 mmol/L) CONCLUSIONS Results of this indirect treatment comparison using two studies suggest iGlarLixi and IDegLira appear to offer similar benefits for HbA1c target achievement However, the findings suggest differences in other glycaemia results and hypoglycaemia, which may reflect differences in study design and titration approaches

Treatment of recurrent metastatic uterine leiomyosarcoma of the spine: a multimodality approach using resection, radiosurgery, and chemotherapy.

Abstract: The authors describe the case of a patient who initially presented with uterine leiomyosarcoma (LMS) that later metastasized to the spine. The patient was treated at another institution for her primary uterine LMS, undergoing resection followed by adjuvant chemotherapy. After several years of disease remission, the patient presented in January 2011 to the authors’ institution with recurrent uterine LMS metastatic to the spine, which has been treated with multiple therapeutic modalities in a combination of surgery, radiosurgery, and chemotherapy. As a result of this approach, the patient has been progression free for 35 months since her presentation (April 2011 to March 2014). We herein describe our experience treating this patient with recurrent uterine LMS of the spine and suggest that patients with recurrent uterine LMSs should be considered for treatment using a multimodality approach with emphasis on enrollment into clinical trials.

3D Fusion between Fluoroscopy Angiograms and SPECT Myocardial Perfusion Images to Guide Percutaneous Coronary Intervention

Abstract: Background. Percutaneous coronary intervention(PCI) in stable coronary artery disease(CAD) is commonly triggered by abnormal myocardial perfusion imaging(MPI). However, due to the possibilities of multivessel disease and variability of coronary artery perfusion distribution, opportunity exists to better align anatomic stenosis with perfusion abnormalities to improve revascularization decisions. This study aims to develop a 3D multi-modality fusion approach to assist decision-making for PCI. Methods. Coronary arteries from fluoroscopic angiography(FA) were reconstructed into 3D artery anatomy. Left ventricular(LV) epicardial surface was extracted from SPECT. The 3D artery anatomy was non-rigidly fused with the LV epicardial surface. The accuracy of the 3D fusion was evaluated via both computer simulation and real patient data. For technical validation, simulated FA and MPI were integrated and then compared with the ground truth from a digital phantom. For clinical validation, FA and SPECT images were integrated and then compared with the ground truth from CT angiograms. Results. In the technical evaluation, the distance-based mismatch error between simulated fluoroscopy and phantom arteries is 1.86(SD:1.43)mm for left coronary arteries(LCA) and 2.21(SD:2.50)mm for right coronary arteries(RCA). In the clinical validation, the distance-based mismatch errors between the fluoroscopy and CT arteries were 3.84(SD:3.15)mm for LCA and 5.55(SD:3.64)mm for RCA. The presence of the corresponding fluoroscopy and CT arteries in the AHA 17-segment model agreed well with a Kappa value of 0.91(95% CI: 0.89-0.93) for LCA and 0.80(CI: 0.67-0.92) for RCA. Conclusions. Our fusion approach is technically accurate to assist PCI decision-making and is clinically feasible to be used in the catheterization laboratory. There is an opportunity to improve the decision-making and outcomes of PCI in stable CAD.

Use of Body Fatness Cutoff Points–Reply–I

Abstract: We appreciate Dr Snitker's interest in our recent editorial1 and his insightful comments regarding body fat (BF) and obesity. Additionally, we are aware of his clinical and research efforts in the area of obesity in children at the University of Maryland School of Medicine. Dr Snitker is correct that currently there is no definitive cutoff for percent BF in defining overweightness or obesity in men or women. In our efforts to simplify the message for readers, we referenced an easily accessible National Institutes of Health (NIH) publication2 that we thought was representative. Generally, we have referenced a major source from the World Health Organization (WHO)3 as opposed to this simple NIH Web site in our research publications from Ochsner Clinic4 and Mayo Clinic.5,6 However, we agree with Snitker that, regardless of the reference, there is no criterion standard for defining overweightness or obesity by the BF method. We previously demonstrated in a cross-sectional design of 13,601 participants (age, 20-80 years; 48% men) from the Third National Health and Nutrition Examination Survey (NHANES III)6 that the mean ± SD body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) in men was 26.6±4.6 and the mean ± SD percent BF was 24.8%±6.0%. Corresponding values in women were 27.6±6.4 and 36.7%±7.4%, respectively. In 6171 participants in NHANES III who had a BMI in the reference range (18.5-24.9), the highest tertile of BF was greater than 23.1% in men and greater than 33.3% in women (labeled as normal weight obesity).7 In this cohort with normal weight obesity defined by elevated BF, the prevalence of metabolic syndrome was 4 times higher than in those with low BF, and these individuals had a higher prevalence of dyslipidemia (men and women) and of hypertension (men) and a 2.2-fold increased risk of cardiovascular (CV) mortality (women) compared with those with low BF. These data suggest that this level of BF is associated with adverse CV risk and prognosis in primary prevention. In secondary prevention, having increased BF (>25% in men and >35% in women) appears to be associated with a protective effect in patients with coronary heart disease (CHD).4 In fact, in patients with CHD4,8 and in those with heart failure,9,10 a higher BF was an independent predictor of event-free survival because of the obesity paradox, which we discussed in our editorial.1 Oreopoulos et al11 in their heart failure study used a Gallager classification of BF based on age, sex, and race and classified patients as underweight, normal, overweight, and obese.12 In preliminary data from our CHD population (n=581) using this Gallager classification, we have found the highest mortality in the underweight and lowest mortality in the overweight, who also had significantly lower mortality than the “normal BF” group during a 3-year follow-up (A.D.S, C.J.L, and R.V.M., unpublished observations, May 1, 2010). The obese group had intermediate mortality, which was significantly lower than the underweight and trended lower than the normal BF group but did not reach statistical significance. Therefore, current research suggests that the obesity cutoff points of BF are in the 23%-25% range in men and 33%-35% range in women (or 30% in women from the NIH,2 as Dr Snitker stated in his letter), which are associated with increased CV risk in primary prevention and reduced risk in patients with established CV disease (obesity paradox). However, we agree that additional research is needed to clearly define optimal BF in patients of both sexes and of various ages, races, and ethnic groups, as well as disease states. Clearly, major organizations such as the WHO, NIH, and major obesity societies should attempt to establish such cutoff points for BF, as was done years ago with BMI.