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.

The Mechanism of Methylmercury Permeation Through the Blood-Brain Barrier using <i>Caenorhabditis elegans</i>

Abstract: Methylmercury is a neurotoxin present in fish tissues that permeates the blood-brain barrier after consumption. Previous research has shown that methylmercury is harmful to neurons, causing pH alterations, oxidative stress, excitotoxicity, and parenchymal damage. Methylmercury is a known factor of neurological disorders including Alzheimer's and Parkinson's. The method by which methylmercury passes through the blood-brain barrier is largely unknown. According to preliminary studies, one way methylmercury crosses the blood-brain barrier is by creating a complex with L-Cysteine, which facilitates its passage by the LATs system through mimicking another amino acid existing in the body. The human blood-brain barrier was studied using C. elegans as a model organism. It was hypothesized that if methylmercury passes through the blood-brain barrier of C. elegans faster with L-Cysteine present than without L-Cysteine present, the methylmercury's adverse effects (death and locomotive difficulty) will occur sooner. Each of the four experimental groups contained one C. elegans: the control, the L-Cysteine group, the methylmercury group, and the methylmercury and L-Cysteine combination group. The effects of L-Cysteine and methylmercury on C. elegans were studied using three metrics: viability, locomotive disability, and time for locomotive effects to occur. The group that received both methylmercury and L-Cysteine had reduced viability rates and a decreased time for locomotive difficulty to develop, supporting the hypothesis. These findings suggest that L-Cysteine aids methylmercury permeation through the blood-brain barrier. Because the experiment indicates how methylmercury penetrates the blood-brain barrier, these results aid in finding a therapeutic solution to reverse methylmercury neurotoxicity in the brain. Additionally, this study further opens channels into potential therapeutic and preventative measures for dementia, improving morbidity and mortality in neurodegenerative diseases.

Intervención aguda en el ictus: el papel de los cardiólogos intervencionistas

Abstract: E n los últimos años se ha producido un cambio de paradigma en la asistencia aguda del ictus como consecuencia de una serie de ensayos controlados y aleatorizados que han demostrado que una reperfusión realizada en el momento oportuno mediante una trombectomía mecánica (TM) proporciona unos resultados mejores que los de la trombólisis intravenosa en los pacientes con una oclusión de vaso grande (OVG). Este avance crucial en el tratamiento del ictus aporta una mejora trascendental en el restablecimiento funcional en los pacientes con ictus grave que, sin ello, requerirían una cantidad desproporcionada de recursos asistenciales como consecuencia de su discapacidad además de un aumento de la mortalidad. Estos estudios reafirman el principio de que el “tiempo es cerebro” y de que una reperfusión más precoz proporciona un resultado significativamente mejor en los pacientes con ictus por OVG. El proceso de selección de “el paciente apropiado para el tratamiento apropiado y en el momento apropiado” continúa evolucionando con las técnicas de diagnóstico por la imagen que evalúan el tejido cerebral viable residual (penumbra) y una selección más exacta de los pacientes que no se basa ya tan solo en el tiempo transcurrido desde el inicio de los síntomas, lo cual lleva a ampliar el número de pacientes que son candidatos a un tratamiento de reperfusión. En los Estados Unidos, aproximadamente un 10% de los 675.000 primeros ictus isquémicos tienen una OVG y son posibles candidatos a una intervención urgente. Reducir al mínimo el tiempo transcurrido hasta la reperfusión es crucial para optimizar los resultados en cuanto a calidad de vida. Cada 10 min de retraso en la asistencia reducen el periodo de vida del paciente sin discapacidad en alrededor de 40 días y reducen el beneficio monetario neto de la TM en aproximadamente $10.000 (1). El hecho de que actualmente no podamos proporcionar una intervención para el ictus en un periodo de tiempo adecuado a los pacientes que sufren este trastorno fuera de los grandes centros metropolitanos nos trae a la mente un principio planteado por el Premio Nobel Amartya Sen en Poverty and Famines: An Essay on Entitlement and Deprivation (Pobreza y hambrunas: un ensayo sobre el derecho y la privación), en donde explica que, al examinar la inanición y las hambrunas, no solo importa el aporte de alimentos, sino que también la capacidad de las personas de obtenerlos (lo que él denomina derecho) constituye un factor bien definido y de igual importancia como causa del hambre. La comunidad de la neurociencia argumenta que no faltan especialistas neurointervencionistas (NI) para tratar el volumen anual de OVG causantes de ictus. Lo que falta reconocer es la mala distribución geográfica de esos especialistas, que se concentran predominantemente en los centros médicos académicos de las ciudades (2). En los Estados Unidos, tan solo un 50% de la población tiene acceso en un tiempo ≤ 1 h, mediante transporte terrestre, a un centro integral de ictus (CII) con capacidad para tratar el ictus con TM. En California, en 2015, tan solo un 39% de los pacientes con ictus agudos estuvieron a menos de 1 h de hospitales que realizaran 10 intervenciones del ictus o más al año (3). Aun en el supuesto poco realista de que se añadieran 20 CII de ubicación óptima en cada estado, una tercera parte de los pacientes con ictus continuarían sin estar a menos de 1 h de la asistencia en transporte terrestre. Hay varias opciones para mejorar el acceso a la intervención inmediata para los pacientes con ictus. La primera de ellas, respaldada por la comunidad NI, es el “modelo hub-and-spoke” (modelo radial respecto a centro de referencia). Se sugiere establecer un sistema nacional de cribado para trasladar rápidamente a los pacientes con ictus

Epigenetic Biomarkers in Melanoma

Abstract: Epigenetics, defined in its most basic sense as a stable heritable change in gene function that is not a result of changes in the actual DNA sequence, has been one of the fastest growing fields of cancer research over the past decade. DNA promoter methylation is known to directly inhibit gene expression and is a common occurrence during tumor formation and progression. This action may lead to the formation of a heterochromatic environment at the promoter or other sites by histone deacetylases to further suppress target genes.

Bioethics in practice - a quarterly column about medical ethics: ethics, quality, safety, and a just culture: the link is evident.

Abstract: Despite the current challenges of healthcare reform, most would agree that quality in medicine will continue to advance. For example, our ability to accurately diagnose and treat complex and simple disease states has never been as advanced as it is today; this ability will continue to grow. At the same time, participation in the current healthcare system is becoming increasingly complex and therefore potentially even more dangerous to patients. Not surprisingly, patient safety has emerged as a dominant theme in American medicine. Safety experts agree on the critical role that organizational culture plays in reliably preventing medical errors. Culture has been defined as “the way we do things around here.” An effective safety culture is characterized by an environment in which frontline personnel are comfortable disclosing errors, including their own, without fear of repercussions. The “just culture” concept codifies this approach as a job performance expectation that maintains professional accountability. A just culture recognizes that individuals should not be held accountable for the failings of a care system that they do not control, and it maintains professional accountability by not tolerating reckless behavior, conscious disregard of clear risk to patients, or gross misconduct. Innovations in medicine will present the medical community with new options for treating familiar conditions, at times offering opportunities for greater financial gain and reward. As innovations are adopted, variation in care delivery inevitably increases, leading to challenges in ensuring quality and affordability. Albeit with some delay, the medical profession develops and implements outcomes-based guidelines for treatment and diagnosis that are generally based on the ethical principles of beneficence, nonmalfeasance, respect for persons, and justice (responsible allocation of resources). Healthcare providers are challenged daily with situations requiring decisions that balance patient safety with the ethical allocation of resources. Healthcare organizations are increasingly aware of opportunities to change processes and systems and to prevent avoidable harm. It seems that every year a new program is created to improve quality and safety. A new administrator is hired or advanced, and a new medical director is given a title to allow for the advancement of care improvement in the healthcare organization. For individual members of the healthcare team, these activities can quickly result in initiative fatigue. But in the end, one should remember that, as healthcare providers, we are only being asked to always do the right thing, at the right time, to the right person. We are asked to place the patient above everyone, everything, and every strategy. Basically, ethical consideration in all activities within the healthcare setting is demanded. The science of safety, based on work in other industries that involve high-risk situations, is now being applied to medicine. Diligent process reviews to discover variation and prevent defects are at the heart of this science. The ability of any member of the team to feel comfortable reporting any problem at any time is vital for continued success. Linking ethical behavior and decisionmaking to a quality and safety program with a just culture as its most basic component is only logical.1 In a practice environment with a just culture, all members of the healthcare team understand their ethical responsibility to call out defects, including their own, in the system of care without fear of retribution. The organizational ethic is reviewed and controlled by systemwide committees that often spend hours reviewing policies and behaviors surrounding life and death issues. The movement to a just culture applies this type of thinking to everyday healthcare activity. For example, what are the ethical and safety connections of the implementation of the universal time out, wherein all members of the team about to perform a procedure stop all activity to mindfully double-check the patient's identity, the procedure to be performed, the key items needed, and any special considerations affecting safe performance? No moral or ethically correct provider would ever want to perform a procedure on the wrong patient or on the wrong side of the body or to perform the wrong procedure altogether. Yet we continue to see examples of improper time-out practices. In the past year, improper time outs have occurred several times even in our own organization. The physician, nurse, technician, and everyone else involved in patient care failed to do the right thing. Safety, quality, medical legal risk, and ethics were all compromised in one fleeting moment that could have prevented the harm and hardship that befell the patients affected by these lapses. We argue that such events will continue until we collectively achieve a culture of safety and a just culture in our practice settings and organizations. A safe environment for patients requires a culture that allows for the safety of those reporting practitioner lapses and system defects. An ethical organization will have a just culture encoded in its DNA. Every member of the healthcare organization must participate to obtain accurate reporting of potential and actual defects in the delivery system. In safety science, these reports of defective processes—whether or not actual harm did result or could have resulted—are considered essential to the improvement of care systems to achieve a safer patient environment. Hierarchy in healthcare is built into the training and privileging system and will always exist. High-risk industries such as air transportation have identified the authority gradient that results from such hierarchies as a key problem. Establishment of a just culture can improve safety because it clearly demonstrates that speaking up to identify a potential safety hazard or defect is expected of every member of the healthcare team. Some organizations, including ours, have gone as far as using policy to anchor a just culture, but more important is how the spirit of a just culture is practiced every day. In a just culture, the physician is viewed as a member of a team with the same ethical responsibility to provide safe care in an environment that is also psychologically safe for team members.2 The just culture in medicine breaks down the authority gradients and hierarchal barriers that remain prevalent in many practice settings. An ethically correct culture allows for the right behavior toward the patient as well as the individuals involved in the care of that patient. Ethics is about making the right decisions and implementing policies that are fair and just. Ethical thinking protects those who cannot protect themselves. Safety and quality strategies have the same objective. Their successful implementation requires a just culture at their core to protect the entire healthcare team in the reporting of unsafe conditions and behaviors. The connection is pure and simple: Ethics, quality, safety, and a just culture all involve doing the right thing at the right time to the right individual.

Primary Vertical Partial Laryngectomy for T1‐T3 Squamous Cell Carcinoma of the Glottic Larynx

Abstract: Objective: Squamous cell carcinoma of the glottis represents one of the most common malignancies of the head and neck. Although non-operative treatment of these lesions has dominated the last two decades, the use of surgical options, particularly transoral laser microsurgery, has recently seen an increase. Considering this paradigm shift, we seek to revisit the therapeutic role of vertical partial laryngectomy and present our experience with its application for T1-T3 glottic carcinoma.