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 & Heart failure. The organization has 980 authors who have published 1159 publications receiving 49961 citations. The organization is also known as: Ochsner Hospital & Ochsner Foundation Hospital.

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

Laser-assisted extraction of a pacing lead with a supraclavicular course

Abstract: A 68-year-old man with a right-sided pacemaker originallyimplanted as a ventricular-only device more than 25 yearsbefore presentation and later upgraded to a dual-chamberdevice was admitted with a fever. Blood cultures grewmethicillin-resistant Staphylococcus aureus. Transesopha-geal echocardiography revealed a vegetation on a pacinglead. The patient was not pacemaker dependent. Because ofpersistent gram-positive bacteremia, he was referred forextraction of the pacing system.Chestradiographyraisedconcernforanunusualcourseofthe ventricular pacing lead (Figure 1). We suspected that thelead had been implanted via a supraclavicular approach.At the time of the procedure, rotational fluoroscopy(Figure 2 and Online Supplemental Video) verified that thelead coursed over the clavicle, with likely vascular entry atthe right internal jugular vein. Of note, the lead appeared tohave a passive fixation mechanism. Given the passivefixation and the age of the lead, we anticipated the needfor advanced extraction techniques, including laser sheathapplication and/or snaring.The pacemaker pocket was entered and the generatorremoved. The active fixation atrial lead was removed withsimple traction. We then undertook extraction of theventricular lead. The lead was dissected from the extensivelyfibrotic pacemaker pocket. No model number or serialnumber could be identified on the lead. A small supra-clavicular incision was made in the skin overlying thepalpable lead (Figure 3A). In the search for anysupraclavicular anchoring device (eg, suture and/or suturesleeve), the surrounding connective tissue was dissectedaway, but no such anchor was found. The lead was

From policy to practice: A DNP student perspective

Abstract: Background Healthcare's rapid evolution has increased focus on doctoral nursing education and expanded experiential immersion opportunities created through innovative academic-community partnerships. Methods A partnership between an academic institution and a state board of nursing was formed to provide two Doctorate of Nursing Practice (DNP) students with a fellowship opportunity to learn health policy, strategy, and systems thinking which culminated in participation in a state-wide collaborative and published report. Results Practicum experience outcomes consisted of learner comprehension of DNP Essential II as evidenced by attendance at health policy meetings, participation in state-wide Summit planning meetings with community partners and Summit participation, facilitation and follow-up report contribution. Conclusions Providing students with a practicum experience based on the DNP essentials promotes a curriculum based on scholarly evidence to assure the DNP will be competent to face current demands in healthcare. Experiential learning provides a framework for the DNP to fulfill curriculum while applying skills learned in a real-world environment.

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.

New concepts in heart failure with preserved ejection fraction and hypertension

Abstract: Hypertension (HTN) remains the most common and strongest contributing factor to the development of heart failure with preserved ejection fraction (HFpEF). In this review, we aim to summarize the pathophysiological processes linking HTN to HFpEF and highlight novel concepts in medical and device-based management of HFpEF and HTN.Despite the global increase in the prevalence of HFpEF, there has been limited benefit in current medication and device-based therapy for this complex syndrome. The hallmark of HFpEF is an elevated left intra-atrial and ventricular pressure and exertional dyspnea. Traditional medications used for treating HTN in patients with reduced left ventricular ejection fraction have unclear benefits in patients with HFpEF. Careful analysis of emerging medications such as angiotensin receptor-neprilysin inhibitor and sodium-glucose co-transporter-2 inhibitors showed benefit in reducing not only blood pressure but also hospitalizations in patients with HFpEF. Current data on device-based therapy aims to reduce left intra-atrial pressure, ventricular pressure and stimulate baroreceptors to lower blood pressure; however, needs further investigation.The nexus of HTN and HFpEF remains strong and complex. Although traditional medications for treating HFrEF did not affect long-term outcomes, novel therapies with angiotensin receptor neprilysin-inhibitor and sodium-glucose co-transporter-2 inhibitor offer promising results. Many device-based interventions in the HFpEF population are being developed with the aim to reduce left intra-atrial and ventricular pressure; however, their role in HFpEF hypertensive patients needs to be further investigated.