Mayo Clinic proceedings
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Mayo Clinic proceedings · Jul 2010
Review Meta AnalysisIntraoperative echocardiography in valvular heart disease: an evidence-based appraisal.
Intraoperative (IO) transesophageal echocardiography (TEE) is widely used for assessing the results of valvular heart disease (VHD) surgery. Epiaortic ultrasonography (EAU) has been recommended for prevention of perioperative strokes. To what extent does high-quality evidence justify the widespread use of these imaging modalities? In March 2009, we searched MEDLINE (PubMed and OVID interfaces) and EMBASE for studies published in English using database-specific controlled vocabulary describing the concepts of IOTEE, cardiac surgery, VHD, and EAU. ⋯ The value of IOTEE in isolated aortic valve replacement remains less clear. Evidence supporting EAU is scientifically more robust but conflicting. These findings have important clinical policy and research implications.
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Mayo Clinic proceedings · Jul 2010
ReviewCancer-associated myeloproliferation: old association, new therapeutic target.
The association between malignancy and development of a paraneoplastic leukocytosis, the so-called leukemoid reaction, has long been appreciated. Although a leukemoid reaction has conventionally been defined as a peripheral blood leukocytosis composed of both mature and immature granulocytes that exceeds 50,000/microL, a less profound leukocytosis may be appreciated in many patients harboring a malignant disease. More recent insights have shed new light on this long-recognized association, because research performed in both murine models and cancer patients has uncovered multiple mechanisms by which tumors both drive myelopoiesis, sometimes leading to a clinically apparent leukocytosis, and inhibit the differentiation of myeloid cells, resulting in a qualitative change in myelopoiesis. ⋯ More recently, myeloid cells have been shown to promote tumor angiogenesis. Cancer-associated myeloproliferation is not merely a paraneoplastic phenomenon of questionable importance but leads to the suppression of host immunity and promotion of tumor angiogenesis, both of which play an integral part in tumorigenesis and metastasis. Therefore, cancer-associated myeloproliferation represents a novel therapeutic target in cancer that, decades after its recognition, is only now being translated into clinical practice.
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Mayo Clinic proceedings · Jul 2010
Review Meta AnalysisSexual abuse and lifetime diagnosis of psychiatric disorders: systematic review and meta-analysis.
To systematically assess the evidence for an association between sexual abuse and a lifetime diagnosis of psychiatric disorders. ⋯ A history of sexual abuse is associated with an increased risk of a lifetime diagnosis of multiple psychiatric disorders.
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Mayo Clinic proceedings · Jul 2010
Randomized Controlled Trial Multicenter Study Comparative StudyA phase 3, double-blind, randomized, placebo-controlled study of armodafinil for excessive sleepiness associated with jet lag disorder.
To assess the effect of armodafinil, the longer-lasting isomer of modafinil, on jet lag disorder. ⋯ Armodafinil increased wakefulness after eastward travel through 6 time zones.