309 Jackson St 4Th Floor Nicu
Monroe LA 71201
Medical School: Other - Unknown
Accepts Medicare: No
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: 08063R
Request Appointment Information
Awards & Recognitions
Medical Malpractice Cases
Medical Board Sanctions
Heterogeneity of metastatic pancreatic adenocarcinoma: Lung metastasis show better prognosis than liver metastasis-a case control study. - Oncotarget
The prognosis of metastatic pancreatic ductal adenocarcinoma (PDAC) is grim, with a median overall survival of under 1 year. In our clinical practice, we observed a few cases of isolated lung metastases from PDAC with unusually long outcomes. We compared these cases in a case-control study of lung-only vs. liver-only metastases from PDAC.From our database, we found 37 cases of lung-only metastases and paired them with 37 cases of liver-only metastases by age, tumor location and treatment.The lung-only group differed significantly from the liver-only group with respect to the following parameters: female predominance, more metachronous cases, fewer nodules per patient, and smaller increases in tumor markers. Local invasion parameters (i.e., arterial or venous involvement) were not significantly different. The outcomes were significantly different, with a median overall survival from the occurrence of metastases of 20.8 vs. 9.1 months and a median progression-free survival of 11 vs. 3.5 months.In conclusion, this case-control study seemed to confirm that lung-only PDAC metastases have prognoses different from those of liver-only metastases. A better understanding of the mechanisms underlying these differences will help identify abnormalities associated with tumor aggressiveness.
On the computation of a retina resistivity profile for applications in multi-scale modeling of electrical stimulation and absorption. - Physics in medicine and biology
This study proposes a methodology for computationally estimating resistive properties of tissue in multi-scale computational models, used for studying the interaction of electromagnetic fields with neural tissue, with applications to both dosimetry and neuroprosthetics. Traditionally, models at bulk tissue- and cellular-level scales are solved independently, linking resulting voltage from existing resistive tissue-scale models as extracellular sources to cellular models. This allows for solving the effects that external electric fields have on cellular activity. There are two major limitations to this approach: first, the resistive properties of the tissue need to be chosen, of which there are contradicting measurements in literature; second, the measurements of resistivity themselves may be inaccurate, leading to the mentioned contradicting results found across different studies. Our proposed methodology allows for constructing computed resistivity profiles using knowledge of only the neural morphology within the multi-scale model, resulting in a practical implementation of the effective medium theory; this bypasses concerns regarding the choice of resistive properties and accuracy of measurement setups. A multi-scale model of retina is constructed with an external electrode to serve as a test bench for analyzing existing and resulting resistivity profiles, and validation is presented through the reconstruction of a published resistivity profile of retina tissue. Results include a computed resistivity profile of retina tissue for use with a retina multi-scale model used to analyze effects of external electric fields on neural activity.
Retinal Remodeling and Metabolic Alterations in Human AMD. - Frontiers in cellular neuroscience
Age-related macular degeneration (AMD) is a progressive retinal degeneration resulting in central visual field loss, ultimately causing debilitating blindness. AMD affects 18% of Americans from 65 to 74, 30% older than 74 years of age and is the leading cause of severe vision loss and blindness in Western populations. While many genetic and environmental risk factors are known for AMD, we currently know less about the mechanisms mediating disease progression. The pathways and mechanisms through which genetic and non-genetic risk factors modulate development of AMD pathogenesis remain largely unexplored. Moreover, current treatment for AMD is palliative and limited to wet/exudative forms. Retina is a complex, heterocellular tissue and most retinal cell classes are impacted or altered in AMD. Defining disease and stage-specific cytoarchitectural and metabolic responses in AMD is critical for highlighting targets for intervention. The goal of this article is to illustrate cell types impacted in AMD and demonstrate the implications of those changes, likely beginning in the retinal pigment epithelium (RPE), for remodeling of the the neural retina. Tracking heterocellular responses in disease progression is best achieved with computational molecular phenotyping (CMP), a tool that enables acquisition of a small molecule fingerprint for every cell in the retina. CMP uncovered critical cellular and molecular pathologies (remodeling and reprogramming) in progressive retinal degenerations such as retinitis pigmentosa (RP). We now applied these approaches to normal human and AMD tissues mapping progression of cellular and molecular changes in AMD retinas, including late-stage forms of the disease.
Heart rate variability and cardiac baroreflex inhibition-derived index predicts pain perception in burn patients. - Burns : journal of the International Society for Burn Injuries
Dressing changes induce acute pain in burn patients. This pain is difficult to predict and may be therefore undertreated. Two different non-invasive electrophysiological indices from heart rate variability and baroreflex inhibition-derived indices, analgesia/nociception index (ANI) and cardiovascular depth of analgesia (CARDEAN), have been proposed to predict and better assess adequacy of anti-nociception. The aim of this study was to evaluate these techniques as early pain alert tools in conscious burnt patients during dressing changes' procedures.Twenty adult burnt patients undergoing scheduled wound treatment procedures were included in this prospective observational study. Pain intensity was assessed using a 0-10 numerical rating scale (NRS) and was compared with both ANI and CARDEAN, during the procedures. Non parametric rank sum test and linear discriminant analysis were used for evaluating potential differences of measured variables between periods with different pain intensities. Receiver-operating characteristic (ROC) curves were built to assess their performance to detect pain within following 15s.The sensitivity and specificity of ANI to detect pain were 67% and 70% and those of CARDEAN were 77% and 80%, with area under the curve (AUC) values of 0.75 and 0.83, respectively. Their combination increased AUC to 0.87.Both ANI and CARDEAN indices during wound treatment procedures seem to discriminate periods with and without pain within 15s, serving as a potential complementary tool for early optimized pain control.Copyright Â© 2016 Elsevier Ltd and ISBI. All rights reserved.
Identification of selenocompounds with promising properties to reverse cancer multidrug resistance. - Bioorganic & medicinal chemistry letters
In previous studies, 56 novel selenoesters and one cyclic selenoanhydride with chemopreventive, antiproliferative and cytotoxic activity were described. Herein, the selenoanhydride and selected selenoesters were evaluated for their ability to reverse the cancer multidrug resistance (MDR) using the ABCB1 efflux pump inhibition assay in mouse MDR T-lymphoma cells. Results showed that the selenoanhydride (1) and the selenoesters with ketone terminal fragments (9-11) exerted (1.7-3.6)-fold stronger efflux pump inhibitory action than the reference verapamil. In addition, those four derivatives triggered apoptotic events in more than 80% of the examined MDR mouse cells.Copyright Â© 2016 Elsevier Ltd. All rights reserved.
MÃ¼ller cell metabolic chaos during retinal degeneration. - Experimental eye research
MÃ¼ller cells play a critical role in retinal metabolism and are among the first cells to demonstrate metabolic changes in retinal stress or disease. The timing, extent, regulation, and impacts of these changes are not yet known. We evaluated metabolic phenotypes of MÃ¼ller cells in the degenerating retina. Retinas harvested from wild-type (WT) and rhodopsin Tg P347L rabbits were fixed in mixed aldehydes and resin embedded for computational molecular phenotyping (CMP). CMP facilitates small molecule fingerprinting of every cell in the retina, allowing evaluation of metabolite levels in single cells. CMP revealed signature variations in metabolite levels across MÃ¼ller cells from TgP347L retina. In brief, neighboring MÃ¼ller cells demonstrated variability in taurine, glutamate, glutamine, glutathione, glutamine synthetase (GS), and CRALBP. This variability showed no correlation across metabolites, implying the changes are functionally chaotic rather than simply heterogeneous. The inability of any clustering algorithm to classify MÃ¼ller cell as a single class in the TgP347L retina is a formal proof of metabolic variability in the present in degenerating retina. Although retinal degeneration is certainly the trigger, MÃ¼ller cell metabolic alterations are not a coherent response to the microenvironment. And while GS is believed to be the primary enzyme responsible for the conversion of glutamate to glutamine in the retina, alternative pathways appear to be unmasked in degenerating retina. Somehow, long term remodeling involves loss of MÃ¼ller cell coordination and identity, which has negative implications for therapeutic interventions that target neurons alone.Copyright Â© 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.
Why Patient Matching Is a Challenge: Research on Master Patient Index (MPI) Data Discrepancies in Key Identifying Fields. - Perspectives in health information management / AHIMA, American Health Information Management Association
Patient identification matching problems are a major contributor to data integrity issues within electronic health records. These issues impede the improvement of healthcare quality through health information exchange and care coordination, and contribute to deaths resulting from medical errors. Despite best practices in the area of patient access and medical record management to avoid duplicating patient records, duplicate records continue to be a significant problem in healthcare. This study examined the underlying causes of duplicate records using a multisite data set of 398,939 patient records with confirmed duplicates and analyzed multiple reasons for data discrepancies between those record matches. The field that had the greatest proportion of mismatches (nondefault values) was the middle name, accounting for 58.30 percent of mismatches. The Social Security number was the second most frequent mismatch, occurring in 53.54 percent of the duplicate pairs. The majority of the mismatches in the name fields were the result of misspellings (53.14 percent in first name and 33.62 percent in last name) or swapped last name/first name, first name/middle name, or last name/middle name pairs. The use of more sophisticated technologies is critical to improving patient matching. However, no amount of advanced technology or increased data capture will completely eliminate human errors. Thus, the establishment of policies and procedures (such as standard naming conventions or search routines) for front-end and back-end staff to follow is foundational for the overall data integrity process. Training staff on standard policies and procedures will result in fewer duplicates created on the front end and more accurate duplicate record matching and merging on the back end. Furthermore, monitoring, analyzing trends, and identifying errors that occur are proactive ways to identify data integrity issues.
Determination of 3-Monochloropropane-1,2-diol and 2-Monochloropropane-1,3-diol (MCPD) Esters and Glycidyl Esters by Microwave Extraction in Different Foodstuffs. - Journal of agricultural and food chemistry
This paper describes a method for the determination of 3-monochloropropane-1,2-diol and 2-monochloropropane-1,3-diol (MCPD) esters and glycidyl esters in various foodstuffs, which are isolated using microwave extraction. The next step is based on alkaline-catalyzed ester cleavage. The released glycidol is transformed into monobromopropanediol (MBPD). All compounds are derivatized in free diols (MCPD and MBPD) with phenylboronic acid and analyzed by gas chromatography-mass spectrometry (GC-MS). The method was validated for oils with a limit of quantitation (LOQ) of 0.1 mg/kg, for chips and crisps with a LOQ of 0.02 mg/kg, and for infant formula with a LOQ of 0.0025 mg/L. Recoveries of each sample were controlled by standard addition on extracts before derivatization. Quantitation was performed by the addition of isotopically labeled glycidyl and 3-monochloropropane-1,2-diol (3-MCPD) esters.
[Association of sarcoidosis and Takayasu's disease: A case report]. - Revue de pneumologie clinique
Vascular lesion of sarcoidosis is rare, it may precede, follow or occur with the symptoms of a Takayasu's disease. Many pathogenic mechanisms (infectious, genetic and immunological) participate in associating those two diseases.We describe the case of a 24-year-old female patient, hospitalized for a check up for mediastinal and cervical adenopathies, nasal obstruction with intermittent claudication in the upper limbs evolving over eight months the clinic examination shows an abolition of radial pulses. The final diagnosis was sarcoidosis with mediastinal and peripheral lymphadenopathy and a nasal lesion associated to a Takayasu arteritis (4 ACR criteria for Takayasu disease). We noticed a good clinical and radiological evolution after one year of oral corticotherapy.The association between sarcoidosis and Takayasu's disease remains rare, thus a differential diagnosis.Copyright Â© 2015 Elsevier Masson SAS. All rights reserved.
Physical Activity Volumes during Pregnancy: A Systematic Review and Meta-Analysis of Observational Studies Assessing the Association with Infant's Birth Weight. - AJP reports
Objectiveâ€ƒThis study aims to examine the association between different maternal physical activity exposures during pregnancy and infant's birth weight, body composition, and risk of inadequate weight. Methodsâ€ƒTwo reviewers (M.B. and J.L.G.) identified observational studies reporting total or leisure time activity during pregnancy and birth weight outcomes. Pooled analyses were performed to summarize the risk associated with high or moderate volumes of physical activity on birth weight. Resultsâ€ƒA total of 54 studies among 4,080 reported the association between physical activity and birth weight (37 studies) or risks of small or large birth weight. The association between physical activity and birth weight was evaluated by physical activity levels (low, moderate, or high). Despite heterogeneity, pooled results (23 studies) suggested that moderate levels of activity are associated with an increased birth weight (mean difference: 61.5â€‰g, 95% confidence interval [CI]: 16.6, 106.5, 15 studies), while high levels were associated with lower birth weight (mean difference: -69.9â€‰g, 95% CI: -114.8, -25.0, 15 studies). Data were insufficient to provide robust estimates for other outcomes. Conclusionsâ€ƒThe results of observational studies suggest an inverted u-shaped association between physical activity and birth weight, despite methodological variability. These results could help refining physical activity guidelines for pregnancy and provide guidance for future research.
Map & Directions
309 Jackson St 4Th Floor Nicu Monroe, LA 71201
611 Grammont St.