Mayo Clinic proceedings最新文献

{"title":"Epidemiology of Postural Orthostatic Tachycardia Syndrome.","authors":"Jay B Lusk, Cheryl Kalapura, Fan Li, Brian Mac Grory, Emily O'Brien, Shannon Aymes","doi":"10.1016/j.mayocp.2025.04.027","DOIUrl":"https://doi.org/10.1016/j.mayocp.2025.04.027","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasma Levels of Fibroblast Growth Factor 21 and Adverse Kidney Outcomes.","authors":"Hee Byung Koh, Hyo Jeong Kim, Hyung Woo Kim, Tae Ik Chang, Jung Tak Park, Tae-Hyun Yoo, Shin-Wook Kang, Seung Hyeok Han","doi":"10.1016/j.mayocp.2024.10.026","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.10.026","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the association between fibroblast growth factor 21 (FGF21) and adverse kidney outcomes.</p><p><strong>Methods: </strong>From the prospective observational cohort study using data from the UK Biobank between March 13, 2006, and August 31, 2017, a total of 32,281 individuals with estimated glomerular filtration rate of 60 mL/min per 1.73 m² and higher and urine albumin to creatinine ratio below 30 mg/g (cohort 1) and 3339 individuals with estimated glomerular filtration rate below 60 mL/min per 1.73 m² or urine albumin to creatinine ratio of 30 mg/g and higher (cohort 2), all with baseline plasma FGF21 measurements, were included. The primary predictor was plasma FGF21 levels measured by proximity extension assay. The primary outcomes were incident chronic kidney disease (CKD) for cohort 1 and incident kidney failure requiring replacement therapy (KFRT) for cohort 2.</p><p><strong>Results: </strong>In cohort 1, 804 (5.6%) participants experienced the CKD outcome during a median 13.7 years of follow-up. A cause-specific competing model revealed adjusted hazard ratios with 95% CIs of 1.01 (0.88 to 1.17), 1.01 (0.87 to 1.17), and 1.25 (1.08 to 1.44) for Q2 to Q4 compared with Q1 (P_trend=.002). In cohort 2, 83 (2.5%) participants had KFRT during a median 13.7 years of follow-up. Elevated FGF21 levels were similarly associated with a higher KFRT risk, with adjusted hazard ratios of 2.79 (0.97 to 8.05), 3.91 (1.44 to 10.66), and 3.81 (1.44 to 10.08) for Q2 to Q4 (P_trend=.01). Subgroup analysis revealed stronger association in non-CKD participants with obesity and dyslipidemia, whereas for CKD participants, this association was stronger in those with increased inflammatory markers.</p><p><strong>Conclusion: </strong>Higher FGF21 levels correlated with heightened risks of adverse kidney outcomes in individuals with and without CKD. However, the metabolic abnormalities potentially influencing this association varied according to baseline kidney function.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence-Enhanced Electrocardiography for Prediction of Occult Atrial Fibrillation in Patients With Stroke Who Undergo Prolonged Cardiac Monitoring.","authors":"Carmen R Holmes, Ahmed K Ahmed, Kathryn E Mangold, Peter A Noseworthy, Francisco Lopez-Jimenez, Jonathan Graff-Radford, Alejandro A Rabinstein, Stephen W English","doi":"10.1016/j.mayocp.2024.10.019","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.10.019","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the performance of an artificial intelligence (AI)-enhanced electrocardiography (ECG; AI-ECG) algorithm to predict atrial fibrillation (AF) detection on prolonged cardiac monitoring (PCM) after index stroke.</p><p><strong>Patients and methods: </strong>This retrospective study included all adult patients with ischemic stroke evaluated at Mayo Clinic with baseline ECG and PCM from January 1, 2018, to December 31, 2020. We recorded demographic characteristics, clinical features, presumed stroke mechanism, PCM duration, and PCM outcome (AF vs no AF) and AF burden. Electrocardiograms were analyzed using the AI-ECG algorithm to determine likelihood of AF capture with PCM. Stroke etiology was adjudicated using TOAST (Trial of ORG 10172 in Acute Stroke Treatment) and embolic stroke of undetermined source (ESUS) definitions. The ability of the AI-ECG algorithm to predict AF detected by PCM was assessed via receiver operating characteristics analysis, calculating the area under the receiver operating characteristic curve (C statistic). Sensitivity and specificity analyses were performed for each tool using optimal cutoffs (using maximum Youden indices).</p><p><strong>Results: </strong>We identified 863 patients for inclusion in the study. The median age was 69 years, 496 (57.5%) were male, 367 (42.5%) were women, and 561 patients (65.0%) were categorized as having ESUS. Prolonged cardiac monitoring detected AF in 85 patients (9.8%). Median duration of PCM was 30 days (IQR, 25 to 30 days). The AI-ECG algorithm identified a notable difference in probability of AF on PCM. For its optimal model output cutoff of 0.24, AI-ECG had a negative predictive value of 94.2% (95% CI, 92.2% to 95.9%) and a specificity of 81.8% (95% CI, 78.9% to 84.4%) for excluding AF on PCM. When evaluating for an AF burden of 6 minutes or longer, the AI-ECG had a negative predictive value of 96.7% (95% CI, 95.5% to 97.6%). There was no significant difference in the area under the receiver operating characteristic curve when comparing the ESUS vs non-ESUS subgroups (P=.42).</p><p><strong>Conclusion: </strong>This study found that AI-ECG may help identify patients unlikely to have AF on PCM and can predict the occurrence of longer episodes of AF. Thus, AI-ECG may be used to stratify which patients should undergo PCM after stroke. Future studies should compare the performance of AI-ECG and PCM for the clinical end point of stroke recurrence.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CSF1R-Related Leukoencephalopathy.","authors":"Daniel Demehin, Daniel L Kenney-Jung, Francis Deng","doi":"10.1016/j.mayocp.2025.04.003","DOIUrl":"https://doi.org/10.1016/j.mayocp.2025.04.003","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors and Outcomes of Patients With Cholangiocarcinoma and Primary Sclerosing Cholangitis.","authors":"Srija Manchkanti, Udhayvir Singh Grewal","doi":"10.1016/j.mayocp.2025.04.013","DOIUrl":"https://doi.org/10.1016/j.mayocp.2025.04.013","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rosai-Dorfman Disease: Meningioma Mimics.","authors":"Qinglin Zhong, Xueqi Sun, Binglin Lai","doi":"10.1016/j.mayocp.2025.04.001","DOIUrl":"https://doi.org/10.1016/j.mayocp.2025.04.001","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal Sepsis Review and Update","authors":"Fadi B. Yahya MD, MHA ,&nbsp;Amy L. Van Abel PharmD, RPh ,&nbsp;Benjamin D. Brakke DO ,&nbsp;Raj Palraj MBBS ,&nbsp;Linda M. Szymanski MD, PhD ,&nbsp;Megan L. Chapman PharmD, RPh, MPH ,&nbsp;Yvonne S. Butler Tobah MD ,&nbsp;Nipunie S. Rajapakse MD, MPH ,&nbsp;Laura M. Dinnes PharmD, BCIDP, BCPPS","doi":"10.1016/j.mayocp.2025.03.024","DOIUrl":"10.1016/j.mayocp.2025.03.024","url":null,"abstract":"<div><div>Maternal sepsis rates are increasing and now rank as the second leading cause of preventable maternal mortality. The Centers for Medicare and Medicaid Services (CMS) has responded to this trend through the Severe Sepsis/Septic Shock Management Bundle (SEP-1) initiative, which aims to improve sepsis care and will be integrated into the Hospital Value-Based Purchasing program by 2026. This article provides an update on maternal sepsis definitions, screening, and management in line with recent CMS guidance. A comprehensive literature search was conducted with PubMed, Google Scholar, Scholar GPT, and Google to identify national and international guidelines on maternal sepsis. In addition, 2 focused literature searches were performed: one targeting maternal sepsis review articles and the other exploring early warning tools for maternal sepsis. Recognizing that maternal sepsis occurs in the outpatient and inpatient settings, we emphasize the need for early detection in both settings. We introduce a 3-stage screening and diagnostic framework along with a care process model for the initial management of maternal sepsis, both grounded in best practices and designed to align with CMS guidance. In addition, alternative regimens for treating peripartum infections are suggested in light of the recent Clinical and Laboratory Standards Institute updates on aminoglycosides. Strategies for managing β-lactam allergies are also explored, offering tailored treatment regimens for patients with varying allergic reactions. The article concludes by highlighting the long-term impact of sepsis and the critical need for comprehensive postdischarge follow-up to ensure optimal recovery.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 7","pages":"Pages 1212-1230"},"PeriodicalIF":6.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144519098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Reply: “Dialysis Transition Patterns of Chronic Kidney Disease Patients With and Without Heart Failure”","authors":"John J. Sim MD,&nbsp;Mitchell E. Flagg MD","doi":"10.1016/j.mayocp.2025.04.026","DOIUrl":"10.1016/j.mayocp.2025.04.026","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 7","pages":"Pages 1252-1254"},"PeriodicalIF":6.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144519097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early-Onset Gastrointestinal Cancers and Metabolic Risk Factors: Global Trends From the Global Burden of Disease Study 2021","authors":"Pojsakorn Danpanichkul MD ,&nbsp;Kanokphong Suparan MD ,&nbsp;Thanida Auttapracha ,&nbsp;Primrose Tothanarungroj ,&nbsp;Siwanart Kongarin ,&nbsp;Krittameth Rakwong ,&nbsp;Darren Jun Hao Tan MBBS ,&nbsp;Banthoon Sukphutanan MD ,&nbsp;Mark D. Muthiah MBBS ,&nbsp;Daniel Tung MD ,&nbsp;Junpeng Luo MD ,&nbsp;Asahiro Morishita MD ,&nbsp;En Ying Tan MD ,&nbsp;Hirokazu Takahashi MD ,&nbsp;Omar Y. Mousa MD ,&nbsp;Rashid N. Lui MBBS ,&nbsp;Mazen Noureddin MD ,&nbsp;Donghee Kim MD ,&nbsp;Denise M. Harnois DO ,&nbsp;Ju Dong Yang MD ,&nbsp;Karn Wijarnpreecha MD","doi":"10.1016/j.mayocp.2024.10.021","DOIUrl":"10.1016/j.mayocp.2024.10.021","url":null,"abstract":"<div><h3>Objective</h3><div>To explore the increasing incidence of gastrointestinal (GI) cancers and related risk factors in younger patients.</div></div><div><h3>Patient and Methods</h3><div>We used data from the Global Burden of Disease Study 2021 to assess the incidence, mortality, and disability-adjusted life years (DALYs) for early-onset (age 15 to 49 years) GI cancers, including mortality and DALYs from diabetes mellitus and high body mass index.</div></div><div><h3>Results</h3><div>In 2021, there were approximately 499,800 incident cases, 285,900 deaths, and 14.01 million DALYs from early-onset GI cancer. Early-onset GI cancer accounted for 9.51% of the incidence and 7.73% of the mortality of the overall GI cancer. From 2000 to 2021, age-standardized incidence rates increased for early-onset colorectal cancer (annual percent change, 0.84%; 95% CI, 0.71% to 0.97%<strong><em>)</em></strong> and biliary tract cancer (annual percent change, 0.19%; 95% CI, 0.06% to 0.32%). In 2021, there were 20,860 deaths from early-onset GI cancer attributable to metabolic risk factors. The age-standardized death rates of early-onset GI cancer from metabolic risk factors increased in all types of early-onset GI cancer.</div></div><div><h3>Conclusion</h3><div>Our research highlights a significant increase in early-onset GI cancer, emphasizing the need for a strategy that includes controlling risk factors, particularly metabolic risk factors, adoption of effective screening methods, and effective cancer management.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 7","pages":"Pages 1159-1171"},"PeriodicalIF":6.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Midwest Urban-Rural Differences in Cancer Prevalence","authors":"Christine M. Prissel MPH ,&nbsp;Brandon R. Grossardt MS ,&nbsp;Lila J. Finney Rutten PhD, MPH ,&nbsp;Christi A. Patten PhD, MA ,&nbsp;Jessica D. Austin PhD, MPH ,&nbsp;Jennifer L. St. Sauver PhD, MPH","doi":"10.1016/j.mayocp.2024.11.026","DOIUrl":"10.1016/j.mayocp.2024.11.026","url":null,"abstract":"<div><h3>Objective</h3><div>To assess differences in cancer prevalence across the urban-rural continuum, which may help identify target areas for cancer treatment and prevention efforts.</div></div><div><h3>Methods</h3><div>We identified residents of a 27-county region of Minnesota and Wisconsin on January 1, 2020, using the Rochester Epidemiology Project. Rural-urban commuting area classifications were used to categorize addresses as urban core, large town, small town, or isolated rural. Diagnostic codes were extracted from the 4 years prior. Codes were grouped into cancer types by Clinical Classifications Software Refined categories. Logistic regression models were used to estimate the effect of rurality on cancer prevalence. Analyses were stratified by rurality, directly standardized by age and sex to the total 2020 US population using survey sampling weights and analytically adjusted by including indicator variables for non-White race, Hispanic ethnicity, and smoking status.</div></div><div><h3>Results</h3><div>We found a higher prevalence of Hodgkin lymphoma among isolated rural residents compared with urban residents (odds ratio [OR], 1.77; 95% CI, 1.28 to 2.44). In addition, men in large towns had a higher prevalence of throat cancer compared with urban men (OR, 1.57 [1.03 to 2.39]). Rural women had a higher prevalence of colorectal (large town: OR, 1.32 [1.12 to 1.55]; small town: OR, 1.23 [1.00 to 1.53]), anal (isolated rural: OR, 2.22 [1.27 to 3.88]), and ovarian (large town: OR, 1.40 [1.09 to 1.78]) cancer compared with women residing in urban areas.</div></div><div><h3>Conclusion</h3><div>Our findings underscore the importance of moving beyond the simple urban-rural dichotomy to address cancer disparities.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 7","pages":"Pages 1172-1187"},"PeriodicalIF":6.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}