Mayo Clinic proceedings最新文献

{"title":"Cross-sectional and Longitudinal Associations Between Family History of Type 2 Diabetes Mellitus, Hypertension, and Dyslipidemia and Their Prevalence and Incidence: Toranomon Hospital Health Management Center Study (TOPICS24).","authors":"Izumi Ikeda, Risa Igarashi, Kazuya Fujihara, Yasunaga Takeda, Efrem d'Ávila Ferreira, Khin Lay Mon, Satoru Kodama, Yasumichi Mori, Takashi Kadowaki, Ritsuko Honda, Yasuji Arase, Hirohito Sone","doi":"10.1016/j.mayocp.2024.10.020","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.10.020","url":null,"abstract":"<p><strong>Objective: </strong>To examine the association between a positive family history (parents, siblings, and grandparents) of type 2 diabetes mellitus (T2DM), hypertension, and dyslipidemia and their prevalence and incidence in the same population.</p><p><strong>Patients and methods: </strong>Data on 41,361 participants who underwent health examinations between January 1, 1997, and December 31, 2007, were analyzed, and the results of logistic and Cox regression analyses in the same cohort were examined.</p><p><strong>Results: </strong>Cross-sectional analyses showed that the prevalence of all three diseases increased with a positive family history, especially T2DM, with an odds ratio (OR) of 12.00 (95% CI, 7.82 to 18.41) when the number of affected relatives was greater than or equal to 3 with an OR of 20.43 (95% CI, 11.0 to 37.8) for a positive family history across three generations compared with no family history. However, redefining family history from \"parents, siblings, and grandparents\" to \"parents and siblings\" or \"parents only\" did not significantly change ORs for each disease. Among those with a positive family history and body mass index greater than or equal to 30.0 kg/m² hypertension was 19 times more prevalent compared with no family history and body mass index of 18.5 to 24.9 kg/m². In the longitudinal study, family history strongly influenced incident T2DM (hazard ratio[HR], 2.40; 95% CI, 1.93 to 2.98), hypertension (HR, 1.43; 95% CI, 1.26 to 1.62), and dyslipidemia (HR, 1.41; 95% CI, 1.08 to 1.83), respectively.</p><p><strong>Conclusion: </strong>Obtaining a family history of these diseases was useful in identifying high-risk groups. Also, for T2DM, the influence of a positive family history was strongest with a marked increase in risk with overlap of affected family members, suggesting that a family history is useful for early detection and prevention.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080599","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":"When Patients Present With Direct-to-Consumer Pharmacogenomic Test Results.","authors":"Roseann S Donnelly, Houriya Ayoubieh, Elizabeth L Kudron, Rachel Mills, Tracey Weiler, Philip E Empey","doi":"10.1016/j.mayocp.2024.10.016","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.10.016","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008082","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":"Twenty-Four Years of Lung Cancer Mortality in the United States.","authors":"Camilla Mattiuzzi, Giuseppe Lippi","doi":"10.1016/j.mayocp.2024.10.007","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.10.007","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008079","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":"County-Level Social Determinants of Health and Coronary Heart Disease: An Ecological Analysis of US Adults.","authors":"Alexander R Zheutlin, Eric L Stulberg, Alexander Chaitoff, Benjamin R E Harris","doi":"10.1016/j.mayocp.2024.10.004","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.10.004","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979049","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":"A Primer on Carceral Health for Clinicians: Care Delivery, Regulatory Oversight, Legal and Ethical Considerations, and Clinician Responsibilities.","authors":"Nicholas V Nguyen, Kirsten A Riggan, Gabriel B Eber, Brie A Williams, Erin S DeMartino","doi":"10.1016/j.mayocp.2024.09.009","DOIUrl":"10.1016/j.mayocp.2024.09.009","url":null,"abstract":"<p><p>The United States has one of the highest incarceration rates in the world, with approximately 1.7 million individuals detained in jails or federal or state prisons. Chronic medical conditions are more prevalent among adults in custody than among their nonincarcerated counterparts, resulting in needs that often surpass the on-site medical treatment capabilities of carceral facilities. For this reason, many community-based health care professionals will encounter incarcerated patients in an ambulatory or inpatient setting. Yet, although carceral status engenders pragmatic and ethical complexities in patient care, health care professionals in academic and community settings receive little or no education about correctional health. This special article seeks to address this knowledge gap by providing demographic and patient characteristics of this population, describing health care delivery in the criminal legal system, summarizing incarcerated patients' health care rights, conveying the current state of oversight and regulation for correctional health care, and presenting the role of health care professionals in advocating for the ethical care of incarcerated patients. By equipping themselves with this knowledge, clinicians may provide holistic and ethical care for persons involved in the criminal legal system.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142964701","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":"Excessive Initial Renal Function Decline Following Sodium-Glucose Cotransporter-2 Inhibitor Treatment Predicts Major Adverse Cardiorenal Outcomes.","authors":"Chi-Yu Chen, Shao-Sung Huang, Shuo-Ming Ou, Yang Ho, Tz-Heng Chen, Kuo-Hua Lee, Yuan-Chia Chu, Yao-Pin Lin, Wei-Cheng Tseng, Der-Cherng Tarng","doi":"10.1016/j.mayocp.2024.08.028","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.08.028","url":null,"abstract":"<p><strong>Objective: </strong>To investigate how estimated glomerular filtration rate (eGFR) decline following sodium-glucose cotransporter-2 inhibitors (SGLT2i) initiation predicts long-term cardiorenal outcomes.</p><p><strong>Methods: </strong>From 2016 to 2020, a longitudinal cohort of 4942 diabetic patients treated with SGLT2i were enrolled and followed until December 2021. Patients were categorized into mild (≤30%), moderate (>30%∼≤40%) and severe (>40%) decline groups by the maximal eGFR change between 2 to 12 weeks after SGLT2i treatment. Cox regression was used to explore the association between eGFR decline and risks of a composite outcome of all-cause mortality, major adverse cardiovascular events (MACE), and major adverse renal events (MARE) after comprehensively adjusting for clinical and laboratory confounders.</p><p><strong>Results: </strong>After a median follow-up of 2.57 years, 125 deaths, 192 MACE, and 247 MARE occurred. Severe and moderate eGFR decline groups showed higher risks of composite outcome (severe adjusted hazard ratio [aHR], 4.56; 95% CI, 2.70 to 7.70; moderate aHR, 1.94; 95% CI, 1.17 to 3.24) and death (severe aHR, 3.54; 95% CI, 1.16 to 10.83; moderate aHR, 3.63; 95% CI, 1.22 to 10.77) vs mild decline group. The severe decline group also had higher MACE (aHR, 3.65; 95% CI, 1.76 to 7.59) and MARE (aHR, 4.94; 95% CI 2.71 to 9.01) risks, whereas the moderate decline group only demonstrated higher MARE risk (aHR, 2.25; 95% CI, 1.22 to 4.14). The results were consistent in restricted cubic spline and sensitivity analyses.</p><p><strong>Conclusion: </strong>An excessive eGFR decline greater than 30% after SGLT2i initiation was progressively associated with higher hazards of major adverse cardiorenal events. Careful and vigilant surveillance with timely treatment in such patients are suggested.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965311","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":"Deep Neural Network Analysis of the 12-Lead Electrocardiogram Distinguishes Patients With Congenital Long QT Syndrome From Patients With Acquired QT Prolongation.","authors":"J Martijn Bos, Kan Liu, Zachi I Attia, Peter A Noseworthy, Paul A Friedman, Michael J Ackerman","doi":"10.1016/j.mayocp.2024.07.016","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.07.016","url":null,"abstract":"<p><strong>Objective: </strong>To test whether an artificial intelligence (AI) deep neural network (DNN)-derived analysis of the 12-lead electrocardiogram (ECG) can distinguish patients with long QT syndrome (LQTS) from those with acquired QT prolongation.</p><p><strong>Methods: </strong>The study cohort included all patients with genetically confirmed LQTS evaluated in the Windland Smith Rice Genetic Heart Rhythm Clinic and controls from Mayo Clinic's ECG data vault comprising more than 2.5 million patients. For the AI-DNN model, every patient and control with 1 or more ECGs above age- and sex-specific 99th percentile values for QTc (>460 ms for all patients [male/female] <13 years of age or >470 ms for men and >480 ms for women above this age) were included. LQTS patients were age and sex matched to controls at a 1:5 ratio. An AI-DNN involving a multilayer convolutional neural network was developed to classify patients.</p><p><strong>Results: </strong>Of the 1,599 patients with genetically confirmed LQTS, 808 had 1 or more ECGs with QTc above the defined thresholds (2987 ECGs) compared with 361,069 of 2.5 million controls (14% of Mayo Clinic patients having an ECG, \"presumed negative\"; 989,313 ECGs). Following age and sex matching and splitting, 3,309 (training), 411 (validation), and 887 (testing) ECGs were used. This model distinguished patients with LQTS from those with acquired QT prolongation with an area under the curve of 0.896 (accuracy 85%, sensitivity 77%, specificity 87%). The model remained robust with areas under the curve close to or above 0.9, independent of matching ratio (range, 1:5 to 1:2000) or type of ECG data used (rhythm strip of median beat) and after excluding patients with wide QRS or ventricular pacemaker.</p><p><strong>Conclusion: </strong>For patients with a QTc exceeding its 99th percentile values, this novel AI-DNN functions as an LQTS mutation detector, being able to identify patients with abnormal QT prolongation secondary to an LQTS-causative mutation rather than with acquired QT prolongation. This algorithm may facilitate screening for this potentially lethal yet highly treatable genetic heart disease.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965372","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":"Cardiovascular Outcomes With Antidiabetic Drugs in People With Type 2 Diabetes and a Prior Stroke.","authors":"Jae Hyun Bae, Jimi Choi, Nam Hoon Kim, Sin Gon Kim","doi":"10.1016/j.mayocp.2024.08.015","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.08.015","url":null,"abstract":"<p><strong>Objective: </strong>To assess the comparative effectiveness of sodium-glucose cotransporter 2 inhibitors (SGLT2i), thiazolidinediones (TZD), and dipeptidyl peptidase-4 inhibitors (DPP-4i) for the cardiorenal outcomes and mortality in individuals with type 2 diabetes and a prior stroke.</p><p><strong>Patients and methods: </strong>Using the Korean National Health Insurance Service database from 2014 to 2021, a new-user cohort was established through propensity score matching for SGLT2i, TZD, and DPP-4i. The primary outcomes were major adverse cardiovascular events (MACE), comprising myocardial infarction, ischemic stroke, and cardiovascular death. Secondary outcomes included individual components of MACE, hospitalization for heart failure, a composite kidney outcome, and all-cause mortality. Weighted Cox proportional hazard models were used to calculate HRs and 95% CIs.</p><p><strong>Results: </strong>Among 9733 participants (mean age, 67.2±3.2 years; 46.8% women), the incidence rate of MACE was 220, 202, and 251 per 1000 person-years for the SGLT2i, TZD, and DPP-4i groups. SGLT2i (HR, 0.86; 95% CI, 0.77 to 0.97; P=.01) and TZD (HR, 0.80; 95% CI, 0.70 to 0.90; P<.001) showed a lower risk of MACE compared to DPP-4i. Importantly, no significant difference in MACE was observed between SGLT2i and TZD. TZD was associated with a reduced risk of ischemic stroke, cardiovascular death, and the composite kidney outcome, whereas SGLT2i reduced risks of hospitalization for heart failure, the composite kidney outcome, and all-cause mortality compared to DPP-4i.</p><p><strong>Conclusion: </strong>SGLT2i and TZD use in people with type 2 diabetes and a prior stroke was associated with reduced risks of MACE, the composite kidney outcome, and mortality compared with DPP-4i, with variations in effects on individual outcomes.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965390","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":"79-Year-Old Woman With Nausea and Diarrhea.","authors":"Omar Baqal, Holly M Thomson, Mira T Keddis","doi":"10.1016/j.mayocp.2024.02.028","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.02.028","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932292","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":"A Randomized, Controlled Trial of In-Hospital Use of Virtual Reality to Reduce Preoperative Anxiety Prior to Cardiac Surgery.","authors":"Thirusivapragasam Subramaniam, Joseph A Dearani, John M Stulak, Brian Lahr, Alex Lee, Jordan D Miller","doi":"10.1016/j.mayocp.2024.08.027","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.08.027","url":null,"abstract":"<p><strong>Objective: </strong>To study the effectiveness of virtual reality (VR) in reducing anxiety levels in patients undergoing first-time sternotomy for cardiac surgery.</p><p><strong>Patients and methods: </strong>A total of 100 adult patients scheduled for cardiac surgery at Mayo Clinic in Rochester, Minnesota, USA, was recruited from April 19, 2022, to October 12, 2022. Before surgery, patients wore a physiological monitor to record vital signs. On the day of surgery, patients completed the State-Trait Anxiety Inventory (STAI) and were randomized into two groups: one receiving a tablet-based intervention (control) and the other an immersive VR experience in the preoperative holding area. After the interventions, patients repeated the state anxiety component of the STAI.</p><p><strong>Results: </strong>The results showed that overall state anxiety scores decreased an average of 2.0 points with tablet treatment, but this change failed to reach statistical significance. However, 6 of 20 specific state anxiety features significantly improved with tablet treatment whereas 1 feature significantly worsened. With the VR experience, overall state anxiety scores were significantly reduced by an average of 2.9 points, with improvement in seven state anxiety features (three of which did not overlap with the tablet intervention). Despite a greater reduction in the STAI score with the VR experience, there were no significant differences in the anxiolytic responses between groups. Physiologically, both tablet and VR treatments slightly but significantly reduced pulse rate, with no difference between the groups.</p><p><strong>Conclusion: </strong>Overall, the findings suggest that treatment of older adults with an immersive VR experience before cardiac surgery can significantly reduce overall anxiety. Further investigation determining how such interventions can be optimally implemented in surgical practices and whether such interventions reduce the need for anxiolytic medications and improve the overall patient experience is needed.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932295","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}