Mayo Clinic proceedings最新文献

{"title":"Plasma Levels of Fibroblast Growth Factor 21 and Adverse Kidney Outcomes","authors":"Hee Byung Koh MD ,&nbsp;Hyo Jeong Kim MD ,&nbsp;Hyung Woo Kim MD ,&nbsp;Tae Ik Chang MD, PhD ,&nbsp;Jung Tak Park MD, PhD ,&nbsp;Tae-Hyun Yoo MD, PhD ,&nbsp;Shin-Wook Kang MD, PhD ,&nbsp;Seung Hyeok Han MD, PhD","doi":"10.1016/j.mayocp.2024.10.026","DOIUrl":"10.1016/j.mayocp.2024.10.026","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the association between fibroblast growth factor 21 (FGF21) and adverse kidney outcomes.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>P</em>_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 (<em>P</em>_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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 8","pages":"Pages 1345-1359"},"PeriodicalIF":6.7,"publicationDate":"2025-08-01","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":"Decision-Making in Transplant Candidate Selection Committees","authors":"Christopher Ho Kim ,&nbsp;Frank G. Lee MD ,&nbsp;Lindsay R. Beaman BS ,&nbsp;Leigh E. Meyer BA ,&nbsp;Tayyab S. Diwan MD","doi":"10.1016/j.mayocp.2025.04.022","DOIUrl":"10.1016/j.mayocp.2025.04.022","url":null,"abstract":"<div><div>Organ transplant selection committees are tasked with deciding whether patients seeking a transplant are medically and psychosocially appropriate to be placed on the waitlist. The selection process is obscure to patients and those outside of the institution. Currently, very limited standards exist for decision-making in selection committees, which could exacerbate inequities and disparities in the transplant process, a major concern among patients. Additionally, limited literature exists regarding decision-making in recipient selection committees. Evaluation of different decision-making frameworks and their factors may inform how current recipient selection committees should operate. There is no dearth of frameworks described for decision-making. The four group decision-making frameworks — autocratic, minority-control, majority-control, and consensus-based — were chosen for their ability to best represent different factors as they specifically relate to the transplant recipient selection process and were vetted against many other frameworks which were either deemed not applicable to transplant decision or not representative of the challenges faced in recipient selection. From the literature, we identified six themes that selection committees should be cognizant of during decision-making: reducing bias, balancing efficiency, confronting hierarchical structure, preventing groupthink, preventing group polarization, and using advocates and dissenters. These factors contribute to suboptimal outcomes and can be mitigated through a variety of factors. By creating uniform standards and policies and articulating them, increasing transparency of the decision-making processes in transplant selection, we may achieve more public trust in the system and more equity in the care of our patients.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 8","pages":"Pages 1402-1410"},"PeriodicalIF":6.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567625","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 MD ,&nbsp;Ahmed K. Ahmed MD, MS ,&nbsp;Kathryn E. Mangold PhD ,&nbsp;Peter A. Noseworthy MD, MBA ,&nbsp;Francisco Lopez-Jimenez MD, MS ,&nbsp;Jonathan Graff-Radford MD ,&nbsp;Alejandro A. Rabinstein MD ,&nbsp;Stephen W. English MD, MBA","doi":"10.1016/j.mayocp.2024.10.019","DOIUrl":"10.1016/j.mayocp.2024.10.019","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Patients and Methods</h3><div>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).</div></div><div><h3>Results</h3><div>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 (<em>P</em>=.42).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 8","pages":"Pages 1360-1369"},"PeriodicalIF":6.7,"publicationDate":"2025-08-01","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":"Highlights from the Current Issue – Audiovisual Summary","authors":"Karl A. Nath MBChB","doi":"10.1016/j.mayocp.2025.07.014","DOIUrl":"10.1016/j.mayocp.2025.07.014","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 8","pages":"Page e1"},"PeriodicalIF":6.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144749063","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":"Muscle Power Versus Strength as a Predictor of Mortality in Middle-Aged and Older Men and Women","authors":"Claudio Gil S. Araújo MD, PhD ,&nbsp;Setor K. Kunutsor MD, PhD ,&nbsp;Thijs M.H. Eijsvogels PhD ,&nbsp;Jonathan Myers PhD ,&nbsp;Jari A. Laukkanen MD, PhD ,&nbsp;Dusan Hamar MD, PhD ,&nbsp;Josef Niebauer MD, PhD, MBA ,&nbsp;Atanu Bhattacharjee PhD ,&nbsp;Christina G. de Souza e Silva MD, PhD ,&nbsp;João Felipe Franca MD ,&nbsp;Claudia Lucia B. Castro MD, MSc","doi":"10.1016/j.mayocp.2025.02.015","DOIUrl":"10.1016/j.mayocp.2025.02.015","url":null,"abstract":"<div><h3>Objective</h3><div>To assess whether muscle power (force times velocity) outperforms strength as a risk indicator and predictor of mortality.</div></div><div><h3>Participants and Methods</h3><div>Anthropometric, clinical and vital status, muscle power, and strength data were assessed in 3889 individuals aged 46 to 75 years (2636 [67.8%] men) who were participants in the CLINIMEX Exercise prospective cohort between February 13, 2001, and October 31, 2022. Study participants were stratified by sex and categorized into 4 groups according to the distribution of the results of relative muscle power and strength (adjusted for body weight) measured, respectively, by handgrip and upper row movement tests.</div></div><div><h3>Results</h3><div>Death rates were 14.2% (373 of 2636) and 8.9% (111 of 1253) for men and women, respectively, during a median (IQR) follow-up of 10.8 years (6.7 to 15.5 years). In multivariable Cox proportional hazards regression analyses, the hazard ratios (95% CIs) for mortality comparing the lowest vs highest categories of relative muscle power were 5.88 (2.28 to 15.17; <em>P</em>&lt;.001) and 6.90 (1.61 to 29.58; <em>P</em>=.009) for men and women, respectively. The corresponding hazard ratios (95% CIs) for relative strength were 1.62 (0.89 to 2.96; <em>P</em>=.11) and 1.71 (0.61 to 4.80; <em>P</em>=.31), respectively. Sex-specific results of risk prediction analyses revealed that improvements in C index provided by relative power over relative strength were 0.0110 (95% CI, 0.0039 to 0.0182) in men and 0.0112 (95% CI, −0.0040 to 0.0265) in women.</div></div><div><h3>Conclusion</h3><div>In this large prospective study, relative muscle power was a stronger predictor of mortality than relative strength in middle-aged and older men and women. Evaluating and training muscle power could be of clinical and practical relevance.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 8","pages":"Pages 1319-1331"},"PeriodicalIF":6.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032019","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 BS ,&nbsp;Daniel L. Kenney-Jung MD ,&nbsp;Francis Deng MD","doi":"10.1016/j.mayocp.2025.04.003","DOIUrl":"10.1016/j.mayocp.2025.04.003","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 8","pages":"Pages 1383-1384"},"PeriodicalIF":6.7,"publicationDate":"2025-08-01","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":"Reimagining the Electronic Health Record to Reduce Administrative Burden","authors":"Megna M. Kuverji MHA ,&nbsp;Natalie A. Caine MHA ,&nbsp;Jon O. Ebbert MD ,&nbsp;Vijay H. Shah MD","doi":"10.1016/j.mayocp.2025.04.029","DOIUrl":"10.1016/j.mayocp.2025.04.029","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 8","pages":"Pages 1293-1296"},"PeriodicalIF":6.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567627","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":"General Information","authors":"","doi":"10.1016/S0025-6196(25)00367-2","DOIUrl":"10.1016/S0025-6196(25)00367-2","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 8","pages":"Page A7"},"PeriodicalIF":6.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144748647","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":"The Need for Speed: Improving Muscle Power for Longevity","authors":"Salvatore Carbone PhD, MS, RDN, FHFSA, FASPEN,&nbsp;Windy W. Alonso PhD, RN, FHFSA, FAHA","doi":"10.1016/j.mayocp.2025.06.011","DOIUrl":"10.1016/j.mayocp.2025.06.011","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 8","pages":"Pages 1281-1284"},"PeriodicalIF":6.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144748835","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":"Impact of Renal Function and Acute Kidney Injury on Long-term Outcomes After Percutaneous Coronary Intervention","authors":"Vinayak Nagaraja MD ,&nbsp;Charanjit S. Rihal MD ,&nbsp;Guy Reeder MD ,&nbsp;Karl A. Nath MBChB ,&nbsp;Bradley R. Lewis MS ,&nbsp;Mandeep Singh MD, MPH","doi":"10.1016/j.mayocp.2025.01.020","DOIUrl":"10.1016/j.mayocp.2025.01.020","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the incidence, predictors, and prognostic implications of acute kidney injury (AKI) after percutaneous coronary intervention (PCI).</div></div><div><h3>Patients and Methods</h3><div>Retrospective analysis of the Mayo Clinic PCI registry identified 9199 patients who underwent PCI from January 1, 2009, through June 30, 2023.</div></div><div><h3>Results</h3><div>A total of 856 patients (9.3%) developed AKI (increase in serum creatinine level by ≥0.3 mg/dL or ≥1.5 times baseline), with 87 (0.9%) requiring hemodialysis. A monotonic increase in the yearly incidence of AKI was observed (<em>P</em>&lt;.001). In multivariable analysis, AKI was associated with older age (odds ratio [OR], 1.01; 95% CI, 1.00 to 1.02), female sex (OR, 1.27; 95% CI, 1.08 to 1.49), diabetes (OR, 1.62; 95% CI, 1.38 to 1.89), congestive heart failure (OR, 2.99; 95% CI, 2.54 to 3.52), chronic kidney disease (OR, 2.46; 95% CI, 2.00 to 3.02), acute myocardial infarction (OR, 3.34; 95% CI, 2.80 to 3.99), intra-aortic balloon pump (OR, 3.49; 95% CI, 2.55 to 4.73), and contrast volume (OR, 1.28; 95% CI, 1.17 to 1.41). In-hospital mortality was 11.1% vs 1.0% in patients with vs without AKI (<em>P</em>&lt;.001). After adjustment, AKI remained strongly associated with in-hospital mortality (hazard ratio, 5.75; 95% CI, 4.06 to 8.13). Among hospital survivors, 1-, 5-, and 10-year all-cause mortality, repeated revascularization, myocardial infarction, and major adverse cardiovascular event rates were significantly higher in those who developed AKI.</div></div><div><h3>Conclusions</h3><div>The incidence of AKI after PCI remains high in the contemporary era. Higher in-hospital and long-term mortality and adverse cardiac event rates were noted in patients who developed AKI after PCI.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 8","pages":"Pages 1309-1318"},"PeriodicalIF":6.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248666","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}