Mayo Clinic proceedings最新文献

{"title":"Prevalence and Incidence of Type 1 Brugada Pattern: A 30-Year Experience at Mayo Clinic.","authors":"Pattara Rattanawong, Carolyn Mead-Harvey, Olubadewa A Fatunde, Charles Van Der Walt, Nway Ko Ko, Patrick Hooke, Thanaboon Yinadsawaphan, Narathorn Kulthamrongsri, Win-Kuang Shen, Dan Sorajja","doi":"10.1016/j.mayocp.2024.05.028","DOIUrl":"10.1016/j.mayocp.2024.05.028","url":null,"abstract":"<p><strong>Objective: </strong>To identify the incidence and prevalence of type 1 Brugada pattern at Mayo Clinic during 30 years.</p><p><strong>Methods: </strong>We retrospectively reviewed the electronic medical records from 1992 to 2021 at Mayo Clinic Enterprise. Patients with type 1 Brugada pattern electrocardiogram (ECG) were identified by a systematic keyword search. Incidences are calculated by decade. The incidence rate ratios (IRRs) between races were then calculated. Analysis of the association between groups and major arrhythmic event-free survival was conducted.</p><p><strong>Results: </strong>The study analyzed 5,381,186 ECGs from 2,304,809 patients; 150 patients had at least 1 ECG with a type 1 Brugada pattern (76.0% Brugada syndrome, 62.0% spontaneous, 18.7% fever induced, and 10.7% drug induced). The mean follow-up was 6.6±6.7 years. The incidence (per 100,000 person-years) of type 1 Brugada pattern increased during the past 3 decades (0.505 [95% CI, 0.203 to 1.040], 3.015 [95% CI, 2.272 to 3.925], and 3.916 [95% CI, 3.128 to 4.842]). The incidence in Black patients was approximately 1.5-fold higher compared with non-Hispanic White patients (IRR, 1.492 [95% CI, 0.610 to 3.649]; P=.38). The incidence in Hispanic White patients was 3-fold higher than in non-Hispanic White patients (IRR, 3.021 [95% CI, 1.410 to 6.474]; P=.005). The incidence in Asian patients was 2-fold higher than in Hispanic patients (IRR, 1.894 [95% CI, 0.705 to 5.086]; P=.21). The overall prevalence of the type 1 Brugada pattern between 2010 and 2021 was 10.094 per 100,000. The major arrhythmic events occurred in 8.6%, 7.1%, 12.5%, and 7.7% for spontaneous, fever-induced, drug-induced, and other type 1 Brugada patterns, respectively, during follow-up.</p><p><strong>Conclusion: </strong>The incidence of type 1 Brugada pattern at Mayo Clinic has increased during 3 decades. The prevalence of type 1 Brugada pattern in the United States is higher than previously reported. Type 1 Brugada pattern in Black and Hispanic populations is more common than previously suspected.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":"80-93"},"PeriodicalIF":6.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786272","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":"50-Year-Old Man With Malaise, Chills, and Weight Loss.","authors":"Nader James Al-Shakarchi, Jenny J Cao, Ivan D Carabenciov","doi":"10.1016/j.mayocp.2024.02.027","DOIUrl":"10.1016/j.mayocp.2024.02.027","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":"141-145"},"PeriodicalIF":6.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142730121","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":"Acral Persistent Papular Mucinosis.","authors":"Xiao Ma, Dong-Lai Ma","doi":"10.1016/j.mayocp.2024.11.002","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.11.002","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 1","pages":"158-159"},"PeriodicalIF":6.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927484","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":"Decoding Obesity Management Medications and the Journey to Informed Treatment Choices for Patients.","authors":"Afton M Koball, Gretchen E Ames, Karen B Grothe, Matthew M Clark, Maria L Collazo-Clavell, Enrique F Elli","doi":"10.1016/j.mayocp.2024.10.003","DOIUrl":"10.1016/j.mayocp.2024.10.003","url":null,"abstract":"<p><p>Incretin-based obesity management medications (OMMs) fill a treatment gap in a stepped-care model between lifestyle change alone and metabolic bariatric surgery, resulting in weight loss of 15% to 20% of body weight. Public interest in and demand for OMMs has recently increased dramatically. Unfortunately, cost and access to OMMs remain a significant barrier for many patients. Although these medications have the potential to produce large weight loss outcomes, many unanswered questions remain regarding informed choice and optimization of obesity care protocols, especially for patients with a body mass index of 35 kg/m² or higher who may be considering various intervention options such as lifestyle changes, OMMs, endoscopic weight loss procedures, and/or metabolic bariatric surgery. When considering strategies to aid patients in decision making about obesity treatment, several considerations warrant discussion because patients may have unrealistic perceptions about risk vs efficacy and may hold numerous misconceptions about long-term behavior change and outcomes. This article outlines considerations for informed obesity treatment decision making and reviews aspects of obesity treatment specific to OMMs, including adverse effects, patient expectations for treatment outcome, equitable access to care, the impact of weight bias on patient care, the risk of weight recurrence, and the need for long-term multicomponent treatment to achieve weight loss and weight maintenance.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":"111-123"},"PeriodicalIF":6.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786201","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":"34-Year-Old-Woman With Shortness of Breath.","authors":"Eric C Zuberi, Adam Sandin, Himesh B Zaver","doi":"10.1016/j.mayocp.2024.02.025","DOIUrl":"10.1016/j.mayocp.2024.02.025","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":"152-157"},"PeriodicalIF":6.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142730114","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":"Genotype-Guided P2Y₁₂ Inhibitor Monotherapy Within 7 Days of Percutaneous Coronary Intervention in High Bleeding Risk Patients: The CHAMP Trial - A Pilot Study and Safety Assessment.","authors":"Brenden S Ingraham, Samuel B Huxley, Conor M Lane, Rajiv Gulati, Bradley R Lewis, Allan S Jaffe, Malcolm R Bell, Amir Lerman, Naveen L Pereira, Ann M Moyer, Linnea M Baudhuin, Charanjit S Rihal, Mandeep Singh","doi":"10.1016/j.mayocp.2024.05.030","DOIUrl":"10.1016/j.mayocp.2024.05.030","url":null,"abstract":"<p><strong>Objective: </strong>To test the feasibility and safety of genotype guidance in the selection of P2Y₁₂ monotherapy within 1 week of percutaneous coronary interventions (PCIs) among patients with high bleeding risk (HBR).</p><p><strong>Patient and methods: </strong>The study was a single-center, open-label, pilot trial. Patients (n=100) with HBR (as defined by an academic research consortium) after successful PCI received dual antiplatelet therapy with clopidogrel and aspirin. Following availability of cytochrome P450 2C19 (CYP2C19) genotype results (mean, 2.9 days), aspirin was discontinued. Normal, rapid, or ultrarapid CYP2C19 metabolizers continued clopidogrel monotherapy for 90 days whereas loss-of-function allele carriers switched to prasugrel or ticagrelor monotherapy. The primary safety endpoints were a composite of post-dismissal cardiac death/spontaneous myocardial infarction less than 30 days or stent thrombosis <90 days of discharge. The subjects also underwent post-dismissal assessment for BARC (Bleeding Academic Research Consortium) type 3 or 5 bleeding, all-cause death, any MI, and/or repeat revascularization up to 90 days.</p><p><strong>Results: </strong>There were 98 patients with complete data (median age, 76.5 years, 36% women; 49% acute coronary syndrome). Sixty-nine (70.4%) were normal, rapid, or ultrarapid metabolizers and continued clopidogrel monotherapy, and 29 (29.6%) were intermediate CYP2C19 metabolizers and received monotherapy with prasugrel (n=21) or ticagrelor (n=8). The mean duration of dual antiplatelet therapy was 5.1 days. During 90-day follow-up, no patient died, there was one possible stent thrombosis, and three patients on clopidogrel had Bleeding Academic Research Consortium type 3 bleeding events.</p><p><strong>Conclusion: </strong>Genotype-guided P2Y₁₂ inhibitor monotherapy within a week of PCI is feasible and likely safe in patients with HBR (CHAMP [Clopidogrel With High Bleeding Risk and Adverse Events With Monotherapy in Patients Undergoing Percutaneous Coronary Interventions]; NCT05223335).</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":"94-108"},"PeriodicalIF":6.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142730143","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":"Fox-Fordyce Disease of the Breast.","authors":"Maya I Davis, Steven A Nelson, Leah A Swanson","doi":"10.1016/j.mayocp.2024.11.003","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.11.003","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 1","pages":"109-110"},"PeriodicalIF":6.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927487","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":"Difficult Chronic Pain Clinical Encounters Are Common and Not Easy for the Clinician.","authors":"Hance Clarke, Mary-Ann Fitzcharles","doi":"10.1016/j.mayocp.2024.11.015","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.11.015","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 1","pages":"11-13"},"PeriodicalIF":6.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927486","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":"From Test Taking to Lifesaving: Will AI Be Your Next Cardiologist?","authors":"Joseph G Murphy, Anthony H Kashou, Nandan S Anavekar","doi":"10.1016/j.mayocp.2024.11.013","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.11.013","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 1","pages":"14-16"},"PeriodicalIF":6.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927488","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 Health Considerations for Primary Care Physicians Treating Breast Cancer Survivors.","authors":"Redet D Kidane, Kathryn J Ruddy, Grace Lin, Nicole P Sandhu","doi":"10.1016/j.mayocp.2024.08.014","DOIUrl":"10.1016/j.mayocp.2024.08.014","url":null,"abstract":"<p><p>Breast cancer (BC) survivors are at increased risk for cardiovascular disease (CVD) and require their primary care physicians to manage their long-term general medical care, including cardiovascular (CV) health. Yet, evidence exists that some primary care physicians possess insufficient knowledge about survivorship care. With the goal of bridging these knowledge gaps, a PubMed review was conducted from July 7, 2020, through October 2, 2020, with an updated PubMed review from January 3, 2024, through April 28, 2024, focusing on CV health considerations in the primary care of BC survivors. Search terms included variations of \"breast cancer survivors\" and \"cardiovascular.\" In total, 152 publications were included. Breasts cancer survivors may have increased CVD risk because some anticancer therapies are cardiotoxic and risk factors for BC often also increase the risk for CVD. Multiple risk factors overlap for BC and CVD such as older age, Western diet, early menarche, physical inactivity, high body mass index, and smoking. In this review, results are summarized from studies that report the presence of CV risk factors and CVD in BC survivors. Also described are the CV effects of BC therapies (chemotherapy, hormonal agents, targeted therapies, and radiotherapy) and the type of CV evaluation (cardiac imaging and measurement of biomarkers) that these patients may need. Primary care physicians have an important role in managing the CV health of BC survivors from preventing, assessing, and managing CV risk factors to referring patients to appropriate specialists when needed.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":"124-140"},"PeriodicalIF":6.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786196","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}