Mayo Clinic proceedings最新文献

{"title":"Association Between Angiotensin Receptor Blocker Use and Cardiovascular Outcomes Compared With Angiotensin-Converting Enzyme Inhibitors in Patients With Atherosclerotic Cardiovascular Disease","authors":"Jheng-Yan Wu MS,&nbsp;Keng-Wei Lee MD,&nbsp;Sheng-Chi Huang MD,&nbsp;Hsuan-Yuan Chang MD,&nbsp;Yu-Min Lin MD","doi":"10.1016/j.mayocp.2026.05.016","DOIUrl":"10.1016/j.mayocp.2026.05.016","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the association between angiotensin receptor blocker (ARB) use and cardiovascular outcomes compared with angiotensin-converting enzyme inhibitor (ACEI) use in patients with atherosclerotic cardiovascular disease (ASCVD) in real-world clinical practice.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using the TriNetX global federated research network. Adults (≥18 years) with established ASCVD between January 1, 2002, and August 31, 2025, were included. Patients prescribed ARB were compared with those prescribed ACEI, excluding those who received both within 1 year of the index date. Propensity score matching (1:1) was performed to balance baseline demographics, comorbidities, medications, and laboratory data. The primary outcome was 1-year major adverse cardiac events (MACE) (ie, myocardial infarction, ischemic stroke, or all-cause mortality). Secondary outcomes included individual components of MACE. Skin cancer served as a negative control outcome. Hazard ratios were estimated using Cox proportional hazards models.</div></div><div><h3>Results</h3><div>After matching, 1,203,920 patients were included. Compared with ACEI users, ARB users were associated with lower 1-year incidence of MACE (7.0% vs 8.6%; HR, 0.77; 95% CI, 0.76 to 0.78; <em>P</em>&lt;.001). Use of ARB was also associated with lower risks of ischemic stroke (HR, 0.76; 95% CI, 0.75 to 0.78), acute myocardial infarction (HR, 0.85; 95% CI, 0.83 to 0.87), and all-cause mortality (HR, 0.73; 95% CI, 0.72 to 0.74). Findings were generally consistent across subgroups.</div></div><div><h3>Conclusion</h3><div>In this large real-world cohort of patients with ASCVD, ARB use was associated with a lower short-term risk of adverse cardiovascular outcomes compared with ACEI use. These findings should be interpreted as noncausal and may reflect differences in treatment patterns, adherence, and patient characteristics rather than intrinsic pharmacologic superiority. Further studies are needed to confirm these observations.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 9","pages":"Pages 1482-1496"},"PeriodicalIF":6.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148283816","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":"DICER1 Syndrome–Associated Thyroid Follicular Nodular Disease","authors":"Rumeal D. Whaley MD,&nbsp;Sounak Gupta MBBS, PhD,&nbsp;Lori A. Erickson MD","doi":"10.1016/j.mayocp.2026.06.003","DOIUrl":"10.1016/j.mayocp.2026.06.003","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 9","pages":"Pages 1662-1663"},"PeriodicalIF":6.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148211910","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":"Lumbar Puncture in the 21st Century: An Imaging-Based Primer to Determine Procedural Safety","authors":"Michael J. Rigby MD, PhD,&nbsp;Sherri A. Braksick MD,&nbsp;Maximilano A. Hawkes MD","doi":"10.1016/j.mayocp.2026.06.016","DOIUrl":"10.1016/j.mayocp.2026.06.016","url":null,"abstract":"<div><div>Lumbar puncture (LP) is a crucial procedure in the diagnosis and management of multiple neurologic diseases, and the procedure can be safely performed in most patients. However, dangerous complications may rarely occur, including herniation and death. There remains a paucity of high-quality data identifying patients at increased risk of life-threatening complications from LP, even in the post-neuroimaging era. Therefore, we performed a comprehensive review of the literature to summarize the known physiologic changes and associated complications after LP, especially in the presence of central nervous system mass lesions or altered cerebrospinal fluid dynamics. Based on this, we propose an imaging-based primer to guide clinicians in making decisions about candidacy for LP. Imaging findings that contraindicate LP include the presence of supratentorial mass lesions with preexisting herniation or significant midline shift, medium to large posterior fossa masses, posterior fossa malformation, globally elevated intracranial pressure with mass effect or generalized edema, severe brain sag, and obstructive hydrocephalus. We integrate these imaging features with prior LP clinical guidelines for a concise flowchart to aid in identification of LP contraindications.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 9","pages":"Pages 1589-1601"},"PeriodicalIF":6.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317865","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":"MRI-Negative Posterior Reversible Encephalopathy Syndrome","authors":"Molly C. Bates MD,&nbsp;Jennifer E. Fugate DO,&nbsp;Jay N. Mandrekar PhD,&nbsp;Alejandro A. Rabinstein MD","doi":"10.1016/j.mayocp.2026.01.022","DOIUrl":"10.1016/j.mayocp.2026.01.022","url":null,"abstract":"<div><h3>Objective</h3><div>To explore whether posterior reversible encephalopathy syndrome (PRES) can present with negative magnetic resonance imaging (MRI) by comparing clinical features between cases of PRES with vasogenic edema and cases of hypertensive encephalopathy without MRI changes.</div></div><div><h3>Patients and Methods</h3><div>Patients diagnosed with hypertensive encephalopathy from August 1, 2008, to December 31, 2017, were identified retrospectively and matched by age (±5 years) and sex in a 1:2 ratio to patients retrospectively identified as having PRES from January 1, 2002, to November 30, 2017. A review of MRI images and clinical information was performed.</div></div><div><h3>Results</h3><div>We identified 16 cases of hypertensive encephalopathy and 32 age- and sex-matched controls with PRES showing vasogenic edema on MRI. There were no statistically significant differences in the odds of presentation with headache (odds ratio [OR], 1.372; 95% CI, 0.458 to 4.106), encephalopathy (OR, 2.303; 95% CI, 0.433 to 12.236), visual disturbance (OR, 0.826; 95% CI, 0.185 to 3.697), or focal neurologic deficit (OR, 4.000; 95% CI, 0.767 to 20.872). Seizures were more common in patients with vasogenic edema (OR, 0.082; 95% CI, 0.010 to 0.664). There were no significant differences in odds of acute kidney injury (OR, 2.90; 95% CI, 0.679 to 12.449) or odds of having a history of malignancy (OR, 0.295; 95% CI, 0.076 to 1.152), transplantation (OR, 3.347; 95% CI, 0.594 to 18.880), or autoimmune disease (OR, 0.400; 95% CI, 0.104 to 1.532). Systolic blood pressure at presentation was higher in patients with hypertensive encephalopathy and negative MRI as compared with patients with PRES and vasogenic edema (OR, 1.03; 95% CI, 1.01 to 1.05).</div></div><div><h3>Conclusion</h3><div>Most presenting symptoms and risk factors were not significantly different between cases of hypertensive encephalopathy with and without vasogenic edema, arguing that the diagnosis of PRES in the setting of acute severe hypertension may not depend on MRI confirmation.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 9","pages":"Pages 1512-1518"},"PeriodicalIF":6.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148653830","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":"Featuring Neurology—Limelight, September 2026","authors":"Karl A. Nath MBChB (Editor-in-Chief)","doi":"10.1016/j.mayocp.2026.07.025","DOIUrl":"10.1016/j.mayocp.2026.07.025","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 9","pages":"Pages 1459-1461"},"PeriodicalIF":6.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859319","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":"Primary Care Management of Ileal Pouch Disorders: Diagnosis, Treatment, and Referral","authors":"Mauricio F. Jin MD,&nbsp;June Tome MD,&nbsp;Darrell S. Pardi MD, MS","doi":"10.1016/j.mayocp.2026.04.024","DOIUrl":"10.1016/j.mayocp.2026.04.024","url":null,"abstract":"<div><div>Ileal pouch–anal anastomosis (IPAA) is the preferred surgical treatment of patients with ulcerative colitis and familial adenomatous polyposis. As the incidence of ulcerative colitis rises globally, increasing numbers of patients live long term with IPAA. Whereas most patients with IPAA achieve good functional outcomes, studies suggest that up to 80% will experience pouchitis during their lifetime, among other inflammatory and structural pouch-related complications.</div><div>Patients with pouch disorders present with nonspecific gastrointestinal symptoms that may include increased stool frequency, urgency, abdominal or pelvic discomfort, tenesmus, rectal bleeding, and difficulty in evacuating the pouch. Common inflammatory conditions include acute or intermittent pouchitis, chronic antibiotic-dependent pouchitis, chronic antibiotic-refractory pouchitis, cuffitis, and Crohn-like disease of the pouch. Structural complications, such as anastomotic leaks, strictures, and fistulas, may also occur and be manifested with obstructive or infectious symptoms.</div><div>Primary care clinicians play an important role in the early recognition and initial management of pouch-related complications. For example, patients with mild suspected pouchitis and no alarm features may be treated with empirical antibiotic therapy with close follow-up. Topical mesalamine may be used for suspected cuffitis. However, persistent symptoms, recurrent pouchitis, suspected Crohn-like disease of the pouch, or signs of structural complications warrant prompt referral to subspecialist care.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 9","pages":"Pages 1615-1624"},"PeriodicalIF":6.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859324","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: Reassessing Cancer Attribution and Methodologic Limitations in PLA2R-Associated Membranous Nephropathy","authors":"Ilario Russo MD,&nbsp;Maria J. Vargas-Brochero MD,&nbsp;Anila Cara MD,&nbsp;Gian Marco Berti MD,&nbsp;Francesca Annese MD,&nbsp;Jing Miao MD,&nbsp;Loreto Gesualdo MD, PhD,&nbsp;Fernando C. Fervenza MD, PhD,&nbsp;Ladan Zand MD","doi":"10.1016/j.mayocp.2026.06.006","DOIUrl":"10.1016/j.mayocp.2026.06.006","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 9","pages":"Pages 1660-1661"},"PeriodicalIF":6.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148258749","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 Time Is Right for a Tailored Approach to Occupational Radiation Protection","authors":"Kenneth A. Fetterly PhD,&nbsp;Malcolm Bell MD,&nbsp;Rajiv Gulati MD, PhD","doi":"10.1016/j.mayocp.2026.07.010","DOIUrl":"10.1016/j.mayocp.2026.07.010","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 9","pages":"Pages 1462-1463"},"PeriodicalIF":6.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148859320","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":"Red Blood Cell Dynamics Over Time: Dapsone, Then Iron","authors":"Walker M. Schmidt MD,&nbsp;Angela M. Collie MD, PhD,&nbsp;Richard C. Godby MD","doi":"10.1016/j.mayocp.2026.04.006","DOIUrl":"10.1016/j.mayocp.2026.04.006","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 9","pages":"Pages 1469-1470"},"PeriodicalIF":6.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775095","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":"Maxillary Sinus Recirculation Syndrome","authors":"Kanupriya Gupta MD,&nbsp;Spencer C. Payne MD,&nbsp;Prem P. Batchala MD","doi":"10.1016/j.mayocp.2026.04.013","DOIUrl":"10.1016/j.mayocp.2026.04.013","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 9","pages":"Pages 1558-1560"},"PeriodicalIF":6.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816672","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}