Mayo Clinic proceedings最新文献

{"title":"Responses of Kidney Transplant Recipients to Vaccination and Boosting","authors":"Walter D. Park BS ,&nbsp;Sumi S. Nair MBBS, MD ,&nbsp;Hani M. Wadei MD ,&nbsp;Yun Liang MD ,&nbsp;Byron H. Smith PhD ,&nbsp;Ahmed Abdelrheem MB, BCh ,&nbsp;Carrie A. Schinstock MD ,&nbsp;Crescent R. Isham MA ,&nbsp;Attila Kumanovics MD ,&nbsp;Nina Ahmad MD ,&nbsp;Richard B. Simonson BS ,&nbsp;Martin F. Ryser MD ,&nbsp;Gabriela Tapia-Cealle ,&nbsp;Andrew D. Badley MD ,&nbsp;Mark D. Stegall MD","doi":"10.1016/j.mayocp.2025.03.017","DOIUrl":"10.1016/j.mayocp.2025.03.017","url":null,"abstract":"<div><h3>Objective</h3><div>To assess heterologous booster (HB) with Janssen Ad26.COV2.S in kidney transplant recipients (KTRs) with low antibody levels after multiple COVID-19 mRNA vaccinations.</div></div><div><h3>Patients and Methods</h3><div>This multicenter study examined anti–spike protein antibody levels in KTRs with two or more doses of mRNA vaccinations. Enrollment was from April 11, 2022, to September 19, 2023. Kidney transplant recipients with low levels (LL, 0.4-250 IU/mL) were offered HB with Janssen Ad26.COV2.S vaccine. Those with undetectable levels (UL, &lt;0.4 IU/mL) were randomized to HB with or without immunosuppression adjustment. The primary endpoint was anti–spike protein antibody levels greater than 250 IU/mL (high level [HL]) at 28 days after HB. Subset analysis included lymphocyte, immunoglobulin, and COVID-19–specific T- and B-cell levels.</div></div><div><h3>Results</h3><div>Of the 419 unique KTRs assessed, 80.0% (n=335) were HL, 12.9% (n=54) were LL, and 7.2% (n=30) were UL. All KTRs vaccinated pretransplantation had detectable levels. Twenty-eight days after HB, 62.9% (n=22 of 35) of patients with LL achieved HL. Although 9 of 20 (45%) patients with UL achieved LL, none achieved HL by 28 days despite mycophenolate mofetil cessation before HB. Undetectable level was associated with fewer T and B cells in many subsets and fewer COVID-19–specific memory B cells.</div></div><div><h3>Conclusion</h3><div>Most KTRs had HL anti–spike protein antibodies after two or more mRNA vaccinations due to vaccinations with or without prior infection. Many LL patients responded to HB. No UL reached HL; likely due to severely impaired immune system. In this KTR population, a potential durable antibody response was identified if vaccinated before transplantation. Ultimately, monitoring antibody levels after vaccination might identify patients who could benefit from alternative prophylaxis strategies. ClinicalTrials.gov <span><span>NCT05220397</span><svg><path></path></svg></span></div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 9","pages":"Pages 1506-1518"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637402","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":"Association of Obesity and Obesity Severity With Primary Care Use","authors":"Zhiqi Yao MD, ScM ,&nbsp;Michael J. Blaha MD, MPH","doi":"10.1016/j.mayocp.2025.05.008","DOIUrl":"10.1016/j.mayocp.2025.05.008","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 9","pages":"Pages 1662-1664"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144732096","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":"Highly Pathogenic Avian Influenza A (H5N1)","authors":"Myeongji Kim MD ,&nbsp;Nischal Ranganath MD, PhD ,&nbsp;Matthew J. Binnicker PhD ,&nbsp;Rebecca C. Faller MPH ,&nbsp;Pritish K. Tosh MD ,&nbsp;Kristina M. Sokol MS, RN ,&nbsp;Colin M. Bucks MD ,&nbsp;Aditya Shah MBBS","doi":"10.1016/j.mayocp.2025.06.007","DOIUrl":"10.1016/j.mayocp.2025.06.007","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 9","pages":"Pages 1473-1481"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144732099","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":"Effect of Earlier Age of Tobacco Exposure on Accelerated Biological Aging in Adulthood","authors":"Hang Wang PhD ,&nbsp;Xiaowen Qin PhD ,&nbsp;Conghui Qiao MSc ,&nbsp;Shenghan Lou PhD ,&nbsp;Xinyi Sun PhD ,&nbsp;Yuqing Song MSc ,&nbsp;Yang Chen PhD ,&nbsp;Tianshu Han PhD ,&nbsp;Wei Wei PhD ,&nbsp;Yingdong Zuo MSc ,&nbsp;Jiaxin Huang PhD ,&nbsp;Peng Han PhD ,&nbsp;Wenbo Jiang PhD","doi":"10.1016/j.mayocp.2025.01.009","DOIUrl":"10.1016/j.mayocp.2025.01.009","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate how early-life tobacco exposures implicate accelerated biological aging in adulthood and the potential mechanism.</div></div><div><h3>Participants and Methods</h3><div>This study used questionnaires to determine when the participants smoked and whether their mothers smoked when pregnant. Early-life tobacco exposures included in utero tobacco exposure and age of smoking initiation. For evaluating biological aging, we used the following 8 outcome measures: telomere length, frailty index, homeostatic dysregulation score, Klemera-Doubal method biological age, age-related hospitalization rate, premature death, and life expectancy. Mediation analysis was used to identify the role of inflammation factors.</div></div><div><h3>Results</h3><div>During a median follow-up of 14.6 years, 8 outcome measures in participants were analyzed for age of smoking initiation (N=320,453). Compared with never smoking, smoking initiation at age 5 to 12 years (β=3.043; 95% CI, 2.683 to 3.403 and β=−0.011; 95% CI, −0.016 to −0.006), 13 to 17 years (β=1.343; 95% CI, 1.226 to 1.460 and β=−0.007; 95% CI, −0.009 to −0.005), and 18 years and above (β=0.949; 95% CI, 0.823 to 1.075 and β=−0.004; 95% CI, −0.006 to −0.003) were significantly associated with increased Klemera-Doubal method bioage and shorter telomere length, as well as with other aging-related outcome measures. Markers of inflammation significantly mediated up to 0.00% to 43.58% of the studied associations above.</div></div><div><h3>Conclusion</h3><div>In utero tobacco exposure and earlier age of smoking initiation were significantly associated with accelerated biological aging. These associations were in part mediated through inflammation markers.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 9","pages":"Pages 1519-1534"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753743","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 Impact of Open Surgical Team Consistency on Oncologic and Functional Outcomes Following Radical Prostatectomy","authors":"Francis A. Jefferson MD,&nbsp;Stephen A. Boorjian MD,&nbsp;Prabin Thapa MS,&nbsp;Matthew K. Tollefson MD,&nbsp;Igor Frank MD,&nbsp;Matthew T. Gettman MD,&nbsp;R. Houston Thompson MD,&nbsp;R. Jeffrey Karnes MD,&nbsp;Brian J. Linder MD","doi":"10.1016/j.mayocp.2025.02.019","DOIUrl":"10.1016/j.mayocp.2025.02.019","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the impact of surgical team consistency on patient outcomes following radical prostatectomy (RP).</div></div><div><h3>Patients and Methods</h3><div>Patients undergoing RP at a single institution from 2010 to 2019 were identified. The surgical care team comprised three members: a certified surgical assistant, a certified surgical technologist, and a circulating nurse. Primary team member status for each of the three roles was assigned on a quarterly basis to team members who were present for the highest proportion of a surgeon’s cases. For each procedure, the surgical care team present at the time of the surgical timeout was assessed. Low-consistency teams were defined as those with zero to one primary team members present for a procedure, and high-consistency teams were defined as those with two to three primary team members present. Outcomes included prostate cancer recurrence as well as urinary continence and erectile function (assessed at 1 year after surgery). Cox-proportional hazard regression models evaluated the association of care team consistency with oncologic outcomes, controlling for clinicopathologic variables.</div></div><div><h3>Results</h3><div>Overall, 4188 of 6216 (67.3%) RPs were performed with high-consistency teams. High-consistency surgical teams were associated with significantly improved 5-year prostate cancer recurrence-free survival (76% vs 72.9%; <em>P=</em>.009). On multivariable analysis, high-consistency teams remained significantly associated with a lower rate of prostate cancer recurrence (HR, 0.93; <em>P</em>=.01). One year postoperatively, high-consistency teams had significantly higher urinary continence rates (0-1 pads/d) (93.9% vs 90.3%; <em>P</em>&lt;.0001) and lower rates of erectile dysfunction (32.9% vs 35.2%; <em>P</em>=.02).</div></div><div><h3>Conclusion</h3><div>High-consistency surgical teams during RP are associated with significantly lower rates of prostate cancer recurrence and improved functional outcomes.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 9","pages":"Pages 1487-1494"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753744","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":"Residency and Fellowship: Fostering Physician Well-being Over the Career Life Cycle","authors":"Larissa R. Thomas MD, MPH ,&nbsp;Timothy Brigham MDiv, PhD ,&nbsp;Tait Shanafelt MD","doi":"10.1016/j.mayocp.2025.05.024","DOIUrl":"10.1016/j.mayocp.2025.05.024","url":null,"abstract":"<div><div>Being a physician offers tremendous opportunity to make a difference in the lives of patients through meaningful work. A career in medicine is also demanding and challenging. Some challenges to well-being affect physicians at all stages of their career while others impact physicians differently at different career stages. This article is the first in a series of 5 articles considering the different stages of physicians’ career life cycle. The present article focuses on exploring the residency and fellowship, or graduate medical education (GME) phase, including a summary of literature on evidence-based interventions. Residents and fellows face a steep learning curve while having significant responsibility for direct patient care, and have unique needs in the system due to their status as both trainee and employee. They are also particularly vulnerable to mistreatment, and are in a unique time of transformative professional growth. With intentionality, organizations can create a training environment that fosters growth, professional development, and well-being for residents and fellows. Leveraging accreditation requirements, funding strategic roles to support resident and fellow well-being, enhancing faculty development programs, and providing benefits and resources can address system challenges. Leaders and faculty can build a supportive culture by modeling vulnerability, community building, developing mentoring relationships, and encouraging and protecting time for residents and fellows to engage in self-care and physical and mental health appointments. Helping residents and fellows develop growth mindsets and self-care skills will also prepare them for a meaningful, productive, and sustainable career with benefits for other phases of the physician career life cycle.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 9","pages":"Pages 1649-1659"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775720","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":"Dupilumab- and Mepolizumab-Induced Psoriasis After Treatment of HES/AERD","authors":"Zhubene Mesbah MB, BCh, BAO,&nbsp;David J. DiCaudo MD,&nbsp;Yul W. Yang MD, PhD,&nbsp;Catherine M. Freeman MB, BCh","doi":"10.1016/j.mayocp.2025.05.007","DOIUrl":"10.1016/j.mayocp.2025.05.007","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 9","pages":"Pages 1669-1670"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144926480","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 American College of Cardology/American Heart Association Heart Failure Staging System Highlights Diagnostic Delay and Predicts Outcome in Transthyretin Cardiac Amyloidosis","authors":"Mattia Zampieri MD ,&nbsp;Annamaria Del Franco MD, PhD ,&nbsp;Giulia Biagioni MD ,&nbsp;Giacomo Tini MD ,&nbsp;Beatrice Musumeci MD ,&nbsp;Emanuele Barbato MD ,&nbsp;Simone Longhi MD, PhD ,&nbsp;Elena Biagini MD, PhD ,&nbsp;Giulia Saturi MD ,&nbsp;Aldostefano Porcari MD ,&nbsp;Marco Merlo MD ,&nbsp;Gianfranco Sinagra MD ,&nbsp;Camillo Autore MD ,&nbsp;Marco Canepa MD, PhD ,&nbsp;Italo Porto MD, PhD ,&nbsp;Alessia Argirò MD ,&nbsp;Carlotta Mazzoni MD ,&nbsp;Carlo Fumagalli MD ,&nbsp;Federica Colio MD ,&nbsp;Tullio Catalucci MD ,&nbsp;Francesco Cappelli MD, PhD","doi":"10.1016/j.mayocp.2024.11.025","DOIUrl":"10.1016/j.mayocp.2024.11.025","url":null,"abstract":"<div><h3>Objective</h3><div><span>To apply the American College of Cardiology (ACC) and American Heart Association (AHA) heart failure (HF) staging system to patients with transthyretin </span>cardiac amyloidosis (TTR-CA) in order to assess diagnostic delay and evaluate prognosis.</div></div><div><h3>Patients and Methods</h3><div>Consecutive patients with TTR-CA enrolled in an Italian registry were classified according to the ACC/AHA HF staging system at diagnosis. Outcome was assessed as all-cause mortality during a 3-year follow-up.</div></div><div><h3>Results</h3><div><span>At diagnosis, of 549 patients with TTR-CA, 115 (20.9%) presented with HF stage B, 172 (31.3%) with stage C1, 198 (36.1%) with stage C2, and 64 (11.7%) with stage D. Patients with stages B, C1, C2, and D presented with hierarchically higher prevalence of left ventricular systolic impairment, advanced diastolic dysfunction, advanced </span>New York Heart Association functional class<span>, hospitalization for HF, and N-terminal pro–B-type natriuretic peptide values. At 3 years, the survival rate was 94% in patients with stage B HF, decreasing to 69% with stage C1, 43% with stage C2, and 17% with stage D. At multivariable analysis, considering stage B as the reference, risk increase for all-cause mortality was 4, 5, and 11 for stages C1, C2, and D, respectively.</span></div></div><div><h3>Conclusion</h3><div>At diagnosis, almost half of patients with TTR-CA present with advanced stages of HF (C2 or D), suggesting marked diagnostic delay. The ACC/AHA HF staging system accurately stratifies prognosis and may be usefully added to the multiparametric evaluation of patients with TTR-CA.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 9","pages":"Pages 1563-1574"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136075","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 Value — and the Values — of Listening","authors":"Leonard L. Berry PhD, MBA ,&nbsp;Maureen Bisognano RN, MSN ,&nbsp;Nana A.Y. Twum-Danso MD, MHP ,&nbsp;Rana L.A. Awdish MD, MS","doi":"10.1016/j.mayocp.2025.06.002","DOIUrl":"10.1016/j.mayocp.2025.06.002","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 9","pages":"Pages 1482-1486"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144732103","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":"Optimizing Vaccines in Adult Solid Organ Transplant Recipients: We Can Do Better","authors":"Deborah B. Adey MD","doi":"10.1016/j.mayocp.2025.07.015","DOIUrl":"10.1016/j.mayocp.2025.07.015","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 9","pages":"Pages 1468-1470"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144925631","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}