Mayo Clinic proceedings最新文献

{"title":"Lower Rates of Abdominal Aortic Aneurysm Repair and Higher Long-term Aortic Mortality in Women Compared With Men: Results of a Population-Based Study Spanning 4 Decades.","authors":"Indrani Sen, Jill Colglazier, Jennifer St Sauver, William S Harmsen, Jay Mandrekar, Manju Kalra","doi":"10.1016/j.mayocp.2024.11.027","DOIUrl":"10.1016/j.mayocp.2024.11.027","url":null,"abstract":"<p><strong>Objective: </strong>To determine the population-level impact of screening and endovascular repair as well as mortality in women with abdominal aortic aneurysms (AAAs).</p><p><strong>Patients and methods: </strong>We conducted a population-based cohort study of patients from Olmsted County, Minnesota, in whom AAA was diagnosed between January 1, 1980, and December 31, 2017. The AAAs were identified using the International Classification of Diseases, Ninth and Tenth Revisions and Current Procedural Terminology codes with medical record review to confirm the diagnosis and identify late events. Survival analysis for overall and aortic mortality was performed and stratified based on sex and repair status.</p><p><strong>Results: </strong>There were 1537 patients in our study cohort (75% [1156] male; median age, 74 years). Compared with men, women were older (80 vs 73 years; P<.001), had smaller initial aneurysm size (4 vs 4.3 cm; P<.001), underwent AAA repair less frequently (26% [99] vs 41% [475]; P<.001), and had similar 30-day mortality from AAA repair (4% [4 of 381] vs 5% [22 of 1156]; P=.50). Median follow-up was 18 years. Aortic and all-cause mortality at 10 and 20 years were highest in females who did not undergo repair (hazard ratio, 3; 95% CI, 1.8 to 4.5; P<.001), as compared with all men and women who underwent AAA repair. Cumulative aortic mortality analyzed with non-aortic-related deaths as a competing risk factor remained significantly higher in NRF (15% [40 of 282] vs 5% to 8% in other groups; 5/99 in females undergoing repair, 39/681 in non repaired males and 37/475 in males who underwent repair, P=.001). All patients with aortic-related mortality had refused repair due to older age and comorbidities, except 2 females with ruptures of 4.8 and 5.5 cm AAAs awaiting repair.</p><p><strong>Conclusion: </strong>Abdominal aortic aneurysms are diagnosed in women almost a decade later and repaired less often than in men. There is a 3-fold greater long-term aortic-related mortality in women not undergoing AAA repair compared with men and women who underwent AAA repair.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476087","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":"Dialysis Transition Patterns of Chronic Kidney Disease Patients With and Without Heart Failure.","authors":"Mitchell E Flagg, Simran K Bhandari, Katherine J Pak, Hui Zhou, Sally F Shaw, Jiaxiao M Shi, Connie M Rhee, Benjamin I Broder, John J Sim","doi":"10.1016/j.mayocp.2024.11.029","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.11.029","url":null,"abstract":"<p><strong>Objective: </strong>To compare dialysis transition patterns of chronic kidney disease (CKD) patients with heart failure (HF) and without HF, including inpatient \"crash start\" initiation of long-term (\"maintenance\") dialysis, early dialysis initiation as evaluated by estimated glomerular filtration rate (eGFR), and rate of central venous catheter (CVC) use for hemodialysis.</p><p><strong>Methods: </strong>A cross-sectional study was performed within Kaiser Permanente Southern California of patients (age ≥18 years) with observed incidence of CKD who initiated maintenance dialysis between January 1, 2007, and December 31, 2018. Heart failure was further categorized into HF with preserved ejection fraction (>40%) or HF with reduced ejection fraction (≤40%). Associations between HF and risk of inpatient initiation of maintenance dialysis or hemodialysis vascular access were assessed by rate ratio (RR) using Poisson regression with robust variance error.</p><p><strong>Results: </strong>Of 6812 patients with CKD initiating dialysis, 2498 (37%) had HF. Inpatient dialysis initiation occurred in 463 (18.5%) patients with HF vs 416 (9.6%) without HF. Mean (SD) eGFR at dialysis was 11.3 (6.2) mL/min per 1.73 m² with HF vs 9.4 (5.2) mL/min per 1.73 m² without HF (P<.001). Of 5499 patients who initiated hemodialysis, CVC use occurred in 1302 (58.5%) HF patients vs 1698 (51.9%) non-HF patients. Compared with non-HF patients, patients with HF had multivariate RRs (95% CI) of 1.46 (1.26 to 1.69) and 1.04 (0.99 to 1.10) for inpatient dialysis initiation and CVC use, respectively. Patients with HF with reduced ejection fraction had CVC placement RR of 1.23 (1.14 to 1.33).</p><p><strong>Conclusion: </strong>Patients with CKD and HF had higher rates of suboptimal dialysis initiation: more frequent inpatient dialysis starts, more frequent CVC placement for hemodialysis access, and higher eGFR at dialysis initiation. Our findings suggest that CKD patients with HF may warrant different management strategies as they progress to dialysis.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449278","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":"Comparative Predictors of Mortality Risk in Contemporary Patients Referred for Stress Myocardial Perfusion Imaging.","authors":"Alan Rozanski, Heidi Gransar, Robert J H Miller, Donghee Han, Sean W Hayes, John D Friedman, Louise Thomson, Carl J Lavie, Daniel S Berman","doi":"10.1016/j.mayocp.2024.09.019","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.09.019","url":null,"abstract":"<p><strong>Objective: </strong>To assess the relative predictors of mortality risk in a contemporary cohort of patients referred for stress single-photon emission computed tomography myocardial perfusion imaging in whom all relevant risk factors and cardiac-related comorbidities were evaluated at the time of cardiac stress testing.</p><p><strong>Methods: </strong>We evaluated 15,662 patients undergoing stress single-photon emission computed tomography myocardial perfusion imaging between 2008 and 2017. Patients were observed for a median of 6.7 years for all-cause mortality. Patients were assessed for their mode of stress testing (exercise vs pharmacologic testing), myocardial ischemia, coronary artery disease risk factors, and cardiac-related comorbidities, such as chronic kidney disease.</p><p><strong>Results: </strong>Age and pharmacologic stress testing, which was performed in 48.1% of our patients, were the most potent predictors of mortality. Moderate to severe myocardial ischemia, a traditional driver of mortality, was present in only 3.6% of patients. There was a stepwise increase in annualized mortality according to patients' number of risk factors (P < .001) or comorbidities (P < .001). After stratification of patients according to their mode of stress testing, this stepwise relationship of multimorbidity to mortality was noted only in pharmacologically tested patients. By contrast, the annualized mortality risk of patients undergoing treadmill exercise not only was low (<1%/year) but remained so even for patients with a high degree of multimorbidity.</p><p><strong>Conclusion: </strong>Patients referred for cardiac stress testing manifest a stepwise increase in mortality risk with an increasing burden of coronary artery disease risk factors and concomitant comorbidities. However, this stepwise increase is not observed in patients who perform treadmill exercise at the time of cardiac stress testing.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449336","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":"Early-Onset Gastrointestinal Cancers and Metabolic Risk Factors: Global Trends From the Global Burden of Disease Study 2021.","authors":"Pojsakorn Danpanichkul, Kanokphong Suparan, Thanida Auttapracha, Primrose Tothanarungroj, Siwanart Kongarin, Krittameth Rakwong, Darren Jun Hao Tan, Banthoon Sukphutanan, Mark D Muthiah, Daniel Tung, Junpeng Luo, Asahiro Morishita, En Ying Tan, Hirokazu Takahashi, Omar Y Mousa, Rashid N Lui, Mazen Noureddin, Donghee Kim, Denise M Harnois, Ju Dong Yang, Lewis R Roberts, Michael B Wallace, Karn Wijarnpreecha","doi":"10.1016/j.mayocp.2024.10.021","DOIUrl":"https://doi.org/10.1016/j.mayocp.2024.10.021","url":null,"abstract":"<p><strong>Objective: </strong>To explore the increasing incidence of gastrointestinal (GI) cancers and related risk factors in younger patients.</p><p><strong>Patient and methods: </strong>We used data from the Global Burden of Disease Study 2021 to assess the incidence, mortality, and disability-adjusted life years (DALYs) for early-onset (age 15 to 49 years) GI cancers, including mortality and DALYs from diabetes mellitus and high body mass index.</p><p><strong>Results: </strong>In 2021, there were approximately 499,800 incident cases, 285,900 deaths, and 14.01 million DALYs from early-onset GI cancer. Early-onset GI cancer accounted for 9.51% of the incidence and 7.73% of the mortality of the overall GI cancer. From 2000 to 2021, age-standardized incidence rates increased for early-onset colorectal cancer (annual percent change, 0.84%; 95% CI, 0.71% to 0.97%) and biliary tract cancer (annual percent change, 0.19%; 95% CI, 0.06% to 0.32%). In 2021, there were 20,860 deaths from early-onset GI cancer attributable to metabolic risk factors. The age-standardized death rates of early-onset GI cancer from metabolic risk factors increased in all types of early-onset GI cancer.</p><p><strong>Conclusion: </strong>Our research highlights a significant increase in early-onset GI cancer, emphasizing the need for a strategy that includes controlling risk factors, particularly metabolic risk factors, adoption of effective screening methods, and effective cancer management.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408297","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":"Human Papillomavirus–Associated Penile Squamous Cell Carcinoma","authors":"Burak Tekin MD,&nbsp;Lori A. Erickson MD,&nbsp;Sounak Gupta MBBS, PhD","doi":"10.1016/j.mayocp.2024.09.008","DOIUrl":"10.1016/j.mayocp.2024.09.008","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 2","pages":"Pages 394-396"},"PeriodicalIF":6.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143149128","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":"Stroke Survivors With Type 2 Diabetes: Repositioning Pioglitazone in an Era Dominated by Gliflozins","authors":"Navin Suthahar MD, MSc, PhD, FESC","doi":"10.1016/j.mayocp.2024.12.006","DOIUrl":"10.1016/j.mayocp.2024.12.006","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 2","pages":"Pages 187-189"},"PeriodicalIF":6.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143149561","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":"Characteristic Histology of Autoimmune Hepatitis–Primary Biliary Cholangitis","authors":"Ryan Kendziora MD ,&nbsp;Kristina Matkowskyj MD, PhD","doi":"10.1016/j.mayocp.2024.11.006","DOIUrl":"10.1016/j.mayocp.2024.11.006","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 2","pages":"Page 380"},"PeriodicalIF":6.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903373","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":"Historic Logo, Rochester Methodist Hospital by Robert Freeman and Ellerbe Associates, Inc","authors":"Margaret R. Wentz BA","doi":"10.1016/j.mayocp.2024.12.008","DOIUrl":"10.1016/j.mayocp.2024.12.008","url":null,"abstract":"<div><div>Art is integrated into the Mayo Clinic environment. Since the original Mayo Clinic Building was finished in 1914, many pieces have been donated or commissioned for patients and staff to enjoy. Each issue of <em>Mayo Clinic Proceedings</em> features a work of art (as interpreted by the author) that is displayed in a building or on the grounds of Mayo Clinic campuses.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 2","pages":"Page 397"},"PeriodicalIF":6.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143135073","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":"Relevance of High Bleeding Risk and Postdischarge Bleeding in Patients Undergoing Percutaneous Coronary Intervention","authors":"Brenden S. Ingraham MD ,&nbsp;Marco Valgimigli MD, PhD ,&nbsp;Dominick J. Angiolillo MD, PhD ,&nbsp;Davide Capodanno MD, PhD ,&nbsp;Sunil V. Rao MD, PhD ,&nbsp;Philip Urban MD ,&nbsp;Mandeep Singh MD, MPH","doi":"10.1016/j.mayocp.2024.09.010","DOIUrl":"10.1016/j.mayocp.2024.09.010","url":null,"abstract":"<div><div>Bleeding avoidance strategies are critical in the modern era of percutaneous coronary intervention; however, most efforts are geared toward reducing access-related complications. Improvements in procedural techniques (radial access, improved procedural anticoagulation regimens, etc) and modifications in postdischarge pharmacotherapy (shortened dual antiplatelet therapy, genotype-guided P2Y₁₂ inhibition, etc) that led to a decline in bleeding related to percutaneous procedures were largely offset by increases in complexity and performance of percutaneous coronary intervention in high-risk patients. Among patients presenting with acute coronary syndrome, aggressive antiplatelet regimens with potent P2Y₁₂ inhibitors are typically prescribed for a longer duration, prioritizing reduction in ischemic events over bleeding risk. Because postdischarge bleeding connotes an adverse prognosis similar to an ischemic event, postprocedure freedom from adverse outcomes can be best tailored by individualizing and recognizing the patient’s bleeding and ischemic risks. This review of the contemporary and historical literature (PubMed, EMBASE, Cochrane Library) summarizes the available data, provides strategies to navigate these complex decisions, and helps individualize antithrombotic therapy.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 2","pages":"Pages 304-331"},"PeriodicalIF":6.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143149567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Academic Promotions in Medicine","authors":"Rahma Warsame MD ,&nbsp;Yong-Hun Kim MD ,&nbsp;Melody Y. Ouk MEd ,&nbsp;Kristin C. Cole MS ,&nbsp;Martha Q. Lacy MD ,&nbsp;Sharonne N. Hayes MD ,&nbsp;Zamzam Shalle BS ,&nbsp;Joyce Balls-Berry PhD ,&nbsp;Barbara L. Jordan MS ,&nbsp;Alexandra P. Wolanskyj-Spinner MD ,&nbsp;Robert J. Spinner MD ,&nbsp;Felicity T. Enders PhD","doi":"10.1016/j.mayocp.2024.05.032","DOIUrl":"10.1016/j.mayocp.2024.05.032","url":null,"abstract":"<div><h3>Objective</h3><div>Evaluate quantitative and qualitative differences by sex and race/ethnic identities in curriculum vitae (CV) of faculty candidates for promotion.</div></div><div><h3>Methods</h3><div>This was a retrospective, multisite, single-institution study of all candidates who applied to be considered for promotion to associate professor or professor from January 2015 to July 2019. Data on leadership positions, grants, and publications were abstracted from CV using a standardized procedure. Demographic data, including sex, race, and part-time status were obtained from the Human Resources database. Characteristics from CV were compared between groups using χ² or Fisher exact tests for categorical data, and Kruskal-Wallis tests for continuous data.</div></div><div><h3>Results</h3><div>A total of 162 women and 300 men applied for associate professorship and 89 women and 231 men applied for professorship. There were 304 White, 112 Asian, and 43 underrepresented in medicine (URM) candidates for associate professorship and 228 White, 68 Asian, and 22 URM candidates for professorship. Women were more likely to work part-time than men (associate professor: 23.5% vs 3.3%, respectively, <em>P</em>&lt;.001; professor: 24.7% vs 5.6%, respectively, <em>P</em>&lt;.001) and had fewer papers published overall (associate professor: median 35 vs 40, respectively, <em>P</em>=.001; professor: median 66 vs 77, respectively, <em>P</em>=.012). White candidates were more likely to have held an elected office to society (13.5% vs 3.6% Asian vs 0% URM, <em>P</em>=.001). Asian candidates were less likely to be a chair/co-chair compared with White individuals and other URMs (3.6% vs 10.9% vs 14.0%, respectively, <em>P</em>=.043). The ratios of candidates for professor-to–associate professor for women and URM was 50% compared with 25% for White men, respectively.</div></div><div><h3>Conclusion</h3><div>The participants’ CV demonstrated notable differences associated with the candidate’s race/ethnicity and sex.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 2","pages":"Pages 249-264"},"PeriodicalIF":6.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143149569","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}