Mayo Clinic proceedings最新文献

{"title":"Year in Review: Selection of Best Papers in Gastroenterology and Hepatology 2024","authors":"Michael Camilleri MD, DSc ,&nbsp;Evan S. Dellon MD, MPH","doi":"10.1016/j.mayocp.2025.06.001","DOIUrl":"10.1016/j.mayocp.2025.06.001","url":null,"abstract":"<div><div>This review addresses selected topics in gastroenterology and hepatology that are of interest and relevance to general internists. The topics were selected on the basis of publications in 2024 in top general medicine journals (<em>New England Journal of Medicine</em>, <em>Journal of the American Medical Association</em>, <em>Annals of Internal Medicine</em>, <em>Lancet</em>), often complemented with publications in the top gastroenterology journals pertaining to the same themes. General internists may be the primary providers for some of these diseases or the first to evaluate symptoms—such as uncontrolled heartburn; dysphagia, which is increasingly recognized as being associated with allergic mechanisms including eosinophil infiltration of the esophagus; irritable bowel syndrome; and the effects of incretin therapies (glucagon-like peptide 1 and glucagon-dependent insulinotropic peptide agonists) on obesity, metabolic-associated steatohepatitis, or steatotic liver diseases—and to screen for colorectal cancer by novel blood or stool markers. Alternatively, internists may provide continuity of care for more complex diseases, including a novel diagnostic approach to pancreatic ductal adenocarcinoma, immunotherapy for locally advanced mismatch repair–deficient colorectal cancer, and treatment of rarer liver diseases such as primary biliary cholangitis. These topics illustrate impressive advances in 2024 in the diagnosis and management of diseases affecting the gastrointestinal tract and liver.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 9","pages":"Pages 1621-1631"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768775","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":"Acute Effects of Myeloperoxidase Inhibition on Exercise Hemodynamics in Heart Failure With Preserved Ejection Fraction: A Randomized Clinical Trial","authors":"Dejana Popovic MD, PhD ,&nbsp;Yogesh N.V. Reddy MD ,&nbsp;Massar Omar MD, PhD ,&nbsp;Kazunori Omote MD, PhD ,&nbsp;Vojtech Melenovsky MD, PhD ,&nbsp;Daniel Burkhoff MD, PhD ,&nbsp;Barry A. Borlaug MD","doi":"10.1016/j.mayocp.2025.02.022","DOIUrl":"10.1016/j.mayocp.2025.02.022","url":null,"abstract":"<div><h3>Objective</h3><div>Myeloperoxidase (MPO) is a heme peroxidase that scavenges nitric oxide and contributes to microvascular dysfunction. Patients with heart failure and preserved ejection fraction (HFpEF) have microvascular dysfunction that leads to increased pulmonary capillary wedge pressure (PCWP). We sought to investigate whether acute MPO inhibition can reduce exertional PCWP in patients with HFpEF.</div></div><div><h3>Patients and Methods</h3><div>Between July 1, 2018, and February 24, 2022, participants with HFpEF were recruited. They underwent baseline invasive hemodynamic exercise evaluation and were then randomized, double-blind, to a single dose of the MPO inhibitor mitiperstat at 30 mg or matching placebo, after which they underwent repeated invasive hemodynamic exercise testing. The primary end point was PCWP during 20-W exercise workload.</div></div><div><h3>Results</h3><div>Patients with HFpEF (N=30; mean ± SD age, 70±9 years; 11 female [37%]; body mass index, 34.0 kg/m²) displayed typical hemodynamic responses to exercise prior to treatment, with PCWP increasing from 17±5 to 32±6 mm Hg with exercise and mean pulmonary artery pressure increasing from 28±9 to 49±11 mm Hg. Contrary to our hypothesis, as compared with placebo, mitiperstat treatment resulted in a higher PCWP during the second bout of exercise (−1±3 vs −4±5 mm Hg; <em>P</em>=.04). There was a trend for less reduction in mean pulmonary artery pressure and lower pulmonary artery compliance during exercise with mitiperstat as compared with placebo. There was no effect of mitiperstat on arterial, coronary sinus, or transcardiac uptake/release of O₂, CO₂, and lactate compared with placebo.</div></div><div><h3>Conclusion</h3><div>Acute MPO inhibition with mitiperstat did not reduce exertional hemodynamic congestion in patients with HFpEF.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 9","pages":"Pages 1495-1505"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789530","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":"Entering the Fourth Decade of the Opioid Crisis: An Institution’s Efforts to Redefine Opioid Stewardship","authors":"Benjamin Lai MB BCh BAO, MSc ,&nbsp;Julie Cunningham PharmD ,&nbsp;Nancy O’Keefe MHA, BSN, RN, CPHQ ,&nbsp;Mary Beth Chambers DNP, RN-ACNS ,&nbsp;Casey Clements MD, PhD ,&nbsp;Holly Geyer MD","doi":"10.1016/j.mayocp.2025.05.017","DOIUrl":"10.1016/j.mayocp.2025.05.017","url":null,"abstract":"<div><div>The opioid crisis in the United States has grown increasingly complex as it enters its fourth decade. Synthetic opioids and psychostimulants now contribute to significant morbidity and mortality. Despite recent declining trends in overdose deaths, they remain magnitudes higher compared with the early years of the crisis. Against this backdrop, our institution formed an Opioid Stewardship Program in 2017 with representation from multiple disciplines and across 5 US states. Our mission was to establish and to maintain opioid analgesic prescribing and monitoring best practices through the development of guidelines, risk mitigation strategies, electronic health record tools, dashboards, and leadership push reports as well as education for patients and staff. As the epidemic evolved, we shifted our focus to opioid use disorder (OUD) screening and treatment, and community engagement. We continued to keep our institutional leadership abreast of regulatory and guideline updates—keeping them accountable for upholding best practices. Work to date has yielded improvements in opioid prescribing trends, enhanced awareness and knowledge of clinic staff across disciplines, and increasing numbers of patients with OUD receiving treatment. Much remains to be done, but we remain optimistic that our ongoing efforts will drive continued improvements—ultimately saving lives and improving access to OUD treatment.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 9","pages":"Pages 1606-1620"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768771","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: eGFR Decline at Initiation of Sodium-Glucose Cotransporter 2 Inhibitors","authors":"Chi-Yu Chen MD,&nbsp;Shao-Sung Huang MD,&nbsp;Der-Cherng Tarng MD, PhD,&nbsp;Wei-Cheng Tseng MD, PhD","doi":"10.1016/j.mayocp.2025.05.022","DOIUrl":"10.1016/j.mayocp.2025.05.022","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 9","pages":"Pages 1671-1672"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144926482","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":"Population-Based Cohort of Renal Morbidity in Type 1 Diabetes","authors":"Aleksandra Kukla MD ,&nbsp;Shafaq Rizvi MD ,&nbsp;Petar Veruovic MD ,&nbsp;Lisa Vaughan MS ,&nbsp;Leidy Plaza Enriquez MD ,&nbsp;Rana Ibrahim MD ,&nbsp;Phillip Schulte PhD ,&nbsp;Lilach Lerman MD, PhD ,&nbsp;Chung Wi II MD ,&nbsp;Yogish C. Kudva MBBS","doi":"10.1016/j.mayocp.2025.05.012","DOIUrl":"10.1016/j.mayocp.2025.05.012","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 9","pages":"Pages 1665-1668"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144926479","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":"Hand Blisters","authors":"Wenting Hu MD ,&nbsp;Shuli Du MD ,&nbsp;Min Gao MD, PhD","doi":"10.1016/j.mayocp.2025.04.002","DOIUrl":"10.1016/j.mayocp.2025.04.002","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 9","pages":"Pages 1471-1472"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718097","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":"Deep Vein Thrombosis in Transit","authors":"Steven Callori MPH ,&nbsp;Wendaline VanBuren MD ,&nbsp;Robert D. McBane II MD","doi":"10.1016/j.mayocp.2025.04.006","DOIUrl":"10.1016/j.mayocp.2025.04.006","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 9","pages":"Pages 1660-1661"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144732098","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":"Heart Transplantation for Cardiac Amyloidosis: Mayo Clinic Consensus Statement","authors":"Melissa A. Lyle MD ,&nbsp;Julie L. Rosenthal MD ,&nbsp;Jose N. Nativi Nicolau MD ,&nbsp;Juan Carlos Leoni Moreno MD ,&nbsp;Parag C. Patel MD ,&nbsp;Awais A. Malik MD ,&nbsp;Nabeel Aslam MD ,&nbsp;Tambi Jarmi MD ,&nbsp;Elizabeth A. Mauricio MD ,&nbsp;Christopher J. Lamb MD ,&nbsp;Timothy A. Woodward MD ,&nbsp;Maoyin Pang MD, PhD ,&nbsp;John C. Haney MD, MPH ,&nbsp;David E. Steidley MD ,&nbsp;Rafael Fonseca MD ,&nbsp;Alfredo L. Clavell MD ,&nbsp;Omar F. Abou Ezzeddine MD, MS ,&nbsp;Andrew N. Rosenbaum MD ,&nbsp;Barry A. Boilson MD ,&nbsp;Sudhir S. Kushwaha MD ,&nbsp;Taimur Sher MBBS, MD","doi":"10.1016/j.mayocp.2025.05.009","DOIUrl":"10.1016/j.mayocp.2025.05.009","url":null,"abstract":"<div><div>Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy secondary to amyloid fibril deposition in the myocardium. The two precursor proteins that most frequently infiltrate the heart resulting in cardiac amyloidosis are immunoglobulin light chains (AL) and transthyretin (ATTR). Regardless of the type of amyloidosis, cardiac involvement portends a worse prognosis, and those patients with symptoms of advanced heart failure should be referred to a heart failure specialist for further evaluation and management. Given the lack of formalized guidelines for heart transplantation in CA, we propose recommendations for the pretransplant evaluation and posttransplant management within the context of the best current evidence in addition to expert opinion.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 9","pages":"Pages 1578-1605"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789531","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.2025.08.009","DOIUrl":"10.1016/j.mayocp.2025.08.009","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"100 9","pages":"Page e1"},"PeriodicalIF":6.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144926529","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 Pathogenic/Likely Pathogenic Inherited Cardiomyopathy Variants With Heart Failure: A TOPMed Multiancestry Analysis.","authors":"Naman S Shetty, Mokshad Gaonkar, Akhil Pampana, Nirav Patel, April P Carson, Bernhard Haring, Bruce M Psaty, Charles Kooperberg, Eric Boerwinkle, Jerome I Rotter, João A C Lima, Jorge R Kizer, Lisa Warsinger Martin, Kent D Taylor, Michael E Hall, Myriam Fornage, Sanjiv J Shah, Stephen S Rich, Ramachandran S Vasan, Rami Nassir, Peng Li, Garima Arora, Pankaj Arora","doi":"10.1016/j.mayocp.2025.01.021","DOIUrl":"https://doi.org/10.1016/j.mayocp.2025.01.021","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the prevalence of pathogenic/likely pathogenic inherited cardiomyopathy variants and their association with heart failure in the (TOPMed) TransOmic for Precision of Medicine cohorts.</p><p><strong>Methods: </strong>A retrospective cohort study using the TOPMed cohorts, including multi-ancestry US adults (≥18 years of age) with sequencing data, was conducted. Pathogenic/likely pathogenic inherited cardiomyopathy variant carrier status was determined based on ClinVar variants classified with two or more stars of evidence. Individuals without pathogenic/likely pathogenic variants were used as the reference group. The primary outcome was heart failure , adjudicated by an expert panel. Cox proportional hazards models assessed the association between carrier status and heart failure risk, adjusting for sex, study cohort, coronary artery disease, and genetic ancestry. Age was used as the timescale to account for the effect of variants since birth, and interval censoring was used to handle the uncertainty in the timing of heart failure events.</p><p><strong>Results: </strong>Among 30,977 individuals (median age, 61.0 years; 71.3% female; 37.0% non-European ancestry), 229 (0.7%) were identified as pathogenic/likely pathogenic inherited cardiomyopathy variant carriers. There were 3,298 events of heart failure (35 in carriers and 3,263 in non-carriers). The heart failure incidence rate was higher in variant carriers (2.06 per 1000 person-years) compared with noncarriers (1.40 per 1000 person-years), with an adjusted hazard ratio of 1.68 (95% CI, 1.29-2.22).</p><p><strong>Conclusion: </strong>Approximately 1 in 140 US adults carry a cardiomyopathy variant, which increases heart failure risk. Targeted genetic screening may facilitate early identification and preventive interventions to reduce heart failure risk in carriers.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959495","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}