Mayo Clinic proceedings. Innovations, quality & outcomes最新文献

{"title":"First Reported Case of Dual Hereditary Gelsolin and Transthyretin Wild-Type Cardiac Amyloidosis in a Man in his late 40s","authors":"Jeanne L. Theis PhD ,&nbsp;Surendra Dasari PhD ,&nbsp;Jason D. Theis BS ,&nbsp;Julie A. Vrana PhD ,&nbsp;Linda Hasadsri MD, PhD ,&nbsp;Joel Fernandez MD ,&nbsp;Ellen D. McPhail MD","doi":"10.1016/j.mayocpiqo.2025.100648","DOIUrl":"10.1016/j.mayocpiqo.2025.100648","url":null,"abstract":"<div><div>Amyloidosis is a group of disorders characterized by abnormal deposition of amyloid proteins in various tissues and organs, leading to progressive organ dysfunction. With over 40 precursor proteins linked to amyloid formation, identification of the amyloid type is critical to guide treatment. A man in his late 40s presenting with heart failure was diagnosed with cardiac amyloidosis based on an endomyocardial biopsy. Amyloid typing performed on the heart biopsy at Mayo Clinic Laboratories using differential laser microdissection and shotgun proteomics with mass spectrometry reported gelsolin amyloid (AGel) deposits exclusively in the vasculature and transthyretin amyloid deposits exclusively within the interstitium. Mutational analysis identified a novel p.Y474N in the gelsolin gene, establishing a diagnosis of hereditary AGel amyloidosis. Transthyretin gene mutations were absent, confirming a concurrent diagnosis of acquired transthyretin wild-type amyloidosis. The patient, who had been treated with guideline-directed medical therapy since his initial presentation, was subsequently started on tafamidis, with subsequent improvement of his ejection fraction after 6-7 months. Although rare, 2 different amyloid types may arise in the same anatomic site. Identification of all amyloid types is crucial for optimal patient management. In this case, the co-existence of 2 rare amyloid types (AGel with a novel mutation coupled with ATTRwt in a patient under 50 years of age) in mutually exclusive anatomic compartments in the same cardiac biopsy raises the possibility that an unknown systemic factor may play a role in amyloidogenesis in dual amyloid cases.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 5","pages":"Article 100648"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144864405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Clinical Outcomes and Health Care Utilization: Telehealth Versus Traditional Care at US Rural Hemodialysis Units","authors":"Mariam Charkviani MD ,&nbsp;Lagu A. Androga MD ,&nbsp;Arvind K. Garg MD ,&nbsp;Priya Ramar MPH ,&nbsp;Rachel H. Amundson MHA ,&nbsp;Lisa E. Vaughan MS ,&nbsp;Ziad Zoghby MD ,&nbsp;Robert C. Albright Jr. DO","doi":"10.1016/j.mayocpiqo.2025.100645","DOIUrl":"10.1016/j.mayocpiqo.2025.100645","url":null,"abstract":"<div><h3>Objective</h3><div>To determine whether novel dialysis delivery models, such as telehealth visits combined with face-to-face visits in a hybrid model (telehealth hybrid model), positively influence clinical outcomes and healthcare utilization.</div></div><div><h3>Patients and Methods</h3><div>This retrospective cohort study compares the rates of emergency department visits, hospitalizations, and Medicare established hemodialysis quality metrics before and after implementation of a telehealth hybrid model focused among rural populations in regions served by the Mayo Clinic dialysis system between January 1, 2020, to December 31, 2020, versus face-to-face visits alone before implementation of the program from January 1, 2019, to December 31, 2019. In addition, we used a standardized anonymous survey to examine patient perspectives toward the implementation of telehealth at the dialysis units.</div></div><div><h3>Results</h3><div>No significant differences in health care utilization outcomes (emergency department visits: Incidence rate ratios, 95% CI, 0.87 (0.62-1.22); <em>P</em>=.41; hospitalizations: Incidence rate ratios, 95% CI, 0.92 (0.63-1.35); <em>P</em>=.68) or clinical outcomes (abnormal laboratory measures) between the telehealth and standard care groups were observed. Patient satisfaction with telehealth was high, with 90% reporting successful video visits.</div></div><div><h3>Conclusion</h3><div>Our study provides evidence suggesting that the telehealth hybrid model can deliver nephrology care comparable to traditional care models in in-center dialysis without negatively impacting clinical outcomes, health care utilization, or patient satisfaction. Further research is necessary to confirm these results in other settings and to explore the long-term impacts of such hybrid care models.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 5","pages":"Article 100645"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144713436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Dual-Modality Ultrasound Video Recognition Model for Distinguishing Subpleural Pulmonary Nodules","authors":"Yin Wang MD, PhD ,&nbsp;Mengjun Shen MD ,&nbsp;Ke Bi MD ,&nbsp;Wei Yang MD, PhD ,&nbsp;Xiaofei Ye MD, PhD ,&nbsp;Qing Tang MD, PhD ,&nbsp;Yi Zhang MD ,&nbsp;Yang Cong MD ,&nbsp;Huiming Zhu MD ,&nbsp;Hongwei Chen MD ,&nbsp;Chunhong Tang MD ,&nbsp;Martin R. Prince MD, PhD","doi":"10.1016/j.mayocpiqo.2025.100659","DOIUrl":"10.1016/j.mayocpiqo.2025.100659","url":null,"abstract":"<div><h3>Objective</h3><div>To develop a deep learning model based on dual-modality ultrasound (DMUS) video recognition for the differential diagnosis of benign and malignant subpleural pulmonary nodules (SPNs).</div></div><div><h3>Patients and Methods</h3><div>Participant data (n=193, median age, 58 years [IQR, 34-66 years]; 123 men) with SPNs, prospectively collected from January 7, to December 21, 2020, were divided into training (n=154) and validation (n=39) sets in an 8:2 ratio. Additionally, independent internal (n=88) and external (n=91) test sets were prospectively collected from January 10 to June 25, 2021. The nature of the SPNs was determined through biopsy (n=306) and clinical follow-up (n=66). Our model integrated DMUS videos, time-intensity curves, and clinical information. The model’s performance was evaluated using area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity and compared with state-of-the-art video classification models, as well as ultrasound and computed tomography diagnoses made by radiologists.</div></div><div><h3>Results</h3><div>In the internal test set, our model accurately distinguished malignant from benign SPNs with an AUC, accuracy, sensitivity, and specificity of 0.91, 91% (80 of 88), 90% (27 of 30), and 91% (53 of 58), outperforming state-of-the-art video classification models (all <em>P</em>&lt;.05). In the external test set, the model achieved the accuracy, sensitivity, and specificity of 89% (81 of 91), 84% (27 of 32), and 92% (54 of 59), which were higher than the parameters for radiologist interpretations of ultrasound (81% [74 of 91], 63% [20 of 32], and 92% [54 of 59]) and computed tomography (76% [69 of 91], 91% [29 of 32], and 68% [40 of 59]), respectively.</div></div><div><h3>Conclusion</h3><div>This deep learning model based on DMUS video recognition enhances the performance of ultrasound in differentiating benign from malignant SPNs.</div></div><div><h3>Trial Registration</h3><div><span><span>clinicaltrials.gov</span><svg><path></path></svg></span> Identifier: ChiCTR1800019828</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 5","pages":"Article 100659"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145019007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of Juvenile Idiopathic Arthritis Following HPV9 Vaccination: A Retrospective Cohort Study Before and During the COVID-19 Pandemic","authors":"Ming-Chin Tsai MD ,&nbsp;Hsin-Hua Chen MD, PhD ,&nbsp;Wen-Yu Wu MD ,&nbsp;Yung-Chieh Huang MD ,&nbsp;Chiann-Yi Hsu MSc ,&nbsp;Lin-Shien Fu MD","doi":"10.1016/j.mayocpiqo.2025.100647","DOIUrl":"10.1016/j.mayocpiqo.2025.100647","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate whether 9-valent human papillomavirus (HPV9) vaccination is associated with an increased risk of juvenile idiopathic arthritis (JIA), particularly during the coronavirus disease-2019 (COVID-19) pandemic.</div></div><div><h3>Patients and Methods</h3><div>We conducted a retrospective cohort study using TriNetX U.S. Collaborative Network data from January 1, 2016, to December 31, 2023. Girls aged 9-13 years who received their first HPV9 dose in either the prepandemic (2016-2019) or pandemic (2020-2023) period were matched with unvaccinated controls. Exclusion criteria included previous JIA diagnosis, antirheumatic drug use, or positive rheumatoid factor. Incidence of new-onset JIA was tracked over 8 days to 36 months. Cox regression and Kaplan-Meier survival analysis were used to evaluate hazard ratios (HRs) and JIA-free survival.</div></div><div><h3>Results</h3><div>Among 99,243 vaccinated and 1.1 million control individuals, HPV9 recipients had a significantly reduced risk of JIA at 36 months in both periods (HR 2016-2019, 0.207, <em>P</em>&lt;.001; HR 2020-2023, 0.287, <em>P</em>&lt;.001). No increased risk was observed during the early postvaccination period. The estimated cumulative probability of JIA did not differ significantly between vaccinated groups across the 2 periods (<em>P</em>=.9), nor among unvaccinated controls (<em>P</em>=.238), indicating no modifying effect from COVID-19.</div></div><div><h3>Conclusion</h3><div>The HPV9 vaccination was associated with a lower risk of JIA, and this effect can last at least for 3 years. The COVID-19 pandemic did not alter this relationship. These findings reinforce the immunological safety of HPV9 and provide reassurance for adolescent vaccination programs, even in pandemic contexts.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 5","pages":"Article 100647"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145019006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comorbidity Disease Pattern in Japanese Elderly Population: A Network-Based Analysis","authors":"Shuko Nojiri PhD ,&nbsp;Wataru Urasaki MSc ,&nbsp;Masao Iwagami MD, PhD ,&nbsp;Masashi Nagao MD, PhD ,&nbsp;Takuya Uematsu MSc ,&nbsp;Muneaki Ishijima MD, PhD ,&nbsp;Hiroyuki Daida MD, PhD ,&nbsp;Yuji Nishizaki MD, PhD","doi":"10.1016/j.mayocpiqo.2025.100646","DOIUrl":"10.1016/j.mayocpiqo.2025.100646","url":null,"abstract":"<div><h3>Objective</h3><div>To clarify the disease pattern for elderly individuals in the general population in Japan with multimorbidity networks based on an analysis of common chronic conditions.</div></div><div><h3>Patients and Methods</h3><div>This study is a population study of disease network analysis in elderly in Japan. We obtained medical records for 4,797,907 elderly patients in Japan (from January 1, 2020 to December 31, 2020) from administrative claim databases. The administrative claim records were transformed for temporal disease occurrence pattern analysis and used to find frequently occurring disease sequences to predict the onset of disease progression.</div></div><div><h3>Results</h3><div>In those aged 75 years and older, circulatory and respiratory diseases gained predominance, while the burden of mental disorders remained substantial across all age groups. In men aged below 75 years, disseminated intravascular coagulation co-occurred frequently with acute myocardial infarction and respiratory failure. In women aged below 75 years, the pairing of vestibular dysfunction and hearing loss exhibited the highest association. For women aged 75 years and older, renal disease pairings, psychiatric comorbidities, and fall-related injuries were dominant. Network analyses reported increasing multimorbidity complexity with age. Respiratory, circulatory, and digestive disease clusters were central across age groups, with psychiatric and fracture-related conditions becoming more prominent in older adults, particularly women. Disease heatmaps further highlighted systemic comorbidity hubs involving pneumonia, iron deficiency anemia, kidney disease, and cardiovascular conditions.</div></div><div><h3>Conclusion</h3><div>In this study, we identified major comorbidity patterns and reported that atherosclerosis, angina pectoris, gastritis, and duodenitis were the most important comorbid diseases in the elderly population in Japan. The identification of distinctive comorbidity profiles from routine clinical data provides insights that may be leveraged to improve diagnosis and identify treatment targets for patients.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 5","pages":"Article 100646"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144879947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PainDETECT as a Potential Tool for Personalized Medicine: Predicting Outcome One Year After Knee Arthroplasty","authors":"Amanda J.W. Wall MSc ,&nbsp;Kirsten M. Leyland MSc, DPhil ,&nbsp;Amit Kiran PhD ,&nbsp;Nigel K. Arden MD ,&nbsp;Cyrus Cooper MA, DM ,&nbsp;Vishvarani Wanigasekera MBBS, DPhil ,&nbsp;M. Kassim Javaid MBBS, PhD ,&nbsp;Andrew J. Price MA, PhD ,&nbsp;Irene M.C. Tracey MA, DPhil ,&nbsp;Anushka Irani MA, BM BCh, DPhil","doi":"10.1016/j.mayocpiqo.2025.100649","DOIUrl":"10.1016/j.mayocpiqo.2025.100649","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate whether neuropathic-like pain, identified using the PainDETECT questionnaire, predicts postoperative symptoms, using data from 2 independent, prospective cohort studies.</div></div><div><h3>Patients and Methods</h3><div>Data were collected from patients undergoing primary knee arthroplasty for primary osteoarthritis recruited to the Evaluation of perioperative Pain in Osteoarthritis of the kNEe (EPIONE) Study n=120, from October 1, 2011, to May 30, 2014, and the Clinical Outcomes in Arthroplasty Study (COASt) n=404, from January 1, 2010, to December 31, 2018). The PainDETECT questionnaire score was used to divide patients into nociceptive (&lt;13), unclear (13-18), and neuropathic pain (&gt;18) groups preoperatively using validated cutoffs. As the neuropathic group also captures nociplastic pain, we used neuropathic-like to represent this combination. Surgical outcome was compared between groups using the Oxford Knee Score (OKS) and the presence of moderate to severe pain 12 months after arthroplasty.</div></div><div><h3>Results</h3><div>Total of 296 (56%) reported nociceptive, 144 (27%) unclear, and 84 (16%) neuropathic-like pain preoperatively. Patients in the neuropathic-like pain group had significantly worse OKS postoperatively, compared with the nociceptive group (34 [12] vs 40 [8], <em>P</em>&lt;.05), independent of baseline OKS, age, sex, and body mass index. Moderate to severe pain 12 months after arthroplasty was statistically significantly higher in the unclear (OR 2.19 [95% CI, 1.36-3.53]) and neuropathic-like (OR, 2.83 [95% CI, 1.58-5.09]) pain groups when compared with the nociceptive group.</div></div><div><h3>Conclusion</h3><div>Patients classified presurgery as having unclear and neuropathic pain by the modified PainDETECT have considerably worse outcomes after surgery. Neuropathic pain categorized by this tool commonly has centralized pain features and is a potential predictor of ongoing postsurgical pain. Knowledge of this may aid informed decision-making with respect to surgical intervention for those with knee osteoarthritis.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 5","pages":"Article 100649"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vital Signs–Only Machine Learning Model for Acute Inpatient Deterioration: A Retrospective Multicenter Study","authors":"Santiago Romero-Brufau MD, PhD ,&nbsp;Radit Smunyahirun PhD ,&nbsp;Timothée Filhol MiM ,&nbsp;Lucille Niederhauser MS ,&nbsp;Thanawin Trakoolwilaiwan MS ,&nbsp;Gurpreet Singh PhD","doi":"10.1016/j.mayocpiqo.2025.100663","DOIUrl":"10.1016/j.mayocpiqo.2025.100663","url":null,"abstract":"<div><h3>Objective</h3><div>To develop predictive models that are compatible with vital signs monitoring devices to identify patients at risk of clinical deterioration, defined as requiring a rapid response team intervention or an unplanned intensive care unit transfer.</div></div><div><h3>Patients and Methods</h3><div>Targeted vital signs from 227,858 inpatients admitted to general care or telemetry beds at a multihospital health care institution between January 1, 2019, and July 31, 2023, were selected. After filtering for high-quality data, 30,118 patients were used to train a Light Gradient Boosting Machine, and 30,095 were reserved for blind validation. We developed a machine learning model designed to minimize false positives while maintaining clinical relevance in identifying low-prevalence clinical deterioration events.</div></div><div><h3>Results</h3><div>At a sensitivity of 73.4% (95% CI, 72.2%-74.4%), the model achieved a positive predictive value (PPV) of 30.4% (95% CI, 29.6%-31.3%), with a C-statistic of 0.874 (95% CI, 0.867-0.881), alert rate of 0.170 (95% CI, 0.167-0.173) per patient per day, and normalized alert rate of 2.41 (95% CI, 2.31-2.51). Stratified analysis by hospital revealed that PPV was highest at the Rochester site, reaching 54.9% (95% CI, 52.9%-57.0%) and outperforming the EPIC deterioration index by 46% or a factor of 6 (7.57%).</div></div><div><h3>Conclusion</h3><div>Achieving a high PPV is crucial because it ensures a larger proportion of alerts are true positives, reducing the burden of false alarms. The considerable improvement in results comes from the novel 2-window feature extraction method. This technique enables the model to capture both long-term trends and recent changes in patient status, enhancing predictive performance.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 5","pages":"Article 100663"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Adult Medical Care Can Learn from Pediatrics: Creating Comfort, Connection, and Joy in the Hospital","authors":"Michael K. Hole MD, MBA ,&nbsp;Sunjay Letchuman BBA ,&nbsp;Jennifer Gates MD, MPH ,&nbsp;Leonard L. Berry MBA, PhD","doi":"10.1016/j.mayocpiqo.2025.100650","DOIUrl":"10.1016/j.mayocpiqo.2025.100650","url":null,"abstract":"","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 5","pages":"Article 100650"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144781305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Mood or Affect With Respiratory-Related Quality of Life, Lung Function, and All-Cause Mortality in Fibrotic Interstitial Lung Disease","authors":"Urbee Disha Peterson DO, MS ,&nbsp;Madison Beenken MS ,&nbsp;Teng Moua MD","doi":"10.1016/j.mayocpiqo.2025.100660","DOIUrl":"10.1016/j.mayocpiqo.2025.100660","url":null,"abstract":"<div><h3>Objective</h3><div>To assess whether self-reported acute mood or affect is associated with other patient-reported outcome measures, lung function, and all-cause mortality, in patients with fibrotic interstitial lung disease (f-ILD).</div></div><div><h3>Patients and Methods</h3><div>The Positive and Negative Affect Schedule (PANAS) is a 20-item questionnaire reflecting recent mood or affect over the past week, reported as Positive, Negative, or Ratio (Positive:Negative) subscores. Baseline and serial PANAS scores were assessed for their correlation with the Chronic Respiratory Questionnaire, Self-Management Assessment Scale 30, and lung function over a 3-year study period, and association with incident anxiety, depression, and all-cause mortality.</div></div><div><h3>Results</h3><div>In total, 199 patients with f-ILD were enrolled. Baseline PANAS scores correlated moderately with Chronic Respiratory Questionnaire and Self-Management Assessment Scale 30 scores. Higher PANAS Positive and Ratio scores were associated with higher percent predicted forced vital capacity. Mean PANAS scores were higher or lower when stratified by clinically suspected anxiety and/or depression and predictive of all-cause mortality on adjusted analysis, respectively. Incident anxiety and/or depression was not associated with worse survival outcome.</div></div><div><h3>Conclusion</h3><div>Self-reported acute mood or affect may be associated with RR-QoL, lung function, and adjusted all-cause mortality in patients with f-ILD.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 5","pages":"Article 100660"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Routine Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement: A Meta-Analysis of Randomized Controlled Trials","authors":"Mahmoud Ismayl MBBS,&nbsp;Musa Mufarrih MBBS,&nbsp;Mackram F. Eleid MD,&nbsp;Charanjit S. Rihal MD,&nbsp;Mayra Guerrero MD","doi":"10.1016/j.mayocpiqo.2025.100651","DOIUrl":"10.1016/j.mayocpiqo.2025.100651","url":null,"abstract":"<div><div>The risk of periprocedural stroke with TAVR remains a significant concern. Cerebral embolic protection (CEP) devices have been developed to mitigate this risk, but their clinical benefit remains uncertain. We aimed to evaluate the effectiveness and safety of routine CEP use during TAVR through a meta-analysis of randomized controlled trials (RCTs). A systematic search of PubMed, EMBASE, and ClinicalTrials.gov was conducted from inception to May 22, 2025, to identify RCTs comparing CEP versus standard care during TAVR. The primary outcome was stroke (including disabling and nondisabling strokes). Secondary outcomes included disabling stroke, new ischemic lesions on post-TAVR brain magnetic resonance imaging, all-cause mortality, major vascular complications, life-threatening bleeding, and acute kidney injury. Risk ratios (RRs) were pooled using a random-effects model. A total of 9 RCTs encompassing 11,641 patients (5970 with CEP and 5671 without) were included. CEP use did not significantly reduce the risk of stroke (RR, 0.91; 95% CI, 0.73–1.14; <em>P=</em>.41), disabling stroke (RR, 0.80; 95% CI, 0.57–1.12; <em>P</em>=.19), or new ischemic lesions on magnetic resonance imaging (RR, 0.98; 95% CI, 0.91–1.06; <em>P</em>=.64). There were no significant differences in all-cause mortality or safety outcomes between the CEP and control groups. Subgroup analyses based on the type of CEP device showed no significant differences in outcomes between the 2 groups, regardless of device type. In conclusion, routine CEP use during TAVR was not associated with reductions in stroke, disabling stroke, or all-cause mortality. Future studies are warranted to identify subgroups that may benefit from selective CEP use.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 5","pages":"Article 100651"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144781307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}