Pub Date : 2026-01-01DOI: 10.1016/j.mayocp.2025.08.019
Ziad Zalaquett MD, MSc, Neehal Shukla MD, Joseph Hajj MD, Michel Chedid El Helou MD, MSc, Rohit Moudgil MD, PhD, Patrick Collier MD, PhD
Fluoropyrimidines, including 5-fluorouracil and capecitabine, are widely used in the treatment of numerous malignant neoplasms. However, they are a common cause of chemotherapy-induced cardiac toxicity. The cardiovascular adverse events can range from arrhythmias to myocardial infarction and cardiogenic shock, with incidence rates varying between 1.2% and 30%. Despite increasing recognition of risk factors and clinical presentations, the exact mechanisms underlying fluoropyrimidine cardiotoxicity remain unclear. Proposed mechanisms include coronary vasospasm, direct myocardial toxicity due to mitochondrial injury, endothelial dysfunction, and ferroptosis. It is challenging to identify and diagnose the adverse event because of the variability in clinical manifestations and the absence of specific biomarkers. Biomarkers such as troponins or imaging modalities including electrocardiographic changes and echocardiographic assessment may aid in detecting toxicity, but their predictive value remains limited. The primary approach to management involves discontinuation of therapy and symptomatic treatment. Calcium channel blockers and nitrates are commonly used for vasospasm-related events. Rechallenge strategies incorporating dose modifications and cardioprotective medications have been explored but remain controversial owing to high recurrence rates. This review provides an updated overview of fluoropyrimidine-associated cardiotoxicity, emphasizing epidemiology, pathophysiology, diagnostic approaches, and management strategies to enhance patient safety and treatment outcomes.
{"title":"Cardiovascular Toxicity of Fluoropyrimidines: What We Know","authors":"Ziad Zalaquett MD, MSc, Neehal Shukla MD, Joseph Hajj MD, Michel Chedid El Helou MD, MSc, Rohit Moudgil MD, PhD, Patrick Collier MD, PhD","doi":"10.1016/j.mayocp.2025.08.019","DOIUrl":"10.1016/j.mayocp.2025.08.019","url":null,"abstract":"<div><div>Fluoropyrimidines, including 5-fluorouracil and capecitabine, are widely used in the treatment of numerous malignant neoplasms. However, they are a common cause of chemotherapy-induced cardiac toxicity. The cardiovascular adverse events can range from arrhythmias to myocardial infarction and cardiogenic shock, with incidence rates varying between 1.2% and 30%. Despite increasing recognition of risk factors and clinical presentations, the exact mechanisms underlying fluoropyrimidine cardiotoxicity remain unclear. Proposed mechanisms include coronary vasospasm, direct myocardial toxicity due to mitochondrial injury, endothelial dysfunction, and ferroptosis. It is challenging to identify and diagnose the adverse event because of the variability in clinical manifestations and the absence of specific biomarkers. Biomarkers such as troponins or imaging modalities including electrocardiographic changes and echocardiographic assessment may aid in detecting toxicity, but their predictive value remains limited. The primary approach to management involves discontinuation of therapy and symptomatic treatment. Calcium channel blockers and nitrates are commonly used for vasospasm-related events. Rechallenge strategies incorporating dose modifications and cardioprotective medications have been explored but remain controversial owing to high recurrence rates. This review provides an updated overview of fluoropyrimidine-associated cardiotoxicity, emphasizing epidemiology, pathophysiology, diagnostic approaches, and management strategies to enhance patient safety and treatment outcomes.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 1","pages":"Pages 136-155"},"PeriodicalIF":6.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145678044","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}
Pub Date : 2026-01-01DOI: 10.1016/j.mayocp.2025.08.008
Pierre Deharo MD , Thomas Cuisset MD , Christophe Saint Etienne MD , Thierry Bourguignon MD , Anne Bernard MD , Jean Michel Clerc MD , Jeremy Boyer MD , Laurent Fauchier MD
{"title":"Surgical vs Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve Stenosis: A Propensity Score–Matched Analysis","authors":"Pierre Deharo MD , Thomas Cuisset MD , Christophe Saint Etienne MD , Thierry Bourguignon MD , Anne Bernard MD , Jean Michel Clerc MD , Jeremy Boyer MD , Laurent Fauchier MD","doi":"10.1016/j.mayocp.2025.08.008","DOIUrl":"10.1016/j.mayocp.2025.08.008","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 1","pages":"Pages 192-194"},"PeriodicalIF":6.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145678072","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}
Pub Date : 2026-01-01DOI: 10.1016/j.mayocp.2025.09.004
The Mayo Clinic Center for Individualized Medicine Implementing Genetics in Primary Care Task Force, Elisa J.F. Houwink MD, PhD (Chair) , Karen M. Meagher PhD (Co-Chair) , Bjoerg (Bjorg) Thorsteinsdottir MD (Co-Chair) , Preya Agam MPH , Omar Kawam , Jenny L. Anderson MS, CGC , Jessa Bidwell MS, CGC , Ewan K. Cobran PhD , Sagar B. Dugani MD, PhD, MPH , Denise Dupras MD, PhD , Jennifer L. Kemppainen MS, GCG , Iftikhar J. Kullo MD , Richard J. (John) Presutti DO , Sandhya Pruthi MD , Thomas G. Salter MD , Paul Y. Takahashi MD, MPH , Richard R. Sharp Ph.D
Genomic innovations, including pharmacogenomics, are becoming increasingly relevant to routine medical care and hold promise for advancing prevention, early diagnosis, and treatment in primary care. However, integrating genetic services in this setting requires navigating a fragmented health care system, guided by national recommendations but marked by variability in reimbursement, clinician training, and infrastructure across regions. This article presents insights from a multidisciplinary Mayo Clinic task force examining the clinical, ethical, and implementation aspects of genomic services for adult primary care patients. We highlight the role of primary care clinicians in identifying individuals at risk for inherited conditions, such as hereditary breast and ovarian cancer syndrome, Lynch syndrome, and familial hypercholesterolemia. The article outlines current implementation models, emphasizes the value of family history, and addresses persistent challenges including limited clinician confidence, time constraints, and inconsistent access to services due to insurance and reimbursement variability. Educational and systems-level approaches, including core competencies, clinical decision support, and ethical frameworks, are essential to support primary care clinicians and to ensure responsible, scalable implementation. We also explore how genomics can reinforce the primary care mission by enabling patient-centered care, improving outcomes, and proactively addressing gaps in access. Ethical considerations, such as patient autonomy, informed consent, and privacy-sensitive communication
{"title":"Ethically Integrating Genomics in Primary Care: An Invitation to Share Implementation Best Practices","authors":"The Mayo Clinic Center for Individualized Medicine Implementing Genetics in Primary Care Task Force, Elisa J.F. Houwink MD, PhD (Chair) , Karen M. Meagher PhD (Co-Chair) , Bjoerg (Bjorg) Thorsteinsdottir MD (Co-Chair) , Preya Agam MPH , Omar Kawam , Jenny L. Anderson MS, CGC , Jessa Bidwell MS, CGC , Ewan K. Cobran PhD , Sagar B. Dugani MD, PhD, MPH , Denise Dupras MD, PhD , Jennifer L. Kemppainen MS, GCG , Iftikhar J. Kullo MD , Richard J. (John) Presutti DO , Sandhya Pruthi MD , Thomas G. Salter MD , Paul Y. Takahashi MD, MPH , Richard R. Sharp Ph.D","doi":"10.1016/j.mayocp.2025.09.004","DOIUrl":"10.1016/j.mayocp.2025.09.004","url":null,"abstract":"<div><div>Genomic innovations, including pharmacogenomics, are becoming increasingly relevant to routine medical care and hold promise for advancing prevention, early diagnosis, and treatment in primary care. However, integrating genetic services in this setting requires navigating a fragmented health care system, guided by national recommendations but marked by variability in reimbursement, clinician training, and infrastructure across regions. This article presents insights from a multidisciplinary Mayo Clinic task force examining the clinical, ethical, and implementation aspects of genomic services for adult primary care patients. We highlight the role of primary care clinicians in identifying individuals at risk for inherited conditions, such as hereditary breast and ovarian cancer syndrome, Lynch syndrome, and familial hypercholesterolemia. The article outlines current implementation models, emphasizes the value of family history, and addresses persistent challenges including limited clinician confidence, time constraints, and inconsistent access to services due to insurance and reimbursement variability. Educational and systems-level approaches, including core competencies, clinical decision support, and ethical frameworks, are essential to support primary care clinicians and to ensure responsible, scalable implementation. We also explore how genomics can reinforce the primary care mission by enabling patient-centered care, improving outcomes, and proactively addressing gaps in access. Ethical considerations, such as patient autonomy, informed consent, and privacy-sensitive communication</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 1","pages":"Pages 120-135"},"PeriodicalIF":6.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145715015","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}
Pub Date : 2026-01-01DOI: 10.1016/j.mayocp.2025.04.016
Sean Tackett MD, MPH , Gayle Adams MSW , Belinda Chen MD , Scott M. Wright MD
Objective
To systematically define humanizing health care to guide systems improvements that better meet patient and health care workers’ needs.
Participants and Methods
We conducted group concept mapping at Johns Hopkins Medicine, a large academic health system with five hospitals in Maryland and Washington, DC, outpatient practices, telemedicine, and homecare services. From October 2023 to May 2024, we recruited participants who brainstormed to the focus prompt: “One thing that can be done to more fully humanize healthcare experiences is:” The study team synthesized ideas for participants to sort them. Group concept mapping software generated cluster maps, which were interpreted by the study team to generate the concept map.
Results
In brainstorming, 63 individuals participated, including those with the perspectives of patients (n=40, 63%), caregivers (n=25, 40%), physicians (n=23, 37%), other types of health care professionals (n=14, 22%), health professions educators (n=28, 44%), and health care researchers (n=25, 40%). The 395 statements from brainstorming were synthesized into 207 ideas for sorting, which was completed by 13 participants. The final concept map included eight domains and 32 subdomains. Domains addressed: (1) effective communication, (2) health care worker attitudes, (3) health care culture, (4) health care worker community, (5) institutional policies and health care value, (6) physical and digital systems and access to care, (7) time and attention for patients, and (8) embedding patient perspectives throughout health care.
Conclusion
Health care is fundamentally about human experiences. This concept map, generated by individuals representing the perspectives of a variety of individuals involved in health care, offers guidance for interventions and measures to make health care more humanizing.
{"title":"A Group Concept Mapping Study to Define Humanizing Health Care","authors":"Sean Tackett MD, MPH , Gayle Adams MSW , Belinda Chen MD , Scott M. Wright MD","doi":"10.1016/j.mayocp.2025.04.016","DOIUrl":"10.1016/j.mayocp.2025.04.016","url":null,"abstract":"<div><h3>Objective</h3><div>To systematically define humanizing health care to guide systems improvements that better meet patient and health care workers’ needs.</div></div><div><h3>Participants and Methods</h3><div>We conducted group concept mapping at Johns Hopkins Medicine, a large academic health system with five hospitals in Maryland and Washington, DC, outpatient practices, telemedicine, and homecare services. From October 2023 to May 2024, we recruited participants who brainstormed to the focus prompt: “One thing that can be done to more fully humanize healthcare experiences is:” The study team synthesized ideas for participants to sort them. Group concept mapping software generated cluster maps, which were interpreted by the study team to generate the concept map.</div></div><div><h3>Results</h3><div>In brainstorming, 63 individuals participated, including those with the perspectives of patients (n=40, 63%), caregivers (n=25, 40%), physicians (n=23, 37%), other types of health care professionals (n=14, 22%), health professions educators (n=28, 44%), and health care researchers (n=25, 40%). The 395 statements from brainstorming were synthesized into 207 ideas for sorting, which was completed by 13 participants. The final concept map included eight domains and 32 subdomains. Domains addressed: (1) effective communication, (2) health care worker attitudes, (3) health care culture, (4) health care worker community, (5) institutional policies and health care value, (6) physical and digital systems and access to care, (7) time and attention for patients, and (8) embedding patient perspectives throughout health care.</div></div><div><h3>Conclusion</h3><div>Health care is fundamentally about human experiences. This concept map, generated by individuals representing the perspectives of a variety of individuals involved in health care, offers guidance for interventions and measures to make health care more humanizing.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 1","pages":"Pages 95-105"},"PeriodicalIF":6.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144732095","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}
Pub Date : 2026-01-01DOI: 10.1016/j.mayocp.2025.01.019
Shun-Cheng Chang MD , Chen-Yi Yang MS , Ching-Uen Huang HN , Yi-Chun Wu MD , Feng-Chou Tsai MD, PhD , Hao-Chin Chang BS , Jung-Hsuan Chang OT , Xin-Yi Lin RN , Yu-Fen Chiu RN , Nai-Chen Cheng MD, PhD (co-corresponding author) , Huang-Tz Ou PhD (co-corresponding author)
Objective
To evaluate the real-world effectiveness and dose-response of ON101 , especially for high-risk patients with poor healing outcomes.
Patients and Methods
ON101 cream, a novel treatment for diabetic foot ulcers (DFUs), modulates the function of macrophages and accelerates the emergence and expansion of anti-inflammatory properties. In this study, 80 and 98 patients with DFU who were treated using ON101 and standard care with adjuvant therapy (denoted as nonuse), respectively, from January 1, 2020, to December 31, 2022, were identified from Taipei Medical University-Shuang Ho Hospital, Taiwan. The primary outcome was a complete healing event within 120 days following treatment initiation. Secondary outcomes included ulcer recurrence, amputation, and all-cause mortality within 1 year of follow-up. Cox proportional hazard model analysis was applied to determine the treatment effect on study outcomes. The dose-response of ON101 on healing outcomes was modeled using a regression analysis.
Results
Compared with nonuse, ON101 use significantly increased the complete healing outcome by 79% (HR, 1.79; 95% CI, 1.24 to 2.58), with an average of 1.85 ON101 tubes used per person with healed ulcers. Favorable healing outcomes were consistently shown in the analyses of high-risk patients. The dose-response analysis results suggest 25%, 107%, 33%, and 19% decreases in the ulcer size per additional ON101 tube use for all study patients and those with Wagner grade 1, 2, and 3 ulcers, respectively (all P<.01).
Conclusion
Promising healing outcomes following ON101 therapy at lower doses among real-world patients with DFU are corroborated, with a potential therapeutic benefit for clinically disadvantaged patients and practical feasibility for use in routine practice.
{"title":"Real-World Effectiveness and Dose-Response of ON101 Therapy for Healing of Diabetic Foot Ulcers","authors":"Shun-Cheng Chang MD , Chen-Yi Yang MS , Ching-Uen Huang HN , Yi-Chun Wu MD , Feng-Chou Tsai MD, PhD , Hao-Chin Chang BS , Jung-Hsuan Chang OT , Xin-Yi Lin RN , Yu-Fen Chiu RN , Nai-Chen Cheng MD, PhD (co-corresponding author) , Huang-Tz Ou PhD (co-corresponding author)","doi":"10.1016/j.mayocp.2025.01.019","DOIUrl":"10.1016/j.mayocp.2025.01.019","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the real-world effectiveness and dose-response of ON101 , especially for high-risk patients with poor healing outcomes.</div></div><div><h3>Patients and Methods</h3><div>ON101 cream, a novel treatment for diabetic foot ulcers (DFUs), modulates the function of macrophages and accelerates the emergence and expansion of anti-inflammatory properties. In this study, 80 and 98 patients with DFU who were treated using ON101 and standard care with adjuvant therapy (denoted as nonuse), respectively, from January 1, 2020, to December 31, 2022, were identified from Taipei Medical University-Shuang Ho Hospital, Taiwan. The primary outcome was a complete healing event within 120 days following treatment initiation. Secondary outcomes included ulcer recurrence, amputation, and all-cause mortality within 1 year of follow-up. Cox proportional hazard model analysis was applied to determine the treatment effect on study outcomes. The dose-response of ON101 on healing outcomes was modeled using a regression analysis.</div></div><div><h3>Results</h3><div>Compared with nonuse, ON101 use significantly increased the complete healing outcome by 79% (HR, 1.79; 95% CI, 1.24 to 2.58), with an average of 1.85 ON101 tubes used per person with healed ulcers. Favorable healing outcomes were consistently shown in the analyses of high-risk patients. The dose-response analysis results suggest 25%, 107%, 33%, and 19% decreases in the ulcer size per additional ON101 tube use for all study patients and those with Wagner grade 1, 2, and 3 ulcers, respectively (all <em>P</em><.01).</div></div><div><h3>Conclusion</h3><div>Promising healing outcomes following ON101 therapy at lower doses among real-world patients with DFU are corroborated, with a potential therapeutic benefit for clinically disadvantaged patients and practical feasibility for use in routine practice.</div></div>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 1","pages":"Pages 85-94"},"PeriodicalIF":6.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768773","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}
Pub Date : 2026-01-01DOI: 10.1016/j.mayocp.2025.09.003
Chintan V. Shah MD, Matthew A. Sparks MD, David Cassiman MD, PhD
{"title":"Long-Term Effects of Sodium-Glucose Cotransporter Inhibitors on Refractory Hypomagnesemia and Urinary Magnesium Excretion","authors":"Chintan V. Shah MD, Matthew A. Sparks MD, David Cassiman MD, PhD","doi":"10.1016/j.mayocp.2025.09.003","DOIUrl":"10.1016/j.mayocp.2025.09.003","url":null,"abstract":"","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":"101 1","pages":"Pages 199-200"},"PeriodicalIF":6.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145677999","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}
Pub Date : 2025-12-24DOI: 10.1016/j.mayocp.2025.07.022
Toru Yoshino, Sae X Morita, Ralph G Zinner, Hirotaka Kato
Objective: To identify previously overlooked and marginalized populations with shared characteristics that influence lung cancer screening rates, including demographic, socioeconomic, geographic, and clinical factors.
Patients and methods: Using the Behavioral Risk Factor Surveillance System data spanning 2018 to 2021, we analyzed responses from 11,096 individuals eligible for lung cancer screening. Multiple-group latent class analysis was fitted using 10 indicators, states as known groups, and race/ethnicity as covariates while accounted for complex survey designs. Latent class analysis revealed 11 latent classes with varying screening probabilities and shared characteristics. We conducted this study from March 1 to July 31, 2023.
Results: Three latent classes with the lowest screening rates (≤5%), representing about 12% of the population (320,543 of 2,752,380 participants), were characterized by limited care access as evidenced by a lack of insurance and primary care. Black individuals were less likely to belong to one of these classes. In contrast, 4 latent classes, comprising 53% (1,457,378 of 2,752,380) of the population who were healthy working or retired individuals, had low screening rates (15% [69,496 of 479,282] to 17% [35,202 of 204,664]), despite having primary care access. Among the remaining 4 classes, individuals with chronic obstructive pulmonary disease and poor health status had higher screening rates (16% [52,513 of 334,480] to 41% [129,065 of 315,562]). Black individuals were less likely to be in one of these classes.
Conclusion: Our study underscores the necessity of a nuanced approach to lung cancer screening, moving beyond individual attributes to consider complex interactions of multiple factors. These findings lay the foundation for developing effective interventions to address the disparities in screening.
{"title":"Uncovering Hidden Marginalized Populations in Lung Cancer Screening via Latent Class Analysis.","authors":"Toru Yoshino, Sae X Morita, Ralph G Zinner, Hirotaka Kato","doi":"10.1016/j.mayocp.2025.07.022","DOIUrl":"https://doi.org/10.1016/j.mayocp.2025.07.022","url":null,"abstract":"<p><strong>Objective: </strong>To identify previously overlooked and marginalized populations with shared characteristics that influence lung cancer screening rates, including demographic, socioeconomic, geographic, and clinical factors.</p><p><strong>Patients and methods: </strong>Using the Behavioral Risk Factor Surveillance System data spanning 2018 to 2021, we analyzed responses from 11,096 individuals eligible for lung cancer screening. Multiple-group latent class analysis was fitted using 10 indicators, states as known groups, and race/ethnicity as covariates while accounted for complex survey designs. Latent class analysis revealed 11 latent classes with varying screening probabilities and shared characteristics. We conducted this study from March 1 to July 31, 2023.</p><p><strong>Results: </strong>Three latent classes with the lowest screening rates (≤5%), representing about 12% of the population (320,543 of 2,752,380 participants), were characterized by limited care access as evidenced by a lack of insurance and primary care. Black individuals were less likely to belong to one of these classes. In contrast, 4 latent classes, comprising 53% (1,457,378 of 2,752,380) of the population who were healthy working or retired individuals, had low screening rates (15% [69,496 of 479,282] to 17% [35,202 of 204,664]), despite having primary care access. Among the remaining 4 classes, individuals with chronic obstructive pulmonary disease and poor health status had higher screening rates (16% [52,513 of 334,480] to 41% [129,065 of 315,562]). Black individuals were less likely to be in one of these classes.</p><p><strong>Conclusion: </strong>Our study underscores the necessity of a nuanced approach to lung cancer screening, moving beyond individual attributes to consider complex interactions of multiple factors. These findings lay the foundation for developing effective interventions to address the disparities in screening.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145828027","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}
Pub Date : 2025-12-10DOI: 10.1016/j.mayocp.2025.07.033
Boyukkhanim Ahmadzada, Ahmer Sultan, Julio Cisneros Correa, Kamal H Hussein, Byron H Smith, Kay L Kosberg, Sara Kazeminia, Ty S Diwan, Timucin Taner, Julie K Heimbach, Mikel Prieto, Walter K Kremers, Carrie A Schinstock, Mark D Stegall, Scott L Nyberg
Objective: To compare the clinical outcomes and costs of kidney paired donation (KPD) with other kidney transplant options in patients who are unable to undergo living donor transplant because of blood- or tissue-type incompatibility.
Patients and methods: We retrospectively analyzed kidney transplants at our center using data from the United Network for Organ Sharing and Mayo Clinic in Rochester, Minnesota, from January 1, 2017, to January 1, 2023. Patients were categorized by kidney source as follows: deceased donor kidney (DDK), living donor traditional (LDT), KPD-local, and KPD-external. Financial data were collected to assess the cost benefits of KPD compared with traditional options.
Results: We analyzed 1266 adult kidney transplants, including 406 DDK, 611 LDT, 151 KPD-external, and 98 KPD-local transplants. Graft failure rates were higher in the KPD-external group (3.3% [5 of 151]) than in the DDK (2.7% [11 of 406]), KPD-local (1.0% [1 of 98]), and LDT (2.5% [15 of 611]) groups, although these differences were not statistically significant. The medical costs were assessed at 30, 90, and 365 days. At 30 days, costs were DDK, $86,769±$69,989; LDT, $115,597±$28,002; KPD-external, $109,769±$32,704; and KPD-local, $124,660±$88,627 (P=.001 for DDK).
Conclusion: Our findings provide insights into transplant outcomes, suggesting that KPD is similar to traditional kidney transplant.
{"title":"Living Paired Exchange Donation: Unlocking New Horizons in Kidney Transplantation.","authors":"Boyukkhanim Ahmadzada, Ahmer Sultan, Julio Cisneros Correa, Kamal H Hussein, Byron H Smith, Kay L Kosberg, Sara Kazeminia, Ty S Diwan, Timucin Taner, Julie K Heimbach, Mikel Prieto, Walter K Kremers, Carrie A Schinstock, Mark D Stegall, Scott L Nyberg","doi":"10.1016/j.mayocp.2025.07.033","DOIUrl":"https://doi.org/10.1016/j.mayocp.2025.07.033","url":null,"abstract":"<p><strong>Objective: </strong>To compare the clinical outcomes and costs of kidney paired donation (KPD) with other kidney transplant options in patients who are unable to undergo living donor transplant because of blood- or tissue-type incompatibility.</p><p><strong>Patients and methods: </strong>We retrospectively analyzed kidney transplants at our center using data from the United Network for Organ Sharing and Mayo Clinic in Rochester, Minnesota, from January 1, 2017, to January 1, 2023. Patients were categorized by kidney source as follows: deceased donor kidney (DDK), living donor traditional (LDT), KPD-local, and KPD-external. Financial data were collected to assess the cost benefits of KPD compared with traditional options.</p><p><strong>Results: </strong>We analyzed 1266 adult kidney transplants, including 406 DDK, 611 LDT, 151 KPD-external, and 98 KPD-local transplants. Graft failure rates were higher in the KPD-external group (3.3% [5 of 151]) than in the DDK (2.7% [11 of 406]), KPD-local (1.0% [1 of 98]), and LDT (2.5% [15 of 611]) groups, although these differences were not statistically significant. The medical costs were assessed at 30, 90, and 365 days. At 30 days, costs were DDK, $86,769±$69,989; LDT, $115,597±$28,002; KPD-external, $109,769±$32,704; and KPD-local, $124,660±$88,627 (P=.001 for DDK).</p><p><strong>Conclusion: </strong>Our findings provide insights into transplant outcomes, suggesting that KPD is similar to traditional kidney transplant.</p>","PeriodicalId":18334,"journal":{"name":"Mayo Clinic proceedings","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145724624","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}
Pub Date : 2025-12-01DOI: 10.1016/j.mayocp.2025.07.029
Richard C. Godby MD , Surbhi Shah MBBS
Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired clonal hematologic disorder characterized by intravascular destruction of red blood cells by the complement system. This intravascular hemolysis can lead to a constellation of symptoms, including anemia, fatigue, shortness of breath, smooth muscle dystonia, and dark urine that is classically prominent in the morning. Paroxysmal nocturnal hemoglobinuria can be a deadly disease with significant morbidity and mortality associated with bone marrow failure and thrombosis. Although it has historically been a life-threatening disease from extensive thrombosis, advancements in treatment have significantly improved the prognosis for individuals with PNH. It is a disease that has garnered much interest, given its intersectionality of hemolytic anemia, complement system dysregulation, marrow failure syndromes, thrombophilia, and the emergence of targeted therapies. While complement inhibitors have transformed the treatment landscape for PNH, allogeneic hematopoietic stem cell transplant remains the only curative option. Early diagnosis and treatment are crucial for improving outcomes in individuals with PNH. With ongoing research and the development of novel therapies, the outlook for individuals with PNH continues to improve. Focusing on clinically relevant articles available through MEDLINE, this article provides a contemporary, succinct review of classic PNH with predominant features of intravascular hemolysis, encompassing its pathophysiology, epidemiology, clinical manifestations, diagnosis, treatment, and outcomes.
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