Mayo Clinic proceedings. Innovations, quality & outcomes最新文献_第3页

Dynamic Changes in Bilirubin Predict 90-Day Mortality in Patients With Hepatocellular Carcinoma and Acute Decompensations of Cirrhosis: The HCC-AD Score 胆红素动态变化预测肝细胞癌和肝硬化急性失代偿患者90天死亡率：HCC-AD评分

Mayo Clinic proceedings. Innovations, quality & outcomes

Pub Date : 2025-09-12 DOI: 10.1016/j.mayocpiqo.2025.100661

Oliver Moore MBBS , Fran Neveu-Coble BN , Scott Read PhD , Wai-See Ma MBChB , Adnan Nagriel PhD , Anna Di Bartolomeo MBBS , Jacob George PhD , Golo Ahlenstiel PhD

Objective

To develop a score to predict 90-day mortality in patients with hepatocellular carcinoma (HCC) admitted with an acute decompensation (AD) event of chronic liver disease.

Patients and Methods

This retrospective cohort study was conducted at Blacktown and Westmead Hospitals in Australia, including patients with decompensated cirrhosis and concomitant HCC between January 1, 2012, and May 31, 2023. Participants were separated into derivation (n=233) and validation (n=132) cohorts. Demographic and clinical data were collected at admission and day 7. Independent predictors for 90-day transplant-free survival were entered into classification and regression tree analysis to develop the HCC-AD score. Discrimination was assessed in the validation cohort using Harrell C statistic. Subgroup analysis was conducted for each Barcelona Clinic Liver Cancer (BCLC) class with comparisons made to current scores.

Results

A cohort of 355 patients was considered. Admission bilirubin (P=.009) and 7-day change in bilirubin (P=.018) remained significant for 90-day mortality in multivariable analysis. The HCC-acute decompensation (AD) score stratified patients into 3 risk groups with predicted mortality of 26%, 49%, and 89%, respectively. The HCC-AD score showed good discrimination (Harrell C=0.731). Cox regression analysis determined the HCC-AD score remained predictive in BCLC B (P<.001), C (P<.001), and D (P=.010) scored HCC. The model for end-stage liver disease 3.0 (P=.058) and Child-Pugh (P=.11) scores were not predictive in BCLC D HCC.

Conclusion

A simple score that stratifies patients with HCC into 3 risk categories based on changes in bilirubin predicts 90-day mortality following an acute decompensatory event. It is superior to other scores in advanced HCC.

目的建立一种评分方法来预测合并慢性肝病急性失代偿（AD）事件的肝细胞癌（HCC）患者90天死亡率。患者和方法这项回顾性队列研究在澳大利亚的Blacktown和Westmead医院进行，包括2012年1月1日至2023年5月31日期间患有失代偿性肝硬化和合并HCC的患者。参与者被分为衍生组（n=233）和验证组（n=132）。入院和第7天收集人口学和临床资料。对90天无移植生存的独立预测因子进行分类和回归树分析，得出HCC-AD评分。在验证队列中采用Harrell C统计量评估歧视。对巴塞罗那临床肝癌（BCLC）的每个类别进行亚组分析，并与当前评分进行比较。结果纳入355例患者。在多变量分析中，入院胆红素（P= 0.009）和7天胆红素变化（P= 0.018）对90天死亡率仍有显著影响。hcc急性失代偿（AD）评分将患者分为3个危险组，预测死亡率分别为26%、49%和89%。HCC-AD评分具有较好的判别性（Harrell C=0.731）。Cox回归分析表明，HCC- ad评分对BCLC B （P < 0.01）、C （P < 0.01）和D （P < 0.01）评分的HCC仍具有预测作用。终末期肝病模型3.0 （P= 0.058）和Child-Pugh （P= 0.11）评分对BCLC - D型HCC无预测作用。结论基于胆红素变化将HCC患者分为3个危险类别的简单评分可预测急性失代偿事件后90天的死亡率。在晚期HCC中，它优于其他评分。

{"title":"Dynamic Changes in Bilirubin Predict 90-Day Mortality in Patients With Hepatocellular Carcinoma and Acute Decompensations of Cirrhosis: The HCC-AD Score","authors":"Oliver Moore MBBS , Fran Neveu-Coble BN , Scott Read PhD , Wai-See Ma MBChB , Adnan Nagriel PhD , Anna Di Bartolomeo MBBS , Jacob George PhD , Golo Ahlenstiel PhD","doi":"10.1016/j.mayocpiqo.2025.100661","DOIUrl":"10.1016/j.mayocpiqo.2025.100661","url":null,"abstract":"<div><h3>Objective</h3><div>To develop a score to predict 90-day mortality in patients with hepatocellular carcinoma (HCC) admitted with an acute decompensation (AD) event of chronic liver disease.</div></div><div><h3>Patients and Methods</h3><div>This retrospective cohort study was conducted at Blacktown and Westmead Hospitals in Australia, including patients with decompensated cirrhosis and concomitant HCC between January 1, 2012, and May 31, 2023. Participants were separated into derivation (n=233) and validation (n=132) cohorts. Demographic and clinical data were collected at admission and day 7. Independent predictors for 90-day transplant-free survival were entered into classification and regression tree analysis to develop the HCC-AD score. Discrimination was assessed in the validation cohort using Harrell C statistic. Subgroup analysis was conducted for each Barcelona Clinic Liver Cancer (BCLC) class with comparisons made to current scores.</div></div><div><h3>Results</h3><div>A cohort of 355 patients was considered. Admission bilirubin (<em>P</em>=.009) and 7-day change in bilirubin (<em>P</em>=.018) remained significant for 90-day mortality in multivariable analysis. The HCC-acute decompensation (AD) score stratified patients into 3 risk groups with predicted mortality of 26%, 49%, and 89%, respectively. The HCC-AD score showed good discrimination (Harrell C=0.731). Cox regression analysis determined the HCC-AD score remained predictive in BCLC B (<em>P</em><.001), C (<em>P</em><.001), and D (<em>P</em>=.010) scored HCC. The model for end-stage liver disease 3.0 (<em>P</em>=.058) and Child-Pugh (<em>P</em>=.11) scores were not predictive in BCLC D HCC.</div></div><div><h3>Conclusion</h3><div>A simple score that stratifies patients with HCC into 3 risk categories based on changes in bilirubin predicts 90-day mortality following an acute decompensatory event. It is superior to other scores in advanced HCC.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 5","pages":"Article 100661"},"PeriodicalIF":0.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048362","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}

引用次数: 0

Risk of Juvenile Idiopathic Arthritis Following HPV9 Vaccination: A Retrospective Cohort Study Before and During the COVID-19 Pandemic 接种HPV9疫苗后青少年特发性关节炎的风险：COVID-19大流行之前和期间的回顾性队列研究

Mayo Clinic proceedings. Innovations, quality & outcomes

Pub Date : 2025-09-09 DOI: 10.1016/j.mayocpiqo.2025.100647

Ming-Chin Tsai MD , Hsin-Hua Chen MD, PhD , Wen-Yu Wu MD , Yung-Chieh Huang MD , Chiann-Yi Hsu MSc , Lin-Shien Fu MD

Objective

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.

Patients and Methods

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.

Results

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, P<.001; HR 2020-2023, 0.287, P<.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 (P=.9), nor among unvaccinated controls (P=.238), indicating no modifying effect from COVID-19.

Conclusion

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.

目的评估9价人乳头瘤病毒（HPV9）疫苗接种是否与青少年特发性关节炎（JIA）风险增加相关，特别是在冠状病毒病-2019 （COVID-19）大流行期间。患者和方法我们使用TriNetX美国协作网络（U.S. Collaborative Network） 2016年1月1日至2023年12月31日的数据进行了一项回顾性队列研究。在大流行前（2016-2019年）或大流行期间（2020-2023年）接种了第一剂HPV9疫苗的9-13岁女孩与未接种疫苗的对照组相匹配。排除标准包括既往JIA诊断、使用抗风湿药物或类风湿因子阳性。在8天至36个月期间追踪新发JIA的发生率。采用Cox回归和Kaplan-Meier生存分析评估风险比（hr）和无jia生存。结果在99243名疫苗接种者和110万对照组中，HPV9接种者在两个时期的36个月发生JIA的风险均显著降低（HR 2016-2019, 0.207, P<.001; HR 2020-2023, 0.287, P<.001）。在疫苗接种后早期未观察到风险增加。在两个时期，接种疫苗组之间JIA的估计累积概率无显著差异（P=.9），未接种疫苗的对照组之间也无显著差异（P=.238），表明COVID-19没有改变作用。结论接种HPV9疫苗与JIA发生风险降低相关，且这种效果至少可持续3年。COVID-19大流行并未改变这种关系。这些发现加强了HPV9的免疫安全性，并为青少年疫苗接种计划提供了保证，即使在大流行背景下也是如此。

{"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 , Hsin-Hua Chen MD, PhD , Wen-Yu Wu MD , Yung-Chieh Huang MD , Chiann-Yi Hsu MSc , 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><.001; HR 2020-2023, 0.287, <em>P</em><.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":"2025-09-09","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}

引用次数: 0

A Dual-Modality Ultrasound Video Recognition Model for Distinguishing Subpleural Pulmonary Nodules 胸膜下肺结节的双模超声视频识别模型

Mayo Clinic proceedings. Innovations, quality & outcomes

Pub Date : 2025-09-09 DOI: 10.1016/j.mayocpiqo.2025.100659

Yin Wang MD, PhD , Mengjun Shen MD , Ke Bi MD , Wei Yang MD, PhD , Xiaofei Ye MD, PhD , Qing Tang MD, PhD , Yi Zhang MD , Yang Cong MD , Huiming Zhu MD , Hongwei Chen MD , Chunhong Tang MD , Martin R. Prince MD, PhD

Objective

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).

Patients and Methods

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.

Results

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 P<.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.

Conclusion

This deep learning model based on DMUS video recognition enhances the performance of ultrasound in differentiating benign from malignant SPNs.

Trial Registration

clinicaltrials.gov Identifier: ChiCTR1800019828

目的建立基于双模超声（DMUS）视频识别的深度学习模型用于良恶性胸膜下肺结节（SPNs）鉴别诊断。患者和方法前瞻性收集2020年1月7日至12月21日SPNs患者数据（n=193，中位年龄58岁[IQR， 34-66岁]；123名男性），按8:2的比例分为训练组（n=154）和验证组（n=39）。此外，在2021年1月10日至6月25日期间，前瞻性地收集了独立的内部（n=88）和外部（n=91）测试集。spn的性质通过活检（n=306）和临床随访（n=66）确定。我们的模型集成了DMUS视频、时间强度曲线和临床信息。该模型的性能通过接受者工作特征曲线下的面积、准确性、灵敏度和特异性进行评估，并与最先进的视频分类模型以及放射科医生的超声和计算机断层扫描诊断进行比较。结果在内部测试集中，我们的模型准确地区分了恶性和良性spn， AUC、准确度、灵敏度和特异性分别为0.91、91%（88分之80）、90%（30分之27）和91%(58分之53)，优于最先进的视频分类模型（均为P<； 0.05）。在外部测试集中，该模型的准确性、灵敏度和特异性分别为89%（81 / 91）、84%（27 / 32）和92%(54 / 59)，高于放射医师超声解释的参数（81%[74 / 91]、63%[20 / 32]和92%[54 / 59]）和计算机断层扫描（76%[69 / 91]、91%[29 / 32]和68%[40 / 59]）。结论基于DMUS视频识别的深度学习模型提高了超声对SPNs良恶性的鉴别能力。临床试验注册号：ChiCTR1800019828

{"title":"A Dual-Modality Ultrasound Video Recognition Model for Distinguishing Subpleural Pulmonary Nodules","authors":"Yin Wang MD, PhD , Mengjun Shen MD , Ke Bi MD , Wei Yang MD, PhD , Xiaofei Ye MD, PhD , Qing Tang MD, PhD , Yi Zhang MD , Yang Cong MD , Huiming Zhu MD , Hongwei Chen MD , Chunhong Tang MD , 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><.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":"2025-09-09","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}

引用次数: 0

Association of Mood or Affect With Respiratory-Related Quality of Life, Lung Function, and All-Cause Mortality in Fibrotic Interstitial Lung Disease 纤维化间质性肺病患者的情绪或情绪与呼吸相关生活质量、肺功能和全因死亡率的关系

Mayo Clinic proceedings. Innovations, quality & outcomes

Pub Date : 2025-08-29 DOI: 10.1016/j.mayocpiqo.2025.100660

Urbee Disha Peterson DO, MS , Madison Beenken MS , Teng Moua MD

Objective

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).

Patients and Methods

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.

Results

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.

Conclusion

Self-reported acute mood or affect may be associated with RR-QoL, lung function, and adjusted all-cause mortality in patients with f-ILD.

目的评估纤维化间质性肺病（f-ILD）患者自我报告的急性情绪或情绪是否与其他患者报告的结局指标、肺功能和全因死亡率相关。患者和方法积极和消极情绪表（PANAS）是一份20项的问卷，反映了过去一周内最近的情绪或情绪，报告为积极，消极或比率（积极：消极）分值。在3年的研究期间，评估基线和系列PANAS评分与慢性呼吸问卷、自我管理评估量表30和肺功能的相关性，以及与突发焦虑、抑郁和全因死亡率的相关性。结果共纳入199例f-ILD患者。基线PANAS评分与慢性呼吸问卷和自我管理评估量表30分有中度相关。较高的PANAS阳性和Ratio评分与较高的预测强迫肺活量百分比相关。在调整分析中，按临床疑似焦虑和/或抑郁分层和预测全因死亡率时，平均PANAS评分分别较高或较低。突发焦虑和/或抑郁与较差的生存结果无关。结论自述急性心境或情绪可能与f-ILD患者的RR-QoL、肺功能和校正全因死亡率相关。

{"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 , Madison Beenken MS , 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":"2025-08-29","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}

引用次数: 0

Practice Improvement Project: Developing a Platform for a Remote At-Home Preoperative Evaluation for Elective Noncardiac Procedures 实践改进项目：为选择性非心脏手术开发远程家庭术前评估平台

Mayo Clinic proceedings. Innovations, quality & outcomes

Pub Date : 2025-08-25 DOI: 10.1016/j.mayocpiqo.2025.100657

Joshua Ivare MD, MS , David N. Tryon MD , Adam K. Jacob MD , Timothy B. Curry MD, PhD , Amir Lerman MD

Objective

To assess the feasibility, safety, and patient satisfaction associated with a remote cardiac evaluation protocol during a preanesthesia medical evaluation (PAME) before elective noncardiac surgical procedures.

Patients and Methods

Eligible patients undergoing elective noncardiac procedures from May 1, 2022 to September 30, 2023 were selected from an anesthesia triage list at a single health care center. Patients received electronic devices for remote blood pressure measurement and 12-lead electrocardiogram collection. Patients either had a telemedicine-based PAME (tPAME) visit or an in-person PAME (iPAME) visit afterward. Patients’ charts were reviewed 30 days after procedure to identify after procedure complications. Patients were asked to provide feedback about their experiences through a digital after procedure satisfaction survey. Comparisons between the tPAME group and the iPAME group were made with χ², Fisher exact, or Mann-Whitney U tests.

Results

Of 129 eligible patients, 48 (37.2%) participated in the study. 29 (60.4%) patients had an iPAME visit, and 19 (39.6%) patients had a tPAME visit. There were no major adverse cardiovascular events after a remote cardiac evaluation in the iPAME and the tPAME groups. One (3.4%) patient in the iPAME group developed a deep vein thrombosis and pulmonary embolism after procedure, and 1 (3.4%) patient in the iPAME group had an emergency room visit within 30 days after their procedure. Patients were very satisfied with their experience in the study.

Conclusion

These findings support the concept that a remote cardiac evaluation during a PAME before elective noncardiac procedures is feasible, safe, and associated with high patient satisfaction.

目的评估选择性非心脏手术前麻醉前医学评估（PAME）中远程心脏评估方案的可行性、安全性和患者满意度。患者与方法：选取于2022年5月1日至2023年9月30日在同一医疗保健中心接受选择性非心脏手术的符合条件的患者。患者使用电子设备进行远程血压测量和12导联心电图采集。患者要么进行基于远程医疗的PAME （tPAME）访问，要么随后进行亲自PAME （iPAME）访问。术后30天回顾患者的病历以确定术后并发症。患者被要求通过数字手术后满意度调查提供他们的体验反馈。tPAME组与iPAME组间比较采用χ2、Fisher精确检验或Mann-Whitney U检验。结果129例符合条件的患者中，48例（37.2%）参加了研究。iPAME访视29例（60.4%），tPAME访视19例（39.6%）。iPAME组和tPAME组在远程心脏评估后没有出现主要的心血管不良事件。iPAME组1例（3.4%）患者术后出现深静脉血栓形成和肺栓塞，iPAME组1例（3.4%）患者术后30天内急诊就诊。病人对他们在研究中的经历非常满意。结论：这些研究结果支持了在选择性非心脏手术前进行PAME期间远程心脏评估是可行的、安全的，并且与高患者满意度相关。

{"title":"Practice Improvement Project: Developing a Platform for a Remote At-Home Preoperative Evaluation for Elective Noncardiac Procedures","authors":"Joshua Ivare MD, MS , David N. Tryon MD , Adam K. Jacob MD , Timothy B. Curry MD, PhD , Amir Lerman MD","doi":"10.1016/j.mayocpiqo.2025.100657","DOIUrl":"10.1016/j.mayocpiqo.2025.100657","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the feasibility, safety, and patient satisfaction associated with a remote cardiac evaluation protocol during a preanesthesia medical evaluation (PAME) before elective noncardiac surgical procedures.</div></div><div><h3>Patients and Methods</h3><div>Eligible patients undergoing elective noncardiac procedures from May 1, 2022 to September 30, 2023 were selected from an anesthesia triage list at a single health care center. Patients received electronic devices for remote blood pressure measurement and 12-lead electrocardiogram collection. Patients either had a telemedicine-based PAME (tPAME) visit or an in-person PAME (iPAME) visit afterward. Patients’ charts were reviewed 30 days after procedure to identify after procedure complications. Patients were asked to provide feedback about their experiences through a digital after procedure satisfaction survey. Comparisons between the tPAME group and the iPAME group were made with χ<sup>2</sup>, Fisher exact, or Mann-Whitney U tests.</div></div><div><h3>Results</h3><div>Of 129 eligible patients, 48 (37.2%) participated in the study. 29 (60.4%) patients had an iPAME visit, and 19 (39.6%) patients had a tPAME visit. There were no major adverse cardiovascular events after a remote cardiac evaluation in the iPAME and the tPAME groups. One (3.4%) patient in the iPAME group developed a deep vein thrombosis and pulmonary embolism after procedure, and 1 (3.4%) patient in the iPAME group had an emergency room visit within 30 days after their procedure. Patients were very satisfied with their experience in the study.</div></div><div><h3>Conclusion</h3><div>These findings support the concept that a remote cardiac evaluation during a PAME before elective noncardiac procedures is feasible, safe, and associated with high patient satisfaction.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 5","pages":"Article 100657"},"PeriodicalIF":0.0,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144893507","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}

引用次数: 0

Comorbidity Disease Pattern in Japanese Elderly Population: A Network-Based Analysis 日本老年人群共病模式：基于网络的分析

Mayo Clinic proceedings. Innovations, quality & outcomes

Pub Date : 2025-08-20 DOI: 10.1016/j.mayocpiqo.2025.100646

Shuko Nojiri PhD , Wataru Urasaki MSc , Masao Iwagami MD, PhD , Masashi Nagao MD, PhD , Takuya Uematsu MSc , Muneaki Ishijima MD, PhD , Hiroyuki Daida MD, PhD , Yuji Nishizaki MD, PhD

Objective

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.

Patients and Methods

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.

Results

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.

Conclusion

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.

目的通过对常见慢性疾病的分析，阐明日本普通人群中多病网络老年人的疾病模式。患者与方法本研究是日本老年人疾病网络分析的人群研究。我们从行政索赔数据库中获取了4,797,907名日本老年患者的医疗记录（从2020年1月1日至2020年12月31日）。将行政权利要求记录转换为时间疾病发生模式分析，并用于发现频繁发生的疾病序列以预测疾病进展的开始。结果在75岁及以上人群中，循环系统疾病和呼吸系统疾病占主导地位，而精神障碍的负担在所有年龄组中仍然很大。在75岁以下的男性中，弥散性血管内凝血经常与急性心肌梗死和呼吸衰竭同时发生。在75岁以下的女性中，前庭功能障碍和听力损失的相关性最高。对于75岁及以上的女性，肾脏疾病配对、精神合并症和跌倒相关损伤是主要因素。网络分析报告，随着年龄的增长，多病复杂性增加。呼吸、循环和消化系统疾病是各年龄组的中心，精神疾病和骨折相关疾病在老年人，特别是女性中变得更加突出。疾病热图进一步强调了系统性合并症中心，包括肺炎、缺铁性贫血、肾脏疾病和心血管疾病。结论在这项研究中，我们确定了主要的合并症模式，并报道动脉粥样硬化、心绞痛、胃炎和十二指肠炎是日本老年人最重要的合并症。从常规临床数据中识别出独特的合并症概况，可以为提高诊断和确定患者的治疗目标提供见解。

{"title":"Comorbidity Disease Pattern in Japanese Elderly Population: A Network-Based Analysis","authors":"Shuko Nojiri PhD , Wataru Urasaki MSc , Masao Iwagami MD, PhD , Masashi Nagao MD, PhD , Takuya Uematsu MSc , Muneaki Ishijima MD, PhD , Hiroyuki Daida MD, PhD , 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":"2025-08-20","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}

引用次数: 0

An Artificial Intelligence-Enabled Electrocardiogram to Evaluate Patients With Dyspnea in the Emergency Department 在急诊科评估呼吸困难患者的人工智能心电图

Mayo Clinic proceedings. Innovations, quality & outcomes

Pub Date : 2025-08-20 DOI: 10.1016/j.mayocpiqo.2025.100652

Hee Tae Yu MD, PhD , Laura E. Walker MD , Eunjung Lee PhD , Muhannad Abbasi MBBCh , Samuel Wopperer MD , Gal Tsaban MD, PhD , Kathleen Kopecky MD , Francisco Lopez-Jimenez MD , Paul Friedman MD , Zachi Attia PhD , Jae K. Oh MD

Objective

To evaluate whether an Artificial Intelligence-Enabled Electrocardiogram (AI-ECG) for diastolic function/filling pressure can determine whether dyspnea in emergency department (ED) patients is cardiac in origin.

Patients and Methods

We identified 2412 patients aged 18 years or older presented with dyspnea/shortness of breath to the ED who had an ECG performed at the time of evaluation from January 2020 to December 2022. The AI-ECG for determining left ventricular diastolic function to identify the patients with cardiac cause of dyspnea was assessed, using the final diagnosis based on subsequent evaluation.

Results

Of the 2412 patients, 966 (40%) were found to have cardiac dyspnea, and the remaining 1446 (60%) were noncardiac. The AI-ECG-estimated diastolic function was divided into 4 groups: 922 (38.2%) were normal, 245 (10.2%) grade 1, 1192 (49.4%) grade 2, and 53 (2.2%) grade 3. The probability of cardiac dyspnea was considerably higher in patients with grade 2 (62.2%±48.5%) and 3 (83%±37.9%) diastolic function compared with normal (14.1%±34.8%) and grade 1 (20.8%±40.7%). The incidence of cardiac dyspnea increased as the probability of increasing filling pressure increased on AI-ECG.

Conclusion

Patients often present to the ED with undifferentiated dyspnea. It is important to promptly determine whether the symptoms have cardiac origin. Cardiac dyspnea often reflects elevated left ventricular filling pressures. Artificial intelligence-enhanced 12-lead electrocardiograms can precisely assess diastolic function and filling pressures. Among patients who presented to the ED with dyspnea/shortness of breath, AI-ECG assessing diastolic function strongly distinguished whether the cause was cardiac.

目的评价人工智能心电图（AI-ECG）舒张功能/充盈压力是否可以判断急诊科（ED）患者呼吸困难是否由心脏原因引起。患者和方法我们确定了2412名年龄在18岁或以上的患者，他们在2020年1月至2022年12月评估时进行了心电图检查，出现呼吸困难/呼吸短促。评估AI-ECG检测左室舒张功能以识别心源性呼吸困难患者，根据后续评价进行最终诊断。结果2412例患者中，966例（40%）为心源性呼吸困难，其余1446例（60%）为非心源性呼吸困难。ai - ecg舒张功能评分分为4组：正常922例（38.2%），1级245例（10.2%），2级1192例（49.4%），3级53例（2.2%）。舒张功能2级（62.2%±48.5%）和3级（83%±37.9%）患者发生心源性呼吸困难的概率明显高于正常（14.1%±34.8%）和1级（20.8%±40.7%）患者。心源性呼吸困难的发生率随着心电充盈压力增大的概率增加而增加。结论急诊科患者多以未分化性呼吸困难就诊。重要的是要及时确定症状是否有心脏起源。心源性呼吸困难常反映左心室充盈压力升高。人工智能增强的12导联心电图可以精确评估舒张功能和充盈压力。在以呼吸困难/呼吸短促向ED就诊的患者中，通过AI-ECG评估舒张功能，可以很好地区分是否是心脏原因。

{"title":"An Artificial Intelligence-Enabled Electrocardiogram to Evaluate Patients With Dyspnea in the Emergency Department","authors":"Hee Tae Yu MD, PhD , Laura E. Walker MD , Eunjung Lee PhD , Muhannad Abbasi MBBCh , Samuel Wopperer MD , Gal Tsaban MD, PhD , Kathleen Kopecky MD , Francisco Lopez-Jimenez MD , Paul Friedman MD , Zachi Attia PhD , Jae K. Oh MD","doi":"10.1016/j.mayocpiqo.2025.100652","DOIUrl":"10.1016/j.mayocpiqo.2025.100652","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate whether an Artificial Intelligence-Enabled Electrocardiogram (AI-ECG) for diastolic function/filling pressure can determine whether dyspnea in emergency department (ED) patients is cardiac in origin.</div></div><div><h3>Patients and Methods</h3><div>We identified 2412 patients aged 18 years or older presented with dyspnea/shortness of breath to the ED who had an ECG performed at the time of evaluation from January 2020 to December 2022. The AI-ECG for determining left ventricular diastolic function to identify the patients with cardiac cause of dyspnea was assessed, using the final diagnosis based on subsequent evaluation.</div></div><div><h3>Results</h3><div>Of the 2412 patients, 966 (40%) were found to have cardiac dyspnea, and the remaining 1446 (60%) were noncardiac. The AI-ECG-estimated diastolic function was divided into 4 groups: 922 (38.2%) were normal, 245 (10.2%) grade 1, 1192 (49.4%) grade 2, and 53 (2.2%) grade 3. The probability of cardiac dyspnea was considerably higher in patients with grade 2 (62.2%±48.5%) and 3 (83%±37.9%) diastolic function compared with normal (14.1%±34.8%) and grade 1 (20.8%±40.7%). The incidence of cardiac dyspnea increased as the probability of increasing filling pressure increased on AI-ECG.</div></div><div><h3>Conclusion</h3><div>Patients often present to the ED with undifferentiated dyspnea. It is important to promptly determine whether the symptoms have cardiac origin. Cardiac dyspnea often reflects elevated left ventricular filling pressures. Artificial intelligence-enhanced 12-lead electrocardiograms can precisely assess diastolic function and filling pressures. Among patients who presented to the ED with dyspnea/shortness of breath, AI-ECG assessing diastolic function strongly distinguished whether the cause was cardiac.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 5","pages":"Article 100652"},"PeriodicalIF":0.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144879948","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}

引用次数: 0

First Reported Case of Dual Hereditary Gelsolin and Transthyretin Wild-Type Cardiac Amyloidosis in a Man in his late 40s 第一例报告的双遗传性凝胶蛋白和甲状腺转蛋白野生型心脏淀粉样变性在40多岁的男性

Mayo Clinic proceedings. Innovations, quality & outcomes

Pub Date : 2025-08-19 DOI: 10.1016/j.mayocpiqo.2025.100648

Jeanne L. Theis PhD , Surendra Dasari PhD , Jason D. Theis BS , Julie A. Vrana PhD , Linda Hasadsri MD, PhD , Joel Fernandez MD , Ellen D. McPhail MD

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.

淀粉样变性是一组以淀粉样蛋白在各种组织和器官中异常沉积，导致进行性器官功能障碍为特征的疾病。有超过40种前体蛋白与淀粉样蛋白的形成有关，淀粉样蛋白类型的鉴定对指导治疗至关重要。一名40多岁的男子因心力衰竭被诊断为心脏淀粉样变，基于心内肌活检。梅奥诊所实验室对心脏活检进行了淀粉样蛋白分型，使用微分激光显微解剖和霰弹枪蛋白质组学与质谱分析，结果显示凝胶淀粉样蛋白（AGel）只沉积在脉管系统中，转甲状腺素淀粉样蛋白只沉积在间质中。突变分析在凝胶蛋白基因中发现了一个新的p.Y474N，建立了遗传性AGel淀粉样变性的诊断。转甲状腺素基因突变不存在，证实了获得性转甲状腺素野生型淀粉样变性的并发诊断。该患者自首次就诊以来一直接受指南指导的药物治疗，随后开始服用他法米地，6-7个月后其射血分数有所改善。虽然罕见，2种不同的淀粉样蛋白类型可能出现在同一解剖部位。所有淀粉样蛋白类型的鉴定对于优化患者管理至关重要。在本例中，在同一例心脏活检中，两种罕见的淀粉样蛋白类型共存于相互排斥的解剖室中（年龄在50岁以下的患者中有一种新型突变的AGel与ATTRwt结合），这表明在双重淀粉样蛋白病例中，一种未知的全身因素可能在淀粉样蛋白形成中起作用。

{"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 , Surendra Dasari PhD , Jason D. Theis BS , Julie A. Vrana PhD , Linda Hasadsri MD, PhD , Joel Fernandez MD , 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":"2025-08-19","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}

引用次数: 0

What Adult Medical Care Can Learn from Pediatrics: Creating Comfort, Connection, and Joy in the Hospital 成人医疗可以从儿科学到的：在医院里创造舒适、联系和快乐

Mayo Clinic proceedings. Innovations, quality & outcomes

Pub Date : 2025-08-06 DOI: 10.1016/j.mayocpiqo.2025.100650

Michael K. Hole MD, MBA , Sunjay Letchuman BBA , Jennifer Gates MD, MPH , Leonard L. Berry MBA, PhD

引用次数: 0

Routine Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement: A Meta-Analysis of Randomized Controlled Trials 经导管主动脉瓣置换术中常规脑栓塞保护：随机对照试验的荟萃分析

Mayo Clinic proceedings. Innovations, quality & outcomes

Pub Date : 2025-08-06 DOI: 10.1016/j.mayocpiqo.2025.100651

Mahmoud Ismayl MBBS, Musa Mufarrih MBBS, Mackram F. Eleid MD, Charanjit S. Rihal MD, Mayra Guerrero MD

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; P=.41), disabling stroke (RR, 0.80; 95% CI, 0.57–1.12; P=.19), or new ischemic lesions on magnetic resonance imaging (RR, 0.98; 95% CI, 0.91–1.06; P=.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.

TAVR围手术期卒中的风险仍然是一个值得关注的问题。脑栓塞保护（CEP）装置已被开发出来以减轻这种风险，但其临床效益仍不确定。我们旨在通过随机对照试验（RCTs）的荟萃分析来评估TAVR期间常规CEP使用的有效性和安全性。系统检索PubMed， EMBASE和ClinicalTrials.gov从开始到2025年5月22日进行，以确定比较TAVR期间CEP与标准治疗的随机对照试验。主要结局是中风（包括致残性和非致残性中风）。次要结局包括致残性卒中、tavr后脑磁共振成像显示的新缺血性病变、全因死亡率、主要血管并发症、危及生命的出血和急性肾损伤。风险比（rr）采用随机效应模型汇总。共纳入9项随机对照试验，共11,641例患者（5970例患有CEP， 5671例没有CEP）。使用CEP没有显著降低卒中风险(RR, 0.91；95% ci, 0.73-1.14；P= 0.41)，致残性卒中(RR, 0.80；95% ci, 0.57-1.12；P= 0.19)，或磁共振成像上出现新的缺血性病变(RR, 0.98；95% ci, 0.91-1.06；P = .64点)。CEP组和对照组的全因死亡率和安全性结果无显著差异。基于CEP设备类型的亚组分析显示，无论设备类型如何，两组之间的结果无显著差异。总之，TAVR期间常规使用CEP与卒中、致残性卒中或全因死亡率的降低无关。未来的研究有必要确定可能从选择性CEP使用中受益的亚组。

{"title":"Routine Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement: A Meta-Analysis of Randomized Controlled Trials","authors":"Mahmoud Ismayl MBBS, Musa Mufarrih MBBS, Mackram F. Eleid MD, Charanjit S. Rihal MD, 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":"2025-08-06","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}

引用次数: 0