Pub Date : 2025-08-19DOI: 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.
{"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}
Pub Date : 2025-08-06DOI: 10.1016/j.mayocpiqo.2025.100650
Michael K. Hole MD, MBA , Sunjay Letchuman BBA , Jennifer Gates MD, MPH , Leonard L. Berry MBA, PhD
{"title":"What Adult Medical Care Can Learn from Pediatrics: Creating Comfort, Connection, and Joy in the Hospital","authors":"Michael K. Hole MD, MBA , Sunjay Letchuman BBA , Jennifer Gates MD, MPH , 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":"2025-08-06","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}
Pub Date : 2025-08-06DOI: 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.
{"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}
Pub Date : 2025-08-04DOI: 10.1016/j.mayocpiqo.2025.100649
Amanda J.W. Wall MSc , Kirsten M. Leyland MSc, DPhil , Amit Kiran PhD , Nigel K. Arden MD , Cyrus Cooper MA, DM , Vishvarani Wanigasekera MBBS, DPhil , M. Kassim Javaid MBBS, PhD , Andrew J. Price MA, PhD , Irene M.C. Tracey MA, DPhil , Anushka Irani MA, BM BCh, DPhil
Objective
To investigate whether neuropathic-like pain, identified using the PainDETECT questionnaire, predicts postoperative symptoms, using data from 2 independent, prospective cohort studies.
Patients and Methods
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 (<13), unclear (13-18), and neuropathic pain (>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.
Results
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], P<.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.
Conclusion
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.
{"title":"PainDETECT as a Potential Tool for Personalized Medicine: Predicting Outcome One Year After Knee Arthroplasty","authors":"Amanda J.W. Wall MSc , Kirsten M. Leyland MSc, DPhil , Amit Kiran PhD , Nigel K. Arden MD , Cyrus Cooper MA, DM , Vishvarani Wanigasekera MBBS, DPhil , M. Kassim Javaid MBBS, PhD , Andrew J. Price MA, PhD , Irene M.C. Tracey MA, DPhil , 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 (<13), unclear (13-18), and neuropathic pain (>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><.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":"2025-08-04","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}
Pub Date : 2025-07-28DOI: 10.1016/j.mayocpiqo.2025.100645
Mariam Charkviani MD , Lagu A. Androga MD , Arvind K. Garg MD , Priya Ramar MPH , Rachel H. Amundson MHA , Lisa E. Vaughan MS , Ziad Zoghby MD , Robert C. Albright Jr. DO
Objective
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.
Patients and Methods
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.
Results
No significant differences in health care utilization outcomes (emergency department visits: Incidence rate ratios, 95% CI, 0.87 (0.62-1.22); P=.41; hospitalizations: Incidence rate ratios, 95% CI, 0.92 (0.63-1.35); P=.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.
Conclusion
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.
{"title":"Comparing Clinical Outcomes and Health Care Utilization: Telehealth Versus Traditional Care at US Rural Hemodialysis Units","authors":"Mariam Charkviani MD , Lagu A. Androga MD , Arvind K. Garg MD , Priya Ramar MPH , Rachel H. Amundson MHA , Lisa E. Vaughan MS , Ziad Zoghby MD , 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":"2025-07-28","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}
Pub Date : 2025-07-21DOI: 10.1016/j.mayocpiqo.2025.100644
Subhash Chander MBBS, MPH , Marco A. Bracamonte MD , Newton B. Neidert MD , Samuel I. Garcia MD
Abdominal compartment syndrome (ACS) is a critical condition characterized by increased intra-abdominal pressure and, if left untreated, can cause organ dysfunction and multiorgan failure. We present a case of an elderly man who developed ACS secondary to hemoperitoneum from a splenic artery laceration after multiple falls. Despite successful arterial embolization, the patients’ ACS worsened considerably. Given his high surgical risk and advanced age, percutaneous catheter drainage was performed. The procedure was uneventful and led to the resolution of the ACS. This case highlights the importance of early recognition and close monitoring of intra-abdominal pressure and the utility of minimally invasive strategies for managing ACS in patients with high-surgical risk.
{"title":"Nonsurgical Management of Abdominal Compartment Syndrome Using Transarterial Embolization and Percutaneous Catheter Drainage: A Case Report","authors":"Subhash Chander MBBS, MPH , Marco A. Bracamonte MD , Newton B. Neidert MD , Samuel I. Garcia MD","doi":"10.1016/j.mayocpiqo.2025.100644","DOIUrl":"10.1016/j.mayocpiqo.2025.100644","url":null,"abstract":"<div><div>Abdominal compartment syndrome (ACS) is a critical condition characterized by increased intra-abdominal pressure and, if left untreated, can cause organ dysfunction and multiorgan failure. We present a case of an elderly man who developed ACS secondary to hemoperitoneum from a splenic artery laceration after multiple falls. Despite successful arterial embolization, the patients’ ACS worsened considerably. Given his high surgical risk and advanced age, percutaneous catheter drainage was performed. The procedure was uneventful and led to the resolution of the ACS. This case highlights the importance of early recognition and close monitoring of intra-abdominal pressure and the utility of minimally invasive strategies for managing ACS in patients with high-surgical risk.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 4","pages":"Article 100644"},"PeriodicalIF":0.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144670842","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}
Pub Date : 2025-07-19DOI: 10.1016/j.mayocpiqo.2025.100643
Lorenza Di Marco MD, PhD , Fabio Cartabellotta MD , Fabio Santangelo MD , Fabrizio Scalici MD , Rosario Insinna RN , Tullio Prestileo MD , Maria Giovanna Minissale MD , Francesca Pasca PA , Vincenza Calvaruso MD, AP , Antonio Craxi MD, FP , Vito Di Marco MD, FP
Objective
To eradicate hepatitis C virus (HCV) infection among prisoners using specific models of screening and linkage to care.
Patients and Methods
The Sicilian Network for Therapy, Epidemiology and Screening in Hepatology (SINTESI) runs an HCV point-of-care project in all 23 prisons in Sicily. All prisoners received information on HCV screening and the possibility of receiving treatment with direct-acting antiviral (DAA) therapy during imprisonment. HCV status was assessed by rapid oral test and immediate reflex testing for HCV-RNA by Xpert HCV Viral Load. HCV-RNA–positive subjects received DAA therapy within 72 hours of screening.
Results
The project was conducted from October 18, 2021, through March 24, 2023. Among 5912 prisoners (98% of the entire prison population) informed of the screening project, 5050 (85.4%) accepted HCV testing. The mean age was 41.8 years (range, 18-86 years), and 4843 (95.9%) were males. Overall, 245 subjects (4.8%) tested positive for anti-HCV. Among 245 anti-HCV-positive prisoners, 20 (8.1%) refused the HCV-RNA test; 100 (40.9%) tested negative (80 had a previous DAA treatment) and 125 (51.1%) tested positive for HCV-RNA. Twelve (4.9%) of the latter refused treatment, whereas 113 (46.2%) started a cycle of DAA drugs during imprisonment. Of these, 99 (87.9%) completed DAA therapy, and 98 (86.7%) obtained HCV clearance.
Conclusion
The findings highlight the importance of tailored interventions for high-risk populations, and the model is replicable in other regions and contexts.
{"title":"Point-of-Care Testing and Treatment of Hepatitis C Virus in Prisons: The SINTESI Project in Sicily","authors":"Lorenza Di Marco MD, PhD , Fabio Cartabellotta MD , Fabio Santangelo MD , Fabrizio Scalici MD , Rosario Insinna RN , Tullio Prestileo MD , Maria Giovanna Minissale MD , Francesca Pasca PA , Vincenza Calvaruso MD, AP , Antonio Craxi MD, FP , Vito Di Marco MD, FP","doi":"10.1016/j.mayocpiqo.2025.100643","DOIUrl":"10.1016/j.mayocpiqo.2025.100643","url":null,"abstract":"<div><h3>Objective</h3><div>To eradicate hepatitis C virus (HCV) infection among prisoners using specific models of screening and linkage to care.</div></div><div><h3>Patients and Methods</h3><div>The Sicilian Network for Therapy, Epidemiology and Screening in Hepatology (SINTESI) runs an HCV point-of-care project in all 23 prisons in Sicily. All prisoners received information on HCV screening and the possibility of receiving treatment with direct-acting antiviral (DAA) therapy during imprisonment. HCV status was assessed by rapid oral test and immediate reflex testing for HCV-RNA by Xpert HCV Viral Load. HCV-RNA–positive subjects received DAA therapy within 72 hours of screening.</div></div><div><h3>Results</h3><div>The project was conducted from October 18, 2021, through March 24, 2023. Among 5912 prisoners (98% of the entire prison population) informed of the screening project, 5050 (85.4%) accepted HCV testing. The mean age was 41.8 years (range, 18-86 years), and 4843 (95.9%) were males. Overall, 245 subjects (4.8%) tested positive for anti-HCV. Among 245 anti-HCV-positive prisoners, 20 (8.1%) refused the HCV-RNA test; 100 (40.9%) tested negative (80 had a previous DAA treatment) and 125 (51.1%) tested positive for HCV-RNA. Twelve (4.9%) of the latter refused treatment, whereas 113 (46.2%) started a cycle of DAA drugs during imprisonment. Of these, 99 (87.9%) completed DAA therapy, and 98 (86.7%) obtained HCV clearance.</div></div><div><h3>Conclusion</h3><div>The findings highlight the importance of tailored interventions for high-risk populations, and the model is replicable in other regions and contexts.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 4","pages":"Article 100643"},"PeriodicalIF":0.0,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663343","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}
Pub Date : 2025-07-11DOI: 10.1016/j.mayocpiqo.2025.100642
Sue Ann Costa Clemens MD, PhD , Sagida Bibi PhD , Natalie G. Marchevsky MSc , Parvinder K. Aley PhD , Federica Cappuccini PhD , Sophie A. Davies BSc , Isabela Gonzalez PhD , Sarah C. Kelly MSc , Yama F. Mujadidi MSc , Eveline Pipolo Milan MD, PhD , Alexandre V. Schwarzbold PhD , Eduardo Sprinz MD, DSc , Merryn Voysey DPhil , Lily Y. Weckx MD, PhD , Daniel Wright DPhil , Himanshu Bansal MS , Maria A.S. Bergagård MSc , Abby J. Isaacs MS , Elizabeth J. Kelly PhD , Dongmei Lan MS , Andrew J. Pollard FMedSci
Objective
To address that, despite widespread use of ChAdOx1 nCoV-19 (AZD1222) as a COVID-2019 booster, fourth-dose clinical outcomes data are limited. We report immunogenicity and safety for ChAdOx1 nCoV-19 as a homologous fourth-dose booster.
Participants and Methods
Participants (aged ≥18 years) who had received 2 doses of ChAdOx1 nCoV-19 in phase 3 COV003 trial in Brazil were offered a third dose after a planned dose interval from 11 to 13 months and a fourth dose after a planned interval from 6 to 15 months (both 5 × 1010 viral particles). All fourth doses were administered to substudy participants between August 18 and October 28, 2022. The data cutoff was December 9, 2022. The primary immunogenicity outcome was noninferiority of ancestral severe acute respiratory syndrome coronavirus (SARS-CoV)-2–neutralizing antibody responses 28 days after dose 4 versus dose 3. Solicited and unsolicited adverse events were recorded 7 and 28 days postdose 4, respectively.
Results
172 participants received a fourth dose (median interval postthird dose, 10.7 months). Ancestral SARS-CoV-2–neutralizing antibody titers postdose 4 were noninferior to those postdose 3; geometric mean fold rise was 1.9 (95% CI, 1.6-2.4; n=112). Immunogenicity results were consistent across all variants analyzed. Local and systemic solicited adverse events were reported in 60.3% (n=35/58) and 43.1% (n=25/58) of participants, respectively.
Conclusion
Immune responses after a fourth dose of ChAdOx1 nCoV-19 were noninferior to those after a third dose across SARS-CoV-2 variants. The fourth dose was well tolerated with no emergent safety concerns, supporting the continued development of the ChAdOx1 platform in preparation for future pandemics.
{"title":"Immunogenicity and Safety of ChAdOx1 nCoV-19 (AZD1222) as a Homologous Fourth-Dose Booster: A Substudy of the Phase 3 COV003 Trial in Brazil","authors":"Sue Ann Costa Clemens MD, PhD , Sagida Bibi PhD , Natalie G. Marchevsky MSc , Parvinder K. Aley PhD , Federica Cappuccini PhD , Sophie A. Davies BSc , Isabela Gonzalez PhD , Sarah C. Kelly MSc , Yama F. Mujadidi MSc , Eveline Pipolo Milan MD, PhD , Alexandre V. Schwarzbold PhD , Eduardo Sprinz MD, DSc , Merryn Voysey DPhil , Lily Y. Weckx MD, PhD , Daniel Wright DPhil , Himanshu Bansal MS , Maria A.S. Bergagård MSc , Abby J. Isaacs MS , Elizabeth J. Kelly PhD , Dongmei Lan MS , Andrew J. Pollard FMedSci","doi":"10.1016/j.mayocpiqo.2025.100642","DOIUrl":"10.1016/j.mayocpiqo.2025.100642","url":null,"abstract":"<div><h3>Objective</h3><div>To address that, despite widespread use of ChAdOx1 nCoV-19 (AZD1222) as a COVID-2019 booster, fourth-dose clinical outcomes data are limited. We report immunogenicity and safety for ChAdOx1 nCoV-19 as a homologous fourth-dose booster.</div></div><div><h3>Participants and Methods</h3><div>Participants (aged ≥18 years) who had received 2 doses of ChAdOx1 nCoV-19 in phase 3 COV003 trial in Brazil were offered a third dose after a planned dose interval from 11 to 13 months and a fourth dose after a planned interval from 6 to 15 months (both 5 × 10<sup>10</sup> viral particles). All fourth doses were administered to substudy participants between August 18 and October 28, 2022. The data cutoff was December 9, 2022. The primary immunogenicity outcome was noninferiority of ancestral severe acute respiratory syndrome coronavirus (SARS-CoV)-2–neutralizing antibody responses 28 days after dose 4 versus dose 3. Solicited and unsolicited adverse events were recorded 7 and 28 days postdose 4, respectively.</div></div><div><h3>Results</h3><div>172 participants received a fourth dose (median interval postthird dose, 10.7 months). Ancestral SARS-CoV-2–neutralizing antibody titers postdose 4 were noninferior to those postdose 3; geometric mean fold rise was 1.9 (95% CI, 1.6-2.4; n=112). Immunogenicity results were consistent across all variants analyzed. Local and systemic solicited adverse events were reported in 60.3% (n=35/58) and 43.1% (n=25/58) of participants, respectively.</div></div><div><h3>Conclusion</h3><div>Immune responses after a fourth dose of ChAdOx1 nCoV-19 were noninferior to those after a third dose across SARS-CoV-2 variants. The fourth dose was well tolerated with no emergent safety concerns, supporting the continued development of the ChAdOx1 platform in preparation for future pandemics.</div></div><div><h3>Trial Registration</h3><div><span><span>clinicaltrials.gov</span><svg><path></path></svg></span> Identifier: <span><span>NCT04536051</span><svg><path></path></svg></span></div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 4","pages":"Article 100642"},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605570","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}
Pub Date : 2025-07-01DOI: 10.1016/j.mayocpiqo.2025.100640
Maddi A. Jacobson MPAS, PA-C , Yasamin Sharifzadeh MD , Arkadiusz Z. Dudek MD, PhD , Svetomir N. Markovic MD, PhD , Jeffrey E. Johnson MD , Jonathan M. Morris MD , Scott C. Lester MD , Robert W. Mutter MD , Michael P. Grams PhD , Sean S. Park MD, PhD
We report a case of novel radiation treatment referred to as minibeam radiation therapy (MBRT) that was used to treat recurrent mucosal melanoma. The patient’s disease recurred after surgery, conventional radiation therapy, and 4 lines of systemic therapy, and then, the patient was referred to our clinic. Despite substantial disease progression after multiple prior therapies, a complete metabolic and clinical response, along with an improved quality of life and performance status, was achieved after 2 treatments of MBRT. Additionally, disease response was noted in an unirradiated abdominal metastasis. The MBRT treatments were well-tolerated, with minimal toxicity reported more than 6 months posttreatment. This case highlights the potential of MBRT as a completely novel form of radiation therapy that warrants further study.
{"title":"Minibeam Radiation Therapy for Recurrent Mucosal Melanoma: An Eye-Opening Response","authors":"Maddi A. Jacobson MPAS, PA-C , Yasamin Sharifzadeh MD , Arkadiusz Z. Dudek MD, PhD , Svetomir N. Markovic MD, PhD , Jeffrey E. Johnson MD , Jonathan M. Morris MD , Scott C. Lester MD , Robert W. Mutter MD , Michael P. Grams PhD , Sean S. Park MD, PhD","doi":"10.1016/j.mayocpiqo.2025.100640","DOIUrl":"10.1016/j.mayocpiqo.2025.100640","url":null,"abstract":"<div><div>We report a case of novel radiation treatment referred to as minibeam radiation therapy (MBRT) that was used to treat recurrent mucosal melanoma. The patient’s disease recurred after surgery, conventional radiation therapy, and 4 lines of systemic therapy, and then, the patient was referred to our clinic. Despite substantial disease progression after multiple prior therapies, a complete metabolic and clinical response, along with an improved quality of life and performance status, was achieved after 2 treatments of MBRT. Additionally, disease response was noted in an unirradiated abdominal metastasis. The MBRT treatments were well-tolerated, with minimal toxicity reported more than 6 months posttreatment. This case highlights the potential of MBRT as a completely novel form of radiation therapy that warrants further study.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 4","pages":"Article 100640"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517639","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}
Pub Date : 2025-06-25DOI: 10.1016/j.mayocpiqo.2025.100641
Li Wang MM , Lei Tang MM , Ji Zhang MM , Ye Li MM , Feng Zhang MD , Qiaoling Tang MB , Siyuan Ma MB , Ran Liu MB , Xiangbin Zhang MM , Sai Wang MD , Yupeng Zhang MM , Lei Chen MM , Junyi Ma MM , Xuelun Zou MM , Tianxing Yao MM , Rongmei Tang MM , Yexiang Yi MB , Yi Zeng PhD , Duolao Wang PhD , Le Zhang MD
Objective
To address the long-term impact of childhood idiopathic epilepsy on health and families, and to provide epidemiological evidence for developing effective prevention and treatment strategies, this study aimed to explore the trends in incidence, deaths, and disability-adjusted life years (DALYs) of childhood idiopathic epilepsy globally and across regions from 1990 to 2021.
Patients and Methods
This cross-sectional analysis utilized data from the 2021 Global Burden of Disease database, covering idiopathic epilepsy cases among children aged 0-14 years across 204 countries and regions. The study period was from September 15, 2024, to October 31, 2024. Key indicators included incidence, deaths (all-cause and specific), and DALYs, with trend analysis conducted using the exponential annual percentage change (EAPC). All analyses were stratified by region, country, gender, and sociodemographic index (SDI).
Results
In 2021, there were 1,227,191 new cases of childhood idiopathic epilepsy globally (95% uncertainty interval [UI], 786,363-1,734,488). From 1990 to 2021, the total number of cases increased by 26.3% (95% UI, 6.8%-51.2%), with the incidence rising from 55.85 per 100,000 population to 60.998, and an EAPC of 0.2% (95% CI, 0.17-0.23). Deaths decreased by 29.5%, from 25,768 to 18,171, with the death rate dropping from 1.482 per 100,000 to 0.903 and an EAPC of −1.39% (95% CI, −1.48 to −1.3). DALYs decreased by 14.90%, reaching 3,564,497 in 2021 (95% UI, 2,700,944-4,753,410), with an EAPC of −0.94% (95% CI, −1.0 to −0.89). Low SDI regions bore the highest burden, with the highest death rate (1.459 per 100,000 in 2021). Regionally, tropical Latin America saw the fastest growth in incidence (EAPC 0.29), whereas Tajikistan had the highest death rate (2.766 per 100,000), and Taiwan Province of China had the highest DALY rate (99.718 per 100,000).
Conclusion
Childhood idiopathic epilepsy remains a significant global health challenge, with an increasing incidence. Despite a decline in global deaths and DALYs, the disease burden in low SDI regions remains substantial. Understanding the epidemiological characteristics of childhood idiopathic epilepsy is critical for developing effective prevention and management strategies. The findings highlight the importance of targeted interventions in resource-limited settings to bridge the gap in treatment outcomes for childhood epilepsy globally.
{"title":"Epidemiological Study of Childhood Idiopathic Epilepsy from 1990 to 2021 at Global, Regional, and National Scales","authors":"Li Wang MM , Lei Tang MM , Ji Zhang MM , Ye Li MM , Feng Zhang MD , Qiaoling Tang MB , Siyuan Ma MB , Ran Liu MB , Xiangbin Zhang MM , Sai Wang MD , Yupeng Zhang MM , Lei Chen MM , Junyi Ma MM , Xuelun Zou MM , Tianxing Yao MM , Rongmei Tang MM , Yexiang Yi MB , Yi Zeng PhD , Duolao Wang PhD , Le Zhang MD","doi":"10.1016/j.mayocpiqo.2025.100641","DOIUrl":"10.1016/j.mayocpiqo.2025.100641","url":null,"abstract":"<div><h3>Objective</h3><div>To address the long-term impact of childhood idiopathic epilepsy on health and families, and to provide epidemiological evidence for developing effective prevention and treatment strategies, this study aimed to explore the trends in incidence, deaths, and disability-adjusted life years (DALYs) of childhood idiopathic epilepsy globally and across regions from 1990 to 2021.</div></div><div><h3>Patients and Methods</h3><div>This cross-sectional analysis utilized data from the 2021 Global Burden of Disease database, covering idiopathic epilepsy cases among children aged 0-14 years across 204 countries and regions. The study period was from September 15, 2024, to October 31, 2024. Key indicators included incidence, deaths (all-cause and specific), and DALYs, with trend analysis conducted using the exponential annual percentage change (EAPC). All analyses were stratified by region, country, gender, and sociodemographic index (SDI).</div></div><div><h3>Results</h3><div>In 2021, there were 1,227,191 new cases of childhood idiopathic epilepsy globally (95% uncertainty interval [UI], 786,363-1,734,488). From 1990 to 2021, the total number of cases increased by 26.3% (95% UI, 6.8%-51.2%), with the incidence rising from 55.85 per 100,000 population to 60.998, and an EAPC of 0.2% (95% CI, 0.17-0.23). Deaths decreased by 29.5%, from 25,768 to 18,171, with the death rate dropping from 1.482 per 100,000 to 0.903 and an EAPC of −1.39% (95% CI, −1.48 to −1.3). DALYs decreased by 14.90%, reaching 3,564,497 in 2021 (95% UI, 2,700,944-4,753,410), with an EAPC of −0.94% (95% CI, −1.0 to −0.89). Low SDI regions bore the highest burden, with the highest death rate (1.459 per 100,000 in 2021). Regionally, tropical Latin America saw the fastest growth in incidence (EAPC 0.29), whereas Tajikistan had the highest death rate (2.766 per 100,000), and Taiwan Province of China had the highest DALY rate (99.718 per 100,000).</div></div><div><h3>Conclusion</h3><div>Childhood idiopathic epilepsy remains a significant global health challenge, with an increasing incidence. Despite a decline in global deaths and DALYs, the disease burden in low SDI regions remains substantial. Understanding the epidemiological characteristics of childhood idiopathic epilepsy is critical for developing effective prevention and management strategies. The findings highlight the importance of targeted interventions in resource-limited settings to bridge the gap in treatment outcomes for childhood epilepsy globally.</div></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":"9 4","pages":"Article 100641"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144480191","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}
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