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Mayo Clinic Medical Science Blog – an eclectic collection of research- and research education-related stories: feature stories, mini news bites, learning opportunities, profiles and more from Mayo Clinic.

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2 days ago · Research News Roundup--March 2020

medical team huddle in ICU hall

Even though it’s April Fool’s Day, the stories we share in this monthly column are no joke. Because since last month our world has shifted focus, we’ve divided these releases into two sections – COVID-related, and everything else.

“Everything else” is at the end this month, because it is the bigger section, with nearly a dozen stories out in the first half of March. We should note that although a wide variety of health care and biomedical research, as well as research education, continues at Mayo Clinic, most communication activities have since shifted focused to supporting content regarding COVID-19 concerns for patients, staff and community.

COVID-19 research-related news releases

Guidance on patients at risk of drug-induced sudden cardiac death from off-label COVID-19 treatments (3/25)

SARS-CoV-2, the virus that causes COVID-19, continues to spread, leading to more than 20,000 deaths worldwide in less than four months. Efforts are progressing to develop a COVID-19 vaccine, but it’s still likely 12 to 18 months away.

In the meantime, the pandemic, with over 400,000 confirmed cases worldwide already, is driving researchers to find safe and effective therapies for patients with COVID-19, and an antimalarial drug is potentially on the front lines of that effort. While new and repurposed drugs are being tested in clinical trials, some of these promising drugs are simultaneously being used off-label for compassionate use to treat patients.

Some of the medications being used to treat COVID-19 are known to cause drug-induced prolongation of the QTc of some people. The QTc is an indicator of the health of the heart’s electrical recharging system. Patients with a dangerously prolonged QTc are at increased risk for potentially life-threatening ventricular rhythm abnormalities that can culminate in sudden cardiac death.


Mayo Clinic Laboratories significantly expands testing capability for the COVID-19 virus (3/19)

Mayo Clinic has significantly expanded its capacity to test clinical samples for SARS-CoV-2, the virus that causes COVID-19. With new equipment that went online Tuesday, Mayo Clinic Laboratories now has the capacity to process COVID-19 test samples from all Mayo Clinic sites. In addition, it has begun processing test samples from its clients across Minnesota, including eight major health systems.

“The capability to test and process clinical samples for the SARS-CoV-2 virus is urgently needed nationwide and we have been working around the clock to make this expansion happen as quickly as possible,” says William Morice, II, M.D., Ph.D., president of Mayo Clinic Laboratories and chair of Mayo Clinic’s Department of Laboratory Medicine and Pathology. “Our expanded capacity will expedite caring for patients at this critical time, and hopefully will ease the burden being felt at test processing laboratories in Minnesota and a growing number of geographies.”


Mayo Clinic develops test to detect COVID-19 infection (3/12)

Inside Mayo Clinic Laboratories, the sample conveyor system and some individual sorting stations

Mayo Clinic has developed a test that can detect the SARS-CoV-2 virus in clinical samples. The SARS-CoV-2 virus causes COVID-19.

The test, “Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2), Molecular Detection” has been fully validated. Data from this test will be submitted to the Food and Drug Administration for review and emergency use authorization.

The real-time polymerase chain reaction (PCR) test can identify SARS-CoV-2 from a variety of clinical samples. The PCR assay has been validated to test respiratory samples collected from suspected COVID-19 patients, including nasopharyngeal swabs, sputum, throat swabs, bronchoalveolar lavages, and bronchial washings

Everything else covered in March 2020 news releases

Homeless people receive less treatment in hospitals for heart attacks, have higher readmission rates

Homelessness has become a social crisis and public health problem around the world, affecting people of all ages. Most homeless people are at a disadvantage with few resources, and may or may not have adequate health insurance. Mental illness and substance abuse are common issues in the homeless community. People living on the streets have a high likelihood of developing heart disease. Yet they have little ability to take care of their health.

A new study published in Mayo Clinic Proceedings examined in-hospital outcomes and 30-day readmission rates of 3,937 homeless patients from more than 1.5 million people admitted for a heart attack. Researchers used two years of data (2015–2016) from the National Readmission Database. The findings show that homeless patients often receive less treatment and are more likely to end up readmitted to the hospital within a month.


Mayo Clinic Alix School of Medicine once again in top 10 U.S. News & World Report ‘Best Medical School’ rankings

“To be included as one of the top medical schools in the country is a real testament to the tremendous educational efforts of our faculty, students and staff,” says Fredric Meyer, M.D., Waugh Executive Dean for Education, Mayo Clinic. “It also recognizes the strong bonds between Practice, Research and Education at Mayo Clinic, and how we work together to face head-on the medical challenges that will present to our school, our institution and the patients we serve now and in the future.”


Most surgeons in pain after surgery, Mayo research finds

Almost two-thirds of surgeons reported an increase in neck pain after performing surgery, and one-quarter rated their neck or lower back pain as clinically significant, a new Mayo Clinic study has found. The research was published in the Journal of American College of Surgeons.


Surgery with anesthesia not associated with indicator of Alzheimer’s disease

Older adults who have surgery with general anesthesia may experience a modest acceleration of cognitive decline, even years later. But there’s no evidence of a link to Alzheimer’s disease, according to new research from Mayo Clinic.

The research, published in the British Journal of Anaesthesia, examined brain scans from 585 patients, ages 70 to 91 ― 493 of whom had at least one surgery with general anesthesia. The analysis found cortical thinning in cerebral areas but no significant evidence of deposits of amyloid protein, a hallmark of Alzheimer’s disease. The cortex is the outermost layer of the brain’s nerve cell tissue, and thinning of that tissue is associated with diminished cognitive functions.


Mayo Clinic research discovers how stem cells repair damage from heart attacks

Mayo Clinic researchers have uncovered stem cell-activated mechanisms of healing after a heart attack. Stem cells restored cardiac muscle back to its condition before the heart attack, in turn providing a blueprint of how stem cells may work.

The study, published in NPJ Regenerative Medicine, finds that human cardiopoietic cells zero in on damaged proteins to reverse complex changes caused by a heart attack. Cardiopoietic cells are derived from adult stem cell sources of bone marrow.


New evidence supports ablation for heart failure patients with atrial fibrillation

Only 1 in 13 everyday patients could have participated in a pivotal international clinical trial looking at the use of catheter ablation to treat atrial fibrillation (AFib) among people with heart failure. However, new Mayo Clinic research provides evidence supporting the benefit of ablation, and shows what the outcomes might be for everyday patients. The Mayo study was published in Heart Rhythm Journal.

The Catheter Ablation for Atrial Fibrillation with Heart Failure (CASTLE-AF) trial compared catheter ablation versus medical therapy alone for atrial fibrillation in patients with heart failure. In early 2018, the results of that trial were announced. Although the trial was fairly small with 363 participants, it showed an impressive 38% reduction in risk of death or hospitalization for worsening heart failure.


Gene variants may increase susceptibility to accumulate Alzheimer’s protein tau, study shows

tau protein artistic imaging

The toxic protein tau is a key biological feature in the brains of people with Alzheimer’s disease. Yet the factors that make people susceptible or resistant to tau accumulation are not well-understood. A preliminary Mayo Clinic study shows that inherited DNA variants may be associated with developing tau deposits in older adults.

The research was to have be presented during the American Academy of Neurology’s 72nd Annual Meeting in Toronto April 25–May 1. Due to COVID-19 pandemic, the conference has been canceled.


Immune cells may improve accuracy of predicting survival in colorectal cancer

3-d image of cancer cells

The density of immune cells, called tumor infiltrating lymphocytes, when combined with analysis of tumor budding may serve as a method to more accurately predict survival in patients with stage III colon cancer. The findings, by a team of researchers led by Mayo Clinic gastroenterologist and oncologist, Frank Sinicrope, M.D., were published March 2 in Annals of Oncology.

Using colon cancer tissues from a completed clinical trial, Dr. Sinicrope and his colleagues were able to demonstrate that the extent or density of tumor infiltrating lymphocytes (TILs), reflecting the patient’s anti-tumor immune response, is a robust predictor of survival in patients with stage III colon cancer.  TILs are a type of immune cell that has moved from the blood into a tumor that can recognize and kill cancer cells.


Mayo researchers recommend all women with breast cancer diagnosis under age 66 be offered genetic testing

A study by researchers at Mayo Clinic published March 3 in the Journal of Clinical Oncology suggests that all women with a breast cancer diagnosis under the age of 66 be offered germline genetic testing to determine if they have a gene mutation known to increase the risk of developing other cancers and cancers among blood relatives. Current guidelines from the National Comprehensive Cancer Network (NCCN) recommend germline testing for all women diagnosed with breast cancer under the age of 46 regardless of their family history and breast cancer subtype.


‘Start low, go slow’ still applies for pain management, especially for older patients

Chronic pain affects a large proportion of older adults and most long-term care residents. Managing chronic pain effectively is essential but challenging, and it has been complicated by concerns about opioid abuse.

Pain management can be safely optimized with a plan that balances the risks and benefits of treatments, according to a commentary in Mayo Clinic Proceedings. Treating chronic pain is best achieved when pharmacologic strategies and nondrug therapies are used at the same time.

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Tue, Mar 3 6:00am · Research News Roundup--February 2020

closeup of lab equipment arranged on table

Each month, we publish Mayo Clinic’s Research News Roundup. This article includes brief summaries and links to news releases from the preceding month that discuss some of our latest medical research and/or research education. It also connects readers to related resources.

Read on for recent findings of Mayo Clinic Research:

aerial photo of the Mayo Clinic campus in Florida

John Thrasher, president of Florida State University, and Mayo Clinic representatives signed a multifaceted agreement on Tuesday, Feb. 25, in Jacksonville to attract and retain top talent in the biomedical field.

The collaborative education efforts will focus on medical innovation and promote a market-driven approach to create a highly trained workforce focused on taking medical technology from the research space to clinical practice.


grandmother and granddaughter having a conversation

Diabetes affects nearly 1 in 10 adults in the U.S., of these millions, more than 90% have Type 2 diabetes. Controlling blood sugar and glycosylated hemoglobin levels ― or HbA1c, which is sometimes referred to as A1C ― is key to diabetes management and necessary to prevent its immediate and long-term complications. However, new Mayo Clinic research shows that diabetes management may be dangerously misaligned.

The new study, published in BMJ Open Diabetes Research & Care, shows paradoxical trends in overtreatment and undertreatment of patients with Type 2 diabetes.


artistic image depicting aspects of the health care applications of artificial intelligence

An approach based on artificial intelligence (AI) may allow EKGs to be used to screen for hypertrophic cardiomyopathy in the future. With hypertrophic cardiomyopathy, the heart walls become thick and may interfere with the heart’s ability to function properly. The disease also predisposes some patients to potentially fatal abnormal rhythms. Current EKG technology has limited diagnostic yield for this disease.

New Mayo Clinic research suggests that a convolutional neural network AI can be trained to detect unseen characteristics of hypertrophic cardiomyopathy. The standard 12-lead EKG is a readily available, low-cost test that can be performed in many settings, including those with limited resources.

Hypertrophic cardiomyopathy is one of the leading causes of sudden death in adolescents and young adults participating in sports.


seated elderly woman with hand on chest

COPD is a chronic lung disease that makes it difficult to breathe. COPD is the third leading cause of death in the U.S., with more than 15 million people currently living with the disease, according to the American Lung Association.

In a new paper published Feb. 4 in JAMA, Mayo Clinic researchers describe the benefits of in-home noninvasive ventilation therapy ― which includes a type referred to as bilevel positive airway pressure, or BiPAP ― for many patients with chronic obstructive pulmonary disease (COPD). The team identified a number of benefits, including reduced mortality, fewer hospital admissions, lower risk of intubation, improved shortness of breath, and fewer emergency department visits.


view of the trunk of a younger woman in pajamas, with her hands over her heart, not smiling

Men and women differ in the way their vascular systems age and the rate at which atherosclerosis ― the hardening of artery walls or buildup of arterial blockage ― progresses over time. These sex- and age-related differences have a direct bearing on a woman’s risk factors for cardiovascular disease.

Mayo Clinic researchers, in collaboration with international investigators, suggest a new approach of evaluating vascular function earlier in women, starting in middle age before arterial damage becomes severe. Amir Lerman, M.D., a Mayo Clinic cardiologist and director of the Cardiovascular Research Center at Mayo Clinic in Rochester, is senior investigator on the study. This study, “Endothelial Vascular Function as a Surrogate of Vascular Risk and Aging in Women,” was recently published in Mayo Clinic Proceedings.

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Information about many of the clinical trials available across Mayo Clinic is online as well.

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Tue, Feb 25 6:00am · Vitamin D deficiency - a common thread, commonly missed

a small boy sliding down a playground slide

Everyone has heard of vitamin D. Most of us know that our
bodies produce vitamin D when we spend time in the sun, and that if we don’t
get enough sunlight, or if for some other reason our bodies don’t produce
enough vitamin D, it’s not good.

But why exactly is it bad for our bodies to not get enough vitamin D?

Vitamin D plays a critical role in calcium absorption and the body’s processes that build and strengthen bones. According to the National Institutes of Health, it also has a number of other roles, “including modulation of cell growth, neuromuscular and immune function, and reduction of inflammation.”

All-in-all, it seems like a pretty important vitamin.

Recent Mayo Clinic research further supports that notion.

Andrea Aul explaining a PowerPoint slide showing a Venn diagram of the hypocalcemia incidence findings to her mentor Dr. Thacher. Display screen is large monitor mounted on the wall over a table.
Andrea Aul discusses the hypocalcemia incidence findings with her mentor Dr. Thacher.

The research

Andrea Aul, a 4th-year medical student in the Mayo Clinic Alix School of Medicine is the first author of a recent article in the Journal of Pediatrics, describing the incidence of several potentially life-threatening complications of hypocalcemia (low levels of calcium), and their connection to vitamin D deficiency.

Aul’s study was population-based, using the Rochester Epidemiology Project, a medical records linkage system and long-time research collaborative based in Olmsted County, Minnesota.

The research team began with the records of 15,419 children (age 0-5), residing in Olmsted County between Jan. 1, 1996 and June 30, 2017. Of these, 1,305 were diagnosed during that time with seizures, cardiomyopathy, cardiac arrest, respiratory arrest, laryngospasm, and/or tetany. (Tetany refers to hyperexcitability of the nervous system resulting in uncontrollable muscle spasms.)

The common thread

“These life threatening conditions all could be related to
hypocalcemia,” says Aul. “I was intrigued by something as common and treatable
as vitamin D deficiency having such potentially devastating consequences.”

Aul and her mentors, Jason O’Grady Sr., M.D., and Tom Thacher, M.D., (the paper’s senior author) assembled a team to investigate.

They first calculated the incidence of diagnosed hypocalcemia
plus a potentially life-threatening complication.

“We found that among children aged 0 to 5 years, the
incidence of hypocalcemia and a potentially life-threatening complication of
hypocalcemia, was 6.1 per 100,000 person-years,” says Aul.

Although this number was not extremely high, it was another
number that caused the team more concern.

Of those original 1,305 babies and children with the noted
serious complications, less than half (460) had their serum calcium checked
within 14 days of presentation, the authors report. Of those, 85 had
hypocalcemia, and when other sources of the complications were excluded, 16
children were found to have a potentially life-threatening complication due to
hypocalcemia.

Hypocalcemia is easily treated, once you’ve identified the
problem.

However, as the authors note, “for the majority of children with life-threatening complications of hypocalcemia, it is unknown whether vitamin D deficiency contributed to their hypocalcemia, because [it] was never measured.”

Behind the scenes

This is Aul’s first peer-reviewed publication – a key
milestone for individuals pursuing a doctoral degree. At Mayo Clinic, research
drives everything we do for patients, and her findings build the evidence base
for informed, best practice care.

She has been interested in adding research to her portfolio
since she started medical school. Her advisor Dr. O’Grady recommended her as an
addition to Dr. Thacher’s team, and opportunity was born.

“My advisor, Dr. O’Grady, had already agreed to collaborate
with Dr. Thacher on this project and they, along with other members of the
team, welcomed me to the group,” Aul says. “In addition to the excellent
mentorship opportunities through this project, I also was excited by the chance
to use the Rochester Epidemiology Project to better understand our community
and hopefully impact patients both locally and far away.”

Aul says that although she is just getting started in
research, she knows she wants to be a pediatrician. With that career focus, she
hopes to build out her expertise by conducting more pediatric-specific research.
Specifically she finds population health
studies — such as her current work — intriguing. “I hope to utilize the
unique capabilities of the REP for conducting population-based research,
however possible, in the future,” she says.

Dr. Thacher, who is a family medicine doctor and researcher at Mayo Clinic, agrees that a unique value can be found in the Rochester Epidemiology Project. “Due to comprehensive medical information on the Olmsted County population going back more than 50 years, it enables one to assess disease incidence, trends over time, and long-term outcomes of clinical conditions.”

The rest of the story

Dr. Thacher
says that calcium and vitamin D testing are not part of standard newborn
panels.

However, knowing that vitamin D deficiency is fairly common in general, especially among infants and new mothers, he says, “We recommend vitamin D supplementation for all infants — 400 IU daily — or high dose vitamin D supplementation of mothers — 5,000 IU daily — to fortify their breast milk, in order to prevent vitamin D deficiency in infants.”

And, even more so now that the results of this study are in, he and his colleagues recommend testing for hypocalcemia and vitamin D deficiency in children who present with symptoms of seizures, muscle spasms, heart failure, and cardiac or respiratory arrest.

Aul says their paper “illustrates that although vitamin D
deficiency is potentially deadly, it is easily identifiable, treatable, and
avoidable. Additionally, we recommend parents learn about sources of vitamin
D—through the diet, sunlight exposure, and in certain groups, through
supplementation—and have conversations with their child’s healthcare provider
to ensure their child receives adequate vitamin D.”

Their paper was accompanied by an editorial written by Carol Wagner, M.D., Shawn Jenkins Children’s Hospital, Medical University of South Carolina, Charleston.

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Tue, Feb 4 6:00am · Research News Roundup--January 2020

If you’re interested in genetics, diabetes, transplant or robotics, January was a good month.

The Mayo Clinic Research News Roundup includes brief summaries and links to these and a tidy sum of other recent research-related news releases from Mayo Clinic. You also might find some other handy resources.

Read on for more information from Mayo Clinic Research.

Mayo Clinic medical school student talking with a patient.

Human trafficking is a growing international public health concern. An estimated 400,000 people in the U.S. are affected, with as many as 88% of victims having seen a health care professional while they were being trafficked.

As human trafficking evolves as a health concern, medical schools are starting to include the topic in education. However, it’s still in the early stages, says a Mayo Clinic study in the American Journal of Preventive Medicine. The research was led by third-year medical student at Mayo Clinic Alix School of Medicine, Jennifer Talbott, who suggested that human trafficking training be included in the curriculum at the school.

Working with the medical school faculty, Talbott helped develop coursework to train fellow students to identify and provide resources to potential victims of human trafficking. Talbott’s adviser, Juliana Kling, M.D., a Mayo Clinic women’s health internist, says training in identifying and providing resources to human trafficking victims is essential for medical school students.


microscopic view of slide containing color-stained kidney biopsy tissue

Mayo Clinic researchers have discovered that subtle structural features in kidneys from living donors that can only be seen with a microscope may predict the risk of transplant failure in recipients. The findings are published online in the Journal of the American Society of Nephrology.

“We think that those subtle abnormalities in the living kidney donor may make the kidney more susceptible to fail in the future in the recipients,” says Naim Issa, M.D., a Mayo Clinic nephrologist and the study’s lead author. “These important findings may provide insights into unrecognized predictors of kidney transplant failure in recipients.”


microscopic image of liver-derived mesenchymal stromal cells

Mesenchymal stromal cells from fat tissue and bone marrow are widely used in therapeutic trials for their anti-inflammatory qualities, but new Mayo Clinic research finds that liver cells may be of greater value.

The study, published in Liver Transplantation, finds that liver mesenchymal stromal cells have immunoregulatory qualities that make them more effective than similar cells derived from adipose, or fat, tissue and bone marrow.


two female nurse midwives examining pregnant patient in hospital bed

Fewer physicians are pursuing careers in obstetrics, in part because of the intense, round-the-clock demands of the job and a high burnout rate. An unusually large number of practicing obstetricians are expected to retire within the next decade, which will add to an already acute physician shortage.

One solution to this staffing challenge is a collaborative care model used at Mayo Clinic Health System ― Franciscan Healthcare in La Crosse, where certified nurse-midwives lead the care team. Certified nurse-midwives provide care for obstetric patients who are at low to moderate risk as part of a team model described in Mayo Clinic Proceedings: Innovations, Quality & Outcomes.


artistic interpretation of artificial intelligence and data analytics

Mayo Clinic announced the Clinical Data Analytics Platform as the first venture under the Mayo Clinic Platform, a strategic initiative to improve health care through insights and knowledge derived from data.

The Clinical Data Analytics Platform will apply advanced data analytics on deidentified data from Mayo Clinic and other organizations, as well as the vast information in the scientific literature to advance medicine and improve the health of patients. Clinical Data Analytics Platform is based on a federated architecture, which enables multiple participants to build a common, robust artificial intelligence and machine learning model without sharing datasets, thus addressing critical issues such as data privacy, security and access rights to heterogeneous sources of data.

Mayo selected nference, a Cambridge, Massachusetts, -based augmented intelligence company, as its first Clinical Data Analytics Platform partner to accelerate drug discovery and development across the biopharmaceutical ecosystem to create cures for patients.


female lab worker working under a glass hood, pipetting liquid, gloves, lab coat

A molecular switch has the ability to turn on a substance in animals that repairs neurological damage in disorders such as multiple sclerosis (MS)Mayo Clinic researchers discovered. The early research in animal models could advance an already approved Food and Drug Administration therapy and also could lead to new strategies for treating diseases of the central nervous system.

Research by Isobel Scarisbrick, Ph.D., published in the Journal of Neuroscience finds that by genetically switching off a receptor activated by blood proteins, named Protease Activated Receptor 1 (PAR1), the body switches on regeneration of myelin, a fatty substance that coats and protects nerves.


extreme close up of tools used in DNA extraction

Mayo Clinic is creating a library of genomic sequencing data on 100,000 consented Mayo Clinic participants to advance research and patient care.

“We believe that whole exome sequencing has the potential to reveal predispositions to health problems and enable earlier use of preventive measures throughout a person’s lifespan,” says Keith Stewart, M.B., Ch.B., Carlson and Nelson Endowed director, Mayo Clinic Center for Individualized Medicine.

Mayo is collaborating with Helix, a population genomics company. Helix’s clinical Exome+ sequencing is a technology that reads all 20,000 genes that code for proteins, plus hundreds of thousands of regions outside the protein-coding regions that are known to be informative, and thus have the most impact on an individual’s health. This comprehensive DNA test uses Next Generation Sequencing technology to screen the exome for genetic variants that can significantly increase the risk for disease.


Researchers used post-mortem genetic testing to find the underlying cause of multiple sudden deaths in young people and sudden cardiac arrests in two large Amish families.

Using an exome molecular autopsy, Michael Ackerman, M.D., Ph.D., and his associates conducted genetic testing of four siblings who each died suddenly during exercise. Dr. Ackerman is a genetic cardiologist and director of the Windland Smith Rice Comprehensive Sudden Cardiac Death Program at Mayo Clinic. The findings are published in JAMA Cardiology, with Dr. Ackerman as the senior author.


syringe laying on document titled Diabetes, next to the head of a stethoscope

The most commonly used forms of insulin cost 10 times more in the U.S. than in any other developed country, according to a commentary in Mayo Clinic Proceedings. This prohibitive cost is causing some U.S. patients with Type 1 diabetes to ration the amount of insulin they use, with life-threatening implications.

The commentary by S. Vincent Rajkumar, M.D., a Mayo Clinic physician, describes the cost of insulin as an urgent public health issue. “There are 30 million patients with diabetes in the United States, and about 25%, or 7.4 million Americans, need insulin. For the 1.3 million patients with Type 1 diabetes, insulin is as vital as air and water. Some patients are rationing insulin or switching to cheaper forms without proper supervision. We cannot wait to act.”


blood sugar tracker form on a clipboard, insulin injector pen, handheld digital gadget for reading blood sugar, foam heart and stethoscope artistically arranged

Heart problems are a common development for people with diabetes. In fact, about 33% of people in the U.S. admitted to the hospital for heart failure also have diabetes. Heart failure may be the result of a co-condition, such as hypertension or coronary heart disease, but not always.

A study published in Mayo Clinic Proceedings examines the idea of diabetic cardiomyopathy and heart failure from the effects of diabetes alone.

The study was conducted using the Rochester Epidemiology Project, a unique medical records linkage collaboration in Minnesota and Wisconsin.


two older women walking outdoors for exercise, smiling, each holding a water bottle

A study in Mayo Clinic Proceedings from the German Center for Neurodegenerative Diseases provides new evidence of an association between cardiorespiratory fitness and brain health, particularly in gray matter and total brain volume — regions of the brain involved with cognitive decline and aging.

The results suggest cardiorespiratory exercise may contribute to improved brain health and decelerate a decline in gray matter. While not conducted by Mayo researchers, the study was published in one of Mayo’s two peer-reviewed journals. And experts from Mayo Clinic provided an editorial published in conjunction with the article, commenting on the study.

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At Mayo Clinic, research drives everything we do for patients. From the laboratory bench to each patient’s bedside, from training our own care providers to improving health for our global community, we are continuously striving to transform the practice of medicine, one piece of evidence at a time. Read about the Mayo Model of Research, or visit the Mayo Clinic College of Science and Medicine website to learn about our five schools.

Wed, Jan 29 6:00am · A case for public health initiatives

medical illustration of COPD, with the parts of the lung and diseased areas identified

COPD is a chronic lung disease that makes it difficult to breath. According to the American Lung Association, COPD is the third leading cause of death in
the U.S., with more than 15 million people currently living with the disease. It
also increases the likelihood that people will develop heart disease, lung
cancer and other debilitating conditions.

In a recent study, health care delivery researchers at Mayo Clinic, the University of North Florida, Jacksonville, and McMaster University, Hamilton, Ontario, found a relationship between hospitalizations among patients with COPD and anti-smoking laws where they live. Specifically, in counties where smoke-free policies covered the workplace, restaurants and bars, people with COPD were 19% less likely (than where no such policies existed) to be readmitted for COPD complications within 30 days of a previous hospitalization. In counties with partial smoke-free policies (one or two of the three locations were not required to be smoke-free) patients were 13% less likely to be re-hospitalized.

The team used the American Nonsmokers’ Rights Foundation Tobacco Control Laws Database to identify U.S. counties with partial, full, or no smoke-free policies. During the time frame of the study (July 1, 2013 to June 30, 2016), the database contained information on smoke-free laws for 1,788 counties.

a close-up of a No Smoking symbol on a sign along a busy city sidewalk

Despite the well-known
risks associated with smoking in the workplace, some 21% of the counties had no
smoke-free policies.

“We were surprised
to find out how many counties didn’t have a smoking policy,” says Aaron
Spaulding, Ph.D.
, a health services researcher in the Mayo
Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care
Delivery
. “We also found it notable that there were significant variations
in the policies that existed.”

The research team
combined hospital and county demographic information from several other data
sources, overlaying it with the smoke-free policy information to examine
associations between county-level smoke-free policies and average hospital COPD
readmission rates.

In addition to learning that lacking smoke-free policies was clearly linked to COPD readmissions, the team made other observations about the counties that didn’t have policies. The researchers found that on average, these counties had fewer hospital beds, were more likely to be rural, had the highest levels of poverty and diversity and tended to have the lowest adult education and median population age.

“30-day readmissions are a key quality indicator used by the
Center for Medicare and Medicaid Services to drive reimbursement,” says Dr.
Spaulding. “Further, the Affordable Care Act requires nonprofit hospitals to conduct
an assessment of the health needs of the people in the communities they serve
and take steps toward addressing those needs.

“It follows that hospitals should actively lobby for smoke-free
policies in their regions.”

However, the research team also notes problems with quality
and reimbursement models that penalize hospitals for aspects of health they
don’t control.

“Ideally, aspects such as county smoke-free policies should be used in risk adjustment, and local, state, and federal governments should consider how such policies could influence health care costs as well as improve the health of their constituents,” adds Sericea Stallings-Smith, Dr.P.H., an assistant professor of public health in the Brooks College of Health at the University of North Florida.

Although this is a focused study of one health outcome associated with smoke-free policies, Dr. Stallings-Smith says it provides important insight into the critical role played by social determinants of health. Better understanding of social determinants – particularly among decision makers – can lead to advancements in public health practice and policy, and improvements in local and even global health.

Other
researchers on the team were:

  • Hanadi Hamadi, Ph.D., and Breck Peterson (M.P.H. candidate), University of North Florida
  • Emma Apatu, Dr.P.H., McMaster University

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Fri, Jan 17 6:00am · Did you know? Mayo Clinic publishes two peer-reviewed journals

image of the cover of the January 2020 issue of journal

Continuously published since 1926, Mayo Clinic Proceedings is a peer-reviewed journal, ranked among the top 10% of the 160 clinical journals in the Medicine, General and Internal category. The journal has a distribution of approximately 127,000.

Articles published in peer-reviewed journals have been reviewed by experts in the relevant field to ensure they contain high quality science and valid interpretations. For more discussion, read this article.

Although sponsored by Mayo Clinic, Mayo Clinic Proceedings publishes articles submitted by authors worldwide — approximately 80% of submissions come from non-Mayo authors.

Editor-in-Chief, Karl Nath, M.D., recently published the 2020 Vision for Mayo Clinic Proceedings, recapping some of its history and reminding readers of the diverse and deep content it has provided. In the article, Dr. Nath explains that the “defining nature of the Proceedings, one that will be both sustained and nurtured, reflects and speaks to the heterogeneity in interests and readership that exist in clinical practice, research, and education.” 

Several new features were launched in 2019, and 2020 has already seen the launch of another new section “Radiology, Imaging, and Intervention,” led by James Andrews, M.D.

The sister journal, Mayo Clinic Proceedings: Innovations, Quality & Outcomes, is online-only, open access, and has its own editorial board.

Mayo Clinic Proceedings: Innovations, Quality & Outcomes publishes content focusing on clinical innovations, quality improvement, and optimal outcomes, in medicine and surgery.

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Tue, Jan 7 6:00am · Research News Roundup--December 2019

diverse research team, female researcher readys slide on microscope tray while two male colleagues watch

December’s Research News Roundup highlights a number of advancements in understanding and treating different cancers, including blood, breast and gastrointestinal; in addition to other research news from Mayo Clinic.

The Roundup also connects readers to related resources. Read on for more information from Mayo Clinic Research.

male doctor in conversation with male patient, both are middle-aged

A Mayo Clinic study involving 5,540 patients with metastatic colorectal cancer found maintenance chemotherapy after initial treatment is more beneficial for patients whose disease is under control, compared with more aggressive treatment.

A maintenance strategy with a fluoropyrimidine chemotherapy, such as 5-FU or capecitabine, is preferred, though observation (no chemo) is an acceptable option for some patients, according to the analysis of results from 12 randomized clinical trials. The study appears in JAMA Oncology.


diverse group of resident physicians in clinical hallway at Mayo Clinic

Gender pay equity in the field of medicine remains elusive. Gender-based pay differences have been shown to persist, even when controlling for experience, clinical productivity, academic rank and other factors. These inequities result in significantly lower lifetime earnings, job burnout and negative attitudes toward work, and adverse effects on the profession and society.

One model for eliminating pay disparities among physicians is a structured, salary-only plan that incorporates national benchmarks, and standardized pay steps and increments, such as the plan that is used at Mayo Clinic.

A Mayo Clinic study set out to assess how well the institution adheres to its own compensation model and achieves pay equity.  Read more in the news release.


This is an alarming trend, as stomach cancer is a devastating disease. There is little awareness in the U.S. of the signs and symptoms of stomach cancer, and many younger patients may be diagnosed late.

Many people under 60 who develop stomach cancer have a “genetically and clinically distinct” disease, new Mayo Clinic research has discovered.

female doctor examining younger middle-aged African American female patient

Compared to stomach cancer in older adults, this new, early onset form often grows and spreads more quickly, has a worse prognosis, and is more resistant to traditional chemotherapy treatments, the study finds. The research was published recently in the journal Surgery.

While rates of stomach cancer in older patients have been declining for decades, this early onset cancer is increasing and now makes up more than 30% of stomach cancer diagnoses.


artist's interpretation of microbes, colorful cells of different shapes and sizes

Endometrial cancer is the most common gynecological malignancy in the U.S. and the fourth most common cancer among women. In addition, endometrial cancer incidence rates are on the rise in the western world, suggesting that alterations in environmental factors such as diet, lifestyle, and the vaginal microbiome may be important drivers in its cause.

In a study published in Scientific Reports Mayo Clinic researchers identified a vaginal microbiome signature associated with endometrial cancer, which is in part promoted by post menopause. The goal of the study was to understand how endometrial cancer risk factors alter the reproductive tract microbiome and endometrial cancer risk.


Researchers found most women who survive breast cancer beyond 10 years are at risk to develop serious medical conditions including heart disease, cerebrovascular disease and Alzheimer’s disease

close up shot of woman in white tank top with pink ribbon attached over left breast

Overall survival of patients with breast cancer in the U.S. has significantly improved over the past two decades. However, as breast cancer survivors live longer, their risk of developing other serious medical conditions also increases, according to a Mayo Clinic-led study published in the journal Cancer.

The retrospective study provides the largest and most recent population-based, long- term analysis to date of non-cancer causes of death among women diagnosed with breast cancer. It also provides a detailed assessment of changes in the risk of each cause of death, compared to those in the general U.S. population over the same period.


smiling young woman with new hair growth just beginning to show on her head

Mayo Clinic researchers presented 22 different studies during the 2019 San Antonio Breast Cancer Symposium, Dec. 10–14.

Three in particular were highlighted in the Mayo Clinic news release. Titles below are taken from the plain language release, but link to the abstracts presented at the symposium.


group of people lifting kettlebells in a fitness class

High-intensity group workout classes are increasingly popular at fitness centers. While research has shown that these workouts can have cardiovascular and other benefits, few studies have been conducted on whether they lead to more injuries.

Mayo Clinic study that closely tracked 100 participants in a six-week high-intensity functional training program showed a statistically insignificant increase in the rate of injury, compared with less intensive workouts.

The study, published in Mayo Clinic Proceedings, reported an injury rate of 9 injuries per 1,000 training hours during the six-week training, compared with 5 injuries per 1,000 training hours during the six weeks preceding enrollment. The data showed that 18% of participants reported an injury during the training period, and 37.5% reported an injury during a training session.


gloved, with lab coat and dark rimmed glasses; female researcher pipetting samples

There were dozens of presentations featuring Mayo Clinic research throughout the American Society of Hematology Annual Meeting, Dec. 7–10 in Orlando.

Three were featured in the news release from Mayo. The below titles are drawn from the news release, but are linked to the related abstracts:

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Find out more:

Dec 12, 2019 · A unique competition showcases Mayo's innovative capabilities

a hospital staff person wearing protective eye wear and a head cover, touching a futuristic medical concept of artificial intelligence images on transparent glass.

An innovative artificial intelligence project from a group of Mayo Clinic investigators was among the top 25 participants selected to advance to Stage 1 of the Centers for Medicare & Medicaid Services (CMS) Artificial Intelligence Health Outcomes Challenge.

The challenge is to develop
technology that can be used to predict unplanned hospital and skilled nursing
facility admissions, and adverse events within 30 days – using Medicare claims
data.

Patrick Wilson
Patrick Wilson is a statistician at Mayo Clinic in Rochester, Minn.

“In addition, teams are expected to develop strategies to explain AI-derived predictions to front-line clinicians and patients, and identify ways to increase use of AI-enhanced data for quality improvement,” says Patrick Wilson, a statistician in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

Along with James Naessens, Sc.D., a researcher in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, focused on issues in quality and safety, Wilson co-leads Mayo Clinic’s project that made it through the first cut in the competition.

More than 300 teams submitted
entries in response to the CMS challenge. Now 25 are competing for 7 spots in Stage
2 of the Challenge.

Mayo’s advancing project is
“Building Interpretable Model Ensembles to Reduce Unnecessary Hospital and SNF
Admissions – A Claims-based Learning Framework to Improve Patient Care through
Policy.”

James Naessens, Sc.D.
James Naessens, Sc.D.

“More than 10 years ago, then President and CEO Dr. Denny
Cortese and collaborators developed the Mayo Clinic value equation,” says Dr.
Naessens. “Value equals quality over cost, with quality defined as outcomes,
safety, and service, and cost considered over time.”

“This work is an outgrowth of that value equation – and a
chance for us to share our expertise and potentially transfer some of our value
to the nation’s health care system.”

Dr. Naessens
and Wilson are leading a diverse team to design a claims-based learning framework for developing machine learning
models. They are using what the team refers to as ‘ensemble models’ – a
methodology that incorporates multiple machine learning algorithms to leverage
the diversity of different concepts, expertise and backgrounds.

“These ‘ensemble models’ will predict
unplanned hospital and skilled nursing facility admissions and readmissions, as
well as other adverse events,” says Wilson. “We are developing the ensemble
model to work with the current data delivery and management capabilities of CMS.”

word graphic titled 'Design Process' that shows three separate work loops. First loop has three boxes: Develop Features, Testing, Clinician in the Loop! Second loop has three boxes: Developing visualizations, building dashboards, clinician in the loop!! third loop has three boxes: Develop proof of concept, dockerize models, clinician in the loop!!!

To build a scalable and sustainable artificial intelligence framework
with a high likelihood of integrating into a CMS health innovation model, Wilson
says the following five design principles are critical. The model must:

  • Be iterative
  • Have a low barrier to implementation
  • Be highly accurate
  • Be easily interpretable
  • Be open and trustworthy

Usability is ensured by integrating clinicians throughout the process.

“Our team is leveraging the
collective knowledge and experience of several health services researchers and
health care policy analysts, as well as potential physician users, and
combining it with the power of artificial intelligence/machine learning,” says
Dr. Naessens. “This multidisciplinary, team science approach is one of the
critical elements of Mayo Clinic’s practice transforming research and value for
our patients.”

He and Wilson say that Mayo
Clinic’s algorithms will produce clear, actionable insights, and if selected as
a winning proposal, CMS could incorporate them into an innovation solution for
quality improvement across model participants.

“We view this as the main
objective for this project,” says Wilson. “However, the claims-based learning
framework we are developing could be leveraged for multiple purposes involving
other prediction models, quality improvement initiatives, risk adjustment and
testing for subgroups of program treatment response.”

Wish them luck and stay tuned – winners
of Stage 1 will advance to Stage 2 in April 2020.

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