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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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6 days ago · Strengthening the case for palliative care

The Mayo
Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care
Delivery
is the group at Mayo Clinic charged with driving practice
transformation. Basically, this means to help Mayo Clinic improve the way health care
is delivered, reaching patients where they are, with the right answers when
they are needed.

Center researchers work within multi-disciplinary teams
across Mayo Clinic on projects ranging from better ways to support women during
pregnancy, to faster visits in the ER and new ways to help elderly patients
stay out of the hospital.

One
recent research project
with the Department
of Cardiovascular Medicine
looked at how often palliative care is part of
the care plan for patients who suffer a heart attack accompanied by cardiogenic
shock. Public Affairs sat down with two of the study authors to find out more
about their project, and how it may lead to better care for patients.

The study first author, Saraschandra Vallabhajosyula,
M.B.B.S., is a cardiology
fellow
at Mayo Clinic, with prior training in critical care medicine. His
mentor and the study’s senior author is Gregory
Barsness, M.D.
, the medical director of the Mayo Clinic Cardiac Intensive
Care Unit with additional expertise in interventional cardiology and radiology.


Dr. Vallabhajosyula,
what made you decide to study this topic?

Saraschandra Vallabhajosyula, M.B.B.S.

Cardiogenic
shock
after acute myocardial infarction is my clinical and
research interest. These patients are often admitted to the cardiac intensive
care unit with multi-organ failure needing cardiac and non-cardiac organ
support.

They have a high risk of death in
the cardiac intensive care unit and the hospital. Therefore, there is an
important need to understand the issues surrounding end-of-life in these
complex patients.

Furthermore, palliative
care
is frequently mistaken as ‘futile care’ rather than ‘patient-centric
care’ by both patients and physicians. We sought to understand the national
trends and predictors in this population.

Dr. Vallabhajosyula:
What is cardiogenic shock, and what makes these heart attacks different for
patients experiencing them?

Cardiogenic shock is a state of low cardiac
output (pumping ability of the heart) and about 80% of these cases are due to an
acute myocardial infarction – commonly known as a heart attack. While there are
other reasons a person might develop cardiogenic shock, when it occurs as a
result of cardiac muscle damage during a heart attack, it happens very quickly.
It is difficult to predict how well a patient will do in this situation, and in
fact, nearly a third of these patients die in the hospital.

This results in a rather urgent need to quickly develop a
patient-centric care plan, one that incorporates the patient’s condition and
wishes, as well as that of their family when they are unable to communicate.

The typical health care team surrounding a patient who
has had a heart attack is well versed in the technologies and procedures needed
to extend life. However, this has to be balanced with detailed conversations
about the risks and benefits of each with patients and families, or to develop
a palliative care plan that aligns interventions with patient goals.

Dr. Barsness, what is palliative care, and what do
palliative care specialists do?

Gregory Barsness, M.D.

The practice
of palliative care aligns what is possible with what is desired. In modern
medicine, there are a great many more treatment options available to patients
and these treatments carry different potential benefits and risks. The health care
decisions that patients and their families make are directly related to how
patients understand these risks and benefits and how the results might align
with their overall life goals. 

Palliative
care specialists provide insight and guidance to help patients and their
families understand and integrate advanced diagnostics and treatments therapeutics
with their social, emotional and spiritual needs.

Palliative
care specialists play a crucial role in the care of patients with acute or
chronic conditions. In particular, in the acute cardiac ICU setting, they can
assist patients and families faced with choices that include treatments that prolong
life but do not cure. For example, there are a number of different machines
that help the heart pump, breathe for the patient or filter a patient’s blood
when their kidneys stop working.

Many of these
patients may also experience significant changes in their health and needs
during their time in the hospital, leading to later decisions that could be
inconsistent with their overall goals of care.

Dr. Barsness: Why is it important
to make palliative care an integral offering in the cardiac ICU?

A team-based approach incorporating palliative care
specialists to care for patients with cardiogenic shock following a heart
attack is crucial to individualizing care based on each patient’s specific
goals and desires. This is actually an ideal approach for patients with any
acute or chronic condition that has substantial implications for quality and
longevity of life.

The cardiac ICU, in particular, is a fast-paced environment
where crucial decisions often revolve around technical feasibility with an
emphasis on the science of medicine. Involving team members with special skills
in palliative medicine assures that we place appropriate emphasis on individual
values and choices.

At Mayo Clinic, we do that routinely via scheduled family
conferences and open visitation schedules and health care providers present and
available around-the-clock. Use of palliative care is an extension of the same
philosophy wherein we value the patients’ and families’ emotional, spiritual
and social concerns along with the science of care delivery. So incorporating
palliative care specialists is like getting a different set of eyes, i.e.
different perspective, on the same core issue – the needs of the patient.

Dr. Vallabhajosyula,
while at Mayo Clinic including palliative care support may be more the norm,
your study showed that in general, across the U.S., palliative care is not provided
to these patients. Do you have any thoughts as to why?

I think it is a combination of factors that largely have to
do with the perception of palliative care. Hospice care, end-of-life care and
palliative care are presumed to be interchangeable, potentially resulting in
late referrals of ‘actively dying’ patients.

As Dr. Barsness and I previously noted, the philosophy of
palliative care is compatible with continued medical care and does not mean
‘giving up,’ or the cessation of care. That being said, we all can do better.

Only 4.5% of the nearly 450,000 patients (admitted to
hospital) in our national study were offered palliative care. Other research
has shown that the national rates for palliative care use in a range of
critical care settings, 7%-13%, are still very low.

Dr. Barsness: Your study showed
that people receiving palliative care support were more likely to die in
hospital or not return home. Were there any things about this finding that
concerned you?

As
noted in the study, patients with palliative care visits were sicker, had
higher acute organ failure and were likely offered palliative care too late in
their hospital course.

Our
results might suggest that patients with palliative care support received
futile care less often and adopted life limiting decisions more frequently –
that is, they perhaps chose to reduce or decline use of equipment and
technologies that prolonged life. They also may have sought non-hospitalization
care during end-of-life.

However,
to draw firm conclusions, more data are needed on the timing of palliative care
consultation, as well as any changes care in management plans that result from
palliative care consultation.

Dr. Vallabhajosyula continues:

The
major findings of our study are the strikingly low use of palliative care
specialists in a patient population that has nearly 30% in-hospital mortality.

Though
the time trends analyses show higher use in more recent years, there still
remain multiple barriers. Perceptions of palliative care and other barriers to
incorporation are common as we noted previously. Additionally, we found geographic,
racial, sex and age-related disparities.

These
factors indicate the need for more qualitative research to understand these
barriers to implementing high-quality care.

Dr.
Barsness: Do you expect Mayo Clinic practice to change as a result of these
findings?

These
national results are certainly eye-opening and would make many of us working in
the cardiac ICU reflect on our practice. Given Mayo’s emphasis on
multidisciplinary care, the high spirit of collaboration and prioritizing the
needs of our patients, our numbers are significantly better than these national
statistics. However, in our relentless efforts to provide the best possible
care for our patients, we seek to continually improve on this aspect and many
others relating to health care delivery in the CICU.


When asked if there was anything else they’d like to add, both doctors chimed in with thanks to that same multidisciplinary team they mentioned – the nurses, therapists, pharmacists and technicians of the cardiac ICU that make it possible to deliver high quality care to critically ill patients, while providing hope and healing to these patients and their families. They went on to credit other groups without which they would not have been able to conduct this research, the Divisions of Pulmonary and Critical Care Medicine and General Internal Medicine, Mayo Clinic Center for Palliative Medicine, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic Center for Clinical and Translational Science and the Mayo Clinic School of Graduate Medical Education.

###

Tue, Nov 5 6:00am · Research News Roundup--October 2019

If you were camping near the Boundary Waters, hiking the Grand Canyon, or snorkeling off the Florida Keys last month, you might have missed some of Mayo Clinic’s research news.

The Mayo Clinic Research News Roundup includes brief summaries and links to research news releases from the past month. It also connects readers to related resources. Read on for more information from Mayo Clinic Research.


Mayo Clinic-led study involving 488 cardiac patients whose cases were followed for up to 12 years finds that microvascular endothelial dysfunction, a common early sign of cardiovascular disease, is associated with a greater than twofold risk of cancer.

The study, published in the European Journal of Preventive Cardiology, finds that microvascular endothelial dysfunction may be a useful marker for predicting risk of solid-tumor cancer, in addition to its known ability to predict more advanced cardiovascular disease, says Amir Lerman, M.D., a Mayo Clinic cardiologist and the study’s senior author.


New research from the Well Living Lab, a Delos and Mayo Clinic collaboration, shows that office areas with windows, which provide people with natural light and views of the outdoors, improve workers’ cognitive performance and satisfaction with their office environment. Modern shading and glass tinting techniques can mitigate eyestrain, reducing discomfort from daylight glare.

These findings are published in the November volume of Building and Environment. The study was conducted by researchers from the fields of environmental, health and behavioral science.


In cell and mouse models, Mayo Clinic researchers and collaborators have identified a way to slow and reverse the process of uncontrolled internal scarring, called fibrosis.

This disease process has few effective therapies, no cure and can be fatal when it occurs in organs such as the liver (cirrhosis) or lungs (pulmonary fibrosis). The findings appear Wednesday, Oct. 30, in Science Translational Medicine.


Among other Mayo Clinic research, four studies were of particular interest – the news release describes these more fully:

  • Patients with microscopic colitis do not have reduced risk of developing colon polyps
  • Anti-tumor necrosis factor (TNF) therapy linked to preeclampsia in women with inflammatory bowel disease
  • Positive polymerase chain reaction (PCR) test results may not predict recurrence of common infection
  • Study proposes new method, protocol to study stomach function after bariatric surgery


The largest randomized trial in asymptomatic patients with smoldering multiple myeloma suggests that lenalidomide, a cancer drug, may delay the onset of bone and other myeloma-related organ damage.

Results of the study, which was conducted by the Eastern Cooperative Oncology Group and funded by the National Cancer Institute, were published Friday, Oct. 25, in the Journal of Clinical Oncology.


Courtesy of The New England Journal of Medicine. This figure shows photos of four participants (top two rows) and corresponding reconstructions of their faces (bottom row) created from their research MRI scans.

Though identifying data typically are removed from medical image files before they are shared for research, a Mayo Clinic study finds that this may not be enough to protect patient privacy.

The study, described in a letter published in The New England Journal of Medicine, finds that it’s possible to use commercial facial recognition software to identify people from brain MRI that includes imagery of the face, despite steps that researchers typically take to protect patient privacy. 


In a consensus report released Wednesday, Oct. 23, the National Academy of Medicine makes recommendations for system-level change needed to improve the professional well-being of clinicians, students and trainees across health care.

Lotte Dyrbye, M.D., co-director of Mayo Clinic’s Program on Physician Well-Being, was on the committee that developed the report and presented its findings to Congress and the nation.

Clinician burnout has been identified as a major problem in the U.S., affecting 35%–54% of nurses and physicians, and 45%–60% of medical students and residents. Some research suggests that these numbers are reflected in all areas of health care (oral, pharmacy, etc.). Along with burnout comes a corresponding threat to organizations’ abilities to provide high-quality patient care.

The new report, “Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being,” hopes to reduce these numbers, and states, “Taking action to mitigate burnout requires a bold vision for redesigning clinical systems — one which focuses on the activities that patients find important to their care, and which enables and empowers clinicians to provide high-quality care.”


Chronic kidney disease, which afflicts an estimated 6.4% of U.S. adults 45 and older, is associated with an increased risk of heart attack and other adverse cardiovascular outcomes, according to new research from Mayo Clinic.

The retrospective review of 1,981 patients who were treated for chronic kidney disease at Mayo Clinic between 1997 and 2000 found that over a 10.2-year follow-up period, these patients had significantly elevated cardiac biomarkers, and were at increased risk of heart attack, congestive heart failure, stroke and other adverse cardiovascular events.

According to the study, which is published in Mayo Clinic Proceedings, the results regarding heart attack were especially striking: Chronic kidney disease was associated with a 95% increased risk of heart attack during the follow-up period.


Frontotemporal lobar degeneration is the overarching term for a group of disorders that involve shrinkage of the frontal and temporal lobes of the brain.

Frontotemporal lobar degeneration is the overarching term for a group of disorders that involve shrinkage of the frontal and temporal lobes of the brain.

The National Institutes of Health has awarded a five-year, multi-investigator research grant expected to total more than $63 million to Mayo Clinic and the University of California, San Francisco, to advance treatments for frontotemporal lobar degeneration.

Frontotemporal lobar degeneration is the overarching term for a group of neurodegenerative disorders that primarily affect areas of the brain associated with personality, behavior, memory and language. These disorders are estimated to account for 10%–20% of dementia cases in the U.S.

Unlike Alzheimer’s disease, which typically affects people over 65 and often progresses slowly, frontotemporal lobar degeneration frequently affects people in their 40s, 50s and 60s who are still working and raising families. It often leads to rapid cognitive and physical decline, and death, in less than 10 years. There are no effective treatments.


Although this release was mainly to provide reporters with some experts to contact during National Breast Cancer Awareness Month, it also offered a glimpse of the results of new research showing that young breast cancer patients may experience more advanced cancers.

Judy Boughey, M.D., a Mayo Clinic breast surgeon, recently conducted a study of more than 46,000 women ages 15–49. This study found that while adolescents and young women account for less than 2% of breast cancer patients, they tended to be diagnosed with more advanced breast cancer and more aggressive tumor biology, including triple-negative and HER2-positive breast cancers.

“Our study found that very young women, ages 15–29 years, experienced more advanced disease than women ages 30–39 years, so it’s very important that these women take note of any changes in their breasts and discuss those changes with their physician,” says Dr. Boughey.


Research into the pathology of vaping-associated lung injury is in its early stages, but a Mayo Clinic study published in The New England Journal of Medicine finds that lung injuries from vaping most likely are caused by direct toxicity or tissue damage from noxious chemical fumes.

Researchers reviewed lung biopsies from 17 patients, all of whom had vaped and were suspected to have vaping-associated lung injury. The study was the first to examine a group of biopsies from patients with lung injury due to vaping. Researchers found no evidence of tissue injury caused by accumulation of lipids — fatty substances such as mineral oils — which has been suspected as a possible cause of the lung injuries associated with vaping.

Brandon Larsen, M.D., Ph.D., a surgical pathologist at Mayo Clinic Arizona, and a national expert in lung pathology, discusses the vaping-associated lung injury study.

###

Other ways to connect with Mayo Clinic:

Thu, Oct 24 6:00am · New research shows spinal stimulation may work better than medication for long-term pain reduction

In a recent study, a team of Mayo Clinic researchers
examined the effectiveness of spinal stimulation for pain control, compared to
medical therapy or multiple surgeries for patients with long-term spine or limb
pain.

They found spinal stimulation was significantly more likely to reduce pain than medication for patients with intractable pain. Their findings were published in Mayo Clinic Proceedings.

“Intractable pain, or refractory pain is pain that occurs when multiple evidence‐based treatments have been tried and the patient has not reached treatment goals,” says study first author Tim Lamer, M.D., an anesthesiologist, pain management, and spine care specialist at Mayo Clinic. “Typically this means they have not achieved satisfactory pain reduction and/or functional improvement.”

According to the National Institutes of Health, “almost 11 million U.S. adults have ‘High Impact Chronic Pain,’ that is, pain that has lasted 3 months or longer and is accompanied by at least one major activity restriction, such as being unable to work outside the home, go to school, or do household chores.”

Because back and/or limb problems are the commonest pain
complaints, Dr. Lamer says it made sense to try and determine the most
effective ways to help patients.

The research

In this meta-analysis (analysis of a collection of relevant
studies), the team study used a random-effects model to compare any type of
spinal stimulation to medical therapy. They also compared newer stimulation technologies
such as high frequency spinal cord stimulation and dorsal root ganglion
stimulation to conventional spinal stimulation.

“This kind of research (random-effects) incorporates uncertainties due to differences between the settings of the studies, like patient or provider characteristics,” says senior author M. Hassan Murad, M.D., a preventive medicine physician and health services researcher at Mayo Clinic. “It’s a common tool in meta-analyses.”

After conducting a search of peer-reviewed publications,
they found 17 manuscripts, from 12 clinical trials comparing medical therapy or
repeated surgeries to either conventional or new spinal stimulation for pain
control.

Physical therapy doctor discusses spine model with patient.

The researchers also employed the indirect comparison
technique. “If studies compare treatments A vs B, and B vs C, we can indirectly
compare A and C,” explains Dr. Murad.

“Because we found no studies comparing new spinal
stimulation technologies to medical therapy, we needed to indirectly compare
them.”

Although there are some limitations, Dr. Murad says this
kind of research can help lead to the best possible outcomes for patients.

“The estimates we provide should be used to support shared-decision
making,” he says. “Other factors, such as patient’s values and preferences,
feasibility and accessibility of treatment also need to be considered when
making treatment decisions.”

Publishing the meta-analysis in and of itself may prove to
be helpful for patients, as it calls attention to the option of spinal
stimulation for pain control.

“Many non-pain specialists are not generally aware of spinal
cord stimulation,” says Dr. Lamer, “and how effective it can be for properly
selected patients with difficult to manage chronic pain.”

He says that this includes patients with complex spinal pain
syndromes, painful neuropathies including diabetic neuropathy, and
post-traumatic pain syndromes such as complex regional pain syndrome.  

“Patients who are not responding to conventional
conservative measures such as medications and physical therapy should be
referred to a qualified interventional pain specialist to be evaluated for
spinal cord stimulation candidacy.” 

###

Dr. Murad leads knowledge synthesis research like this
meta-analysis, in the Mayo Clinic Robert D. and Patricia E. Kern Center for the
Science of Health Care Delivery
. He also is the director of the Evidence-based Practice Center.

Related resources:

Implantable spinal cord stimulator (video news item)

###

Fri, Oct 4 6:00am · Chemo first for better outcomes in bile duct cancer, says new research

Oncology care teams frequently use chemotherapy along with surgery to treat cholangiocarcinoma, or bile duct cancer. However, until now, little evidence existed regarding if and when receiving chemotherapy was likely to have the best effect.

Recently Mayo Clinic researchers found that patients who
received chemotherapy before surgery to remove their bile duct cancer were more
likely to live longer than patients who received chemotherapy after surgery. Their
findings
are published in the European Journal of Surgical Oncology.

“Cholangiocarcinoma is a rare malignancy with poor outcomes and limited treatment options,” says Siddhartha Yadav, M.D., F.A.C.P., study first author, and a hematology/oncology fellow at Mayo Clinic in Rochester, Minnesota. “We hope that our findings will lead to clinical trials to further evaluate the role of neoadjuvant chemotherapy in cholangiocarcinoma and significantly improve the outcomes of patients with this rare and aggressive tumor.”

According to the American Cancer Society, cholangiocarcinoma
is rare, with about
8,000 people in the U.S. diagnosed each year
. The outlook for these
patients is not good, with 5-year
survival rates
ranging from less than 25% in the best case (localized
cancer, within the liver), and 1% worst case (cancer has spread beyond bile
ducts to distant parts of the body).

“At Mayo Clinic, we get referrals from all over the world to
our tertiary care center,” says Amit Mahipal, M.B.B.S., study senior author,
and a gastrointestinal oncologist at Mayo Clinic in Rochester, Minnesota. “We
do research into rare conditions because little research exits for these
conditions due to small numbers. But because of our unique institution and
patient population, we are able to conduct research with select groups of
patients with rare diseases like cholangiocarcinoma.”

The researchers used the National Cancer Database to
identify patients who underwent
surgery and chemotherapy for stage I-III cholangiocarcinoma between 2006 and
2014. Of 1,450 patients, the team found that 299 received chemotherapy before
surgery, and 1,151 received it after surgery. They investigated subgroups of
these, matching 278 patients who received pre-surgery chemo to 700 patients
with similar characteristics to the post-surgery chemo group.

On average, the
patients who received chemotherapy before surgery lived 7.5 months longer than
those receiving it after surgery. Their 5-year survival rate was also more than
10% higher (42.5% versus 31.7%).

“We have other
research showing neoadjuvant (before surgery) chemotherapy nets better results
for patients with pancreatic or breast cancer,” says Dr. Mahipal, “so these
results were not very surprising. However, because of this research, we now
know what the best practice should be, and we hope to see application of this
evidence into treatment for patients everywhere with bile duct cancer.”

This research was the result multidisciplinary collaboration across several departments at Mayo Clinic and Yale New Haven Health. It was supported by Mayo Clinic Cancer Center and the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. This study was presented in part as a poster presentation at the 2018 European Society of Medical Oncology Annual Congress in Munich, Germany.

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Wed, Oct 2 6:00am · Research News Roundup--September 2019

Let me tell you what you missed.

The Mayo Clinic Research News Roundup includes brief summaries and links to research-related news releases from Mayo Clinic in the past month. It also connects readers to associated resources. Read on for more information from Mayo Clinic Research.


Though research shows that medication-assisted treatment can help people who are addicted to opioids, the three drugs approved by the Food and Drug Administration are underused, according to a review of current medical data on opioid addiction in the U.S. This review appears in the October issue of Mayo Clinic Proceedings.

Along with addiction counseling, the drugs naltrexone, buprenorphine and methadone all have a place in treatment for opioid use disorder, says Tyler Oesterle, M.D., medical director of Mayo Clinic Health System’s Fountain Centers drug and alcohol treatment programs. Evidence of the three drugs’ effectiveness in treating opioid use disorder is well-established, says Dr. Oesterle, the review’s lead author. This review uses data from available medical literature to provide a framework for determining the optimal approach for medication-assisted treatments.


When a patient has had coronary artery bypass grafting, and needs a second surgery because of recurrent chest pain, more often than not they will receive a percutaneous coronary intervention, commonly known as coronary angioplasty with stents.

study published in September in Mayo Clinic Proceedings says that a better option may be repeating the coronary artery bypass grafting operation. The cohort study, based on health records of 1,612 patients at Mayo Clinic from 2000 to 2013, finds that overall survival was increased with repeat coronary artery bypass grafting versus patients who underwent  percutaneous coronary intervention.

Long-term survival was improved, especially when compared with percutaneous coronary intervention involving previous bypass grafts.


Pancreatic adenocarcinoma is a lethal malignancy that most often is resistant to chemotherapy. Researchers have been searching for ways to increase the sensitivity of the tumors to cancer-fighting drugs.

A Mayo Clinic-led study published Sept. 13, 2019, in Clinical Cancer Research, opens a promising new front in that battle.

Using patient cell lines and tumor-bearing models, researchers found that inhibition of GSK-3, an enzyme involved in many cancer-promoting processes, sensitizes PDAC cell lines to gemcitabine, the most commonly used chemotherapy. They found that GSK-3 inhibitor treatment prevented cancer cells’ ability to repair single-strand DNA damage induced by gemcitabine.


In a small safety and feasibility clinical trial, Mayo Clinic researchers have demonstrated for the first time that senescent cells can be removed from the body using drugs termed “senolytics”. The result was verified not only in analysis of blood but also in changes in skin and fat tissue senescent cell abundance. The findings appear in the journal EBioMedicine.

This trial — involving participants who had diabetes-related kidney disease — is the second clinical study of senolytics to be published by Mayo, but is the first trial to show that senolytic drugs, discovered by Mayo researchers, can remove senescent cells from humans as they did in numerous studies in animals. 

Senescent cells are malfunctioning cells that accumulate with aging and in organs affected by chronic diseases. Senescent cells can remain in the body and contribute to multiple diseases as well as features of aging, ranging from heart disease to frailty, dementias, osteoporosis, diabetes, and kidney, liver, and lung diseases.


The Food and Drug Administration has approved the use of a positron emission tomography radiochemistry facility, also known as the cyclotron facility, at Mayo Clinic in Florida.

Mayo Clinic is now the only academic center with a cyclotron facility in Northeast Florida that is approved by the FDA for patient care. This approval paves the way for Mayo to use sophisticated imaging agents to detect medical conditions at early stages.

This facility will deliver breakthrough diagnostic tests and research capabilities for individualizing patient care across a wide range of applications, including cancer, heart disease, stroke, dementia and infections.


Mayo Clinic and Google announced a 10-year strategic partnership on Tuesday, Sept. 10. This partnership will redefine how health care is delivered and accelerate the pace of health care innovation through digital technologies.

Mayo Clinic selected Google Cloud to be the cornerstone of its digital transformation. Mayo will use advanced cloud computing, data analytics, machine learning and artificial intelligence (AI) to redefine health care delivery, bringing together global providers and consumers to make health care better.

With the help of Google, Mayo Clinic will transform the way it advances virtual care with AI-enabled digital diagnostics. Mayo also will leverage Google technology to boost its ability to conduct medical research. Through this partnership, Mayo Clinic will be able to develop and deploy new machine learning models designed to improve treatment precision and clinical outcomes of diseases.


Hysterectomy is associated with an increased risk of long-term mental health issues, especially depression and anxiety, according to a cohort study by Mayo Clinic researchers involving nearly 2,100 women.

The review of health records from 1980 to 2002 involved women who underwent removal of the uterus but not the ovaries. The study, which used data from the Rochester Epidemiology Project, considered only new diagnoses of depression, anxiety, dementia, substance abuse and schizophrenia after hysterectomy, and excluded women with prior diagnoses.

Researchers found an absolute risk increase of 6.6% for depression and 4.7% for anxiety over 30 years, says senior author Shannon Laughlin-Tommaso, M.D., a Mayo Clinic OB-GYN. For women who underwent hysterectomy between the ages of 18 and 35, the risk of depression was higher, with absolute risk increase over 30 years of 12%.


Mayo Clinic physicians presented findings at the American Society for Therapeutic Radiology and Oncology annual meeting Sept. 15–18 in Chicago.

Among many other projects, these four were highlighted as especially newsworthy:

Prolonged radiation therapy does not improve brain tumor control

Prolonged radiation therapy for brain cancer patients does not improve brain tumor control and may have more side effects, according to Mayo Clinic research, which concludes that 10 treatments of whole-brain radiotherapy should be the standard of care. Current international standards for whole-brain radiotherapy call for 10 or 15 treatments.

Native American cancer patients tend to have significant concerns about radiation therapy

Native American cancer patients tend to have significant concerns about radiation therapy that are not being addressed adequately, according to a collaborative study by researchers at Mayo Clinic in Arizona and Phoenix Indian Medical Center. Fifty American Indian or Alaska Native radiation patients at Phoenix Indian Medical Center were surveyed regarding attitudes and concerns about radiation therapy.

The patients surveyed expressed concern about the side effects of radiation therapy, with special concerns about cost, transportation to and from the treatment center, and insurance compatibility.

DNA in blood test may help identify patients with HPV-associated cancers

Another study presented as late-breaking research at the meeting suggests that a DNA blood test could be used to identify patients with HPV-associated cancers. The test also may help in subtyping HPV without requiring a biopsy of the tumor.

There are more than 100 varieties of HPV, and infection with HPV can cause skin or mucous membrane growths, such as warts. Some types of HPV infection can cause cancer. The study involved patients treated at Mayo Clinic for cancers of the head and neck associated with HPV and investigated whether DNA shed by a patient’s tumor was detectable before and after surgery.

PD-L1 contained within cancer cells has role in making the cells more resistant to therapy

The protein PD-L1 is frequently present on the surface of cancer cells and is known for its role in helping cancer cells escape the immune system by shutting down immune cells’ anti-tumor function.

Mayo Clinic-led researchers have discovered a new role for PD-L1 in cancer.  They found that cancer cells also use PD-L1 to promote their resistance to cancer therapy by improving their ability to fix DNA damage caused by radiotherapy or chemotherapy. According to Robert Mutter, M.D., a Mayo Clinic radiation oncologist and co-corresponding author along with Zhenkun Lou, Ph.D., and Haidong Dong, M.D., an antibody named H1A can be used to target this function of PD-L1 in cancers.

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At Mayo Clinic, research is integral to everything we do. 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.

Fri, Sep 20 6:00am · Good news about the effectiveness of antifibrotics for IPF

In a recent study published in the American Journal of Respiratory and Critical Care, a research team led by Andrew Limper, M.D., a pulmonology and critical care physician at Mayo Clinic, evaluated the effectiveness of pirfenidone and nintedanib for patients with idiopathic pulmonary fibrosis. The researchers reported “the medications had an association with a reduced risk of all-cause mortality and hospitalizations for up to two years.”

Consultant360 recorded an interview with Andrew Limper, M.D., explaining this research and the team’s findings.

These drugs are the only medications approved by the Food and Drug Administration for idiopathic pulmonary fibrosis. Although clinical trials had shown that the medications slowed the decline in lung function, no research previously existed as to their effect on other important outcomes such as hospitalizations or mortality.

The investigators used the OptumLabs Data Warehouse to conduct this retrospective study. This database is a longitudinal, real-world data asset with de-identified administrative claims and electronic health record data.

They compared the outcomes of 1,255 treated (with either medication) and 1,255 untreated adults with idiopathic pulmonary fibrosis. The untreated group members were selected from 6,843 patient records, matching baseline characteristics (list available in full publication) to the 1,255 treated patients.

Although the findings provided positive information for patients, the researchers cautioned, “these medications are not curative, meaning that fibrosis continues to progress over time, as do clinical events such as acute exacerbations.”

They also noted, “one of the more intriguing findings from this study is the decline in the benefit of therapy over time.”  They hope future research will seek to understand why this occurs, and find ways to extend the benefits of the therapy.

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Dr. Limper is the Robert D. and Patricia E. Kern Associate Dean of Practice Transformation and Walter and Leonore Annenberg Professor of Pulmonary Medicine at Mayo Clinic in Rochester, Minnesota. He is also a professor of Biochemistry and Molecular Biology and Medicine at the Mayo Clinic College of Medicine and Science.

He directs the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, which manages the relationship with OptumLabs for Mayo Clinic.

Fri, Sep 13 6:00am · REAL WORLD EVIDENCE in health care improvement

In late 2012 Optum and Mayo Clinic came together to form OptumLabs, an open, collaborative research and innovation center, dedicated to improving patient care and patient value through data-driven health care research, leading-edge data science and strong partner collaboration. 

Since that time, approximately 150 collaborative projects have led to peer-reviewed publication, a critical step towards evidence-based practice improvements. Most of these leverage the real world data available in the OptumLabs Data Warehouse.

Recently OptumLabs Chief Scientific Officer William Crown, Ph.D., connected with research collaborator David Kent, M.D., director of the Predictive Analytics and Comparative Effectiveness (PACE) Center at Tufts Medical Center and the Clinical and Translational Science Graduate Program at Tufts University, to share perspectives on the use of real world evidence based on their extensive experience working with data from both clinical trials and real-world data from the OptumLabs Data Warehouse.

Among others, they highlighted two Mayo-led studies in their discussion, a clinical trial examining the comparative effectiveness of cardiac ablation or medication to treat atrial fibrillation. (Read related news release.) The other was an observational study, using the OptumLabs Data Warehouse, and conducted in parallel to the clinical trial. (Read related news release.)

You can read their whole discussion in the OptumLabs spotlight, as they explore:

  • The Real World Evidence landscape
  • Benefits of Real World Evidence
  • Real World Evidence and clinical trials
  • Data quality and opportunities
  • What lies ahead for use of Real World Evidence?

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Thu, Sep 12 6:00am · Behind the scenes--Mayo Clinic Research

Everything health care has to offer for patients is the result of research and education related to that research. At Mayo Clinic, research drives everything we do, resulting in evidence-based treatments and continuous improvements in the way patients, caregivers and others experience health care.

At Mayo Clinic we share information about our programs and projects through many means, including the website http://www.mayo.edu.

This site provides the opportunity to get behind the scenes with our researchers and learn about new findings and ongoing exploration. Below are brief summaries of what you will find on the pages of our newest research programs, as well as a few areas with substantially updated content to share.


Skeletal muscle is a hub for metabolic health, physical function and quality of life. In the Muscle Physiology and Metabolism Lab, Ian Lanza, Ph.D., and his team focus on understanding how skeletal muscle can be leveraged as a therapeutic target to lessen the burden of such chronic diseases as Type 2 diabetes, cancer cachexia and sarcopenia of aging.

Skeletal muscle is critical to health and quality of life. Beyond allowing us to navigate our environment and live independently, muscle is important to metabolic health through influence on glucose homeostasis, redox balance and whole-body energy metabolism.

A major goal of the research in Dr. Lanza’s lab is to gain new insights into the molecular events that either promote or interfere with adaptive responses to exercise. An area of particular interest is the impact of such lifestyle interventions as exercise and nutrition on skeletal muscle function, energy metabolism and adaptations to exercise.

Related lab: Skeletal Muscle Wasting and Progenitor Cell Biology, led by Jason Doles, Ph.D.


Cellular therapies taken to the next level. This is the mission of the Cancer Research and Cellular Therapies Lab, led by Januario Castro, M.D., which is working to improve existing cancer treatments, such as chimeric antigen receptor (CAR)-T cell therapy, and investigating new treatment targets, including alternative splicing mechanisms and epitope spreading.

Dr. Castro’s team studies advanced cellular therapies for cancer, with a particular emphasis on hematological malignancies. They also collaborate on research projects involving solid tumors.

Special areas of research interest include:

Related labs and programs include:


Patient-centered research is the focus of the Cardiovascular Disease and Outcomes Research Program. Led by co-directors Veronique Roger, M.D., and Suzette Bielinski, Ph.D., the program’s research agenda is to drive improvements in prevention, diagnosis and treatment of cardiovascular disease. Their multidisciplinary team investigates the individual differences in cardiovascular disease that can ultimately be used to tailor care to a patient’s specific molecular and risk profile. Their research also informs models of patient-centered care and can be used to design more-effective interventions to manage patients with cardiovascular disease.

Much of the work in the Cardiovascular Disease and Outcomes Program originates from a massive amount of patient data collected through the Heart Disease in Communities cohort. The cohort is comprised of comprehensive electronic health records indexed by the Rochester Epidemiology Project. The research team is able to analyze cohort data, developing accurate and scalable computable phenotypes (patient groupings based on observable physical, behavioral and environmental characteristics). Identifying phenotypes allows the development of more individualized interventions.


Research in the Renal Disease Laboratory focuses on understanding the development and treatment of bone disease seen in patients with kidney failure, osteoporosis and hypophosphatemia. Led by Rajiv Kumar, M.D., some of the team’s work is in examining the role of phosphate in the body, and novel phosphate-regulating hormones. Another area of investigation is the function of vitamin D in muscle, bone and the central nervous system.

Specific projects include:

  • The regulation of serum and whole body phosphate by novel phosphate-regulating hormones
  • The mechanism of action 1α,25-dihydroxyvitamin D in muscle, bone and the central nervous system
  • The regulation of vascular remodeling in arteriovenous fistulas (AVFs) that is required for hemodialysis and the treatment of vascular stenosis in AVFs with various novel chemical agents
  • The pathogenesis of urinary stone disease focusing on defects in vitamin D metabolism
  • The pathophysiology of skeletal muscle loss, cardiac abnormalities and bone loss in cancer cachexia
  • The structural biology of DNA polymerase ζ (zeta)
  • Clinical bone mineral physiology in health and disease


Addressing right and wrong is what the Biomedical Ethics Research Program at Mayo Clinic exists for. The team, led by Richard Sharp, Ph.D., assesses and addresses difficult questions about right and wrong in medicine and biomedical science.

As scientific discoveries are made and health care evolves, the values at stake in biomedical science and health care are contested and debated. The solutions to these debates are rarely straightforward, and they involve complex trade-offs for scientists, clinicians and health care organizations.

Members of the Biomedical Ethics Research Program conduct rigorous research, teach and engage in policy discussions about ethical questions. Their work helps ensure that biomedical science and health care are conducted with human decency and fairness.


Hemodialysis — filtering the blood of a person whose kidneys don’t work correctly — requires a permanent point of entry into the body’s vascular (blood vessel) system. This access allows blood to be pumped through an artificial kidney machine, cleaned, and returned to the body. In the Vascular and Interventional Radiology Translational Research Laboratory, the team led by Sanjay Misra, M.D., is working on ways to improve the function and longevity of these access points.

There are two types of permanent vascular access used in hemodialysis — arteriovenous fistulae and arteriovenous grafts. In the Vascular and Interventional Radiology Translational Research Laboratory, Dr. Misra’s team is trying to identify the cause for graft failure, as well as potential interventions. They also are developing new ways to improve patency (how well it stays clear and open) of the hemodialysis vascular access.

The team has clinical trials ongoing in support of this research.


Elbow and Shoulder Laboratory team members study the development and refinement of techniques to repair and reconstruct injured elbows and shoulders. Led by Shawn O’Driscoll, M.D., Ph.D., projects in the Elbow and Shoulder Lab include studying the biomechanics of prosthetic radial head (top of radius bone, just below elbow) replacement and the development of a coronoid (projecting part of the ulna bone) fracture classification system to help determine the best course of action to treat posteromedial rotatory instability (a common type of elbow instability).

Research advances that translate into new and better treatment options would improve outcomes for patients with elbow and shoulder injuries and decrease long-term health care costs.


Unmet needs in health care drive research at Mayo Clinic. One major need in modern medicine is preventing the neurodegeneration that is responsible for the development of Alzheimer’s disease, dementia, cognitive impairment and related cognitive disorders. Led by Zvonimir Katusic, M.D., Ph.D., the research team in the Vascular Biology Laboratory hopes to help meet that need.

Dr. Katusic and his team focus their research efforts on the blood vessels of the brain, and their role in the pathogenesis of neurodegeneration (how and why the brain loses neurons, resulting in breakdown of neurological function).

Specifically they are looking for keys to cognitive disorders by studying endothelial dysfunction, microglia and the role of proteins in the protection of vascular function. They hope to expand treatment and prevention options in Alzheimer’s disease and dementia.

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