Immunization Strategies to Span the Spectrum of Immunocompromised Adults
The Advisory Committee on Immunization Practices to the US Centers for Disease Control and Prevention provides annual recommendations for routine adult immunizations. Many recommendations consider patient factors such as age, medical conditions, and medications that increase an individual ’s risk for infection with a vaccine-preventable disease. These factors, particularly those that lead to immunocompromise, may also alter the risk-benefit ratio for live vaccines, and/or lead to decreased vaccine immunogenicity and effectiveness. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - February 14, 2020 Category: Internal Medicine Authors: Jennifer A. Whitaker Tags: Thematic review on vaccines Source Type: research

Principles of Vaccine Licensure, Approval, and Recommendations for Use
The licensure and recommendation processes for vaccines are complex. In the United States, vaccines are licensed for the civilian and military populations on the basis of review of Biologics License Applications submitted to the Food and Drug Administration (FDA) by vaccine manufacturers. For FDA-licensed vaccines, the product label includes indications, contraindications, and precautions for each vaccine. Package inserts do not include recommendations for vaccine use from the Advisory Committee on Immunization Practices (ACIP). (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - February 13, 2020 Category: Internal Medicine Authors: Larry K. Pickering, H. Cody Meissner, Walter A. Orenstein, Amanda C. Cohn Tags: Thematic review on vaccines Source Type: research

A Practical Approach for the Management of the Mixed Opioid Agonist-Antagonist Buprenorphine During Acute Pain and Surgery
The use of buprenorphine, a mixed opioid agonist-antagonist, for the management of chronic pain and/or opioid use disorder is increasing. As such, medical providers will more frequently encounter patients on this therapy. In this paper, we synthesize existing knowledge (derived through keyword searches using MEDLINE databases) in a novel conceptual framework for patients on buprenorphine presenting with acute pain or for those requiring surgical or invasive procedures. This framework is based on three unique domains: the patient, the features of the acute pain insult, and the environment. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - February 12, 2020 Category: Internal Medicine Authors: Nafisseh S. Warner, Matthew A. Warner, Julie L. Cunningham, Halena M. Gazelka, W. Michael Hooten, Bhanuprakash Kolla, David O. Warner Tags: Review Source Type: research

Sex Differences in Systemic Lupus Erythematosus
Systemic lupus erythematosus (SLE) is a chronic, multiorgan, systemic autoimmune disease that is more common in women than men and is typically diagnosed during reproductive age, necessitating sex-specific considerations in care. In women there is no substantive evidence to suggest that SLE reduces fertility, but subfertility may occur as a result of active disease, immunosuppressive drugs, and age-related declines in fertility related to delays in childbearing. Although pregnancy outcomes have improved, SLE still poses risks in  pregnancy that contribute to poorer maternal and fetal outcomes. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - February 1, 2020 Category: Internal Medicine Authors: Julie S. Nusbaum, Ibraheem Mirza, Justine Shum, Robert W. Freilich, Rebecca E. Cohen, Michael H. Pillinger, Peter M. Izmirly, Jill P. Buyon Tags: Thematic review series on women's health Source Type: research

Postsurgical Neuropathy: A Descriptive Review
Postsurgical neuropathies represent an infrequent but potentially devastating complication of surgery that may result in significant morbidity with medicolegal implications. Elucidation of this phenomenon has evolved over the past few decades, with emerging evidence for not only iatrogenic factors contributing to this process but also inflammatory causes. This distinction can be important; for instance, cases in which inflammatory etiologies are suspected may benefit from further investigations including nerve biopsy and may benefit from treatment in the form of immunotherapy. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - February 1, 2020 Category: Internal Medicine Authors: Ruple S. Laughlin, Rebecca L. Johnson, Christopher M. Burkle, Nathan P. Staff Tags: Review Source Type: research

Maintenance of Certification and the Platinum Rule
Maintenance of Certification (MOC) programs administered by American Board of Medical Specialties (ABMS) member boards are facing an existential crisis. A series of lawsuits have been filed against various member boards challenging the validity of MOC programs. Granted, these lawsuits appear to be coordinated by a relatively small group of anti-MOC activists, and although none of the plaintiffs have yet to prevail, the lawsuits have underscored the inescapable fact that MOC programs generally are disliked by the very group they were designed to benefit, the diplomates. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - February 1, 2020 Category: Internal Medicine Authors: Richard G. Ellenbogen, E. Sander Connolly, Fredric B. Meyer Tags: Perspective and controversy Source Type: research

43-Year-Old Man With Polyuria and Bone Pain
A 43-year-old man presented to the clinic with a 2-week history of polydipsia, polyuria, nocturia, and fatigue. He reported consuming 19 L of water per day and complained of nausea and severe dryness of the mouth if he did not drink every 2 hours. He was in his usual state of health until the onset of his symptoms. He reported no fevers, productive cough, vomiting, or diarrhea. The patient was a nonsmoker and occasionally drank alcohol. His medical history included major depression, hypertriglyceridemia, and hypertension. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - February 1, 2020 Category: Internal Medicine Authors: Gordon J. Ruan, Gaurav Goyal, Ronald S. Go Tags: Residents ’ clinic Source Type: research

26-Year-Old Woman With Shortness of Breath and Chest Pain
A 26-year-old woman presented to the emergency department with shortness of breath and chest pain worsened with inspiration. She had delivered a newborn by cesarean section 3 days before presentation, and symptoms began early in the postpartum period. Other medical history was notable only for nicotine dependence, and the patient was taking no prescribed medications aside from a prenatal multivitamin. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - February 1, 2020 Category: Internal Medicine Authors: Nicholas R. Oblizajek, Nandan S. Anavekar Tags: Residents ’ clinic Source Type: research

Association Between Income Disparities and Risk of Chronic Kidney Disease
To examine the association between income level and incident chronic kidney disease (CKD) in adults with normal baseline kidney function. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - February 1, 2020 Category: Internal Medicine Authors: Tae Ik Chang, Hyunsun Lim, Cheol Ho Park, Connie M. Rhee, Kamyar Kalantar-Zadeh, Ea Wha Kang, Shin-Wook Kang, Seung Hyeok Han Tags: Original article Source Type: research

Pseudoaneurysm of the Superficial Temporal Artery After Blunt Trauma
A woman in her mid-80s presented to the emergency department because of progressive increase in volume of a subcutaneous frontal hematoma (Figure  1). This hematoma had initially appeared 6 weeks earlier, following a fall resulting in direct facial trauma. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - February 1, 2020 Category: Internal Medicine Authors: Antoine Balligand, Nicolas Mulquin Tags: Medical image Source Type: research

Reexamining the Ethics of Human Germline Editing in the Wake of Scandal
In November 2018, the announcement that genetically edited human embryos had been used for reproductive purposes caused international uproar; many observers argued that editing the human germline was unethical, particularly given the early stage of the science and the absence of appropriate oversight. We provide an overview of the implications of these events, focusing on the relevant ethical considerations for physicians addressing patient questions and concerns. The editing of the human germline for reproductive purposes should be understood against an historic backdrop of clinical research in assisted reproduction, as w...
Source: Mayo Clinic Proceedings - February 1, 2020 Category: Internal Medicine Authors: Karen M. Meagher, Megan A. Allyse, Zubin Master, Richard R. Sharp Tags: Special article Source Type: research

Globus Pallidus Externus Deep Brain Stimulation Treats Insomnia in a Patient With Parkinson Disease
Sleep disorders are the second most common complaint in patients with Parkinson disease (PD), affecting up to 78.3% of patients and having severe impact on quality of life. Many patients fail hypnotic therapy or cognitive behavioral therapy for insomnia. In addition, many pharmacological treatments carry added risks in patients with PD (eg, increased risk of falls). The majority of existing studies exploring sleep outcomes in patients undergoing deep brain stimulation (DBS) for Parkinson disease in neuronal regions targeted for improvement of motor symptoms (eg, globus pallidus internus [GPi] and subthalamic nucleus [STN])...
Source: Mayo Clinic Proceedings - February 1, 2020 Category: Internal Medicine Authors: Pablo R. Castillo, Erik H. Middlebrooks, Sanjeet S. Grewal, Lela Okromelidze, James F. Meschia, Alfredo Quinones-Hinojosa, Ryan J. Uitti, Robert E. Wharen Tags: Letter to the editor Source Type: research

Juvenile Hyaline Fibromatosis
A 27-year-old African American man presented to an orthopedic surgeon with a painful mass on his left fourth toe, which impaired ambulation and the wearing of closed footwear. His medical history was notable for juvenile hyaline fibromatosis diagnosed at age 4 years and for multiple prior operations to remove symptomatic masses on his face and extremities. Physical examination revealed multiple masses of varying size on his face and all extremities (Figure A), with a large mass on the distal aspect of the fourth toe on the right foot that had eroded into the distal phalanx and another painful mass on his medial hallux (Fig...
Source: Mayo Clinic Proceedings - February 1, 2020 Category: Internal Medicine Authors: Andrew L. Folpe, Michael Schoen, Steve Kang Tags: Medical image Source Type: research

In Reply, IgA Vasculitis (Henoch-Sch önlein Purpura) in Argentina
As noted by Brom et  al,1 limited observational studies investigating IgA vasculitis have been reported from Latin America,2-4 and these cohorts have thus far focused only on pediatric populations. These aforementioned studies present data similar to that reported by Brom et al, as well as our group, demonstrating a less severe renal outcome among pediatric cases of IgA vasculitis. Although the comparative data between the pediatric and adult groups in the report by Brom et al needs to be considered in the context of the small size of the adult population presented (n=11), these findings remain con...
Source: Mayo Clinic Proceedings - February 1, 2020 Category: Internal Medicine Authors: Matthew Koster, Michel Villatoro-Villar Tags: Letter to the editor Source Type: research

IgA Vasculitis (Henoch-Sch önlein Purpura) in Argentina
As Villatoro-Villar et  al.1 mentioned in their article, IgA vasculitis is a usually mild disease in children, whereas it shows an aggressive course in adults, especially regarding renal prognosis.1 Nevertheless, studies from India2 and Israel3 did not find any difference regarding renal outcomes or long-term prognoses a nd hypothesized that ethnic and geographic differences could affect the phenotype of the disease. Moreover, several genetic polymorphisms are now known to be associated with the severity of IgA vasculitis. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - February 1, 2020 Category: Internal Medicine Authors: Mart ín Brom, Ignacio J. Gandino, Marina Scolnik Tags: Letter to the editor Source Type: research

Evaluation and Treatment of Overactive Bladder in Women
Overactive bladder (OAB) is a symptom complex that includes urinary urgency, frequency, urgency incontinence, and nocturia. It is highly prevalent, affecting up to 12% of the adult population, and can significantly impact quality of life. The diagnosis of OAB is made by history, physical examination, and a urinalysis to rule out underlying infection or other concerning potential etiologies. The need for additional testing is based on the initial evaluation findings, and is recommended in cases of underlying urinary tract infection, microscopic hematuria, obstructive voiding symptoms, and symptoms refractory to previous tre...
Source: Mayo Clinic Proceedings - February 1, 2020 Category: Internal Medicine Authors: Rubin Raju, Brian J. Linder Tags: Concise review Source Type: research

Oncology Drug Advisory Committee Recommendations and the US Food and Drug Administration ’s Actions
Recently, the US Food and Drug Administration (FDA) approved selinexor for patients with multiple myeloma, overruling the final vote of the Oncology Drug Advisory Committee (ODAC). Several oncologists voiced criticism of this approval, citing marginal objective response rate, largely partial response, and considerable toxicity.1,2 (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - February 1, 2020 Category: Internal Medicine Authors: Alyson Haslam, Jennifer Gill, Vinay Prasad Tags: Letter to the editor Source Type: research

Intestinal Spirochetosis
An adult male presented with mild abdominal pain and watery diarrhea and underwent a colonoscopy. The colon was grossly normal, so biopsies were taken to rule out lymphocytic or collagenous colitis. The colon biopsy showed a thick fuzzy layer (arrows) on the surface of the epithelium. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - February 1, 2020 Category: Internal Medicine Authors: Lori A. Erickson, Michael S. Torbenson Tags: Path to patient image quiz Source Type: research

Comparative Effectiveness of Sodium-Glucose Cotransporter-2 Inhibitors Versus Other Classes of Glucose-Lowering Medications on Renal Outcome in Type 2 Diabetes
To assess whether sodium-glucose cotransporter-2 inhibitor (SGLT2i) therapy is associated with a favorable renal prognosis for patients with type 2 diabetes melllitus (T2DM) outside the clinical trials setting. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - February 1, 2020 Category: Internal Medicine Authors: Masato Takeuchi, Masahito Ogura, Takaaki Minoura, Nobuya Inagaki, Koji Kawakami Tags: Original article Source Type: research

Patent Foramen Ovale “High-Risk” Anatomy
A 67-year-old man was admitted to the emergency department with a 2-day history of headache, nausea, and left-hand weakness. On physical examination, his blood pressure was 145/70 mm Hg, heart rate 80 beats per minute, respiratory rate 20 breaths per minute, oxygen saturation 92%, and the grip strength on his left hand was grade 3. His medical history included migraines and hypertension. Magnetic resonance imaging showed right parietal infarct on diffusion-weighted imaging. Laboratory test results revealed that complete blood count, partial thromboplastin time, and prothrombin time were normal. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - February 1, 2020 Category: Internal Medicine Authors: Julio C. Sauza-Sosa, Oscar Millan-Iturbe Tags: Medical image Source Type: research

Are International Standards for Exercise Capacity Ready for Prime Time?
There is a long history of investigation into clinical exercise testing. As described by Ellestad,1 some of the first published descriptions were from Feil and Siegal (published in 1928), who had subjects with known angina perform sit-ups to elicit ischemia. Master and Oppenheimer (published in 1929) developed the first standardized exercise test (Master ’s Two-Step) to estimate “cardiac capacity,” based on an individual’s heart rate and blood pressure responses. Missal (published in 1938) may have been the first to report on maximal exercise testing in subjects who ran up 3 to 6 flights of stairs. ...
Source: Mayo Clinic Proceedings - February 1, 2020 Category: Internal Medicine Authors: Clinton A. Brawner, Jonathan K. Ehrman, Steven J. Keteyian Tags: Editorial Source Type: research

The River by Pat and Gage Kruse
Recognizing the contribution art has had in the Mayo Clinic environment since the original Mayo Clinic Building was finished in 1914, Mayo Clinic Proceedings features some of the numerous works of art displayed throughout the buildings and grounds on Mayo Clinic campuses as interpreted by the author. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - February 1, 2020 Category: Internal Medicine Authors: Margaret R. Wentz Tags: Art at mayo clinic Source Type: research

Erasing Paralysis
Stem cell therapies have been an active focus of research for several decades, with nearly 1200 clinical trials completed to date in the United States alone and many more across the globe. However, this monumental clinical effort has yielded only a limited number of therapeutic solutions approved for use, underscoring the nascent nature of the regenerative medicine space. What has been established is an increased understanding of what stem cell therapy can deliver to the recipient tissue to foster healing. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - February 1, 2020 Category: Internal Medicine Authors: Michael Sabbah, Atta Behfar Tags: Editorial Source Type: research

A Vision of the Platinum Rule
Over the past 50 years, specialty board certification has evolved from a lifetime credential bestowed upon diplomates after successfully completing a postgraduate medical training program and passing a secure examination to a time-limited certificate, requiring diplomates to engage in continuous certification programs, referred to as Maintenance of Certification (MOC) by the American Board of Medical Specialties (ABMS). As the practice of medicine advanced, the MOC process was developed so that diplomates could report that their knowledge and skills remained up to date by passing a periodic secure pass-fail examination. (S...
Source: Mayo Clinic Proceedings - February 1, 2020 Category: Internal Medicine Authors: Suzanne M. Norby Tags: Editorial Source Type: research

In the Limelight: February 2020
This monthly feature highlights three articles in the current print and online issue of Mayo Clinic Proceedings. These articles are also featured on the Mayo Clinic Proceedings ’ YouTube Channel (https://youtu.be/vHUmlFhFfeE). (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - February 1, 2020 Category: Internal Medicine Authors: Karl A. Nath Tags: In the limelight Source Type: research

Injection Safety in the United States: Miles to Go?
Injections are an essential component of modern medicine. Pascal is credited with inventing the first modern syringe in 1650, although Roman and Greek literature alludes to syringe-like devices used both for medical procedures and for nonmedical purposes such as changing the pitch of musical instruments.1 Francis Rynd, an Irish physician, invented the hollow metal needle and used it to administer the first recorded subcutaneous injections in 1844. Today, needles and syringes are used for prevention (vaccines), diagnosis (contrast material, radioactive isotopes, and blood tests), and treatment (antibiotics, chemotherapy, in...
Source: Mayo Clinic Proceedings - February 1, 2020 Category: Internal Medicine Authors: Priya Sampathkumar Tags: Editorial Source Type: research

Money Matters: Income and Risk of Chronic Kidney Disease in South Korea
There is little debate that socioeconomic factors such as income, education, and employment play fundamental roles in determining health outcomes, and their inequitable distribution is a root cause of health and health care disparities. Lower income is associated with a higher risk of all-cause mortality as compared with higher income,1 and the burden of numerous health conditions has been noted in many settings to be greater in persons with low socioeconomic status (SES). (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - February 1, 2020 Category: Internal Medicine Authors: Kaushik Parvathaneni, Deidra C. Crews Tags: Editorial Source Type: research

CRISPR Transgressions, the Language of Wrongness, and the Task of Ethics
In this issue of Mayo Clinic Proceedings, Meagher at al1 provide a concise summary of the scandal that emerged in late 2018 involving the purported use of CRISPR gene editing technology in 2 human embryos subsequently implanted and delivered. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - February 1, 2020 Category: Internal Medicine Authors: Jon C. Tilburt Tags: Editorial Source Type: research

Editorial Board
(Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - February 1, 2020 Category: Internal Medicine Source Type: research

Table of Contents
(Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - February 1, 2020 Category: Internal Medicine Source Type: research

General Information
(Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - February 1, 2020 Category: Internal Medicine Source Type: research

Highlights from the Current Issue – Audiovisual Summary
Karl A. Nath, MBChB, Editor-in-Chief of Mayo Clinic Proceedings, discusses the Editor ’s Choice and Highlights articles appearing in the February 2020 issue. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - February 1, 2020 Category: Internal Medicine Authors: Karl A. Nath Tags: Issue summary Source Type: research

Risk Factors for Acute Kidney Injury in Hospitalized Non –Critically Ill Patients: A Population-Based Study
To develop and validate an acute kidney injury (AKI) risk prediction model for hospitalized non –critically ill patients. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - January 30, 2020 Category: Internal Medicine Authors: Sami Safadi, Musab S. Hommos, Felicity T. Enders, John C. Lieske, Kianoush B. Kashani Tags: Original article Source Type: research

Dose-Response Effects of Exercise on Glucose-Lowering Medications for Type 2 Diabetes: A Secondary Analysis of a Randomized Clinical Trial
To investigate whether a dose-response relationship exists between volume of exercise and discontinuation of glucose-lowering medication treatment in patients with type 2 diabetes. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - January 30, 2020 Category: Internal Medicine Authors: Christopher S. MacDonald, Mette Y. Johansen, Sabrina M. Nielsen, Robin Christensen, Katrine B. Hansen, Henning Langberg, Allan A. Vaag, Kristian Karstoft, Daniel E. Lieberman, Bente K. Pedersen, Mathias Ried-Larsen Tags: Original article Source Type: research

Endothelial Vascular Function as a Surrogate of Vascular Risk and Aging in Women
Cardiovascular disease is the leading cause of morbidity and mortality in women. We suggest the need to develop a paradigm that connects sex- and age-specific nontraditional risk factors that serve as a common mechanism ultimately leading to an increased risk of cardiovascular events. Vascular injury with abnormal repair leading to functional, rather than structural, abnormalities can be regarded as accelerated vascular aging. It emerges as a common feature that can trigger the early diagnosis and risk stratification for cardiovascular disease in women. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - January 22, 2020 Category: Internal Medicine Authors: Peter Collins, Angela Maas, Megha Prasad, Louise Schierbeck, Amir Lerman Tags: Review Source Type: research

Sex-Specific Human Cardiomyocyte Gene Regulation in Left Ventricular Pressure Overload
To assess gene expression in cardiomyocytes isolated from patients with aortic stenosis, hypothesizing that maladaptive remodeling and inflammation-related genes are higher in male vs female patients. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - January 14, 2020 Category: Internal Medicine Authors: Lea Gaignebet, Maciej M. Ka ńduła, Daniel Lehmann, Christoph Knosalla, David P. Kreil, Georgios Kararigas Tags: Original article Source Type: research

Clinical and Economic Burden of Hospitalizations for Infective Endocarditis in the United States
To assess contemporary trends in the incidence, characteristics, and outcomes of hospital admissions for infective endocarditis (IE) in the United States. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - January 5, 2020 Category: Internal Medicine Authors: Mohamad Alkhouli, Fahad Alqahtani, Muhammed Alhajji, Chalak O. Berzingi, M. Rizwan Sohail Tags: Original article Source Type: research

Screening for Colon Cancer in Older Adults: Risks, Benefits, and When to Stop
Colorectal cancer (CRC) is the fourth leading cause of cancer and second leading cause of mortality from cancer in the United States. As the population ages, decisions regarding the initiation and cessation of screening and surveillance for CRC are of increasing importance. In elderly patients, the risks of CRC and the presenting signs and symptoms are similar to those in younger patients. Screening and ongoing surveillance should be considered in patients who have a life expectancy of 10 years or more. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - January 1, 2020 Category: Internal Medicine Authors: Judy Nee, Ryan Z. Chippendale, Joseph D. Feuerstein Tags: Thematic review on gastroenterological diseases Source Type: research

Vaccination of Adults in General Medical Practice
In vaccinating adults, clinicians face 2 types of challenges: (1) staying current on recommendations for influenza, pneumococcal, hepatitis A and B, zoster, and other vaccines and (2) addressing systemic barriers to implementing practices that increase vaccination rates. Although adult immunization rates remain suboptimal, there has been much good news in adult vaccination recently. New high-dose and adjuvanted influenza vaccines help improve immune response and may reduce influenza complications in older adults. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - January 1, 2020 Category: Internal Medicine Authors: Paul Hunter, Sandra Adamson Fryhofer, Peter G. Szilagyi Tags: Thematic review on vaccines Source Type: research

Acute Myocardial Infarction in Young Individuals
Globally, cardiovascular disease remains a major cause of adverse outcomes in young individuals, unlike its decline in other age groups. This group is not well studied and has a unique risk profile with less traditional cardiovascular risk factors compared with older populations. Plaque rupture still remains the most common etiology of myocardial infarction, but unique syndromes such as plaque erosion, coronary microvascular dysfunction, spontaneous coronary artery dissection, and coronary spasm related to drug use are more prevalent in this age group. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - January 1, 2020 Category: Internal Medicine Authors: Rajiv Gulati, Atta Behfar, Jagat Narula, Ardaas Kanwar, Amir Lerman, Leslie Cooper, Mandeep Singh Tags: Review Source Type: research

Surveillance in Patients With Diffuse Large B Cell Lymphoma
With improvement in the cure rates for diffuse large B cell lymphoma, the question of surveillance imaging in patients who achieve complete remission after the initial therapy has become relevant. Some of the clinical practice guidelines recommend surveillance scanning. However, several studies have reported no benefit in overall survival with scans. Moreover, studies have highlighted an increased risk for developing secondary malignancies because of exposure to ionizing radiation from the scans. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - January 1, 2020 Category: Internal Medicine Authors: Avyakta Kallam, Jayanth Adusumalli, James O. Armitage Tags: Review Source Type: research

Cardiorespiratory Fitness and Gray Matter Volume in the Temporal, Frontal, and Cerebellar Regions in the General Population
To analyze the association between cardiorespiratory fitness (CRF) and global and local brain volumes. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - January 1, 2020 Category: Internal Medicine Authors: Katharina Wittfeld, Carmen Jochem, Marcus D örr, Ulf Schminke, Sven Gläser, Martin Bahls, Marcello R.P. Markus, Stephan B. Felix, Michael F. Leitzmann, Ralf Ewert, Robin Bülow, Henry Völzke, Deborah Janowitz, Sebastian E. Baumeister, Hans Jörgen Grab Tags: Original article Source Type: research

Diabetes Mellitus Is an Independent Predictor for the Development of Heart Failure
To delineate the impact of diabetes mellitus (DM) on the development of cardiovascular diseases in a community population. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - January 1, 2020 Category: Internal Medicine Authors: Michael D. Klajda, Christopher G. Scott, Richard J. Rodeheffer, Horng H. Chen Tags: Original article Source Type: research

A Safety Comparison of Metformin vs Sulfonylurea Initiation in Patients With Type 2 Diabetes and Chronic Kidney Disease: A Retrospective Cohort Study
To compare the safety of metformin vs sulfonylureas in patients with type 2 diabetes by chronic kidney disease (CKD) stage. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - January 1, 2020 Category: Internal Medicine Authors: Reid H. Whitlock, Ingrid Hougen, Paul Komenda, Claudio Rigatto, Kristin K. Clemens, Navdeep Tangri Tags: Original article Source Type: research

A Structured Compensation Plan Results in Equitable Physician Compensation
To assess adherence to and individual or systematic deviations from predicted physician compensation by gender or race/ethnicity at a large academic medical center that uses a salary-only structured compensation model incorporating national benchmarks and clear standardized pay steps and increments. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - January 1, 2020 Category: Internal Medicine Authors: Sharonne N. Hayes, John H. Noseworthy, Gianrico Farrugia Tags: Original article Source Type: research

Pulseless Paradoxus: A Unique Sign of Cardiac Tamponade in the Era of Continuous Flow Left Ventricular Assist Devices
The change from pulsatile to nonpulsatile blood flow in patients supported with a continuous flow left ventricular assist device (cLVAD) alters the bedside cardiovascular physical exam. Diagnosing cardiac tamponade in patients supported with a cLVAD can be challenging for 2 reasons: First, classic findings such as Beck ’s triad and pulsus paradoxus are of limited diagnostic value. Second, isolated left heart tamponade is possible because of continuous unloading of the left ventricle, thereby reducing its pressure to below pericardial pressure. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - January 1, 2020 Category: Internal Medicine Authors: Faris G. Araj, Jun D. Sasaki Tags: Letter to the editor Source Type: research

85-Year-Old Man With Chest Pain
An 85-year-old man presented to the emergency department with 3 hours of left-sided chest pain. He described the pain as an abrupt onset, intense, sharp, and pleuritic discomfort radiating to the left trapezius ridge. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - January 1, 2020 Category: Internal Medicine Authors: Anthony H. Kashou, Adam M. May, Peter A. Noseworthy Tags: Residents ’ clinic Source Type: research

82-Year-Old Woman With Acute-Onset Left-Sided Weakness
An 82-year-old woman with a history of type 2 diabetes mellitus, hyperlipidemia, and hypertension presented to the emergency department with sudden onset of left arm and leg weakness. She was sitting in church when she developed left-sided posterior neck and shoulder pain, followed 1 hour later by sudden-onset dense left-sided weakness. Emergency medical services were called, and they activated the prehospital stroke-notification protocol. The patient arrived at the emergency department approximately 30 minutes after the onset of the weakness. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - January 1, 2020 Category: Internal Medicine Authors: Ronstan Lobo, Adam P. Sawatsky Tags: Residents ’ clinic Source Type: research

In reply —Amikacin Liposome Inhalation Suspension as a Treatment Option for Refractory Nontuberculous Mycobacterial Lung Disease Caused by Mycobacterium avium Complex
We thank Swenson and Del Parigi1 for their comments on our article.2 The article originally submitted on September 6, 2018. This formulation of amikacin inhalation (Arikayce) received Food and Drug Administration approval on September 28, 2018. Although we agreed that liposomal amikacin is an important therapeutic option for refractory mycobacterium avium complex pulmonary disease, at the time of our original submission we had included timely information on pages 1574 to 1575. Unfortunately, we did not have the Food and Drug Administration –approved dosage of Arikayce at the time of submission nor did the reviewers r...
Source: Mayo Clinic Proceedings - January 1, 2020 Category: Internal Medicine Authors: Jennifer Shulha Tags: Letter to the editor Source Type: research

Amikacin Liposome Inhalation Suspension as  a Treatment Option for Refractory Nontuberculous Mycobacterial Lung Disease Caused by Mycobacterium avium Complex
We read with much interest the review by Shulha et  al.1 The article is a comprehensive and well-written overview of pharmacological treatment approaches of nontuberculous mycobacterial (NTM) diseases. Table 2 (titled “NTM Medication Dosing, Adverse Effects, and Recommended Monitoring”), however, did not include an approved treatment option fo r NTM lung disease caused by Mycobacterium avium complex (MAC), namely, amikacin liposome inhalation suspension (ALIS; Arikayce). Amikacin liposome inhalation suspension is the first Food and Drug Administration (FDA)–approved medication with a specific in...
Source: Mayo Clinic Proceedings - January 1, 2020 Category: Internal Medicine Authors: Colin Swenson, Angelo Del Parigi Tags: Letter to the editor Source Type: research