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Sommaires des Revues - Mayo Clinic Proceedings

Mayo Clinic Proceedings

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Clinical Manifestations and Outcomes of Fluoroquinolone-Related Acute Interstitial Nephritis  Voir?

To describe the clinical presentation, diagnosis, and outcomes of patients with biopsy-proven acute interstitial nephritis (AIN) related to fluoroquinolone (FQ) therapy.
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Survival of the Fittest—Promoting Fitness Throughout the Life Span  Voir?

Considerable evidence during the past 3 decades has identified levels of cardiorespiratory fitness (CRF), generally determined by exercise treadmill or exercise bicycle testing, as a powerful risk factor for cardiovascular disease (CVD), as well as CVD and all-cause mortality.1 In fact, in many studies, CRF is the most powerful risk factor, even more so than standard risk factors such as dyslipidemia, hypertension, glucose abnormalities including metabolic syndrome (MetSyn) and diabetes mellitus (DM), and smoking.

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Cardiorespiratory Fitness Cutoff Points for Early Detection of Present and Future Cardiovascular Risk in Children  Voir?

To examine the association between cardiorespiratory fitness (CRF) at baseline and cardiovascular disease (CVD) risk in 6- to 10-year-olds (cross-sectional) and 2 years later (8- to 12-year-olds [longitudinal]) and whether changes with age in CRF are associated with CVD risk in children aged 8 to 12 years.

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Moderate to High Levels of Cardiorespiratory Fitness Attenuate the Effects of Triglyceride to High-Density Lipoprotein Cholesterol Ratio on Coronary Heart Disease Mortality in Men  Voir?

To examine the prospective relationships among cardiorespiratory fitness (CRF), fasting blood triglyceride to high density lipoprotein cholesterol ratio (TG:HDL-C), and coronary heart disease (CHD) mortality in men.
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Challenges Facing the Aging Surgeon  Voir?

The phenomenon of professional burnout among physicians is the focus of considerable and merited attention.1,2 Such burnout, arising from a variety of stressors, has diminished professional satisfaction, and, indeed, it is predicted that substantial numbers of physicians will reduce their work hours in medical practice, entirely relinquish the practice of medicine, or switch careers, including to ones outside of medical practice (personal communication and cited with permission).3 These changes in medical careers, were they to occur, may exacerbate the anticipated shortfall in the physician workforce in the United States.

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The Aging Neurosurgeon: When Is Enough, Enough? Attitudes Toward Ceasing Practice and Testing in Late Career  Voir?

To present the first wide-scale survey to assess perceptions of testing the aging neurosurgeon.
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47-Year-Old Woman With Anemia and Thrombocytopenia  Voir?

A 47-year old Middle Eastern woman presented to the emergency department with a 1-day history of dizziness and feeling generally unwell and rectal bleeding of several weeks' duration. Her history was notable for rectal adenocarcinoma treated with neoadjuvant chemoradiotherapy, followed by low anterior resection with ileostomy and adjuvant chemotherapy, which was completed 5 months before presentation. One month before presentation, she experienced rectal bleeding, and recurrent adenocarcinoma was diagnosed.

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47-Year-Old Man With Abdominal Pain and Diarrhea  Voir?

A 47-year-old man presented with diffuse abdominal pain and multiple watery, nonbloody, nonmelenic bowel movements of 2 days' duration. The patient stated that he had roughly 10 bowel movements daily but reported no fevers or chills.
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A Conceptual Framework for Understanding Unintended Prolonged Opioid Use  Voir?

An urgent need exists to better understand the transition from short-term opioid use to unintended prolonged opioid use (UPOU). The purpose of this work is to propose a conceptual framework for understanding UPOU that posits the influence of 3 principal domains that include the characteristics of (1) individual patients, (2) the practice environment, and (3) opioid prescribers. Although no standardized method exists for developing a conceptual framework, the process often involves identifying corroborative evidence, leveraging expert opinion to identify factors for inclusion in the framework, and developing a graphic depiction of the relationships between the various factors and the clinical problem of interest.

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Increased Risk of Multimorbidity in Patients With Sarcoidosis: A Population-Based Cohort Study 1976 to 2013  Voir?

To evaluate the risk and pattern of multimorbidity in patients with sarcoidosis.
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Use of the Coronary Artery Calcium Score in Discussion of Initiation of Statin Therapy in Primary Prevention  Voir?

Clinical guidelines for instituting pharmacotherapy for the primary prevention of atherosclerotic cardiovascular disease (ASCVD), specifically lipid management and aspirin, have long been based on absolute risk. However, lipid management in the current era remains challenging to both patients and clinicians in the setting of somewhat discordant recommendations from various organizations. All guidelines endorse the use of statins for primary prevention for those at sufficient absolute risk, and treatment recommendations are generally “risk-based” rather than exclusively targeting specific low-density lipoprotein cholesterol levels.

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The Incidence of Primary vs Secondary Focal Segmental Glomerulosclerosis: A Clinicopathologic Study  Voir?

To describe the change in the incidence rates of primary and secondary focal segmental glomerulosclerosis (FSGS) from 1994 through 2013 in Olmsted County, Minnesota, and to identify the clinical and biopsy characteristics that distinguish primary from secondary FSGS.
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25-Year Physical Activity Trajectories and Development of Subclinical Coronary Artery Disease as Measured by Coronary Artery Calcium: The Coronary Artery Risk Development in Young Adults (CARDIA) Study  Voir?

To evaluate 25-year physical activity (PA) trajectories from young to middle age and assess associations with the prevalence of coronary artery calcification (CAC).
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20-Year-Old Woman With Postprandial Nausea, Vomiting, and Abdominal Pain  Voir?

A 20-year-old woman who had undergone a corrective spinal operation for scoliosis 6 weeks previously presented with a 3-week history of nausea, vomiting, diarrhea, diffuse abdominal pain, fatigue, and a 6.8-kg weight loss. She stated that the symptoms occurred approximately 20 minutes after eating. The patient reported no melena, hematochezia, fevers, chills, diaphoresis after eating, chest pain, palpitations, shortness of breath, heat or cold intolerance, hair loss, or focal neurologic deficits.

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58-Year-Old Woman With Diarrhea, Weakness, and Memory Loss  Voir?

A 58-year-old woman with a medical history of osteoporosis and Crohn disease presents with her husband for evaluation of chronic diarrhea. Her medications included mesalamine and alendronate, as well as an over-the-counter multivitamin. Recently, Crohn colitis had been diagnosed when colon biopsies revealed scattered colonic inflammation and ulcerations. In addition to unrelenting diarrhea during the months before her presentation, she had experienced a severe functional decline. Six months before her visit, the patient could care for herself and walk several miles at a time without trouble.

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Highlights from the Current Issue – Audiovisual Summary  Voir?

Karl A. Nath, MBChB, Editor-in-Chief of Mayo Clinic Proceedings, discusses the Editor’s Choice and Highlights articles appearing in the November 2017 issue.
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General Information  Voir?

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Table of Contents  Voir?

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Editorial Board  Voir?

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Gut Microbiota and Cancer Patients: A Broad-Ranging Relationship  Voir?

In this issue of the Proceedings, Hefazi et al1 report their experience in applying fecal microbiota transplantation (FMT) for the treatment of recurrent Clostridium difficile infection (rCDI) in cancer patients previously treated with chemotherapy. Twenty-three consecutive patients who experienced a median of 4 (range, 2-9) CDI episodes were included in the study. Twelve (52%) had severe/severe-complicated CDI at some stage and 8 (35%) patients had active cancer; 6 of the latter had received chemotherapy within 12 weeks before FMT.

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Physician Burnout—A Leading Indicator of Health System Performance?  Voir?

Like the proverbial canary in the coal mine that alerts miners to the need for course correction, physician burnout provides an early indicator of health system dysfunction in time for decision-makers to change course and avoid health system failures. In this issue of Mayo Clinic Proceedings, Sinsky et al1 report that physicians may be exiting their careers in medicine faster than they enter; their intentions to withdraw are highly correlated with burnout (odds ratio [OR] 5.8). Also in this issue, Shanafelt et al2 advocate to proactively monitor and manage professional burnout and wellbeing in individuals as a way to avert crises.

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Thalassemia and Thomas Benton Cooley  Voir?

The term ‘thalassemia’ was coined in 1932 by George Hoyt Whipple (1878-1976) of the University of Rochester in Rochester, New York. The term is derived from the Greek words “thalassa” (Θάλασσα) meaning “sea” and the suffix -aima (αίμα) or “blood,” denoting the high prevalence of this hematologic disorder in people of Greek, Italian, Cypriot, Turkish, or Sicilian ancestry—all of whom originate around the Mediterranean and Black Seas.

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REM Sleep Behavior Disorder: Diagnosis, Clinical Implications, and Future Directions  Voir?

Rapid eye movement sleep behavior disorder (RBD) is diagnosed by a clinical history of dream enactment accompanied by polysomnographic rapid eye movement sleep atonia loss (rapid eye movement sleep without atonia). Rapid eye movement sleep behavior disorder is strongly associated with neurodegenerative disease, especially synucleinopathies such as Parkinson disease, dementia with Lewy bodies, and multiple system atrophy. A history of RBD may begin several years to decades before onset of any clear daytime symptoms of motor, cognitive, or autonomic impairments, suggesting that RBD is the presenting manifestation of a neurodegenerative process.

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Wolf Hat by Preston Singletary  Voir?

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.

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Gestational Trophoblastic Disease  Voir?

A middle-aged woman presented with vaginal bleeding leading to the identification of a uterine mass and serum hCG level of more than 700,000 mIU/mL. Imaging revealed no evidence of a gestational sac or fetal pole. She underwent hysterectomy. The photograph is of a bisected uterus containing a network of vesicular villi connected by fibrous strands historically referred to as resembling a “cluster of grapes.”

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Propofol Frenzy: Clinical Spectrum in 3 Patients  Voir?

Postsedation neuroexcitation is sometimes attributed to intravenous injection of the sedative-hypnotic drug propofol. The movements associated with these events have strongly suggested convulsive activity, but they rarely have been comprehensively evaluated. We present video recordings of 3 healthy young patients who underwent elective surgery under conscious sedation and emerged from sedation with transient but repetitive violent motor activity and impaired consciousness. These manifestations required considerable mobilization of multiple health care workers to protect the patient from inflicting harm.

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The Association of Serum Free Light Chains With Mortality and Progression to End-Stage Renal Disease in Chronic Kidney Disease: Systematic Review and Individual Patient Data Meta-analysis  Voir?

To clarify the associations between polyclonal serum free light chain (sFLC) levels and adverse outcomes in patients with chronic kidney disease (CKD) by conducting a systematic review and individual patient data meta-analyses.
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An Organization Model to Assist Individual Physicians, Scientists, and Senior Health Care Administrators With Personal and Professional Needs  Voir?

Working as a physician, scientist, or senior health care administrator is a demanding career. Studies have demonstrated that burnout and other forms of distress are common among individuals in these professions, with potentially substantive personal and professional consequences. In addition to system-level interventions to promote well-being globally, health care organizations must provide robust support systems to assist individuals in distress. Here, we describe the 15-year experience of the Mayo Clinic Office of Staff Services (OSS) providing peer support to physicians, scientists, and senior administrators at one center.

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Pharmacogenomics: Precision Medicine and Drug Response  Voir?

Pharmacogenomics is the use of genomic and other “omic” information to individualize drug selection and drug use to avoid adverse drug reactions and to maximize drug efficacy. The science underlying pharmacogenomics has evolved rapidly over the 50 years since it was first suggested that genetics might influence drug response phenotypes. That process has occurred in parallel with advances in DNA sequencing and other molecular technologies, with striking increases in our understanding of the human genome.

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Effect of Cardiac Rehabilitation Dose on Mortality and Morbidity: A Systematic Review and Meta-regression Analysis  Voir?

To ascertain the effect of cardiac rehabilitation (CR) dose (ie, duration × frequency/wk; categorized as low [<12 sessions], medium [12-35 sessions], or high [≥36 sessions]) on mortality and morbidity.
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Extremely Elevated Erythrocyte Sedimentation Rates: Associations With Patients' Diagnoses, Demographic Characteristics, and Comorbidities  Voir?

To study associations between extreme erythrocyte sedimentation rate (ESR) elevations (≥100 mm/h) and diseases, age, sex, race, Charlson Comorbidity Index (CCI), and C-reactive protein (CRP) level.
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Brunner Gland Adenoma  Voir?

A 42-year-old man with a history of dyspepsia presented to the hospital with 2 weeks of epigastric pain, weakness, fatigue, dyspnea on exertion, and melenic stools. Labs were significant for a hemoglobin of 5.9 g/dL from a baseline of 14.2 g/dL (reference range, 13.5-17.5 g/dL). Esophagogastroduodenoscopy demonstrated a large pedunculated duodenal mass with surface erosions, extending from the pylorus into the third portion; on endoscopic ultrasound, the stalk appeared to originate from the submucosa and had prominent central vessels without evidence of varices.

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Professional Satisfaction and the Career Plans of US Physicians  Voir?

To evaluate the relationship between burnout, satisfaction with electronic health records and work-life integration, and the career plans of US physicians.
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Safety and Efficacy of Fecal Microbiota Transplant for Recurrent Clostridium difficile Infection in Patients With Cancer Treated With Cytotoxic Chemotherapy: A Single-Institution Retrospective Case Series  Voir?

To study the safety and efficacy of fecal microbiota transplant (FMT) for Clostridium difficile infection (CDI) in patients with cancer treated with cytotoxic chemotherapy in a single-institution retrospective case series.
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Quality of Shared Decision Making in Lung Cancer Screening: The Right Process, With the Right Partners, at the Right Time and Place  Voir?

When lung cancer screening with low-dose computed tomography (LDCT) was added as a Medicare benefit in 2015, a lung cancer screening counseling and shared decision making (SDM) visit before the initial screen was made a condition for reimbursement. It was specified that SDM should involve the use of decision aids and the discussion of benefits and harms of proceeding or not with screening (eg, false-positive findings leading to unnecessary invasive investigations, overdiagnosis, and radiation exposure).

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Practical Considerations for the Diagnosis and Management of Asthma in Older Adults  Voir?

Although often considered a disease of childhood, the prevalence of asthma in US adults aged 65 years or older is similar to that in children, with the number of older patients needing care for asthma likely to continue to increase. As with most chronic diseases, there are challenges associated with the diagnosis and management of asthma in an older population. This review discusses these challenges, suggesting practical management strategies for primary care physicians and their teams. Asthma comprises a spectrum of phenotypes, some associated with adult onset.

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Dernière mise à jour : 22/11/2017 : 17:40


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