Podcasts about mayo clinic rochester

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Play Episode Listen Later Sep 5, 2024 38:59

Hosts: Chatura Alur, M.D., M.P.H. | Meghan G. Theofiles, M.D. Guest: Julie A. Lamppa, APRN, CNM Welcome to our OB/GYN mini-series! “Help me OB/GYN! You're my only hope”. Today, we're back with Julie A. Lamppa, APRN, CNM, director of our midwifery services at Mayo Clinic Rochester and director of the Early Pregnancy Care Clinic at Mayo Clinic in Rochester. For this episode, we will be continuing our conversation about first trimester bleeding but going more towards how it relates to pregnancy loss. To learn more about this series, click here Connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Conversations in OB/GYN Edition | First Trimester Bleeding

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Play Episode Listen Later Sep 3, 2024 40:37

Hosts: Chatura Alur, M.D., M.P.H. | Meghan G. Theofiles, M.D. Guest: Julie A. Lamppa, APRN, CNM Welcome to our OB/GYN mini-series! “Help me OB/GYN! You're my only hope”. This podcast edition is specifically designed for the non-OB/GYN frontline provider. Today, we're going to be addressing first trimester bleeding and we are joined by our content expert, Julie A. Lamppa, APRN, CNM. She is the director of our midwifery services at Mayo Clinic Rochester and the director of the Early Pregnancy Care Clinic at Mayo Clinic in Rochester. To learn more about this series, click here Connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Episode 111: Transforming ME/CFS Care

Power On Your Plate

Play Episode Listen Later Jul 16, 2024 52:51

Discover the secret to removing poisons with my Detox Decoded Masterclass! https://hayliepomroy.com/detox In this episode, I'm joined by Jaime Seltzer, Director of Scientific and Medical Outreach at the MEAction Network, to discuss the challenges faced by patients with ME/CFS and Long COVID and how it can be improved. We explain how crucial patient-reported symptoms are for accurately diagnosing ME/CFS. We also talk about Jaime's organization, the MEAction Network, and its efforts to transform clinical care and education. We also tackle the complexities of post-viral conditions and the relationship between viral damage, immune responses, and genetic factors, and explore how symptoms vary in these conditions. Tune in to this week's episode of Fast Metabolism Matters: Transforming ME/CFS Care. Enjoy this episode? Subscribe to Power On Your Plate on Apple Podcasts and leave a 5-star review. https://podcasts.apple.com/us/podcast/power-on-your-plate-with-haylie-pomroy/id1548802705 Sign up for the 10-Day Cleanse Challenge here! https://hayliepomroy.com/cleanse Get a FREE hard copy of the Fast Metabolism Diet book! https://hayliepomroy.com/freebook Become a certified Fast Metabolism Health Coach NOW! https://hayliepomroy.com/fmdc Become a member, FREE for 30 days! https://hayliepomroy.com/member Jaime Seltzer is the Director of Scientific and Medical Outreach at ME Action, a nonprofit advocating for those with chronic illnesses. She bridges communication between healthcare, government, and research sectors, representing ME Action globally. Additionally, Jaime collaborates with institutions like Stanford Medicine and Mayo Clinic Rochester on post-infectious chronic diseases research. She brings personal insight to her work as someone living with ME/CFS. LinkedIn: https://www.linkedin.com/in/jaime-seltzer-b23abb14/ Twitter: https://twitter.com/exceedhergrasp1 Follow the MeAction Network. Website: https://www.meaction.net/ Instagram: https://www.instagram.com/meactnet/ YouTube: https://www.youtube.com/c/MEActionNet X: https://x.com/meactnet Facebook: https://www.facebook.com/MEActNet LinkedIn: https://www.linkedin.com/company/-meaction-the-myalgic-encephalomyelitis-action-network-/ TikTok: https://www.tiktok.com/@meactnet #MECFS #myalgicencephalomyelitis #chronicfatiguesyndrome #chronicfatigue #chronicillness #longCOVID #postCOVIDsyndrome #diagnosis #POTS #posturalorthostatictachycardiasyndrome #SARS #MERS #PEM

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Episode 111: Transforming ME/CFS Care

Fast Metabolism Matters with Haylie Pomroy

Play Episode Listen Later Jul 16, 2024 52:51

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The Lead Podcast - Episode 67

The Lead Podcast presented by Heart Rhythm Society

Play Episode Listen Later Jun 27, 2024 16:42

Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital is joined by Tina Baykaner, MD, MPH Stanford University, and Gurukripa N Kowlgi, MBBS, MSci, Mayo Clinic–Rochester to discuss; the multicenter study investigated the potential of machine learning (ML) models to improve risk stratification for implantable cardioverter-defibrillator (ICD) implantation in patients at risk of sudden cardiac death (SCD). By combining clinical variables with 12-lead electrocardiogram (ECG) time-series features, the models aimed to predict non-arrhythmic mortality within three years after device implantation. Results showed that ML models identified patients at risk with high accuracy, demonstrating robust performance in both the development and external validation cohorts. This suggests that ML-based approaches could enhance risk assessment for SCD prevention in primary prevention populations. https://www.hrsonline.org/education/TheLead https://academic.oup.com/europace/article/25/9/euad271/7274626 Host Disclosure(s): D. Varghese: Nothing to disclose Contributor Disclosure(s): G. Kowlgi: Nothing to disclose T. Baykaner: Honoraria, Speaking, and Consulting: Medtronic Inc., Pacemate, Research: NIH This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode67

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Gray Hair and Silver Linings with Geriatrician Dr. Christina Chen

Friends of Franz

Play Episode Listen Later May 17, 2024 53:33

According to the National Academies of Sciences, Engineering, and Medicine (NASEM), nearly one-fourth of older adults aged 65 and older are at increased risk for loneliness and are considered to be socially isolated, with risk factors being attributed to hearing loss, losing family or friends, role changes such as retirement, living alone, and chronic disease. Geriatric syndromes — such as polypharmacy, falls, cognitive impairment like dementia and Alzheimer's disease, malnutrition, and incontinence — are clinical conditions and multifactorial impairments that are more commonly identified in older adults. Aging is definitely the normal trajectory of human life, but how can one age in a way that is considered healthy and with an optimal quality of life? How can an older adult look forward to the remaining years of life despite chronic illness? How can we help safeguard a geriatric's mental health despite feelings of abandonment, loneliness, and fear of being a burden to their caregiver/s?We are joined today by Dr. Christina Chen, a double board-certified geriatrician and internist at Mayo Clinic. She received her BS in Biology and Psychology from Michigan State University, MD from St George's University School Of Medicine, Internal Medicine residency at the University of Illinois College of Medicine, and Geriatric Medicine fellowship at the Mayo Clinic College of Medicine. She further achieved certificates in Acupuncture for Physicians from Helms Medical Institute and Executive Women in Leadership from Cornell University. Dr. Chen currently stands as an Attending Geriatrician and Assistant Professor of Medicine at Mayo Clinic Rochester, the Host of the Aging Forward Podcast, the Course Director of the Mayo Clinic Alix School of Medicine Senior Sages Curriculum. the Editor of the Mayo Clinic on Healthy Aging book, and the Medical Advisory Board of GrandPad, a customizable platform that delivers virtual care to seniors at home while keeping seniors connected to reduce social isolation and improve the telehealth experience.Livestream Air Date: August 17, 2023Follow Ying Ying (Christina) Chen, MD: InstagramFollow Friends of Franz Podcast: Website, Instagram, FacebookFollow Christian Franz Bulacan (Host): Instagram, YouTubeThankful to the season's brand partners: Covry, House of M Beauty, Nguyen Coffee Supply, V Coterie, Skin By Anthos, Halmi, By Dr Mom, LOUPN, Baisun Candle Co., RĒJINS, Twrl Milk Tea, 1587 Sneakers

1208. MOGcast - Understanding Cortical Encephalitis

Ask the Expert

Play Episode Listen Later May 3, 2024 60:22

This “MOGcast” edition of the “Ask the Expert” podcast series is a collaborative episode titled, “MOGcast 2: Understanding Cortical Encephalitis.” Dr. Eoin Flanagan and Dr. Cristina Valencia Sanchez joined Julia Lefelar of The MOG Project and Dr. GG deFiebre of SRNA to discuss cortical encephalitis, its symptoms, and the connection to MOG antibody disease (MOGAD) [00:04:21]. Audience members asked about the distinction between ADEM and cerebral cortical encephalitis, their treatments, diagnostic methods, and long-term impacts [00:35:34]. Dr. Flanagan and Dr. Sanchez agreed that the preventive treatment approach remains similar regardless of the MOGAD phenotype [00:40:36]. The discussion touched on recent studies on the diagnostic utility of MOG antibody testing in cerebrospinal fluid, and ongoing research on treatments, including clinical trials for developing FDA-approved medications for MOGAD [00:43:05]. Dr. Flanagan and Dr. Sanchez addressed community questions on fulminant cortical involvement cases [00:50:00], the long-term effects of Rituximab treatment [00:51:23], anxiety attacks and mood swings in ADEM [00:53:34], and treatment decisions based on antibody levels [00:54:49]. Eoin Flanagan, MB, BCh is a Professor of Neurology and Consultant in the departments of Neurology and Laboratory Medicine and Pathology at the Mayo Clinic (Rochester, MN). He completed his medical school training at University College Dublin in Ireland in 2005. He did a medical residency in Ireland and then completed neurology residency, fellowships in neuroimmunology and a masters in clinical and translational science at Mayo Clinic (Rochester, MN). He works in the Autoimmune Neurology and Multiple Sclerosis Clinics and the Neuroimmunology Laboratory at the Mayo Clinic. His clinical expertise and research are focused on inflammatory myelopathies and their imaging patterns, myelin oligodendrocyte glycoprotein (MOG) antibody associated disorder, neuromyelitis optica spectrum disorders, autoimmune encephalitis, paraneoplastic neurologic disorders, and multiple sclerosis. He is principal investigator on an NIH RO1 grant studying MOG antibody associated disorder. Cristina Valencia Sanchez, MD, PhD is an Assistant Professor of Neurology and Senior Associate Consultant in the Department of Neurology at the Mayo Clinic (Phoenix, AZ). She completed her medical school training and PhD in Neuroscience at the Universidad Complutense de Madrid. She did a Neurology residency in the Hospital Universitario Clinico San Carlos and then completed Neurology residency and fellowships in ARZ Multiple Sclerosis and RST Autoimmune Neurology at the Mayo School of Graduate Medical Education, Mayo Clinic College of Medicine, in Arizona and Minnesota. The research interests of Dr. Valencia Sanchez focus on autoimmune disorders involving the central nervous system. These include neuromyelitis optica spectrum disorders, myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), autoimmune encephalitis, and paraneoplastic neurological syndromes. She is particularly interested in the neurological complications of immune checkpoint inhibitor cancer immunotherapy. The clinical trials that she leads at Mayo Clinic in Arizona are among the first studies that may lead to approval of new targeted therapies for MOGAD and autoimmune encephalitis. Additionally, Dr. Valencia Sanchez's clinical research allows for increased recognition of autoimmune neurological disorders. Also, her work is helping to avoid misdiagnosing autoimmune encephalitis in the clinical setting. Her research leads to earlier diagnosis and appropriate treatment to ultimately improve patient outcomes.

EP20: ME/CFS in Action: Transforming Chronic Illness Care

Hope and Help For Fatigue & Chronic Illness

Play Episode Listen Later May 1, 2024 50:55

Watch Jaime Seltzer and other experts share their expertise at the INIM Conference 2024 on May 10, 2024. Register here: https://www.nova.edu/nim/events.html In this episode, Haylie Pomroy and Jaime Seltzer discuss the challenges faced by patients with myalgic encephalomyelitis (ME/CFS) and Post-COVID Syndrome (or Long COVID) in obtaining proper diagnosis and treatment due to the lack of understanding among medical providers. Together, they emphasize the importance of patient-reported symptoms in diagnosing ME/CFS accurately and discuss efforts by Jaime's organization, ME Action, to improve clinical care and education. Don't miss out on this episode as Jaime and Haylie explain the complexities of post-viral conditions like ME/CFS and Long Covid, including the relationship between viral damage, immune responses, and genetic factors. Explore the various sources of symptoms in these conditions and the need for personalized approaches to address them effectively. Resources Mentioned: Mayo Clinic Paper, “Diagnosis and Management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome”: https://www.mayoclinicproceedings.org/action/showPdf?pii=S0025-6196%2823%2900402-0 Pacing and Management Guides: https://www.meaction.net/resource/pacing-and-management-guide/ Neuroinflammation Research Review (2019) by Jaime Seltzer: http://www.meaction.net/wp-content/uploads/2019/06/19_MEA_Revised_2019_Research_Summary_190610.pdf Subscribe to the MEAction Newsletter: https://www.meaction.net/subscribe/ Donate to the MEAction Network: meaction.net/donate Jaime Seltzer is the Director of Scientific and Medical Outreach at ME Action, a nonprofit advocating for those with chronic illnesses. She bridges communication between healthcare, government, and research sectors, representing ME Action globally. Additionally, Jaime collaborates with institutions like Stanford Medicine and Mayo Clinic Rochester on post-infectious chronic diseases research. She brings personal insight to her work as someone living with ME/CFS. LinkedIn: https://www.linkedin.com/in/jaime-seltzer-b23abb14/ Twitter: https://twitter.com/exceedhergrasp1 Website: https://www.meaction.net/ —------------------------------------------------------------------------------------------------ Thank you for tuning in to the Hope and Help For Fatigue and Chronic Illness Podcast. Sign up today for our newsletter.

Unsung heroes-healthcare volunteers

Mayo Clinic Key In To Quality

Play Episode Listen Later Mar 21, 2024 25:07

Volunteers fill many significant roles to support the human experience in healthcare. Hear from Erin Pittman, Director of Volunteer Services, who oversees volunteer programs, hospital gift shops and animal assisted services at Mayo Clinic Rochester. Erin shares her perspectives about the complex field of volunteer management and the importance of understanding the impact of volunteers have in connecting with patients through empathy, kindness and human centered care. She discusses the process to engage volunteers and discover their personal “why” to volunteer. Erin describes the shifts and future innovations in volunteer services including embracing diversity and other success tips. #mayokeyintoquality Hosted by: Hosted by: Timothy Morgenthaler, M.D., Vice Chair, Quality, Mayo Clinic, and Sheri Nemec, Consultation and Relationship Manager, Quality Department, Mayo Clinic LinkedIn: Timothy Morgenthaler, M.D. and Sheri Nemec Twitter: @DrTimMorg Guest LinkedIn: Erin Pittman

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Everything is Figureoutable (shout out Marie Forleo!) | Dr. Sarah Asch (Part 1 of 2)

The Direct Care Derm

Play Episode Listen Later Feb 22, 2024 52:15

Episode 010 | Sarah Asch, MD, FAAP, FAAD is a trailblazer in direct care pediatric dermatology. She's on a mission to expand high-quality pediatric dermatology care throughout underserved areas of the Upper Midwest and beyond. She LOVES her work in pediatric dermatology, and she wanted to love her job again. She decided to solve that problem by founding Hometown Pediatric Dermatology. Join us for the Part 1 of a wide ranging, provocative, educational, and fun conversation with a wildly talented doctor and delightful person. Part 2 will be out next Thursday.(This episode is marked as explicit. It's just one tiny BS. :)In this episode:

Shirley Billigmeier - Eating For Joy: Honoring Hunger & Avoiding Deprivation

PASSION PURPOSE AND POSSIBILITIES

Play Episode Listen Later Feb 5, 2024 49:18

Here's what to expect on the podcast:Is it possible to lose weight without worrying about what food to eat and what to avoid?What strategies or practices can help transform a deprivation mindset into one of abundance?What is the hunger scale, and how does it function as a tool for managing eating habits?How does the communication between the gut and the brain influence various aspects of someone's well-being?And much more! About Shirley:Shirley Billigmeier has been a Body Image Specialist, Eating Consultant, Best-Selling Author, and Sought-After Speaker for more than 50 years. Shirley helps women, men, teens, and children resolve their issues with food and eating outside of any form of "dieting."Since the publication of her first book, Inner Eating (forward written by Michael Jensen, a professor and MD of Mayo Clinic Rochester), she has worked with over 10,000 clients on their weight loss journeys. Over the past four decades, she has refined her company, Innergetics, into a much more comprehensive, holistic solution than mindful eating alone.Shirley helps people recover the joy of eating and the "inner knowing" we are all born with when it comes to hunger. As a baby, we ate only when we were hungry, enjoyed every moment, and naturally stopped eating as soon as their body felt nourished. These inner triggers get lost over time. Discover how Shirley's four decades of honing this methodology have completely transformed countless lives. Never count a calorie again with this groundbreaking method. Once the gut and brain reconnect, much more than weight becomes vibrant and optimal! Connect with Shirley Billigmeier!Website: https://www.innergetics.com/LinkedIn: https://www.linkedin.com/in/shirley-billigmeier-33a49b5/Check out Shirley's book, Inner Eating: How to Free Yourself Forever from the Tyranny of Food, on Amazon! https://www.amazon.com/Inner-Eating-Yourself-Forever-Tyranny/dp/0840796234 Connect with Candice Snyder!Website: https://hairhealthvitality.com/passion-purpose-and-possibilities/Facebook: https://www.facebook.com/candice.snyderInstagram: https://www.instagram.com/candicesny17/LinkedIn: https://www.linkedin.com/in/candicesnyder/ICAN Institute: https://vl729.isrefer.com/go/mindandbody/PassionPurpose22/Shop For A Cause With Gifts That Give Back to Nonprofits: https://thekindnesscause.com/

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Cryptocurrency with Dr. Chris Aakre

Doctor+

Play Episode Listen Later Dec 6, 2023 25:38

"It gives your the flexibility so that when go to do things outside of medicine, you have the ability to do that." Hosts Tseganesh and David speak with Dr. Chris Aakre about cryptocurrency. About the guest: Dr. Chris Aakre graduated from University of Minnesota Medical School in 2011. Afterwards, he completed residency, chief residency, and clinical informatics fellowship at Mayo Clinic Rochester before joining the division of General Internal Medicine at Mayo Clinic. He discovered bitcoin and related digital assets in 2011 from another technologically inclined radiology co-resident. Over the next few years, he built a specialized computer to mine transaction verification rewards (unsuccessfully), explored alternative blockchains, and even contributed code towards specific blockchain projects. There is no better way to gain an in-depth understanding of the blockchain technology and its potential applications than diving into the code! Resources for learning more about cryptocurrency: Coinbase: Crypto Questions, Answered: https://www.coinbase.com/learn Kraken: Learn about blockchain, crypto, and NFTs: https://www.kraken.com/learn Crypto.com: Guides for Beginners and Veterans: https://crypto.com/university Support for Doctor+ has been provided by the American College of Physicians. Doctor+ is hosted by Dr. David Hilden and Dr. Tseganesh Selameab and is produced by Julie Censullo. For more information, visit doctorpluspodcast.com.

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Ep. 132 Metabolic Workup for Pediatric Stone Patients with Dr. David Sas

BackTable Urology

Play Episode Listen Later Oct 27, 2023 61:32

This week on BackTable Urology, Dr. Jose Silva and Dr. David Sas, a pediatric nephrologist at the Mayo Clinic-Rochester, discuss clinical presentation and prevention of kidney stones in children as well as workup of metabolic diseases. --- SHOW NOTES First, David explains how laboratory and genetic tests can be useful when determining the cause of kidney stones. Obtaining a 24-hour urine sample and analyzing stone composition are important for understanding the causes of stone formation in teenagers. Environmental and genetic factors can also contribute to the formation of stones. For example, CYP24A1 mutation a gene can cause a hypersensitivity to vitamin D and calcium in the diet. Next, David and Jose discuss lifestyle modifications for preventing stones in teenagers. They talk about how to limit sodium intake, the use of thiazide diuretics, and supplementing potassium citrate for calcium oxalate stones. Furthermore, they delve into the causes of hyperoxaluria, which are genetic primary hyperoxaluria and enteric hyperoxaluria. Additionally, they discuss the rare monosodium urate stones, which are usually associated with metabolic acidosis but can be caused by chronic diarrhea or eating a lot of protein. The doctors end by discussing the challenges of transitioning pediatric management to adult management. Lastly, they discuss the potential causes of why more kids are forming stones, such as increasing sweet juices and fast food in the diet.

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Improving Our Understanding of TNBC to Advance Health Equity

Reducing Patient Risk

Play Episode Listen Later Oct 18, 2023 59:56

Triple Negative Breast Cancer (TNBC) is an aggressive form of cancer with high rates of recurrence. Despite incredible strides made to lower breast cancer mortality in the U.S., the risk of death for women diagnosed with TNBC is far greater than for those diagnosed other types of breast cancer. Significant progress has been made in the fight against TNBC, but there is much more work to be done to improve outcomes for all women diagnosed with TNBC. This interactive discussion with leaders in the breast cancer community aims to raise awareness on inequities surrounding early diagnosis and survival of Black, Hispanic/Latina, and young women affected by TNBC and the importance of continued research and development to bring more treatment options to TNBC patients. Panelists Ricki Fairley, TNBC survivor CEO of TOUCH, The Black Breast Cancer Alliance #Whenwetrial Movement, Founder and Co-Host Ricki is an award-winning, marketing veteran that has transformed her strategic acumen into breast cancer advocacy. Ricki co-founded and serves as CEO of TOUCH, The Black Breast Cancer Alliance to address Black Breast Cancer as a unique and special disease state. Ricki founded and serves as co-host for “The Doctor Is In,” a weekly live breast cancer advocacy web series on the BlackDoctor.org Facebook page that reaches over 3 million viewers. She is a founding member of #BlackDataMatters. Elizabeth Valencia, MD JD, FCLM Consultant Breast Imaging & Intervention, Department of Radiology, Mayo Clinic Rochester American Medical Association-Minority Affairs Section, Chair of Engagement Dr. Valencia is a medical expert in Breast Cancer Imaging and Intervention at Mayo Clinic Rochester. She is a passionate breast cancer and community advocate, and former Enterprise Associate Dean of Diversity Equity and Inclusion for Mayo Clinic Alix School of Medicine Arizona, Florida, Minnesota campuses. Dr. Valencia serves on the Board of Governors for the American College of Legal Medicine and Southern Illinois University School of Medicine, serves as the American Medical Association's Minority Affairs Section-Chair of Engagement, Women for Wellness Equity and Leadership Scholar, and National Hispanic Medical Association Leadership Scholar, and Student National Medical Association (SNMA) Hall of Fame faculty and community advocate. Vivian Jolley Bea, M.D., FACS Section Chief of Breast Surgical Oncology, Department of Surgery New York - Presbyterian Brooklyn Methodist Hospital Vivian Jolley Bea, MD, has been appointed Section Chief of Breast Surgical Oncology in the Department of Surgery for New York- Presbyterian Brooklyn Methodist Hospital. Dr. Bea received her masters degree in biology from Drexel University and her medical degree from Morehouse School of Medicine. She completed her training in general surgery at the Medical University of South Carolina and a fellowship in breast surgical oncology at the University of Texas MD Anderson Cancer Center. Melissa Davis, PhD Director of the Institute of Translational Genomic Medicine Morehouse School of Medicine Dr. Davis serves as Scientific Director of the International Center for the Study of Breast Cancer Subtypes (ICSBCS), (Interim) Director of Health Equity for the Englander Institute of Precision Medicine and Associate Professor of Cell and Developmental Biology in the Department of Surgery and at Weill Cornell Medicine in New York, NY. She is also a Cancer Ethnicity Scholar, co leading the PolyEthnic-1000 project at New York Genome Center. Catherine Lai, PharmD Executive Director, Clinical Development Gilead Sciences Catherine Lai, PharmD is the Executive Director of Clinical Research in Oncology responsible for overseeing TNBC research at Gilead Sciences. Her current work primarily focuses on the development of medicines in the treatment of Breast Cancer with the goal of bringing meaningful improvements for all those impacted by the disease.

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Breaking new ground in the treatment of fibrosis, Bernard Coulie, President & CEO, Pliant Tx

Biotech 2050 Podcast

Play Episode Listen Later Sep 20, 2023 33:15

Synopsis: Bernard Coulie is the President and CEO of Pliant Therapeutics, a clinical stage biopharmaceutical company focused on discovering and developing novel therapeutics that seek to halt progression of fibrotic diseases — ultimately preserving organ function. Bernard discusses the arc of his career and shares his perspective on the European biotech ecosystem compared to the United States, and how that's changed over the last 10 years. He talks about the importance of having access to lots of capital in the early days of starting a company. He discusses fibrotic disease, the high medical need to treat it, and the indications they are pursuing. Finally, he discusses the challenges of focusing on multiple therapeutic areas and the advice he would give to others. Biography: Pliant CEO Bernard Coulie, M.D., Ph.D., brings to the company more than 15 years of senior leadership experience and drug development expertise. He joined Pliant from ActoGeniX (acquired by Intrexon Corporation in February 2015), where he was CEO, Chief Medical Officer and Co-Founder. In these positions, Dr. Coulie played an integral role in advancing the company's unique technology platform for oral delivery of biologics from early discovery stage through Phase 2 studies. Prior to ActoGeniX, Dr. Coulie held various positions with increasing responsibilities in drug discovery and clinical development at Johnson & Johnson Pharmaceutical Research and Development Europe. At Johnson & Johnson, he served as Therapeutic Area Leader Internal Medicine, managing a portfolio of products in GI, metabolic diseases and inflammation/immunology, ranging from early drug discovery through Phase 2 studies. Earlier in his career, Dr. Coulie was a Staff Physician in the Department of Gastroenterology and Hepatology at Mayo Clinic (Rochester, MN), Assistant Professor in Medicine at Mayo Medical School and a Mayo Foundation scholar. Dr. Coulie serves as Chairman of the Board of Directors of SQZ Biotechnologies, a publicly-traded cell therapy biotechnology company, as Independent Chairman of Dualyx, a privately-held biotechnology company based in Belgium and as an Independent Director at Calypso Biotech, a privately-held biotechnology company based in the Netherlands. Dr. Coulie holds an M.D. and Ph.D. from the University of Leuven, Belgium. He is a board-certified internist and holds an MBA from the Vlerick Management School, Leuven, Belgium.

Breaking the mold: Gender diversity, pregnancy and parenting

Read. Talk. Grow.

Play Episode Listen Later Aug 9, 2023 43:11

We talked with:Krys Malcolm Belc is the author of "The Natural Mother of the Child: A Memoir of Nonbinary Parenting." His essays have been featured in Granta, Guernica, The Rumpus and elsewhere.Caroline Davidge-Pitts, M.D., is an associate professor of medicine and associate practice chair of the Division of Endocrinology, Diabetes, and Nutrition at Mayo Clinic Rochester. She is the medical director of the Transgender and Intersex Specialty Care Clinic.We talked about:In this episode, Dr. Millstine and her guests discuss:Navigating nontraditional parenthood. From defying your parents' expectations to strange looks from strangers to having to adopt your own children, Krys talks about his experience with fertility treatment, pregnancy care and parenting as a transmasculine parent.Navigating the health care system. How can health care providers make parenthood more accessible and comfortable for gender diverse people? Krys and Dr. Davidge-Pitts have some ideas.Can't get enough?Purchase Krys' book "The Natural Mother of the Child: A Memoir of Nonbinary Parenting."From Bookshop.orgFrom AmazonFrom Barnes & Noble Want to read more on the topic? Check out our blog:How can I train myself to use the right pronouns?Is chestfeeding the new breastfeeding?: Explaining gender-neutral medical terms.Caring for transgender and gender-diverse children, teensGot feedback?If you've got ideas or book suggestions, email us at readtalkgrow@mayo.edu.We invite you to complete the following survey as part of a research study at Mayo Clinic. Your responses are anonymous. Your participation in this survey as well as its completion are voluntary.

Isolated Nodal Recurrence in Endometrial Cancer with Andrea Mariani and Ilaria Capasso

IJGC Podcast

Play Episode Listen Later Jul 31, 2023 33:14

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Drs. Andrea Mariani and Ilaria Capasso to discuss isolated nodal recurrence in endometrial cancer. Dr. Mariani is a Full Professor in the Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, at Mayo Clinic in Rochester, Minnesota. He is the Gynecologic Oncology Division Chair in the Department of Obstetrics and Gynecology. Dr. Mariani's research interest is endometrial cancer with a special interest in robotic surgery. He is internationally recognized for his contributions in the advancement of surgical and postoperative treatment of endometrial cancer. Since 2019, Dr. Capasso has been employed as an OBGYN Resident at Fondazione Policlinico Agostino Gemelli (Rome, Italy), where she mainly works in the Gynecologic Oncology Unit, with a special focus on clinical and translational research in endometrial cancer. Between May 2022 and May 2023, she held the position of Visiting Research Fellow at Mayo Clinic (Rochester, MN, US), where she led clinical and translational research projects mainly related to AI, microbiome, and ctDNA in endometrial cancer. She currently holds the position of Research Collaborator at Mayo Clinic (Rochester, MN, US). Highlights: This study aimed to analyze the clinicopathological features and outcomes of patients with endometrial cancer who experienced isolated lymphatic recurrence after lymphadenectomy, categorized by different recurrence sites and treatment approaches. The researchers retrospectively reviewed surgically treated endometrial cancer patients and identified 66 women (1.6%) with isolated lymphatic recurrence. The overall median cause-specific survival for these patients was 24 months. Survival outcomes were not significantly different among the four isolated lymphatic recurrence groups, although patients with recurrence in the para-aortic area showed better long-term survival rates higher rates of long-term survivors (patients who survived more than 5 years after the recurrence). Factors associated with improved cause-specific survival included low-grade histology and the absence of lymphovascular space invasion in the primary tumor. Moreover, patients who underwent surgical treatment with/without other associated treatments for isolated lymphatic recurrence exhibited better cause-specific survival compared to those who did not undergo surgery, even after adjusting for age.

108 - Anders Olmanson - REMplenish Myo Nozzle - Reducing Snoring while Drinking Water

Sleep Apnea Stories

Play Episode Listen Later Jul 26, 2023 44:56

Emma is joined by Anders Olmanson to talk about the REMplenish Myo Nozzle. In this episode: * Anders talks about research his team did to understand the problems surrounding sleep apnea diagnosis and treatment. * Research on myofunctional therapy/oropharyngeal exercises and how they were shown to decrease AHI significantly. * Brainstorming ideas around a gadget or device which could encourage people to more easily do myofunctional therapy exercises. * How the "Myo Nozzle" idea came and the multiple iterations that happened to develop the final product. * Anders describes receiving an NIH grant to carry out a clinical study to research the Myo Nozzle. * Recruiting participants for the study at Mayo Clinic Rochester, Minnesota. Connect with Anders: https://www.facebook.com/remasteredsleep https://www.instagram.com/remasteredsleep https://remasteredsleep.com/ Connect with Emma: Get on the email list ⁠here⁠ Follow the podcast on Instagram:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ @sleepapneastories⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Email Emma at ⁠⁠⁠⁠⁠⁠⁠⁠⁠sleepapneastories@gmail.com⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.sleepapneastories.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Sponsors: BetterHelp⁠⁠⁠⁠⁠⁠⁠⁠⁠ https://www.betterhelp.com/emma⁠⁠⁠⁠⁠⁠⁠⁠⁠ for 10% off your first month of online therapy NEW! Support the Podcast! If you would like to support Emma and the 'Sleep Apnea Stories' podcast, you can now contribute monthly. ⁠⁠⁠⁠⁠⁠⁠⁠https://podcasters.spotify.com/pod/show/emma-cooksey⁠⁠⁠⁠⁠⁠⁠⁠ Click "Support this Podcast". Disclaimer: This podcast episode includes people with sleep apnea discussing their experiences of medical procedures and devices. This is for information purposes only and you should consult with your medical professionals before starting or stopping any medication or treatment. --- Support this podcast: https://podcasters.spotify.com/pod/show/emma-cooksey/support

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Nuts and Bolts of Neoadjuvant Therapy for Pancreatic Adenocarcinoma

SurgOnc Today

Play Episode Listen Later Jun 30, 2023 28:19

In this episode of SurgOnc Today, Alexander Parikh MD, MPH, FACS, FSSO, from the University of Texas, San Antonio and Chair of the SSO HPB Disease Site Work Group, and Julie Hallet, MD, M.Sc., FRCSC, from the University of Toronto, and Vice-Chair of the SSO HPB Disease Site Work Group, are joined by Flavio G. Rocha, MD, FACS, FSSO, from the Oregon Health and Science University and Susanne G. Warner, MD, from the Mayo Clinic Rochester. They discuss two important aspects of delivering neoadjuvant therapy for pancreatic adenocarcinoma: the use of staging laparoscopy and the assessment of response.

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Surgery or Endovascular Therapy for Chronic Limb-Threatening Ischemia

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Play Episode Listen Later Jun 27, 2023 19:10

Surgery or Endovascular Therapy for Chronic Limb-Threatening Ischemia Guest: Fahad Shuja, M.D Hosts: Greg Barsness, M.D. Hello and welcome to the Mayo Clinic Cardiovascular Interviews with Experts podcast. I am Greg Barsness, an interventional and critical care cardiologist at Mayo, and I'm thrilled to be joined here by Dr. Fahad Shuja, Assistant Professor in the Division of Vascular and Endovascular surgery at Mayo Clinic Rochester, Minnesota in the USA. Fahad attended medical school at the Aga Khan University in Pakistan. Topics Discussed in this Episode: Endovascular Therapy Peripheral Arterial Disease Ischemia treatment Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

The David Procedure

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Play Episode Listen Later Jun 13, 2023 9:37

The David Procedure Guest: Malakh L. Shrestha, M.B.B.S., Ph.D. Host: Paul A. Friedman, M.D. (@drpaulfriedman) Joining us today to discuss The David Procedure is Malakh L. Shrestha, M.B.B.S., Ph.D., cardiac surgeon and director of the Mayo Clinic aortic center of excellence and director of aortic surgery for cardiovascular surgery at Mayo Clinic Rochester, Minnesota. Tune in to learn more about The David Procedure. Specific topics discussed: Aortic Regurgitation Aortic Valve replacement The David Procedure Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV. Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

Frozen Elephant Trunk Procedure

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Play Episode Listen Later May 23, 2023 8:58

Frozen Elephant Trunk Procedure Guest: Malakh L. Shrestha, M.B.B.S., Ph.D. Host: Paul A. Friedman, M.D. (@drpaulfriedman) Joining us today to discuss the frozen elephant trunk procedure is Malakh L. Shrestha, M.B.B.S., Ph.D., cardiac surgeon and director of the Mayo Clinic aortic center of excellence and director of aortic surgery for cardiovascular surgery at Mayo Clinic Rochester, Minnesota. Tune in to learn more about the frozen elephant trunk procedure. Specific topics discussed: What is the frozen elephant trunk (FET) procedure, and where was it invented? What are the indications and uses for it? What is latest on FET procedures in the united states? Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV. Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

There's no putting the genie back in the bottle, pharmacogenomics are here to stay!

VerifiedRx

Play Episode Listen Later May 9, 2023 11:48

Vizient Pharmacy Vision Awards celebrate the values and achievement of our pharmacy members. The winner of the Excellence in Clinical Practice Award implements novel strategies to improve patient outcomes and reduce the cost of medication utilization. Dr. Eric Teye Matey, Clinical Pharmacogenomics Pharmacist and Residency Program Director of the PGY-2 Pharmacogenomics program from Mayo Clinic Rochester discusses the forward thinking of the pharmacogenomics program at Mayo with host Gretchen Brummel. Guest speakers: Eric Teye Matey, PharmD, RPh, MBA Clinical Pharmacogenomics Pharmacist and Residency Program Director of the PGY-2 Pharmacogenomics program Mayo Clinic Rochester Moderator: Gretchen Brummel, PharmD, BCPS Pharmacy Executive Director Vizient Center for Pharmacy Practice Excellence Show Notes: [00:51 - 04:54] Eric's role at Mayo and background and integral pharmacogenomics team members [04:55 - 06:16] Origins of the pharmacogenomics program at Mayo [06:17 - 07:33] How the program has expanded [07:34 - 08:35] Accomplishments of the program [08:36 - 10:08] What frontline pharmacy staff should know about applied pharmacogenomics [10:09 - 11:08] Future plans for the program Links | Resources: ASHP statement CPIC Subscribe Today! Apple Podcasts Amazon Podcasts Google Podcasts Spotify Stitcher Android RSS Feed

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Positive Health and Well-Being for You and Your Patients with Dorian Mintzer and Dr. Tom Kottke

Revolutionize Your Retirement Radio

Play Episode Listen Later May 9, 2023 54:47

As those of us born in the Baby Boomer Generation are expected to live longer than our parents, there are a number of behaviors in which we can engage that make that life expectancy a joy rather than a burden. These include physical, emotional, and empathetic activities that will help Boomers flourish in their later years.In this episode, participants will discover:Six behaviors that have a strong impact on healthy life expectancy (nutrition, physical activity, tobacco, alcohol, sleep, and healthy thinking)Six building blocks of well-being (emotional & mental, social & interpersonal, financial, career, physical, and community)Three behaviors that increase one's own well-being and well-being in others (reflections of gratitude, acts of kindness, expressions of thankfulness)Martin Seligman's 5 components of flourishing (positive emotion, engagement, positive relationships, meaning and purpose, and accomplishment.About Dr. Tom Kottke:Dr. Tom Kottke is a cardiologist and health services researcher in the Twin Cities area of Minneapolis and St. Paul. After 17 years practicing at Mayo Clinic Rochester, he moved to HealthPartners, now Medical Director for Well-Being, while continuing to practice cardiology. Currently, his research and program development focuses on how individuals can increase their healthy life expectancy and increase their sense of well-being.Get in touch with Dr. Tom Kottke:Visit Tom's website: https://www.healthpartners.com/knowledgeexchange/display/person-Kottke-T-EDownload Tom's Handout: https://revolutionizeretirement.com/kottke What to do next: Click to grab our free guide, 10 Key Issues to Consider as You Explore Your Retirement Transition Please leave a review at Apple Podcasts. Join our Revolutionize Your Retirement group on Facebook.

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Post-PARP Myeloid Neoplasms with Giuseppe Caruso

IJGC Podcast

Play Episode Listen Later May 8, 2023 28:30

In this episode of the IJGC podcast, Editor-in-Chief, Dr. Pedro Ramirez, is joined by Dr. Giuseppe Caruso discuss post-PARP myeloid neoplasms. Dr. Caruso is a fifth-year resident in Obstetrics and Gynecology and a first-year fellow of the PhD in “Network Oncology and Precision Medicine” at Sapienza University of Rome in Italy. Over the past year, he has been attending the Department of Gynecologic Oncology at the European Institution of Oncology (Milan) under the mentorship of Professor Nicoletta Colombo and has now started his research fellowship period at Mayo Clinic (Rochester) under the supervision of Professor William Cliby. His main interest areas are gynecologic oncology, personalized oncology, and clinical research. Highlights: - Myeloid neoplasms post PARPi in patients with ovarian cancer are gradually emerging as life-threatening late toxicities and should not be underestimated. - The first two years of PARPi exposure are the critical window of onset and persistent cytopenia has been recognized as an early warning sign. - Active surveillance, differential diagnosis, and prompt hematological referral are crucial. - PARPi are recommended in the first line also to improve the risk-benefit ratio. - PARPi should be used cautiously in patients with a higher baseline risk and/or those who are less likely to have a significant benefit.

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AI-ECG to Detect Cardiac Amyloidosis: Strengths, Limitations, and Future Directions

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Play Episode Listen Later Apr 13, 2023 14:15

AI-ECG to Detect Cardiac Amyloidosis: Strengths, Limitations, and Future Directions Guests: David M. Harmon, Jr. M.D. Hosts: Anthony H. Kashou, M.D. (@anthonykashoumd) Joining us today to discuss using AI-ECG to detect cardiac amyloidosis is David M. Harmon, Jr. M.D., cardiology fellow at Mayo Clinic Rochester, Minnesota. Dr. Harmon's research interests include the clinical application of artificial intelligence electrocardiography and assessing the utility of AI algorithms on wearable devices. Tune in to learn about using AI-ECG to detect cardiac amyloidosis. Specific topics discussed: Can you share a little background as to why AI-ECG for cardiac amyloidosis screening? What are some of the most surprising results of your validation study? What are the biggest limitations you found in this work? What are some next steps for this algorithm? Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. Facebook: MayoCVservices LinkedIn: Mayo Clinic Cardiovascular Services NEW Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

Transcatheter Aortic Valve Replacement (TAVR) vs. Aortic Valve Replacement (AVR)

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Play Episode Listen Later Apr 11, 2023 16:11

Transcatheter Aortic Valve Replacement (TAVR) vs. Aortic Valve Replacement (AVR) Guest: Kevin L. Greason, M.D. Host: Kyle W. Klarich, M.D. Joining us today to discuss Transcatheter Aortic Valve Replacement (TAVR) versus Aortic Valve Replacement (AVR) is Kevin Greason, M.D., associate professor of surgery and cardiac surgeon at Mayo Clinic Rochester, Minnesota. Tune in to learn more about the surgical differences between TAVR and AVR. Specific topics discussed: What are the main advantages of TAVR? What are the main advantages of SAVR? How do you select patients for one treatment or another? What are the advantages of mechanical valves and when do you use them? What is the durability of TAVR and SAVR? Rate of reoperation/reintervention? What treatment do you recommend for a young patient with aortic stenosis? Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV. NEW Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

Coronary Revascularization

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Play Episode Listen Later Apr 4, 2023 19:30

Coronary Revascularization Guest: John M. Stulak, M.D. Host: Malcolm R. Bell, M.D. Joining us today to discuss coronary revascularization is John Stulak, M.D., professor of surgery and cardiac surgeon at Mayo Clinic Rochester, Minnesota. Tune in to learn more about the surgical approach to coronary revascularization. Specific topics discussed: Current era of CABG, trends, status of the practice Alternate approaches – hybrid, off pump. Robotic/minimally invasive Conduit choices, multiple arterial revascularization Future state Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV. NEW Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

Minimally Invasive Cardiac Surgery

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Play Episode Listen Later Mar 28, 2023 11:37

Minimally Invasive Cardiac Surgery Guest: Malakh L. Shrestha, M.B.B.S., Ph.D. Host: Kyle W. Klarich, M.D. Joining us today to discuss minimally invasive cardiac surgery is Malakh L. Shrestha, M.B.B.S., Ph.D., cardiac surgeon at Mayo Clinic Rochester, Minnesota. Dr. Shrestha was recruited from Germany and starting a Center for Excellence for Aortic Disease at Mayo Clinic; he also contributed to the American Association of Thoracic Surgery (AATS) guidelines for aortic dissection. Tune in to learn more about minimally invasive cardiac surgery. Specific topics discussed: Present status of Aortic valve repair Durability and peri-operative risks Is minimally Invasive Aortic valve repair possible? Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV. NEW Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

What is a Cardio-Protective Diet?

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Play Episode Listen Later Mar 21, 2023 18:51

What is a Cardio-Protective Diet? Guest: Kyla M. Lara-Breitinger, M.D. Host: Malcolm R. Bell, M.D. Joining us today to discuss cardio-protective diet is Kyla M. Lara-Breitinger, M.D., instructor in medicine in preventive cardiology at Mayo Clinic Rochester, Minnesota. Tune in to learn more about a cardio-protective diet. Specific topics discussed: What determines a cardio-protective diet? Is there a best cardioprotective diet to follow out there based on scientific data? There are many controversies out there like the egg debate, dairy debate, ketogenic, and low-fat diets. What do you say to patients that ask you these specific questions in clinic? Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV. NEW Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

Aortic Dissection

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Play Episode Listen Later Mar 14, 2023 12:11

Aortic Dissection Guest: Malakh L. Shrestha, M.B.B.S., Ph.D. Host: Kyle W. Klarich, M.D. Joining us today to discuss aortic dissection is Malakh L. Shrestha, M.B.B.S., Ph.D., cardiac surgeon at Mayo Clinic Rochester, Minnesota. Dr. Shrestha was recruited from Germany and starting a Center for Excellence for Aortic Disease at Mayo Clinic; he also contributed to the American Association of Thoracic Surgery (AATS) guidelines for aortic dissection. Tune in to learn more about the surgical approach to aortic dissection. Specific topics discussed: The AATS guidelines and what it means to surgeons interested in aortic disease. How to look for aortic dissection. What is the frozen elephant trunk technique? Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV. NEW Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

Season 4 Ep. 8 : Colorectal Cancer Awareness Month

The PQI Podcast

Play Episode Listen Later Mar 9, 2023 38:01

This week we sit down with Maria Vazquez Roque, MD, MSc to discuss screening for colon cancer and cancer disparities in the hispanic population in recognition of Colorectal Cancer Awareness Month.Dr. Vazquez Roque is from San Juan, Puerto Rico. In 2003, she completed her medical degree at the University of Puerto Rico Medical Sciences Campus. In 2008 she finished her internal medicine residency in Puerto Rico. She then pursued a Gastroenterology fellowship in the NIH training grant at Mayo Clinic Rochester, Minnesota. After graduating from GI fellowship, she began to work in the Division of Gastroenterology and Hepatology at Mayo Clinic Florida in April 2012. She is currently an Associate Professor in the Department of Medicine, the Associate Chair for the Outpatient Practice for the Department of Medicine, and Medical Director for Accreditation and Supply Chain for Mayo Clinic Florida. She championed and developed the Fecal Microbiota Transplant program at the Mayo Clinic Florida campus for patients who suffer from recurrent episodes of Clostridium difficile infection and to date has conducted over 200 procedures with success. She is actively participating in research studies evaluating the role of the gut microbiome in immunotherapy and immune checkpoint inhibitor colitis.

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Today's Headlines: Rochester rapid-transit plans are moving forward

Post Bulletin Minute

Play Episode Listen Later Feb 7, 2023 5:15

Stories in this episode: Day in History: 1923: Dr. Banting, Nobel Peace Prize recipient, to visit Mayo Clinic Rochester rapid-transit plans are moving forward Fountain's new mayor 'excited to serve the community' Decades later, Kenyon-Wanamingo raises curtain on one-act competition with existential performance Winona goalie faced 100 shots in a game, kept coming back for more

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Today's Headlines: Food service workers picket in front of Mayo Clinic

Post Bulletin Minute

Play Episode Listen Later Aug 26, 2022 6:53

Stories in this episode: Day in History: 1922: Room and board needed for students attending school Food service workers picket in front of Mayo Clinic Rochester and Winona schools partner for online learning Rustic doesn't come cheap; Pine Island log cabin asking price just below $1 million Scary soccer thought: St. Charles/Lewiston-Altura's Gust is back to 100 percent The Post Bulletin is proud to be a part of the Trust Project. Learn more at thetrustproject.org.

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Dr. Parichita Choudhury - How to Decrease Cognitive Decline

ListenUp!

Play Episode Listen Later Jul 28, 2022 33:31

Dr. Parichita Choudhury is a cognitive neurologist at Banner Health in Arizona. She received her M.D. from the University of Alberta and immediately joined the University of Calgary as a Resident Physician. She was a fellow at the Mayo Clinic Rochester and now shares her passion for medical education with others. Dr. Choudhury's clinical research focuses on neurodegenerative dementia, diagnosis, and prognosis, with an emphasis on early detection. In this episode… Recent research has pointed toward a connection between hearing loss and cognitive decline. While it's invaluable to treat hearing loss to combat neurological disease, that's not the only solution. In fact, as more work is done in the field, science is offering more ways than ever to diagnose and fight against cognitive decline. As a cognitive neurologist, Dr. Parichita Choudhury is aware of the impact hearing has on brain function. She is a proponent of healthy mental exercise and testing, working hands-on with her patients to help their cognitive health, and now, explains exactly what that looks like in practice. Dr. Mark Syms has a thorough discussion with Dr. Parichita Choudhury, a cognitive neurologist at Banner Health, about cognitive decline and how to fight against it. They discuss her qualifications and observations in the field before diving deep into subjects such as brain testing programs, how the MoCA works, and exercises people can perform to strengthen their cognition. Hear the full conversation on this episode of the ListenUp! Podcast!

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Parenteral Nutrition Shortages featuring Dr. Ryan Hurt, MD, PhD

Dietitians in Nutrition Support: DNS Podcast

Play Episode Listen Later Jul 25, 2022 22:58

In this episode, we explore the current state of parenteral nutrition shortages with physician and current ASPEN president, Dr. Ryan Hurt, MD, PhD. Dr. Hurt is a faculty member in the Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota where he has a joint appointment in the Divisions of Gastroenterology and Endocrinology, Mayo Clinic. He is the Program Director for the Home Parenteral and Enteral Nutrition Program at Mayo Clinic Rochester, and has developed a clinical interest in nutrition, obesity, and addiction and most recently Long COVID, and has published over 150 peer-reviewed manuscripts and 14 book chapters in these areas. This episode is hosted by Christina Rollins, MBA, MS, RDN, LDN, FAND, CNSC. Recorded on 6/29/2022

The Outs and Ins of Vitamins

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Play Episode Listen Later Jul 19, 2022 20:40

Guest: Donald D. Hensrud, M.D., M.S. Host: Edward (Edward R.) R. Laskowski, M.D. (@DrEdSportsMed) A recent Harris poll found that 86% of people take some sort of vitamin or supplement, and a recent research study found that approximately 60% of people report using dietary supplements in the past 30 days. Multiple claims are made regarding the benefits of vitamins. How do we know which are true? How do we sift through all the hype? When should we consider taking vitamins or recommending them for our patients? This episode features Donald D. Hensrud, M.D., M.S., an Associate Professor of Nutrition and Preventive Medicine at Mayo Clinic Rochester, Director of the Mayo Clinic Healthy Living Program, and editor of multiple books on healthy eating and living a healthy lifestyle, including The Mayo Clinic Diet and The New Mayo Clinic cookbook. Connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Fostering Innovation in Cardiology & Partnerships Between Engineers and Academics; Innovation Into Products

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Play Episode Listen Later Jun 9, 2022 17:38

Fostering Innovation in Cardiology & Partnerships Between Engineers and Academics: Innovation Into Products Guest: Paul A. Friedman, M.D. (@drpaulfriedman) Hosts: Anthony H. Kashou, M.D. (@anthonykashoumd) Joining us today to discuss Fostering Innovation in Cardiology & Partnerships Between Engineers and Academics: Innovation Into Products is Paul A. Friedman, M.D., professor of medicine in cardiology and chair of the department of cardiology at Mayo Clinic Rochester, Minnesota. Specific topics discussed: The ECG has been around for over 100 years -- are there really opportunities to innovate in this space -- what are the opportunities? What are the opportunities and challenges in recruiting engineers to a medical center? Are the ECG innovations scalable? How does a medical center bring these to patients widely? Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. Facebook: MayoCVservices LinkedIn: Mayo Clinic Cardiovascular Services NEW Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

The Importance of the ECG in Interpreting Troponin

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Play Episode Listen Later May 26, 2022 37:01

The Importance of the ECG in Interpreting Troponin Guest: Allan S. Jaffe, M.D. Hosts: Anthony H. Kashou, M.D. (@anthonykashoumd) Joining us today to discuss high sensitivity cardiac troponin levels is Allan S. Jaffe, M.D., professor of medicine in cardiology and laboratory medicine and pathology at Mayo Clinic Rochester, Minnesota. Specific topics discussed: How to best use high sensitivity cardiac troponin levels in suspected acute coronary syndrome (ACS) and the utility of the ECG in those cases How the evaluation of cardiac troponin levels can be performed in various patient populations: Acutely ill Post-operative Chronic medical conditions Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. Facebook: MayoCVservices LinkedIn: Mayo Clinic Cardiovascular Services NEW Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

Fellowship Interview Tips with Dr. Ryan D'Souza

PM&R Scholars Podcast

Play Episode Listen Later Apr 30, 2022 33:52

On this PM&R Scholars podcast, we hosted Dr. Ryan D'Souza, current director of neuromodulation and former pain medicine fellow at Mayo Clinic Rochester. Dr. D'Souza shared his experiences and tips regarding #interviews for #residency #fellowship #painmedicine #physiatry #anesthesiology #meded We hope that you enjoy this session and best of luck to all of you interviewing soon!

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Community Pharmacy: Training Future Leaders

ASHPOfficial

Play Episode Listen Later Mar 8, 2022 33:01

In this podcast episode, we chat with Dr. Garrett Schramm, Director of Pharmacy Education and Academic Affairs at Mayo Clinic – Rochester, about the value of community-based pharmacy residencies in training future leaders. Dr. Schramm reviews his organization's pursuit of expanding available pharmacy residencies in community-based practice at Mayo, and the importance of quality training for future practice leaders. The information presented during the podcast reflects solely the opinions of the presenter. The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.

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Precision Medicine in Oncology: Ep.5 Precision medicine for metastatic colorectal cancer

IMPACT Medicom

Play Episode Listen Later Sep 27, 2021 22:22

In this episode of IMPACT Medicom's podcast series on Precision Medicine in Oncology we discuss:· The current standards for molecular testing in metastatic colorectal cancer· The potential benefit of a Canadian guideline for molecular testing in metastatic colorectal cancerOur guest:Dr. Sharlene Gill is Professor of Medicine at the University of British Columbia and Medical Oncologist at BC Cancer in Vancouver. Dr. Gill earned her MD from the University of British Columbia and completed a fellowship in gastrointestinal oncology at the Mayo Clinic (Rochester, MN). She also received a Master of Public Health degree from the Harvard School of Public Health and completed her MBA at the Kenan-Flagler School of Business at the University of North Carolina. Dr. Gill currently specializes in the treatment of gastrointestinal malignancies and serves as the Chair of the Canadian Clinical Trials Group GI Disease Site Committee. In addition, she is President-Elect of the Canadian Association of Medical Oncologists and is Editor-in-Chief for the peer-reviewed journal Current Oncology. This podcast episode was sponsored by Merck Canada. If you enjoy our podcast, please review and subscribe. For more podcasts and other medical education content, visit our website at: https://www.impactmedicom.com

Ask the Experts: Tips for Quickly Evaluating Literature

ASHPOfficial

Play Episode Listen Later Aug 30, 2021 32:31

As pharmacists, we are extensively trained on the intricacies of evaluating medical literature, but how can we do it more efficiently? In this podcast episode, we interview Dr. Garrett Schramm, Director of Pharmacy Education and Academic Affairs at Mayo Clinic - Rochester and Dr. Scott Nei, Cardiovascular Critical Care Pharmacist and PGY1 Residency Program Director at Mayo Clinic - Rochester to learn tips and tricks for quickly evaluating literature. The information presented during the podcast reflects solely the opinions of the presenter. The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.

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Circulation April 6, 2021 Issue

Play Episode Listen Later Apr 5, 2021 26:39

For this week's Feature Discussion, please join authors Igor Klem, Pasquale Santangeli, Mark N.A. Estes III, and Associate Editor Victoria Delgado as they discuss, in a panel forum, the articles: " The Relationship of LVEF and Myocardial Scar to Long-Term Mortality Risk and Mode of Death in Patients with Non-Ischemic Cardiomyopathy," "Prognostic Value of Non-Ischemic Ring-Like Left Ventricular Scar in Patients with Apparently Idiopathic Non-Sustained Ventricular Arrhythmias," and "Cardiac Magnetic Resonance Imaging in Nonischemic Cardiomyopathy: Prediction Without Prevention of Sudden Death." Dr. Carolyn Lam: Welcome to Circulation on the run, your weekly podcast summary and backstage pass to the journal and its editors. We're your co-hosts. I'm Dr. Carolyn Lam, Associate editor from the National Heart Center and Duke National University of Singapore. Dr. Greg Hundley: And I'm Dr. Greg Hundley, Associate editor, Director of the Pauley Heart Center in Richmond, Virginia. Well Carolyn, this week we've got another sort of double feature with a forum and our focus is going to be on myocardial scar that's observed with late gadolinium enhancement during cardiovascular magnetic resonance and the two author groups we'll be discussing the impact of that scar on the development of ventricular arrhythmias. But before we get to that, how about we grab a cup of coffee and jump into the other articles in the issue? Would you like to go first? Dr. Carolyn Lam: I certainly would. Although I have to say, can't wait for the double feature. I love those, and this is right up your alley too. All right. But first, the first paper I want to talk about provides new randomized trial information regarding the benefits of catheter ablation in atrial fibrillation in patients who also have heart failure. Now, this is a sub-study of the CABANA trial. Dr. Greg Hundley: So Carolyn, remind us a little bit about the CABANA trial first. Dr. Carolyn Lam: I thought you might ask. Well, CABANA randomized 2,204 patients with atrial fibrillation who were 65 years or older or less than 65 with one or more risk factors for stroke at, it was huge at 126 sites, and they were randomized to ablation with pulmonary vein isolation or drug therapy. Now of these, 35% of 778 patients had New York Heart Association Class II or higher at baseline, and really formed the subject of the current paper. Although this sub-study was not specifically designed to evaluate patients with heart failure with preserved ejection fraction, about 91% of the patients with a clinical diagnosis of heart failure participating in CABANA for whom such data on injection fraction were available, really had an ejection fraction of above 40% and fully 79% had an ejection fraction above 50%. So excitingly, this is really majority talking about, have HFpEF. Now, what did they find well in patients with New York heart Association Class II or III heart failure at trial entry, most of whom did not have a reduced ejection fraction. Dr. Carolyn Lam: There was substantial clinical outcome benefits with the ablation over drug therapy with a 36% relative reduction in the primary composite endpoint of death, disabling stroke, serious bleeding or cardiac arrest. Benefits were evident for both all-cause mortality and atrial fibrillation reduction. However, the effects on heart failure hospitalization were small and not significant. Authors also caution that these results should not be viewed as practice changing until they are reproduced in a confirmatory trial of ablation in the same population. And this is beautifully discussed in an editorial by Lynda Rosenfeld and Alan Enriquez from Yale University School of Medicine. Dr. Greg Hundley: Oh, wow. Thanks Carolyn. Well, my first paper comes from the world of basic science and it's from Professor Thomas Braun, from the Max Planck Institute for Heart and Lung Research. So Carolyn, vascular smooth muscle cells show a remarkable phenotypic plasticity allowing acquisition of contractile or synthetic states, but critical information is missing about the physiological signals that promote formation and maintenance of contractile vascular smooth muscle cells in vivo. So BMP-9 and BMP-10 are known to regulate endothelial quiescence after secretion from the liver and right atrium. And these investigators are studied the role of BMP-9 and 10 for controlling formation of contract, all vascular smooth muscle cells. Dr. Carolyn Lam: Greg, talking about vascular smooth muscle cells always reminds me of their role in pulmonary hypertension, am I right? Dr. Greg Hundley: Yes, Carolyn. So these investigators found that in mouse models, BMP-9 and BMP-10 act directly on vascular smooth muscle cells for induction and maintenance of their contractile state, and surprisingly the effects of BMP-9 and 10 in vascular smooth muscle cells are mediated by different combinations of BMP type 1 receptors in a vessel bed specific manner. And therefore, just as you suggest, Carolyn, these results may offer new opportunities to manipulate blood pressure in the pulmonary circulation. Dr. Carolyn Lam: Thank you, Greg. Well, my next paper provides the first proof of principle of gene therapy for complete correction of Type 1 Long QT syndrome. Dr. Greg Hundley: Ah, so tell us a little bit about Type 1 Long QT syndrome, Carolyn. Dr. Carolyn Lam: Okay. Well Type 1 long QT syndrome is caused by loss of function variants in the KCNQ1 and coded potassium channel alpha sub-unit. And that is essential for cardiac repolarization providing the slow delayed rectifier current. Now no current therapies target the molecular cause of this Type 1 long QT syndrome. Well, this study from Dr. Michael Ackerman colleagues from Mayo Clinic Rochester really established a novel dual component suppression and replacement KCNQ1 gene therapy approach for Type 1 long QT syndrome. And it's the type that contains the KCNQ1 short hairpin RNA to suppress endogenous expression and a codeine altered short hairpin RNA immune copy of this KCNQ1 for gene replacement. Dr. Carolyn Lam: So this very novel approach rescued the prolonged action potential duration in inducible pluripotent STEM cell cardiomyocytes derived from four patients with unique Type 1 Long QT syndrome, causative, KCNQ1 variants. So it's super cool. Just go have a look. Dr. Greg Hundley: Well, thanks Carolyn. Dr. Carolyn Lam: I want to also tell you about other things in the mail bag. We have ECG Challenge by Dr. Dai on “Severe Arrhythmia Caused by a Chinese Herbal Liqueur. What's the Diagnosis?” I'm not going to tell you. You have to go see. We have Dr. Karen Sliwa writing a beautiful Joint Opinion paper from the World Heart Federation and American College of Cardiology, American Heart Association, and European Society of Cardiology on "Taking a Stand Against Air Pollution, the Impact on Cardiovascular Disease." Dr. Greg Hundley: Well, thanks Carolyn. So I've got a couple other articles. First Professor Yacoub has a global rounds describing and working towards meeting the challenges of improving cardiovascular health in Egypt. Those are really interesting features to learn about cardiovascular care worldwide. Next there's an In Depth article by Professor Thum entitled, "Therapeutic and Diagnostic Translation of Extracellular Vesicles in Cardiovascular Diseases, Roadmap to the Clinic." And then finally, a Research Letter from Dr. Bottá entitled, "Risk of Coronary Artery Disease Conferred by Low Density Lipoprotein Cholesterol Depends on Apologetic Background." Well, Carolyn, what a great issue and how about now we proceed on to that double feature? Dr. Carolyn Lam: Oh, I can't wait. Thanks Greg. Dr. Greg Hundley: Well, listeners, we are here for a really exciting feature discussion today that's going to focus on imaging, in particular magnetic, resonance imaging, and some new findings in that era and how those findings may pertain to ventricular dysrhythmias. With us today, we have Dr. Igor Klem from Duke University who will be discussing a paper, Dr. Pasquale Santangeli from University of Pennsylvania, our own associate editor, Dr. Victoria Delgado from Leiden and an editorialist, Dr. Mark Estes from UPMC in Pittsburgh. Welcome to all of you. Well, Igor, we're going to start with you. Could you tell us what was the hypothesis for your study and what was your study population in study design? Dr. Igor Klem: Yes. Good morning, Greg and thanks for the invitation. We wanted to know if you have a patient who you diagnosed with non ischemic cardiomyopathy based on clinical grounds and you refer him for a cardiac MRI study with contrast, what is the additional information that you get from the MRI study? And so we wanted to compare, and that's primarily related to the findings on scar imaging with late gadolinium enhancement. And we wanted to compare that to one of the most robust clinical parameters in cardiology, which is left ventricular ejection fraction, and in particular using a cutoff of 35%, which somehow in our clinical management has sort of as established as a break point for many clinical decisions. Dr. Igor Klem: And so we created a registry among three centers of patients who undergo a cardiac MRI study, where we found an LVEF of less than 50% and we followed them for a number of outcomes. One is all caused death. And then we wanted to separate a little bit the events into those who have cardiac mortality to look at a little epidemiology because in those patients, we have two major adverse events: one as heart failure related mortality. One is arrhythmia related mortality. Dr. Greg Hundley: And how many subjects did you include? Dr. Igor Klem: We included about a thousand patients from three centers and coming to the major findings of our study, we found that both left ventricular ejection fraction, as we know, is a robust marker of all cause mortality and cardiac death. And so it was the presence of myocardial scar on cardiac MRI. But the major difference was in relation to the arrhythmic events. We founded left ventricular ejection fraction in particular, when we use the 35% cutoff actually had very little predictive power to inform us who is at risk of arrhythmic events. In contrast, there was a very strong and robust relationship or multiple statistical methods to stratify patients who are at risk for sudden cardiac death, appropriate ICD shock, as well as arrhythmic cardiac death. Dr. Greg Hundley: Very good. Well, Pasquale understand you also performed a research study utilizing cardiovascular magnetic resonance. Could you describe for us your hypothesis as well as what was your population and your study design? Dr. Pasquale Santangeli: Thank you, Greg. And of course, thanks to the editor for the interest in our paper. I need to thank also the first call authors Daniele Muser and Gaetano Nucifora for putting together a registry of 70 institutions throughout the U.S., Europe, and Japan and the our hypothesis came from a clinical need. We do know that patients with idiopathic ventricular re we ask, which includes not sustain a weakness like PVCs or non-sustained VT. Very few of them, but there is a group of them that have a higher risk of ending malignant and up comes in terms of your ethnic events over follow-up. And prior studies have shown that by doing an MRI and showings and the detecting scar related announcement, there is an increase with how we make events of a follow-up. However, if you do look at those studies late, an answer's been reported in up to 70% of these patients, which you never view is a highly practical way of re-stratifying these patients, because you have a risk factor that is present 70% of those, then it's hard to use it for clinical decision-making. Dr. Pasquale Santangeli: So in this registry, which you put it again at 686 patients with panel data idiopathic, not sustained ventricular arrhythmias, which were defined by a normal WBC gene status, a normal echocardiogram and a normal stress test. We looked at whether there is a specific pattern of late announcement. So how basically I believe lands, and it looks on the MRI, they may predict better or outcomes over follow-up. And again, we use a composite and Pauline the full cost mortality, but associated cardiac arrest due to ventricular fibrillation or a hemodynamically unstable BP, or in a subgroup of patients that underwent ICD therapy. We also looked at, I approve SED shocks. Dr. Pasquale Santangeli: The groups were divided in three different categories. The first one, which is a larger group of 85% of patients and no late announcement. The second group, the one with late announcement, which represents the remaining 50% of 15% of patients, we divided it into a ring light pattern, which was defined as that word says, as a ring like distribution of the lead announcement in the mid-market segments, which involves a three consecutive continuous segments in a short axis view. It looks like really at least half the ring or three-quarters of the ring. Dr. Pasquale Santangeli: And the other group is the one that had the leader announcement without a ring light pattern. And it's interesting that the third and the latest announcement was not that similar between the ring light and the one without ring light late announcement. What we did find though for our follow-up the patient with a ring light pattern, a significantly higher rate of the primary composite endpoint, which happened in the median follow-up about 61 months so it was quite long. And the composite outcome occurred in 50% of patients in the ring light group versus 19% in the no ring light a positive announcement group and a 0.3%. So really, really rare in patients. So then concluded that of course, late announcement does provide some information in general, particularly the type of announcement that increases the risk significantly. Probably although this has to be confirmed prospective fashion patient with a ring light pattern may benefit from other forms of interventions, including potentially defibrillator therapy in a prophylactic fashion. Dr. Greg Hundley: Very nice. So now listeners, we're going to turn to our associate editor. One of the imaging experts here at Circulation, Dr. Victoria Delgado. Victoria, you see a lot of papers come across your desk and as an imaging expert, what attracted you to these two papers? And what do you think are their significance? Dr. Victoria Delgado: Thank you, Greg. I think that these two papers are important because right now, if we follow the clinical guidelines, we decide implantation. For example, of an ICD based on the ejection fraction, and we see that in many patients based on ejection fraction, they may not benefit ever from an ICD because they don't have arrhythmias. What other patients who do not meet the criteria often injection fraction below 35%. They may have still arrhythmias. So the article by Igor highlights the relevance of the amount of burden of late government Huntsman with CMR, in patients with non ischemic cardiomyopathy, which are sometimes very challenging patients on how to decide when we implant an ICD or not. We need sometimes to base the decision on genetics. Dr. Victoria Delgado: If we have an on the other hand, the paper of Pasquale, these were patients with normal echocardiogram. So what patient, having arrhythmias where we don't see on echocardiogram, that is the first imaging technique that we usually use to evaluate these patients. We don't see anything, but CMR can give us more information in terms of structural abnormalities and particularly not only the burden of scar, but also the pattern of the scar. And we have seen in other studies that for example, not only for ICD implantation, but for ventricular tachycardia ablation. The characteristics of that scar and some areas where these are short of panel that can be targeted for that ventricular tachycardia ablation can lead to much more precise treatment if you want of these patients. Dr. Greg Hundley: Thank you, Victoria. So it sounds like listeners we're hearing late gadolinium enhancement, regardless of EF could be forecasting, future arrhythmic events. And then also the pattern of late gadolinium enhancement, where contiguous segments in a ring-like fashion may also offer additional prognostic information. Well, now we're going to turn to our editorialists and as you know, listeners at Circulation, we'll bring in an editorialist to really help put things together and uniquely here today, we have Dr. Mark Estes, who is really not an imager per se, but like many of us uses the information from imaging to make clinical decisions. Mark, how do you see this late gadolinium enhancement as perhaps a new consideration for placement of devices? Dr. N.A. Mark Estes: Greg, that's one of the key questions. There's no doubt, not only based on these two studies, which extend our prior information about LGE and patients with valid and non ischemic cardiomyopathies that scar burden is important in predicting not only total mortality, but arrhythmic events. All of the criteria that were used in the original ICD studies, which include the definite, the Skuid half Danish and made it our it trials use only ejection fraction and functional status, no imaging. These are legacy trials. Now, many of them, a decade or more older. And the treatment of advanced heart failure has progressed to the point that the total mortality is dramatically lower than it was at the time of these studies. In some instances down to 4 or 5% per year. The studies are important in that they identify a subgroup of patients with low ejection fractions, less than 35%, who might qualify for ICDs, who are unlikely to benefit. Dr. N.A. Mark Estes: They also identify a group of patients with preserved ejection fraction greater than 35%, less than 50 in whom the risk of sudden death may be substantial. And it extends prior observations about patchy, mid Meyer, cardio wall fibrosis, subendocardial, subepicardial and important ways. But the key issue here, and it was alluded to with Pasquale's comments about prospective validation, is that when one has a risk stratifier and identifies a high risk population that has to be linked to an unequivocal therapy, it improves survival. And we don't have that link quite yet. Dr. N.A. Mark Estes: Prospective randomized trials are unlikely to be done in the low ejection fraction because they would probably be considered unethical. Given the trials that have shown the benefit you can't randomize to defibrillator versus an implantable loop recorders. I think the future really lies in risk stratification for people with preserved ejection fractions greater than 35%, less than 50 using LG in that patient population. Currently, I think the best information we can give to clinicians is to stick with the AHA guidelines, which is PF less than 35% with dilated, nonischemic class II symptoms who have had optimal medical therapy for at least three months using perhaps in that patient population LGE for shared decision-making in patients about the magnitude of the risk. And I think that's as far as we can go pending future studies, and there is one which we can discuss later on the CMR study at just that preserved ejection fraction LGE randomizing to defibrillator versus ILR. Dr. Greg Hundley: Thank you, Mark. So listeners just really quickly, let's go back to each of our experts and ask them, you know, in 20 seconds, Igor, Pasquale, Victoria, and Mark, what's the next study that needs to be performed in this space? Igor, we'll start with you. Dr. Igor Klem: Well, number one, following on Mark's comment on the less than 35% population, I think that it's unlikely that they're randomized clinical trial is ethical in this population, but we may consider a wealth of registry data by now that shows that there is a subgroup of patients who have a lower risk or lower benefit from an ICD. I think in the preserved ejection fraction above 35%, maybe up to 45%, 50%. That's an interesting study that's coming up. Maybe there's more trials that can provide us that robust information that we need today in order to change the guidelines to risk stratify, not based on the LVF, but on the presence of scar or maybe subgroups of scar. Dr. Greg Hundley: Pasquale? Dr. Pasquale Santangeli: Yes. So I think of course, one of the major studies is the one already alluded by this, which is a prospective study that links as specific therapy like ICD or even additional risk factors like we've been using program's stimulation some of these patients to further risk for the five to see what they can benefit. Dr. Pasquale Santangeli: Based another one that I think is important for the study that we did is a mechanistic more study to understand why the ring light pattern was there, as opposed to other patterns. We do believe we think that some of these patients may have an initial form of lb dominant arrhythmogenic paramount. There wasn't really a detective before and ran. Now, if we actually extending our study and have a registry to try to screen also the family members or patients with ring light pattern to understand whether there is a familiar component to it, because really we do not see this type of pattern that commonly and it'd been associated with lb dominant. Magnetic kind of alpha in some others, small studies. Dr. Pasquale Santangeli: So that's the other part to dig in a little bit more into the field type for these patients to understand why one pattern versus another happens and whether that gets main to, to explain why there's a higher risk in one population versus another. Dr. Greg Hundley: Victoria. Dr. Victoria Delgado: Yeah. Following what has been said. I think that from the imaging point of view, we are always criticizing in a way that we increase the burden or the cost of healthcare. But I think that these studies or any randomized study where MRI or echo is used in order to design a therapy and show the value of using that imaging technique to optimize the health care costs is important. So I will not add much on which sort of populations, but probably patients within non ischemic cardiomyopathy with preserved ejection fraction that do not fulfill the recent scores, for example, in hypertrophic cardiomyopathy to be implanted with an ICD. But probably if we see a lot of scar on a AGE where specific patterns that can help to decide which are the patients that have benefited from an ICD implantation, for example. Dr. Greg Hundley: Thank you. And finally Mark. Dr. N.A. Mark Estes: But I think all the major points have been hit here. And unfortunately we have a bit of a dilemma. And that dilemma is that these legacy trials for ICDs, which selected based on low ejection fraction and functional class II were done at a time when contemporary heart failure treatment was not as good as it currently is pharmacologically. And it's been reflected with a lower total mortality. When the mortality in this patient population gets down to the 4 and 5% per year, it's unlikely that any intervention for prevention of sudden death is going to impact on that total mortality. Dr. N.A. Mark Estes: So I do think that the registries hold a lot of promise, giving us insights into the subgroup of patients that previously would have been selected for defibrillators who may not have as much benefit or who may benefit the most. And I think that they will play an important part in perhaps refining the risk stratification with greater sensitivity and specificity in the patient population, less than 35%. I think the CMR guide trial is going to be a critical trial and looking at ICDs in the patient population between 35 and 50%, but we need to be mindful of one thing. And that in the Danish trial, they get a sub study looking at about 240 patients using LGE. And they found that ICD in patients with LGE that was positive, did not make a difference in survival or total mortality. So again, we need to get the data. I think the best clinical practice has come out of the best clinical evidence. You'll clearly be limitations to what we can do, but I think in the future, we'll have much better data to make these judgment calls. Dr. Greg Hundley: Very good. Well listeners, we want to thank our panelists, Dr. Igor Clem, Pasquale, Santangeli, Victoria Delgado, and Dr. Mark Estes for this wonderful discussion related to magnetic resonance imaging, late gadolinium enhancement, and how it may be useful in identifying those at risk for future arrhythmic events. On behalf of both Carolyn and myself, want to wish you a great week and we will catch you next week on the run. Dr. Greg Hundley: This program is copyright of the American Heart Association, 2021.

COVID-19 Miniseries Episode 67: Finding a Solution for Every Long-Hauler

covid-19 school solution miniseries mayo clinic haulers general internal medicine longhauler mayo clinic rochester continuous professional development

Play Episode Listen Later Mar 16, 2021 18:30

Guest: Ravindra Ganesh, M.B.B.S., M.D. Host: Amit K. Ghosh, M.D. (@AmitGhosh006) It has been estimated that as many as 10-30% of patients who have recovered from COVID-19 have an array of symptoms, ranging from minor to disabling, that persist more than four weeks post-COVID infection. These symptoms have not only been identified in patients who had severe symptoms of COVID-19 requiring intensive care unit treatment, but also those who only experienced mild-to-moderate symptoms. The exact cause of this state, most popularly called post-COVID long hauler syndrome, is still under investigation. The symptoms range from mild to disabling fatigue, body aches, atypical chest pain, loss of sense of taste and smell, brain fog, among others and many of these patients need additional evaluation and management to deal with their disabling symptoms. In this podcast Dr. Ravindra Ganesh, the consultant in General Internal Medicine who leads the COVID Frontline Care Team (CFCT) efforts, as well as the Post-COVID Clinic, at Mayo Clinic Rochester, discusses the array of symptoms, management strategies, and research possibilities, as well as opening of an upcoming clinic in Mayo Clinic Rochester that would address the concern of the patient's and deal with the post COVID long hauler symptoms Additional Resources: Post-COVID Syndrome on Ask Mayo Expert: https://askmayoexpert.mayoclinic.org/ To refer a patient to or request an appointment at Mayo Clinic, visit: https://www.mayoclinic.org/appointments Post-COVID Recovery on Mayo Clinic Connect: https://connect.mayoclinic.org/page/post-covid-recovery/ Connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Stroke Alert February 2021

Stroke Alert

Play Episode Listen Later Mar 2, 2021 19:39

On Episode 1 of the Stroke Alert podcast, host Dr. Negar Asdaghi highlights two featured articles from the February 2021 issue of Stroke. This episode also features a conversation with Drs. Fabian Flottmann and Matthew Maros from the Department of Diagnostic and Interventional Neuroradiology, University Medical Center, in Hamburg, Germany, to discuss their article “Good Clinical Outcome Decreases With Number of Retrieval Attempts in Stroke Thrombectomy: Beyond the First-Pass Effect.” Dr. Negar Asdaghi: Are women more likely to suffer from stroke than men? Are oral anticoagulants safe in atrial fibrillation patients with a prior history of GI bleeding? Does pregnancy increase the risk of intracerebral hemorrhage in patients with cavernous malformation? Does the number of retrieval attempts during thrombectomy affect the outcomes of stroke patients in whom successful reperfusion is achieved? In today's podcast, we address some of these topics and much more. You're listening to the Stroke Alert Podcast. Stay with us. Dr. Negar Asdaghi: From the Editorial Board of Stroke, welcome to the Stroke Alert Podcast. My name is Negar Asdaghi. I'm an Associate Professor of Neurology at the University of Miami, Miller School of Medicine, and the host of the monthly Stroke Alert Podcast. We're starting our podcasts with the February 2021 issue of the journal, which also features a special section on Go Red for Women stroke, a comprehensive American Heart Association platform to improve the vascular health of women globally. I hope you enjoy it. Dr. Negar Asdaghi: Cavernous malformations or cavernomas are angiographically called vascular abnormalities, which can pose an increased risk for intracerebral hemorrhage. Cavernomas can have diverse neurological presentations ranging from mild neurological symptoms to seizures, but in some cases may remain entirely asymptomatic and are diagnosed incidentally as part of routine neuroimaging completed for other reasons. Earlier studies had reported higher rates of intracerebral hemorrhage from cavernomas during pregnancy, and have postulated a hormone-related increased expression of vascular endothelial growth factor or basic fibroblasts growth factors to explain this increased rate. Subsequent studies, however, have failed to demonstrate either progesterone or estrogen receptors in cavernomas. So the question is, should presence of cavernous malformation, whether symptomatic or asymptomatic, influence the reproductive choices of women of childbearing age? In the “Influence of Pregnancy on Hemorrhage Risk in Women With Cerebral and Spinal Cavernous Malformations,” Dr. Nycole Joseph and colleagues from the Departments of Neurology and Neurosurgery from Mayo Clinic Rochester in Minnesota evaluated 365 pregnancies and 160 women with brain or spinal cord cavernomas. They found that during the cumulative 402 years of study follow-up, the risk of hemorrhage amongst non-pregnant patients in the study was 10.4% per year. They found only four patients with clinical hemorrhage during pregnancy, all of which resulted in the cavernomas being first diagnosed. None of the hemorrhages occurred during delivery, and all of the four patients had functionally independent outcomes by three months. Importantly, they found that no patient who became pregnant after the diagnosis of cavernous malformation had a hemorrhage while pregnant. They had a total of 33 pregnancies in the study, including one patient who had previously bled during a prior pregnancy and also patients with brainstem lesions and those who presented with hemorrhage at diagnosis. Both of these are factors for hemorrhage in cavernomas. So, in summary, in this prospective study, pregnancy did not increase the risk of hemorrhage in women with a known brain or spinal cord cavernous malformation. And the vaginal delivery was safe in this population. The authors concluded that the presence of cavernous malformation should not influence the reproductive choices in women or their type of delivery. Now, speaking of hemorrhage risk, let's move on to our next paper on anticoagulation therapy in patients with atrial fibrillation. The decision to start anticoagulants for atrial fibrillation can often be challenging in those who have suffered from a prior gastrointestinal bleeding. Prior studies have shown that the non–vitamin K antagonist oral anticoagulants, or NOACs, can carry a comparable and, in some cases, even a higher risk of GI bleed than warfarin. It should be noted that patients with a prior GI bleed were generally excluded from the pivotal randomized control trials that approved NOACs. And importantly, the risk of bleeding may also be higher in certain race/ethnic groups, such as the Asian population. In the article titled “Non–Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation and Prior Gastrointestinal Bleeding,” Dr. Soonil Kwon from the Department of Internal Medicine, Seoul National University Hospital, in Seoul, Republic of Korea, studied over 42,000 anticoagulant–naïve patients with nonvalvular atrial fibrillation and prior GI bleed from 2010 to 2018 as part of a retrospective, observational cohort study in Korea. They evaluated the risk of ischemic stroke, major bleeding and combined outcomes in this population. What they found was that, not surprisingly, close to 60% of patients were initiated on a NOAC, with rivaroxaban leading dabigatran, apixaban, followed by edoxaban in terms of frequency of agents used. Just over 40% of patients were started on warfarin. Now, over the study follow-up, when they looked at the safety by looking at major bleeding rate and effectiveness by assessing ischemic stroke rates, NOACs generally did better as compared to warfarin, resulting in 39% risk reduction in recurrent stroke, 27% risk reduction in major bleeding and 34% risk reduction in composite outcomes as compared to warfarin. And the rates of upper and lower GI bleed were similar in NOACs versus warfarin users. NOACs still did better as compared to warfarin amongst patients who suffered from GI bleed as they had a lower transfusion rates and shorter hospital stay. NOACs were also associated with lower risks of fatal clinical outcomes except for fatal GI bleed. So the authors concluded that contrary to some of the prior reports, NOACs may be a better option than warfarin for stroke patients and atrial fibrillation patients with prior GI bleed. Dr. Negar Asdaghi: Moving from secondary prevention to acute stroke therapy, our last article discusses how the technical details of endovascular thrombectomy may affect the outcomes in patients with ischemic stroke. So, achieving a successful reperfusion is the cornerstone of improving clinical outcomes in patients undergoing endovascular therapy, but how many retrieval attempts should be made by the interventionist to obtain that desired successful reperfusion is still unclear. Importantly, if successful reperfusion is ultimately achieved, it's still not clear if there's a relationship between the number of retrieval attempts and favorable clinical outcomes. Joining me now are doctors Fabian Flottmann and Matthew Maros from the Department of Diagnostic and Interventional Neuroradiology, University Medical Center, in Hamburg, Germany, who are the first and senior authors of the study titled “Good Clinical Outcome Decreases With Number of Retrieval Attempts in Stroke Thrombectomy: Beyond the First-Pass Effect.” Good morning from Florida, and good afternoon, Fabian and Máté, in Germany. Thank you for joining us. Dr. Fabian Flottmann: Thank you very much, Negar, for the nice introduction. Good afternoon from Hamburg. At the moment, it's really, really cold here. It's -4 degrees Celsius. I can't translate it to Fahrenheit, but it's pretty cold, let me assure you. And thank you very much for having us today. Dr. Negar Asdaghi: It's great to have you. So I start with Fabian. This is a very interesting and timely study as we're learning more that the way in which we achieve a goal in acute stroke reperfusion therapies is almost as important as the goal itself. Can you tell us a bit about the background of your study, Fabian, and why you felt the need to look at these granular details, which unfold inside the angio suite during endovascular thrombectomy? Dr. Fabian Flottmann: Of course, that's a question that's highly relevant for a neurointerventionalist. This research topic developed from our clinical practice, because quite often we have the situation in the angiography suite, where we try to open a vessel, a patient with a large vessel occlusion, and everything is very easy if the vessel opens after one retrieval attempt, because everybody is happy and you can end the procedure. But what happens if the vessel doesn't open? Then you try again. And what happens if the vessel doesn't open? You try it again, and so on and so on. So the question is, when should you stop? And we ask ourselves, are these maneuvers that we do, like three or four or five maneuvers, are they as successful or as beneficial for the patient as the first maneuver? We did an analysis of our data in Hamburg, and that led to the first paper that we published in Stroke in 2018. And our finding was that the third or fourth retrieval, they were successful in achieving recanalization, but the clinical outcome of those patients was not as good as those patients that you opened with just one retrieval attempt. That was the first finding that we had with our data and our center. And then in the same year, the first pass effect was described. The first pass effect, being the finding that the first retrieval attempt is the most important for the patient. This data was very interesting. And then there were other publications that said, no, there's no connection between the number of retrieval attempts and the clinical outcome. So, as always, in science, when there's more than one opinion, things begin to get interesting. And we said we want to investigate this further. And we decided to do a multicenter study with more patients. And we decided to look at each retrieval attempt separately, to not look just at a first retrieval attempt versus the others, but at each retrieval attempt. Dr. Negar Asdaghi: So interesting indeed. Please tell us, before you tell us about the study findings, about the German Stroke Registry. How many years has the registry been active, and how many centers are involved, and please walk us through your study population and the selection process of your study? Dr. Fabian Flottmann: Germans Stroke Registry. It's a systematic observational registry study from Germany. It's academic, it's independent, prospective, multi-central, there are 25 centers who participate in this registry. And its goal is to have a systematic evaluation of endovascular stroke treatment in Germany. There are stroke centers from all around the country who consecutively enroll their patients. All patients with an intention to treat in the angiography suite are included. All the patient data are collected at the center and all these data are then centralized and we have a central quality check. And what is important that we also try to include the clinical follow-up information for every patient at day 90. So, the modified Rankin Scale at day 90 is also included. And in our work, we did an analysis of the first 2,600 patients of this German Stroke Registry, and our goal was to eliminate bias. So, for example, we wanted to include data on the stroke severity, the NIHSS score, the amount of early infarction, the ASPECTS score and the location of occlusion, the age of the patient. We selected all the patients that had these data entered. So, we were able to select about 1,200 patients from the German Stroke Registry that fulfilled our inclusion criteria for the present study. To our knowledge, this is the largest multicentric, retrospective study that investigated this effect of retrieval attempts on clinical outcome. Dr. Negar Asdaghi: This is really nice because we are really not used to getting granular details and radiographic details in such large numbers. So, the multicenter nature and the large number of patients included in your study are certainly important strengths of your paper, and that should be noted. Now, Matthew, over to you. Please tell us the main findings of the paper. Dr. Matthew Maros: So, one specialty of our applied methodology is that we used a generalized mixed-effects models, if we didn't know logistic regression framework. That means that our target variable was the mRS90 and the good functional outcome, defined by zero to two scores by mRS. We also implied this framework to be comparable to the HERMES meta-analysis by Goyal et al. And we investigated, in our primary analysis, the effect of age, the baseline stroke severity NIHSS score, ASPECTS score, and also the main explanatory variable that we investigated was the successful reperfusion at N-th retrieval attempt. And we found that, so as one would expect, a younger age and the less severe stroke clinical manifestation, like NIHSS score, was inversely associated with a good functional outcome. So, younger patients and less severe stroke were associated with a favorable outcome. And also, a less severe ischemic changes on a non-contrast head CT, so ASPECTS score eight, nine or ten, were also independent predictors for a good function outcome at 90 days. Our main finding was that the success at the first, second, or third retrieval attempts were significantly and independently associated with a good functional outcome. And interestingly, the effect of the consecutive retrieval attempts were gradually diminishing from an odds ratio from six (around) to three. Dr. Negar Asdaghi: This is interesting. So, basically, what you found is that you go in with the first attempt, second and third, you don't achieve that successful recanalization. If you achieve your successful reperfusion after the third attempt, it's good, but not so good, meaning that it doesn't translate to that beautiful, favorable outcome at 90 days as it did for the first three attempts. Dr. Matthew Maros: So, for four or more retrieval attempts, this positive effect on the outcome has flattened, so the curve is more like a sigmoid curve that was asymptotic to a virtual threshold. Dr. Negar Asdaghi: Understood. So, I find it very interesting that this decline in the odds of favorable outcome, despite successful reperfusion, was not simply a factor of time, meaning that, if you tried once and you achieve reperfusion right away, it's so much faster. And of course, time is brain, but if you try five times, it would take longer. It is interesting in your results and your multivariate analysis that even if you adjusted for the factor of delay in time, the results persisted. Could you please tell us about your multivariate analysis and what other factors and co-founders you adjusted for? Dr. Matthew Maros: Exactly. So, as a sensitivity analysis, we also included the time from groin puncture to flow restoration and also sex, and also to be almost identical or highly similar to the model applied in the HERMES meta-analysis. We also included the site of the intracranial occlusion and better intravenous thrombolysis was administered or not. And in the sensitivity analysis, we had almost 90% of our dataset. So almost a thousand one hundred patients. And we found that all the effects of age and NIHSS score stayed significant, and also the effect of the first, second and third retrieval attempts associated with good functional outcome at 90 days were also significant. While interestingly, the effect of intravenous thrombolysis, and also the ASPECTS score, had diminished, but also just narrowly escaped a significant threshold. And interestingly, the effect of time, so time from groin puncture to flow restoration, seemed to be not relevant or be interpreted that way, that the number of retrieval attempts and the effect that we see is not a surrogate of time, that it simply takes longer to perform the interventions, but it's the true effect of achieving recanalization at a certain attempt. Dr. Negar Asdaghi: So, what should be our takeaway from your study, Fabian? Is three that magic number? Are we asking the interventionalist to stop the procedure after the third retrieval attempt if they're unsuccessful, and what should the future hold in terms of studies on this project? Dr. Fabian Flottmann: That's the most important question. Of course, we have to keep in mind that every patient and every intervention is different. The decision to continue or stop the thrombectomy procedure is a very important decision, which is taken by the neurointerventionalist together with his team. And they will take into account multiple factors, including patient's biography, medical history at time from symptom onset, image data, and so on. Our study can provide some guiding information when making this decision. And yes, three could indeed be called a magic number in the following sense. We would like to encourage interventionalists to make at least three attempts in case of persistent occlusion, because we can see a clear benefit even when reperfusion is achieved after the third attempt. Then, in patients with younger age and/or, for example, a good ASPECTS score, even more retrieval attempts are probably warranted regardless of IV thrombolysis, site of occlusion and potentially increased procedure time. Of course, in all these retrospective studies, a bias remains. We don't know why the procedure was stopped in each case. The best thing would be a randomized controlled trial with the following design. You could, in case of persistent occlusions, after two retrievals, randomize to continue or to stop the procedure. And then we would know what the right answer is. So, taken together, our study suggests that in EVT for anterior circulation strokes, at least three retrieval attempts should be performed in cases of persistent occlusion, and up to five attempts of beneficial association with good clinical outcome is expected. Dr. Negar Asdaghi: Doctors Fabian Flottmann and Matthew Maros, thank you very much for joining us and congratulations on this work. And this concludes our podcast today. Don't forget to check the February table of contents for the full list of publications, including original contributions, brief reports, editorials, and our special section on Go Red for Women stroke. Until our next podcast, stay alert with Stroke Alert.

Debates and Controversies in Multiple Myeloma

Healthcare Unfiltered

Play Episode Listen Later Feb 9, 2021 72:31

Vincent Rajkumar, (@VincentRK), MD, hematologist at the Mayo Clinic (Rochester, MN), joins the show to guest host a debate between Sagar Lonial (@SagarLonialMD), MD, FACP, chief medical officer of Winship Cancer Institute of Emory University, and Rafael Fonseca, (@Rfonsi1), MD, interim director of Mayo Clinic Cancer Center. These multiple myeloma “gurus” dive into imaging, smoldering disease, endpoints, maintenance, minimal residual disease, and so much more.

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E18: Life Lessons with Dr. Rondell Graham

Your Path in Focus, LLC

Play Episode Listen Later Feb 5, 2021 59:11

This week's #YourPathInFocus features life lessons from one of my favorite academic pathologists, Dr. Rondell Graham of Mayo Clinic Rochester. Listen to his major life lessons that got him to where he is today, how he structures his day for maximal efficiency, and how he prioritizes family and relationships. This episode is loaded with pearls and strategies for professional and personal success! Want more? Subscribe to YourPathInFocus.com and email me at YourPathInFocus@gmail.com to learn more about my 1:1 coaching services. Your extraordinary everything is waiting. Keep Your Path in Focus, Christina Arnold, MD https://freemusicarchive.org/search?adv=1&music-filter-public-domain=1

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Episode 7 - Residency Application Series: The Path for IMGs to US Neurosurgery

The Neurosurgeon's Journey

Play Episode Listen Later Dec 16, 2020 63:40

A discussion on what it takes for an IMG to earn a neurosurgery residency spot in the United States, with Dr. Panos Kerezoudis, PGY3 from Mayo Clinic Rochester, and Dr. Gregoire Chatain, PGY4 from the University of Colorado.

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COIs in Medicine: A Broken System

Healthcare Unfiltered

Play Episode Listen Later Oct 27, 2020 55:49

Vincent Rajkumar (@VincentRK), MD, hematologist at the Mayo Clinic (Rochester, MN), shares the distinction between conflicts of interest that guide individual physicians and those that guide entire practices, what types of conflicts should be collected as “material” and which should be disregarded (eg, “transfer of value” payments), issues with disclosure expectations in modern medical research, and an idea to create standards for more appropriate and warranted disclosures. Watch a previous discussion Chadi had with Dr. Rajkumar on conflicts of interest https://www.medscape.com/viewarticle/924320

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EP296: Oncology FAQs About Telehealth, Standardizing Care, and Drug Prices, With Vincent Rajkumar, MD, of Mayo Clinic, Rochester

Relentless Health Value

Play Episode Listen Later Oct 15, 2020 33:04

My guest in this health care podcast is Vincent Rajkumar, MD. Dr. Rajkumar is a professor of medicine at Mayo Clinic, Rochester. He’s also a practicing hematologist at the Mayo Clinic with a focus on multiple myeloma. Dr. Rajkumar does research and conducts clinical trials. He’s a well-known thought leader in questions about the cost of drugs in this country versus other countries. So, let me tell you what happened with this episode: I mentioned to a few people I would be speaking with Dr. Rajkumar, and every single person I mentioned it to sent me questions to ask him. So, that happened. I wound up with way too many questions; thus, I spent my Thursday evening organizing said questions into some semblance of a logical order. In this health care podcast, we talk about telehealth in oncology. We talk about standardizing treatment pathways in oncology amidst the growing complexity of said treatments and how this could potentially help community oncologists and generalists. We wrap things up with Dr. Rajkumar’s insights on the high price of oncology and other drugs. You can learn more by reading Dr. Rajkumar’s papers about the high cost of insulin, the high cost of prescription drugs, and cost-effective therapy of multiple myeloma. You can also watch his presentation on the high cost of prescription drugs. S. Vincent Rajkumar, MD, is the editor in chief of Blood Cancer Journal and the Edward W. and Betty Knight Scripps Professor of Medicine, Mayo Clinic, Rochester, Minnesota. His academic career was profiled by The Lancet (November 26, 2011). He is co-chair of the International Myeloma Working Group (IMWG) and chair of the Eastern Cooperative Oncology Group (ECOG) myeloma committee. He also serves as the associate editor for Mayo Clinic Proceedings, Leukemia, and European Journal of Hematology. Dr. Rajkumar has received several awards, including the Giants of Cancer Care Award (2019) from OncLive and the Robert A. Kyle Lifetime Achievement Award, an honor given by the International Myeloma Foundation (IMF). He has also received the Relentless for a Cure Award from the Leukemia and Lymphoma Society (2010), the John Ultmann Lecture and Award (2011), and the Janet Davison Rowley Patient Impact Research Award from Cures Within Reach Foundation (2015). He was named Mayo Clinic Distinguished Investigator in 2018. He serves on the board of directors for the IMF and is a member of the National Institutes of Health’s Multiple Myeloma Steering Committee. Dr. Rajkumar has over 600 publications, including over 350 peer-reviewed original research papers and over 200 reviews and book chapters. 01:45 What is the perspective on telehealth and its impact on oncology? 03:50 “Cancer has become extraordinarily complex.” 05:32 Is it possible to still have community oncologists in the advent of technology? 08:39 What’s the viability for flat-fee reimbursement in oncology? 14:31 “The pathways should be designed and developed by people who don’t have a financial stake [or] conflict.” 18:34 “Part of the problem for physicians is, you want to deliver the best care.” 21:23 “There are no allies in this fight for lower prescription drug costs.” 23:18 “This is not like a television or a car where you can say you can live without it.” 24:33 “It’s absolutely not a free market.” 25:35 “Each drug is a monopoly.” 30:22 “When you do value-based pricing, you’re not putting a price on anybody’s life. You’re only putting a price on what [a] drug is worth.” You can learn more by reading Dr. Rajkumar’s papers about the high cost of insulin, the high cost of prescription drugs, and cost-effective therapy of multiple myeloma. You can also watch his presentation on the high cost of prescription drugs. @VincentRK of @MayoMyeloma discusses #oncology #FAQs on this week’s #healthcarepodcast. #healthcare #digitalhealth #healthtech What is the perspective on telehealth and its impact on oncology? @VincentRK of @MayoMyeloma discusses #oncology #FAQs on this week’s #healthcarepodcast. #healthcare #digitalhealth #healthtech “Cancer has become extraordinarily complex.” @VincentRK of @MayoMyeloma discusses #oncology #FAQs on this week’s #healthcarepodcast. #healthcare #digitalhealth #healthtech Is it possible to still have community oncologists in the advent of technology? @VincentRK of @MayoMyeloma discusses #oncology #FAQs on this week’s #healthcarepodcast. #healthcare #digitalhealth #healthtech “The pathways should be designed and developed by people who don’t have a financial stake [or] conflict.” @VincentRK of @MayoMyeloma discusses #oncology #FAQs on this week’s #healthcarepodcast. #healthcare #digitalhealth #healthtech “Part of the problem for physicians is, you want to deliver the best care.” @VincentRK of @MayoMyeloma discusses #oncology #FAQs on this week’s #healthcarepodcast. #healthcare #digitalhealth #healthtech “There are no allies in this fight for lower prescription drug costs.” @VincentRK of @MayoMyeloma discusses #oncology #FAQs on this week’s #healthcarepodcast. #healthcare #digitalhealth #healthtech “It’s absolutely not a free market.” @VincentRK of @MayoMyeloma discusses #oncology #FAQs on this week’s #healthcarepodcast. #healthcare #digitalhealth #healthtech “Each drug is a monopoly.” @VincentRK of @MayoMyeloma discusses #oncology #FAQs on this week’s #healthcarepodcast. #healthcare #digitalhealth #healthtech

Pelvic Injuries Multidisciplinary Approach

Mountain Land Pelvic Health Podcast

Play Episode Listen Later Sep 7, 2020 49:57

Episode 24 of the Mountain Land Pelvic Health Podcast is now available! Dr. Richard Hurst is our guest for this episode. Dr. Hurst attended Drexel University College of Medicine Philadelphia from 2005-2009 and completed his residency at the Mayo Clinic Rochester in Physical Medicine and Rehabilitation from 2010 to 2013. He is board-certified physical medicine and rehabilitation and is a member of the American Academy of Physical Medicine and Rehabilitation.…

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IHC Talk: Managing Laboratory IHC Testing

The PathPod Podcast

Play Episode Listen Later Jul 31, 2020 60:11

The chromogen siblings talk with Dr. Anja Roden (@AnjaRodenMD) of Mayo Clinic Rochester, Minnesota, and Dr. Frank Ingram (@Chucktowndoc) of Presbyterian Pathology Group in Charlotte, North Carolina, about directing IHC laboratories and managing testing menus. Featured public domain music: Alpha Hydrae, Won't see it comin'.

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Intrapreneuring in Healthcare to Create Better Patient Care

Innovation Unleashed Podcast

Play Episode Listen Later Jul 9, 2020 32:48

Innovation demands trialing and attempts to change entire industries with novel approaches. By nature, innovation is immersed in unusual levels of risk and failure. Typically, we associate entrepreneurs with the ability and fearlessness of facing risk and failure to build innovative technology solutions and companies. But building and leading an innovative future-reaching healthcare organization within a system also requires a certain fearlessness and a similar spirit or an INTRApreneurial spirit. An intrapreneur is defined as “a person within a large organization who takes direct responsibility for turning an idea into a profitable finished product through assertive risk-taking and innovation.” But unlike an entrepreneur, an intrapreneur doesn’t own the product or service that they innovate; the system or organization owns the creative ideas and end products created by the individual(s). INTRApreneurs in healthcare organizations often do this work as part of a calling to help society, create solutions, change industries and impact humanity. This episode’s guest is an Intrapreneur working on the cutting edge of healthcare innovation and has spent her career matching her passion of caring for patients with a desire to implement novel technology solutions to create tools for better patient care at the right time and place. Dr. Tufia Haddad is an Associate Professor of Oncology at the Mayo Clinic College of Medicine and Science, and a Consultant in the Department of Oncology. Her clinical practice and research program is dedicated to breast cancer. She currently serves as the Chair of Digital Health for the Department of Oncology and Chair of the Breast Medical Oncology Practice at Mayo Clinic Rochester. She is the Medical Director of Remote Patient Monitoring services for the Mayo Clinic Center for Connected Care, and she is a member of the Mayo Clinic Advisory Board to the Office of Augmented Human Intelligence. As an oncologist and clinical investigator, she is an active member of the Mayo Clinic Cancer Center, Women’s Cancer Research Program, and she has received federal funding in support of biomarker discovery and early phase clinical trials in drug-resistant breast cancer. In the field of digital health, her interest is in the transformation of healthcare delivery models and development of clinical decision support with novel connected health and artificial intelligence technology solutions. Dr. Haddad has authored over 50 peer-reviewed manuscripts, book chapters, and editorials. Dr. Haddad received her Bachelor of Sciences degree in Biology, magna cum laude, from Marquette University. She completed medical school at Creighton University and is an Alpha Omega Alpha honor society member. Her Internal Medicine residency was completed at the Mayo Clinic (Rochester, Minnesota), and her fellowship in Hematology, Oncology, and Transplantation at the University of Minnesota. She received student humanitarian, individual excellence in medicine, and teaching awards throughout her training, as well as several educational excellence awards while on faculty at the University of Minnesota and the Mayo Clinic College of Medicine and Science.

Opioid Edition 5: Acute Prescribing: Emergency Room Prescribing

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Play Episode Listen Later Feb 20, 2020 23:13

Guest: Casey M. Clements, M.D., Ph.D. (@CaseyClmnts)Host: Tracy McCrayEpisode 5 of 10: Dr. Casey Clements, an emergency physician and practice leader, who works in the opioid stewardship program at Mayo Clinic-Rochester, shares his insights on opioid therapy from the Emergency Department perspective. What is drug diversion? How do you know a patient isn’t receiving prescriptions from multiple physicians?Claim CME credit at ce.mayo.edu/opioidpc. This episode is required to be compliant with controlled substance prescribing guidelines in the state of Minnesota.

Opioid Edition 5: Acute Prescribing: Emergency Room Prescribing

Simply PM&R

Play Episode Listen Later Feb 20, 2020 23:13

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The Road to Chair: Interview with Carmen Terzic, MD, PhD

Association of Academic Physiatrists

Play Episode Listen Later Jan 14, 2020 31:10

Listen to the 5th episode of The Road to Chair, a podcast series developed by the AAP's Resident/Fellow Council (RFC). In this episode, Neal Rakesh, MD, Chair of the RFC, interviews Carmen Terzic, MD, PhD, Department Chair and Professor of PM&R at Mayo Clinic Rochester. Dr. Terzic shares her journey from choosing a career in medicine to becoming a Department Chair, as well as insights and tips on getting into research, advancing in your career, and much more.

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Episode 153: Stefan Madansingh and the Mayo Clinic Office of Entrepreneurship

Rochester Rising

Play Episode Listen Later Nov 20, 2019 27:04

This week on show we chat with Stefan Madansingh, a Research Fellow with the Mayo Clinic Office of Entrepreneurship. The Office of Entrepreneurship (OE) supports aspiring entrepreneurs within Mayo Clinic through educational programs, grant writing support, and community events. On the podcast today we talk about: • The power of the lean startup method to solve business problems using a scientific approach. • The Office of Entrepreneurship’s educational courses within Mayo Clinic, including plans to build a certificate and master’s program in Entrepreneurship. • The OE’s involvement in the community to promote a culture of entrepreneurship, which includes a bi-annual life science business pitch competition called Walleye Tank. • Self-motivation that occurs through surrounding yourself with exciting ideas. • The upcoming Walleye Tank competition, which will be held on December 6th on the Mayo Clinic Rochester campus. • The value of Walleye Tank to startups and other attendees. Links from the podcast today: Walleye Tank: Website: http://www.walleyetank.com/ Eventbrite registation: https://www.eventbrite.com/e/walleye-tank-ice-fishing-edition-2019-tickets-76156713781 Music Attribution: Odd News by Twin Musicom is licensed under a Creative Commons Attribution license (https://creativecommons.org/licenses/by/4.0/). Artist: http://www.twinmusicom.org/ Today’s podcast is sponsored by: Rochester Home Infusion Website: https://www.rochesterhomeinfusion.com/ Facebook: @RochesterHomeInfusion LiveAtom Website: https://liveatom.com/ Facebook: @liveatomnow Twitter: @LiveAtomNow Rochester Area Economic Development, Inc. (RAEDI) Website: http://www.raedi.com/ Facebook: @RAEDImn Twitter: @RAEDIInfo

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713. Imaging Patterns in Myelopathies and Myelitis

Ask the Expert

Play Episode Listen Later Aug 8, 2019 48:09

The TMA is joined by Dr. Eoin Flanagan, Associate Professor of Neurology and Consultant in the departments of Neurology and Laboratory Medicine and Pathology at the Mayo Clinic (Rochester, MN). Dr. Flanagan defines different imaging techniques and discusses how imaging is used to diagnose rare neuroimmune disorders. He discusses what imaging results can tell us about prognosis and the likelihood of developing multiple sclerosis. He provides guidelines for how often to get new MRIs after an inflammatory event, and what new imaging can tell you about your condition. Finally, research and the future of imaging techniques is discussed.

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55 – Anticoagulation of the ECMO Patient with Troy Seelhammer

ED ECMO

Play Episode Listen Later Jun 4, 2019 31:25

Do you give heparin to your ECMO patients? Well, let's rethink this. This episode is All Things Anticoagulation! Zack talks with Troy Seelhammer, an intensivist from Mayo Clinic Rochester. He manages ECMO patients in his daily practice there. He has become a master of the subject of anticoagulation. He will talk about heparin, bilvalirudin, or maybe no anticoagulation. He talks about the when to be aggressive and when to cut back. Below is a wonderful synopsis of Troy's thoughts on anticoagulation on pump. The post 55 – Anticoagulation of the ECMO Patient with Troy Seelhammer appeared first on ED ECMO.

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TRIPOM 1.03 | Setting up a perioperative surgical home

TopMedTalk

Play Episode Listen Later Apr 11, 2019 14:50

What's the need for a perioperative surgical home? How do issues with aging populations and higher risk patients increase the need to intervene early in their care and treatment? How do you build institutional credibility in this area? How do you approach this area from the point of view of patient need? Crucially, how do you build and inspire a multidisciplinary team around these essential strategic needs? What pitfalls arise in the process, how do you inspire a "volunteer army" to help you distribute the workload and how do you set realistic goals and timelines for the overall workflow? Finally, should all of this become part of the "standard of care"? Presented by Robin Schiller and Bridger Bach with their guest Dennis Bierle, M.D. Internist at the Division of General Internal Medicine, Department of Medicine, Mayo Clinic Rochester.

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Living With PSC Episode 9 - Dr. Konstantinos Lazaridis: The Interaction Between Genetics & Environmental Exposures in PSC

Living With PSC

Play Episode Listen Later Feb 11, 2019 30:24

PSC Partners Seeking a Cure is pleased to present Living With PSC, a podcast moderated by Niall McKay. Each month, this podcast will explore the latest research and knowledge about PSC. From patient stories, to the latest research updates from PSC experts, to collaborations that are necessary to find better treatments and a cure, this podcast has it all! In the ninth episode of Living with PSC, Niall McKay discusses the interaction between genetics and environmental exposures in PSC, with Dr. Konstantinos Lazaridis from Mayo Clinic Rochester. Dr. Lazaridis has received multiple PSC Partners research grants. Enjoy!

Troponin Edition: Inpatient Care

care healthcare cme inpatient ep3 jamie newman troponin mayo clinic rochester

Play Episode Listen Later Mar 13, 2018 33:00

Ep3 of 3: Which patients should be placed in monitored beds? Are there other factors to consider besides the troponin values when treating patients with ACS? Dr. Jamie Newman, a hospitalist at Mayo Clinic-Rochester and Dr. Allan Jaffe, a cardiologist and consultant at Mayo Clinic-Rochester share their insights on inpatient care, including pre- and post-surgery patients. Healthcare providers looking to claim CME credit for this podcast series should go to ce.mayo.edu/troponinpc and register.

Troponin Edition: Emergency Medicine

healthcare emergency medicine cme ep2 jamie newman troponin mayo clinic rochester

Play Episode Listen Later Mar 7, 2018 16:05

Ep2 of 3: Dr. Jamie Newman, a hospitalist at Mayo Clinic-Rochester and Dr. Casey Clements, an emergency physician from Mayo Clinic-Rochester discuss how the new 5th generation assay for troponin will affect emergency medicine. What are the benefits and potential difficulties associated with the new test?Healthcare providers looking to claim CME credit for this podcast series should go to ce.mayo.edu/troponinpc and register.

Troponin Edition: The 5th Generation Assay

healthcare generation cme ep1 assay jamie newman troponin mayo clinic rochester

Play Episode Listen Later Feb 28, 2018 18:51

Ep1 of 3: How does the 5th generation assay differ from the 4th generation assay? Will a more sensitive assay improve clinical practice? Dr. Jamie Newman, a hospitalist at Mayo Clinic-Rochester and Dr. Allan Jaffe, a cardiologist and consultant at Mayo Clinic-Rochester walk us through the new 5th generation assay for troponin. Healthcare providers looking to claim CME credit for this podcast series should go to ce.mayo.edu/troponinpc and register.

Opioid Edition 5: Acute Prescribing: Emergency Room Prescribing

minnesota opioids acute emergency rooms clements emergency departments prescribing mayo clinic rochester

Play Episode Listen Later Jan 4, 2018 23:13

Pediatric Urology I

Stay Current in Pediatric Surgery

Play Episode Listen Later Nov 2, 2017 70:01

This podcast is a discussion between Dr. Todd Ponsky and Dr. Patricio C. Gargollo who is the senior associate consultant pediatric urology at the Mayo Clinic Rochester and associate professor of urology at the Mayo medical school. It is a bout pediatric urology mostly regarding external genitalia and this is going to be an overview for pediatric surgeons to get an idea about all the things that we probably should know about external genitalia as a relates to pediatric urology. Facilitator: Dr. Todd Ponsky Editors: Dr. Todd Ponsky, Dr. Sophia Abdulhai, Dr. Abdulraouf Lamoshi and Dr. Raghavendra Rao

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Building a Better Human: Is it morally acceptable to enhance the chemical and genetic nature of persons? Pt. 3 (9/16/2004)

Center for Applied Christian Ethics Lectures

Play Episode Listen Later Oct 12, 2017 27:11

September 16, 2004 Follow-up Focusing on the moral acceptability of genetic enhancement, speakers Dr. Hook and Dr. Peterson presented a thought-provoking and enriching evening at the 2004 Penner Debate. With over 750 in attendance, including many Wheaton College students, the speakers, aided by moderator Steven Penner, engaged in a variety of topics surrounding the ethical application of genetic enhancement. One of the first, was the actual definition of enhancement. Dr. Hook distinguished between healing and enhancement with the former being therapy, genetic or otherwise, that is used to "heal" a person from an affliction as opposed to an actual "enhancement," in which a person voluntarily changes his or her body chemistry. On the other hand, Dr. Peterson presented enhancement as synonymous with an "improvement" that encompasses the entire person, referring to the many improvements recorded in the Bible in both the Old and New Testaments. He did provide four questions that one should consider as guidelines to a moral application of enhancement. Another topic explored was the societal repercussions of enhancement, such as the potential for an extreme type of inequality-those that are "in" and those that are "out"-based on genetics. For example, if the Smiths can pick and choose the traits of their child, maybe we should too, so our child can compete? But the Jones can't afford it and the XYZs don't believe in it. What happens to these children? Or, if one carries an inherited gene that could create challenges for future offspring, than is that person bound by societal pressures to assure a healthy child by eradicating this gene? For further engagement on this subject, the debate is available online through WETN in several file formatsWith rapid developments in genetic engineering and with stunning results in pharmacology, scientists are providing new ways to enhance human performance. Ought we pursue the opportunity to chemically or genetically enhance our bodies? Should parents provide their children with enhancement drugs or treatments? How much latitude do humans have to shape their abilities and characteristics? Are there natural or divine limits to our progress? This debate will provide candid and helpful analysis of the issues surrounding performance-enhancing technologies. The speakers will provide ethical guidelines rooted in a Christian worldview, with sensitivity to the current developments in pharmacology and genetics. YES "Some enhancements are morally acceptable for the Christian" James C. Peterson, Ph.D. Roy A. Hope Chair in Theology, Ethics and Christian Worldview Professor of Theology and Ethics McMaster Divinity College, Ontario Bio NO Enhancement is morally unacceptable for the Christian C. Christopher Hook M.D. Chair, Non-Malignant Hematology Group, Mayo Clinic (Rochester, MN) Bio

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Building a Better Human: Is it morally acceptable to enhance the chemical and genetic nature of persons? Pt. 1 (9/16/2004)

Center for Applied Christian Ethics Lectures

Play Episode Listen Later Oct 12, 2017 34:56

September 16, 2004 Follow-up Focusing on the moral acceptability of genetic enhancement, speakers Dr. Hook and Dr. Peterson presented a thought-provoking and enriching evening at the 2004 Penner Debate. With over 750 in attendance, including many Wheaton College students, the speakers, aided by moderator Steven Penner, engaged in a variety of topics surrounding the ethical application of genetic enhancement. One of the first, was the actual definition of enhancement. Dr. Hook distinguished between healing and enhancement with the former being therapy, genetic or otherwise, that is used to "heal" a person from an affliction as opposed to an actual "enhancement," in which a person voluntarily changes his or her body chemistry. On the other hand, Dr. Peterson presented enhancement as synonymous with an "improvement" that encompasses the entire person, referring to the many improvements recorded in the Bible in both the Old and New Testaments. He did provide four questions that one should consider as guidelines to a moral application of enhancement. Another topic explored was the societal repercussions of enhancement, such as the potential for an extreme type of inequality-those that are "in" and those that are "out"-based on genetics. For example, if the Smiths can pick and choose the traits of their child, maybe we should too, so our child can compete? But the Jones can't afford it and the XYZs don't believe in it. What happens to these children? Or, if one carries an inherited gene that could create challenges for future offspring, than is that person bound by societal pressures to assure a healthy child by eradicating this gene? For further engagement on this subject, the debate is available online through WETN in several file formatsWith rapid developments in genetic engineering and with stunning results in pharmacology, scientists are providing new ways to enhance human performance. Ought we pursue the opportunity to chemically or genetically enhance our bodies? Should parents provide their children with enhancement drugs or treatments? How much latitude do humans have to shape their abilities and characteristics? Are there natural or divine limits to our progress? This debate will provide candid and helpful analysis of the issues surrounding performance-enhancing technologies. The speakers will provide ethical guidelines rooted in a Christian worldview, with sensitivity to the current developments in pharmacology and genetics. YES "Some enhancements are morally acceptable for the Christian" James C. Peterson, Ph.D. Roy A. Hope Chair in Theology, Ethics and Christian Worldview Professor of Theology and Ethics McMaster Divinity College, Ontario NO Enhancement is morally unacceptable for the Christian C. Christopher Hook M.D. Chair, Non-Malignant Hematology Group, Mayo Clinic (Rochester, MN)

bible nature ethics new testament theology peterson hook mn enhance chemical genetic persons acceptable smiths wheaton college morally better human mayo clinic rochester wetn james c peterson

Building a Better Human: Is it morally acceptable to enhance the chemical and genetic nature of persons? Pt. 2 (9/16/2004)

Center for Applied Christian Ethics Lectures

Play Episode Listen Later Oct 12, 2017 25:18

bible nature ethics new testament theology peterson hook enhance chemical genetic persons acceptable smiths wheaton college morally better human mayo clinic rochester wetn james c peterson

Circulation July 4, 2017 Issue

Play Episode Listen Later Jul 3, 2017 20:37

Dr. Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr. Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore. What is the association between fetal congenital heart defects and maternal risk of hypertensive disorders of pregnancy? We will be discussing new data in this area in just a moment, following these summaries. The first paper describes the effect of long-term metformin and lifestyle measures on coronary artery calcium. This is a paper from Dr. Goldberg of George Washington University Biostatistics Center and colleagues of the Diabetes Prevention Program Research Group. The Diabetes Prevention Program and its outcome study is a long-term intervention study in subjects with prediabetes, which showed reduced diabetes risk with lifestyle and metformin compared to placebo. In the current study, the authors looked at subclinical atherosclerosis, which was assessed in 2,029 participants using coronary artery calcium measurements after 14 years of average follow-up. They found that men but not women with prediabetes treated with metformin for an average duration of 14 years had lower coronary calcium scores than their placebo counterparts. No difference in coronary calcium scores was observed in the group receiving a lifestyle intervention as compared to the placebo group. These findings provide the first evidence that metformin may protect against coronary atherosclerosis in men with prediabetes, although demonstration that metformin reduces cardiovascular disease events in these subjects is still needed before firm therapeutic implications of these findings can be made. The reason for an absence of an effect in women is unclear and deserves further study. The next study provides insights on the physiology of angina from invasive catheter laboratory measurements during exercise. Dr. Asrress of Royal North Shore Hospital in Sydney, Australia, and colleagues, studied 40 patients with exertional angina and coronary artery disease who underwent cardiac catheterization via radial axis and performed incremental exercise using a supine cycle ergometer. As they developed limiting angina, sublingual GTN was administered to half the patients and all patients continued to exercise for two minutes at the same workload. Throughout exercise, distal coronary pressure and flow velocity, and central aortic pressure were recorded using sensor wires. Using this novel invasive approach, the authors showed that administration of GTN ameliorated angina by reducing myocardial oxygen demand as well as increasing supply with a key component being the reversal of exercise-induced coronary lesion vasoconstriction. This was evidenced by the fact that there was a relationship between the diastolic velocity pressure gradient with significant increase in relative stenosis severity. In keeping with exercise-induced vasoconstriction of stenosed epicardial segments and dilation of normal segments, with trends towards reversal with GTN. Thus, this study describes the development of a paradigm where patients with coronary artery disease can exercise while simultaneously having coronary and central aortic hemodynamics measured invasively, and has shown that this provides a unique opportunity to study mechanisms underlying the physiology of angina. In treating patients with exercise-induced angina, the results highlight the importance of after-load reduction and the use of agents that reduce arterial wave reflection and promote coronary artery vasodilation. The next study provides mechanistic insights into reverse cholesterol transport, where excess cholesterol is removed from macrophage-derived foam cells in atherosclerotic plaques. It suggests that melanocortin receptor-1, or MC1-R, may play a role. As background, the melanocortin system, consisting of melanocyte-stimulating hormones and their receptors, regulate a variety of physiological functions, ranging from skin pigmentation to centrally-mediated energy balance control. At the cellular level, the biological actions are mediated by G protein-coupled melanocortin receptors, such as MC1-R. MC1-R not only affects melanogenesis in the skin but also has immunomodulatory effects through its wide expression in the cells of the immune system. In the current study from Dr. Rinne of University of Turku in Finland, and colleagues, human and mouse atherosclerotic samples and primary mouse macrophages were used to study the regulatory functions of MC1-R. The impact of pharmacological MC1-R activation on atherosclerosis was further assessed in apolipoprotein E deficient mice. Their findings identified a novel role for MC1-R in macrophage cholesterol transport. Activation of MC1-R conferred protection against macrophage foam cell formation through a dual mechanism. It prevented cholesterol uptake while it concomitantly promoted reverse cholesterol transport by increasing the expression of ATP-binding cassette transporters, ABCA1 and ABCG1. Thus, the identification of MC1-R in lesional macrophages, demonstration of its role in regulating reverse cholesterol transport, combined with its established anti-inflammatory effects, suggests that MC1-R could be a novel new therapeutic target for preventing atherosclerosis. The next study suggests that obesity-related heart failure with preserved ejection fraction, or HFpEF, is a genuine form of cardiac failure and a clinically relevant phenotype that may require specific treatments. First author, Dr. Obokata, corresponding author, Dr. Borlaug, and colleagues from Mayo Clinic Rochester and Minnesota studied 99 patients with obese HFpEF with a BMI above 35, with 96 non-obese HFpEF with a BMI less than 30, and 71 non-obese controls without heart failure. All subjects underwent detailed clinical assessment, echocardiography, and invasive hemodynamic exercise testing. The authors found that, compared to non-obese HFpEF, obese HFpEF patients displayed greater volume overload, more biventricular remodeling, greater right ventricular dysfunction, worse exercise capacity, more impaired pulmonary vasodilation, and more profound hemodynamic arrangements, despite a lower NT-proBNP level. Obese HFpEF patients displayed other important contributors to high left ventricular filling pressures, including greater dependence on plasma volume expansion, increased pericardial restraint, and enhanced ventricular interaction, which was exaggerated as pulmonary pressure load increased. These data provide compelling evidence that patients with the obese HFpEF phenotype have real heart failure and display several pathophysiological mechanisms that differ from non-obese patients with HFpEF. These and other issues are discussed in an accompanying editorial by Dr. Dalane Kitzman and myself. We hope you enjoy it. The final study identifies a novel long noncoding RNA that regulates angiogenesis. As background, although we know that the mammalian genome is pervasively transcribed, a large proportion of the transcripts do not encode a protein, and are thus regarded as noncoding RNAs. Based on their length, they can be divided into small or long noncoding RNAs, long being described as more than 200 nucleotides. Although their function is not fully understood, long noncoding RNAs have been increasingly reported to mediate the expression of other genes, affect the organization of the nucleus, and modify other RNAs. In the current study by first author, Dr. Leisegang, corresponding author, Dr. Brandes, and colleagues of Goethe University in Frankfurt, Germany, epigenetically controlled long noncoding RNAs in human umbilical vein endothelial cells were searched by axon array analysis following knockdown of the histone demethylase JARID1B. The authors discovered a novel noncoding RNA named MANTIS to be strongly upregulated. MANTIS is located in the antisense strand of an intronic region of the gene for annexin A4, calcium- and phospholipid-binding protein. MANTIS is a nuclear long noncoding RNA that is enriched in endothelial cells but also expressed in other cell types. Reducing MANTIS levels led to impaired endothelial sprouting, tube formation, attenuated endothelial migration, and inhibition of the alignment of endothelial cells in response to shear stress. Brahma-like gene 1, or BRG-1, was identified as a direct interaction partner of MANTIS, implying a role of MANTIS in the formation of the switch/sucrose non-fermentable chromatin remodeling complex. MANTIS binding to BRG-1 was shown to stabilize the BRG-1 interaction, hence by inducing an open chromatin conformation, MANTIS was proposed to maintain the endothelial angiogenic potential. The implications of these findings are discussed in an accompanying editorial by Dr. Zampetaki and Mayr from Kings College London. That brings us to the end of our summaries. Now for our feature discussion. Today, we are going to be discussing the association between fetal congenital heart defects and maternal risk of hypertensive disorders of pregnancy. To discuss this, I have the first and corresponding author of our feature paper, Dr. Heather Boyd, from Statens Serum Institut in Copenhagen, and our familiar Dr. Sharon Reimold, content editor for special populations from UT Southwestern. Welcome, Heather and Sharon. Dr. Heather Boyd: Thank you. Dr. Sharon Reimold: Thank you. Dr. Carolyn Lam: Heather, it's a topic that I can't say I'm very familiar with, association between fetal congenital heart defects and maternal risk of hypertensive disorders of pregnancy. Could you start by sharing why would we think there would be a link? What was the hypothesis you were testing? Dr. Heather Boyd: A couple years ago, there was a paper published in the European Heart Journal that reported evidence of angiogenic imbalance in women with fetuses with major congenital heart defects, so women who were pregnant with babies that had heart defects, and then in fetuses that were terminated because of this kind of defect. My research group focuses a lot of attention on preeclampsia. In the last decade or so, angiogenic imbalance in preeclampsia has been a really hot topic. Women with preeclampsia, particularly women with early-onset preeclampsia, have big angiogenic imbalances. When we saw the European Heart Journal paper, we immediately thought, "What's the connection between preeclampsia and heart defects in the offspring?" Dr. Carolyn Lam: Oh! Dr. Heather Boyd: Exactly. That was our entry point to it, was the term "angiogenic imbalance" in that paper sort of was a flag for us. It wasn't a completely new idea, but we in Denmark have one big advantage when considering research questions that involve either rare exposures and/or rare outcomes, and that's our National Health Registry. We have the ability to assemble these huge cohorts and study conditions like heart defects with good power, so we decided just to go for it. Dr. Carolyn Lam: That makes a lot of sense now. Please, tell us what you did and what you found. Dr. Heather Boyd: The first thing we did was look at the association between carrying a baby with a heart defect and then whether the mom had preeclampsia later in the same pregnancy. We had information on almost 2 million pregnancies for this part of the study. We found that women carrying a baby with a heart defect were seven times as likely as women with structurally normal babies to develop early preterm preeclampsia. We defined that as preeclampsia where the baby has to be delivered before 34 weeks, so the really severe form of preeclampsia. Then, women carrying a baby with a heart defect were almost three times as likely to develop late preterm preeclampsia as well. That's where they managed to carry it until 34 weeks but it has to be delivered some time before 37 weeks. These findings were similar to those of other studies, but we were able to go a step further and look at individual heart defect subtypes. What we found there waws that these strong associations were similar across defect categories. Then we decided to see if we could shed any light on the origin of the problem, whether it was coming from the mom's side or the baby's side. To do this, we looked at women with at least two pregnancies in our study period to see whether preeclampsia in one pregnancy had any bearing on the chance of having a baby with a heart defect in another pregnancy or vice versa. This part of the study included 700,000 women. We found very similar findings. We found that women with early preterm preeclampsia in one pregnancy had eight times the risk of having a baby with a heart defect in a subsequent pregnancy. Late-term preeclampsia in one pregnancy was associated with almost three times the risk of offspring heart defects in later pregnancies. Then, we found that it worked the other way around too. Women who had a baby with a heart defect were twice as likely to have preterm preeclampsia in subsequent pregnancies. Those results were really, really exciting, because whatever mechanisms underlie the associations between preterm preeclampsia in moms and heart defects in the babies, they operate across pregnancies. Therefore, that pointed towards something maternal in origin. Dr. Carolyn Lam: That is so fascinating. Sharon, please, share some of the thoughts, your own as well as those of the editors when we saw this paper. Dr. Sharon Reimold: I think that there's a growing data about the links between hypertensive disorders of pregnancy and preeclampsia with subsequent abnormal maternal outcome. But this paper, I think, has implications for how we look at moms who are going to have offspring with congenital heart defects as well as those with preeclampsia. For instance, I would look at a patient now that has preeclampsia, especially in more than one pregnancy, to identify that they may be at risk to have offspring with congenital defects in the future if they have additional children. But the mom is also at risk based on other data for developing other cardiovascular risk factors and disease as she gets older. It was really the link going back and forth with the hypertensive disorders and the congenital defects that we found the most interesting. Dr. Carolyn Lam: That struck me too, especially when you can look at multiple pregnancies and outcomes. That's amazing. You know what, Heather, could you share a little bit about what it's like working with these huge Danish databases? I think there must be a lot more than meets the eye. Dr. Heather Boyd: It's an interesting question, because I'm a Canadian and I was trained in the US. I did my PhD in epidemiology at Emery, and then I moved to Copenhagen. When I first got here, I was absolutely floored at the possibility of doing studies with millions of women in them. It opens some amazing possibilities, like I said earlier, for certain outcomes and certain exposures. You just need to have a question where the information you want is registered. Dr. Carolyn Lam: Yeah. But I think what I also want to put across is, having worked with big databases, and certainly not as big as that one, it's actually a lot of work. People might think, "Oh, it's just all sitting there." But, for example, how long did it take you to come to these observations and conclusions? Dr. Heather Boyd: I have a fabulous statistician. I think she's the second author there, Saima Basit. She spends a lot of her time pulling together data from different registers. But yes, you're right. The data don't always just mesh nicely. The statisticians we have working with us are real pros at this sort of data slinging. Dr. Carolyn Lam: Could I just pose one last question to both of you. What do you think are the remaining gaps? Dr. Sharon Reimold: I think that this is a clinical link. Then, going back to figure more about what's going on biologically to set up this difference? Because right now there's really no intervention that's going to make a difference, it's just a risk going forward. This is sort of like medicine done backwards, that there's this association and now we need to figure out exactly why. Dr. Heather Boyd: I can piggyback on what Sharon said a little bit, because I think one of the things we need to remember is that not all women with preeclampsia have babies with heart defects. Not by a long shot. What we need to do now is to figure out what distinguishes the women who do get this double whammy from the vast majority who don't. One of the things that Denmark does really nicely is that there are large bio banks. One of the things we want to do is go back to bank first trimester maternal blood samples and see if we can identify biomarkers that are unique to the women with both preterm preeclampsia and babies with heart defects. That's one of the things we're thinking about to address this gap. Because, as Sharon says, we've got to figure out what the mechanism is. The other thing we want to do is to see whether the association between preeclampsia and heart defects extends, for example, to other things, to cardiac functional deficits, for example, because it's probably not just severe structural defects. If there's an association, it's probably on a continuum. Are babies born to preeclamptic moms, do their cardiac outputs differ? Do their electrical parameters differ? Do they just have different hearts? We're really lucky because right now the Copenhagen Baby Heart Study is offering to scan the hearts of all infants born at one of the three major university hospitals in the Copenhagen area. We're about to have echocardiography data on 30,000 newborn hearts to help us look at this. I'm really excited about that possibility. Dr. Carolyn Lam: I've learnt so much from this conversation. I'm sure the listeners will agree with me. Thank you both very, very much.

Circulation December 6, 2016 Issue

Play Episode Listen Later Dec 5, 2016 24:27

Dr. Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr. Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore. Our feature discussion is regarding the exciting results of the masked hypertension study showing that clinical blood pressure underestimates ambulatory blood pressure, but first here's your summary of this week's issue. The first study reviews the largest clinical experience so far with pulmonary vein stenosis following ablation for atrial fibrillation. First author Dr. Fender, corresponding author Dr. Packer and colleagues from Mayo Clinic Rochester, Minnesota evaluated the presentation of 124 patients with severe pulmonary stenosis between 2000 and 2014 and examined the risk for re-stenosis after intervention utilizing either balloon angioplasty alone or balloon angioplasty with stenting. All 124 patients were identified as having severe pulmonary vein stenosis by CT in 219 veins. 82% were symptomatic at diagnosis with the most common symptoms being dyspnea, cough, fatigue and decreased exercise tolerance. 92 veins were treated with balloon angioplasty, 86 with stenting and 41 veins were not intervened on. The acute procedural success rate was 94% and did not differ by initial management. Overall, 42% of veins developed re-stenosis, including 27% of veins treated with stenting and 57% of veins treated with balloon angioplasty. The three-year overall rate of re-stenosis was 37% with 49% of balloon angioplasty treated veins compared to 25% of stented veins developing re-stenosis. This was a difference that remained significant even after adjusting for age, CHADS2 VASC score, hypertension and time period of the study with an adjusted [inaudible 00:02:30] ratio of 2.46 for risk of re-stenosis with balloon angioplasty versus stenting. In summary, this study shows that the risk for pulmonary vein re-stenosis is significant following atrial fibrillation ablation. The diagnosis is challenging due to non-specific symptoms and while there is no difference in acute success by type of initial intervention, stenting significantly reduces the risk of subsequent pulmonary vein re-stenosis compared to balloon angioplasty. The next paper shows that the index of microvascular resistance, which is a novel invasive mreasure of coronary microvascular function, has emerging clinical utility as a test for the efficacy of myocardial re-perfusion in invasively managed patients with acute ST elevation myocardial infarction. In this study by first author Dr. [Carrick 00:03:30], corresponding author Dr. Barry and colleagues from the University of Glasgow in Scotland, index of microvascular resistance and coronary flow reserve were measured in the culprit artery at the end of percutaneous coronary intervention in 283 patients with ST elevation myocardial infarction. Authors found that compared with standard clinical measures of the efficacy of myocardial re-perfusion, such as ischemic time, ST segment elevation and angiographic blush grade, the index of microvascular resistance was more consistently and strongly associated with myocardial hemorrhage, microvascular obstruction, changes in left ventricular ejection fraction and left ventricular end diastolic volume at six months as well as all caused death of heart failure during the median follow up of 845 days. In fact, compared with an index of microvascular resistance greater than 40, the combination of this index and coronary flow reserve less than two did not have incremental prognostic value. The take-home message is therefore that an index of microvascular resistance above 40 represents a prognostically validated reference test for failed myocardial re-perfusion at the end of primary percutaneous coronary intervention. This study supports further research into microvascular resistance based therapeutic strategies in these patients. The next study provides experimental data regarding molecular mechanisms underlying calcific aortic valve disease. First author, Dr. Haji, and corresponding authors Dr. Matthew and [Bose 00:05:24] from the Quebec Heart and Lung Institute in Canada performed genomic profiling and in-depth functional assays in human aortic valves. They demonstrated for the first time that the promotor region of the long non-coding RNA H19 is hypomethylated in patients with calcific aortic valve disease. This hypomethylation in turn increases H19 expression in the valve interstitial cells where it prevents Notch 1 transcription by blocking or out-competing P53's recruitment to the Notch 1 promotor. Thus, H19 appears to be the missing link connecting Notch 1 to idiopathic calcific aortic valve disease. It may therefore represent a novel target in calcific aortic valve disease to decrease osteogenic activity in the aortic valve. The next paper describes the largest cohort of mycotic abdominal aortic aneurysms to date and is from Dr. [Sorelias 00:06:37] and colleagues of Uppsala University in Sweden. These authors identified all patients treated for mycotic abdominal aortic aneurysms in Sweden between 1994 and 2014. Among the 132 patients, they noted that the preferred operative technique shifted from open repair to endovascular repair after 2001 with the proportion treated with endovascular repair increasing from 0% in 1994 to 2000 to 60% in the 2008 to 2014 period. Survival at three months was lower for open repair compared to endovascular repair at 74% versus 96% respectively with a similar trend present at one year. A propensity score adjusted analysis confirmed the early better survival associated with endovascular repair. During a median follow up of 36 months for open repair and 41 months for endovascular repair. There was no difference in long-term survival, infection-related complications or re-operation. The take-home message is that endovascular repair appears to be a durable surgical option for treatment of mycotic abdominal aortic aneurysms. The final study provides insights into the molecular mechanisms by which aldosterone triggers inflammation and highlights the particular role of NLRP3 inflammasome, which is a pivotal immune sensor that recognizes endogenous danger signals and triggers sterile inflammation. Authors Dr. Bruden [Esimento 00:08:32], Dr. [Tostes 00:08:33] and colleagues from the University of Sao Paulo in Brazil analyzed vascular function and inflammatory profiles of wild-type NLRP3 knockout, caspase-1 knockout and interleukin-1 receptor knockout mice, all treated with vehicle or aldosterone while receiving 1% saline. They found that mice lacking the interleukin-1 beta receptor or lacking inflammasome components such as NLRP3 and caspase-1 were protected from aldosterone-induced vascular damage. In-vitro, aldosterone stimulated NLRP3-dependent interleukin-1 beta secretion by bone marrow derived macrophages. Chimeric mice reconstituted with NLRP3 deficient hematopoietic cells showed that NLRP3 in immune cells mediated the aldosterone-induced vascular damage. In addition, aldosterone increased the expressions of NLRP3, caspase-1 and mature interleukin-1 beta in human peripheral blood mononuclear cells. Finally, hypertensive patients exhibited increased activity of NLRP3 inflammasome. Together these data demonstrate that NLRP3 inflammasome via activation of interleukin-1 receptor is critically involved in the deleterious vascular effects of aldosterone, thus NLRP3 is a potential target for therapeutic interventions in conditions with high aldosterone levels. That wraps it up for our summaries. Now for our feature discussion. On today's podcast we are going to be discussing the very important issue of masked hypertension. This is an issue that gets a lot less attention than I think compared to white coat hypertension. I'm so pleased to have the first and corresponding author of the masked hypertension study, Dr. Joseph Schwartz, from Stony Brook University and Columbia University in New York. Welcome to the show, Joe. Dr. J. Schwartz: My pleasure. I'm delighted to join you. Dr. Carolyn Lam: We have a regular on the show today as well, Dr. Wanpen Vongpatanasin, associate editor from UT Southwestern. Welcome back Wanpen. Dr. Wanpen V.: Thank you so much. Happy to be here. Dr. Carolyn Lam: Joe, I want to start by addressing the common misperception that ambulatory blood pressure is usually lower than clinical blood pressure. That seems to make a lot of sense to us clinically because, for example, I always use ambulatory blood pressure to diagnose white coat hypertension and so the assumption there is that my clinically measured blood pressure is higher than what I'm going to be finding if this patient measures the blood pressure on an ambulatory 24-hour basis. It's also from the cutoffs that we use. For example, ambulatory blood pressure we use a 24-hour cutoff of 130/80 to make the diagnosis whereas with clinical blood pressure we use a cutoff of 140/90 so all of this kind of reinforces that ambulatory blood pressure is usually lower. Your study, though, tells us otherwise so please fill us in here. Dr. J. Schwartz: You're right that in the doctor's office there are a certain set of people who probably get anxious when they're around a doctor and with that anxiety may cause a temporary increase in their blood pressure, a temporary elevation, and that's the basis of where we think white coat hypertension comes from. That's a very widespread belief among doctors and it's even been in previous guidelines, there have been statements to that effect. When I talk to people out in the general public and tell them I'm doing a study comparing blood pressure out in the real world compared to blood pressure in the doctor's office, all of them tell me, "Well, usually when I'm in a doctor's office that's a relatively calm period for me unless there's really something wrong with me and out in the everyday world I have to face a variety of stressors. I have deadlines. I have places I need to get to. Sometimes I have people yelling at me. Sometimes I'm just in a hurry." All these things elevate your blood pressure out in the real world and so when we were trying to recruit people for the study, and we were very agnostic in recruiting them, telling them that we were interested in the differences in blood pressures between the doctor's office and the ambulatory blood pressure and they might go in either direction. When I told them about the fact that their ambulatory blood pressure or real world blood pressure might be higher than in the doctor's office, the vast majority of people nodded affirmatively and said, "It wouldn't surprise me at all." Dr. Carolyn Lam: Could you define masked hypertension compared to white coat hypertension and tell us a little bit about the population you studied. Dr. J. Schwartz: Sure. First with the definition. I'm going to say something a little bit different from something you said before. You mentioned cutoffs that we typically used for ambulatory blood pressure of 130/80 and those are the cutoffs that are used if you compute an average blood pressure over the entire 24 hours. What many people do, and what we did for this study, was compare the average blood pressure when people were awake to their blood pressure in the doctor's office because obviously in the doctor's office everybody is awake. The typical cutoffs there are 135/85, recommended by numerous guidelines in this country and with our international collaborators. The definition of masked hypertension is having a blood pressure in the clinic setting that's below 140/90 but having an ambulatory blood pressure where either the systolic blood pressure is above 135 or the diastolic is above 85 millimeters of mercury. In terms of the sample, for years I've had a particular strategy for trying to recruit participants. I do worksite-based studies and so I identify large organizations that will allow me to recruit their employees and then what we did for this study is go to individual departments, both here at Stony Brook University, at Columbia University, at a residential veterans' home that's affiliated with Stony Brook University and then also at a local private hedge fund management company. We would go to these sites, I talk to the head of a department and tell them a little bit about masked hypertension and what the study was about and ask them if they would be willing to have their employees participate in the study. Once I had the okay from the department head then we would conduct public health screenings, blood pressure screenings. My staff and I would go into the department for multiple days and invite anybody who was interested to have their blood pressure taken on site and while we were taking those blood pressures carefully. The proper way to take those is to take three readings and leave a minute or two interval between them and rather than just have silence then between the readings we would tell them a little bit about our study. At the end of the study if they didn't have extremely high blood pressure and were not taking blood pressure medication we would ask them if they might be interested in participating in the study that we just described. That's how we identified potential participants and about 2/3 of the people that we talked to who looked eligible indeed chose to participate. Dr. J. Schwartz: The one other thing I might mention that I think we mentioned, I hope we mentioned as a limitation of the study, is that everybody in the study had health insurance and at least until recently there were very large portions of the population that didn't have health insurance, everybody by virtue of their employment by the organizations that participated in the study, did have employer-based health insurance. Dr. Carolyn Lam: Thanks for clarifying the population so well. Could you just give us the top line of your findings. How big a difference did you find, which direction and that intriguing effect of age? Dr. J. Schwartz: Sure. The first thing we found is that on average the systolic blood pressure is seven millimeters mercury higher out in everyday life than it is in the clinic setting where we take our clinic readings. I should mention that unlike most studies, and all studies at the time that we began our study, we brought people in three separate times to take the clinic blood pressure. Up until that, almost all of the studies of ambulatory blood pressure monitoring only had clinic blood pressures from a single visit. I think we have a very reliable measure of the clinic blood pressure as well as reliable measure of ambulatory blood pressure. We see a seven millimeter difference in the systolic blood pressure and a 2 millimeter difference, again the ambulatory being higher for diastolic blood pressure. What's more remarkable is if you think about what's a sizable difference. If you think if we perhaps somewhat arbitrarily say 10 millimeters of systolic blood pressure is a large difference. More than 35% of the population has an ambulatory blood pressure that is more than 10 millimeters higher than their clinic blood pressure whereas only 3% of our sample had that large a difference in the opposite direction, what many people would call a white coat effect. It's more than a 10 to 1 difference in numbers of people who have elevated ambulatory versus elevated clinic. You asked me to mention something about the age difference. When you look at how that difference in systolic blood pressure varies by age, it's quite a bit larger for people who are younger. If you're under 30 the difference is, on average, 10 millimeters rather than seven millimeters and if you go up as you approach 60 years of age or so the difference becomes relatively small, perhaps in the neighborhood of two millimeters. We don't have enough people because it's a working population over 65 to say very much about what would happen. In fairness to prior research, which often is on older populations and particularly hypertensive populations, the studies that have historically shown that ambulatory blood pressure tends to be lower than clinic blood pressure are in these older populations and populations that have elevated blood pressure to start with. My speculation there, and you haven't asked me to mention it but I will, is that older people and those with hypertension have a reason to be more nervous or more anxious when they go to the doctor than people who are not taking medication and probably don't even know that they have hypertension. People who are just being screened perhaps during a routine physical for the possibility of hypertension, because the doctors take a blood pressure reading every time you go in, they're doing that in order to see whether you might have hypertension, but most people who are going in for what we call a well patient visit are not nervous about their blood pressure being high. Dr. Carolyn Lam: I have to say, the take-home message for me when I read this was, I am not paying enough attention to masked hypertension and then another thing was, maybe I need to think about more white coat hypertension in the older and masked hypertension in the younger. Wanpen, do you think it's as simple as that? What were your take-home messages? Dr. Wanpen V.: I think this is a very important study that examines this in a systematic way. I'm not surprised that Joe found as much masked hypertension here. I think that he's absolutely right. We looked at this in Dallas Heart Study as well recently and we found that in the population-based sample in Dallas almost 20% of people have masked hypertension and white coat we found only like 3% and the average in the Dallas Heart Study was very close to those samples, about mid-40s. I think that's a very important finding in that the people with masked hypertension would not be suspected otherwise to have problems. Also, in the Dallas Heart Study they used home readings but Dr. Schwartz used ambulatory blood pressure monitoring. Unless extra out of office monitoring is being done we will totally miss these people who are more likely to have target organ damage from high blood pressure. I think that's absolutely important. Dr. Carolyn Lam: Actually, Wanpen you brought up something I was going to bring up as well. Where does home blood pressure fit in with this? Do you think it's home blood pressure versus ambulatory blood pressure? Dr. Wanpen V.: The US Preventive Services Task Force has issued a little bit of recommendations recently that we need to either use ambulatory blood pressure monitoring or home blood pressure monitoring to confirm diagnosis of hypertension in the office. If someone shows up with elevated blood pressure in the office either home blood pressure or ambulatory blood pressure needs to be done. If we just followed that guidelines we're still going to miss people with masked hypertension because by definition they don't have elevated blood pressure in the office. I think that from these findings and Dr. Schwartz' study I think to catch these people we really need to pay attention to people with pre-hypertension type of blood pressure because it seems like those are the group that has the most probability to have elevated ambulatory blood pressure so anyone with borderline blood pressure in the clinic, those are the ones who the doctor needs to tell the patient to monitor blood pressure at home or order ambulatory blood pressure themselves if that's available in their facility. Dr. Carolyn Lam: Wanpen, I fully agree. What an important message. Joe, I'd like to give you the final word but I'd love to hear how you have maybe taken this into your own practice. Dr. J. Schwartz: I think we mostly focused on and indeed the paper mostly focuses on the difference between clinic blood pressure and ambulatory blood pressure. When we talk about the young people, the young people have a bigger difference but those differences are for the most part all in the normal range. You might see a 10- or a 12-point difference but it might be that the ambulatory is 124 and the clinic is 112 and no doctor is going to worry about that very much. There are really always two things that we're trying to look at simultaneously: The first is what is that difference between the ambulatory and the clinic, but the second is for whom does the clinic stay under the threshold for diagnosis of hypertension but the ambulatory is over? That's the diagnosis of masked hypertension. We haven't said it today so I'll say it: Of those people who had normal clinic blood pressures averaged across three repeated visits, 15.7% of them had elevated ambulatory blood pressure and would have been diagnosed as having hypertension based on their average daytime ambulatory blood pressure reading. That's one message. The last message is unfortunately there is almost no research yet telling us what we should do in terms of treating people with masked hypertension. We are now at the point where we can identify these people and we're also at the point where we now know that there are a lot of such people and we don't even have any research to base guidelines on for deciding what we should do with them. The most obvious thing is to recommend lifestyle changes. If they're overweight we could suggest that they lose weight. We could suggest that they exercise more. We might think about treating some of those people, especially if their ambulatory blood pressure is well above 140/90. There are no statements out in the literature by any of the organizations, and in fact there's no research examining whether there's a benefit or not a benefit to perhaps putting some of those people on medications. I think that's a big question that future research needs to address. Dr. Carolyn Lam: Joe, thank you so much. I think your last statements just really emphasize how important this paper is. It increases awareness and it's going to open the door to much more needed research in this area. Thank you so much. Thank you Joe and Wanpen for being on the show today. Thank you listeners for joining us. Don't forget to join us next week for even more news and exciting discussions.

Circulation August 23, 2016 Issue