Articles from Mayo Clinic proceedings 2020 March

Mayo Clinic proceedings · Mar 2020

Randomized Controlled Trial

Dose-Response Effects of Exercise on Glucose-Lowering Medications for Type 2 Diabetes: A Secondary Analysis of a Randomized Clinical Trial.

To investigate whether a dose-response relationship exists between volume of exercise and discontinuation of glucose-lowering medication treatment in patients with type 2 diabetes. ⋯ ClinicalTrials.gov registration (NCT02417012).

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Mayo Clinic proceedings · Mar 2020

Review

Principles of Vaccine Licensure, Approval, and Recommendations for Use.

The licensure and recommendation processes for vaccines are complex. In the United States, vaccines are licensed for the civilian and military populations on the basis of review of Biologics License Applications submitted to the Food and Drug Administration (FDA) by vaccine manufacturers. For FDA-licensed vaccines, the product label includes indications, contraindications, and precautions for each vaccine. ⋯ To implement ACIP vaccine recommendations in the public and private sectors, a collaboration of federal, state, and local governments as well as private organizations dealing with public health, vaccine supply, vaccine administration, vaccine finance, outcomes monitoring, public perception, and public trust and support must work together. Issues including vaccine misinformation, declining community immunity (herd protection), and need for risk communication add stress to this complex and fragile system. This study describes the functions of and interactions between FDA and ACIP.

Septal Myectomy and Concomitant Coronary Artery Bypass Grafting for Patients With Hypertrophic Cardiomyopathy and Coronary Artery Disease.

Severe coronary artery disease is associated with disproportionately increased risks of death in patients with hypertrophic cardiomyopathy. There is a paucity of data on the long-term effect of coronary revascularization at the time of myectomy. Between January 1, 1961, and October 31, 2017, 2913 adult patients underwent transaortic septal myectomy at Mayo Clinic. ⋯ Overall operative mortality (≤30 days after surgery) was 1.0% and higher in patients who underwent concomitant CABG (2.2% vs 0.8%; P=.048). In multivariable analysis (n=2641), factors independently associated with mortality included concomitant CABG (hazard ratio [95% CI], 1.89 [1.39-2.58]; P<.0001), older age at operation (per interquartile range increase, 2.79 [1.95-3.98]; P<.0001), atrial fibrillation (1.46 [1.11-1.92]; P=.006), diabetes (1.45 [1.04-2.04]; P=.031), higher body mass index (change from 0.95 to 0.5 quantile, 1.95 [1.46-2.59]; P<.0001), and surgery performed earlier in the study period (2.02 [1.31-3.11]; P=.001). In conclusion, obstructive coronary artery disease severe enough to prompt concomitant CABG at the time of septal myectomy is an important risk factor for late mortality.