Aim: To address the unmet needs of patients interested in regenerative medicine, Mayo Clinic created a Regenerative Medicine Consult Service (RMCS). We describe the service and patient satisfaction. Materials & methods: We analyzed RMCS databases through retrospective chart analysis and performed qualitative interviews with patients. Results: The average patient was older to elderly and seeking information about regenerative options for their condition. Patients reported various conditions with osteoarthritis being most common. Over a third of consults included discussions about unproven interventions. About a third of patients received a clinical or research referral. Patients reported the RMCS as useful and the consultant as knowledgeable. Conclusion: An institutional RMCS can meet patients’ informational needs and support the responsible translation of regenerative medicine.

Background Current approaches in tracking Clostridioides difficile infection (CDI) and individualizing patient management are incompletely defined. Methods We recruited 468 subjects with C. difficile infection at Mayo Clinic Rochester between May and December 2016 and performed whole genome sequencing (WGS) on C. difficile isolates from 397. WGS was also performed on isolates from a subset of the subjects at the time of recurrence of infection. Sequence data were analyzed by determining core genome multilocus sequence type (cgMLST), with isolates grouped by allelic differences and predicted ribotype. Results There was no correlation between C. difficile isolates based on cgMLST or ribotype groupings and CDI outcome. Epidemiologic assessment of hospitalized subjects harboring C. difficile isolates with ≤2 allelic differences based on standard infection prevention and control assessment revealed no evidence of person-to-person transmission. Interestingly, community-acquired CDI subjects in 40% of groups with ≤2 allelic differences resided within the same zip code. Among 18 subjects clinically classified as having recurrent CDI, WGS revealed 14 with initial and subsequent isolates differing by ≤2 allelic differences, suggesting relapse of infection with the same initial strain, and 4 with isolates differing by >50 allelic differences, suggesting reinfection. Among the 5 subjects classified as having reinfection based on timing of recurrence, 3 had isolates with ≤2 allelic differences between them suggesting relapse, with 2 having isolates differing by >50 allelic differences - suggesting reinfection. Conclusions Our findings point to potential transmission of C. difficile in the community. WGS better differentiates relapse from reinfection than do definitions based on timing of recurrence.

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