Faculty Bibliography

BACKGROUND:Black men are underrepresented in hypertension trials, even though this population has higher prevalence and more adverse sequelae from hypertension, compared to other groups. In this article we present recruitment and community engagement strategies for the Community-to-Clinic Linkage Implementation Program (CLIP), a cluster-randomized trial on hypertension prevention among Black men. METHODS:Using a 2-stage recruitment process: 1) we enrolled Black-owned barbershops from zip-codes with high hypertension prevalence; and 2) recruited Black male participants who fulfilled the eligibility criteria and were customers of the barbershops. Barbershop and participant recruitment was conducted by a partner community-based organization. RESULTS:The study met the recruitment goals for barbershop enrollment (N=22) and individual participants. Of eligible individuals (N=461), 430 enrolled in the study (93% consent rate, exceeding the original enrollment goal of N=420 participants). Throughout recruitment, the study team conducted 101 unique engagements (41 prior to recruitment, 60 during recruitment), totaling engagement with180 partners across all events, including individual and group meetings, attendance at community events, and educational presentations. In addition to a primary partner community organization, the study team collaborated with a Community Advisory Council, comprised of residents, and civic and community leaders, and with the local health department and varied other organizations. CONCLUSIONS:In CLIP, a high number of academic-community engagement encounters and close collaboration with community partners contributed to successful recruitment of Black men at risk for hypertension and with adverse social determinants. Our experience may serve as to inform investigators focused on recruiting underserved populations in hypertension research trials.

BACKGROUND:Acute appendicitis is the most common abdominal surgical emergency worldwide. Researchers from various countries have evaluated the impact of the COVID-19 pandemic on its diagnosis and treatment, as well as a possible change in its management, such as outpatient treatment. The objective of this study was to describe the characteristics of acute appendicitis treated during the COVID-19 State of Emergency (SOE) and to assess whether it could be included in an ambulatory surgery program. METHODS:Retrospective observational study involving patients treated at public hospitals for appendix diseases (K35-K38). We collected sociodemographic and clinical data. The influence of the lockdown on each variable was evaluated with a multivariate analysis. RESULTS:201 patients were included. The SOE period group comprised 78 patients, and the pre-SOE period (control) included 123 patients who met the same inclusion criteria. The risk of complicated acute appendicitis increased by 1.015 times with age (p = 0.000). The longer surgery time was associated with a 7.265 times higher risk of postsurgical complications (p = 0.000). No differences were observed with respect to drain placement (p = 0.281), although the percentage was higher in 2020 (13.9% vs 19.7%). The length of hospital stay decreased significantly during the lockdown (p = 0.017). CONCLUSION/CONCLUSIONS:The lockdown did not influence the outcome of complicated acute appendicitis from the standpoint of morbidity and mortality, reducing the hospital stay, facilitating the path towards outpatient treatment.

Microangiopathy is a major complication of SARS-CoV-2 infection and contributes to the acute and chronic complications of the disease¹. Endotheliopathy and dysregulated blood coagulation are prominent in COVID-19 and are considered to be major causes of microvascular obstruction^1,2. Here we demonstrate extensive endothelial cell (EC) death in the microvasculature of COVID-19 organs. Notably, EC death was not associated with fibrin formation or platelet deposition, but was linked to microvascular red blood cell (RBC) haemolysis. Importantly, this RBC microangiopathy was associated with ischaemia-reperfusion injury, and was prominent in the microvasculature of humans with myocardial infarction, gut ischaemia, stroke, and septic and cardiogenic shock. Mechanistically, ischaemia induced MLKL-dependent EC necroptosis and complement-dependent RBC haemolysis. Deposition of haemolysed RBC membranes at sites of EC death resulted in the development of a previously unrecognized haemostatic mechanism preventing microvascular bleeding. Exaggeration of this haemolytic response promoted RBC aggregation and microvascular obstruction. Genetic deletion of Mlkl from ECs decreased RBC haemolysis, microvascular obstruction and reduced ischaemic organ injury. Our studies demonstrate the existence of a RBC haemostatic mechanism induced by dying ECs, functioning independently of platelets and fibrin. Therapeutic targeting of this haemolytic process may reduce microvascular obstruction in COVID-19, and other major human diseases associated with organ ischaemia.

OBJECTIVE:The objective of this study is to examine real-world dose titration patterns of semaglutide for weight management (Wegovy, Novo Nordisk A/S) in US adults and identify characteristics associated with early discontinuation. METHODS:We identified 15,811 commercially insured adults who started semaglutide for weight management (administrated through single-dose prefilled pens) between June 2021 and December 2023. We depicted dose-titration patterns over 5 months and identified factors associated with discontinuation using multivariable Cox regression. Sensitivity analyses examined patterns after supply shortage resolution (after October 2023). RESULTS:Most semaglutide users deviated from the recommended monthly dose-escalation schedule within the first 5 months. By the fifth month, nearly one-half (46%) had discontinued the treatment, with similar rates (48%) among those initiating after supply stabilization. Discontinuation was strongly associated with copayment amount, with rates increased from 41% in the lowest quintile ($1-$54 per month) to 51% in the highest quintile ($161-$1460 per month). Higher discontinuation rates were also associated with lower household income and education level. CONCLUSIONS:The deviations from the recommended dose-escalation schedule and high discontinuation rate among real-world semaglutide users indicate important challenges in the delivery of evidence-based care. Policy interventions that reduce financial barriers to the persistence of semaglutide are needed.

BACKGROUND:Online accessible patient education materials (PEMs) are essential for patient empowerment. However, studies have shown that these materials often exceed the recommended sixth-grade reading level, making them difficult for many patients to understand. Large language models (LLMs) have the potential to simplify PEMs into more readable educational content. OBJECTIVE:We sought to evaluate whether 3 LLMs (ChatGPT [OpenAI], Gemini [Google], and Claude [Anthropic PBC]) can optimize the readability of PEMs to the recommended reading level without compromising accuracy. METHODS:This cross-sectional study used 60 randomly selected PEMs available online from 3 websites. We prompted LLMs to simplify the reading level of online PEMs. The primary outcome was the readability of the original online PEMs compared with the LLM-simplified versions. Readability scores were calculated using 4 validated indices Flesch Reading Ease, Flesch-Kincaid Grade Level, Gunning Fog Index, and Simple Measure of Gobbledygook Index. Accuracy and understandability were also assessed as balancing measures, with understandability measured using the Patient Education Materials Assessment Tool-Understandability (PEMAT-U). RESULTS:The original readability scores for the American Heart Association (AHA), American Cancer Society (ACS), and American Stroke Association (ASA) websites were above the recommended sixth-grade level, with mean grade level scores of 10.7,10.0, and 9.6, respectively. After optimization by the LLMs, readability scores significantly improved across all 3 websites when compared with the original text. Compared with the original website, Wilcoxon signed rank test showed ChatGPT improved the readability to 7.6 from 10.1 (P<.001); Gemini, to 6.6 (P<.001); and Claude, to 5.6 (P<.001). Word counts were significantly reduced by all LLMs, with a decrease from a mean range of 410.9-953.9 words to a mean range of 201.9-248.1 words. None of the ChatGPT LLM-simplified PEMs were inaccurate, while 3.3% of Gemini and Claude LLM-simplified PEMs were inaccurate. Baseline understandability scores, as measured by PEMAT-U, were preserved across all LLM-simplified versions. CONCLUSIONS:This cross-sectional study demonstrates that LLMs have the potential to significantly enhance the readability of online PEMs while maintaining accuracy and understandability, making them more accessible to a broader audience. However, variability in model performance and demonstrated inaccuracies underscore the need for human review of LLM output. Further study is needed to explore advanced LLM techniques and models trained for medical content.

INTRODUCTION/UNASSIGNED:Over the last half-century, mortality from renal cell carcinoma (RCC) has seen a dramatic reduction, while 5-year survival rates have reached an all-time high (34% to 75%). CASE PRESENTATION/UNASSIGNED:A 77-year-old female with Stage 4 RCC (cT3c, cN1, cM1) presented with acute onset chest and back pain. Imaging revealed interval enlargement of a left renal mass with propagation of tumor thrombus (TT) throughout the left renal vein, intrahepatic and suprahepatic inferior vena cava (IVC) with extension into the right atrium (RA). The patient successfully underwent a high-risk open left nephrectomy with caval thrombectomy, retroperitoneal lymph node dissection, and atrial thrombectomy. DISCUSSION/UNASSIGNED:Approximately, 1% of RCC cases involve the right atrium, and radical nephrectomy with vena caval thrombectomy remains the most effective treatment for cavoatrial TT, with 5-year survival rates between 30% and 72%. While patients with renal vein involvement have better survival rates than those with IVC involvement, advanced TT cases (Types III and IV) often require extracorporeal circulation. Though the patient understood the prognosis of her RCC, discussing the risks of a complex procedure versus not intervening was challenging. Despite a typical median survival of 12 months for level IV tumor thrombus (TT), she remains stable 28 months post-surgery. CONCLUSION/UNASSIGNED:Although the 5-year survival rate for renal cell carcinoma (RCC) has increased from 34% to 75%, the disease still adversely affects patients' quality of life. A multidisciplinary approach is essential when managing metastatic RCC, particularly involving the heart. Despite the associated risks, surgical intervention is more effective in prolonging life by preventing sudden cardiac death due to embolic events.

Cholangiocarcinoma (CCA) is a malignancy that originates from the epithelial cells of the biliary system. Despite advancements in medical diagnostic techniques, CCAs remain a challenge to detect due to their silent clinical progression, making it difficult to diagnose these diseases. There are several well-established risk factors for CCA, including biliary tract infection and inflammation. However, there is also growing evidence that community and occupational exposures play a significant role in the development of bile duct cancers. This review examines the geographical distribution of these risk factors and the importance of surveillance in individuals exposed to these toxins who are more prone to developing CCA.

Child neglect is a toxic stress with harmful outcomes. It is the most prevalent form of child maltreatment with continued trends for underreporting due to a lack of a widely accepted definition. Given this reality, pediatric clinicians may rely on subjective thresholds for its diagnosis. There are risk factors for neglect countered by protective factors that builds resilience in families. Pediatric clinicians are positioned to prevent neglect through their relationships with families across the life span. Currently, there are evidence-based screening tools available to ensure the skillful differentiation between the signs and symptoms attributable to neglect versus poverty.

BACKGROUND/UNASSIGNED:Phosphodiesterase type 5 (PDE5) inhibitors are used to treat erectile dysfunction, but their cost can limit access. AIM/UNASSIGNED:This study examines PDE5 inhibitors pricing and demographic data across rural and urban New York State (NYS) counties, as well as small, large, and online pharmacies. METHODS/UNASSIGNED:-tests, Wilcoxon rank-sum, and Kruskal-Wallis tests were performed using R Version 4.4.1 (2024-06-14). OUTCOMES/UNASSIGNED:The cash price of the PDE5 inhibitors across various pharmacy chain types and county types. RESULTS/UNASSIGNED: = .177). CLINICAL TRANSLATION/UNASSIGNED:This study aims to highlight the pricing variability of PDE5 inhibitors to help patients identify cost-effective options to circumvent potential financial barriers. STRENGTHS AND LIMITATIONS/UNASSIGNED:This study was the first to examine PDE5 inhibitors pricing specifically within rural populations while also providing a comparative analysis of pricing differences between small and large pharmacy chains serving these communities. The study's limitations include a relatively small sample size of rural and small chain pharmacies resulting in power levels of 75% and 69%, respectively, which may impact the generalizability of the findings. CONCLUSION/UNASSIGNED:Enhancing drug price transparency for PDE5 inhibitors is vital for increasing access and pricing flexibility.