Citations

Abstract Objectives To explore patients’ use of patient portals to access lab test results, their comprehension of lab test data, and factors associated with these. Materials and Methods An online survey was administered to 276 adults 18+ years. Multivariate logistic regression was used to determine factors associated with patient portal use to view lab test results and lab test comprehension. Results The sample was predominantly White (72.5%), female (55.4%), with mean age 50.7 ± 15.5 years. Overall, participants had low numeracy (10.79 ± 2.71) and eHealth literacy skills (23.91 ± 5.29), and moderate lab test comprehension scores (18 ± 2.3). White participants with greater eHealth literacy were more likely to access lab test results via patient portals, whereas those with a college education were less likely to do so (χ2 [3]=31.23, P < .001). The regression showed that older age, fewer chronic conditions, and use of patient portals were significantly related to higher lab test comprehension scores (F [22, 250]=8.73, P <.001). Older adults performed better on comprehension tests but reported having difficulty understanding lab tests, expressing a preference for their doctors to explain them. Discussion The findings shed light on the experiences and needs of different user groups that must be addressed to enhance their ability to effectively use patient portals for obtaining lab test results. Conclusion More research is needed to determine patient barriers to comprehending lab test results online and to develop tailored strategies to improve patients’ self-efficacy to meaningfully use medical information in patient portals.

Background Increasing intentions to quit e-cigarettes among youth and young adults can reduce usage rates by making quit attempts more likely. This study assessed the potential impacts of a national media campaign, focused on building knowledge of e-cigarette use risks and cessation resources, on intentions to quit and campaign-targeted beliefs about mental health and quitting. Methods A national sample from a repeated cross-sectional online survey was collected from March 2022 to August 2023, among youth and young adults who reported e-cigarette use in the past 30 days (N=5169). Regression models were used to assess associations between weekly campaign awareness and frequency of exposure on intentions to quit e-cigarette use within the next 6 months and targeted beliefs related to mental health and quitting. Results Participants who were aware of both cessation and knowledge-building messaging were more likely to report intentions to quit e-cigarette use in the next 6 months (OR 1.43, (95% CI 1.21, 1.69)) and agree with quitting-related targeted beliefs (ORs 1.351.63) and a mental health targeted belief scale (b=1.14 (95% CI 0.69, 1.59)), relative those with no messaging awareness. The frequency of exposure to cessation messaging held a dose-response relationship with almost all outcomes. Conclusion Findings suggest that frequency and awareness of messaging that educates about e-cigarette harms to mental health and about cessation resources are associated with higher quitting intentions among young people who use e-cigarettes.

Background The contact aspiration (CA) technique is often used to perform endovascular thrombectomy (EVT) for acute ischemic stroke (AIS); however, rescue strategies are necessary if CA fails to achieve recanalization. This study investigates the outcomes of incorporating stent retriever (SR) thrombectomy in the rescue strategy following failed CA. Methods EVT patients with failed CA attempts were identified from a large multicenter registry and stratified by rescue technique: CA alone or incorporating SR in the rescue strategy. Outcomes included successful recanalization, 90-day functional outcomes (defined by the modified Rankin Scale (mRS) score), symptomatic intracranial hemorrhage (sICH), and 90-day mortality. Results Among 1885 patients with failed CA attempts, conversion to SR was associated with higher recanalization rates (85.2% vs 80.6%; p=0.03), higher rates of second-pass recanalization (31.2% vs 23.4%; p<0.001), and better 90-day outcomes (mRS 0–2: 35.2% vs 29.9%; p=0.04) when compared with repeated CA attempts. Trevo SRs showed higher odds of successful recanalization (adjusted odds ratio (aOR)=1.9; p=0.02), second-pass recanalization (aOR=1.7; p=0.01), and reduced odds of sICH (aOR=0.3; p=0.02). EmboTrap SRs were associated with higher odds of 90-day mortality (aOR=2.6; p=0.004) and sICH (aOR=2.9; p=0.04) and lower odds of recanalization (aOR=0.5; p=0.03). Conclusions Incorporating SR in the rescue strategy after a failed CA improves recanalization rates and functional outcomes. Trevo SRs demonstrated superior efficacy and safety when incorporated into the rescue strategy.

Background Pancreatic ductal adenocarcinoma (PDAC) is a highly lethal cancer with a 5-year survival rate of 12%. It has two major molecular subtypes: classical and basal, regulated by the master transcription factors (MTFs) GATA6 and ΔNp63, respectively. Objective This study sought to uncover the transcriptional regulatory mechanisms controlling PDAC subtype identity. Design We integrated primary tumour single-cell RNA-seq, patient-derived xenograft RNA-seq and multispectral imaging to identify MTF-dependent, subtype-specific markers. We created subtype-specific fluorescent reporter systems and conducted drug screenings to find actionable targets. We analysed chromatin accessibility (ATAC-seq), genome-wide occupancy (ChIP-seq) for epigenetic status (H3K27ac), MTFs (GATA6, ΔNp63), RNA polymerase II (Pol II), H3K4me3-anchored chromatin topology (HiChIP) and nascent RNA capture sequencing (PRO-seq). Additionally, we used nuclease-dead Cas9 (dCas9) to manipulate transcriptional regulatory mechanisms. Results Our approach identified glucocorticoid receptor (GR) agonists as agents that suppress the classical transcriptional programme by interacting with GATA6. GATA6 regulates classical-specific transcription through promoter-proximal pause release. Depletion of GATA6 increased Pol II occupancy at GATA6-bound enhancers and transcriptional start sites, stabilising enhancer–promoter interactions. Artificially inducing pausing at GATA6-bound enhancers with dCas9 abrogated target gene expression and induced pausing at both the enhancer and target gene promoter. Conversely, in basal PDAC ΔNp63 promotes Pol II recruitment and stabilises enhancer–promoter interactions. Conclusion This study provides new insights into the transcriptional control and role of GR agonists in controlling PDAC molecular subtype identity.

Encompassing a broad spectrum of abnormalities from diffuse liver disorders to focal liver lesions, hypointense findings on hepatobiliary phase MR images offer valuable diagnostic information, provide insight on the functional status of the liver, and aid in characterization of other imaging features.

Ultrasound imaging is vital for musculoskeletal assessment due to its real‐time, high‐resolution capabilities and safety. While protocols exist for rotator cuff evaluation, comprehensive guidelines for imaging the latissimus dorsi and teres major muscles are lacking. This article fills this gap by presenting a detailed ultrasound protocol for these muscles, essential for shoulder stability and movement in overhead athletes. We review their anatomy, propose a standardized examination approach, and discuss clinical indications, aiming to improve diagnostic accuracy and management of these injuries.

Background The immune response to infections may become dysregulated and promote myocardial damage contributing to heart failure (HF). We examined the relationship between infection‐related hospitalization (IRH) and HF, HF with preserved ejection fraction, and HF with reduced ejection fraction. Methods and Results We studied 14 468 adults aged 45 to 64 years in the ARIC (Atherosclerosis Risk in Communities) Study who were HF free at visit 1 (1987–1989). IRH was identified using select International Classification of Diseases ( ICD ) codes in hospital discharge records and was treated as a time‐varying exposure. HF incidence was defined as the first occurrence of either a hospitalization that included an ICD, Ninth Revision ( ICD‐9 ) discharge code of 428 (428.0–428.9) among the primary or secondary diagnoses or a death certificate with an ICD‐9 code of 428 or an ICD, Tenth Revision ( ICD‐10 ) code of I50 among any of the listed diagnoses or underlying causes of death. We used multivariable‐adjusted Cox proportional hazards models to assess the association between IRH and incident HF, HF with reduced ejection fraction, and HF with preserved ejection fraction. Median follow‐up time was 27 years, 55% were women, 26% were Black, mean age at baseline was 54±6 years, 46% had an IRH, and 3565 had incident HF. Hazard ratio (HR) for incident HF events among participants who had an IRH compared with those who did not was 2.35 (95% CI, 2.19–2.52). This relationship was consistent across different types of infections. Additionally, IRH was associated with both HF with reduced ejection fraction and HF with preserved ejection fraction: 1.77 (95% CI, 1.35–2.32) and 2.97 (95% CI, 2.36–3.75), respectively. Conclusions IRH was associated with incident HF, HF with reduced ejection fraction, and HF with preserved ejection fraction. IRH might represent a modifiable risk factor for HF pathophysiology.

Background: Previous studies have linked pericoronary artery adipose tissue attenuation to major adverse cardiac event (MACE). However, the association between pericarotid artery fat and prognosis remains underexplored. This study aimed to investigate the association between preoperative pericarotid fat characteristics and the subsequent prognosis in patients undergoing carotid endarterectomy (CEA). Methods: This study included patients with preoperative computed tomography angiography (CTA) followed by CEA. Preoperative neck CTA images were obtained and analyzed with novel methods using 3D Slicer software. We segmented the common and internal carotid arteries. The segment was horizontally trimmed, isolating the region around the bifurcation, extending 15 mm above and 10 mm below. Pericarotid fat was defined as adipose tissue within a 5 mm radial distance from the outer vessel wall, with Hounsfield units (HU) between -190 and -30 (Figure 1, carotid segmentation [green] and pericarotid fat [yellow]) . For each patient, we calculated the HU average and the volume (mm3) of the pericarotid fat. MACE was defined as a composite of all-cause mortality, myocardial infarction, and cerebrovascular events. The relationship between both pericarotid fat characteristics and MACE was investigated. Results: Of the 43 patients initially included, one was excluded due to an inability to perform segmentation caused by chronic total occlusion, leaving 42 patients (age 73 [67-78] years, 33 [76.7%] male). The comparison of mean pericarotid fat HU between the ipsilateral and contralateral sides showed no significant difference (-60.3±11.0 HU vs. -60.9 ±11.3 HU, p=0.437). However, the median ipsilateral fat volume was significantly higher than the contralateral volume (528 [248, 1100] mm3 vs. 328 [184, 697] mm3, p=0.020). When comparing patients with and without MACE, those with MACE had a significantly lower ipsilateral fat density (-59.4±10.2 HU vs. -66.8 ±11.1 HU, p=0.022) and a higher fat volume (468 [233, 746] mm3 vs. 845 [458, 1451] mm3, p=0.044). Kaplan-Meier analysis revealed that higher volume and lower fat density than the median were significant predictors of MACE (log-rank p=0.015 and p=0.042, respectively) (Figure 2). Conclusions: Assessment of pericarotid fat using a novel CTA analytic method in patients undergoing CEA identified ipsilateral lower fat density and higher fat volume as predictors of adverse outcomes.

Background: Prior studies indicate a relationship between migraine and MACE. Here we assess whether brain white matter hyperintensities (WMH), which are a common imaging finding in patient with migraine, contribute to the risk of MACE above demographics and common risk factors for MACE. Methods: 60,454 patients, ages 18-89, with a ICD-9 or ICD-10 migraine diagnosis code in 2010 or later were identified from the Mayo Clinic electronic health record. Only patients who were seen for migraine in the Neurology Department were included. Patients with a migraine diagnosis who did not have MACE were included only if they had at least two visits at Mayo Clinic during five years. Only patients with sex and race information were included. The final cohort included 577 migraine patients with and 598 migraine patients without MACE. Presence of WMH was determined from radiology notes. Individuals without a brain MRI were assumed not to have WMH. A logistic regression model that included sex, race, known lifetime MACE risk factors (atrial fibrillation, diabetes, hypertension, hyperlipidemia, tobacco use) and WMH as independent variables to predict MACE outcome was fit. Results: Significant factors that increased the risk of MACE in individuals with migraine included being Black or African American (adjusted OR: 2.9, 95% CI: 1.24-6.82, p = 0.014), presence of atrial fibrillation (adj. OR: 1.63, 95% CI: 1.23-2.17, p < 0.001), diabetes (adj. OR: 1.34, 95% CI: 1.02-1.75, p = 0.036), hypertension (adj. OR: 1.9, 95% CI: 1.39-2.6, p < 0.001), tobacco use (adj. OR: 1.66, 95% CI: 1.29-2.14, p < 0.001), and the presence of WMH (adj. OR: 1.43, 95% CI: 1.1-1.87, p = 0.008). Hyperlipidemia showed a marginal association (adj. OR: 1.34, 95% CI: 0.99-1.81, p = 0.061), while other variables such as sex and other racial/ethnic groups did not significantly alter the risk of MACE outcome. Discussion: Results indicate that African American race and presence of WMH in addition to common comorbidities independently increase the risk of MACE outcome.

Background: Multiple randomized clinical trials failed to show benefit of anticoagulation over antiplatelets in the secondary prevention for embolic stroke of undetermined source (ESUS). However, the benefit of combination antithrombotic regimens remains unexplored in the same patient population. Methods: This is a subgroup analysis of a multicenter retrospective observational cohort of consecutive adult patients with ESUS (n=27 sites, 2015-2024). Comparisons were made between patients treated with single (SAPT) or dual antiplatelet therapy (DAPT), exclusive anticoagulation (AC) (direct oral anticoagulant, vitamin K antagonist, low molecular weight heparin) and combination anticoagulation and antiplatelet therapy initiated within the first 7 days of index stroke. The primary composite outcome of recurrent ischemic stroke, major bleeding, or death was assessed using unadjusted and adjusted Cox proportional hazards regression. Secondary outcomes were individual outcomes of recurrent ischemic stroke, major bleeding, or death. Results: Of the 2201 included patients, 1456 (66.1%) were on SAPT, 527 (23.9%) were on DAPT, 195 (8.8%) were on exclusive AC and 23 (1.0%) were on AC+AP (all of which were on DAPT). Patients treated with AC+AP were older (median 66 years [IQR 51-78]), more likely to have history of hypertension, stroke, hyperlipidemia, PFO and left atrial enlargement. Compared to SAPT, all treatment strategies were associated with similar risk of the primary outcomes in the unadjusted and adjusted cox regression. Similarly, there was no difference in individual outcomes including recurrent stroke, major bleeding and death in the adjusted cox regression. However, there was an increased risk of major bleeding with AC+AP in the unadjusted cox regression (HR 4.0, [95% CI 1.2-12.8], p=0.02) but not in the adjusted model when compared to SAPT. Also, DAPT was associated with lower risk of death than SAPT in the unadjusted model (HR 0.61 [95% CI 0.4-0.8],p=0.005) but not the adjusted model. Additionally, when adjusted by the HASBLED score, there was no difference in major bleeding when AC+AP was compared to SAPT. Conclusion: Over 90% of ESUS patients in this cohort were prescribed SAPT or DAPT. Antithrombotic therapy with DAPT, exclusive AC, or AC+AP was not associated with any lower risk of recurrent ischemic stroke, major bleeding and death compared with SAPT in an unselected cohort of ESUS patients.