Introduction The advent of generative artificial intelligence (AI) dialogue platforms and large language models (LLMs) may help facilitate ongoing efforts to improve health literacy. Additionally, recent studies have highlighted inadequate health literacy among patients with cardiac disease. The aim of the present study was to ascertain whether two freely available generative AI dialogue platforms could rewrite online aortic stenosis (AS) patient education materials (PEMs) to meet recommended reading skill levels for the public. Methods Online PEMs were gathered from a professional cardiothoracic surgical society and academic institutions in the USA. PEMs were then inputted into two AI-powered LLMs, ChatGPT-3.5 and Bard, with the prompt “translate to 5th-grade reading level”. Readability of PEMs before and after AI conversion was measured using the validated Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook Index (SMOGI), and Gunning-Fog Index (GFI) scores. Results Overall, 21 PEMs on AS were gathered. Original readability measures indicated difficult readability at the 10th–12th grade reading level. ChatGPT-3.5 successfully improved readability across all four measures (p < 0.001) to the approximately 6th–7th grade reading level. Bard successfully improved readability across all measures (p < 0.001) except for SMOGI (p = 0.729) to the approximately 8th–9th grade level. Neither platform generated PEMs written below the recommended 6th-grade reading level. ChatGPT-3.5 demonstrated significantly more favorable post-conversion readability scores, percentage change in readability scores, and conversion time compared to Bard (all p < 0.001). Conclusion AI dialogue platforms can enhance the readability of PEMs for patients with AS but may not fully meet recommended reading skill levels, highlighting potential tools to help strengthen cardiac health literacy in the future.

Pancreatic neuroendocrine tumors (PNETs) are characterized by dysregulated signaling pathways that are crucial for tumor formation and progression. The efficacy of traditional therapies is limited, particularly in the treatment of PNETs at an advanced stage. Epigenetic alterations profoundly impact the activity of signaling pathways in cancer development, offering potential opportunities for drug development. There is currently a lack of extensive research on epigenetic regulation in PNETs. To fill this gap, we first summarize major signaling events that are involved in PNET development. Then, we discuss the epigenetic regulation of these signaling pathways in the context of both PNETs and commonly occurring—and therefore more extensively studied—malignancies. Finally, we will offer a perspective on the future research direction of the PNET epigenome and its potential applications in patient care.

Background: Pancreatic adenocarcinoma (PCA) incidence is higher in Black compared to White patients. Beyond race, neighborhood socioeconomic status (nSES) may also inform disparities. However, these effects on metastatic pancreatic adenocarcinoma (mPCA) are not well-studied. The aim of this study was to explore whether nSES influences survival in patients with mPCA. Methods: nSES measures were derived from U.S. census data at the census tract (CT) level. We correlated medical records of mPCA patients (diagnosed 2010-2016; n=370) to nSES measures retrospectively via a geocode derived from patient address. Multivariable cox proportional hazards models were used to identify patient-level (age, sex, race, marital status, treatment (radiation/chemo/surgery), PCA family history, stage, Jewish ancestry, tobacco use, BMI, diabetes, and statin use) and nSES measures (deprivation, racial concentration, stability, transportation access, immigration) associated with mPCA survival; P values <0.05 were significant. Results: Eighty-two percent of patients were White; less than one-third of patients resided in highly deprived neighborhoods. Three hundred thirty-three mPCA patient deaths occurred, with a survival ranging from 7–9 months (median 8 months). Patient-level factors including younger age, receipt of chemotherapy or initial surgery and statin use, were associated with improved survival, whereas neighborhood stability (i.e., a higher % of residents still living in the same house as 1 year ago) was significantly associated with poor pancreatic survival. Conclusions: Our findings suggest nSES has limited effect on survival of mPCA patients as compared to clinical variables. This may be due to the aggressive nature of this cancer, however, additional studies with larger, more diverse cohorts are needed to better understand the effect of nSES on survival of patients with mPCA.

There is a paucity of recent literature investigating the sole effect of income level on the treatment and survival of patients with rectal cancer. We analyzed all cases of rectal cancer in the Rectal Cancer PUF of the NCDB from 2010 to 2020. We utilized the Median Income Quartiles 2016–2020 to define our income levels. The two lower quartiles were combined to create a lower income group, with the upper two quartiles creating the higher income group. The total cohort included 201,329 patients, with 116,843 and 84,486 in the higher and lower income groups, respectively. Lower income patients were more often black (17 % vs 6 %), lived farther from the nearest hospital (33.5 miles vs 25.7 miles) despite being more likely to live in urban areas (25 % vs 7 %), and had lower levels of private insurance (36 % vs 49 %). They underwent more APRs (17 % vs 14 %) and had a 13 % higher chance of undergoing an open operation (OR 1.13, CI 1.09–1.17). Higher income patients had a 12 % reduction in 90-day (OR 0.88, 95 % CI 0.82–0.96) and overall mortality (OR 0.88, 95 % CI 0.86–0.89). Clinicians should be aware that lower income patients are often faced with unique challenges that may impact care delivery.