Pub Date : 2025-11-21DOI: 10.1016/j.jvsvi.2025.100326
Evgeniya Molotkova BS , Leah R. Thomas MS , Selah Wangler BS , Jennifer Rechani BS , Victoria Tabacchi BS , Cara Spivey MS , Aileen Helsel PhD , Christopher B. Arena PhD , Tara Newberry COTA/L, CLT, OCC , Andre Muelenaer MD , Ralph Brown Jr. MD
Objective
The LymphaVibe is a newly developed medical device that uses vibration to treat upper extremity lymphedema. Previous studies have demonstrated that the device is safe to use in healthy participants. This study aims to assess the preliminary efficacy and safety of this device when used in patients with clinical upper extremity lymphedema.
Methods
This prospective cohort study enrolled 15 patients who were receiving lymphedema therapy through our institution's outpatient program. Participants received treatment with the LymphaVibe before their standard of care therapy and were seen once a week for 4 weeks. End points included upper extremity circumference, upper extremity induration, lymphedema-related patient reported outcomes (Lymphedema Life Impact Scale), and safety.
Results
Treatment with the LymphaVibe resulted in a significant decrease in upper extremity circumference at 30 cm (P = .012; d = 0.34) and 40 cm (P = .011; d = 0.34) above the wrist. This correlated with a significant increase in induration at 30 cm (P = .017; d = −0.32). Treatment with the LymphaVibe was associated with a significant decrease in total Lymphedema Life Impact Score (P < .01; d = 0.70), as well as significant decreases in all subcategories, except upper extremity strength. Out of 60 total visits, a side effect was reported in 2 and an unexpected problem was reported in 2. There were no adverse events, and no patient elected to terminate a study visit or unenroll owing to discomfort with device use.
Conclusions
The LymphaVibe is safe to use in patients with a diagnosis of upper extremity lymphedema. Although limited by the small sample size, the preliminary efficacy results are promising and warrant further investigation.
目的：LymphaVibe是一种利用振动治疗上肢淋巴水肿的新型医疗器械。先前的研究表明，该设备在健康参与者中使用是安全的。本研究旨在初步评估该装置用于临床上肢淋巴水肿患者的有效性和安全性。方法：本前瞻性队列研究纳入了15例通过我院门诊项目接受淋巴水肿治疗的患者。参与者在标准护理治疗前接受LymphaVibe治疗，每周见一次，持续4周。终点包括上肢围度、上肢硬结、淋巴水肿相关患者报告的结果（淋巴水肿生活影响量表）和安全性。结果经LymphaVibe治疗后，腕部以上30 cm （P = 0.012; d = 0.34）和40 cm （P = 0.011; d = 0.34）上肢周长明显缩短。这与30 cm处硬化的显著增加相关（P = 0.017; d = - 0.32）。使用LymphaVibe治疗与总淋巴水肿生命影响评分（P < 0.01; d = 0.70）显著降低相关，除上肢力量外，所有亚类别均显著降低。在总共60次访问中，2次报告了副作用，2次报告了意外问题。没有不良事件发生，也没有患者因设备使用不适而选择终止研究访问或退出研究。结论LymphaVibe用于诊断为上肢淋巴水肿的患者是安全的。虽然受样本量的限制，初步的疗效结果是有希望的，值得进一步的研究。
{"title":"Clinical evaluation of a device to treat upper extremity lymphedema","authors":"Evgeniya Molotkova BS , Leah R. Thomas MS , Selah Wangler BS , Jennifer Rechani BS , Victoria Tabacchi BS , Cara Spivey MS , Aileen Helsel PhD , Christopher B. Arena PhD , Tara Newberry COTA/L, CLT, OCC , Andre Muelenaer MD , Ralph Brown Jr. MD","doi":"10.1016/j.jvsvi.2025.100326","DOIUrl":"10.1016/j.jvsvi.2025.100326","url":null,"abstract":"<div><h3>Objective</h3><div>The LymphaVibe is a newly developed medical device that uses vibration to treat upper extremity lymphedema. Previous studies have demonstrated that the device is safe to use in healthy participants. This study aims to assess the preliminary efficacy and safety of this device when used in patients with clinical upper extremity lymphedema.</div></div><div><h3>Methods</h3><div>This prospective cohort study enrolled 15 patients who were receiving lymphedema therapy through our institution's outpatient program. Participants received treatment with the LymphaVibe before their standard of care therapy and were seen once a week for 4 weeks. End points included upper extremity circumference, upper extremity induration, lymphedema-related patient reported outcomes (Lymphedema Life Impact Scale), and safety.</div></div><div><h3>Results</h3><div>Treatment with the LymphaVibe resulted in a significant decrease in upper extremity circumference at 30 cm (<em>P</em> = .012; d = 0.34) and 40 cm (<em>P</em> = .011; d = 0.34) above the wrist. This correlated with a significant increase in induration at 30 cm (<em>P</em> = .017; d = −0.32). Treatment with the LymphaVibe was associated with a significant decrease in total Lymphedema Life Impact Score (<em>P</em> < .01; d = 0.70), as well as significant decreases in all subcategories, except upper extremity strength. Out of 60 total visits, a side effect was reported in 2 and an unexpected problem was reported in 2. There were no adverse events, and no patient elected to terminate a study visit or unenroll owing to discomfort with device use.</div></div><div><h3>Conclusions</h3><div>The LymphaVibe is safe to use in patients with a diagnosis of upper extremity lymphedema. Although limited by the small sample size, the preliminary efficacy results are promising and warrant further investigation.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100326"},"PeriodicalIF":0.0,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-21DOI: 10.1016/j.jvsvi.2025.100324
Jiani Zhao MD , Shuai Liu MD , Yacheng Xiong MD , Yu Liu MD , Tinghua Liu MD , Jinjian Sun PhD , Wei Wang PhD
Background
Abdominal aortic aneurysm (AAA) is a life-threatening aortic disease with a high mortality rate in cases of rupture, accompanied by abnormalities in metabolic processes. However, how polyamine metabolism is involved in AAA development remains largely unknown.
Methods
We used single-cell RNA sequencing (scRNA-seq) to analyze the polyamine metabolism pathway in multiple cell clusters within human AAA compared with nonaneurysmal samples.
Results
scRNA-seq analysis revealed higher activity of the polyamine metabolism pathway in multiple cell clusters within human AAA compared with nonaneurysmal samples. The messenger RNA expression levels of genes related to polyamine metabolism, such as ODC1 and SAT1, were also found to be elevated in various cell clusters of human AAA samples. Immunofluorescence assays confirmed an increased expression of ODC1 in AAA tissues relative to controls. Polyamine metabolomic analysis indicated that spermidine (SPD) levels were positively correlated with the diameters of AAA (R = 0.73; P = .04). In angiotensin II (Ang II)-induced AAA model of Apoe−/− mice, SPD treatment significantly decreased the incidence of aneurysm rupture compared with the control group (27% vs 62.5%; P < .0001). scRNA-seq of mouse aortic aneurysm tissues revealed a higher proportion of smooth muscle cells (SMCs) in the SPD-treated groups. Trajectory analysis suggested that the clusters of SMCs underwent the phenotype switch from the contractile SMCs to synthetic SMCs. Differential expressed gene analysis in the SMCs cluster showed that elastin (Eln) messenger RNA is the most markedly upregulated gene in SPD-treated group compared with controls. In both porcine pancreatic elastase-induced AAA mouse models and mouse vascular SMCs, Eln messenger RNA levels were significantly increased in SPD-treated groups than in control groups.
Conclusions
We found that polyamine metabolism is more active in AAA. As one of polyamines, SPD can prevent rupture of aortic aneurysms. Eln upregulation by SPD in SMCs may be the potential molecular mechanism.
腹主动脉瘤（AAA）是一种危及生命的主动脉疾病，破裂时死亡率高，并伴有代谢过程异常。然而，多胺代谢如何参与AAA的发展在很大程度上仍然未知。方法采用单细胞RNA测序（scRNA-seq）技术分析人AAA多细胞簇与非动脉瘤样本的多胺代谢途径。结果scrna -seq分析显示，与非动脉瘤样本相比，人AAA内多个细胞簇的多胺代谢途径活性更高。与多胺代谢相关的基因，如ODC1和SAT1的信使RNA表达水平在人类AAA样本的各种细胞群中也被发现升高。免疫荧光测定证实，与对照组相比，AAA组织中ODC1的表达增加。多胺代谢组学分析表明，亚精胺（SPD）水平与AAA直径呈正相关（R = 0.73; P = 0.04）。在血管紧张素II （Ang II）诱导的Apoe−/−小鼠AAA模型中，与对照组相比，SPD治疗显著降低了动脉瘤破裂的发生率（27% vs 62.5%; P < .0001）。小鼠主动脉瘤组织scRNA-seq显示，spd处理组平滑肌细胞（SMCs）比例较高。轨迹分析表明，SMCs集群经历了从收缩型SMCs到合成型SMCs的表型转换。SMCs集群差异表达基因分析显示，spd处理组与对照组相比，弹性蛋白（Eln）信使RNA表达上调最为显著。在猪胰腺弹性酶诱导的AAA小鼠模型和小鼠血管SMCs中，spd处理组的Eln信使RNA水平均显著高于对照组。结论多胺代谢在AAA中更为活跃，SPD作为多胺的一种，可以预防动脉瘤破裂。SPD在SMCs中上调Eln可能是潜在的分子机制。
{"title":"Multi-omics analysis identified spermidine as a potential compound against aortic aneurysm rupture","authors":"Jiani Zhao MD , Shuai Liu MD , Yacheng Xiong MD , Yu Liu MD , Tinghua Liu MD , Jinjian Sun PhD , Wei Wang PhD","doi":"10.1016/j.jvsvi.2025.100324","DOIUrl":"10.1016/j.jvsvi.2025.100324","url":null,"abstract":"<div><h3>Background</h3><div>Abdominal aortic aneurysm (AAA) is a life-threatening aortic disease with a high mortality rate in cases of rupture, accompanied by abnormalities in metabolic processes. However, how polyamine metabolism is involved in AAA development remains largely unknown.</div></div><div><h3>Methods</h3><div>We used single-cell RNA sequencing (scRNA-seq) to analyze the polyamine metabolism pathway in multiple cell clusters within human AAA compared with nonaneurysmal samples.</div></div><div><h3>Results</h3><div>scRNA-seq analysis revealed higher activity of the polyamine metabolism pathway in multiple cell clusters within human AAA compared with nonaneurysmal samples. The messenger RNA expression levels of genes related to polyamine metabolism, such as ODC1 and SAT1, were also found to be elevated in various cell clusters of human AAA samples. Immunofluorescence assays confirmed an increased expression of ODC1 in AAA tissues relative to controls. Polyamine metabolomic analysis indicated that spermidine (SPD) levels were positively correlated with the diameters of AAA (R = 0.73; <em>P</em> = .04). In angiotensin II (Ang II)-induced AAA model of Apoe<sup>−/−</sup> mice, SPD treatment significantly decreased the incidence of aneurysm rupture compared with the control group (27% vs 62.5%; <em>P</em> < .0001). scRNA-seq of mouse aortic aneurysm tissues revealed a higher proportion of smooth muscle cells (SMCs) in the SPD-treated groups. Trajectory analysis suggested that the clusters of SMCs underwent the phenotype switch from the contractile SMCs to synthetic SMCs. Differential expressed gene analysis in the SMCs cluster showed that elastin (Eln) messenger RNA is the most markedly upregulated gene in SPD-treated group compared with controls. In both porcine pancreatic elastase-induced AAA mouse models and mouse vascular SMCs, Eln messenger RNA levels were significantly increased in SPD-treated groups than in control groups.</div></div><div><h3>Conclusions</h3><div>We found that polyamine metabolism is more active in AAA. As one of polyamines, SPD can prevent rupture of aortic aneurysms. Eln upregulation by SPD in SMCs may be the potential molecular mechanism.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100324"},"PeriodicalIF":0.0,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-05DOI: 10.1016/j.jvsvi.2025.100320
Ryan Gedney MD , Joseph Scalea MD , Mathew D. Wooster MD , Jean M. Ruddy MD , Thomas Brothers MD , David Mahvi MD , Adam Tanious MD
Background
Surgical innovation has offered some of the most remarkable advances in technology in human history, often starting in the clinical setting. Despite unique approaches to problem solving among clinical surgeons, there are few structures for innovation that offer a sustainable pipeline of new technology. We hypothesized that a simple framework addressing four steps would support sustainable innovation.
Methods
To identify unmet needs, we assembled a team of clinical specialists who attended problem-focused quarterly white board sessions. Solutions generated were directed toward a single unmet need, using evidence-based design sketches and prior art assessment in real time. To assess solutions, solution-specific subgroups were built with direct institutional availability to engineering, intellectual property, and business expertise. Entrepreneurs and team leaders then built business models for each opportunity.
Results
Unmet need identification was achieved within the first meeting, and the structured framework rapidly yielded innovative solutions in seven different categories, including surgical training, vascular access, improved ergonomics and patient positioning, visualization enhancement, and workflow optimization. Each project was prioritized for development based on achievable timelines. Within 1 year, this resulted in three patent applications, one issued patent, two funded in-house development projects, and one funded clinician-led startup enrolled in a nationally recognized accelerator program, with a combined total addressable market of $9.8 billion.
Conclusions
We present a successful, innovative structure for a multidisciplinary group within a large academic surgical department focused on education of the innovation process. This clinician-centered, stepwise approach provided a pathway for commercialization that is absent in most surgical environments and facilitates rapid generation of highly valuable ideas.
{"title":"A novel framework for structuring sustainable innovation in surgery","authors":"Ryan Gedney MD , Joseph Scalea MD , Mathew D. Wooster MD , Jean M. Ruddy MD , Thomas Brothers MD , David Mahvi MD , Adam Tanious MD","doi":"10.1016/j.jvsvi.2025.100320","DOIUrl":"10.1016/j.jvsvi.2025.100320","url":null,"abstract":"<div><h3>Background</h3><div>Surgical innovation has offered some of the most remarkable advances in technology in human history, often starting in the clinical setting. Despite unique approaches to problem solving among clinical surgeons, there are few structures for innovation that offer a sustainable pipeline of new technology. We hypothesized that a simple framework addressing four steps would support sustainable innovation.</div></div><div><h3>Methods</h3><div>To identify unmet needs, we assembled a team of clinical specialists who attended problem-focused quarterly white board sessions. Solutions generated were directed toward a single unmet need, using evidence-based design sketches and prior art assessment in real time. To assess solutions, solution-specific subgroups were built with direct institutional availability to engineering, intellectual property, and business expertise. Entrepreneurs and team leaders then built business models for each opportunity.</div></div><div><h3>Results</h3><div>Unmet need identification was achieved within the first meeting, and the structured framework rapidly yielded innovative solutions in seven different categories, including surgical training, vascular access, improved ergonomics and patient positioning, visualization enhancement, and workflow optimization. Each project was prioritized for development based on achievable timelines. Within 1 year, this resulted in three patent applications, one issued patent, two funded in-house development projects, and one funded clinician-led startup enrolled in a nationally recognized accelerator program, with a combined total addressable market of $9.8 billion.</div></div><div><h3>Conclusions</h3><div>We present a successful, innovative structure for a multidisciplinary group within a large academic surgical department focused on education of the innovation process. This clinician-centered, stepwise approach provided a pathway for commercialization that is absent in most surgical environments and facilitates rapid generation of highly valuable ideas.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100320"},"PeriodicalIF":0.0,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145651953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-04DOI: 10.1016/j.jvsvi.2025.100319
Melissa D’Andrea MD , Daniel Nguyen MD , Martina Francis BS , Dylan Joule BS , Kaoru R. Goshima MD, FACS , Wei Zhou MD, FACS
<div><h3>Objective</h3><div>Renal artery stenosis is an uncommon vascular complication following kidney transplantation. Noninvasive renal artery duplex is frequently used for initial screening. However, due to lack of specific criteria for transplanted renal artery, renal artery stenosis is not accurately diagnosed and may result in unnecessary contrast usage for further radiographic evaluation. Given the lack of consensus on duplex criterion, as well as the risks associated with invasive angiography and contrast-enhanced computed tomography angiography, our goal is to identify an accurate ultrasound diagnostic criteria for high grade stenosis in transplanted renal arteries.</div></div><div><h3>Methods</h3><div>A retrospective review was performed of kidney transplant patients managed with duplex screening followed by angiography. Patients underwent renal artery duplex ultrasound on an outpatient basis if there was decline in renal function or uncontrolled hypertension. Upon finding significant stenosis, patients were referred to vascular surgery for intervention. Patients who met >60% stenosis based on the established renal artery duplex criteria were included in the study. Subjects with ≥70% angiographic cross-sectional narrowing or mean pullback pressure gradients of ≥10% underwent intervention. Duplex-derived peak systolic velocities measured along the donor renal artery to iliac artery were correlated with angiographic findings through receiver operating characteristic analysis. Similar calculations were performed for renal-to-iliac artery peak systolic ratios. Student’s <em>t</em>-test and χ<sup>2</sup> analysis were also evaluated.</div></div><div><h3>Results</h3><div>Forty-two patients were evaluated and were deemed to have >60% renal artery stenosis based on the established criteria and underwent angiography. Twenty-one of these surgical patients were transplanted renal patients; however, four did not have angiogram data available. Thus, 17 of those transplant patients who underwent renal angiography between January 2019 and March 2023 were reviewed. Overall mean peak velocity and mean renal-to-iliac peak systolic ratio for the nine subjects treated with balloon angioplasty were 426 ± 34 cm/s and 2.2 ± 0.4, respectively. The eight subjects without angiographic evidence of high-grade stenosis had an overall mean peak velocity of 271 ± 15 cm/s and mean peak ratio of 1.5 ± 0.1. There was a difference in mean peak velocity of the donor renal artery (<em>P</em> = .0049) and overall mean peak velocity across the entire anastomosis (<em>P</em> = .0012). For angiographic stenosis ≥70%, an overall peak velocity of >321 correlated to 88.9% sensitivity, 100% specificity, 100% positive predictive value, and 88.9% negative predictive value with an accuracy of 94.1%. A renal-to-iliac artery peak systolic ratio ≥1.6 corresponded to 85.7% sensitivity, 75.0% specificity, 79.4% positive predictive value, and 82.4% negative predictive value with
{"title":"Assessment of ultrasound criteria for high-grade renal artery stenosis in transplant kidneys","authors":"Melissa D’Andrea MD , Daniel Nguyen MD , Martina Francis BS , Dylan Joule BS , Kaoru R. Goshima MD, FACS , Wei Zhou MD, FACS","doi":"10.1016/j.jvsvi.2025.100319","DOIUrl":"10.1016/j.jvsvi.2025.100319","url":null,"abstract":"<div><h3>Objective</h3><div>Renal artery stenosis is an uncommon vascular complication following kidney transplantation. Noninvasive renal artery duplex is frequently used for initial screening. However, due to lack of specific criteria for transplanted renal artery, renal artery stenosis is not accurately diagnosed and may result in unnecessary contrast usage for further radiographic evaluation. Given the lack of consensus on duplex criterion, as well as the risks associated with invasive angiography and contrast-enhanced computed tomography angiography, our goal is to identify an accurate ultrasound diagnostic criteria for high grade stenosis in transplanted renal arteries.</div></div><div><h3>Methods</h3><div>A retrospective review was performed of kidney transplant patients managed with duplex screening followed by angiography. Patients underwent renal artery duplex ultrasound on an outpatient basis if there was decline in renal function or uncontrolled hypertension. Upon finding significant stenosis, patients were referred to vascular surgery for intervention. Patients who met >60% stenosis based on the established renal artery duplex criteria were included in the study. Subjects with ≥70% angiographic cross-sectional narrowing or mean pullback pressure gradients of ≥10% underwent intervention. Duplex-derived peak systolic velocities measured along the donor renal artery to iliac artery were correlated with angiographic findings through receiver operating characteristic analysis. Similar calculations were performed for renal-to-iliac artery peak systolic ratios. Student’s <em>t</em>-test and χ<sup>2</sup> analysis were also evaluated.</div></div><div><h3>Results</h3><div>Forty-two patients were evaluated and were deemed to have >60% renal artery stenosis based on the established criteria and underwent angiography. Twenty-one of these surgical patients were transplanted renal patients; however, four did not have angiogram data available. Thus, 17 of those transplant patients who underwent renal angiography between January 2019 and March 2023 were reviewed. Overall mean peak velocity and mean renal-to-iliac peak systolic ratio for the nine subjects treated with balloon angioplasty were 426 ± 34 cm/s and 2.2 ± 0.4, respectively. The eight subjects without angiographic evidence of high-grade stenosis had an overall mean peak velocity of 271 ± 15 cm/s and mean peak ratio of 1.5 ± 0.1. There was a difference in mean peak velocity of the donor renal artery (<em>P</em> = .0049) and overall mean peak velocity across the entire anastomosis (<em>P</em> = .0012). For angiographic stenosis ≥70%, an overall peak velocity of >321 correlated to 88.9% sensitivity, 100% specificity, 100% positive predictive value, and 88.9% negative predictive value with an accuracy of 94.1%. A renal-to-iliac artery peak systolic ratio ≥1.6 corresponded to 85.7% sensitivity, 75.0% specificity, 79.4% positive predictive value, and 82.4% negative predictive value with ","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100319"},"PeriodicalIF":0.0,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-04DOI: 10.1016/j.jvsvi.2025.100318
Melissa Chen Xu BS , Nicola Habash BS , Justin Do BS , Jiaying Bi MA , Dawn Salvatore MD , Paul Dimuzio MD , Michael Nooromid MD , Babak Abai MD
Objective
Patient education materials frequently exceed the recommended sixth-grade reading level. Although large language models (LLMs) have shown inconsistent accuracy in medical query responses, they have demonstrated promise in simplifying complex text. This capability has not yet been studied in vascular patient education materials. This study evaluates whether ChatGPT-4o and Gemini 1.5 Pro can improve the readability of Society for Vascular Surgery (SVS) patient education flyers.
Methods
SVS health flyers were selected based on five common vascular conditions: abdominal aortic aneurysm, carotid artery disease, deep vein thrombosis, peripheral artery disease, and varicose veins. Each flyer was submitted to ChatGPT-4o and Gemini 1.5 Pro, which generated simplified versions using structured Extensible Markup Language prompts to guide consistent editing. Vascular surgeons, who were blinded to the source of each flyer, independently scored the original and LLM-modified flyers on accuracy, comprehensiveness, and understandability using a 0 to 10 Likert scale. Readability was assessed using the Average Reading Level Consensus tool, and textual features—including word count, sentence count, syllables per word, and percentage of complex words—were quantified. Paired t-tests were used to analyze differences in readability scores. Analysis of variance with Tukey honestly significant difference post hoc testing was used to assess textual characteristics.
Results
The original SVS flyers had an average reading grade level of 10.61 (standard deviation [SD], 0.88). Gemini and ChatGPT-4o significantly reduced the reading level to 8.18 (SD, 1.24; P = .012) and 8.37 (SD, 0.88; P = .00013), respectively. SVS flyers averaged 605 words, 29.8 sentences, 1.7 syllables per word, and 20.4% complex words. Both LLMs significantly reduced syllables per word (Gemini: 1.52; P < .0001; ChatGPT: 1.53; P < .0001) and the proportion of complex words (Gemini: 12.7%; P < .0001; ChatGPT: 13.6%; P < .0001). There were no significant differences between the Gemini and ChatGPT outputs in readability or textual metrics. Physician scores for accuracy, comprehensiveness, and understandability showed no significant differences between SVS and either LLM model, nor between the two LLMs.
Conclusions
LLMs significantly improved the readability of SVS patient education materials by approximately two grade levels without compromising content accuracy. These findings support the use of LLMs to enhance the accessibility of medical information when grounded in trusted source material, rather than relying on unprompted content generation.
目的患者教育材料经常超过推荐的六年级阅读水平。尽管大型语言模型（llm）在医疗查询响应中显示出不一致的准确性，但它们在简化复杂文本方面表现出了希望。这种能力尚未在血管患者教育材料中进行研究。本研究评估chatgpt - 40和Gemini 1.5 Pro是否可以提高血管外科学会（SVS）患者教育传单的可读性。方法根据腹主动脉瘤、颈动脉疾病、深静脉血栓形成、外周动脉疾病和静脉曲张等5种常见血管疾病，选择ssvs健康飞行员。每个传单都提交给chatgpt - 40和Gemini 1.5 Pro，后者使用结构化的可扩展标记语言提示生成简化版本，以指导一致的编辑。血管外科医生对每个传单的来源不知情，使用0到10的李克特量表独立地对原始传单和llm修改传单的准确性、全全性和可理解性进行评分。使用平均阅读水平共识工具评估可读性，并对文本特征（包括单词计数、句子计数、每个单词的音节数和复杂单词的百分比）进行量化。配对t检验用于分析可读性评分的差异。方差分析采用Tukey诚实显著差异事后检验来评估文本特征。结果原始SVS传单的平均阅读等级水平为10.61（标准差[SD]， 0.88）。Gemini和chatgpt - 40分别显著降低阅读水平至8.18 （SD, 1.24; P = 0.012）和8.37 （SD, 0.88; P = 0.00013）。SVS传单平均605个单词，29.8个句子，每个单词1.7个音节，20.4%的复杂单词。两个LLMs都显著减少了每个单词的音节数（Gemini: 1.52; P < .0001; ChatGPT: 1.53; P < .0001）和复杂单词的比例（Gemini: 12.7%; P < .0001; ChatGPT: 13.6%; P < .0001）。Gemini和ChatGPT输出在可读性或文本度量方面没有显著差异。医生对准确性、全面性和可理解性的评分在SVS和任何LLM模型之间没有显著差异，在两个LLM模型之间也没有显著差异。结论sllm显著提高了SVS患者教育材料的可读性，在不影响内容准确性的情况下提高了约两个等级。这些发现支持使用法学硕士来增强基于可信源材料的医学信息的可访问性，而不是依赖于未经提示的内容生成。
{"title":"Large language models improve readability of patient education materials on vascular conditions","authors":"Melissa Chen Xu BS , Nicola Habash BS , Justin Do BS , Jiaying Bi MA , Dawn Salvatore MD , Paul Dimuzio MD , Michael Nooromid MD , Babak Abai MD","doi":"10.1016/j.jvsvi.2025.100318","DOIUrl":"10.1016/j.jvsvi.2025.100318","url":null,"abstract":"<div><h3>Objective</h3><div>Patient education materials frequently exceed the recommended sixth-grade reading level. Although large language models (LLMs) have shown inconsistent accuracy in medical query responses, they have demonstrated promise in simplifying complex text. This capability has not yet been studied in vascular patient education materials. This study evaluates whether ChatGPT-4o and Gemini 1.5 Pro can improve the readability of Society for Vascular Surgery (SVS) patient education flyers.</div></div><div><h3>Methods</h3><div>SVS health flyers were selected based on five common vascular conditions: abdominal aortic aneurysm, carotid artery disease, deep vein thrombosis, peripheral artery disease, and varicose veins. Each flyer was submitted to ChatGPT-4o and Gemini 1.5 Pro, which generated simplified versions using structured Extensible Markup Language prompts to guide consistent editing. Vascular surgeons, who were blinded to the source of each flyer, independently scored the original and LLM-modified flyers on accuracy, comprehensiveness, and understandability using a 0 to 10 Likert scale. Readability was assessed using the Average Reading Level Consensus tool, and textual features—including word count, sentence count, syllables per word, and percentage of complex words—were quantified. Paired <em>t</em>-tests were used to analyze differences in readability scores. Analysis of variance with Tukey honestly significant difference post hoc testing was used to assess textual characteristics.</div></div><div><h3>Results</h3><div>The original SVS flyers had an average reading grade level of 10.61 (standard deviation [SD], 0.88). Gemini and ChatGPT-4o significantly reduced the reading level to 8.18 (SD, 1.24; <em>P</em> = .012) and 8.37 (SD, 0.88; <em>P</em> = .00013), respectively. SVS flyers averaged 605 words, 29.8 sentences, 1.7 syllables per word, and 20.4% complex words. Both LLMs significantly reduced syllables per word (Gemini: 1.52; <em>P</em> < .0001; ChatGPT: 1.53; <em>P</em> < .0001) and the proportion of complex words (Gemini: 12.7%; <em>P</em> < .0001; ChatGPT: 13.6%; <em>P</em> < .0001). There were no significant differences between the Gemini and ChatGPT outputs in readability or textual metrics. Physician scores for accuracy, comprehensiveness, and understandability showed no significant differences between SVS and either LLM model, nor between the two LLMs.</div></div><div><h3>Conclusions</h3><div>LLMs significantly improved the readability of SVS patient education materials by approximately two grade levels without compromising content accuracy. These findings support the use of LLMs to enhance the accessibility of medical information when grounded in trusted source material, rather than relying on unprompted content generation.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100318"},"PeriodicalIF":0.0,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145651951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acute ischemia after intra-arterial injection of crushed tablets remains an under-reported phenomenon with no established medical interventions to halt its progression. Tapentadol, a synthetic opioid, has been increasingly misused, leading to vascular complications. This study aimed to present a case series of patients who developed digital ischemia following intra-arterial injection of crushed tablet tapentadol, highlighting clinical presentation, diagnostic findings, and treatment outcomes.
Methods
This was a prospective case series conducted at Government Stanley Medical College Hospital, specifically in the vascular surgery department. The study focused on patients presenting with digital ischemia following intra-arterial injection of crushed tapentadol tablets.
Results
A total of 11 cases were documented, primarily young males (18-29 years). Patients presented with symptoms ranging from cyanotic changes to gangrene of the distal phalanges. Angiography revealed distal arterial occlusions, with absent distal flow in necrotic digits and partial flow in cyanotic fingers. Treatment involved systemic anticoagulation with heparin, calcium channel blockers, and intravenous prostaglandin therapy. Eight patients recovered completely, and three experienced autoamputation of necrotic fingertips. No major infections or limb-threatening complications were observed.
Conclusions
This case series underscores the emerging public health concern of tapentadol abuse and its potential to cause digital ischemia. The ischemic manifestations are hypothesized to result from microcrystalline cellulose embolism rather than the pharmacological properties of the drug itself. A structured approach to diagnosis and treatment, including early anticoagulation and vasodilatory therapy, may improve patient outcomes. Further research is necessary to establish definitive treatment protocols and enhance awareness among health care providers.
{"title":"Digital ischemic manifestations by tablet tapentadol intravascular abuse: A case series exploring clinical outcomes","authors":"Kalyanaraman Elancheralathan MS, Mch, Vikraman Gurusamy MS, DNB, MCh, Ashok Kumar MS, Mch, Thangavel Rajkumar MS, Mch, Sharath Rajkumar MS, Mch","doi":"10.1016/j.jvsvi.2025.100309","DOIUrl":"10.1016/j.jvsvi.2025.100309","url":null,"abstract":"<div><h3>Objective</h3><div>Acute ischemia after intra-arterial injection of crushed tablets remains an under-reported phenomenon with no established medical interventions to halt its progression. Tapentadol, a synthetic opioid, has been increasingly misused, leading to vascular complications. This study aimed to present a case series of patients who developed digital ischemia following intra-arterial injection of crushed tablet tapentadol, highlighting clinical presentation, diagnostic findings, and treatment outcomes.</div></div><div><h3>Methods</h3><div>This was a prospective case series conducted at Government Stanley Medical College Hospital, specifically in the vascular surgery department. The study focused on patients presenting with digital ischemia following intra-arterial injection of crushed tapentadol tablets.</div></div><div><h3>Results</h3><div>A total of 11 cases were documented, primarily young males (18-29 years). Patients presented with symptoms ranging from cyanotic changes to gangrene of the distal phalanges. Angiography revealed distal arterial occlusions, with absent distal flow in necrotic digits and partial flow in cyanotic fingers. Treatment involved systemic anticoagulation with heparin, calcium channel blockers, and intravenous prostaglandin therapy. Eight patients recovered completely, and three experienced autoamputation of necrotic fingertips. No major infections or limb-threatening complications were observed.</div></div><div><h3>Conclusions</h3><div>This case series underscores the emerging public health concern of tapentadol abuse and its potential to cause digital ischemia. The ischemic manifestations are hypothesized to result from microcrystalline cellulose embolism rather than the pharmacological properties of the drug itself. A structured approach to diagnosis and treatment, including early anticoagulation and vasodilatory therapy, may improve patient outcomes. Further research is necessary to establish definitive treatment protocols and enhance awareness among health care providers.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"4 ","pages":"Article 100309"},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145651952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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