Faculty Bibliography

BACKGROUND:Long-term effect of COVID-19 (Long COVID) may persist for months or years after SARS-CoV-2 infection, but longer-term cardiopulmonary manifestations have not been previously reported. OBJECTIVES/OBJECTIVE:The objective of the study was to characterize cardiopulmonary function after SARS-CoV-2 infection in a digital health substudy of the nationwide Researching COVID-19 to Enhance Recovery Adult Cohort Study. METHODS:Associations between wearable sensor device measures of cardiopulmonary fitness and survey-derived Long COVID symptoms were estimated over a 6-month window at least 6 months after infection using linear regression models adjusted for wear time, age, sex, race/ethnicity, and body mass index. RESULTS:Among 1,475 participants (72% female, 65% non-Hispanic White) a median of 21 months (IQR: 15-31 months) after infection, 498 (34%) had high symptom burden as characterized by the Researching COVID-19 to Enhance Recovery Long COVID Research Index (LCRI). High LCRI (vs low LCRI) was associated with significantly lower heart rate variability (-4.4 ms; 95% CI: -6.5 to -2.4; P < 0.001), higher resting heart rate (+1.5 beats/min [+0.7 to +2.4]; P < 0.001), fewer metabolic equivalent of task minutes (-96.3 [-128.8 to -63.8]; P < 0.001), lower step counts (-1,624 steps/day [-1,952 to -1,296]; P < 0.001), and lower activity levels (-7.9 minutes/day very or fairly active [-10.9 to -5.0]; P < 0.001). Hierarchal clustering analysis identified two subphenotypes with abnormal cardiovascular measures associated with low quality of life scores. CONCLUSIONS:Long COVID is associated with worse cardiovascular fitness. Additional studies are needed to determine if Long COVID is a novel risk factor for incident cardiovascular disease.

Complex extremity wounds, if not addressed properly, are a leading cause of major limb amputation. Chronic wounds in salvaged extremities contribute to long-term morbidity in the extremity. Orthoplastic surgery treats limb-threatening conditions through the combined application of orthopaedic and plastic surgical principles, applied to clinical problems simultaneously. Key components include early stakeholder evaluation of the limb and patient and open collaborative communication between orthopaedic and plastic surgeons. Meticulous débridement at the time of presentation and careful selection of fixation informed by the overall reconstructive plan should be executed when the patient presents to the emergency department. Implementation of Orthoplastic protocols results in quicker time to skeletal stabilization and soft tissue coverage, reduced risk of infection, improved functional outcomes, and less cost for care. This review presents a protocol-driven guide for establishing an Orthoplastic program and optimizing limb salvage outcomes across diverse practice settings.

INTRODUCTION/BACKGROUND:Contemporary abdominal wall reconstruction places a strong emphasis on optimizing extraperitoneal mesh placement. When the posterior layer is insufficient for closure, adjuncts such as hernia sac, omentum, or Vicryl mesh have been described. The outcomes of various posterior layer supplementation (PLS) materials, both autologous and non-autologous, have not been well examined. We aim to evaluate the outcomes of patients undergoing ventral hernia repair with extraperitoneal mesh placement who undergo PLS and compare how PLS materials impact these outcomes. METHODS:All patients who underwent a retromuscular hernia (RM) repair with PLS between Jan 2021 and Jan 2025 at a single center were reviewed. Patient demographics, preoperative characteristics, intraoperative factors, and postoperative outcomes were evaluated. Descriptive statistics and comparative tests including Mann-Whitney U test, Student's t-test, and Fisher's exact test were utilized. RESULTS:Sixty-seven patients underwent RM repair with PLS. Supplement materials used included hernia sac, omentum, falciform ligament, prior mesh, new biologic, and biosynthetic coated mesh. Fifty-two percent (n = 35) of the repairs were retrorectus only and 48% (n = 32) were transversus abdominus releases. The average length of follow-up was 189 days with a recurrence rate of 3%. Sixty percent of PLS was performed with autologous material with 40% utilizing new biologic or biosynthetic coated meshes. SSI, SSO, and SSOPI were similar between the autologous and non-autologous supplementation groups (p = 1, p = 0.16, p = 0.29, respectively). There were more postoperative bowel obstructions in the non-autologous group (n = 4) as compared to the autologous group (n = 0) (p = 0.02). All the bowel obstructions were managed nonoperatively. DISCUSSION/CONCLUSIONS:Our findings suggest that outcomes are acceptable with minimal morbidity when comparing autologous tissue to biologic and biosynthetic coated mesh for PLS. The low recurrence rates observed, regardless of the material used, support the continued adoption of this approach. Proactive supplementation of the visceral sac may decrease need for lateral myofascial release.

Thirty-three panelists from 23 institutions participated in a three-round Delphi consensus process to establish interdisciplinary guidelines for reporting knee MRI findings on 11 meniscus topics: MRI criteria for tears, possible tears, tear patterns, tear descriptors, intrameniscal descriptors, meniscal roots, posteromedial meniscocapsular junction, meniscus extrusion, assessment of the postoperative meniscus, retear descriptors, and ancillary findings. All panelists completed all Delphi rounds. In round 1, 350 free-text entries (mean, 31.8 entries per topic ± 2.2 [SD]) were submitted. In round 2, 32 statements (mean, 2.9 entries per topic ± 1.6) were collected from 11 teams (one orthopedic surgeon and two musculoskeletal radiologists per team), with 75% (24 of 32 panelists) achieving consensus using a 9-point Likert scale. Consensus was defined as a score of at least 7 (≥80% of panelists) and a median score of at least 7 (IQR ≤3). In round 3, all statements achieved consensus. Between rounds 2 and 3, agreement significantly increased (P < .05) among all panelists on the topics of possible tears (to express uncertainty) and tear descriptors (for treatment planning), among orthopedic surgeons on MRI criteria for tear and the assessment of the postoperative meniscus (specifically on reporting equivocal findings and the use of MR arthrography), and among radiologists on tear patterns, intrameniscal descriptors, meniscal roots, and retear descriptors.

BACKGROUND AND AIM/OBJECTIVE:Optimizing health and quality of life for pediatric liver transplant (LT) recipients requires balancing protection of the liver graft with overall burden of treatments on the child. Since the AASLD's 2013 guidelines, strategies for achieving this balance have evolved, with a particular focus on mitigating long-term complications. Advances include operative and intensive care strategies for reducing complications, minimizing exposure to immunosuppression and its long-term adverse effects for other organs, infection prevention with prophylaxis and vaccination, optimizing support of early nutrition and development, and improving support around transition from pediatric to adult care. This document aims to provide an evidence-based guideline to comprehensive care of pediatric LT recipients, starting at transplant and continuing as they advance to adulthood. METHODS:A multidisciplinary writing group of pediatric liver transplant experts and a medical librarian was convened by AASLD, with guidance by its Practice Guidelines Development Policy, and in collaboration with the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the American Society of Transplantation (AST). We conducted a systematic global literature review, formulated key clinical questions, and developed recommendations. Each recommendation was graded using the Oxford Centre for Evidence-Based Medicine framework and categorized by strength through a consensus voting process. CONCLUSION/CONCLUSIONS:All recommendations are based on best-available evidence and reflect expert consensus. Most of the evidence basis remains retrospective or observational data, or extrapolation from related populations. To continue improving long-term outcomes after pediatric liver transplant, multi-disciplinary, multi-center collaboration to strengthen the evidence will be essential.

OBJECTIVES/OBJECTIVE:To test whether unilateral recurrent laryngeal nerve (RLN) transection elicits side specific transcriptomic responses in rat vocal fold compartments. We compared the medial thyroarytenoid (MTA) muscle and mucosa on the left versus right, accounting for baseline laterality. METHODS:Unilateral RLN transection was performed in five adult rats (Left RLN: 2-males, 1-female; Right RLN: 1-male, 1-female). 5-weeks post-injury, the medial thyroarytenoid (MTA) muscle and vocal fold mucosa were harvested for RNA sequencing. Differential expression analysis compared Left-denervated versus Right-denervated tissues. A separate control Left-versus-Right analysis (1-male; 1-female) was used to assess baseline laterality and to contextualize TF transcription-factor inferences. TF activity was inferred using perturbation-based signatures, and baseline trends were used to classify overlapping signals as consistent with, opposite to, or distinct from baseline laterality. RESULTS:Left RLN denervation elicited distinct transcriptional responses in both compartments. In mucosa, TFs governing epithelial stability were reduced while regenerative cues were activated, suggesting impaired differentiation and recruitment of progenitor-like programs. In MTA, left-sided injury increased TFs consistent with stress signaling and mitochondrial compensation. TFs involved in epigenetic stability were reduced. Lateralized activity was observed in developmental regulators putatively related to positional memory or differential stress adaptation. Pathway analysis revealed enrichment of skeletal development processes in MTA and immune/matrix regulation in mucosa, indicating coordinated remodeling across muscle and epithelial compartments. CONCLUSION/CONCLUSIONS:RLN injury produces side-specific muscle and mucosal changes, with left-sided denervation showing stronger atrophy and stress responses. These results emphasize the importance of laterality and coordinated tissue adaptation. LEVEL OF EVIDENCE/METHODS:NA.

INTRODUCTION/BACKGROUND:Anastomotic leaks (AL) are a devastating complication of simultaneous resection of primary colon cancer and liver metastases. We aimed to determine the risk factors of AL using a 10-year cohort from a nationwide database. PATIENTS AND METHODS/METHODS:The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) from 2014 to 2023 was used. Patients who underwent simultaneous colectomy and liver resection were included. Multivariate analysis was performed with AL as the outcome variable. The 2:1 propensity score matching (PSM) was performed on preoperative and operative covariates. RESULTS:2.27) were independent risk factors for AL. A 2:1 PSM cohort for blood transfusions resulted in 205 patient pairs. The rate of AL in the blood transfusion cohort was higher (10.7% versus 5.0%, p < 0.01). CONCLUSIONS:In this study, we found that a higher ASA score, chronic steroid use, major hepatectomies, and blood transfusions were independent predictors of AL. In matched cohorts, there was also an increased risk for AL. Thus, for high-risk patient populations undergoing simultaneous resection of primary colon cancer and liver metastasis, consideration should be given for fecal diversion or staged procedures.