Faculty Bibliography

BACKGROUND:Mild autonomous cortisol secretion causes substantial cardiometabolic morbidity, yet evidence for benefits following adrenalectomy remains mixed. Prior studies are limited by small sample sizes and heterogeneous definitions. This study evaluates the metabolic impact of adrenalectomy compared with nonoperative management in mild autonomous cortisol secretion using standardized biochemical criteria from the Epic Cosmos database. METHODS:Mild autonomous cortisol secretion was defined biochemically using dexamethasone suppression test cortisol 1.8-10 μg/dL, dexamethasone, and adrenocorticotropic hormone levels. Surgical patients underwent unilateral adrenalectomy with biochemical resolution of hypercortisolism. Inverse probability of treatment weighting was performed, adjusting for demographics, baseline cardiometabolic parameters, dexamethasone suppression test cortisol level, and glucagon-like peptide-1 receptor agonist use. The starting time point was the adrenalectomy date or, for nonoperative patients, the dexamethasone suppression test date plus the median time to surgery. Follow-up outcomes (A1C, lipid profile, body mass index, and blood pressure) were assessed for categorical improvement at last follow-up within 3 years using a weighted logistic regression model. RESULTS:From 2018 to 2025, 395 patients met inclusion criteria (54 surgical, 341 nonoperative). Surgical patients had a higher adjusted likelihood of categorical improvements in A1C (25.6% vs 9.5%, odds ratio, 3.30; P = .002), total cholesterol (14.6% vs 3.9%, odds ratio, 4.25; P = .004), and body mass index (24.9% vs 12.1%, odds ratio, 2.42; P = .018). There were no differences in blood pressure between groups (28.4% vs 26.7%, odds ratio, 1.09; P = .803). CONCLUSION/CONCLUSIONS:This is the largest cohort study to date evaluating metabolic outcomes after surgery for mild autonomous cortisol secretion. Adrenalectomy was associated with categorical improvement in A1C, body mass index, and total cholesterol, supporting more widespread consideration for selective operative management.

MOTIVATION/UNASSIGNED:Ferroptosis is an iron-dependent regulated cell death process involving lipid peroxidation, redox imbalance, and impaired antioxidant defense. It is increasingly relevant to metabolic liver disease and non-alcoholic steatohepatitis. Existing ferroptosis resources mainly provide gene annotations and disease associations, but they do not offer an integrated workflow for user-uploaded transcriptome data, liver-focused enrichment, dataset-level scoring, and ferroptosis-senescence cross-talk analysis. RESULTS/UNASSIGNED:We developed FerroEnrich, an open-source web platform for analyzing ferroptosis and senescence programs in human and mouse liver transcriptome datasets. FerroEnrich supports count matrix upload, metadata-guided differential expression analysis, identification of ferroptosis-prone and ferroptosis-resistant genes, dataset-level ferroptosis index scoring, sample-level susceptibility estimation, curated liver module enrichment, interaction network visualization, and ferroptosis-senescence cross-talk analysis. Application to human advanced non-alcoholic steatohepatitis and mouse diet-induced liver disease datasets demonstrated cross-species utility and identified conserved remodeling, including reduced ferroptosis-protective signatures and increased senescence- and fibrosis-associated modules. AVAILABILITY AND IMPLEMENTATION/UNASSIGNED:FerroEnrich is freely available at https://ferroenrich.shinyapps.io/ferroenrich/. Source code, documentation, and demo datasets are available at the FerroEnrich GitHub repository.

Background Stroke remains a leading cause of death and long-term disability. Although stem cell-based approaches are being investigated as possible regenerative strategies for stroke, public perceptions of their potential benefits, risks, mechanisms, and clinical use are not well-characterized. This exploratory survey described responses to an investigator-developed questionnaire about stem cell therapy for stroke. Methods A 10-item cross-sectional questionnaire was distributed electronically through Google Forms (Google, Inc., Mountain View, CA) to 36 individuals in a convenience sample; 26 completed questionnaires were received (response rate: 72.2%). The questionnaire was investigator-developed and was not validated as a measure of factual knowledge, clinical efficacy, or safety. Responses were categorized as "yes," "no," or "maybe"; one item used time-based response categories. Counts and percentages were calculated using the total number of completed questionnaires as the denominator. The survey was independently conducted as a student-led summer academic project and did not undergo review by an institutional review board, school ethics committee, or independent ethics authority. Results Twenty-six responses were analyzed. For the item asking whether embryonic stem cells are effective in stroke treatment, eight respondents (30.77%) selected "yes," 16 (61.54%) selected "maybe," and two (7.69%) selected "no." For the item asking whether stem cell treatment has advantages for stroke, 21 respondents (80.77%) selected "yes," four (15.38%) selected "maybe," and one (3.85%) selected "no." "Maybe" was the majority or joint-most-frequent response for six of 10 items, including items about animal testing, adverse effects, alternative regenerative treatments, and use during pregnancy. Conclusions In this small convenience sample, responses to an investigator-developed questionnaire suggested favorable perceptions of possible benefits of stem cell therapy for stroke, alongside frequent uncertainty about safety, mechanisms, the timing of improvement, and use in special populations. Because the questionnaire was not validated as a factual-knowledge instrument, findings should be interpreted strictly as descriptive perceptions rather than as evidence of respondents' medical knowledge, treatment confidence, or the clinical efficacy or safety of stem cell therapy. Larger studies using validated instruments and representative sampling are needed.

OBJECTIVES/OBJECTIVE:To compare growth z-scores and prematurity-related comorbidities for preterm infants receiving Soybean Oil-Intravenous Lipid Emulsion (SO-ILE) versus Soybean + Medium-chain triglycerides + Olive + Fish oil ILE (SMOF-ILE). STUDY DESIGN/METHODS:A multicenter, retrospective cohort study of 347 preterm infants <32 weeks' gestational age with birth weight ≤1500 grams who received SO-ILE or SMOF-ILE for at least seven consecutive days. RESULTS:SO-ILE group (n = 179) demonstrated significantly improved growth for length (p ≤ 0.001) and head circumference z-scores (p = 0.015) at 36 weeks' postmenstrual age and significantly worse growth for weight z-scores at 1 month (p = 0.017) compared to the SMOF-ILE group (n = 168). SO-ILE group had significantly lower rates of bronchopulmonary dysplasia (BPD) (p < 0.001) and urinary tract infections (UTI) (p = 0.045). CONCLUSION/CONCLUSIONS:In this population, SO-ILE had better outcomes for growth, BPD, and UTI compared to SMOF-ILE. Therefore, SO-ILE remains a reasonable lipid emulsion for preterm infants until more evidence is available.

BACKGROUND:The purpose of this study was to compare outcomes of distal radius fractures with a volar ulnar corner (VUC) component treated with standard volar plating or by specific VUC fixation. This study investigated outcomes, radiographic measures, and specialty-based preference associated with surgical treatment of VUC injuries using VUC-specific fixation versus nonspecific VUC fixation. METHODS:We retrospectively analyzed outcomes for 39 patients with a distal radius fracture with VUC component at a level-1 trauma center over 10 years, 2011-2021. Patients underwent either VUC-specific fixation with implants such as a volar rim plate, or with a standard volar plate. The primary outcome of this study was fixation failure and need for revision. Secondary outcomes included complication rate, radiographic alignment, and differences in fixation based on fellowship training. RESULTS:Sixteen of the 39 patients studied had undergone VUC-specific fixation, with a significantly higher rate of use of VUC-specific fixation in fellowship trained hand surgeons compared with fellowship-trained trauma surgeons. There was no significant difference in loss of reduction, revision surgery, or complications. Radiographic measures were statistically similar between both groups postoperatively. Trauma trained surgeons had a significantly increased postoperative radial inclination versus hand-trained surgeons. CONCLUSIONS:This study suggests that not all VUC injuries require specific VUC fixation, and we may be overtreating distal radius fractures that have a VUC component. Fellowship-trained hand surgeons are more likely to employ VUC-specific fixation methods. Additional studies are warranted to determine whether other considerations such as dynamic testing intraoperatively are worthwhile.

BACKGROUND:Sinus of Valsalva aneurysms (SVAs) are rare cardiac anomalies that often remain silent until rupture occurs. Prompt recognition and repair is essential, as untreated ruptured SVAs can lead to progressive right heart failure and early mortality. CASE SUMMARY:A 26-year-old woman with a ruptured SVA and aorto-right atrial fistula underwent definitive surgical repair after failed transcatheter closure, with excellent postoperative recovery. DISCUSSION:Ruptured SVAs are rare and can present with subtle symptoms that can mimic other pathologies. Astute clinical examination, multimodal imaging, and timely surgical management all assist in ensuring excellent long-term outcomes. TAKE-HOME MESSAGE:Early recognition and meticulous perioperative management of ruptured SVAs are the keys to ensuring excellent long-term outcomes.

BACKGROUND:The potential impact of treatment sequencing in chemoimmunotherapy combinations remains underexplored. We evaluated 2 alternative dosing schedules of chemotherapy (cisplatin and gemcitabine [GC]) and an immune checkpoint inhibitor (CPI; atezolizumab [A]) for metastatic urothelial carcinoma (mUC). METHODS:This multicenter phase II study randomized cisplatin-eligible patients with previously untreated mUC in a 1:1 ratio. The chemo-first schedule included 2 cycles of GC, followed by 4 cycles of GC + A and A maintenance. The CPI-first schedule originally included a two-cycle A lead-in, later amended to a one-cycle lead-in, followed by 6 cycles of GC + A and A maintenance. The primary endpoint was objective response rate after the protocol amendment. Secondary endpoints included progression-free survival, overall survival, and safety. RESULTS:Overall, 31 patients were randomized between 9/2017 and 2/2021 (chemo-first, n = 15; CPI-first, n = 16), with early discontinuation due to the evolving mUC management paradigm. Among the per-protocol evaluable patients (n = 19), ORR was 44% (95% CI, 14%-79%) in the chemo-first schedule and 40% (95% CI, 12%-74%) in the CPI-first amended schedule, with neither arm meeting the predefined efficacy threshold. Median follow-up was 60 months (95% CI 48-not reached [NR]). Median progression-free survival and overall survival (95% CI) were: chemo-first, 6.1 (4.4-NR) and 15 (10-NR) months; CPI-first original, 1.3 (1.1-NR) and 12 (8.4-NR) months; and CPI-first amended, 7.6 (2.0-NR) and 26 (3.6-NR) months. No new safety signals or treatment-related deaths occurred. CONCLUSIONS:This study evaluating the impact of chemotherapy and CPI dosing sequence in patients with mUC was limited by a small sample size and early discontinuation, with neither arm meeting the primary endpoint. Exploratory observations highlight CPI lead-in duration as a potential consideration for future trial design.

BACKGROUND/UNASSIGNED:Tricuspid regurgitation (TR) leads to systemic venous congestion and congestive hepatopathy, but conventional TR imaging parameters incompletely capture systemic consequences. Hepatic extracellular volume fraction (ECV) on cardiac magnetic resonance T1 mapping may reflect hepatic tissue remodeling and provide prognostic information beyond conventional risk markers. METHODS/UNASSIGNED:Consecutive patients with moderate or greater TR who underwent cardiac magnetic resonance with hepatic T1 mapping were studied. Hepatic ECV was calculated using pre- and postcontrast T1 values and hematocrit. Patients were stratified by hepatic ECV tertiles. The primary end point was all-cause mortality. RESULTS/UNASSIGNED:=0.02). CONCLUSIONS/UNASSIGNED:Hepatic ECV is a novel prognostic marker that provides incremental risk stratification in TR and has potential to impact therapeutic decision-making in the era of expanded treatment options for TR.

BACKGROUND:Visual evoked potential (VEP) P100 latency is routinely used to assess optic nerve demyelination. However, there is no established methodology for disentangling whether shifts in VEP P100 latency may reflect upstream changes in the visual pathway, such as the level of the retina, or whether these delays could be reflective of downstream disturbances in broader brain structure and functioning. OBJECTIVE:To determine the relationship between VEP-based P100 and MRI-based outcomes in people with MS (PwMS) after accounting for structural retinal changes assessed by spectral domain optical coherence tomography (OCT). METHODS:64 study participants underwent OCT, VEP, and MRI. Standardized VEP assessment derived monocular P100 latency for both eyes. Similarly, OCT performed on Heidelberg Spectralis hardware provided peripapillary retinal nerve fiber layer (pRNFL) thickness. Mediation analyses were performed to assess the relationship between P100 and MRI-based outcomes, adjusting for mediating effects of pRNFL and age. RESULTS:VEP-based P100 was significantly associated with lower whole brain volume (WBV) (p=0.0037), with 87.8% of the total effect being both direct and independent from RNFL and the significant age-WBV covariate effect. Similarly, greater VEP-based P100 latency was directly and independently predictive of lower gray matter volume (GMV) (p=0.015) and greater T2-FLAIR LV (p=0.0036) after adjusting for RNFL and age mediating effects. CONCLUSION/CONCLUSIONS:VEP-based P100 latency shows both age- and RNFL-independent associations with MRI-based MS outcomes. In addition to their established diagnostic utility, VEP measures may provide a neurophysiological, objective metric to assess neurodegeneration.

PURPOSE/OBJECTIVE:To evaluate whether the duration between staged bilateral hip arthroscopy affects patient-reported outcomes, the rate of arthroscopic revision, or conversion to total hip arthroplasty. METHODS:A retrospective comparative case series was conducted of a single-surgeon prospective database of patients who underwent hip arthroscopy for femoroacetabular impingement syndrome with a minimum of 2-year follow-up. Modified Harris Hip Score and Nonarthritic Hip Score were recorded preoperatively and 2 years postoperatively for each hip. For analysis, patients were allocated into 2 groups: staged procedures <1 year apart and ≥1 year apart. RESULTS:A total of 76 patients (152 hips) underwent staged bilateral primary hip arthroscopies. Overall, the mean age at the first surgery was 36.1 ± 13.1 years and the cohort was 59.2% women. Of these, 43 patients (56.6%) underwent staged procedures <1 year apart, whereas 33 patients (43.4%) were staged 1 year apart. Age (P = .092), sex (P = .828), and body mass index (P = .867) did not significantly differ between groups. At 2-year follow-up, modified Harris Hip Score (first hip: 85.2 ± 17.9 vs 82.5 ± 13.3, P = .588; second hip: 84.7 ± 19.3 vs 79.3 ± 16.0, P = .514) and Nonarthritic Hip Score (first hip: 85.3 ± 19.1 vs 83.2 ± 12.4, P = .660; second hip: 86.5 ± 22.8 vs 84.9 ± 12.2, P = .823) were similar between groups staged <1 year and ≥1 year. There were no significant differences in rates of revision arthroscopy (7.0% vs 12.1%, P = .460) or conversion to total hip arthroplasty (4.7% vs 3.0%, P > .999) between groups staged <1 year and ≥1 year. Based on logistic regression, the duration between hip arthroscopy stages was not associated with the risk of arthroscopic failure (odds ratio: 1.29, P = .227). CONCLUSIONS:There were no significant differences in patient-reported outcomes, rates of revision arthroscopy, and conversion to total hip arthroplasty between patients who underwent staged bilateral hip arthroscopy less than or greater than 1 year apart. Duration of time between staged procedures was not found to affect rates of arthroscopic failure. LEVEL OF EVIDENCE/METHODS:Level III, retrospective comparative case series.