Faculty Bibliography

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: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.

Contact dermatitis (CD) is the 5th most common skin disease1 and affects 15-20% of the general population over their lifetimes.2 Currently, the T.R.U.E. TEST® is the only FDA-approved diagnostic product to aid in the diagnosis of Allergic Contact Dermatitis. To address that diagnostic gap, the US Food and Drug Administration held a public workshop in October 2025. These proceedings summarize the workshop presentations and discussions.

Percutaneous transhepatic biliary drainage (PTBD) is a common interventional radiology (IR) procedure typically used in the treatment of biliary obstruction when an endoscopic approach has failed or is not technically feasible. PTBD has a low overall complication rate with the Society of Interventional Radiology suggesting adverse event thresholds of 10% for major complications, 5.7% for hemorrhage, 2% for hemobilia, and 3.3% for death, with the average reported rates of each of these being significantly lower. However, in rare instances serious complications such as vascular injury occur. The present report describes a case of a 62-year-old woman with Non-Alcoholic Steatohepatitis (NASH) cirrhosis and remote Whipple procedure who developed symptomatic choledocholithiasis with failed Endoscopic Retrograde Cholangiopancreatography (ERCP). Interventional radiology was consulted for PTBD, which was complicated by an iatrogenic portobiliary fistula (PBF). Diagnosis required sequential imaging and procedural evaluation, as initial non-invasive computed tomography (CT) and initial portal venography failed to clearly demonstrate the connection due to catheter occlusion of the fistula. This case report focuses on the management of this complication, which was successfully treated with balloon-expandable covered stent placement in the biliary system and dual-tract coil embolization.

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: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.