Associations of Fatty Liver Disease With Recovery After Traumatic Injury.

INTRODUCTION: Fatty liver disease (FLD) is associated with systemic inflammation, metabolic disease, and socioeconomic risk factors for poor health outcomes. Little is known on how adults with FLD recover from traumatic injury. METHODS: We studied adults admitted to the intensive care unit of a level 1 trauma center (2016-2020), excluding severe head injury/cirrhosis (N = 510). We measured the liver-spleen attenuation difference in Hounsfield units (HUL-S) using virtual noncontrast computerized tomography scans: none (HUL-S>1), mild (-10≤HUL-S<1), moderate/severe (HUL-S < -10). We used Cox models to examine the "hazard" of recovery from systemic inflammatory response (SIRS score 2 or higher) organ dysfunction, defined as sequential organ failure assessment score 2 or higher, and lactate clearance (<2 mmol/L) in relation to FLD. RESULTS: Fifty-one participants had mild and 29 had moderate/severe FLD. The association of FLD with recovery from SIRS differed according to whether an individual had shock on admission (hazard ratio [HR] = 0.76; 95% confidence interval [CI] 0.55-1.05 with shock; HR = 1.81; 95% CI 1.43-2.28 without shock). Compared to patients with no FLD, the hazard of lactate clearance was similar for mild FLD (HR = 1.04; 95% CI 0.63-1.70) and lower for moderate/severe FLD (HR = 0.40; 95% CI 0.18-0.89). CONCLUSIONS: FLD is common among injured adults. Associations of FLD with outcomes after shock and critical illness warrant further study.

Generation Learning Differences in Surgery: Why They Exist, Implication, and Future Directions.

The evolution of the knowledge economy and technology industry have fundamentally changed the learning environments occupied by contemporary surgical trainees and created pressures that will force the surgical community to consider. Although some learning differences are intrinsic to the generations themselves, these differences are primarily a function of the environments in which surgeons of different generations trained. Acknowledgment of the principles of connectivism and thoughtful integration of artificial intelligence and computerized decision support tools must play a central role in charting the future course of surgical education.