Simeng Wang, MD

All Publications

• Surgical Infection Society Guidelines on Antibacterial and Antifungal Prophylaxis in Liver Transplantation. Surgical infections Wang, S., Bendjemil, S. M., Bonatti, H., Chiu, W. C., Huston, J. M., Jensen, A. R., Ozhathil, D. K., Forrester, J. D. 2026: 10962964261452028

  Abstract

  Liver transplantation is a life-saving procedure for patients with end-stage liver disease. Risk of post-transplantation infection remains high despite improvement in graft and patient survival. Antibacterial and antifungal prophylaxis plays an important role in reducing infection-related morbidity and mortality, but optimal timing and regimens are not well defined.The Surgical Infection Society's (SIS) Therapeutics and Guidelines Committee and individuals with content expertise convened to develop guidelines on antibacterial and antifungal prophylaxis in liver transplant to prevent surgical site infection and other infections, shorten intensive care unit length of stay, and decrease mortality. PubMed, Embase, Web of Science, and the Cochrane Database were searched using Medical Subject Heading terms including "liver transplantation," "antibiotic prophylaxis," and "antifungal prophylaxis" for studies limited to randomized controlled trials, systematic reviews, meta-analyses, cohort, and case-control studies in adult patients. Evaluation of the published evidence was performed using the Grading of Recommendations Assessment, Development and Evaluation system, and final recommendations were developed by an iterative process.We cannot make a recommendation for or against using pre-operative (more than 1 h before incision) antibiotic agent prophylaxis in liver transplantation with available evidence. We suggest the use of broad-spectrum antibiotic agent prophylaxis in liver transplantation rather than gram-positive antibiotic agent prophylaxis alone (Grade 2B). We recommend limiting administration of antibiotic agent prophylaxis to 24 hours post-operatively after liver transplant (Grade 1B). We recommend against empiric antifungal prophylaxis for patients at low risk for invasive fungal infections (IFIs) after liver transplant; for patients at high risk for IFI, we recommend antifungal prophylaxis (Grade 1B).This guideline summarizes the current SIS recommendations on antibacterial and antifungal prophylaxis in liver transplantation.

  View details for DOI 10.1177/10962964261452028

  View details for PubMedID 42136040

• BREAKING DOWN THE EVIDENCE: A MULTICENTER ANALYSIS OF VENOUS THROMBOEMBOLISM AMONG TRAUMA PATIENTS WITH LOWER EXTREMITY FRACTURES. Journal of orthopaedic trauma Knowlton, L. M., Guorgui, J. G., Wang, S., Arnow, K., Knudson, M. M. 2026

  Abstract

  To determine whether chemoprophylaxis initiation within 24 hours reduces venous thromboembolism risk among trauma patients with lower extremity long bone fractures.Design: This was a retrospective cohort study.17 Level I trauma centers as a part of the Consortium of Leaders in the Study of Traumatic Thromboembolism (CLOTT) study group.Patients aged 18-40 years with a diagnosis of lower extremity long bone fracture between January 1, 2018 to December 31, 2020 were included.Primary outcome was VTE during admission. Patients were compared based on VTE chemoprophylaxis initiation within 24 hours (early prophylaxis, E-PROPH) versus not (late or no prophylaxis, L-PROPH) using inverse probability weighted Cox survival analysis.120 (5.3%) among 2,264 patients with lower extremity fractures developed VTE. 57.5% received E-PROPH and 42.5% received L-PROPH. E-PROPH group had fewer patients with an injury severity score 16 (30.3% vs. 52.4%, p<0.001) and a lower proportion of associated head injury (8.1% vs. 26.7%, p<0.001). VTE incidence was significantly higher in L-PROPH group than in E-PROPH group (8.6% vs. 2.8%, p<0.001). In the adjusted model, E-PROPH was independently associated with nearly a half reduction in VTE incidence (hazard ratio: 0.54, 95% confidence interval: 0.34-0.85). There was no significant difference in the adjusted bleeding complications model (aOR 1.84, 95% CI 0.75, 4.57).VTE chemoprophylaxis within the first 24 hours of admission was associated with a marked reduction in VTE incidence among patients with traumatic lower extremity long bone fractures without increase in bleeding risks.Level III: retrospective cohort study.

  View details for DOI 10.1097/BOT.0000000000003174

  View details for PubMedID 41949896

• Lost fractures: prevalence and risk factors for missed costosternal and costal cartilage fractures among patients with radiologic chest wall injury. Trauma surgery & acute care open Forrester, J. D., Abou Chaar, M., Barnes, A. T., Bauman, Z. M., Bendjemil, S., Betts, N. N., Christie, B., Dasari, R., Wb, D., Earley, M. J., Faliks, B., Johns, T. J., Johnson, C., Junker, M. S., Kim, B. D., King, J. M., Knight, A. W., Schweibinz, A. A., Stephens, D., Stuever, M., Wang, S. 2026; 11 (1): e002020

  Abstract

  Costosternal cartilages and the costal margin, collectively termed costal cartilage, are hyaline cartilage connecting ribs to the sternum and to adjacent ribs, respectively. Presence of intact costal cartilage is essential for elasticity of the chest wall. Anecdotally, costal cartilage injuries are underdiagnosed on trauma CT scan in patients with rib fractures. Our aim was to determine a baseline frequency of acute costal cartilage injury among patients presenting with rib fractures.We performed a retrospective cohort study of injured adult patients admitted to Level I/II trauma centers with rib fractures from January 2020 to July 2024. CT images obtained at admission were manually reviewed by chest wall surgeons for presence of costal cartilage injury. Concordance with the original radiology report was obtained. Multivariable regression was used to analyze factors associated with costal cartilage injury and missed cartilage fractures.1441 patients were identified; 197 (14%) had a costal cartilage fracture. A plurality of injuries included falls (n=667, 46%). Median ISS (Injury Severity Score) was 13 (IQR: 9 to 21), median Abbreviated Injury Scale thorax score was 3 (IQR: 3 to 3), and median number of fractured ribs was 3 (IQR: 3 to 7). 294 (21%) patients had radiographic flail segments, and 136 (9%) had sternal fractures. 172 (87%) patients had a costal cartilage fracture missed on initial trauma chest CT. On multivariable analysis, ISS (adjusted OR (aOR) 1.02 (95% CI 1.01 to 1.04), radiographic flail segment (aOR 1.6 (95% CI 1.10 to 2.31)) and presence of sternal fracture (aOR 1.85 (95% CI 1.19 to 2.89)) were associated with costal cartilage fractures. Only the total number of rib fractures was associated with a missed costal cartilage fracture on univariate analysis (OR 1.17 (95% CI 1.01 to 1.36)).Costal cartilage injuries are common and frequently are not identified during interpretation of the initial trauma CT. A higher index of suspicion is warranted for costal cartilage fractures among patients with greater injury burden, radiographic flail segment, and sternal fractures.Level III.

  View details for DOI 10.1136/tsaco-2025-002020

  View details for PubMedID 41561394

  View details for PubMedCentralID PMC12815250

• Chilling the nerve, easing the pain?: A randomized clinical trial evaluating surgeon-administered bedside percutaneous cryoneurolysis for rib fracture pain. The journal of trauma and acute care surgery Forrester, J. D., Tung, J. T., Knight, A. W., Wang, S., Myers, A. A., King, J. M., Earley, M. J., Guthrie-Baker, S., Flojo, R. B., Chen, J. T., Abreo, A. M. 2025

  Abstract

  A cornerstone of rib fracture management is multimodal pain control, which includes scheduled nonopioid analgesics, as-needed opioids, regional or neuraxial blockade, and surgical stabilization of rib fractures. However, adverse effect profiles and individual factors limit their use in all patients. Surgeon-administered, ultrasound-guided percutaneous cryoneurolysis performed at the patient bedside is a promising analgesic adjunct.We performed a prospective, randomized clinical trial assessing benefit and safety of surgeon-administered percutaneous cryoneurolysis to our existing multimodal rib fracture pain control bundle (standard of care [SoC]) for injured adults aged 18 to 64 years. Patients with fractured ribs 3 to 9 were randomized within 72 hours of admission to receive either surgeon-administered, ultrasound-guided percutaneous cryoneurolysis at the bedside and our multimodal pain control bundle, or SoC alone. Patients undergoing surgical stabilization of rib fractures were excluded. The primary outcome was pain score at discharge. Secondary outcomes included hospital length of stay, intervention-associated adverse events, morphine milligram equivalent (MME) use, Short Form (SF)-12, and McGill Pain Score (Patient Reported Outcomes), which were assessed at discharge and 1-, 3-, and 12-month intervals after discharge.Forty-three patients were randomized: 24 in the intervention arm and 19 in the SoC arm, with 3 screen failures. The median age was 53 years (interquartile range [IQR], 45-60 years), 9 patients (23%) were female, the median Injury Severity Score was 13 (IQR, 10-17), and the median number of rib fractures was 6 (IQR, 4-8). Patients were well matched with no differences between groups. No intervention-associated adverse events were identified. Pain scores, MME use, and Patient Reported Outcomes were not different between groups at discharge, 1 month, 3 months, or 12 months.Application of surgeon-administered, ultrasound-guided percutaneous cryoneurolysis at the bedside is safe but was not associated with reduced pain or MME use when compared with SoC.Therapeutic/Care Management; Level II.

  View details for DOI 10.1097/TA.0000000000004885

  View details for PubMedID 41604277

• Evaluating Financial Toxicity and Quality of Life Among Acute Care Surgery Patients: A Mixed-Methods Study. Journal of the American College of Surgeons Kennedy, C., Wang, S., Chen, J., Flojo, R., King, J., Arnow, K., Earley, M., Abreo, A., Knowlton, L. M., S-SPIRE Qualitative Study Team 2025

  Abstract

  BACKGROUND: Acute care surgery (ACS) patients face financial burdens and impact on quality-of-life (QoL), which can be significant for the uninsured. Hospital Presumptive Eligibility (HPE) aims to reduce costs and improve access. We evaluated patient-reported outcomes following hospitalization, hypothesizing that HPE improved recovery trajectory.STUDY DESIGN: A convergent mixed methods study of ACS patients 18-64 years was performed at an academic Level I trauma center from December 2024 to August 2025. HPE patients were compared with insured patients. SF-12 QoL and American Association for the Surgery of Trauma (AAST) financial hardship survey tool were completed at hospitalization and 1-3 months post-discharge. Thematic analysis of semi-structured interviews was conducted to evaluate access to care and financial toxicity.RESULTS: Ten out of the 110 patients were HPE and the rest were insured controls. HPE patients were younger (median: 39.5 vs. 43.5 years), had higher ICU admission (30% vs. 9%) and non-routine discharge (22% vs.7%) rates. At 3 months post-discharge, both groups had reduced household income (HPE vs. controls: 33% vs. 20%) and difficulty paying non-medical bills (50% vs. 25%). HPE patients additionally reported lower SF-12 measures. In qualitative analysis, HPE patients cited rapid access to insurance and expected reduction in out-of-pocket cost as program benefits.CONCLUSION: Risk for financial toxicity remains high among ACS patients. Patients enrolled in HPE faced additional financial and psychosocial strains during post-admission recovery. QoL and financial metrics are important to understand longitudinal patient outcomes and guide policies to improve patient recovery.

  View details for DOI 10.1097/XCS.0000000000001652

  View details for PubMedID 41051099

• Ultrasound-guided percutaneous cryoneurolysis of intercostal nerves in traumatic rib fractures. Injury Forrester, J. D., Wang, S., Myers, A. A., Earley, M., Guthrie-Baker, S., Abreo, A., Knight, A. W., Tung, J. 2025: 112321

  Abstract

  Multimodal pain control is the cornerstone of managing acute traumatic rib fractures. We employed surgeon-administered, ultrasound-guided percutaneous cryoneurolysis of intercostal nerves (USPCNIN) as an adjunct opioid-sparing analgesic modality at the bedside.This was a single-institution case series. Patients between 18-64 years of age who sustained traumatic rib fracture between ribs 3-9, deemed ineligible for surgical stabilization, and had pre-procedure numeric pain scores ≥5 underwent USPCNIN within 24 h of study enrollment by an attending chest wall surgeon. Primary outcomes were changes in daily narcotic use and numeric pain score from pre-intervention up to 30-day follow-up visits. Additional outcomes included hospital length of stay, procedure-related adverse events, and rib-specific readmission.Fifteen patients were identified. Median (IQR) patient age was 52 (43, 58) years and four (27 %) were female. Median (IQR) number of rib fractures was 5 (4, 8). Median (IQR) hospital length of stay was 4 (3, 7) days. Daily opioid use (measured in morphine milligram equivalents, MME) and present pain intensity (PPI) decreased significantly from pre-intervention to hospital discharge (median MME 96.5 vs. 49.5, p = 0.043; median PPI 10 vs. 7, p = 0.020). Twelve patients completed 30-day follow-up and had significantly decreased MME and PPI from hospital discharge (median MME 62.3 vs. 5, p = 0.014; median PPI 6.5 vs. 3, p = 0.001). There were no complications directly attributable to the procedure. There were no rib-specific readmissions.USPCNIN is a minimally-invasive, bedside procedure that can be safely performed by trauma surgeons and augment pain control for acute traumatic rib fractures.

  View details for DOI 10.1016/j.injury.2025.112321

  View details for PubMedID 40240230

• Medicaid Enrollment After Hospital Presumptive Eligibility in the Emergency Department. JAMA health forum Wang, S., Arnow, K., Sakamoto, M. M., Knowlton, L. M. 2025; 6 (4): e250768

  Abstract

  Hospital presumptive eligibility (HPE) is an emergency Medicaid program enabling eligible uninsured patients to temporarily access Medicaid benefits during hospital encounters. It provides a pathway to long-term Medicaid coverage, but this feature may be underutilized among patients who received HPE in the emergency department (ED) and were discharged immediately thereafter.To characterize if 6-month Medicaid enrollment rates varied by patient demographics and ED encounter characteristics and identify factors that potentially impact enrollment.A retrospective cohort study analyzing data from HPE-participating EDs in California between January 1, 2016, and December 31, 2021, was carried out from January 2024 to November 2024. Unadjusted differences in 6-month Medicaid enrollment rates among patient groups were analyzed with χ2 tests. Multivariable logistic regression was used to evaluate the adjusted odds of enrollment by different demographic and encounter characteristics. Patients aged 19 to 64 years who were uninsured, were treated and released from ED, and received HPE during the encounter were included.Receiving HPE during ED encounters.The primary outcome was Medicaid enrollment within 6 months after receiving HPE in ED.Of the 585 693 patients who received HPE during ED treat-and-release encounters, 175 495 were of Hispanic ethnicity (30.0%), 73 518 were White (12.6%), 33 829 were Black (5.8%), 12 824 were Asian or Pacific Islanders (2.2%), 1685 were Alaskan Native or American Indian (0.003%), 27 610 were of other race and ethnicity (0.05%), and 260 732 did not report race and ethnicity (44.5%). A total of 217 430 (37.1%) of 585 693 patientsof the total study population who received HPE during ED treat-and-release encounters enrolled in Medicaid by 6 months. In the regression model, male (adjusted odds ratio [aOR] 0.74; 95% CI, 0.72-0.76; P < .001), Hispanic (vs White: aOR, 0.94; 95% CI, 0.90-0.98; P = .007), and Spanish speaking (vs English speaking: aOR, 0.72; 95% CI, 0.68-0.77; P < .001) patients were less likely to enroll in Medicaid coverage. Annual enrollment rates declined notably following the onset of the COVID-19 pandemic (40.6% to 29.8%). Weekend encounters were more likely to have lower enrollment (vs weekday: aOR, 0.95; 95% CI, 0.93-0.97; P < .001). EDs in public hospitals (vs nonprofit: aOR, 1.27; 95% CI, 1.04-1.55; P = .02) or large hospitals (vs small: aOR, 1.13; 95% CI, 1.00-1.27; P = .04) were more likely to have higher enrollment. There was variable enrollment across different regions of California (27.3%-47.2%).In this cohort study, Medicaid enrollment rates after receiving HPE in ED varied across different patient, facility, and geographic characteristics, highlighting the need for additional resources to ensure Medicaid coverage among this high-risk uninsured population.

  View details for DOI 10.1001/jamahealthforum.2025.0768

  View details for PubMedID 40279116

• The role of respiratory therapy in rib fracture management. Current problems in surgery Anderson, T. N., Wang, S., Free, D., Forrester, J. D. 2024; 61 (12): 101664

  View details for DOI 10.1016/j.cpsurg.2024.101664

  View details for PubMedID 39647970

• Percutaneous cryoneurolysis: new kid on the rib fracture pain 'Block'. Trauma surgery & acute care open Wang, S., Myers, A. A., Forrester, J. D. 2024; 9 (1): e001575

  View details for DOI 10.1136/tsaco-2024-001575

  View details for PubMedID 39296595

  View details for PubMedCentralID PMC11409356

• Percutaneous Cryoneurolysis for Pain Control After Rib Fractures in Older Adults. JAMA surgery Wang, S., Earley, M., Kesselman, A., Vezeridis, A. M., Picel, A. C., Kothary, N., Forrester, J. D. 2024

  View details for DOI 10.1001/jamasurg.2024.2063

  View details for PubMedID 39110467

  View details for PubMedCentralID PMC11307162

• Small bowel obstruction due to a migrated pyloric stent. Trauma surgery & acute care open Agolia, J. P., Wang, S., Fisher, A., Bryan, J. L., Knowlton, L. M. 2024; 9 (1): e001443

  View details for DOI 10.1136/tsaco-2024-001443

  View details for PubMedID 38756695

  View details for PubMedCentralID PMC11097799

• Severe intracranial and intra-abdominal hemorrhage: timing is everything. Trauma surgery & acute care open Farooqi, N. B., Wong, S. Y., Wang, S., Knowlton, L. M. 2024; 9 (1): e001434

  View details for DOI 10.1136/tsaco-2024-001434

  View details for PubMedID 38616787

  View details for PubMedCentralID PMC11015236

• Prolonged Ischemia Increases Complications Among High- and Low-Volume Centers in Lung Transplantation ANNALS OF THORACIC SURGERY Wadowski, B. J., Wang, S., Angel, L. F., Geraci, T. C., Chan, J. C. Y., Chang, S. H. 2023; 116 (2): 374-381

  Abstract

  The effect of prolonged allograft ischemic time on lung transplant outcomes remains controversial, with most studies associating it with increased mortality, but this effect is partly mitigated by center volume. This study sought to evaluate the mechanism of these findings and clarify the impact of ischemic time on short-term outcomes in a national sample.Data on lung transplants (January 2010-Janary 2017) were extracted from the Scientific Registry of Transplant Recipients database. Ischemic time was dichotomized as prolonged ischemic time (PIT) or no PIT (N-PIT) at 6 hours. High-volume centers were defined as the top quintile. The primary outcome was 30-day, 1-year, and 3-year mortality; secondary outcomes included in-hospital complications and 72-hour oxygenation.Among 11,809 records, there were significant differences between PIT and N-PIT recipients by demographics, lung allocation score, and donor organ metrics. In a 1:1 propensity score-matched cohort (n = 6422), PIT recipients had reduced survival compared with N-PIT at 3 years (66.5% vs 68.8%, P = .031). On multivariable analysis, this effect persisted among low-volume but not high-volume centers. PIT recipients were more likely to require reintubation, prolonged (>5 days) mechanical ventilation, hemodialysis, longer stay, and acute rejection (all P < .01). Except for reintubation, these disparities were present at both high- and low-volume centers independently. Ischemic time had no effect on 72-hour oxygenation.PIT remains associated with higher rates of postoperative complications and reduced short-term survival. While center volume ameliorated the survival impact, this was not achieved by reducing postoperative complications. Further research is warranted before broadening ischemic time thresholds among low-volume centers.

  View details for DOI 10.1016/j.athoracsur.2022.10.018

  View details for Web of Science ID 001051261500001

  View details for PubMedID 37489398

• Protein arginine methyltransferase 1 is a novel regulator of MYCN in neuroblastoma ONCOTARGET Eberhardt, A., Hansen, J. N., Koster, J., Lotta, L. T., Wang, S., Livingstone, E., Qian, K., Valentijn, L. J., Zheng, Y., Schor, N. F., Li, X. 2016; 7 (39): 63629-63639

  Abstract

  Amplification or overexpression of MYCN is associated with poor prognosis of human neuroblastoma. We have recently defined a MYCN-dependent transcriptional signature, including protein arginine methyltransferase 1 (PRMT1), which identifies a subgroup of patients with high-risk disease. Here we provide several lines of evidence demonstrating PRMT1 as a novel regulator of MYCN and implicating PRMT1 as a potential therapeutic target in neuroblastoma pathogenesis. First, we observed a strong correlation between MYCN and PRMT1 protein levels in primary neuroblastoma tumors. Second, MYCN physically associates with PRMT1 by direct protein-protein interaction. Third, depletion of PRMT1 through siRNA knockdown reduced neuroblastoma cell viability and MYCN expression. Fourth, we showed that PRMT1 regulates MYCN stability and identified MYCN as a novel substrate of PRMT1. Finally, we demonstrated that mutation of putatively methylated arginine R65 to alanine decreased MYCN stability by altering phosphorylation at residues serine 62 and threonine 58. These results provide mechanistic insights into the modulation of MYCN oncoprotein by PRMT1, and suggest that targeting PRMT1 may have a therapeutic impact on MYCN-driven oncogenesis.

  View details for DOI 10.18632/oncotarget.11556

  View details for Web of Science ID 000387167800063

  View details for PubMedID 27571165

  View details for PubMedCentralID PMC5325390