Update on Hypothalamic Inflammation and Gliosis: Expanding Evidence of Relevance Beyond Obesity.

Purpose Of Review: To evaluate the role of hypothalamic inflammation and gliosis in human obesity pathogenesis and other disease processes influenced by obesity.

Recent Findings: Recent studies using established and novel magnetic resonance imaging (MRI) techniques to assess alterations in hypothalamic microarchitecture in humans support the presence of hypothalamic inflammation and gliosis in adults and children with obesity. Studies also identify prenatal exposure to maternal obesity or diabetes as a risk factor for hypothalamic inflammation and gliosis and increased obesity risk in offspring.

Effect of surgical, medical, and behavioral weight loss on hormonal and sexual function in men: a contemporary narrative review.

This review explores the mechanisms and ramifications of weight loss achieved through lifestyle modifications, medical treatments, and bariatric surgery on testosterone levels and sexual health. Obesity significantly affects the hypothalamic-pituitary-gonadal axis in men, leading to diminished libido and erectile dysfunction. Here, we delve into the physiological disruptions caused by this imbalance and the intricate interplay of hormonal factors contributing to the dysregulation associated with obesity to comprehensively grasp the consequences of weight loss via diverse mechanisms.

Evaluation of Glycemic Control and Predictors of Severe Illness and Death in Patients with Diabetes Hospitalized With COVID-19.

Objectives: To identify risk factors for severe disease and death among patients with diabetes and coronavirus disease 2019 (COVID-19) infection.

Methods: This retrospective cohort study conducted at three hospitals included 733 consecutive patients with DM admitted with confirmed COVID-19 (March 1 - December 31, 2020). Multivariable logistic regression was performed to identify predictors of severe disease and death.

Trends in Total Hip Arthroplasty Under the Patient Protection and Affordable Care Act: A National Database Analysis Between 2008 and 2015.

The Patient Protection and Affordable Care Act expanded health coverage for low-earning individuals and families. With more Americans having access to care, the use of elective procedures, such as total hip arthroplasty (THA), was expected to increase. Therefore, the aim of this study was to evaluate trends in THA before and after the initiation of the Patient Protection and Affordable Care Act regarding race, age, body mass index, and sex between 2008 and 2015.

Decreasing the Incidence of Surgical-Site Infections After Total Joint Arthroplasty.

Surgical-site infection (SSI) after total joint arthroplasty (TJA) continues to pose a challenge and place a substantial burden on patients, surgeons, and the healthcare system. Given the estimated 1.0% to 2.

Decline in allogeneic blood transfusion usage in total hip arthroplasty patients: National Inpatient Sample 2009 to 2013.

Introduction: Although total hip arthroplasty (THA) is an effective treatment for end-stage arthritis, it is also associated with substantial blood loss that may require allogeneic blood transfusion. However, these transfusions may increase the risk of certain complications. The purpose of our study is to evaluate: (i) the incidence/trends of allogeneic blood transfusion; (ii) the associated risk factors and adverse events; and (iii) the discharge disposition, length of stay (LOS), and costs for these patients between 2009 and 2013.

Management of Injuries to the Medial Patellofemoral Ligament: A Review.

The medial patellofemoral ligament (MPFL) is thought to be the most important medial structure providing restraint to lateral subluxation of the patella. After an initial patellar dislocation, the MPFL is frequently injured and can usually be treated with conservative measures. However, these patients often suffer from recurrent dislocations, which thereby necessitate operative intervention.

What Influences How Patients with Depression Rate Hospital Stay After Total Joint Arthroplasty?

Background: Recent healthcare reform has spurred important changes to provider reimbursement. With the implementation of the Value Based Purchasing program, significant weight is placed on patient experience of care. The Press Ganey (PG) survey is currently used by over 10,000 hospitals, as it serves to help optimize patient satisfaction.

Does Addition of Adductor Canal Blockade to Multimodal Periarticular Analgesia Improve Discharge Status, Pain Levels, Opioid Use, and Length of Stay after Total Knee Arthroplasty?

Total knee arthroplasty (TKA) can be associated with substantial postoperative pain that may affect satisfaction and return to function. Various forms of pain control have been used; however, multimodal periarticular analgesia (MPA) and adductor canal block (ACB) have recently gained popularity. The purpose of this study was to compare (1) discharge status, (2) pain levels, (3) postoperative opioid consumption, and (4) length of stay (LOS) between TKA patients who received MPA only and those who received both MPA and ACB.

Current Epidemiology of Revision Total Hip Arthroplasty in the United States: National Inpatient Sample 2009 to 2013.

Background: Despite the excellent outcomes associated with primary total hip arthroplasty (THA), implant failure and revision continues to burden the healthcare system. THA failure has evolved and displays variability throughout the literature. In order to understand how THAs are failing and how to reduce this burden, it is essential to assess modes of implant failure on a large scale.

Pain Management with Adductor Canal Blockade or Multimodal Periarticular Analgesia in Elderly Total Knee Arthroplasty Patients.

Introduction: Post-operative pain management in elderly total knee arthroplasty (TKA) patients has traditionally included opioids, epidurals, and femoral nerve blocks. Although these modalities are effective, they are often associated with adverse side effects, which may have a greater impact on this population. Alternative modalities, such as adductor canal blocks (ACB) and multimodal periarticular analgesia (MPA) have demonstrated great efficacy with a low side effect profile.

Development of an Encompassing Questionnaire for Evaluating the Outcomes Following Total Knee Arthroplasty.

Introduction: There are many standardized scales and questionnaires used to evaluate TKA patients; however, individually they do not always assess patients adequately. Consequently, many are used in combinations to provide a thorough evaluation. However, this leads to redundancy, confusion, and an excessive patient time-burden.

Efficacy of Adductor Canal Blockade Compared to Multimodal Peri-Articular Analgesia Following Total Knee Arthroplasty.

Introduction: Postoperative pain after total knee arthroplasty (TKA) can be an impediment to patient recovery. Many commonly used pain control modalities are effective, but are also associated with adverse effects. Other modalities, such as adductor canal blocks (ACB) and multimodal periarticular analgesia (MPA), have gained popularity due to their efficacy and high safety profile.

Does Addition of Multimodal Periarticular Analgesia to Adductor Canal Block Improve Lengths of Stay, Pain, Discharge Status, and Opioid Use After Total Knee Arthroplasty?

Background: Postoperative pain after total knee arthroplasty (TKA) can be burdensome. Multiple methods of pain control have been used, including adductor canal block (ACB) and multimodal periarticular analgesia (MPA). These two techniques have been studied have proven to be efficacious separately.

Intraarticular Administration of Tranexamic Acid is Safe and Effective in Total Knee Arthroplasty Patients at High-Risk for Thromboembolism.

Introduction: Tranexamic acid (TXA) is an antifibrinolytic agent that can be used to reduce blood loss in total knee arthroplasty (TKA) patients. Due to its thrombogenic properties, intravenous (IV) TXA is contraindicated in patients who have an increased risk of arterial or venous thrombosis. For such patients, intraarticular (IA) TXA may be a safe alternative.

Nerve Decompression Surgery After Total Hip Arthroplasty: What Are the Outcomes?

Background: The purpose of our study was to compare (1) muscle strength; (2) pain; (3) sensation; (4) various outcome measurement scales between post-total hip arthroplasty (THA) patients who had a sciatic nerve injury and did or did not receive decompression surgery for this condition; and (5) to compare these findings with current literature.

Methods: Nineteen patients who had nerve injury after THA were reviewed. Patients were stratified into those who had a nerve decompression (n = 12), and those who had not (n = 7).

Trunnionosis in total hip arthroplasty: a review.

Trunnionosis is defined as wear of the femoral head-neck interface and has recently been acknowledged as a growing cause of total hip arthroplasty failure. Some studies have reported that it accounts for up to 3 % of all revisions. The exact cause of trunnionosis is currently unknown; however, postulated etiologies include modular junction wear, corrosion damage, and metal ion release.