Kidney Biopsy Utility: Patient and Clinician Perspectives from the Kidney Precision Medicine Project.

Rationale & Objective: Limited data exist on patient perspectives of the implications of kidney biopsies. We explored patients' perspectives alongside those of clinicians to better understand how kidney biopsies affect patients' viewpoints and the clinical utility of biopsies.

Study Design: Prospective Cohort Study.

Detailed Analysis of Simultaneous Renal and Liver Allografts in the Presence of DSA.

Unlabelled: Liver allografts protect renal allografts from the same donor from some, but not all, preformed donor specific alloantibodies (DSA). However, the precise mechanisms of protection and the potential for more subtle alterations/injuries within the grafts resulting from DSA interactions require further study.

Methods: We reevaluated allograft biopsies from simultaneous liver-kidney transplant recipients who had both allografts biopsied within 60 d of one another and within 30 d of DSA being positive in serum (positive: mean florescence intensity ≥5000).

Patient Characteristics, Length of Stay, Cost of Care, and Complications in Super-Obese Patients Undergoing Total Hip Arthroplasty: A National Database Study.

Background: The purpose of this study was to compare postoperative complication rates in super-obese (SO) patients with a body mass index (BMI) ≥ 50 kg/m undergoing total hip arthroplasty (THA) versus non-super-obese (NSO) patients undergoing THA.

Methods: In this retrospective study using the National Inpatient Sample (NIS) database, 1,646 cases of THA in SO (BMI ≥ 50 kg/m) patients were reviewed. We used International Classification of Diseases (ICD)-10 codes to assess postoperative variables including length of stay, cost of care (cost of inpatient hospitalization), and medical and surgical complications among SO patients undergoing THA compared to NSO patients before being discharged.

Analysis of inpatient complications in HIV/AIDS patients undergoing total hip arthroplasty - A propensity matched cohort study.

Patients with human immunodeficiency virus (HIV) are at higher risk for orthopedic related diseases due to dysregulation in bone metabolism and metabolic effects related to their medication regimen. Furthermore, the rate of hip arthroplasty in HIV patients is increasing. With the recent changes in THA methodologies and improvements in HIV treatment, there is a need for updated research analyzing hip arthroplasty outcomes in this high-risk patient population.

Postoperative complications of spinal vs general anesthesia in elderly patients undergoing hip hemiarthroplasty.

Introduction: Elderly patients with hip fractures are at high risk for mortality due to postsurgical complications. Hip hemiarthroplasty is a routine procedure done in elderly patients for surgical repair  of femoral neck fractures. Both general and spinal anesthesia can be used in elderly patients undergoing hemiarthroplasty.

Early paracentesis is associated with better prognosis compared with late or no-paracentesis in hospitalized veterans with cirrhosis and ascites.

Guidelines recommend that all hospitalized patients with cirrhosis and ascites receive an early (<24 h from admission) paracentesis. However, national data are not available regarding compliance with and the consequences of this quality metric. We used the national Veterans Administration Corporate Data Warehouse and validated International Classification of Disease codes to evaluate the rate and subsequent outcomes of early, late, and no paracentesis for patients with cirrhosis and ascites during their first inpatient admission between 2016 and 2019.

Microglia as a cellular target of diclofenac therapy in Alzheimer's disease.

Alzheimer's disease (AD) is an untreatable cause of dementia, and new therapeutic approaches are urgently needed. AD pathology is defined by extracellular amyloid plaques and intracellular neurofibrillary tangles. Research of the past decades has suggested that neuroinflammation plays a critical role in the pathophysiology of AD.

Eosinophilic Gastroenteritis and Colitis After Intragastric Balloon Placement.

Eosinophilic gastrointestinal diseases are rare disorders characterized by infiltration of eosinophils in one or multiple segments of the gastrointestinal tract. Hypersensitivity to food or environmental allergens is believed to play an important role in the pathogenesis. In this case report, we describe a 61-year-old man who developed eosinophilic gastroenteritis and colitis with severe peripheral eosinophilia after intragastric balloon (IGB) placement for weight loss.

T cell responses to COVID-19 infection and vaccination in patients with multiple sclerosis receiving disease-modifying therapy.

Background: Multiple sclerosis (MS) is a neurological disorder marked by accumulating immune-mediated damage to the central nervous system. The dysregulated immune system in MS combined with immune effects of disease-modifying therapies (DMTs) used in MS treatment could alter responses to infections, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19). Most of the literature on immune response to SARS-CoV-2 infection and COVID-19 vaccination, in both the general population and patients with MS on DMTs, has focused on humoral immunity.

Role of Oral Health, Frailty, and Minimal Hepatic Encephalopathy in the Risk of Hospitalization: A Prospective Multi-Center Cohort of Outpatients With Cirrhosis.

Background & Aims: Hospitalizations are a sentinel event in cirrhosis; however, the changing demographics in patients with cirrhosis require updated hospitalization prediction models. Periodontitis is a risk factor for liver disease and potentially progression. The aim of this study was to determine factors, including poor oral health, associated with 3-month hospitalizations in a multi-center cohort of outpatients with cirrhosis.

Hypoglycemia Management Using a Bundled Care Approach: A Quality Improvement Project.

Background: Hypoglycemia is a leading cause of preventable hospitalization, and can increase morbidity, mortality, and length of hospital stay. Up to 35% of diabetic patients experience severe hypoglycemia during hospitalization; this concerns veterans, as 25% have been diagnosed with diabetes.

Local Problem: A medical-surgical unit in a Veterans Affairs facility saw increased hypoglycemic episodes, with 26.

Estimating individualized treatment effects using a risk-modeling approach: an application to epidural steroid injections for lumbar spinal stenosis.

Conventional "1-variable-at-a-time" analyses to identify treatment effect modifiers are often underpowered and prone to false-positive results. This study used a "risk-modeling" approach guided by the Predictive Approaches to Treatment effect Heterogeneity (PATH) Statement framework: (1) developing and validating a multivariable model to estimate predicted future back-related functional limitations as measured by the Roland-Morris Disability Questionnaire (RMDQ) and (2) stratifying patients from a randomized controlled trial (RCT) of lumbar epidural steroid injections (LESIs) for the treatment of lumbar spinal stenosis into subgroups with different individualized treatment effects on RMDQ scores at the 3-week follow-up. Model development and validation were conducted in a cohort (n = 3259) randomly split into training and testing sets in a 4:1 ratio.

Variation of Hepatocellular Carcinoma Treatment Patterns and Survival Across Geographic Regions in a Veteran Population.

Background: Veteran populations have five times the incidence of hepatocellular carcinoma (HCC) compared with the general population. The incidence of HCC has increased in the Veteran's Affairs Health System (VAHS), primarily due to the increased prevalence of cirrhosis. This study aimed to characterize differences in treatment patterns and overall survival rates across the five VAHS geographic regions.

A comparison of prolonged exposure therapy, pharmacotherapy, and their combination for PTSD: What works best and for whom; study protocol for a randomized trial.

Background: Several efficacious psychological and pharmacological treatments for posttraumatic stress disorder (PTSD) are available; however, the comparative effectiveness of these treatments represents a major gap in the literature. The proposed study will compare the effectiveness of two leading PTSD treatments - Prolonged Exposure (PE) therapy and pharmacotherapy with paroxetine or venlafaxine extended release - as well as the combination of PE and medication.

Methods: In a randomized clinical trial, veterans with PTSD (N = 450) recruited across six Veterans Affairs Medical Centers will complete assessments at baseline, mid-treatment (Week 7), post-treatment (Week 14), and follow-up (Weeks 27 and 40).

Retrograde Intramedullary Nailing and Locked Plating for the Treatment of Periprosthetic Supracondylar Femur Fractures: A Meta-Analysis and Quantitative Review.

Background: As the prevalence of Total Knee Arthroplasty increases, there is still debate over the preferred method of treatment of supracondylar periprosthetic femoral fractures. The aim of this study was to compare two of the common methods of fixation: Locked Plating and Retrograde Intramedullary Nailing with respect to nonunion, delayed union and surgical revision rate.

Methods: A comprehensive database search via Pubmed was conducted, yielding 16 eligible studies.

Trends and Disparities in Treatment Utilization for Early-Stage Hepatocellular Carcinoma in the Veteran Population.

Background: The incidence of hepatocellular carcinoma (HCC) has substantially increased over the last two decades within the Veteran Affairs Health System (VAHS). This study aims to describe the temporal trend of early-stage HCC (ES-HCC) treatment in the VAHS and identify patient/hospital factors associated with treatment disparities.

Patients And Methods: VA Corporate Data Warehouse was used to identify patients diagnosed with ES-HCC (stages I/II) from 2001 to 2015.

Pulmonary Artery Bleed from an Eloesser flap.

An open thoracic window involves the creation of a semi-permanent pleural-cutaneous connection to treat chronic organising empyemas, bronchopleural fistulas and postpneumonectomy empyemas in patients too ill for video-assisted thoracic surgery decortication. An Eloesser flap is a type of open thoracic window. Antibiotics have made the use of Eloesser flaps and other open thoracic windows for treatment of empyemas rare.