Malakoplakia among kidney transplant recipients: case series and literature review.

We report two cases of malakoplakia after kidney transplant, a rare granulomatous condition that occurs primarily in immunocompromised patients and his thought to occur due to incomplete clearance of phagocytized bacterial residue by macrophages. Both patients were at heightened immunological risk due to being highly sensitized or prior episodes of rejection, both experienced infections in the first 4 months after transplant, and both presented with granulomatous masses that were biopsied and confirmed to be malakoplakia. Both were treated with suppressive antibiotics and required urinary drainage of the transplant kidney, resulting in improvements in the size of the mass on imaging.

Obesity management before and after pancreas transplantation.

Purpose Of Review: We provide a review on the incidence, consequences, and management of obesity in patients before and after pancreas transplant.

Recent Findings: Obesity is common in patients with both type 1 and type 2 diabetes. Obesity at the time of pancreas transplant is associated with worse graft and patient survival, while weight gain after transplant is associated with insulin resistance and posttransplant diabetes.

A Unified Approach to Health Data Exchange: A Report From the US DHHS.

Importance: Health information technology, such as electronic health records (EHRs), has been widely adopted, yet accessing and exchanging data in the fragmented US health care system remains challenging. To unlock the potential of EHR data to improve patient health, public health, and health care, it is essential to streamline the exchange of health data. As leaders across the US Department of Health and Human Services (DHHS), we describe how DHHS has implemented fundamental building blocks to achieve this vision.

Why Evidence Generation Should Matter to Payers and How They Can Help.

Importance: The US leads the world in bringing new medical products to market, but the ability to generate evidence to inform clinical practice in postmarket settings needs improvement. Although a diverse group of stakeholders is working to improve postmarket evidence generation, the role of private payers has been underappreciated.

Observations: Payers are crucial allies in improving evidence generation because better data would better inform coverage decisions, their policies and practices influence the conduct of care and research, and their claims data are a source of real-world evidence used in medical product evaluation.

Don't Ask Us to Stop Cycling: A Surgical Perspective.

In this surgical perspective, we argue that counseling avoidance of bicycle commuting is not the right approach to cycling injury prevention or to overall urban health. Instead, we propose surgeons should take a more holistic approach that includes mitigating individual risk factors as well as creating an equitable environment of safety.

Precision Oncology in Breast Cancer Surgery.

Outcomes for patients with breast cancer have improved over time due to increased screening and the availability of more effective therapies. It is important to recognize that breast cancer is a heterogeneous disease that requires treatment based on molecular characteristics. Early endpoints such as pathologic complete response correlate with event-free survival, allowing the opportunity to consider de-escalation of certain cancer treatments to avoid overtreatment.

Why some Patients Benefit from Participating in a Sham Surgery Trial.

Objective: We analyze the ethics of sham surgical trials from a utilitarian perspective and explore whether patients can benefit from participating in these trials.

Background: Sham-controlled randomized trials are an essential tool to evaluate the risks and benefits of some surgical procedures. However, sham trials are controversial because they expose patients to the harms of a sham procedure without the possibility of benefit.

Tracheal Reconstruction Using Endotracheal Stent and Pectoralis Major Muscle Flap.

We present a case of tracheal anastomotic dehiscence requiring circumferential tracheal replacement. We developed a novel approach by deploying a silicone stent using a hybrid surgical and endobronchial technique, followed by pectoralis major flap coverage. The patient has remained free from dyspnea 6 months after the operation.

Association of a New Trauma Center With Racial, Ethnic, and Socioeconomic Disparities in Access to Trauma Care.

This observational study assesses the association of a new trauma center with transport times for trauma patients as a measure of prompt access to care and specifically examines changes in racial, ethnic, and income disparities in transport times.

Opioid Prescribing Patterns Before Fatal Opioid Overdose.

Introduction: Although opioid prescribing has decreased since 2010, overdose deaths involving illicit opioids have continued to rise. This study explores prescribing patterns before fatal overdose of decedents who died of prescription and illicit opioid overdoses.

Methods: This retrospective cohort study was conducted in 2019 and included all 1,893 Illinois residents who died of an opioid-related overdose in 2016.

Mutational load causes stochastic evolutionary outcomes in acute RNA viral infection.

Mutational load is known to be of importance for the evolution of RNA viruses, the combination of a high mutation rate and large population size leading to an accumulation of deleterious mutations. However, while the effects of mutational load on global viral populations have been considered, its quantitative effects at the within-host scale of infection are less well understood. We here show that even on the rapid timescale of acute disease, mutational load has an effect on within-host viral adaptation, reducing the effective selection acting upon beneficial variants by ∼10 per cent.

Health Care Utilization of Opioid Overdose Decedents with No Opioid Analgesic Prescription History.

Opioid overprescribing is a major driver of the current opioid overdose epidemic. However, annual opioid prescribing in the USA dropped from 782 to 640 morphine milligram equivalents per capita between 2010 and 2015, while opioid overdose deaths increased by 63%. To better understand the role of prescription opioids and health care utilization prior to opioid-related overdose, we analyzed the death records of decedents who died of an opioid overdose in Illinois in 2016 and linked to any existing controlled substance monitoring program (CSMP) and emergency department (ED) or hospital discharge records.