The advent of Human Immunodeficiency Virus (HIV) antiretrovirals have reduced the severity of HIV related neurological comorbidities but they nevertheless remain prevalent. Synaptic degeneration due to the action of several viral factors released from infected brain myeloid and glia cells and inflammatory cytokines has been attributed to the manifestation of a range of cognitive and behavioral deficits. The contributions of specific pro-inflammatory factors and their interplay with viral factors in the setting of treatment and persistence are incompletely understood. Exposure of neurons to chemokine receptor-4(CXCR4)-tropic HIV-1 envelope glycoprotein (Env) can lead to post-synaptic degradation of dendritic spines. The contribution of members of the extracellular matrix (ECM) and specifically, of perineuronal nets (PNN) toward synaptic degeneration, is not fully known, even though these structures are found to be disrupted in post-mortem HIV-infected brains. Osteopontin (Opn, gene name SPP1), a cytokine-like protein, is found in abundance in the HIV-infected brain. In this study, we investigated the role of Opn and its ECM integrin receptors, β1- and β3 integrin in modifying neuronal synaptic sculpting. We found that in hippocampal neurons incubated with HIV-1 Env protein and recombinant Opn, post-synaptic-95 (PSD-95) puncta were significantly increased and distributed to dendritic spines when compared to Env-only treated neurons. This effect was mediated through β3 integrin, as silencing of this receptor abrogated the increase in post-synaptic spines. Silencing of β1 integrin, however, did not block the increase of post-synaptic spines in hippocampal cultures treated with Opn. However, a decrease in the PNN to βIII-tubulin ratio was found, indicating an increased capacity to support spine growth. From these results, we conclude that one of the mechanisms by which Opn counters the damaging impact of the HIV Env protein on hippocampal post-synaptic plasticity is through complex interactions between Opn and components of the ECM which activate downstream protective signaling pathways that help maintain the potential for effective post-synaptic plasticity.

Numerous studies have investigated the outcomes of outpatient total shoulder arthroplasty (TSA). However, some patients originally planned for outpatient surgery may unexpectedly require inpatient hospital stay, which can obscure the distinction of “outpatient” and “inpatient” cases. Ultimately, this inconsistent classification of “outpatient” surgery may influence study results. The objectives of this study were (1) to characterize the differences in definition of “outpatient” surgery (hospital-defined outpatient [HDO] vs. same-day discharge [SDD]), and (2) to study the effect of different definitions on 30-day outcomes following TSA. The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent TSA between 2011 and 2021. HDO cases were identified based on the National Surgical Quality Improvement Program inpatient or outpatient variable, and SDD cases were identified based on length of stay = 0. Demographic and clinical characteristics were compared between HDO and SDD cohorts. Propensity score was utilized to match each HDO and SDD case with one inpatient case without replacement. Two distinct sets of multivariate analyses, using Poisson regressions with robust error variance, were performed to calculate the risks of readmission, reoperation, morbidity, and complications for HDO and SDD. A total of 30,458 patients met the inclusion criteria, including 6711 HDO and 4490 SDD cases. 3501 out of the 6711 (52.2%) HDO patients required at least one night of inpatient hospital stay (length of stay >0). Between 2011 and 2021, the annual incidence of HDO TSA rose from 4.1% to 61.6% of all TSA cases, and the incidence of SDD TSA increased from 2.0% to 34.1% of all TSA cases. Compared to SDD, HDO was associated with female sex, higher body mass index, functional dependence, diabetes, chronic obstructive pulmonary disease, congestive heart failure, hypertension, American Society of Anesthesiologists ≥3, longer operation time, and nonhome discharge. After controlling for potential confounders, inpatient TSA was associated with increased risk of 30-day readmission and reoperation compared with HDO cases, while morbidity and individual complication rates were similar. However, compared with SDD patients, inpatient TSA was associated with higher rates of readmission, reoperation, morbidity, pneumonia, pulmonary embolism, myocardial infarction, and deep venous thrombosis. Definitional differences in “outpatient” surgery can lead to significantly different study outcomes related to TSA. Future investigations on this topic should maintain consistency in the definition of “outpatient” surgery. Accurate data on the risk factors for adverse events after TSA are critical for appropriate patient selection and improving surgical outcomes.

An 8-year-old boy with no significant past medical history presented to his pediatrician with 5 days of fever, diffuse abdominal pain, and pallor. The pediatrician referred the patient to the emergency department (ED), out of concern for possible malignancy. Initial vital signs indicated fever, tachypnea, and tachycardia. Physical examination was significant for marked abdominal distension, hepatosplenomegaly, and abdominal tenderness in the right upper and lower quadrants. Initial laboratory studies were notable for pancytopenia as well as an elevated erythrocyte sedimentation rate and C-reactive protein. Computed tomography (CT) of the abdomen and pelvis showed massive splenomegaly. The only significant history of travel was immigration from Albania 10 months before admission. The patient was admitted to a tertiary care children’s hospital and was evaluated by hematology–oncology, infectious disease, genetics, and rheumatology subspecialty teams. Our multidisciplinary panel of experts will discuss the evaluation of pancytopenia with apparent multiorgan involvement and the diagnosis and appropriate management of a rare disease.

We describe our experience transforming our cardiac catheterization laboratories to accommodate an influx of COVID-19 patients so as to provide other hospitals with a potential blueprint. from Journal of Invasive Cardiology.