Harbor–UCLA Medical Center, is a 570-bed public teaching hospital located at 1000 West Carson Street in West Carson, an unincorporated area within Los Angeles County, California. As implied by the name, the hospital is owned by the Los Angeles County and operated by the Los Angeles County Department of Health Services, while doctors are faculty of the David Geffen School of Medicine at UCLA, who oversee the medical residents being trained at the facility.The facility is one of two level I trauma centers (providing the highest level of surgical care to trauma patients) operated by Los Angeles County, the other is LAC+USC Medical Center.
This article provides a focused update to the clinical practice guideline on the treatment and management of patients with coronavirus disease 2019, developed by the Infectious Diseases Society of America. The guideline panel presents a recommendation on the use of the anti-severe acute respiratory syndrome coronavirus 2 neutralizing antibody pemivibart as pre-exposure prophylaxis. The recommendation is based on evidence derived from a systematic review and adheres to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Information on pemivibart is included in the U.S. Food and Drug Administration Emergency Use Authorization for this agent.
Measures from affinity-proteomics platforms often correlate poorly, challenging interpretation of protein associations with genetic variants and phenotypes. Here, we examine 2157 proteins measured on both SomaScan 7k and Olink Explore 3072 across 1930 participants with genetic similarity to European, African, East Asian, and Admixed American ancestry references. Inter-platform correlation coefficients for these 2157 proteins follow a bimodal distribution (median r = 0.30). We evaluate protein measure associations with genetic variants, and find approximately 25-30
Importance:More than 100 000 patients in the US begin hemodialysis each year. While arteriovenous fistulas (AVFs) have been the preferred dialysis access due to their durability and lower complication rates, contemporary guidelines now emphasize achieving a functional access tailored to individual patient needs. Prosthetic arteriovenous grafts (AVGs) remain a critical alternative for patients with suboptimal autogenous options. Given the essential role of hemodialysis access in patient survival, both surgeons and nonsurgeons must be familiar with the unique challenges of placing and maintaining AVFs and AVGs. This review highlights common complications associated with each access type and evidence-based management strategies. Observations:Complications of arteriovenous (AV) access can manifest at varying time points, ranging from the immediate postoperative period to months or years later due to long-term sequelae of altered hemodynamics and repeated cannulation. Determining whether symptoms, such as pain, weakness, paresthesia, and hand dysfunction, are due to the AV access or simply due to outcomes of kidney failure can be extremely challenging, emphasizing the importance of a detailed patient history, comprehensive physical examination, and duplex imaging. Certain complications, including access-related hand ischemia (ie, steal syndrome), carpal tunnel syndrome, ulnar neuropathy, aneurysms, and pseudoaneurysms, have multiple treatment options that span conservative management, open surgery, and endovascular procedures. Treatment decisions should consider patient comorbidities, anatomical factors, the risk of access site loss, and the availability of alternate access sites. Other complications, such as ischemic monomelic neuropathy, persistent bleeding, and high-output heart failure, require urgent intervention to prevent loss of limb or life. Conclusions and Relevance:Patients with upper-extremity AVF and AVG can face a number of access-related complications. Understanding the diagnostic evaluation and treatment options is essential to balance preserving access longevity while minimizing the risk of short and long-term morbidity and mortality.
This article provides a focused update to the clinical practice guideline on the treatment and management of patients with coronavirus disease 2019 (COVID-19), developed by the Infectious Diseases Society of America. The guideline panel presents a recommendation on the use of abatacept in hospitalized adults with severe or critical COVID-19. The recommendation is based on evidence derived from a systematic literature review and adheres to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.
Whole genome sequence (WGS) data in multi-ancestry samples supports discovery of low-frequency or population-specific genetic variants associated with chronic obstructive pulmonary disease (COPD) and lung function. We performed single variant, structural variant, and gene-based analysis of pulmonary function (FEV1, FVC and FEV1/FVC) and COPD case–control status in 44,287 multi-ancestry participants from the NHLBI Trans-Omics for Precision Medicine (TOPMed) Program. We validated findings using the UK Biobank and assessed implicated genes using lung single-cell RNA-seq (scRNA-seq) data sets. Applying a genome-wide significance threshold (P < 5 × 10–9), we replicated known loci and identified novel associations near LY86, MAGI1, GRK7, and LINC02668. Colocalization with gene expression quantitative trait loci (eQTL) from the Lung Tissue Research Consortium highlighted known candidate genes including ADAM19, THSD4, C4B, and PSMA4, which were not identified through other eQTL sources. Multi-ancestry analysis improved fine-mapping resolution (e.g., HTR4 and RIN3). Gene-based analysis identified and replicated HMCN1. In human lung scRNA-seq data sets, lung epithelial cells and immune cell types showed enriched expression, while fibroblasts showed higher expression for HMCN1. CRISPR targeting HMCN1 in IMR90 demonstrated reduced expression of collagen genes. Large-scale multi-ancestry WGS analysis improves variant discovery and fine-mapping resolution for lung function and COPD and highlights biologically relevant genes and pathways.
