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Simultaneous bilateral total hip arthroplasty (blTHA) offers the benefit of a single episode of care with the potential for lower cumulative operative times and rehabilitation periods than staged bilateral total hip arthroplasty (stTHA). This study analyzes short-term complication rates after blTHA relative to unilateral THA (ulTHA) and projected stTHA in patients with bilateral hip osteoarthritis. We compared complications in a simultaneous blTHA group and a ulTHA group using the National Surgical Quality Improvement Program (NSQIP) database. ulTHA patients were propensity-matched two-to-one against blTHA patients using morbidity probability score. Thirty-day complication rates were compared. Outcomes in staged procedures (stTHA) were projected by doubling complication rates in ulTHA procedures. There were 805 blTHA patients and 1,610 ulTHA patients used to estimate stTHA outcomes. The rate of major complications or death after blTHA was no higher than the projected stTHA rate (2.0 vs 3.0%, p = 0.179), but minor complications were more common after blTHA than stTHA projections (13.5 vs 6.8%, p

We suggest that people living with HIV (PLWH) may serve as pre-exposure prophylaxis (PrEP) educators for partners when informed about PrEP. Participants in this study were a convenience sample of PLWH at a public hospital in Miami. A cross-sectional survey assessed the frequency of serostatus disclosure, PrEP awareness, and willingness to recommend PrEP to intimate partners. To evaluate stigma surrounding human immunodeficiency virus (HIV), comfort discussing HIV with family, friends and intimate partners was interrogated. Surveys were completed by 137 participants; 39.5% had potentially sero-discordant sexual partners. Among respondents, 29.2% reported that they ‘occasionally’ or ‘never’ disclose HIV status to sexual partners. In all, 66.4% of patients reported that they had never heard of PrEP. After being educated about PrEP, 86.0% of respondents reported that they would encourage partners to use it. Participants were asked how often the subject of HIV comes up in conversations. Most indicated that ‘rarely’ or ‘never’ does it come up with friends and family; 46.1% indicated that ‘never’ or ‘rarely’ does it come up with partners. In bivariate analyses, participants with prior awareness of PrEP were more likely to indicate higher frequency of conversations regarding HIV with intimate partners. It is concluded that interventions which utilize partner education to increase PrEP uptake should address stigma and knowledge among other barriers.

Background Ischemic cardiomyopathy ( ICM ) and dilated cardiomyopathy ( DCM ) differ in histopathology and prognosis. Although transendocardial delivery of mesenchymal stem cells is safe and provides cardiovascular benefits in both, a comparison of mesenchymal stem cell efficacy in ICM versus DCM has not been done. Methods and Results We conducted a subanalysis of 3 single‐center, randomized, and blinded clinical trials: (1) TAC‐HFT (Transendocardial Autologous Mesenchymal Stem Cells and Mononuclear Bone Marrow Cells in Ischemic Heart Failure Trial); (2) POSEIDON (A Phase I/II, Randomized Pilot Study of the Comparative Safety and Efficacy of Transendocardial Injection of Autologous Mesenchymal Stem Cells Versus Allogeneic Mesenchymal Stem Cells in Patients With Chronic Ischemic Left Ventricular Dysfunction Secondary to Myocardial Infarction); and (3) POSEIDON‐DCM (Percutaneous Stem Cell Injection Delivery Effects on Neomyogenesis in Dilated Cardiomyopathy). Baseline and 1‐year cardiac structure and function and quality‐of‐life data were compared in a post hoc pooled analysis including ICM (n=46) and DCM (n=33) patients who received autologous or allogeneic mesenchymal stem cells. Ejection fraction improved in DCM by 7% (within‐group, P =0.002) compared to ICM (1.5%; within‐group, P =0.14; between‐group, P =0.003). Similarly, stroke volume increased in DCM by 10.59 mL ( P =0.046) versus ICM (−0.2 mL; P =0.73; between‐group, P =0.02). End‐diastolic volume improved only in ICM (10.6 mL; P =0.04) and end‐systolic volume improved only in DCM (17.8 mL; P =0.049). The sphericity index decreased only in ICM (−0.04; P =0.0002). End‐diastolic mass increased in ICM (23.1 g; P DCM (−4.1 g; P =0.34; between‐group, P =0.007). The 6‐minute walk test improved in DCM (31.1 m; P =0.009) and ICM (36.3 m; P =0.006) with no between‐group difference ( P =0.79). The New York Heart Association class improved in DCM ( P =0.005) and ICM ( P =0.02; between‐group P =0.20). The Minnesota Living with Heart Failure Questionnaire improved in DCM (−19.5; P =0.002) and ICM (−6.4; P =0.03; δ between‐group difference P =0.042) patients. Conclusions Mesenchymal stem cell therapy is beneficial in DCM and ICM patients, despite variable effects on cardiac phenotypic outcomes. Whereas cardiac function improved preferentially in DCM patients, ICM patients experienced reverse remodeling. Mesenchymal stem cell therapy enhanced quality of life and functional capacity in both etiologies. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifiers: TAC ‐ HFT : NCT 00768066, POSEIDON : NCT 01087996, POSEIDON ‐ DCM : NCT 01392625.

Background Management of velopharyngeal insufficiency (VPI) has traditionally involved surgical repair to improve speech. Posterior pharyngeal augmentation using injectable synthetic materials has been advocated. However, outcomes have been equivocal. More recently, autologous fat injection (AFI) has been advocated for correction of mild to moderate VPI. However, long-term efficacy and safety of this procedure remain unsettled. Methods A systematic review of the literature was performed. Available studies that reported outcomes of autologous fat velopharyngeal injection for treatment of documented VPI were included. Preclinical animal studies were excluded. Study characteristics, patient demographics, treatment details including fat harvest site, volume injected, and outcome measures were evaluated. Results Fifteen studies met inclusion criteria, yielding 251 patients who underwent AFI. There was high variability in terms of indications for procedure and reporting of outcomes. Majority of studies required velopharyngeal gap closure of at least 50% in order to undergo AFI. Most common etiology of VPI was secondary to cleft palate. Some studies included patients with velocardiofacial syndromes. Improvements in speech and nasalance were reported in a majority of patients. Major complications were rare. Only 1 patient with graft hypertrophy resulting in obstructive sleep apnea was reported. Conclusion Autologous fat injection offers a minimally invasive approach to the treatment of VPI. Current literature is limited to small noncomparative studies. These appear to suggest efficacy and safety in mild to moderate patients with VPI. Future prospective studies with standardized technique and objective outcomes are required to definitively establish its safety and efficacy, as well as define patient selection criteria.