Chronic kidney disease (CKD) affects over 35 million Americans, yet only 12.3% are aware of their diagnosis and fewer than 20% of at-risk patients receive guideline-concordant albuminuria testing. We conducted a retrospective electronic health record-based analysis, to evaluate observed progression from CKD to end-stage kidney disease (EKRD) across sex, racial, ethnic, and age groups in diabetic patients, with a focus on albuminuria severity. Using UCLA i2b2 database from 2016 to 2026, we identified 161,291 adults with diabetes, including 77,911 with CKD. Among these, 1,815 with albuminuria >30 mg/g, and 500 with albuminuria >300 mg/g. Documented albuminuria was present in only 1.13% of patients, indicating substantial under- detection in routine clinical practice. Albuminuria severity showed a strong stepwise association with observed progression to ESKD, 8.21% in patients with albuminuria >30 mg/g and 19.00% in those >300 mg/g. Males demonstrated higher observed progression to ESKD than females at severe albuminuria levels, 21% vs 15%. Marked ethnic disparities were observed, with Mexican/Mexican American patients experiencing progression rates of up to 46%. Progression to ESKD was associated with an increase in observed mortality. These findings highlight a critical gap in early detection and risk stratification, supporting universal albuminuria screening and targeted interventions in high-risk populations to reduce progression and mortality.

Polytrauma, defined as injuries to multiple organ systems and an Injury Severity Score greater than 16, induces a systemic inflammatory response syndrome and subsequent immune dysregulation. Mesenchymal stem/stromal cells (MSCs) play a critical role in fracture healing, though emerging evidence suggests that MSC-mediated processes are significantly compromised in polytrauma settings. This review seeks to answer two key questions regarding this: How is the immunoregulatory function of MSCs in fracture healing altered? How can MSC-based therapies be used clinically for systemic immunomodulation of trauma patients? Keyword combinations were used in several databases to identify relevant peer-reviewed literature. MSCs adopt a pro-inflammatory phenotype and demonstrate impaired homing in polytrauma, representing a departure from their role in isolated fracture healing. Dysregulated MSC-mediated functions include impaired macrophage polarization, neutrophil hyperactivity and altered systemic concentration of regulatory T-cells. Preclinical and early clinical data on MSC-based therapies demonstrate significant potential to restore immune balance in a polytrauma setting, but further development and investigation is required. Several knowledge gaps were identified with regard to the role of endogenous MSCs in polytrauma, though it is evident that MSC-based therapies offer a promising means of calming the inflammatory storm that sabotages fracture healing in polytraumatized patients.

Background: Emergency department (ED) crowding and prolonged throughput times remain challenges that impact patient outcomes, satisfaction, and operational efficiency. To address this, the UCLA ED implemented a WestFlex attending:resident dyad model, pairing physicians to function as a coordinated team to treat lower-acuity patients, without increasing overall staffing. Research question: How does the WestFlex dyad model change key ED throughput metrics, and does it meaningfully improve ED efficiency. Methods: This retrospective study used de-identified electronic health record data from all UCLA ED encounters during pre-implementation (Jan–Mar 2025) and a time-matched post-implementation (Jan–Mar 2026) periods. Throughput metrics were summarized by triage acuity level (Emergency Severity Index (ESI)). We used linear regression to correlate dyad implementation and length of stay; logistic regression evaluated the odds of leaving without being seen (LWBS). Results: 3,288 total encounters (90% ESI 3–5; 10% ESI 1–2) during 2025 pre-implementation, and 3,694 total encounters (88% ESI 3–5; 12% ESI 1–2) during 2026 post-implementation. Time to evaluate increased by 14 minutes—dyad-seen patients had a median of 56 minutes vs. 42 minutes for non-dyad patients at the same ESI level. Patients were more likely to LWBS post-implementation. Conclusion: These findings may inform staffing decisions at RRMC and offer a scalable model for academic EDs exploring options to change throughput without increasing physician numbers.

Staphylococcus aureus infects many different tissue sites. We sought to identify genetic determinants associated with human osteomyelitis. 162 S. aureus genomes (osteomyelitis, N=73; non-osteomyelitis, N=89) were obtained from PubMLST and NCBI Pathogens for comparative analysis. Genomes were annotated by Bakta and typed by MLST. Gene presence/absence was detected by Roary with IQTree phylogenetic analysis, and associations tested by Scoary and PYSEER. Curated gene presence/absence of antimicrobial resistance (AMR), virulence factors, and stress response genes was conducted by AMRFinder Plus. Clusters of orthologous groups (COG) were measured by eggNOG. Scoary and PYSEER identified genes suggestively associated with osteomyelitis mainly within metabolism, capsule/cell wall biosynthesis, and stress response pathways. AMRFinder showed a reduced gene burden for AMR genes (p=0.01) and increased representation in arsenic, copper, and mercury stress response genes (p < 0.05). EggNOG identified small but significant increases (p<0.05) in 8 COG functional categories (energy metabolism, carbohydrate transport/metabolism, cell wall/membrane biosynthesis, coenzyme metabolism, chaperone/stress response, nucleotide metabolism, amino acid transport/metabolism, and inorganic ion transport) among osteomyelitis isolates. These findings are hypothesis generating findings and warrant functional validation (i.e., preclinical) with implications for future drug-development.