Socioeconomic status (SES) is defined as an individual's social or economic standing, and is a measure of an individual's or family's social or economic position or rank in a social group. It is a composite of several measures including income, education, occupation, location of residence or housing. Studies have found a lower SES has been linked to disproportionate access to health care in many diseases. There is emerging data in pulmonary diseases such as COPD, asthma, cystic fibrosis, pulmonary hypertension and other chronic respiratory conditions that allude to a similar observation noted in other chronic diseases. In the setting of COPD, SES has an inverse relationship with COPD prevalence, mortality, health utilization costs and HRQoL. Asthma and cystic fibrosis show an increased severity and hospitalizations in relationship to a lower SES. Similar observations were seen in sarcoidosis, PHTN and obstructive sleep apnea. There remains a limited data on non-CF bronchiectasis and interstitial lung diseases. Population SES may be gauged by various measures such as education, occupation, marital status but no value is more indicative than income. Currently guidelines and management algorithms do not factor the effect of SES in the disease process. Despite the great amount of data available, a standardized method must be created to include SES in the prognostic calculations and management of chronic pulmonary diseases.

A low socioeconomic status (SES) has been linked to disproportionate access to health care in many diseases, leading to worse disease severity at initial presentation. There is a paucity of these data in the pulmonary hypertension (PHTN) population. We studied the association of SES, as measured by zip code-based median annual household income, with World Health Organization functional class (WHO-FC) at time of first evaluation in PHTN patients. All patients evaluated at our center with a right heart catheterization revealing a mean pulmonary artery pressure of ≥25 mmHg within 12 months of initial evaluation were considered for the study. Demographics, WHO-FC, and zip codes were obtained from retrospective chart analysis. The 2010 US census was used to obtain zip code-based annual median income. The income groups were divided into quartiles. Patients were categorized by their WHO-FC and zip code-derived median income. Similar analyses were conducted for pulmonary arterial hypertension (PAH) patients. Survival was estimated with the Kaplan-Meier method. Data were analyzed in SAS, and P < 0.05 was considered significant. There were 228 PHTN patients (70 [30.7%] male, 158 [69.3%] female). As median income decreased, the FC at presentation increased, signifying higher disease severity (Spearman correlation: r = −0.161, P < 0.0515). This association between median income groups and WHO-FC at initial evaluation was significant (χ 2 test: P < 0.0168). There were 116 PAH patients (32 [27.6%] male, 84 [72.4%] female). There was again a negative relationship between income and initial FC (Spearman correlation: r = −0.0307, P < 0.0007). A lower SES was associated with worse disease, as measured by WHO-FC.

Progranulin (PGRN) is a growth factor implicated in various pathophysiological processes, including wound healing, inflammation, tumorigenesis, and neurodegeneration. It was previously reported that PGRN binds to tumor necrosis factor receptors (TNFR) and has therapeutic effects in inflammatory arthritis (Tang et. al, in Science 332:478–484, 2011); however, Chen et al. reported their inability to demonstrate the PGRN-TNFR interactions under their own conditions (Chen et. al, in J Neurosci 33:9202–9213, 2013). A letter-to-editor was then published by the original group in response to the Chen et al. paper that discussed the reasons for the latter’s inability to recapitulate the interactions. In addition, the group published follow-up studies that further reinforced and dissected the interactions of PGRN-TNFR. Recently, the dispute about the legitimacy of PGRN-TNFR interactions appears to be finally settled with independent confirmations of these interactions in various conditions by numerous laboratories. This review presents a chronological update on the story of PGRN-TNFR interactions, highlighting the independent confirmations of these interactions in various diseases and conditions.

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When craniotomy complicated by secondary infection requires debridement and craniectomy, the bony defect is typically not reconstructed immediately. Due to concerns about placing a prosthetic material in an infected field, cranioplasty has traditionally been delayed by weeks or months after craniectomy. However, surgeons have begun performing single-stage cranioplasty after craniectomy in an effort to reduce the morbidity associated with multiple procedures and reduce overall healthcare costs. The purpose of this systematic review is to analyze outcomes of immediate cranioplasty performed after bone flap debridement secondary to infection. A literature review from January 1, 1998 through January 1, 2019 was conducted, examining the data on immediate titanium cranioplasty and its complication and reoperation rates. A meta-analysis of these articles was then performed. Variables studied included incidence of infection post-cranioplasty, wound healing complications, need for unplanned reoperation, and mortality. In total, there were 40 patients who underwent immediate cranioplasty after bone flap debridement. Overall, there was a 5% rate of postoperative infection, a 12.5% rate of unplanned return to the operating room, 7.5% rate of CSF fistula or leak, a 2.5% rate of hematoma, and a 2.5% rate of mortality within the immediate post-op period. Although there are insufficient data in the literature to rigorously compare these immediate cranioplasties in a direct way with the more traditional delayed type; the outcomes of immediate cranioplasty procedures secondary to craniectomy for infection were similar to the outcomes of delayed cranioplasty after craniectomy for any reason. Given these results, immediate titanium cranioplasty should be considered in select patients.

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Background Medical tourism has grown increasingly popular in the past few decades. Cosmetic surgery centers have developed in vacation locales, offering procedures at lower prices. However, surgeons and patients alike are often unprepared for management of complications after patients return to the USA. The aim of this study is to provide an overview of US cosmetic surgery tourism patients and the complications faced by US healthcare providers. Methods A systematic review was performed using the Web of Science, Cochrane, Embase, Scopus, and PubMed databases up to February 2022; included articles were full-text, English language, and reported complications of patients receiving postoperative care in the USA after cosmetic surgery abroad. Two independent reviewers performed screening for article eligibility with a 3rd for conflict resolution. Patient demographics, procedure characteristics, and outcomes were extracted and aggregated. Results Twenty studies were included, describing 214 patients. Most patients were female (98.1%, n = 210), middle-aged, and Hispanic. The most common destination country was the Dominican Republic (82.7%, n = 177) and the most common surgical procedure was abdominoplasty (35.7%, n = 114). Complications were mainly infectious (50.9%, n = 112) and required prolonged treatment periods often greater than two months, with high rates of hospitalization (36.8%) and surgical management (51.8%). Conclusions Cosmetic surgery tourism is a growing industry with adverse implications for the US healthcare system and patients themselves. This review aims to serve as a reference to prepare plastic surgeons for the scope of complications associated with cosmetic tourism and improve counseling to better prepare patients for the financial and health risks. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.