The Role of Body Mass Index and Hypoalbuminemia on Postoperative Outcomes in Patients Undergoing Total Knee Arthroplasty.

Obesity and malnutrition are modifiable risk factors associated with increased postoperative complications following total knee arthroplasty (TKA). Obesity is paradoxically associated with malnutrition. Previous studies have only evaluated the impact of body mass index (BMI) and hypoalbuminemia separately in relation to postoperative TKA outcomes and have attempted to compare the impact of these modifiable risk factors. Our study seeks to establish if increased BMI and decreased albumin levels have a compounding effect on postoperative outcomes. A retrospective analysis was conducted using the 2011-2014 American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) dataset. This study reaffirmed that increased BMI and low albumin levels are associated with increased postoperative complications following TKA. Moreover, this study demonstrated that they do not have a compounding effect, but rather only help predict outcomes when analyzed individually. (Journal of Surgical Orthopaedic Advances 32(2) 114-117, 2023).

Academic career outcomes of Orthopedic Research and Education Foundation resident grant recipients.

The Orthopedic Research and Education Foundation (OREF) awards resident research grants to orthopedic surgery residents. Outcomes are lacking for OREF resident grant recipients including academic career choice and scholarly productivity. This was a retrospective cohort study of OREF resident grant recipients (2012-2020). The percentage of OREF resident grant recipients selecting an academic career was compared with the percentage of academic orthopedic surgeons in the United States via a χ2 test. Two hundred and seventy-six OREF resident grants were issued to 272 orthopedic surgery residents at 73 programs. OREF resident grant recipients were predominantly male (79.0%) and Caucasian (70.2%). OREF resident grant recipients had greater women representation than the national cohort of orthopedic surgery residents (21.0% vs. 16.0%, p = 0.030) with similar proportions of underrepresented racial minorities (29.8% vs. 27.2%, p = 0.351). OREF resident grants consisted of clinical (69.6%) and basic/translational science (30.4%) research and were awarded mostly for sports medicine (25.4%), trauma (18.8%), and adult reconstruction (15.9%) topics. The average h-index was 8.5 ± 9.2 resulting from 29.5 ± 51.2 manuscripts. The majority of OREF resident grant recipients selected an academic career, which was higher than the national benchmark of academic orthopedic surgeons (63.8% vs. 24.4%, p < 0.001). Two OREF resident grant recipients transitioned to National Institutes of Health research funding (0.7%). Multivariable logistical regression demonstrated two independent characteristics associated with pursuit of a future academic career: female sex (p = 0.042) and higher h-index values (p = 0.002). Procurement of OREF resident grants is associated with pursuit of an academic career. Clinical significance: There is great interest in fostering the next generation of orthopedic surgeon scientists. Results from this study demonstrate the association between receipt of an OREF resident research grant and pursuit of a future career in academic orthopedic surgery.

SARS-CoV-2 Infection and Racial Disparities in Children: Protective Mechanisms and Severe Complications Related to MIS-C.

A novel coronavirus has resulted in a pandemic with over 176 million confirmed cases and over 3.8 million recorded deaths. In the USA, SARS-CoV-2 infection has a significant burden on minority communities, especially Hispanic and Black communities, which are overrepresented in cases compared to their percentage in the population. SARS-CoV-2 infection can manifest differently in children and adults, with children tending to have less severe disease. A review of current literature was performed to identify the hypothesized protective immune mechanisms in children, and to describe the rare complication of multisystem inflammatory syndrome in children (MIS-C) that has been documented in children post-SARS-CoV-2 infection. Epidemiologic data and case studies have indicated that children are less susceptible to more severe clinical features of SARS-CoV-2 infection, a finding that may be due to differences in the cytokine response generated by the innate immune system, high amounts of ACE-2 which maintain homeostatic functions by preventing inflammation, and trained immunity acquired from regular vaccinations. Despite these protective mechanisms, children are still susceptible to severe complications, such as MIS-C. The racial disparities seen in MIS-C are extremely apparent, and certain populations are more affected. Most specifically, 33% of MIS-C patients are Hispanic/Latino, and 30% Black. Current studies published on MIS-C do not detail whether certain symptoms are more present in certain racial/ethnic groups. Knowledge of these disparities could assist health care professionals with devising appropriate strategies for post-acute SARS-CoV-2 infection follow-up in children as well as vaccine distribution in specific communities to help slow the spread of SARS-CoV-2 infection, and ultimately reduce the potential for complications such as MIS-C.

The Short-Term Effect of Whey Compared with Pea Protein on Appetite, Food Intake, and Energy Expenditure in Young and Older Men.

BACKGROUND: Diets higher in protein have been reported to improve age-related changes in body composition via increased energy expenditure, shifts in substrate oxidation (SO), and decreased appetite. However, how protein source (e.g., animal compared with plant protein) affects energy expenditure, appetite, and food intake as we age is unknown. OBJECTIVES: The objective of this study was to evaluate the effect of protein source as part of a high-protein breakfast on appetite, food intake, energy expenditure, and fat oxidation in young men (YM) compared with older men (OM). METHODS: This study used a randomized, single-blinded crossover design, with a 1-wk washout period between testing days. Fifteen YM (mean ± SD age: 25.2 ± 2.8 y) and 15 OM (67.7 ± 4.5 y), healthy adults, participated in the study. Participants arrived fasted and consumed an isocaloric, volume-matched, high-protein (40-g) test beverage made with either an animal [whey protein isolate (WPI)] or plant [pea protein isolate (PPI)] protein isolate source. Markers of appetite and energy expenditure were determined at baseline and over 4 h postprandial. RESULTS: There was a significant effect of time, age, and protein source on appetite (P < 0.05). There was no effect of protein source on plasma markers of appetite, food intake, energy expenditure, and SO. After controlling for body weight, OM had decreased energy expenditure (P < 0.05) and lower fat oxidation (P < 0.001) compared with YM. CONCLUSIONS: This study indicates that a high-protein breakfast containing WPI or PPI exerts comparable effects on appetite, energy expenditure, and 24-h energy intake in both young and older healthy adult men.This trial was registered at clinicaltrials.gov as NCT03399812.