The association of alcohol use disorder with revision rates and post-operative complications in total shoulder arthroplasty.

Background: Alcohol use disorder (AUD) is the most prevalent substance use disorder in the United States. However, the current literature on AUD as a preoperative risk factor for Total Shoulder Arthroplasty (TSA) outcomes is limited. The purpose of this study was to identify the association of AUD with revision rates and 90-day postoperative complications in TSA. Methods: A retrospective study was conducted using the PearlDiver database. Patients diagnosed with AUD were identified. Patients in remission or with underlying cirrhosis were excluded. Outcomes included 2-year revision, 90-day readmission, 90-day emergency, and 90-day post-operative medical complications. Analysis was performed with univariate chi-squared tests followed by multivariable logistic regression. Results: A total of 59,261 patients who underwent TSA for osteoarthritis were identified, with 1522 patients having a diagnosis of AUD. Multivariable logistic regression showed that patients with AUD were more likely to undergo 2-year all-cause revision (OR = 1.49, p = 0.007), 2-year aseptic revision (OR = 1.47, p = 0.014), 90-day hospital readmission (OR = 1.57, p = 0.015), and 90-day transient mental disorder (OR = 2.13, p = 0.026). Conclusions: AUD is associated with increased rates of 2-year revision surgery, as well as 90-day readmission and 90-day transient mental disorder following primary TSA for osteoarthritis. These findings may assist orthopedic surgeons in counseling patients with AUD during the pre-operative course.

Reduced Early Revision Surgery and Medical Complications in Computer-assisted Knee Arthroplasty Compared With Non-computer-assisted Arthroplasty.

BACKGROUND: Computer assistance can help surgeons achieve mechanical accurate alignment, but the clinical effect of this technology in different arthroplasty types remains controversial because of conflicting functional outcomes, revision rates, and complication rates. The goal of this study was to compare 90-day medical complications and 1 and 2-year revision surgeries after computer-assisted patellofemoral arthroplasty, unicompartmental knee arthroplasty (CA-UKA), bicompartmental knee arthroplasty (CA-BKA), and total knee arthroplasty (CA-TKA) with non-computer-assisted procedures. METHODS: A retrospective cohort analysis was conducted using the Mariner data set of the PearlDiver Patient Records Database from 2010 to 2018. Current Procedural Terminology codes were used to identify patients who underwent patellofemoral arthroplasty, unicompartmental knee arthroplasty, bicompartmental knee arthroplasty, and total knee arthroplasty with or without computer assistance for osteoarthritis. All included patients were followed up for 2 years. Univariate and multivariable analyses were conducted. RESULTS: On multivariable analysis, revision within 1 year was decreased in patients who underwent computer-assisted patellofemoral arthroplasty (odds ratio [OR]: 0.541, P = 0.031), CA-UKA (OR: 0.798, P = 0.019), and computer-assisted bicompartmental knee arthroplasty (OR: 0.186, P = 0.025) compared with the same surgeries without technology assistance. CA-TKA had decreased odds of revision for aseptic loosening at 2 years (OR: 0.789, P < 0.001). CA-UKA and CA-TKA had decreased risk of overall 90-day medical complications (OR: 0.838, P < 0.001; OR: 0.903, P < 0.001, respectively) and major complications (OR: 0.750, P = 0.004; OR: 0.822, P < 0.001, respectively). DISCUSSION: Complication rates and revision surgeries for all arthroplasty types were equivalent or more favorable when computer assistance was used during surgery. Our results quantify some early benefits to using computer assistance in total and partial knee arthroplasties.

Analysis of revision rates and complication rates among patients undergoing unicompartmental and bicompartmental knee Arthroplasties when compared to Total knee arthroplasty.

BACKGROUND: With recent advances in partial knee arthroplasty, there is conflicting data regarding the outcomes and revision rates for bicompartmental knee arthroplasty (BKA) and unicompartamental knee arthroplasty (UKA) compared to total knee arthroplasty (TKA). This study uses national data to compare surgical and medical complications of UKA, BKA, and TKA to aid surgical decision-making. METHODS: A retrospective cohort analysis was done using the Mariner dataset of the PearlDiver patient records database from 2010-2019. Current Procedural Terminology (CPT) codes were used to identify patients who underwent UKA, BKA, and TKA for a primary indication of osteoarthritis (OA). Univariate and multivariable analyses were performed to determine 1-year and 2-year revision, prosthetic joint infection (PJI), and loosening, 1-year manipulation under anesthesia (MUA), and 90-day postoperative medical complications. RESULTS: The BKA cohort was found to have higher odds of one and two-year revision compared to UKA and TKA cohorts. Additionally, the UKA cohort had higher odds of one and two-year revision but lower odds of 1-year MUA than the TKA cohort. However, both the BKA and UKA cohorts had lower odds of any 90-day postoperative complications when compared to the TKA cohort. CONCLUSIONS: Even with modern implants and approaches, our study found that revision rates are highest for BKA followed by UKA and TKA at two years postoperatively. Notably, medical complications were much less common after all partial knee replacement types when compared to TKA. These findings may be used to guide patients in selecting the appropriate surgery to meet their goals and expectations.

Knee arthroplasty utilization trends from 2010 to 2019.

BACKGROUND: Interest in partial knee arthroplasty procedures including unicompartmental arthroplasty (UKA), patellofemoral arthroplasty (PFA), and bicompartmental knee arthroplasty (BKA) has increased due to their bone and ligament preservation compared to total knee arthroplasty (TKA). Implant designs, changing thoughts on appropriate indications for partial knee arthroplasty, and availability of navigation also impacted the field over the last decade. The aims of this study were to evaluate trends over the last decade in utilization of 1) partial and total knee arthroplasty; and 2) computer-assistance in knee arthroplasty. METHODS: A retrospective cohort analysis was conducted using the PearlDiver database. Patients who underwent PFA, UKA, BKA, and TKA for an indication of osteoarthritis (OA) were identified using Current Procedural Terminology (CPT) codes. Trends analysis from 2010 to 2019 was conducted to compare utilization based on procedure type and computer-assistance. Statistical analysis was conducted using Compounded Annual Growth Rates (CAGR) and linear regression. RESULTS: From 2010 to 2019, there was a significant decrease in utilization of PFA (CAGR: -5.73 %; p = 0.011) and BKA (CAGR: -10.49 %; p = 0.013), but no significant difference in that of UKA (p = 0.224) and TKA (p = 0.421). There was a significant increase in the utilization of computer assistance for both UKA (CAGR: +19.81 %; p = 0.002) and TKA (CAGR: +3.90 %; p = 0.038), but there was no significant difference for computer-assisted PFA (p = 0.724) and BKA (p = 0.951). CONCLUSIONS: TKA is still the most common arthroplasty procedure for OA. Decreased utilization of PFA and BKA may be explained by reported failure and revision rates for PFA and BKA compared to TKA.

Modern microprocessor built from complementary carbon nanotube transistors.

Electronics is approaching a major paradigm shift because silicon transistor scaling no longer yields historical energy-efficiency benefits, spurring research towards beyond-silicon nanotechnologies. In particular, carbon nanotube field-effect transistor (CNFET)-based digital circuits promise substantial energy-efficiency benefits, but the inability to perfectly control intrinsic nanoscale defects and variability in carbon nanotubes has precluded the realization of very-large-scale integrated systems. Here we overcome these challenges to demonstrate a beyond-silicon microprocessor built entirely from CNFETs. This 16-bit microprocessor is based on the RISC-V instruction set, runs standard 32-bit instructions on 16-bit data and addresses, comprises more than 14,000 complementary metal-oxide-semiconductor CNFETs and is designed and fabricated using industry-standard design flows and processes. We propose a manufacturing methodology for carbon nanotubes, a set of combined processing and design techniques for overcoming nanoscale imperfections at macroscopic scales across full wafer substrates. This work experimentally validates a promising path towards practical beyond-silicon electronic systems.

Population Changes in a Community of Alkaliphilic Iron-Reducing Bacteria Due to Changes in the Electron Acceptor: Implications for Bioremediation at Alkaline Cr(VI)-Contaminated Sites.

A serial enrichment culture has been grown in an alkaline Fe(III)-citrate-containing medium from an initial inoculum from a soil layer beneath a chromium ore processing residue (COPR) disposal site where Cr(III) is accumulating from Cr(VI) containing leachate. This culture is dominated by two bacterial genera in the order Clostridiales, Tissierella, and an unnamed Clostridium XI subgroup. This paper investigates the growth characteristics of the culture when Cr(VI) is added to the growth medium and when aquifer sand is substituted for Fe(III)-citrate. The aim is to determine how the availability and chemical form of Fe(III) affects the growth of the bacterial consortium, to determine the impact of Cr(VI) on growth, and thus attempt to understand the factors that are controlling Cr(III) accumulation beneath the COPR site. The culture can grow fermentatively at pH 9.2, but growth is stronger when it is associated with Fe(III) reduction. It can withstand Cr(VI) in the medium, but growth only occurs once Cr(VI) is removed from solution. Cr(VI) reduced the abundance of Tissierella sp. in the culture, whereas the Clostridium XI sp. was Cr(VI) tolerant. In contrast, growth with solid phase Fe(III)-oxyhydroxides (present as coatings on aquifer sand) favoured the Tissierella C sp., possibly because it produces riboflavin as an extracellular electron shuttling compound allowing more efficient electron transfer to solid Fe(III) phases. Thus, it is suggested that bacterially mediated Cr(III) reduction in the soil beneath the COPR site is dependent on Fe(III) reduction to sustain the bacterial community.

Extracellular electron transport-mediated Fe(III) reduction by a community of alkaliphilic bacteria that use flavins as electron shuttles.

The biochemical and molecular mechanisms used by alkaliphilic bacterial communities to reduce metals in the environment are currently unknown. We demonstrate that an alkaliphilic (pH > 9) consortium dominated by Tissierella, Clostridium, and Alkaliphilus spp. is capable of using iron (Fe(3+)) as a final electron acceptor under anaerobic conditions. Iron reduction is associated with the production of a freely diffusible species that, upon rudimentary purification and subsequent spectroscopic, high-performance liquid chromatography, and electrochemical analysis, has been identified as a flavin species displaying properties indistinguishable from those of riboflavin. Due to the link between iron reduction and the onset of flavin production, it is likely that riboflavin has an import role in extracellular metal reduction by this alkaliphilic community.

Iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) fast spin-echo imaging of the ankle: initial clinical experience.

OBJECTIVE: Reliable, uniform fat suppression is important. Multiple approaches currently exist, many of which suffer from either suboptimal signal-to-noise ratio (SNR), or the inability to obtain consistent fat suppression around the ankle joint. Our purpose was to test iterative decomposition of water and fat with echo asymmetry and the least-squares estimation (IDEAL) method in combination with fast spin-echo imaging, which is able to achieve reliable high SNR images with uniform fat-water separation. SUBJECTS AND METHODS: We compared IDEAL fast spin-echo with conventional fat-suppressed fast spin-echo imaging in 33 ankles in 32 patients. Quantitative measurements of SNR and contrast-to-noise ratio efficiency were made, and qualitative diagnostic image quality and fat-suppression scores were determined. RESULTS: We found that the SNR efficiency for both cartilage and fluid was similar for both techniques, and fluid/cartilage contrast-to-noise ratio efficiency was higher with IDEAL fast spin-echo imaging. Fat suppression and diagnostic quality scores using the IDEAL method were superior (p < 0.01) to fat-suppressed fast spin-echo imaging. CONCLUSION: IDEAL fast spin-echo imaging is a promising technique for MRI of the ankle.

Driven equilibrium magnetic resonance imaging of articular cartilage: initial clinical experience.

PURPOSE: To evaluate three-dimensional driven equilibrium Fourier transform (3D-DEFT) for image quality and detection of articular cartilage lesions in the knee. MATERIALS AND METHODS: We imaged 104 consecutive patients with knee pain with 3D-DEFT and proton density (PD-FSE) and T2-weighted (T2-FSE) fast spin echo. Twenty-four went on to arthroscopy. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) efficiency were measured. Subjective image quality, fat suppression, and cartilage thickness visibility were assessed. Cartilage lesions on 3D-DEFT and T2-FSE were compared with findings outlined in operative reports. RESULTS: SNR efficiency was higher for 3D-DEFT and PD-FSE than for T2-FSE (P < 0.02). 3D-DEFT and PD-FSE showed superior cartilage thickness visibility compared with T2-FSE (P < 0.02). T2-FSE showed better fat suppression and fewer image artifacts than 3D-DEFT (P < 0.04). 3D-DEFT had similar sensitivity and similar specificity for cartilage lesions compared with PD-FSE and T2-FSE. CONCLUSION: 3D-DEFT provides excellent synovial fluid-to-cartilage contrast while preserving signal from cartilage, giving this method a high cartilage SNR. 3D-DEFT shows the full cartilage thickness better than T2-FSE. T2-FSE had superior fat saturation and fewer artifacts than 3D-DEFT. Overall, 3D-DEFT requires further technical development, but is a promising method for imaging articular cartilage.