Unicompartmental knee arthroplasty: A PearlDiver study evaluating complications rates, opioid use and utilization in the Medicare population.

PURPOSE: Despite increased utilization of unicompartmental knee arthroplasty (UKA) for unicompartmental knee osteoarthritis, outcomes in Medicare patients are not well-reported. The purpose of this study is to analyze practice patterns and outcome differences between UKA and TKA in the Medicare population. It is hypothesized that UKA utilization will have increased over the course of the study period and that UKA will be associated with reduced opioid use and lower complication rates compared to TKA. METHODS: Using PearlDiver, the Humana Claims dataset and the Medicare Standard Analytic File (SAF) were analyzed. Patients who underwent UKA and TKA were identified by CPT codes. Postoperative complications were identified by ICD-9/ICD-10 codes. Opioid use was analyzed by the number of days patients were prescribed opioids postoperatively. Survivorship was defined as conversion to TKA. RESULTS: In the Humana dataset, 7,808 UKA and 150,680 TKA patients were identified. 8-year survivorship was 87.7% (95% CI [0.861,0.894]). Postoperative opioid use was significantly higher after TKA (186.1 days) compared to UKA (144.7 days) (p < 0.01, Δ = 41.1, 95% CI = [30.41, 52.39]). In the SAF dataset, 20,592 UKA patients and 110,562 TKA patients were identified. Survivorship was highest in patients > 80 years old and lowest in patients < 70 years old. In both datasets, postoperative complication rates were higher in TKA patients compared to UKA patients in nearly all categories. CONCLUSIONS: UKA represents an increasingly utilized treatment for osteoarthritis in the Medicare population and may be comparatively advantageous to TKA due to reduced opioid use and complication rates after surgery. LEVEL OF EVIDENCE: Level III.

Rate of Bone Mineral Density Testing and Subsequent Fracture-Free Interval After Distal Forearm Fracture in the Medicare Population.

PURPOSE: Distal forearm fractures are prevalent among the Medicare population. Many patients who sustain these fractures have poor bone health and are at increased risk for subsequent fractures. We sought to determine the rate of bone mineral density (BMD) testing and subsequent fragility fracture-free interval after distal forearm fractures in the Medicare population. METHODS: We examined the 5% Medicare Standard Analytic File dataset using the PearlDiver Application from 2005 to 2014 to identify patients with distal forearm fractures based on International Classification of Diseases-Ninth Revision and Current Procedural Terminology codes. We queried these records to determine the incidence and timing of BMD testing after fracture and the number of patients who went on to hip or vertebral fractures. Survival curves were generated using Kaplan-Meier analysis with hip or vertebral fracture as the end point. RESULTS: A total of 37,473 patients with distal forearm fractures were identified who did not have BMD testing within the 2 years before fracture. Only 9,605 of this unscreened cohort underwent testing after the fracture (26%) and only 2,684 underwent testing within 6 months (7%). The patients least likely to be tested were males (9%), those aged over 85 years (12%), and those less than 65 years (22%). Twenty percent of these patients sustained a subsequent hip or vertebral fracture (n = 7,326). Patients who underwent testing after fracture had a longer fracture-free interval compared with patients without BMD testing (819 vs 579 days). When separated by sex and controlling for comorbidities, males with BMD testing had a worsened fracture-free interval whereas females had an improved fracture-free interval. CONCLUSIONS: Bone mineral density testing is underused nationwide in patients sustaining distal forearm fractures despite current guidelines. Orthopedic surgeons should ensure proper testing of patients because this may be an important time point for intervention. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognosis II.

Reoperation Rates and Costs of Radial Head Arthroplasty Versus Open Reduction and Internal Fixation of Radial Head and Neck Fractures: A Retrospective Database Study.

Background: We conducted a retrospective study to compare reoperation/conversion rates and costs between open reduction and internal fixation (ORIF) and radial head arthroplasty (RHA) in patients with radial head/neck fractures. Methods: We examined the Humana Orthopedic data sets using the PearlDiver Application from January 2007 to June 2016 to identify patients with radial head and neck fractures with and without a concurrent elbow dislocation. Time to revision surgery, odds ratios, and survival curves for reoperations/conversions were calculated comparing ORIF and RHA. Results: A total of 7520 patients were identified who had undergone either ORIF or RHA. Overall, ORIF patients were less likely to undergo a conversion procedure (2.76% vs 7.03%) but more likely to undergo any reoperation (21.36% vs 17.63%) with a higher average cost ($19 688.46 vs $11 626.64). Patients who underwent ORIF without a concurrent elbow dislocation were also less likely to undergo a conversion procedure (2.12% vs 7.24%) but more likely to undergo any reoperation (20.22% vs 16.99%) with a higher average cost ($19 420.21 vs $11 123.61). Patients who underwent ORIF with a concurrent elbow dislocation were more likely to undergo both a conversion procedure (15.86% vs 6.39%) and any reoperation (44.98% vs 19.63%) with a higher average cost per patient ($24 999.62 vs $13 192.00). The average time to reoperation/conversion surgery was less than a year for all patient groups. Conclusions: Overall reoperation rates are high in patients undergoing operative treatment of radial head and neck fractures. RHA is less expensive and has fewer reoperations/conversions in short-term follow-up when compared with ORIF in radial head/neck fracture dislocations of the elbow.

Your role in early diagnosis & Tx of metastatic bone disease.

This approach to the work-up and diagnosis will help you to ensure prompt treatment while maximizing your patient's quality of life.

Move&Find: The Value of Kinaesthetic Experience in a Casual Data Representation.

The value of a data representation is traditionally judged based on aspects like effectiveness and efficiency that are important in utilitarian or work-related contexts. Most multisensory data representations, however, are employed in casual contexts where creativity, affective, physical, intellectual, and social engagement might be of greater value. We introduce Move&Find, a multisensory data representation in which people pedalled on a bicycle to exert the energy required to power a search query on Google's servers. To evaluate Move&Find, we operationalized a framework suitable to evaluate the value of data representations in casual contexts and experimentally compared Move&Find to a corresponding visualization. With Move&Find, participants achieved a higher understanding of the data. Move&Find was judged to be more creative and encouraged more physical and social engagement-components of value that would have been missed using more traditional evaluation frameworks.

Bilateral cervical contusion spinal cord injury: A mouse model to evaluate sensorimotor function.

Spinal cord injury is a severe condition, resulting in specific neurological symptoms depending on the level of damage. Approximately 60% of spinal cord injuries affect the cervical spinal cord, resulting in complete or incomplete tetraplegia and higher mortality rates than injuries of the thoracic or lumbar region. Although cervical spinal cord injuries frequently occur in humans, there are few clinically relevant models of cervical spinal cord injury. Animal models are critical for examining the cellular and molecular manifestations of human cervical spinal cord injury, which is not feasible in the clinical setting, and to develop therapeutic strategies. There is a limited number of studies using cervical, bilateral contusion SCI and providing a behavioral assessment of motor and sensory functions, which is partly due to the high mortality rate and severe impairment observed in severe cervical SCI models. The goal of this study was to develop a mouse model of cervical contusion injury with moderate severity, resulting in an apparent deficit in front and hindlimb function but still allowing for self-care of the animals. In particular, we aimed to characterize a mouse cervical injury model to be able to use genetic models and a wide range of viral techniques to carry out highly mechanistic studies into the cellular and molecular mechanisms of cervical spinal cord injury. After inducing a bilateral, cervical contusion injury at level C5, we followed the recovery of injured and sham-uninjured animals for eight weeks post-surgery. Hindlimb and forelimb motor functions were significantly impaired immediately after injury, and all mice demonstrated partial improvement over time that remained well below that of uninjured control mice. Mice also displayed a significant loss in their sensory function throughout the testing period. This loss of sensory and motor function manifested as a reduced ability to perform skilled motor tasks in all of the injured mice. Here, we describe a new mouse model of moderate bilateral cervical spinal cord injury that does not lead to mortality and provides a comprehensive assessment of histological and behavioral assessments. This model will be useful in enhancing our mechanistic understanding of cervical spinal cord injury and in the development of treatments targeted at promoting neuroprotection, neuroplasticity, and functional recovery after cervical SCI.

Synthesis of Flubromazepam Positional Isomers for Forensic Analysis.

Designer benzodiazepines have recently appeared in many forensic cases as legal alternatives to federally scheduled drugs such as diazepam (Valium) and alprazolam (Xanax). Though current forensic instrumental techniques are often sufficient for identifying novel psychoactive substances, they may not readily differentiate between potential positional isomers. Additionally, characterization data for positional isomers of known designer benzodiazepines are widely nonexistent. In this study, flubromazepam, a recognized designer benzodiazepine since 2012, was targeted for synthesis and characterization due to its potential for federal scheduling and current legal status within the United States. A practical synthetic method was developed to prepare purified reference materials for each positional isomer of flubromazepam in which the positions of the bromine and fluorine substituents were varied. Possible isomers (9 of the 12) were successfully prepared and used for further analysis.

Regulatory mechanisms and clinical manifestations of musculoskeletal aging.

Aging is the strongest risk factor for degenerative bone and joint diseases. Clinical therapies for age-related musculoskeletal disorders face significant challenges as their pathogenic mechanisms remain largely unclear. This review article focuses on the recent advances in the understanding of regulatory mechanisms of musculoskeletal aging and their clinical relevance. We begin with the prevalence and socioeconomic impacts of major age-related musculoskeletal disorders such as sarcopenia, osteoporosis, osteoarthritis, and degenerative tendinopathy. The current understanding of responsible biological mechanisms involved in general aging is then summarized. Proposed molecular, cellular, and biomechanical mechanisms relevant to the clinical manifestations of aging in the musculoskeletal system are discussed in detail, with a focus on the disorders affecting muscle, bone, articular cartilage, and tendon. Although musculoskeletal aging processes share many common pathways with the aging of other body systems, unique molecular and cellular mechanisms may be involved in the aging processes of musculoskeletal tissues. Advancements in the understanding of regulatory mechanisms of musculoskeletal aging may promote the development of novel treatments for age-related musculoskeletal disorders. Finally, future research directions for major musculoskeletal tissues including functional interaction between the tissues and their clinical relevance to age-related musculoskeletal disorders are highlighted in the Future Prospects section. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1475-1488, 2019.

Results of an Interdisciplinary Day Care Approach for Chronic Tinnitus Treatment: A Prospective Study Introducing the Jena Interdisciplinary Treatment for Tinnitus.

Objective: Considering the heterogeneity of the symptoms shown by patients suffering from chronic tinnitus, there are surprisingly few interdisciplinary treatments available, and mostly available only for inpatients. In order to provide an interdisciplinary treatment, we developed a day care concept in which each patient was treated by an ENT doctor, a cognitive behavioral therapist, a specialist for medical rehabilitation and an audiologist (Jena Interdisciplinary Treatment for Tinnitus, JITT). The aim of this study was to observe the changes of tinnitus related distress due to interdisciplinary day care treatment and to determine which factors mediate this change. Subjects and Methods: Tinnitus annoyance was measured using the Tinnitus Questionnaire on 308 patients with chronic tinnitus. They were treated in the day care unit over five consecutive days between July 2013 and December 2014. Data were collected before treatment when screened (T0), at the beginning (T1) and at the end of the 5 day treatment (T2), as well as 20 days (T3) and 6 months after treatment (T4). Results: Overall, tinnitus annoyance improved significantly from the screening day to the beginning of treatment, and to a much larger degree from the beginning to the end of treatment. The treatment outcome remained stable 6 months after treatment. Patients with the following symptoms displayed higher tinnitus annoyance at T0: dizziness at tinnitus onset, tinnitus sound could not be masked with background noise, tinnitus worsening during physical stress, comorbid psychiatric diagnosis, higher age and higher hearing loss. Loudness of tinnitus perceived in the right ear correlated with tinnitus annoyance significantly. Demographic, tinnitus and strain variables could only explain 12.8% of the variance of the change in tinnitus annoyance from T0 to T4. Out of 39 predictors, the only significant ones were "sick leave 6 months before treatment" and "tinnitus annoyance at T0." Conclusion: The newly developed JITT represents a valuable treatment for chronic tinnitus patients with improvement remaining stable for at least 6 months after treatment. Using a large number of variables did not allow predicting treatment outcome which underlines the heterogeneity of tinnitus.

Longitudinal spin Seebeck effect contribution in transverse spin Seebeck effect experiments in Pt/YIG and Pt/NFO.

The spin Seebeck effect, the generation of a spin current by a temperature gradient, has attracted great attention, but the interplay over a millimetre range along a thin ferromagnetic film as well as unintended side effects which hinder an unambiguous detection have evoked controversial discussions. Here, we investigate the inverse spin Hall voltage of a 10 nm thin Pt strip deposited on the magnetic insulators Y3Fe5O12 and NiFe2O4 with a temperature gradient in the film plane. We show characteristics typical of the spin Seebeck effect, although we do not observe the most striking features of the transverse spin Seebeck effect. Instead, we attribute the observed voltages to the longitudinal spin Seebeck effect generated by a contact tip induced parasitic out-of-plane temperature gradient, which depends on material, diameter and temperature of the tip.

Prostate cancer risk alleles are associated with prostate cancer volume and prostate size.

PURPOSE: Genome-wide association studies have identified an increasing number of single nucleotide polymorphisms associated with prostate cancer risk. Some of these genetic variants are also associated with serum prostate specific antigen levels and lower urinary tract symptoms, raising the question of whether they are truly prostate cancer biomarkers or simply lead to detection bias. Therefore, we determined whether single nucleotide polymorphisms associated with prostate cancer risk are more strongly associated with tumor or prostate volume. MATERIALS AND METHODS: The genotypes of 38 validated prostate cancer risk single nucleotide polymorphisms were determined in 1,321 white men who underwent radical prostatectomy. Univariate and multivariate analyses were performed to compare the relationship of single nucleotide polymorphism frequency with total prostate and tumor volumes. RESULTS: On multivariate analysis 2 single nucleotide polymorphisms on chromosome 8q24, rs16901979 (A) and rs6983267 (G), were significantly associated with increased tumor volume (p=0.01 and 0.02, respectively). In contrast, rs17632542 (T) near the PSA gene on 19q13 was associated with significantly lower tumor volume and rs10788160 (A) on 10q26 was associated with significantly larger prostate volume (p=0.02 and 0.01, respectively). CONCLUSIONS: Analysis of 38 single nucleotide polymorphisms associated with prostate cancer risk revealed a significant association between several on chromosome 8q24 and increased tumor volume but not prostate volume. This suggests that they are bona fide markers of prostate cancer susceptibility and possibly more aggressive disease. Other prostate cancer risk alleles are associated with prostate specific antigen and increased prostate or decreased tumor volume, suggesting detection bias due to their phenotypic influence.