Notes

Spore Germination from the Obligate Biotroph Spongospora subterranea: Transcriptome Investigation Discloses Germination Related Genetics.
As the population ages, rate of total knee arthroplasty increases and thus, it is important to maximize efficiency and minimize risk. Identifying patients who are at higher risk for transfusion can help streamline care provided and minimize superfluous, costly hemoglobin monitoring in low risk patients.

Adult patients who underwent total knee arthroplasty (TKA) in 2015 were identified in the National Surgical Quality Improvement Project (NSQIP) database. Patients were divided into two cohorts those who required transfusion post operatively and those who did not. Patient demographics and comorbidities were compared using univariate analysis; and multivariate analysis was used to determine risk factors for short-term complications.

Of 48,055 TKA patients, 3.0% required transfusion. The patients who required transfusion were older, had higher BMI, higher rates of comorbidities and were more frequently ASA class 3-4 (p<0.005). Univariate analysis revealed that patients who required transfusion had higherd readmission, reoperation and mortality. Presence of these risk factors in TKA patients could represent an indication for hemoglobin monitoring post-operatively.
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In a cohort of patients undergoing primary TKA in 2015, history of COPD, black race, operative time, steroid use, bleeding disorder, lack of functional independence and ASA class 3-4 were independent predictors of need for blood transfusion. Additionally, we found that patients who received transfusion demonstrated a significantly higher rate of the following any complication, pneumonia, urinary tract infection, septic shock, deep vein thrombosis, renal insufficiency, cardiac arrest, myocardial infarction, unplanned readmission, reoperation and mortality. Presence of these risk factors in TKA patients could represent an indication for hemoglobin monitoring post-operatively.Level of Evidence IV.
The use of navigation remains a controversial topic in knee arthroplasty. The purpose of this study is to evaluate current rates of utilization of navigation in unicompartmental knee arthroplasty (UKA) in the United States, as well as the incidence of short-term complications and operative times between navigated and non-navigated UKA.

A query of the National Surgical Quality Improvement Project (NSQIP) database was used to identify cases of primary UKA during years 2006-2017. Additional common procedural terminology (CPT) codes were used to identify cases in which navigation was utilized. Operative time, length of stay, and short-term outcomes were compared. Propensity score matching was used to minimize differences in demographics and comorbidities between the navigation and non-navigation cohorts.

A total of 10,586 cases of UKA were identified; 343 of these cases (3.2%) utilized navigation. The unadjusted rate of any complication for the entire cohort was 3.6%. Navigated UKA had mean operative times 8 minutes longer than non-navigated UKA (92.1 min vs. 84.3 min; p<0.001). There was no difference in overall complication rates between the matched navigated (3.5%) and non-navigated (3.2%) cohorts (p=0.65). There was no difference in rates of readmission (0.31% vs. 0.58%; p=0.31), reoperation (0.29% vs. 0.29%; p=1.00), and mean length of stay (1.3 ± 1.6 days vs. 1.2 ± 1.9 days; p=0.15).

UKA utilizing navigation had a mean operative time 8 minutes longer than non-navigated UKA. We found no difference in rates of short-term complications, readmission, reoperation, or mean length of stay between navigated and non-navigated UKA.
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UKA utilizing navigation had a mean operative time 8 minutes longer than non-navigated UKA. We found no difference in rates of short-term complications, readmission, reoperation, or mean length of stay between navigated and non-navigated UKA.Level of Evidence III.
A commonly utilized method of measuring femoral stem migration in total hip arthroplasty (THA) on plain anteroposterior (AP) pelvis radiograph with referenced image magnification has not been rigorously evaluated. This study aims to validate the reproducibility of the methods used in this technique.

A retrospective study of the standardized AP pelvis radiographs of patients who had undergone THA utilizing a Corail® femoral stem was performed from June 2012 through December 2017. Radiological evaluation (head diameter, stem length, and stem seating length) were undertaken at three clinical follow-up times. Each radiographic measurement of each radiograph was repeated five times. Outcomes investigated included inter- and intra-radiograph reproducibility evaluation and radiographic image magnification. The stem length error and stem subsidence were also evaluated.

Two hundred THA patients met the inclusion/ exclusion criteria. The intra-radiograph reproducibility of the stem length and head diameter measurements have at least "good" reproducibility with repeated measurements falling within 0.5 mm for both measurements. The reliability for femoral stem seating length measurements has "questionable/poor" reproducibility. The inter-radiograph reproducibility was, however, substantially lower. High level of unreliable measurements with values less than 0.0 mm for both femoral stem length errors (55%) and femoral stem subsidence (32%) measurements. Less than 45% accuracy (femoral stem length error 33%; femoral stem subsidence 44%) to within 3 mm error.

This study demonstrates that the assessment of radiographic implant migration after THA made on a sequence of plain AP pelvis radiograph have poor reproducibility.
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This study demonstrates that the assessment of radiographic implant migration after THA made on a sequence of plain AP pelvis radiograph have poor reproducibility.Level of Evidence III.
Maladaptive coping strategies can lead to less functional improvement after upper-extremity surgery. It remains uncertain how well surgeons can recognize signs of less effective coping strategies in patients in the absence of formalized questionnaires. Our purpose is to determine if the "Handshake Test" can be used to identify patients with less effective coping strategies. We hypothesize that a simple physical examination finding (a refusal or inability to shake hands) is associated with higher pain level, maladaptive coping strategies and decreased functional status.

We prospectively analyzed 246 consecutive new patients presenting to one of three surgeons with atraumatic upper-extremity conditions. Vismodegib in vitro Patients completed a pain scale (NPRS) and PROMIS instruments including Self-Efficacy (SE) for Managing Symptoms, Pain Interference (PI) and Upper Extremity (UE). Each surgeon recorded a refusal to shake hands as part of a normal greeting, referred to as a "positive Handshake Test".

200 patients (81%) patients completed all outcome measures and were included in our analysis.
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