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Introduction: Preoperative anemia is a risk factor for transfusions and complications following total knee arthroplasty (TKA). Bilateral TKA (bTKA) is more extensive compared to unilateral TKA (uTKA) and a higher preoperative hemoglobin threshold may be warranted. We hypothesized that the optimal hemoglobin cutoff value which predicts the need for postoperative transfusion would be higher for bTKA than uTKA., Methods: We conducted a case control study using a national database and identified patients undergoing primary TKA from 2010-2020. 1:1, nearest-neighbor propensity-score matching was used to create a cohort of patients undergoing uTKA matched with patients undergoing bTKA based on age, gender, Charlston Comorbidity Index (CCI), and American Society of Anesthesiology (ASA) classification. After 2015, NSQIP discontinued collection of the variables MI, angina, and hemiplegia. Thus, the accuracy of CCI, which was used as a matching variable, will be less accurate after 2015. To explore this limitation further, a sensitivity analysis was performed excluding data after 2015 and there was no change in the significance of our primary outcomes. Hemoglobin thresholds which maximally predict postoperative transfusion risk and 30-day complications were identified using Youden's index. Significance was considered if 95% CI's were non-overlapping., Results: 9,891 patients were included in each of the bTKA and uTKA cohorts with successful 1:1 matching (p > 0.05 for all criteria). 3.216 (16 %) of patients received a transfusion in the postoperative period. Hemoglobin values which predict postoperative transfusions were not significantly different between uTKA and bTKA for both female and male groups. In females, the preoperative hemoglobin threshold was 12.8 g/dL (95 % CI: 12.2-13.3) in patients undergoing bTKA and 12.7 g/dL (95 % CI: 12.2 - 13.2) in uTKA. In males, the threshold was 13.9 (95 % CI: 13.7-14.2) in patients undergoing bTKA and 13.1 g/dL (95 % CI: 12.5-13.8) in patients undergoing uTKA., Conclusions: Preoperative hemoglobin values which maximally predict postoperative transfusion risk following uTKA and bTKA are similar without significant differences., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Objective: To evaluate lymphovascular invasion as an independent predictor for overall survival in patients with oral cavity squamous cell carcinoma., Study Design: Retrospective cohort study., Setting: Multi-center, population-based facilities reporting to the National Cancer Database registry., Methods: The database was accessed to collect data on patients with oral cavity squamous cell carcinoma. A multivariate cox proportional hazards model was used to analyze the association between presence of lymphovascular invasion and overall survival., Results: 16,992 patients met inclusion criteria. 3,457 patients had lymphovascular invasion. The mean follow-up was 32 ± 19 months. Lymphovascular invasion predicted reduced 2-year overall survival (relative hazard 1.29, 95% CI: 1.20, 1.38, p < 0.001) and 5-year overall survival (relative hazard 1.30, 95% CI: 1.23, 1.39, p < 0.001). LVI reduced overall survival in patients with squamous cell carcinoma of the oral tongue (HR: 1.27, 95% CI: 1.17, 1.39, p < 0.001), floor of mouth (HR: 1.33, 95% CI: 1.17, 1.52, p < 0.001) and buccal mucosa (HR: 1.44, 95% CI: 1.15, 1.81, p = 0.001). Patients with lymphovascular invasion treated with surgery plus post-operative radiotherapy had significantly improved survival compared to those who underwent surgery alone (relative hazard 1.79, 95% CI: 1.58, 2.03, p < 0.001), and patients treated with surgery + post-operative chemoradiotherapy had improved survival compared to those treated with surgery alone (relative hazard 2.0, 95% CI: 2.26, 1.79, p < 0.001)., Conclusion: Lymphovascular invasion is an important independent risk factor for decreased overall survival in oral cavity squamous cell carcinoma involving the oral tongue, floor of mouth and buccal mucosa subsites., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Elevated body mass index (BMI) is a risk factor for complications following total knee arthroplasty (TKA). Thus, we believe it is important to constantly re-evaluate the relationship between BMI and complication risk following TKA., Method: Patients undergoing primary TKA were identified in a national database from 2012-2020. Rates of major complications, minor complications, and length of stay (LOS) greater than 2 days were calculated. The prevalence of postoperative outcomes were calculated per unit of BMI and then multiplied by a factor of 10 ^2 or 10 ^3 in order to create adjusted-BMI (aBMI). To isolate the effect of aBMI on postoperative outcomes, changes over time were analyzed using linear regression analysis controlling for age, sex, American Society of Anesthesiology (ASA) classification and smoking status., Results: 365,333 patients were included. Mean BMI 33 ± 6.8. 10,616 (2.9%) of patients had a major postoperative complication, 9,345 (2.6%) minor complications, 3,277 (0.9%) had a deep or superficial surgical site infection (SSI). 133,563 (37%) of patients had LOS > 2 days. From 2012-2020, the ratio of major complications to aBMI decreased significantly by an average of -2.7% per year. The ratio of patients with LOS > 2 days to aBMI decreased significantly by -27% per year. The ratio of SSI to aBMI increased significantly by 10.8% per year., Conclusions: From 2012 to 2020, the ratio of major complications and extended LOS following TKA as a function of BMI has decreased significantly, while the ratio of SSI as a function of BMI has doubled., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [Harris: None. Kapoor: None. Gu: None. Agarwal: None. Golladay: Royalties from Stryker; Research support from KCI, Cerus; Financial or material support from AAHKS; Member of AAHKS, Virginia Orthopaedic Society. Thakkar: Research support from 3 M, Depuy; Editorial/governing board Arthroplasty Today, Journal of Arthroplasty, JAAOS, Journal of Hip Surgery; Member of AAOS AUC, AAHKS YAG. The study was exempt from institutional review board approval: IRB00326015.], (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: The outcomes of total joint arthroplasty during the coronavirus disease 2019 (COVID-19) pandemic are unknown. We sought to compare early postoperative complications in total hip arthroplasty (THA) and total knee arthroplasty (TKA) prior to and during the COVID-19 pandemic., Methods: Patients in the American College of Surgeons National Surgical Quality Improvement Program database who had THA or TKA in the latter halves (July to December) of 2019 and 2020 were identified. Patients were divided into pre-COVID-19 (2019) and during-COVID-19 (2020) cohorts. Propensity score matching and logistic regression were used to detect correlations between operative period and outcomes. Statistical significance was set at α = 0.05., Results: A total of 38,234 THA and 61,956 TKA patients were included. There was a significantly higher rate of outpatient procedures in 2020 than that in 2019 for both THA (41.68% vs 6.59%, P < .001) and TKA (41.68% vs 7.56%, P < .001). On matched analysis, surgery in 2020 had lower odds of hospital stay for >1 day (THA: odds ratio [OR] 0.889; P < .001) (TKA: OR 0.644; P < .001) and nonhome discharge (THA: 0.655; P < .001) (TKA: 0.497; P < .001). There was also increased odds of superficial surgical site infection in THA (OR 1.272; P  = .040) and myocardial infarction in TKA patients (OR 1.488; P  = .042) in 2020 compared to those in 2019. There was no difference in the 15 other outcomes assessed., Conclusions: Total joint arthroplasty surgery remains safe despite the COVID-19 pandemic. A statistically significant increase was detected in superficial surgical site infection and myocardial infarction risk during 2020 compared to 2019; however, the clinical significance of this is questionable. A shift away from inpatient stay was also present, possibly reflecting efforts to minimize nosocomial exposure to COVID-19., (© 2022 The Authors.)

Objective: To determine the association of preoperative hyponatremia with short-term postoperative complications and health care utilization (length of stay, readmissions) after anterior cervical fusion and discectomy (ACDF)., Methods: Patients who underwent ACDF were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patients who had revision surgery, trauma, vertebral malignancy, or infection were excluded. Eunatremia was defined as sodium (Na) level between 135 and 145 mEq/L, whereas hyponatremia was defined as Na < 135 mEq/L. Preoperatively, patients with hyponatremia were matched 1:1 with patients with eunatremia using propensity score matching based on age, sex, American Society of Anesthesiologists score, and baseline comorbidities. Minor adverse events included superficial infection, dehiscence, urinary tract infection, pneumonia, and renal insufficiency or failure. Serious adverse events included deep wound infection, reintubation, pulmonary embolism, cerebrovascular accident, cardiac arrest, deep vein thrombosis, sepsis, return to operating room, and death within 30 days. Complications were analyzed using bivariate and logistic analysis with significance set at P < 0.05., Results: Of the 9094 patients undergoing ACDF, 3.64% (n = 331) were preoperatively hyponatremic. Preoperative hyponatremia was an independent risk factor for postoperative pneumonia after ACDF (odds ratio [OR], 4.47; P = 0.020) and extended length of hospital stay >1 SD above the mean (OR, 1.71; P = 0.042). Preoperative hyponatremia was an independent risk factor for having a serious adverse event (OR, 2.40; P = 0.005) and any adverse event (OR, 2.44; P = 0.009)., Conclusions: Preoperative hyponatremia is an independent risk factor for pneumonia and prolonged length of stay after ACDF., (Copyright © 2021. Published by Elsevier Inc.)

Objectives: To evaluate the difference in overall survival (OS) in patients with retromolar trigone squamous cell carcinoma (RMT SCC) treated with surgery alone versus surgery plus postoperative radiotherapy (PORT) versus surgery plus postoperative chemoradiotherapy (POCRT)., Materials and Methods: Retrospective cohort study of patients from 1,500 US facilities reporting to the National Cancer Database (NCDB) registry. Participants were adult patients treated with surgery as primary treatment modality for RMT SCC (n = 2,877). Exposures were primary definitive surgery versus surgery + PORT versus surgery + POCRT. Outcomes included OS after diagnosis and treatment of RMT SCC. A multivariate Cox proportional hazards model was constructed to compare survival between the three treatment modalities. Subgroup analysis was performed by T classification and overall staging., Results: There were 1,415 (50%) patients treated with surgery alone, 870 (30%) patients treated with surgery + PORT, and 572 (20%) treated with surgery + POCRT. Treatment with surgery + PORT was associated with improved OS compared to surgery alone (relative hazard: 1.25, 95% CI: 1.01, 1.54, p = 0.042). Patients treated with surgery + POCRT also had improved OS compared with surgery alone (relative hazard: 1.89, 95% CI 1.45, 2.43, p < 0.001). Patients with T3/4 tumors had improved OS when treated with surgery + PORT (relative hazard 1.39, 95% CI: 1.05, 1.84, p = 0.022) or surgery + POCRT (relative hazard 2.27, 95% CI: 1.66, 3.15, p < 0.001). Patients with T1 or T2 disease had no significant difference in survival in both the surgery + PORT (p = 0.331) and surgery + POCRT treatment groups (p = 0.134). Therefore, there was no difference in OS for patients with stage I or II disease treated with surgery + PORT (p = 0.451), nor with surgery + POCRT (p = 0.853)., Conclusion: Treatment with surgery + PORT +/- chemotherapy appears to be associated with significantly improved OS compared to surgery alone for advanced RMT SCCa., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objective: To investigate the health care resource utilization and the associated 6 months preoperative and 6 months postoperative spending among patients undergoing posterior lumbar fusion., Methods: We retrospectively reviewed a private insurance claims database for patients who underwent single-level posterior spinal fusion from January 2011 to December 2015. Outpatient health services, prescription pain medications, and inpatient admissions were assessed., Results: Among 25,401 patients (mean age, 52 years; 58% female) in the final cohort, median spending during the period from 6 months before surgery to 6 months after surgery was $60,714 (interquartile range [IQR], $46,961-$79,892)/patient. Preoperative spending accounted for 7% ($121 million) of the total costs, and postoperative spending accounted for 8% ($135 million). Median preoperative spending was $3566 (IQR, $2144-$5857) per patient, with imaging accounting for the highest proportion (33%) of preoperative spending. In the 6 months period preceding surgery, 46% patients received injections and 47% received physical therapy. The median postoperative spending was $1954/patient (IQR, $735-$4416). Total postoperative spending was significantly higher among those not discharged home (median, $7525; IQR, $6779-$19,602) compared with those discharged home (median, $1617/patient; IQR, $648-$4033) and home with home care services (median, $2921; IQR, $1406-$5662) (P < 0.001)., Conclusions: Unplanned readmission after posterior spinal fusion was the highest contributor to postoperative spending and the second highest contributor to overall costs. Understanding factors that contribute to the costs in the preoperative and postoperative period in patients undergoing single-level posterior lumbar fusion for degenerative pathology is essential to identify targets for cost containment., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Surface enhanced Raman spectroscopy (SERS) at a silver microelectrode was used to monitor bacterial hydrolysis of triglycerides in lipid mixtures that model sebaceous gland secretions. Mixtures of wax esters, squalene, triolein, and triisostearin were used as model skin secretions. The transformation was followed in vitro as changes in the SERS caused by hydrolysis of triglyceride to fatty acid. The fatty acid was adsorbed as its carboxylate, which is readily identified by the characteristic band at ca. 1395 cm(-1). Co-adsorption of propionate was also observed. The technique can also confirm the presence of bacteria by detection of short chain carboxylic acids released as products of fermentation during the growth of these cells.

Nutrition services are important in the prevention of disabilities as well as in the treatment and/or habilitation of children with chronic illness. Level 1 nutrition care requires some basic knowledge of nutrition to screen for nutritional risk factors, knowledge of and access to referral systems for children identified to be at risk, and ability to use general nutrition education materials. Level 2 involves individualized nutrition assessment and intervention for problems such as anemia, chronic constipation, low- or high-calorie diets, feeding problems, and growth monitoring. Level 3 nutrition services are for children with identified disabilities such as cystic fibrosis, diabetes, and metabolic disorders that require specific complex nutrition interventions. The five major components of assessment of nutritional status in children are: anthropometric, clinical, biochemical, dietary, and feeding skill development.