Prognostic value of preoperative mechanical hyperalgesia and neuropathic pain qualities for postoperative pain after total knee replacement.

BACKGROUND: Total knee replacement (TKR) is the gold standard treatment for end-stage chronic osteoarthritis pain, yet many patients report chronic postoperative pain after TKR. The search for preoperative predictors for chronic postoperative pain following TKR has been studied with inconsistent findings. METHODS: This study investigates the predictive value of quantitative sensory testing (QST) and PainDETECT for postoperative pain 3, 6 and 12 months post-TKR. We assessed preoperative and postoperative (3 and 6 months) QST measures in 77 patients with knee OA (KOA) and 41 healthy controls, along with neuropathic pain scores in patients (PainDETECT). QST parameters included pressure pain pressure threshold (PPT), pain tolerance threshold (PTT), conditioned pain modulation (CPM) and temporal summation (TS) using cuff algometry, alongside mechanical hyperalgesia and temporal summation to repeated pinprick stimulation. RESULTS: Compared to healthy controls, KOA patients at baseline demonstrated hyperalgesia to pinprick stimulation at the medial knee undergoing TKR, and cuff pressure at the calf. Lower cuff algometry PTT and mechanical pinprick hyperalgesia were associated with preoperative KOA pain intensity. Moreover, preoperative pinprick pain hyperalgesia explained 25% of variance in pain intensity 12 months post-TKR and preoperative neuropathic pain scores also captured 30% and 20% of the variance in postoperative pain at 6 and 12 months respectively. A decrease in mechanical pinprick hyperalgesia from before surgery to 3 months after TKR was associated with lower postoperative pain at the 12 months post-TKR follow-up. CONCLUSION: Our findings suggest that preoperative pinprick hyperalgesia and neuropathic-like pain symptoms show predictive value for the development of chronic post-TKR pain. SIGNIFICANCE STATEMENT: This study's findings hold significant implications for chronic pain management in knee osteoarthritis patients, particularly those undergoing total knee replacement surgery (TKR). Mechanical hyperalgesia and neuropathic pain-like characteristics predict postoperative pain 1 year after TKR, emphasizing the importance of understanding pain phenotypes in OA for selecting appropriate pain management strategies. The normalization of hyperalgesia after surgery correlates with better long-term outcomes, further highlighting the therapeutic potential of addressing abnormal pain processing mechanisms pre- and post-TKR.

Initial agronomic benefits of enhanced weathering using basalt: A study of spring oat in a temperate climate.

Addressing soil nutrient degradation and global warming requires novel solutions. Enhanced weathering using crushed basalt rock is a promising dual-action strategy that can enhance soil health and sequester carbon dioxide. This study examines the short-term effects of basalt amendment on spring oat (Avena sativa L.) during the 2022 growing season in NE England. The experimental design consisted of four blocks with control and basalt-amended plots, and two cultivation types within each treatment, laid out in a split plot design. Basalt (18.86 tonnes ha-1) was incorporated into the soil during seeding. Tissue, grain and soil samples were collected for yield, nutrient, and pH analysis. Basalt amendment led to significantly higher yields, averaging 20.5% and 9.3% increases in direct drill and ploughed plots, respectively. Soil pH was significantly higher 256 days after rock application across cultivation types (direct drill: on average 6.47 vs. 6.76 and ploughed: on average 6.69 vs. 6.89, for control and basalt-amended plots, respectively), likely due to rapidly dissolving minerals in the applied basalt, such as calcite. Indications of growing season differences in soil pH are observed through direct measurement of lower manganese and iron uptake in plants grown on basalt-amended soil. Higher grain and tissue potassium, and tissue calcium uptake were observed in basalt-treated crops. Notably, no accumulation of potentially toxic elements (arsenic, cadmium, chromium, nickel) was detected in the grain, indicating that crops grown using this basaltic feedstock are safe for consumption. This study indicates that basalt amendments can improve agronomic performance in sandy clay-loam agricultural soil under temperate climate conditions. These findings offer valuable insights for producers in temperate regions who are considering using such amendments, demonstrating the potential for improved crop yields and environmental benefits while ensuring crop safety.

Mechanical hyperalgesia and neuropathic pain qualities impart risk for chronic postoperative pain after total knee replacement.

Total knee replacement (TKR) is the gold-standard treatment for end-stage chronic osteoarthritis pain, yet many patients report chronic postoperative pain after TKR. The search for preoperative predictors for chronic postoperative pain following TKR has been studied with inconsistent findings. This study investigates the predictive value of quantitative sensory testing (QST) and PainDETECT for postoperative pain 3, 6, and 12 months post-TKR. We assessed baseline and postoperative (3- and 6-months) QST measures in 77 patients with knee OA (KOA) and 41 healthy controls, along with neuropathic pain scores in patients (PainDETECT). QST parameters included pressure pain pressure threshold (PPT), pain tolerance threshold (PTT), conditioned pain modulation (CPM), and temporal summation (TS) using cuff algometry, alongside mechanical hyperalgesia, and mechanical temporal summation to repeated pinprick stimulation. Compared to healthy controls, KOA patients at baseline demonstrated hyperalgesia to pinprick stimulation at the medial OA-affected knee and cuff pressure on the ipsilateral calf. Lower cuff algometry PTT and mechanical pinprick hyperalgesia were associated with baseline KOA pain intensity. Moreover, baseline pinprick pain hyperalgesia explained 25% of variance in pain intensity 12 months post-TKR and preoperative neuropathic pain scores also captured 30% and 20% of the variance in postoperative pain at 6- and 12-months, respectively. A decrease in mechanical pinprick hyperalgesia from before surgery to 3 months after TKR was associated with lower postoperative pain at the 12 months post-TKR follow-up, and vice-versa. Our findings suggest that preoperative pinprick hyperalgesia and PainDETECT neuropathic-like pain symptoms show predictive value for the development of chronic post-TKR pain.

Examining the role of attention during feature binding in visuospatial working memory.

The current experiments address the enduring debate regarding the role of attention in feature binding in visuospatial working memory by considering the nature of the to-be-bound features, i.e., whether they are intrinsic (integrated within the object, such as its color and shape) or extrinsic (not part of the object, such as its spatial location). Specifically, arrays of different-colored shapes in different locations were followed by probed recall: One feature of the probed object prompted recall of one of its remaining two features (e.g., a shape probe prompts recall of color, with the probe displayed at the center of the screen (i.e., without spatial information)) to test the retention of intrinsic (shape, color) and extrinsic (location) features. During the retention interval, we manipulated attention via disruption (Experiment 1) and retro-cues (Experiment 2) to determine their impacts on binding errors, as estimated from a three-parameter mixture model fit to recall error (i.e., the distance between the target and response). Disrupting central versus peripheral attention in Experiment 1 did not respectively increase extrinsic and intrinsic binding errors as predicted, but disrupting central attention reduced target memory of the extrinsic feature relative to a no-disruption baseline. Guiding attention via extrinsic and intrinsic retro-cues in Experiment 2 did not respectively reduce extrinsic and intrinsic binding errors as predicted, but we observed retro-cue benefits to target memory that did not distinguish between extrinsic and intrinsic features. Thus, this work highlights that attentional resources aid target memory, with no consistent distinction between intrinsic and extrinsic features.

Patients Who Have a Prior History of Pulmonary Embolism Require Increased Postoperative Care Following Total Joint Arthroplasty.

BACKGROUND: This study examined the effect of prior pulmonary embolism (PE) on total joint arthroplasty (TJA) outcomes. METHODS: We reviewed patients who had a prior PE undergoing TJA at a single tertiary medical center between January 1, 2012 and January 1, 2021. There were 177 TJA patients who had a prior PE who underwent 1:3 propensity-matching to patients without a history of prior PE. Bivariable and multivariable analyses were performed. Changes over time were evaluated. RESULTS: Patients undergoing total knee arthroplasty who had a prior PE had more complications (25.3% versus 2.0%, P < .001), and postoperative PE (17.3% versus 0.0%, P < .001).and longer hospitalizations (3.15 versus 2.32 days, P = .006). Patients undergoing total hip arthroplasty who had a prior PE demonstrated more complications (14.7% versus 1.77%, P < .001) more postoperative PE (17.3% versus 0.0%, P < .001), and longer hospitalizations (3.30 versus 2.11 days, P < .001). Over the study, complication rates and hospitalizations lengths remained elevated in patients who had a prior PE. On multivariate analyses, prior PE was associated with longer hospitalizations (ß: 0.67, P = .015) and increased complications (odds ratio [OR]: 9.44, P < .001) among total hip arthroplasty patients. Total knee arthroplasty patients had increased readmission (OR: 4.89, P = .003) and complication rates (OR: 21.4, P < .001). CONCLUSIONS: Patients undergoing TJA who had a prior PE are at higher risk of requiring postoperative care. Therefore, thorough preoperative evaluation must be implemented, especially in clinical environments lacking resources for acute care escalation.

Closed Suction Drainage after Total Knee Arthroplasty with Concomitant Intravenous Tranexamic Acid Administration.

Drain use in total knee arthroplasty (TKA) remains controversial. Use has been associated with increased complications, particularly postoperative transfusion, infection, increased cost, and longer hospital stays. However, studies examining drain use were performed before widespread adoption of tranexamic acid (TXA), which markedly reduces transfusion without increasing venous thromboembolism events. We aim to investigate incidence of postoperative transfusion and 90-day return to the operating room (ROR) for hemarthrosis in TKA with use of drains and concomitant intravenous (IV) TXA. Primary TKAs from a single institution were identified from August 2012 to December 2018. Inclusion criteria were primary TKA, age 18 years and over where use of TXA, drains, anticoagulant, and pre- and postsurgical hemoglobin (Hb) were documented during the patient's admission. Primary outcomes were 90-day ROR specifically for hemarthrosis and rate of postoperative transfusion. A total of 2,008 patients were included. Sixteen patients required ROR, three of which were due to hemarthrosis. Drain output was statistically higher in the ROR group (269.3 vs. 152.4 mL, p = 0.05). Five patients required transfusion within 14 days (0.25%). Patients requiring transfusion had significantly lower presurgical Hb (10.2 g/dL, p = 0.01) and 24-hour postoperative Hb (7.7 g/dL, p < 0.001). Drain output between the transfusion and no transfusion groups varied significantly (p = 0.03), with transfusion patients having higher postoperative day 1 drain output of 362.6 mL and total drain output of 376.6 mL. In this series, postoperative drain use with concomitant weight-based IV TXA is shown to be safe and efficacious. We observed exceedingly low risk of postoperative transfusion compared with prior reports of drain use alone as well as preserved low rate of hemarthrosis that has previously been positively linked to drain use.

Patients Who Have Pre-Existing Atrial Fibrillation Require Increased Postoperative Care Following Total Joint Arthroplasty.

BACKGROUND: Approximately 9% of total joint arthroplasty (TJA) patients have pre-existing atrial fibrillation (AF). This study examined the effect of pre-existing AF on TJA outcomes. METHODS: We conducted a 1:3 propensity match of 545 TJA patients who have pre-existing AF to TJA patients who do not have AF at a tertiary care center between January 1st, 2012, and January 1st, 2021. Bivariate and multivariate regressions were performed. Changes over time were evaluated. RESULTS: Patients undergoing total knee arthroplasty (TKA) who have pre-existing AF, experienced more post-operative AFs (P < .001), acute kidney injuries (P = .026), post-operative complications (POC) (P < .001), and 30-day readmissions (P = .036). Patients undergoing total hip arthroplasty (THA) who have pre-existing AF experienced more post-operative AFs (P < .001), pulmonary embolisms (P < .001), increased estimated blood losses (P = .007), more blood transfusions (P = .002), more POCs (P < .001), and longer lengths of stay (LOS) (P < .002). Over time, POC and LOS decreased in both groups, but remained increased in TJA patients who have pre-existing AF. Multivariate analyses of TKA patients showed an increased odds ratio (OR) of any POCs (P < .001), while THA patients had an increased OR of any POCs (P = .01), and LOS (P = .002). CONCLUSION: Patients who have pre-existing AF undergoing TJA have more POCs. TKA patients have more readmissions. THA patients have longer LOS. These findings demonstrate the importance of enhanced peri-operative medical management in patients who have pre-existing AF undergoing TJA.

What you don't know can't hurt you: Retro-cues benefit working memory regardless of prior knowledge in long-term memory.

Knowledge stored in long-term memory (LTM) impacts working memory (WM) overall, but it is unclear whether LTM facilitates focusing or switching attention in WM. We addressed this question using the retro-cue paradigm: Briefly presented arrays of individually calibrated numbers of shapes (concrete or abstract) were followed by a blank retention interval (no-cue) or a retro-cue to focus participants' attention to the to-be-probed shape. Experiment 3 included double retro-cue trials that required participants to switch their attention to a different shape. Participants recalled the color (Experiments 1) or location (Experiment 2) of the probed shape, or recognized the target shape among two other options (Experiment 3). Confirming the overall LTM effect on WM, fewer abstract shapes were needed to match the performance of concrete shapes during the calibration phase. Most importantly, retro-cues benefitted performance regardless of the nature of the shape, suggesting that LTM impacts WM overall without moderating attention.

Kinetics of maize cob and bean straw pyrolysis and combustion.

Kinetic studies are important for the design and optimisation of thermochemical processes. This study involved analysis of the pyrolysis and combustion behaviour of the agricultural residues (bean straw and maize cob) by non-isothermal thermogravimetric analysis. Increasing the heating rate from 10 to 40 K min-1 during both combustion and pyrolysis increased the degradation rate of both feedstocks and the gaseous yields of H2O, CO and CO2. The activation energies determined by the Flynn-Wall-Ozawa and Kissinger-Akahira-Sunose methods varied which reveals that the pyrolysis and combustion of these agricultural residues are complex processes involving multiple reactions. The average activation energy of maize cob and bean straw were 214.15 and 252.09 kJ mol-1 for pyrolysis and 202.26 and 165.64 kJ mol-1 for combustion, respectively. The order of reaction ranged between 9.0-10.3 and 6.3-13.3 for both feedstocks in combustion and inert environments, respectively. Modelled data is important to enable the optimisation of reactor design for pyrolysis and combustion for energy generation from agricultural residues.

Nutrient and stoichiometric time series measurements of decomposing coarse detritus in freshwaters.

Decomposition of coarse detritus (e.g., dead organic matter larger than ~1 mm such as leaf litter or animal carcasses) in freshwater ecosystems is well described in terms of mass loss, particularly as rates that compress mass loss into one number (e.g., a first-order decay coefficient, or breakdown rate, "k"); less described are temporal changes in the elemental composition of these materials during decomposition, with important implications for elemental cycling from microbes to ecosystems. This stands in contrast with work in the terrestrial realm, where a focus on detrital elemental cycling has provided a sharper mechanistic understanding of decomposition, especially with specific processes such as immobilization and mineralization. Notably, freshwater ecologists often measure carbon (C), nitrogen (N), and phosphorus (P), and their stoichiometric ratios in decomposing coarse materials, including carcasses, wood, leaf litter, and more, but these measurements remain piecemeal. These detrital nutrients are measurements of the entire detrital-microbial complex and are integrative of numerous processes, especially nutrient immobilization and mineralization, and associated microbial growth and death. Thus, data relevant to an elemental, mechanistically focused decomposition ecology are available in freshwaters, but have not been fully applied to that purpose. We synthesized published detrital nutrient and stoichiometry measurements at a global scale, yielding 4038 observations comprising 810 decomposition time series (i.e., measurements within a defined cohort of decomposing material through time) to build a basis for understanding the temporality of elemental content in freshwater detritus. Specifically, the dataset focuses on temporally and ontogenetically (mass loss) explicit measurements of N, P, and stoichiometry (C:N, C:P, N:P). We also collected ancillary data, including detrital characteristics (e.g., species, lignin content), water physiochemistry, geographic location, incubation system type, and methodological variables (e.g., bag mesh size). These measurements are important to unlocking mechanistic insights into detrital ontogeny (the temporal trajectory of decomposing materials) that can provide a deeper understanding of heterotroph-driven C and nutrient cycling in freshwaters. Moreover, these data can help to bridge aquatic and terrestrial decomposition ecology, across plant or animal origin. By focusing on temporal trajectories of elements, this dataset facilitates cross-ecosystem comparisons of fundamental decomposition controls on elemental fluxes. It provides a strong starting point (e.g., via modeling efforts) for comparing processes such as immobilization and mineralization that are understudied in freshwaters. Time series from decomposing leaf litter, particularly in streams, are common in the dataset, but we also synthesized ontogenies of animal-based detritus, which tend to decompose rapidly compared with plant-based detritus that contains high concentrations of structural compounds such as lignin and cellulose. Although animal-based data were rare, comprising only three time series, their inclusion in this dataset underscores the opportunities to develop an understanding of decomposition that encompasses all detrital types, from carrion to leaf litter. There are no copyright or proprietary restrictions on the dataset; please cite this data paper when reusing these materials.

Nutrient and stoichiometry dynamics of decomposing litter in stream ecosystems: A global synthesis.

Decomposing organic matter forms a substantial resource base, fueling the biogeochemical function and secondary production of most aquatic ecosystems. However, detrital N (nitrogen) and P (phosphorus) dynamics remain relatively unexplored in aquatic ecosystems relative to terrestrial ecosystems, despite fundamentally linking microbial processes to ecosystem function across broad spatial scales. We synthesized 217 published time series of detrital carbon (C), N, P, and their stoichiometric ratios (C:N, C:P, N:P) from stream ecosystems to analyze the temporal nutrient dynamics of decomposing litter using generalized additive models. Model results indicated that detritus was a net source of N (irrespective of inorganic or organic form) to the environment, regardless of initial N content. In contrast, P sink/source dynamics were more strongly influenced by the initial P content, in which P-poor litters were sinks for nutrients until these shifted to net P mineralization after ~40% mass loss. However, large variations surrounded both the N and P predictions, suggesting the importance of nonmicrobial factors such as fragmentation by invertebrates. Detrital C:N ratios converged and became more similar toward the end of the decomposition, suggesting predictable microbial functional effects throughout detrital ontogeny. C:P and N:P ratios also converged to some degree, but these model predictions were less robust than for C:N, due in part to the lower number of published detrital C:P time series. The explorations of environmental covariate effects were frequently limited by a few coincident covariate measurements across studies, but temperature, N availability, and P tended to accelerate the existing ontogenetic patterns in C:N. Our analysis helps to unite organic matter decomposition across aquatic-terrestrial boundaries by describing the basic patterns of elemental flows catalyzed by decomposition in streams, and points to a research agenda with which to continue addressing gaps in our knowledge of detrital nutrient dynamics across ecosystems.

Biochar benefits carbon off-setting in blue-green infrastructure soils - A lysimeter study.

Carbon sequestration with amendments in blue-green infrastructure soils could off-set anthropogenic greenhouse gas emissions to alleviate climate change. In this 3-year study, the effects of wheat straw and its biochar on carbon sequestration in an urban landscaping soil were investigated under realistic outdoor conditions using two large-scale lysimeters. Both amendments were carried out by incorporating pellets at 0-15 cm soil depth with an equivalent initial total carbon input of 2% of the dry soil weight. Soil carbon, carbon isotope ratios, dissolved carbon in leachates, CO2-C emissions, carbon fixed in above ground vegetation, soil water content, soil bulk electrical conductivity, and water infiltration rates, were then compared between the 2 lysimeters. After 3 years, we observed that, despite having a 17.2% lower vegetation growth, soil organic and inorganic carbon content was higher by 28.8% and 41.5%, respectively, in biochar as compared to wheat straw amended soil. Carbon isotope analysis confirmed the greater stability of the added carbon in the biochar amended soil. Water content was on average 23.2% and 13.0% in the straw pellet and biochar amended soil, respectively, whereas water infiltration rates were not significantly different between the two lysimeters. Overall, the incorporation of wheat straw biochar into soil could store an estimated 30 tonnes of carbon per hectare in city blue-green infrastructure spaces. Interviews involving institution stakeholders examined the feasibility of this biochar application. Stakeholders recognized the potential of biochar as an environment-friendly means for carbon offsetting, but were concerned about the practicality of biochar production and application into soil and increased maintenance work. Consequently, additional potential benefits of biochar for environmental management such as improving the quality of polluted run-off in stormwater treatment systems should be emphasized to make biochar an attractive proposition in sustainable urban development.

Multicenter Effectiveness and Disease Stability Through 3 Years After iStentTrabecular Micro-Bypass with Phacoemulsification in Glaucoma and Ocular Hypertension.

Purpose: To evaluate 3-year safety and efficacy of two second-generation trabecular micro-bypass stents. (iStent inject ®) with phacoemulsification. Materials and Methods: This multicenter retrospective study of iStent inject implantation with phacoemulsification included data from eight surgeons across Australia. Eyes with cataract and mild to advanced glaucoma [predominantly primary open-angle (POAG), primary angle closure (PAC), or normal-tension (NTG) glaucoma] or ocular hypertension (OHT) were included. Study assessments included intraocular pressure (IOP); number of ocular hypotensive medications; proportions of eyes with 0, 1, 2, or ≥3 IOP-lowering medications; IOP ≤15 mmHg or ≤18 mmHg; visual fields (VF); retinal nerve fiber layer thickness (RNFL); central corneal thickness (CCT); intraoperative complications; adverse events; and secondary surgeries. Results: A total of 273 eyes underwent surgery and had 36-month follow-up. At 36 months versus preoperative, mean IOP decreased by 15.5% (16.4±4.6 mmHg to 13.9±3.5 mmHg; p<0.001), and 70.3% of eyes achieved IOP of ≤15 mmHg (versus 49.1% preoperatively; p<0.001). The mean medication burden decreased by 68.5% (from 1.51±1.17 to 0.48±0.89 medications; p<0.001); 71.4% of eyes were medication-free (versus 21.6% preoperatively; p<0.001), while 6.2% of eyes were on ≥3 medications (versus 22.3% preoperatively; p<0.001); 96.3% of eyes maintained or reduced medications vs preoperative. Significant IOP and medication reductions occurred across glaucoma subtypes (POAG, PAC, NTG, OHT): 13-22% for IOP (p<0.05 for all) and 42-94% for medication (p<0.05 for all). Favorable safety included few adverse events; stable VF, RNFL, and CCT; and filtering surgery in only 8 eyes (2.9%) over 3 years. Conclusion: In this multicenter cohort from 8 surgeons across Australia, significant IOP and medication reductions were sustained through 3 years after iStent inject implantation with phacoemulsification. Results were favorable across different glaucoma subtypes (including POAG, PAC, NTG, OHT), severities, and surgeons, thereby underscoring the real-world relevance and efficacy of iStent inject implantation for glaucoma treatment.

Efficacy and Safety of iStent Inject Implantation in Manual and Femtosecond Laser-assisted Cataract Surgery before Lens Extraction.

Aim: To describe the efficacy and safety of iStent implantation prior to phacoemulsification in manual as well as femtosecond laser-assisted cataract surgery (FLACS), and highlight this approach as a reasonable, if not necessary, step to advance one's ability and confidence in the use of microinvasive glaucoma surgery (MIGS) technology in phakic patients. Methods: A retrospective consecutive case series of patients with open angle glaucoma or ocular hypertension who underwent iStent inject implantation followed by cataract surgery (manual or FLACS). All cases underwent postoperative video review and were assessed and classified for intraoperative lens injury and hyphaema. Postoperative data included intraocular pressure (IOP), medication usage and adverse events. Results: Sixty-three eyes (n = 40 manual, n = 23 FLACS) were analyzed. Preoperatively, the mean IOP was 19.2 ± 4.9 mm Hg on 1.4 ± 0.96 mean medications, with 100% of eyes treated with medication. Intraoperatively, no lens injury was identified, and no significant hyphaema that impeded surgery occurred. At 6 months postoperative, mean IOP was 14.2 ± 1.8 mm Hg (38% reduction: p < 0.001), and >90% of eyes had IOP ≤ 16 mm Hg. The mean number of medications reduced to 0.11 ± 0.3 (92% reduction: p < 0.001), with 89% of eyes medication free. Safety was excellent for both manual and FLACS, with two iStents implanted in all eyes, and no cases of significant hyphaema or lens injury. Conclusion: Early implantation is safe, maximizes corneal clarity and angle visualization, avoids the risk of non-implantation due to surgical complications, and has a high success rate in both manual cataract surgery and the setting of FLACS. Clinical significance: The conventional recommended approach of iStent implantation following cataract extraction has been adopted by many, however, with the advent of stand-alone procedures and concern about potential lens injury, there is an opportunity to gain experience with minimal risk in patients undergoing MIGS procedures combined with cataract surgery by implanting iStents at the start of the procedure. There is currently little emphasis or data published in the literature on an early approach to implantation to guide surgeons. How to cite this article: Manning DK, Haider A, Clement C, et al. Efficacy and Safety of iStent Inject Implantation in Manual and Femtosecond Laser-assisted Cataract Surgery before Lens Extraction. J Curr Glaucoma Pract 2022;16(2):105-110.

Removal of atmospheric CO2 by engineered soils in infrastructure projects.

The use of crushed basic igneous rock and crushed concrete for enhanced rock weathering and to facilitate pedogenic carbonate precipitation provides a promising method of carbon sequestration. However, many of the controls on precipitation and subsequent effects on soil properties remain poorly understood. In this study, engineered soil plots, with different ratios of concrete or dolerite combined with sand, have been used to investigate relationships between sequestered inorganic carbon and geotechnical properties, over a two-year period. Cone penetration tests with porewater pressure measurements (CPTu) were conducted to determine changes in tip resistance and pore pressure. C and O isotope analysis was carried out to confirm the pedogenic origin of carbonate minerals. TIC analysis shows greater precipitation of pedogenic carbonate in plots containing concrete than those with dolerite, with the highest sequestration values of plots containing each material being equivalent to 33.7 t C ha-1 yr-1 and 17.5 t C ha-1 yr-1, respectively, calculated from extrapolation of results derived from the TIC analysis. TIC content showed reduction or remained unchanged for the top 0.1 m of soil; at a depth of 0.2 m however, for dolerite plots, a pattern of seasonal accumulation and loss of TIC emerged. CPTu tip resistance measurements showed that the presence of carbonates had no observable effect on penetration resistance, and in the case of porewater pressure measurements, carbonate precipitation does not change the permeability of the substrate, and so does not affect drainage. The results of this study indicate that both the addition of dolerite and concrete serve to enhance CO2 removal in soils, that soil temperature appears to be a control on TIC precipitation, and that mineral carbonation in constructed soils does not lead to reduced drainage or an increased risk of flooding.

The PROMISⓇ-Plus-Osteoarthritis of the Knee (OAK) profile measure integrates generic and condition-specific content to enhance relevance and efficiency.

OBJECTIVE: The Patient-Reported Outcomes Measurement Information System (PROMIS)-Plus-Osteoarthritis of the Knee (OAK) profile integrates universal PROMIS items with knee-specific items across 13 domains. We evaluated the psychometric properties of a subset of six domains associated with quality of life in people with OAK. STUDY DESIGN AND SETTING: In a cross-sectional study of OAK patients (n=600), we estimated reliability using Pearson and Spearman correlations with Knee Injury and Osteoarthritis Outcome Score (KOOS) subscores and known-groups validity with PROMIS Global Health. Measure responsiveness was tested via paired t-tests in a longitudinal study (n=238), pre/post total knee replacement. RESULTS: Across the six domains, internal consistency reliability (Cronbach's alpha) was 0.77-0.95 and test-retest reliability (intraclass correlation coefficients) was ≥0.90. Correlations with Knee Injury and Osteoarthritis Outcome Score (KOOS) subscores and PROMIS Global supported convergent and divergent validity. Known-groups validity testing revealed better scores in all domains for high vs. low global status groups, and knee-specific items added value in physical function and pain. All domains reflected (p<0.001) better health status scores at follow up. CONCLUSION: The six PROMIS-Plus-OAK profile domains demonstrated good psychometric characteristics. The measure integrates universal and knee-specific content to provide enhanced relevance, measurement precision and efficient administration for patient care and clinical research.

The Potential Value of Performing Preoperative Urinalysis Prior to Total Knee Arthroplasty.

BACKGROUND: Although the practice of checking a urinalysis prior to elective total knee arthroplasty (TKA) is relatively common, very little has been reported on the association between a preoperative urinary tract infection (UTI) and adverse events in primary TKA. The goal of this study is to investigate the risk of postoperative complication following TKA as it relates to preoperative UTI. METHODS: Patients undergoing TKA were queried in the National Surgical Quality Improvement Program. Morbid events were classified as minor (transfusion, pneumonia, wound dehiscence, UTI, and renal insufficiency) and serious (wound infection, thromboembolic event, renal failure, myocardial infarction, prolonged ventilation, unplanned intubation, sepsis, and death). Risk factors for adverse events were analyzed in both univariate and multivariate fashion. RESULTS: A total of 203,851 patients undergoing TKA met inclusion criteria and 507 patients had a UTI present at time of surgery (UTI PATOS). A propensity matched analysis controlling for age, gender, body mass index, operative year, and American Society of Anesthesiologists score identified 507 patients without a UTI PATOS to serve as the control group. Following adjustment for baseline characteristics, operative year, and American Society of Anesthesiologists score, UTI PATOS was associated with increased risk for serious adverse events (odds ratio [OR] 2.746, 95% confidence interval [CI] 1.546-4.878, P = .0006), occurrence of any morbid event (OR 1.894, 95% CI 1.299-2.761, P = .0009), and reoperation (OR 4, 95% CI 2.592-6.169, P < .0001). CONCLUSION: This study suggests that a UTI present at time of TKA increases the risk of multiple postoperative complications and reoperation.

Patient-Reported Outcomes Measurement Information System Correlates With Modified Harris Hip Score in Total Hip Arthroplasty.

The modified Harris Hip Score (mHHS) is a validated and disease-specific instrument commonly used to assess outcomes in total hip arthroplasty (THA). The Patient-Reported Outcomes Measurement Information System (PROMIS) is a validated, computer adaptive testing (CAT)-based global health assessment tool. The authors' goal was to examine the correlation between PROMIS Pain Interference and Physical Function CATs and the mHHS in patients undergoing primary THA. All THAs were performed by 1 of 2 fellowship-trained dedicated total joint surgeons at 1 academic institution. Patients completed PROMIS and mHHS assessments preoperatively and at 3, 6, 12, and 52 weeks postoperatively. Descriptive statistics and Pearson correlation values were determined. A total of 48 patients were prospectively enrolled in the study. Preoperatively, mean total PROMIS score (Pain Interference and Physical Function) was 74.2 and mHHS was 50.8. Preoperatively, mean total PROMIS score showed a moderate correlation (r=0.56; P<.0001) with total mHHS. Postoperatively, mean total PROMIS score at 3, 6, 12, and 52 weeks was 82.4, 93.4, 100, and 100, respectively (all P<.01 vs baseline), and mHHS was 68.2, 81.1, 85.9, and 88.6, respectively (all P<.01). At 3, 6, 12, and 52 weeks postoperatively, a strong and consistent correlation was observed between the total PROMIS score and mHHS (r=0.74, 0.74, 0.73, and 0.80, respectively; all P<.0001). The PROMIS Pain Interference and Physical Function CATs accurately assessed preoperative pain and dysfunction, as well as clinical improvement following THA. Combined PROMIS Pain Interference and Physical Function is comparable to the mHHS when assessing outcome following THA for osteoarthritis. [Orthopedics. 2021;44(1):e19-e25.].

Assessment of Psychological Factors in Short-Stay Total Hip Arthroplasty Protocol.

BACKGROUND: Several variables are known to correlate with the successful completion of short-stay total hip arthroplasty (THA) protocols. The role of psychological factors remains unclear. We investigated the interaction between patient-reported measures of psychological fitness and successful completion of a short-stay THA protocol. METHODS: We performed a prospective cohort study of patients undergoing elective anterior total hip arthroplasty enrolled in a short-stay protocol (success defined as LOS ≤1 midnight versus failed, LOS >1 midnight). Psychological fitness was measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) domains for self-efficacy, depression, anxiety, emotional support, and the ability to participate in social roles. PROMIS scores, patient demographics, and surgical factors were assessed for a relationship with failure to complete short-stay protocol. RESULTS: Patients that failed to complete the short-stay protocol had higher mean pre-operative PROMIS depression scores (50.8 vs 47.1, P = .025) and anxiety scores (53.6 vs 49.2, P = .008) and higher postoperative PROMIS depression (48.19 vs 43.49, P = .003) and anxiety scores (51.7 vs 47.1, P = .01). Demographic and surgical variables did not correlate with the successful completion of the short-stay protocol. That seventy-six percent of the patients did not adhere to the short-stay protocol was due to the inability to complete a physical therapy standardized safety assessment. CONCLUSION: Higher levels of preoperative and postoperative anxiety and depression in otherwise psychologically healthy patients, is associated with an increased risk of failure to complete a short-stay protocol following THA. Targeted interventions are needed to facilitate rapid recovery in patients with psychological barriers to early mobilization.