Reduced opioid requirements following unicompartmental knee arthroplasty compared with total knee arthroplasty.

AIMS: Unicompartmental knee arthroplasty (UKA) provides improved early functional outcomes and less postoperative morbidity and pain compared with total knee arthroplasty (TKA). Opioid prescribing has increased in the last two decades, and recently states in the USA have developed online Prescription Drug Monitoring Programs to prevent overprescribing of controlled substances. This study evaluates differences in opioid requirements between patients undergoing TKA and UKA. PATIENTS AND METHODS: We retrospectively reviewed 676 consecutive TKAs and 241 UKAs. Opioid prescriptions in morphine milligram equivalents (MMEs), sedatives, benzodiazepines, and stimulants were collected from State Controlled Substance Monitoring websites six months before and nine months after the initial procedures. Bivariate and multivariate analysis were performed for patients who had a second prescription and continued use. RESULTS: Patients undergoing UKA had a second opioid prescription filled 50.2% of the time, compared with 60.5% for TKA (p = 0.006). After controlling for potential confounders, patients undergoing UKA were still less likely to require a second prescription than those undergoing TKA (adjusted odds ratio (OR) 0.58, 95% confidence interval (CI) 0.42 to 0.81; p = 0.001). Continued opioid use requiring more than five prescriptions occurred in 13.7% of those undergoing TKA and 5.8% for those undergoing UKA (p = 0.001), and was also reduced in UKA patients compared with TKA patients (adjusted OR 0.33, 95% CI 0.16 to 0.67; p = 0.022) in multivariate analysis. The continued use of opioids after six months was 11.8% in those undergoing TKA and 8.3% in those undergoing UKA (p = 0.149). The multivariate models for second prescriptions, continued use with more than five, and continued use beyond six months yielded concordance scores of 0.70, 0.86, and 0.83, respectively. CONCLUSION: Compared with TKA, patients undergoing UKA are less likely to require a second opioid prescription and use significantly fewer opioid prescriptions. Thus, orthopaedic surgeons should adjust their patterns of prescription and educate patients about the reduced expected analgesic requirements after UKA compared with TKA. Cite this article: Bone Joint J 2019;101-B(7 Supple C):22-27.

Increased postoperative glucose variability is associated with adverse outcomes following orthopaedic surgery.

Aims: The aim of this study was to examine the association between postoperative glycaemic variability and adverse outcomes following orthopaedic surgery. Patients and Methods: This retrospective study analyzed data on 12 978 patients (1361 with two operations) who underwent orthopaedic surgery at a single institution between 2001 and 2017. Patients with a minimum of either two postoperative measurements of blood glucose levels per day, or more than three measurements overall, were included in the study. Glycaemic variability was assessed using a coefficient of variation (CV). The length of stay (LOS), in-hospital complications, and 90-day readmission and mortality rates were examined. Data were analyzed with linear and generalized linear mixed models for linear and binary outcomes, adjusting for various covariates. Results: The cohort included 14 339 admissions, of which 3302 (23.0%) involved diabetic patients. Patients with CV values in the upper tertile were twice as likely to have an in-hospital complication compared with patients in the lowest tertile (19.4% versus 9.0%, p < 0.001), and almost five times more likely to die compared with those in the lowest tertile (2.8% versus 0.6%, p < 0.001). Results of the adjusted analyses indicated that the mean LOS was 1.28 days longer in the highest versus the lowest CV tertile (p < 0.001), and the odds of an in-hospital complication and 90-day mortality in the highest CV tertile were respectively 1.91 (p < 0.001) and 2.10 (p = 0.001) times larger than the odds of these events in the lowest CV tertile. These associations were significant even for non-diabetic patients. After adjusting for hypoglycaemia, the relationships remained significant, except that the CV tertile no longer predicted mortality in diabetics. Conclusion: These results indicate that higher glycaemic variability is associated with longer LOS and in-hospital complications. Glycaemic variability also predicted death, although that primarily held for non-diabetic patients in the highest CV tertile following orthopaedic surgery. Prospective studies should examine whether ensuring low postoperative glycaemic variability may reduce complication rates and mortality. Cite this article: Bone Joint J 2018;100-B:1125-32.

New invasion assay using endothelial cells grown on native human basement membrane.

A new invasion assay is introduced using endothelial cells grown on native human basement membrane (BM). The source of the BM was human amnion. The amnion is a uniform tissue composed of an epithelial layer resting on a continuous basement membrane overlying an avascular collagenous stroma. The epithelium was removed exposing the basement membrane (BM) surface. Human umbilical cord endothelium or bovine capillary endothelium were cultivated on the BM surface. Human squamous carcinoma cells were inoculated onto the BM surface in the presence or absence of the endothelial monolayer. Tumor cells attached readily to both the endothelial monolayer or the BM surface alone. Tumor cells which invaded the basement membrane and underlying collagenous connective tissue were collected on a Millipore filter applied to the opposite side of the amnion. Tumor cells invaded the devitalized amnion connective tissue in the absence of endothelium. The presence of either bovine or human endothelium significantly reduced the rate of tumor cell invasion. This system should be useful for further quantitative studies of the interaction between endothelium and tumor cells with regard to the mechanism of invasion.

Quantitation of basement membrane collagen degradation by living tumor cells in vitro.

In order to study the mechanism of tumor cell invasion of basement membranes, a new method has been developed to quantify basement membrane (type IV) collagen degradation by living tumor cells. Tumor cells are inoculated into 16-mm tissue culture wells coatd with biosynthetically [14C]proline-labeled type IV collagen. Soluble degradation products are detected by measuring the radioactivity present in the medium. Using this method, we find that both highly metastatic and non-metastatic tumor cells and normal cells attach, but only the metastatic cells degrade the type IV collagen layer. The present data suggest that the mechanism of degradation is local activation of a latent type IV collagen specific enzyme at the cell substrate interface with no significant cell phagocytosis of substrate.

Issues in research on short-term dynamic psychotherapy.

In this article, we review the development of short-term dynamic psychotherapy (STDP) and introduce some of the important questions to be addressed in studying STDP. We begin by surveying some of the areas not covered in this special edition (e.g., the efficacy of STDP, recent developments in dynamic formulation) because they were recently reviewed elsewhere. We then introduce the four articles included in this special mini-series. We conclude by looking at which questions could benefit from further study and recommend that more data be gathered regarding (a) the differences between the many different forms of STDP; (b) the efficacy of these forms of therapies for specific disorders, including personality disorders; (c) the essential theoretically relevant processes occurring in those treatments; (d) matching patients to different therapies; (e) the interrelations between different therapeutic processes; and (f) the different strategies for teaching STDP.

Therapeutic alliance as a predictor of outcome and retention in the National Institute on Drug Abuse Collaborative Cocaine Treatment Study.

The authors examined the relation between therapeutic alliance, retention, and outcome for 308 cocaine-dependent outpatients participating in the National Institute on Drug Abuse Collaborative Cocaine Treatment Study. High levels of alliance were observed in supportive-expressive therapy (SE), cognitive therapy (CT), and individual drug counseling (IDC), and alliance levels increased slightly but significantly from Session 2 to Session 5 in all groups. In contrast to other studies, alliance was not a significant predictor of drug outcome. However, alliance did predict patient retention differentially across the 3 treatments. In SE and IDC, either higher levels of alliance were associated with increased retention or no relationship between alliance and retention was found, depending on the time alliance was measured. In CT, higher levels of alliance were associated with decreased retention.

Self- and Observer Ratings on the NEO-FFI in Couples: Initial Evidence of the Psychometric Properties of an Observer Form.

The present study investigated the psychometric properties of the NEO Five-Factor Inventory (NEO-FFI) Observer form of the five-factor model of personality by examining agreement between self- and observer ratings. Both partners of 49 young, adult couples rated themselves and their partners on the NEO-FFI. The results provide preliminary evidence of the measurement utility of the NEO-FFI Observer form. Specifically, (a) each personality scale possessed acceptable levels of internal reliability, (b) five factors consistent with the five-factor model of personality emerged in both ratings forms, and (c) there was significant self-observer agreement for all five personality scales. Self-observer agreement was assessed by correlations as well as analyses that test a more stringent definition of agreement. Overall, there is consensus across analyses that points to a substantial amount of concordance between partners' self- and observer ratings.

Body condition scoring: comparing newly trained scorers and micro-computed tomography imaging.

A Body Condition Scoring (BCS) protocol is an easily learned tool that can be used as a means of body condition assessment for random populations of mice. Here, the authors use X-ray computed tomography technology to show that BCS is a quick and effective method for evaluating parameters such as muscle thickness and fat, and that the method is equally as accurate when employed by newly trained or expert scorers.

A review of high-resolution X-ray computed tomography and other imaging modalities for small animal research.

Dedicated high-resolution small animal systems have recently emerged as important new tools for laboratory animal research. These imaging systems permit researchers to noninvasively screen animal models for mutations or pathologies and to monitor disease progression and response to therapy. The authors survey various small animal imaging modalities, including MRI, PET, SPECT, and microCT, and discuss several representative microCT mouse imaging studies.

Toddlers' acquisition of self/other knowledge: ecological and interpersonal aspects of self and other.

The complexity of toddlers' self-development was examined in the context of knowing others. Two studies were designed to test whether toddlers' self-knowledge was different from their knowledge of others (e.g., mother and inanimate object) or whether toddlers' knowledge of persons (e.g., self and mother) was different from their knowledge of objects. Knowledge of self, mother, and inanimate object was observed in developmentally sequenced tasks assessing agency and featural knowledge. When the inanimate object was perceptually different from humans, 12-month-old toddlers responded differently to all 3 versions. When the inanimate object was perceptually similar to humans, 24-month-olds distinguished self from other and did not distinguish between the 2 versions of "other:" mother and inanimate object. We concluded that 12-month-old infants were more sensitive to perceptual features of objects than were older toddlers. Data were interpreted according to Neisser's distinction between the ecological self and the interpersonal self.

Proof construction: adolescent development from inductive to deductive problem-solving strategies.

Inductive and deductive approaches to the construction of problem-solving proofs were examined using a task that requires the discovery of a geometrical figure hidden behind a series of covers. It was proposed that during adolescence, with the acquisition of a formal reasoning competence (as measured by Overton's [1990] version of Wason's selection task), there would be a transition from inductive to deductive proof construction strategies. One hundred adolescents were assessed on both the problem-solving proof task and the reasoning competence is associated with taking a deductive approach to proof construction. Formal reasoners tend to construct a proof based on the use of a falsification strategy as demonstrated by their search for disconfirming instances. A nonformal level of competence on the other hand is associated with inductive approaches. In this situation nonformal subjects tend to employ a verification strategy as demonstrated by the generation of redundant information. Results support the hypothesis that there is a cognitive developmental progression from an inductive approach to the construction of proofs to a deductive approach.

Absence of glomerulonephritis in guinea pigs deficient in the fourth component of complement.

Genetically determined deficiencies of the early components of the classical complement pathway (C1, C4, C2) or of the third component of complement (C3) in both human beings and experimental animals are known to be associated with renal disease, including glomerulonephritis. The current study was performed to examine the C4-deficient (C4D) guinea pig for the presence of renal disease. Eighteen C4D animals and 17 control animals (Crl:Hartley) (divided by sex into four age categories) were examined. Light microscopic examination revealed no differences in mesangium, glomerular cellularity, thickness of capillary loops, or presence of epithelial crescents in the kidneys of C4D guinea pigs as compared with control animals. Electron microscopic examination did not reveal glomerular or tubular immune complex deposits in either C4D or control animals. C4D guinea pigs apparently do not demonstrate glomerulonephritis.

Self and observer reports of interpersonal problems in couples.

This study investigated self-partner agreement on a measure of interpersonal problems as well as the relationship between discrepancy in self-partner ratings and self-reported symptomatology. Both partners of 49 young adult couples rated themselves and their partners on the Inventory of Interpersonal Problems(IIP Horowitz, Rosenberg, Baer, Ureño, & Villaseñor, 1988). The results demonstrated that couples generally evidenced significant agreement in characterizing the interpersonal problems of each target person, suggesting that the substantial self-partner agreement previously reported for personality traits generalizes to the domain of interpersonal problems. Results also indicated that the relationship between self-partner discrepancy and symptomatology depended on the target person's gender. Finally, the data provide preliminary evidence of the psychometric properties of an observer form of the IIP, including its circular structure.

The central relationship questionnaire (CRQ): psychometric properties in a Swedish sample and cross-cultural studies.

The Core Conflictual Relationship Theme (CCRT) method is one of the most widely used and tested instruments developed within a psychoanalytic context for assessing central relationship patterns or characteristic patterns of relating to others. The Swedish version of the Central Relationship Questionnaire (CRQ), a recently developed self-report instrument based on the CCRT, was tested in a sample of Swedish psychology students (31 men, 60 women) and compared with responses of Swedish outpatients (15 men, 15 women) and North American students (49 men, 49 women). The subscales of the Swedish CRQ showed acceptable internal consistency and correlated with each other in a predictable fashion, displaying a pattern of intercorrelations similar to the English version. The CRQ showed meaningful patterns of correspondence with self-reported interpersonal problems as well as meaningful differences between the Swedish students and Swedish outpatients, indicating preliminary convergent and divergent validity.

Evaluation of antibiotic therapies for eradication of Helicobacter hepaticus.

The newly recognized murine pathogen Helicobacter hepaticus is known to colonize the ceca and colons of several strains of mice from a variety of commercial suppliers. Additionally, the organism persistently infects mice, causes a chronic hepatitis, and is linked to hepatic tumors in the A/JCr inbred mouse strain. For this reason, eradication of the organism from infected mouse colonies is desirable. Treatment modalities for eradication of H. hepaticus from the gastrointestinal system consisted of oral administration of various antibiotic combinations previously evaluated for eradication of experimental H. felis gastric infection in mice. A/JCr mice (8 to 10 weeks old) naturally infected with H. hepaticus were divided into six treatment groups of 10 animals each. Animals received monotherapy of amoxicillin, metronidazole, or tetracycline or triple therapy of amoxicillin-metronidazole-bismuth (AMB) or tetracycline-metronidazole-bismuth (TMB). All medications were administered by oral gavage three times daily for 2 weeks. One month after the final treatment, mice were euthanatized and livers, ceca, and colons were cultured for H. hepaticus. All untreated control animals had H. hepaticus isolated from the cecum and/or colon. H. hepaticus was not recovered from the livers, ceca, or colons of the AMB or TMB treatment groups. All animals receiving the various antibiotic monotherapies had H. hepaticus isolated from the cecum and colon. We conclude that at the doses and the route evaluated, AMB and TMB triple therapies are effective for eradication of H. hepaticus in 8- to 10-week old A/JCr mice.

Microbiologic, radiographic, and anatomic study of the nasolacrimal duct apparatus in the rabbit (Oryctolagus cuniculus).

This study was motivated by the sporadic observation of epiphora in two male rabbits. The epiphora was unilateral and not associated with conjunctivitis or Pasteurella infection. To characterize the cause of epiphora, we studied 15 specific-pathogen-free New Zealand White rabbits. This study group was composed of the two affected males, four unaffected males, and nine unaffected females. Clinical evaluation consisted of bacterial culture of conjunctival specimens, examination of conjunctival scrapings for chlamydial inclusions, culture and cytologic examination of specimens from the nasolacrimal duct, plain and contrast radiography, latex casting, histologic examination, and the Schirmer tear test. Important differences found in the rabbits with epiphora included an opalescent, gritty, nasolacrimal duct flush fluid and marked unilateral dilatation of the duct proximal to a dorsal flexure at the caudal limit of the incisor tooth root. The flush solution from one affected rabbit cleared with ether, suggesting the presence of triglycerides or cholesterol. The organisms most commonly isolated from the conjunctiva were Moraxella sp., Oligella urethralis, Staphylococcus aureus, coagulase-negative Staphylococcus sp., and Streptococcus viridans. The organisms most commonly isolated from the nasolacrimal duct flush fluid were Moraxella sp., S. viridans, and Neisseria sp. Culture of the nasolacrimal duct flush fluid yielded microorganisms more consistently than did culture of the conjunctival specimens. All microorganisms isolated from affected rabbits also were isolated from unaffected rabbits. There was no apparent contribution of microorganisms to the development of epiphora, and Schirmer tear test results for affected animals were within the range seen in unaffected animals. Occlusion of the nasolacrimal duct was presumed to be attributable to fat droplets. This study augments the existing literature and represents the first report of anomalous nasolacrimal duct anatomic features in the rabbit.

Evaluation of various oral antimicrobial formulations for eradication of Helicobacter hepaticus.

Helicobacter hepaticus colonizes the cecum and colon of several strains of mice from a variety of commercial suppliers, persistently infects mice, causes chronic hepatitis, is linked to hepatic tumors in A/JCr mice, and has been associated with inflammatory bowel disease of athymic and scid mice. For this reason, eradication of the organism from infected mouse colonies is desirable. We recently reported that amoxicillin or tetracycline-based triple therapy (amoxicillin or tetracycline in combination with metronidazole and bismuth) given by oral gavage 3 times daily for 2 weeks eradicated H. hepaticus in 8- to 10-week-old A/JCr mice. To establish a more convenient therapy regimen for eradicating H. hepaticus, we evaluated water and dietary administration of various antibiotic combinations in A/JCr and DBA/2 mice naturally infected with H. hepaticus. The A/JCr male mice received amoxicillin-based triple therapy in drinking water or by oral gavage, or received tetracycline-based triple therapy in the drinking water. The DBA/2J female mice received amoxicillin-based triple therapy in a specially formulated dietary wafer or by oral gavage, or received enrofloxacin in drinking water. All treatments were given for a 2-week period. Control animals received no treatment. One month after treatment, H. hepaticus was recovered from the liver, cecum, or colon of A/JCr control mice and mice receiving amoxicillin- or tetracycline-based triple therapy in drinking water but not in mice receiving amoxicillin-based triple therapy by oral gavage. Helicobacter hepaticus was not recovered from DBA/2J mice receiving amoxicillin-based triple therapy in dietary wafer or by oral gavage but was recovered from control mice and 7 of 10 mice receiving enrofloxacin in drinking water. Results indicate that amoxicillin-based triple therapy administered in the diet or by oral gavage is effective in eradicating H. hepaticus. Antibiotics administered in the water, however, were not effective in eradicating the organism.

Characterization of dermatologic changes in geriatric rhesus macaques.

Nonhuman primates are frequently used for aging studies. We observed a high prevalence of skin disease among a group of geriatric rhesus monkeys (mean age = 25 years; n = 9) used in aging behavioral studies. Gross and histopathologic changes in the skin of these geriatric rhesus were compared with skin from control adult monkeys (mean age = 10; n = 4) and sun-exposed monkeys (mean age = 11; n = 4) to characterize age-related skin changes. Biopsy specimens were taken from four specified skin locations (lateral to bridge of nose, ventral midline, dorsal midline, perineal area) and from additional areas where skin lesions were present. Samples were routinely processed and evaluated by light microscopy. Blood samples were collected and tested for estrogen, thyroid-stimulating hormone, triiodothyronine thyroxine, and cortisol levels. The axilla was swabbed and samples were obtained for bacterial culturing. All nine of the geriatric monkeys had notable dermal lesions, while one of the control monkeys and one of the sun-exposed monkeys had abnormal findings. Major gross findings included increased areas of erythematous skin, wrinkling, focal skin scaling, thinning of hair, foot calluses, and exudative lesions. Histologic skin changes included subacute dermatitis, acanthotic dermatitis, and a lesion resembling an early solar lentigo in the sun-exposed animal. These changes were not associated with hormonal abnormalities or bacterial pathogens. Histologic changes are compatible with nonspecific skin changes observed in elderly humans. This study establishes a baseline of dermatologic changes of the aging rhesus macaque.