A Decline in Overutilization of Transfusion after Total Knee Arthroplasty Using Pharmacological Agents for Patient Blood Management in South Korea: An Analysis Based on the Korean National Health Insurance Claims Database from 2008 to 2019.

Background: This study aimed to evaluate the annual trends of transfusion rates and utilization of blood management agents in total knee arthroplasty (TKA) based on the operation type and to analyze the risk factors of transfusion after TKA. Methods: Using the Korean National Insurance claims database of 797,106 primary and revision TKAs between January 2008 and October 2019, data on the patients' characteristics, comorbidities, utilization of transfusion, and blood management agents were collected. The patients were categorized into three groups based on the operation type: primary, revision, and simultaneous bilateral TKA. The transfusion rate and utilization of blood management agents (intraoperative tranexamic acid [TXA] and preoperative iron supplements) were compared, and the risk factors for transfusion were evaluated. Results: After excluding the inaccurate data, 730,554 arthroplasties (636,292 primary, 10,540 revision, and 41,861 simultaneous bilateral TKAs) were identified. The transfusion rates of primary, revision, and simultaneous bilateral TKAs in 2019 were 64.0%, 67.7%, and 68.9%, respectively, which were significantly decreased compared with 83.2%, 88.0%, and 92.5% in 2008, respectively (p < 0.001). Conversely, the utilization of intraoperative TXA and preoperative iron supplements was significantly increased from 4.6% and 13.8%, respectively, in 2008 to 52.4% and 27.0%, respectively, in 2019 (p < 0.001). The utilization of intraoperative TXA and preoperative iron supplements significantly lowered the risk of transfusion after TKA (odds ratio [OR], 0.20; p < 0.001 and OR, 0.71; p < 0.001). Conclusions: The transfusion rate after TKA decreased gradually from 83.5% to 64.5% between 2008 and 2019 in South Korea corresponding with the increased utilization of blood management agents. Therefore, consistent attention to patient blood management should be emphasized to reduce the transfusion rate after TKA.

Effects of Whey Protein Supplement on 4-Week Resistance Exercise-Induced Improvements in Muscle Mass and Isokinetic Muscular Function under Dietary Control.

(1) The purpose of this study was to investigate the effect of whey protein supplementation under dietary control on improvements in muscle mass and function following resistance exercise training. (2) Thirty-two men were randomly assigned to a whey protein supplementation group taking whey protein isolate (PSG, n = 17) and a placebo group (CON, n = 15). Participants were provided with three meals per day corresponding to the estimated individual daily energy intake. The supervised resistance exercise program was conducted 60 min per day, six days per week, for four weeks. (3) Post-intervention, there was a significant interaction between groups in terms of muscle mass increase (p = 0.033, η2 = 0.14), with a greater increase in the PSG. There were also significant interactions between the groups and increases in peak torque of the dominant knee flexors (p = 0.048, η2 = 0.12), dominant shoulder extensors, and non-dominant shoulder extensors (p = 0.028, η2 = 0.15; p = 0.015, η2 = 0.18), and the total work of the dominant knee and shoulder extensors (p = 0.012, η2 = 0.19; p = 0.013, η2 = 0.19), with greater increases in the PSG. (4) These results suggest that whey protein supplementation enhances resistance exercise-induced increase in muscle mass and overall muscular strength and endurance, independent of dietary influence.

Blood transfusion has an adverse impact on the prognosis of patients receiving chemotherapy for advanced colorectal cancer: experience from a single institution with a patient blood management program.

PURPOSE: Perioperative blood transfusion in early stage cancer patients had a negative effect on the prognosis of patients, but the prognostic impact of transfusion in advanced cancer patients remains unclear. To minimize and guide rational transfusion, an institutional patient blood management (PBM) program was launched, and we evaluated the new program that has changed the practice and impacted on the prognosis of advanced cancer patients. METHODS: We investigated the medical records of colorectal cancer patients who received chemotherapy from 2015 to 2020. The amount and frequency of transfusion, iron replacement and laboratory findings, and overall survival were compared before and after implementation of PBM. RESULTS: The rate of transfusion in colorectal cancer patients was significantly decreased from 23.5/100 person-quarter in 2015 to 1.2/100 person-quarter in 2020, but iron supplementation therapy was frequently used, and the proportion of patients who received transfusion under hemoglobin 7 g/dL significantly increased from 15.9% in 2015 to 55.3% in 2020. Multivariate analysis revealed that transfusion was a significant risk factor affecting the overall survival of patients (HR 2.70, 95% CI: 1.93-3.78, p<0.001). Kaplan-Meier analysis revealed that overall survival was significantly longer in non-transfused patients than in transfused patients (11.0 versus 22.4 months; HR 0.69, 95% CI: 0.56-0.86, p<0.001). CONCLUSIONS: This study shows that minimized transfusion through an institutional PBM can positively affect the prognosis of patients who are receiving chemotherapy for advanced colorectal cancer.

Intravenous iron supplementation with intra-articular administration of tranexamic acid reduces the rate of allogeneic transfusions after simultaneous bilateral total knee arthroplasty.

BACKGROUND: Peri-operative intravenous administration of iron supplementation seems a good option to reduce allogeneic blood transfusion in major orthopaedic surgery. However, its efficacy in simultaneous bilateral total knee arthroplasty has not been studied. MATERIALS AND METHODS: From December 2014 to May 2015, a total of 72 consecutive patients underwent simultaneous bilateral total knee arthroplasty and received peri-operative intravenous iron supplementation (iron isomaltoside 1000: 600 mg pre-operatively and 400 mg 1 week post-operatively) and intra-articular tranexamic acid (2 g in 20 mL saline at the end of surgery), and were managed with a restrictive transfusion trigger (haemoglobin <7 g/dL). Post-operatively, we observed patients closely for symptoms of anaemia and checked their haemoglobin levels on days 1, 6 and 13 after surgery. RESULTS: The mean baseline haemoglobin level was 13.1 g/dL. The levels remained above 7.0 g/dL on post-operative days 1, 6 and 13 (mean, 11.4 g/dL, 9.9 g/dL and 10.4 g/dL, respectively) in all but one patient who experienced melaena and required allogeneic blood transfusion. DISCUSSION: Intravenous iron supplementation combined with intra-articular administration of tranexamic acid seems to be an effective strategy for reducing the rate of allogeneic blood transfusion in patients undergoing simultaneous bilateral total knee arthroplasty managed with a restrictive transfusion trigger.

The Impact of Different Amounts of Calcium Intake on Bone Mass and Arterial Calcification in Ovariectomized Rats.

Reduced estrogen secretion and low calcium (Ca) intake are risk factors for bone loss and arterial calcification in female rodents. To evaluate the effects of Ca intake at different amounts on bone mass changes and arterial calcification, 8-wk-old female Wistar rats were randomly placed in ovariectomized (OVX) control and OVX with vitamin D3 plus nicotine (VDN) treatment groups. The OVX with VDN rats were then divided into six groups to receive different amounts of Ca in their diets: 0.01%, 0.1%, 0.3%, 0.6%, 1.2%, or 2.4% Ca. After 8 wk of administration, low Ca intake groups with 0.01% and 0.1% Ca diets had significantly reduced bone mineral density (BMD) and bone mechanical properties as compared with those of the other groups, whereas high Ca intake groups with 1.2% and 2.4% Ca diets showed no differences as compared with the 0.6% Ca intake group. For both the 0.01% and 2.4% Ca intake groups, Ca levels in their thoracic arteries were significantly higher as compared with those of the 0.6% Ca diet group, and that was highly correlated with serum PTH levels. An increase in relative BMP-2 mRNA expression in the arterial tissues of the 0.01% and 2.4% Ca diet groups was also observed. These results suggested that extremely low Ca intake during periods of estrogen deficiency may be a possible risk for the complications of reduced BMD and arterial calcification and that extremely high Ca intake may promote arterial calcification with no changes in BMD.

Snapping knee caused by a popliteomeniscal fascicle tear of the lateral meniscus in a professional Taekwondo athlete.

A 19-year-old male professional Taekwondo athlete presented with a 2-year history of pain-free snapping of his right knee. He reported that his right knee joint gave way during games and training and that he could induce pain-free snapping between the proximal-to-fibular head and the lateral knee joint line. None of these physical findings suggested a meniscal pathology or ligamentous instability. Routine radiographs were normal. Magnetic resonance imaging of his right knee joint showed that the shape of the lateral meniscus was normal, and no lateral meniscus tears existed. On arthroscopic examination, popliteal hiatus view showed a posterosuperior popliteomeniscal fascicle tear between the posterior horn of the lateral meniscus and the posterior joint capsule just posteromedial to the popliteus tendon. With medial traction by probing, this popliteomeniscal tear made visible the significant subluxation of the posterior horn of the lateral meniscus to the center or anterior half of the tibial plateau. Based on the diagnosis of a posterosuperior popliteomeniscal tear of the right knee, Fast-Fix (Smith & Nephew, Andover, Massachusetts) was used for the direct repair of the peripheral portion of the lateral meniscus and joint capsule, targeting the popliteomeniscal junction. At 24 months postoperatively, the patient was performing athletic exercises relevant to his profession and was taking part in Taekwondo games, with no pain or recurrence of snapping. To the authors' knowledge, this is the first report of snapping of the lateral aspect of the knee due to a popliteomeniscal fascicle tear.

Tuberculous arthritis of the knee joint mimicking pigmented villonodular synovitis.

UNLABELLED: Tuberculous arthritis is difficult to diagnose early because of its atypical insidious clinical manifestations and non-specific imaging findings. Specifically, monoarticular tuberculosis of the knee may mimic pigmented villonodular synovitis (PVNS). The present report describes a young patient with tuberculous arthritis of the knee. Proper diagnosis was delayed due to magnetic resonance imaging findings, such as hemosiderin deposits and a nodular mass around the knee joint, suggesting the diffuse type of PVNS. These findings suggest that the first step in the diagnosis of tuberculous knee arthritis is to have a high index of suspicion. LEVEL OF EVIDENCE: IV.

DHEA administration activates local bioactive androgen metabolism in cancellous site of tibia of ovariectomized rats.

It is not known whether local androgen metabolism is involved in the mechanisms underlying the dehydroepiandrosterone (DHEA) administration-induced improvement of bone mineral density (BMD) in an estrogen-deficiency state. The aim of the present study was to clarify whether DHEA administration would improve local androgen metabolism and BMD in cancellous site of tibia of ovariectomized (OVX) rats. Twenty-two female rats, 6 weeks old, were randomized into three groups: sham-operated rats, OVX control rats, and OVX rats that received DHEA treatment. DHEA was administered intraperitoneally at 20 mg/kg body weight for 8 weeks. The concentrations of free testosterone and dihydrotestosterone (DHT) in cancellous site of tibia did not change as a result of ovariectomy, while the DHT concentration increased following DHEA administration. We revealed that DHEA administration improved the reduction of 17ß- and 3ß-hydroxysteroid dehydrogenases and clearly reversed the reduction of 5α-reductase types 1 and 2 and androgen receptor in the cancellous site of tibia of OVX rats. DHEA administration suppressed estrogen deficiency relative to the decrease in the cancellous BMD, which was positively associated with local DHT concentration. These findings indicate that DHEA administration enhances local bioactive androgen metabolism in the cancellous tibia of young OVX rats, suggesting that local DHT may play a part in the DHEA administration-induced improvement of cancellous BMD.

Enhancing effect of HT008-1 on cognitive function and quality of life in cognitively declined healthy adults: a randomized, double-blind, placebo-controlled, trial.

HT008-1 is one of the most effective multiherb mixtures that have neuroprotective effects in traditional Korean medicine. The purpose of this study was to conduct a clinical trial of the efficacy of HT008-1 on the neuropsychological functioning and quality of life (QoL) in cognitively intact adults. One hundred and eighteen male (n - 42) and female (n = 76) volunteers who reported no history of dementia or significant neurocognitive impairments and obtained Korean Version of Mini Mental State Examination total scores of at least 24 were examined via an 8-week, randomized, double-blind, fixed-dose, placebo-controlled, parallel group, clinical trial. Participants were randomly assigned to receive either HT008-1 (n = 59) or placebo (n = 59) for 8 weeks. Efficacy measures consisted of participants' performance scores from pretreatment baseline to those obtained just before termination of treatment on standardized neuropsychological measures from the subsets of Wechsler Memory Scale-III (WMS-III). QoL was assessed by subjective questionnaires WHOQoL-Bref about five categories. Participants who scored in the lower third of the Auditory recognition delayed at baseline and received HT008-1 exhibited improvement on the WMS-III Auditory recognition delayed subtest compared with placebo controls. The HT008-1 group also improved on general health scores in the QoL test.