Risk factors for the development of a peri-prosthetic joint infection up to 2 Years following primary reverse shoulder arthroplasty.

Background: Reverse shoulder arthroplasty (RSA) has become commonly used to treat glenohumeral osteoarthritis (GHOA), of which complications such as peri-prosthetic joint infections (PJIs) may develop. The objective of this study was to compare patient demographics of those who did and did not develop PJIs within 2 years after primary RSA for GHOA and identify risk factors for this sequela. Methods: A nationwide database was queried from 2005 to 2014 for Medicare patients treated with primary RSA (International Classification of Disease (ICD-9) procedural code 81.88) for GHOA. Patients who developed PJIs within 2-years of primary RSA defined the study group, whereas those who were devoid of infections represented the comparison group. Our study consisted of 51,824 patients, of which 879 (1.69%) developed a PJI. Patient demographics comprising the Elixhauser comorbidity index (ECI) were compared using Chi-Square analyses. Multivariable logistic regression models were used to compute the odds-ratios (OR) of patient-specific factors associated with acquiring a PJI within 2 years after RSA. P values less than 0.002 were significant. Results: Patients developing a PJI had higher mean ECI (8 vs. 6; p < 0.0001). The greatest risk factors for developing PJIs within 2-years following RSA were male sex (OR: 2.10, 95%CI: 1.81-2.43, p < 0.0001), pathologic weight loss (OR: 1.78, 95%CI: 1.45-2.17, p < 0.0001), iron deficiency anemia (OR: 1.75, 95%CI: 1.49-2.06, p < 0.0001), morbid obesity (OR: 1.52, 95%CI: 1.21-1.88, p = 0.0001), rheumatoid arthritis (OR: 1.32, 95%CI: 1.13-1.54, p = 0.0003), arrhythmias (OR: 1.26, 95%CI 1.09-1.46, p = 0.001), and depressive disorders (OR: 1.23, 95%CI 1.06-1.43, p = 0.001). Conclusions: The greatest risk factors for PJIs within 2 years of primary RSA included male sex; additional modifiable risk factors included iron deficiency anemia, pathologic weight loss, and obesity. Preoperative screening can help to identify modifiable risk factors and alter management for high-risk patients to potentially minimize PJIs.

The Divergence Between Hospital Charges and Reimbursements For Primary 1-2-level Lumbar Fusion Has Increased Over Time: A Medicare Administrative Claims Analysis.

STUDY DESIGN: A retrospective cohort study was performed for patients undergoing 1-2-level lumbar fusion (1-2LF) from 2005 to 2014 using an administrative claims database. OBJECTIVE: The objective of this study was to determine changes in: (1) annual charges; (2) annual reimbursement rates; and (3) annual difference (charges minus reimbursements) in patients undergoing 1-2LF. SUMMARY OF BACKGROUND DATA: With implementation of value-based care in orthopaedics, coupled with the rise in number of patients undergoing 1-2LF, understanding the discordance in hospital charges and reimbursements is needed. The difference in hospital charges to reimbursements specifically for 1-2LF for degenerative disc disease has not been studied. MATERIALS AND METHODS: A Medicare administrative claims database was queried for patients undergoing primary lumbar fusion using ICD-9 procedural code 81.04-81.08. Patients specifically undergoing 1-2LF were filtered from this cohort using ICD-9 procedural code 81.62. The query yielded 547,067 patients who underwent primary 1-2LF. Primary outcomes analyzed included trends in charges, reimbursement rates, and net difference in cost over time and per annual basis. Linear regression evaluated the change in costs over time with a P -value less than 0.05 considered significant. RESULTS: From 2005 to 2014, total charges increased from $6,085,838,407 to $19,621,979,956 and total reimbursements increased from $1,677,764,831 to $4,656,702,685 (all P <0.001). Per patient charges increased 92.10% from 2005 to 2014 for patients undergoing primary 1-2LF from $129,992 to $249,697 ( P <0.001). Similarly, an increase in reimbursement per patient of 65.35% from $35,836 to $59,258 ( P <0.001) was noted. The annual difference in charges to reimbursements increased 102.26% during the study interval from $94,155 to $190,439 ( P <0.001). CONCLUSIONS: Per patient charges and reimbursements both increased over the study period; however, charges increased 30% more than reimbursements. Further breakdown of hospital, surgeon, and anesthesiologist reimbursements for 1-2LF is needed. LEVEL OF EVIDENCE: Level III.

A Review on Tradescantia: Phytochemical Constituents, Biological Activities and Health-Promoting Effects.

Tradescantia is a genus of herbaceous and perennial plants belonging to the Commelinaceae family and organized into three infrageneric classifications and 12 sections. More than 80 species within the genus have been used for centuries for medicinal purposes. Phytochemical compounds (from various species of the genus) such as coumarins, alkaloids, saponins, flavonoids, phenolics, tannins, steroids and terpenoids have recently been characterized and described with antioxidant, cytotoxic, anti-inflammatory, anticancer or antimicrobial properties. The objective of this review is to describe the different aspects of the genus Tradescantia, including its botanical characteristics, traditional uses, phytochemical composition, biological activities, and safety aspects.

The Profiles of Low Molecular Nitrogen Compounds and Fatty Acids in Wort and Beer Obtained with the Addition of Quinoa (Chenopodium quinoa Willd.), Amaranth (Amaranthus cruentus L.) or Maltose Syrup.

Replacement of a part of malt with unmalted materials is a common practice in beer production. These materials may differ in chemical composition than barley malt, which in turn can contribute to changes in the final composition of the wort. Consequently, it may affect yeast metabolism and final parameters of the obtained products. In this research, two unmalted pseudocereals were used: quinoa (Chenopodium quinoa Willd.) and amaranth (Amaranthus cruentus L.). Maltose syrup was tested as a reference material due to its commercial usage as a substitute of malt in production of worts. Replacement of a part of the malt with quinoa or amaranth favorably influenced the profiles of amino and fatty acids. Due to the fact that the type and concentration of individual amino acids and fatty acids in the fermented wort significantly affect the flavor compounds synthesized by yeast, differences in the profiles of esters and higher alcohol have been noted in beers produced with pseudocereals.

Suitability of unmalted quinoa for beer production.

BACKGROUND: This study provides the first detailed investigation into the effect of partially substituting barley malt with quinoa (Chenopodium quinoa Willd.) on the characteristics of wort and beer. Quinoa seeds and flakes were compared in terms of their suitability for brewing. The benefits of applying a commercial enzyme mixture during beer production with quinoa were also investigated. RESULTS: These findings show that quinoa is a good starchy raw material for brewing. Even without exogenous enzymes, it is possible to substitute barley malt with up to 30% quinoa. The form in which quinoa is used has a negligible influence on the quality of the wort and beer. The foam stability of beer made with quinoa was better than that of all-malt beer, despite there being a lower level of soluble nitrogen in quinoa beer in comparison with all-malt beer and more than twice the amount of fat in quinoa in comparison to barley malt. CONCLUSION: The addition of unmalted quinoa does not give unpleasant characteristics to the beer and was even found to have a positive effect on its overall sensory quality. This offers brewers an opportunity to develop good beers with new sensory characteristics. © 2018 Society of Chemical Industry.