Rethinking Substance Use as Social History: Charting a Way Forward.

Physicians have traditionally asked about substance use within the Social History section of the consultation note. Drawing on social science theory and using the authors' own experiences as generalists and addiction scholars, we consider the possible unintended harms associated with this approach. The inclusion of the substance use history within the Social History reproduces the discourse of substance use disorders as "life-style choices" rather than medical conditions, and reinforces stigma among healthcare workers through the attribution of personal responsibility for complications associated with problematic substance use. The ongoing placement of the substance use history within the Social History may lead to a failure to diagnose and make appropriate management plans for clients with substance use disorders. These missed opportunities may include inadequate withdrawal management leading to discharge before medically advised, insufficient use of evidence-based pharmacotherapy and psychotherapy, polypharmacy, medical complications, and repeated admissions to hospital. We argue instead that the Substance Use History should be a stand-alone section within the consultation note. This new section would reduce the invisibility of substance use disorders within our medical systems and model that these chronic medical conditions are amenable to prevention, treatment and harm reduction through the application of evidence-based practices.

Neural responses to reward, threat, and emotion regulation and transition to hazardous alcohol use.

AIMS: Reward processing and regulation of emotions are thought to impact the development of addictive behaviors. In this study, we aimed to determine whether neural responses during reward anticipation, threat appraisal, emotion reactivity, and cognitive reappraisal predicted the transition from low-level to hazardous alcohol use over a 12-month period. METHODS: Seventy-eight individuals aged 18-22 with low-level alcohol use [i.e. Alcohol Use Disorder Identification Test (AUDIT) score <7] at baseline were enrolled. They completed reward-based and emotion regulation tasks during magnetic resonance imaging to examine reward anticipation, emotional reactivity, cognitive reappraisal, and threat anticipation (in the nucleus accumbens, amygdala, superior frontal gyrus, and insula, respectively). Participants completed self-report measures at 3-, 6-, 9-, and 12-month follow-up time points to determine if they transitioned to hazardous use (as defined by AUDIT scores ≥8). RESULTS: Of the 57 participants who completed follow-up, 14 (24.6%) transitioned to hazardous alcohol use. Higher baseline AUDIT scores were associated with greater odds of transitioning to hazardous use (odds ratio = 1.73, 95% confidence interval 1.13-2.66, P = .005). Brain activation to reward, threat, and emotion regulation was not associated with alcohol use. Of the neural variables, the amygdala response to negative imagery was numerically larger in young adults who transitioned to hazardous use (g = 0.31), but this effect was not significant. CONCLUSIONS: Baseline drinking levels were significantly associated with the transition to hazardous alcohol use. Studies with larger samples and longer follow-up should test whether the amygdala response to negative emotional imagery can be used to indicate a future transition to hazardous alcohol use.

Outcomes and Survivorships of Total Knee Arthroplasty Comparing Resurfaced and Unresurfaced Patellae.

BACKGROUND: The decision to resurface the patella in total knee arthroplasty (TKA) is controversial. While there is some consensus that leaving the patella unresurfaced increases risk of reoperation, there is conflicting evidence about patient reported outcomes or indications for resurfacing. This study sought to determine recent rates of patellar resurfacing, examine factors affecting rates of resurfacing, and analyze the associations between patellar resurfacing and both revision rates and patient-reported outcome measures (PROMs). METHODS: The American Joint Replacement Registry was used to identify primary TKAs performed for osteoarthritis between 2012 and 2021. Cases were classified as resurfaced patella and unresurfaced patella (URP). Outcomes analyzed included trends in patellar resurfacing, factors influencing rate of resurfacing, revision rates, operative time, and 2 PROMs. RESULTS: Rates of patellar resurfacing decreased and rates of URP increased significantly faster in ambulatory surgery centers and among high volume surgeons. Operative time was significantly lower in URP versus resurfaced patella (88.15 versus 89.90 minutes). The URP were significantly more likely to require revision surgery (odds ratio = 1.206 (1.078, 1.35), P = .0011). There was no significant difference in the likelihood of achieving the minimal clinically important difference in PROMs between resurfaced and nonresurfaced TKAs at 1 year (odds ratio = 1.060 (0.710, 1.581), P = .7755). CONCLUSION: There was no difference in minimal clinically important difference between resurfaced and URPs and no clinically relevant difference in operative time. However, URPs were more likely to require revision surgery. Therefore, the decision not to resurface should be made carefully considering the known risk of revision and the uncertain benefit.

The effects of acute alcohol administration on circulating endocannabinoid levels in humans.

Several lines of evidence suggest that endocannabinoid signalling may influence alcohol consumption. Preclinical studies have found that pharmacological blockade of cannabinoid receptor 1 leads to reductions in alcohol intake. Furthermore, variations in endocannabinoid metabolism between individuals may be associated with the presence and severity of alcohol use disorder. However, little is known about the acute effects of alcohol on the endocannabinoid system in humans. In this study, we evaluated the effect of acute alcohol administration on circulating endocannabinoid levels by analysing data from two highly-controlled alcohol administration experiments. In the first within-subjects experiment, 47 healthy participants were randomized to receive alcohol and placebo in a counterbalanced order. Alcohol was administered using an intravenous clamping procedure such that each participant attained a nearly identical breath alcohol concentration of 0.05%, maintained over 3 h. In the second experiment, 23 healthy participants self-administered alcohol intravenously; participants had control over their exposure throughout the paradigm. In both experiments, circulating concentrations of two endocannabinoids, N-arachidonoylethanolamine (AEA) and 2-arachidonoylglycerol (2-AG), were measured at baseline and following alcohol exposure. During the intravenous clamping procedure, acute alcohol administration reduced circulating AEA but not 2-AG levels when compared to placebo. This finding was confirmed in the self-administration paradigm, where alcohol reduced AEA levels in an exposure-dependent manner. Future studies should seek to determine whether alcohol administration has similar effects on brain endocannabinoid signalling. An improved understanding of the bidirectional relationship between endocannabinoid signalling and alcohol intake may deepen our understanding of the aetiology and repercussions of alcohol use disorder.

Is Conversion TKA a Primary or Revision? Clinical Course and Complication Risks Approximating Revision TKA Rather Than Primary TKA.

BACKGROUND: Conversion total knee arthroplasty (convTKA) is associated with increased resource utilization and costs compared with primary TKA. The purpose of this study is to compare 1) surgical time, 2) hospitalization length (LOS), 3) complications, 4) infection, and 5) readmissions in patients undergoing convTKA to both primary TKA and revision TKA patients. METHODS: The American College of Surgeons National Surgical Quality Improvement Project database was queried from 2008 to 2018. Patients undergoing convTKA (n = 1,665, 0.5%) were defined by selecting Current Procedural Terminology codes 27,447 and 20,680. We compared the outcomes of interest to patients undergoing primary TKA (n = 348,624) and to patients undergoing aseptic revision TKA (n = 8213). Univariate and multivariate logistic regression was performed to identify the relative risk of postoperative complications. RESULTS: Compared with patients undergoing primary TKA, convTKA patients were younger (P < .001), had lower body mass index (P < .001), and were less likely to be American Society of Anesthesiologist class III/IV (P < .001). These patients had significantly longer operative times (122.6 vs 90.3 min, P < .001), increased LOS (P < .001), increased risks for any complication (OR 1.94), surgical site infection (OR 1.84), reoperation (OR 2.18), and readmissions (OR 1.60) after controlling for confounders. Compared with aseptic TKA revisions, operative times were shorter (122.6 vs 148.2 min, P < .001), but LOS (2.91 vs 2.95 days, P = .698) was similar. Furthermore, relative risk for any complication (P = .350), surgical site infection (P = .964), reoperation (P = .296), and readmissions (P = .844) did not differ. CONCLUSION: Conversion TKA procedures share more similarities with revision TKA rather than primary TKA procedures. Without a distinct procedural and diagnosis-related group, there are financial disincentives to care for these complex patients. LEVEL OF EVIDENCE: II.

Regional Implicit Bias Does Not Account for Racial Disparity in Total Joint Arthroplasty Utilization.

BACKGROUND: Racial disparities surrounding the utilization of total hip and total knee arthroplasty (THA, TKA) are well documented. The Implicit Association Test (IAT) is a validated tool used to measure implicit and explicit bias. The purpose of this study is to evaluate if variations in IAT scores by geographical region in the United States (US) correspond with regional variations in THA and TKA utilization by blacks compared to whites. METHODS: Data from the US Census and National Inpatient Sample from 2012 to 2014 were used to calculate THA and TKA utilization rates among Medicare-aged blacks and whites. Data were aggregated by US Census Bureau Division. Regional implicit bias was assessed by calculating a weighted average of IAT scores for each division. RESULTS: Across all geographic regions and years, the surveyed population demonstrated an implicit bias favoring whites over blacks. The population adjusted ratio of white-to-black utilization of THA and TKA by geographic division varied between 0.86-1.85 and 0.87-2.01, respectively. The difference in utilization between geographic divisions reached statistical significance (P < .001). No correlation was found between the IAT scores and race-specific utilization ratios among geographic divisions. CONCLUSION: Implicit bias as measured by regional IAT did not reflect THA and TKA utilization disparities. The racial disparity in utilization of THA and TKA significantly varied between divisions. The observed disparity was greater in divisions with a relatively higher proportion of blacks. To the authors' knowledge, this is the first study to evaluate the impact of implicit bias on utilization of THA and TKA.

High-risk social drinkers and heavy drinkers display similar rates of alcohol consumption.

Alcohol consumption is often assessed over weeks to months, but few attempts have been made to characterize alcohol consumption rates at the level of an individual drinking session. Here, we aimed to compare the rate of alcohol consumption in social drinkers at high risk for alcohol use disorder (AUD) and heavy drinkers. One hundred and sixty social drinkers and 48 heavy drinkers participated in an alcohol self-administration study. Social drinkers were classified as low risk or high risk for AUD based on sex, impulsivity, and family history of alcoholism. Participants received a priming dose of intravenous alcohol to assess alcohol-induced craving and completed a 125-minute intravenous alcohol self-administration session to assess rate of achieving a binge-level exposure (blood alcohol concentration greater than or equal to 80 mg%). There were no differences between rates of binging in high-risk and heavy drinkers (hazard ratio = 0.87; 95% CI, 0.48-1.56). Heavy drinkers reported higher levels of craving than high-risk and low-risk drinkers at baseline. However, following a priming dose of alcohol, there were no longer differences in craving between high-risk and heavy drinkers. These results indicate that high-risk social drinkers demonstrate binging behavior that is similar to heavy drinkers, which may be driven by alcohol-induced craving. Prospective studies are needed to elucidate whether these patterns of craving and consumption in high-risk social drinkers are predictive of future AUD.

Randomized Clinical Trials Investigating Innovative Interventions for Smoking Cessation in the Last Decade.

Every year, billions of dollars are spent treating smoking and related conditions, yet smoking-related morbidity and mortality continue to rise. There are currently only three FDA-approved medications for smoking cessation: nicotine replacement therapy, bupropion, and varenicline. Although these medications increase abstinence rates, most individuals relapse following treatment. This chapter reviews clinical trials published within the past 10 years investigating novel smoking cessation pharmacotherapies. Among these pharmacotherapies, some showed promising results, such as cytisine and endocannabinoid modulators, whereas others failed to produce significant effects. More research is needed to develop drugs that produce higher rates of long-term abstinence and to determine which subgroups of patients benefit from a given treatment.

Mortality and Complications in Patients with Metastatic Disease after Primary Total Hip and Total Knee Arthroplasty.

BACKGROUND: Although palliative therapies such as radiation are usually performed to improve quality of life in patients with metastatic disease, arthroplasty for joint pain may be indicated in some cases. Therefore, the purpose of this study is to evaluate the 30-day mortality risk, the risk of complications including infection and venous thromboembolic events, and the rate of 30-day reoperations and readmissions in patients with metastatic disease undergoing primary total hip and total knee arthroplasty (THA/TKA). METHODS: We reviewed the National Surgical Quality Improvement Program database from 2008 to 2018 to evaluate rates of postoperative complications after elective primary THA/TKA in patients with disseminated cancer. After exclusions, 205,007 patients undergoing primary THA and 352,337 undergoing primary TKA were retained for analysis: 942 (0.2%) with disseminated cancer. Chi-square was used to compare proportions between groups. Univariate and multivariate logistic regression was used to model the odds ratio of patients with disseminated cancer compared with those without disseminated cancer. RESULTS: After adjustment for covariates, patients with disseminated cancer had a higher risk of death (OR: 5.25, 95% CI: 2.47-11.17), any complication (OR: 1.95, 95% CI: 1.63-2.33), deep venous thrombosis (OR: 2.39, 95% CI: 1.32-4.35), pulmonary embolism (OR: 3.07, 95% CI: 1.52-6.17), cardiovascular complications (OR: 2.98, 95% CI: 1.47-6.04), transfusion (OR: 2.21, 95% CI: 1.82-2.69), reoperations (OR: 1.89, 95% CI: 1.28-2.78), readmissions (OR: 2.51, 95% CI: 1.95-3.23), and longer length of stay (4.3 vs 2.7 days). CONCLUSION: Patients with disseminated cancer have significantly elevated risk of complications after elective primary THA/TKA. Understanding the severity of complications is critical to the risk-benefit analysis that confronts patients and surgeons considering surgery. LEVEL OF EVIDENCE: II.

How to Develop a Fair Revision Arthroplasty Bundle? Using Perioperative Complications and Readmissions to Investigate.

BACKGROUND: The next frontier for value-based health care in total joint arthroplasty is revision surgery. Although the disparity in health care utilization between revision procedures compared with primary total hip and total knee arthroplasty (THA/TKA) procedures is recognized, no agreement regarding the risk adjustment necessary to make revision bundles fair to both payors and providers exists. The purpose of this study is to use the risk of perioperative complications and readmissions of patients undergoing revision THA/TKA to establish the foundations of a fair revision arthroplasty bundle. METHODS: We retrospectively evaluated a consecutive series of 484 aseptic THA/TKA revisions performed at our institution over a 12-month period and compared complications, length of stay, reoperations, and 90-day readmissions to a group of 802 consecutive patients undergoing primary THA/TKA. RESULTS: 169 (34.9%) patients experienced major complications after revision THA/TKA compared with 176 (21.9%) patients undergoing primary THA/TKA (P < .001), (OR 1.91 CI 1.49-2.45, P < .001). Patients undergoing revision TKA were 3.64 times more likely to require hospitalization greater than 3 days (OR 2.59-5.12, CI 95%, P < .001), whereas patients undergoing revision THA were 4.46 times more likely to require hospitalization greater than 3 days (OR 2.89-6.87, CI 95%, P < .001). Revision patients were 3X more likely to have a 90-day readmission and 4X more likely to have a reoperation. CONCLUSION: For a revision bundle to be fair and widely adopted, either significant financial incentive must be instituted or the latitude given to exclude outliers from the final reconciliation. This must be adjusted to not disincentivize institutions from providing care for failed hip and knee arthroplasties.

Endocannabinoid signaling in psychiatric disorders: a review of positron emission tomography studies.

Endocannabinoid signaling is implicated in an array of psychopathologies ranging from anxiety to psychosis and addiction. In recent years, radiotracers targeting the endocannabinoid system have been used in positron emission tomography (PET) studies to determine whether individuals with psychiatric disorders display altered endocannabinoid signaling. We comprehensively reviewed PET studies examining differences in endocannabinoid signaling between individuals with psychiatric illness and healthy controls. Published studies evaluated individuals with five psychiatric disorders: cannabis use disorder, alcohol use disorder, schizophrenia, post-traumatic stress disorder, and eating disorders. Most studies employed radiotracers targeting cannabinoid receptor 1 (CB1). Cannabis users consistently demonstrated decreased CB1 binding compared to controls, with normalization following short periods of abstinence. Findings in those with alcohol use disorder and schizophrenia were less consistent, with some studies demonstrating increased CB1 binding and others demonstrating decreased CB1 binding. Evidence of aberrant CB1 binding was also found in individuals with anorexia nervosa and post-traumatic stress disorder, but limited data have been published to date. Thus, existing evidence suggests that alterations in endocannabinoid signaling are present in a range of psychiatric disorders. Although recent efforts have largely focused on evaluating CB1 binding, the synthesis of new radiotracers targeting enzymes involved in endocannabinoid degradation, such as fatty acid amide hydrolase, will allow for other facets of endocannabinoid signaling to be evaluated in future studies.

Is Obesity Associated With Increased Risk of Deep Vein Thrombosis or Pulmonary Embolism After Hip and Knee Arthroplasty? A Large Database Study.

BACKGROUND: Deep venous thrombosis (DVT) and pulmonary embolus (PE) remain an important cause of morbidity and mortality after THA and TKA. Prior recommendations have advocated for more aggressive prophylaxis for patients with obesity, whereas the evidence supporting these recommendations is conflicting and often based on underpowered studies. QUESTIONS/PURPOSES: (1) What is the association between obesity and DVT and PE after primary and revision THA and TKA? (2) Is there a body mass index (BMI) threshold beyond which DVT and PE risk is elevated? METHODS: We reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2008 to 2016 to evaluate the reported 30-day rates of DVT, PE, and combined venous thromboembolism (VTE) after primary THA, primary TKA, revision THA, and revision TKA according to BMI as a continuous variable and a categorical variable as defined by the World Health Organization cutoffs for underweight, normal weight, overweight, and obesity. This database is risk-adjusted and designed to capture complications after surgery, thus making it ideal for this study. The diagnosis of DVT and PE is included in the ACS-NSQIP database for any DVT or PE requiring treatment. Proximal versus distal DVT is not specified within the database. Multivariate logistic regression was performed to determine if obesity was independently associated with DVT and PE risk by controlling for age, sex, race, American Society of Anesthesiologists score, diabetes, hypertension, smoking status, general anesthesia, and hypoalbuminemia. RESULTS: After controlling for potential confounding variables such as medical comorbidities and procedure type, patients undergoing primary and revision THA and TKA with World Health Organization classification as underweight (BMI < 18.5 kg/m), overweight (BMI 25-29.9 kg/m), Class I obese (BMI 30-34.9 kg/m), Class II obese (BMI 35-39.9 kg/m), or Class III obese (BMI ≥ 40 kg/m) did not demonstrate an association with increased risk of DVT compared with patients classified as normal weight (BMI 18.5-25 kg/m). Compared with patients undergoing primary THA classified as normal weight, the risk of PE was elevated in patients with Class II obesity (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.23-4.50; p = 0.009) and all heavier categories. Compared with patients undergoing TKA classified as normal weight, the risk of PE was elevated in patients classified as overweight (OR, 1.56; 95% CI, 1.03-2.36; p = 0.035) and all heavier categories. CONCLUSIONS: This large administrative database study suggests that patient classification as overweight or obese is associated with increased risk of development of PE but not DVT after primary THA or TKA. Because aggressive pharmacologic anticoagulation regimens can decrease the DVT rate but have not been shown to affect the rate of PE or death, the data do not currently support increased anticoagulation in patients with obesity without other risk factors for VTE undergoing THA or TKA. Additional studies are required to refine VTE prophylaxis protocols to reduce PE risk while maintaining acceptable postoperative bleeding risk. LEVEL OF EVIDENCE: Level III, therapeutic study.

Spinal Fusion Is Associated With Changes in Acetabular Orientation and Reductions in Pelvic Mobility.

BACKGROUND: The importance of spinopelvic motion and its influence on THA stability are well recognized but poorly defined. With dynamic motion, compensatory changes in spine and pelvic positions are required to keep the necessary balance between the axial skeleton and lower extremity to maintain an erect posture. Although prior studies have shown spinal fusions to be an independent risk factor for hip dislocations after primary THA, the direct impact of fusion levels on spinopelvic motion remains unknown. QUESTIONS/PURPOSES: The purposes of this study were (1) to determine if acetabular orientation changes with flexion and extension of the lumbar spine; (2) to determine if the amount of change is different in patients who have undergone spinal fusion at the L5-S1 level; and (3) to identify if the amount of change in acetabular motion is increased in patients who have undergone fusion at additional or other spinal levels. METHODS: We reviewed 100 flexion-extension spine films of patients older than 18 years of age with a history of back pain who had not undergone spinal or hip surgery and compared them with 50 flexion-extension spine films of patients who had undergone lumbar fusion at various levels. These radiographs were acquired between 2012 and 2017 and stored in our institutional radiology database. Only patients with flexion and extension films able to visualize the greater trochanter of the femur were included. For each film, measurements of acetabular version, acetabular version relative to the femoral shaft, lumbar lordosis angle, and sacral slope were digitally performed by two independent observers. Intra- and interrater variability was assessed using Lin's concordance correlation (Rho_c) ranging from 0.59 to 0.91. The change in acetabular version for each patient when going from spinal flexion to extension was compared between patients with no prior spinal or hip surgery and those with prior spinal fusions using a two-tailed t-test. RESULTS: Acetabular version changed -21° as the lumbar spine changed position from flexion to extension in patients without spine surgery (95% confidence interval [CI], -24° to -18°). Acetabular version changed 15° as the lumbar spine changed position from flexion to extension in patients who had undergone prior lumbar spine fusion at all levels (95% CI, -18° to -12°). There was a difference in the change in acetabular version between these two groups of -6° (95% CI, -11° to -1°; p = 0.01). In patients with prior L5-S1 fusion, the change in acetabular version was decreased when compared with patients without prior spine surgery. The change was -10° (95% CI, -15° to -6°), which is less than the change of acetabular version of -21° that we saw in patients without prior spinal fusion (p < 0.01). The difference between these groups was -10° (95% CI, -18° to -3°). Fusion levels above L5 that did not cross the L5-S1 joint did not have a difference in change in acetabular version when compared with patients without surgery with a mean difference of -4° (95% CI, -9° to 2°). CONCLUSIONS: Spinal fusion, specifically at the L5-S1 level, reduces pelvic mobility as the spine moves from flexion to extension. This reduction in motion can reduce the distance to impingement and place patients undergoing THA at risk for dislocation. Further research utilizing three-dimensional imaging modalities and motion analysis can further help define the best hip implant position in these patients. LEVEL OF EVIDENCE: Level III, prognostic study.

Discharge Home is Associated With Decreased Early Complications Following Primary Total Joint Arthroplasty.

BACKGROUND: Primary total hip (THA) and total knee arthroplasty (TKA) volume has increased over the past decade. Patients discharged home (HD) have demonstrated improved postoperative outcomes compared with non-home discharge (NHD) patients. We reviewed trends in HD over the past decade and compared complication rates between HD and NHD primary total joint arthroplasty (TJA) patients. METHODS: Retrospective analysis of the National Surgical Quality Improvement Program was performed on TJA cases and patients were grouped by discharge type. Trends in the prevalence of HD were compared by chi-square test, from 2011 to 2016. Univariate and bivariate statistics were performed. Multivariate logistic and propensity score-matched analyses were used to control for confounding variables. RESULTS: During the 6-year review, HD increased significantly for THA (71.2% to 83.6%) and TKA (65.6% to 80.7%). Overall HD was 75.4% of THA and 71.0% of TKA patients. Propensity matching identified 16,580 THA pairs and 34,952 TKA pairs. Compared with NHD patients, HD patients had shorter operative times, were younger, and had shorter lengths of stay. Controlling for confounders, the HD patients had lower risk of death within 30 days, lower risk of major medical morbidity, decreased risk of reoperation, and decreased risk of readmission compared with NDH patients. Multivariate models demonstrated similar findings. CONCLUSION: HD in both THA and TKA independently predicts decreased early (30-day) postoperative complications after controlling for confounding variables. Given the improved outcomes, we advocate for continued emphasis on HD rather than NHD when clinically appropriate.

Higher Rate of Early Revision Following Primary Total Knee Arthroplasty in Patients Under Age 55: A Cautionary Tale.

BACKGROUND: There has been an increased number of total knee arthroplasties (TKAs) performed in young and active patients. Although improved materials have decreased the likelihood of early catastrophic wear, concerns remain with the performance and survivorship of TKA implants in this patient population. The purpose this study is to evaluate perioperative complications, patient-reported outcomes, and implant survivorship of TKAs performed in patients under age 55. METHODS: We retrospectively reviewed 4259 primary TKAs performed over a 4-year period. There were 741 TKAs in patients under age 55. The primary outcome of interest was rate of revision at 30 days, 1, 2, and 5-year time points. Secondary outcomes included postoperative transfusion rate, length of stay, rate of deep vein thrombosis/pulmonary embolism, need for manipulation under anesthesia, readmission and reoperation within 30 days, as well as patient-reported outcomes. RESULTS: There were 3518 patients over 55 years and 741 patients under 55 years. Overall, 175 patients required revision (4.1%). Patients under 55 years had significantly higher cumulative revision rate at 1 (3.4% vs 1.8%, P < .001), 2 (5.0% vs 2.4%, P < .001), and 5 years (7.3% vs 3.7%, P < .001). Patients under 55 years had a higher rate of early reoperation. Patients over 55 years required more transfusions and suffered a higher rate of early deep vein thrombosis. Patients over 55 years had significantly greater improvements in Patient Reported Outcome Measurement Information System Global 10 Physical scores at 6 months postoperatively compared to patients under 55 years. CONCLUSIONS: Despite improvements in TKA implants, young and active patients remained at higher risk of early revision compared to older patients. The data should be used to counsel young prospective TKA patients about the early risk of reoperation and non-wear-related complications.

Emotion Recognition Biases in Alcohol Use Disorder.

BACKGROUND: Alcohol use disorder (AUD) has been associated with impairments in cognitive and emotional function, including difficulty identifying emotional facial expressions. However, it is unclear whether these deficits are associated with alcohol consumption or related anxious and depressive symptoms. METHODS: We compared the recognition of emotional faces expressing happiness, surprise, sadness, fear, anger, and disgust in 19 AUD participants and 19 healthy volunteers using the Cambridge Neuropsychological Test Automated Battery Emotion Recognition Task. We analyzed group differences in response latency, accuracy, and misidentification patterns (as defined by the tendency to mislabel facial expressions as exhibiting specific emotions). To assess whether misidentification patterns were associated with drinking severity, we also examined associations with alcohol consumption over the past 90 days. RESULTS: There were no differences in response latency or accuracy between groups. However, there were group differences in misidentification patterns. While controls tended to misidentify emotional expressions as happy, those with AUD tended to misidentify expressions as angry or disgusted. In AUD participants, the degree to which individuals were biased toward anger or disgust was positively correlated with the number of drinks they consumed in the past 90 days but was not associated with depression or anxiety scores. CONCLUSIONS: Our findings suggest that individuals with AUD have a bias toward misidentifying emotional facial expressions as hostile, which is not mediated by associated mood changes. This provides further evidence of disrupted social cognition in AUD.

Severity of alcohol dependence is associated with the fatty acid amide hydrolase Pro129Thr missense variant.

The endocannabinoid system plays an important role in reward and addiction. One of the two main endocannabinoid neurotransmitters, anandamide, is metabolized by fatty acid amide hydrolase, an enzyme with a functional genetic polymorphism (FAAH Pro129Thr, rs324420). The Thr129 allele has been linked to problem drug and alcohol use, but the association has not been widely replicated and may be stronger for clinical measures of severity rather than categorical diagnosis. In the present study, we sought to determine whether the Thr129 allele was associated with both alcohol dependence (AD) diagnosis and severity in a sample of 1434 European American and African American individuals, 952 of whom were diagnosed with lifetime AD. Participants were genotyped for FAAH rs324420, and ancestry was determined via a genome-wide panel of ancestry informative markers. Subjects participated in Structured Clinical Interviews for psychiatric disorders and 90-day Timeline Followback interviews to assess recent alcohol use. European American participants with current AD had a higher Thr129 allele frequency than non-dependent controls. In European Americans with lifetime AD, there were significantly different distributions of drinking days and binge drinking days between the two genotype groups, with Thr129 carriers reporting a median of 10 fewer abstinent days and 13 more binge drinking days than Pro129/Pro129 homozygotes. In African American participants, there were no significant differences between Thr129 allele frequency in cases and controls and no significant differences in measures of AD severity by genotype. These findings provide evidence that the Pro129Thr missense variant is associated with AD severity in European Americans.

Sugar-sweetened beverage consumption is associated with abdominal fat partitioning in healthy adults.

Abdominal adiposity, particularly visceral adipose tissue (VAT), is independently linked to the pathogenesis of diabetes and cardiovascular diseases. Emerging evidence suggests that greater intake of sugar-sweetened beverages (SSBs) may be associated with abnormal fat accumulation in VAT. We examined whether habitual SSB consumption and diet soda intakes are differentially associated with deposition of body fat. We conducted a cross-sectional analysis using previously collected data in 2596 middle-aged adults (1306 men and 1290 women) from the Framingham Heart Study Offspring and Third Generation cohorts. VAT and abdominal subcutaneous adipose tissue (SAT) were measured using multidetector computed tomography. Habitual intake of SSBs and diet soda was assessed by a validated food frequency questionnaire. We observed that SSB consumption was positively associated with VAT after adjustment for SAT and other potential confounders (P-trend < 0.001). We observed an inverse association between SSB consumption and SAT (P-trend = 0.04) that persisted after additional adjustment for VAT (P-trend < 0.001). Higher SSB consumption was positively associated with the VAT-to-SAT ratio (P-trend < 0.001). No significant association was found between diet soda consumption and either VAT or the VAT-to-SAT ratio, but diet soda was positively associated with SAT (P-trend < 0.001). Daily consumers of SSBs had a 10% higher absolute VAT volume and a 15% greater VAT-to-SAT ratio compared with nonconsumers, whereas consumption of diet soda was not associated with either volume or distribution of VAT.