No abstract

Perioperative blood management remains a challenge during total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of this study was to systematically examine the relationship between body mass index (BMI) and perioperative blood transfusion during THA and TKA while attempting to resolve conflicting results in previously published studies. The authors retrospectively evaluated 2399 patients, 896 of whom underwent THA and 1503 of whom underwent TKA. Various outcome variables were assessed for their relationship to BMI, which was stratified using the World Health Organization classification scheme (normal, <25 kg/m(2); overweight, 25-30 kg/m(2); obese, >30 kg/m(2)). Among patients undergoing THA, transfusion rates were 34.8%, 27.6%, and 21.9% for normal, overweight, and obese patients, respectively (P=.002). Among patients undergoing TKA, transfusion rates were 17.3%, 11.4%, and 8.3% for normal, overweight, and obese patients, respectively (P=.002). Patients with an elevated BMI have decreased rates of blood transfusion following both THA and TKA. This same cohort also loses a significantly decreased percentage of estimated blood volume. No trends were identified for a relationship between BMI and deep venous thrombosis, pulmonary embolism, myocardial infarction, discharge location, length of stay, 30-day readmission rate, and preoperative hemoglobin level. Elevated BMI was significantly associated with increased estimated blood loss in patients undergoing THA and those undergoing TKA. There was a statistically significant trend toward increased deep surgical-site infection in patients undergoing THA (P=.043). Patients with increased BMI have lower rates of blood transfusion and lose a significantly smaller percentage of estimated blood volume following THA and TKA. [Orthopedics.2016; 39(5):e844-e849.].

Effective control of mosquitoes in rural Midwestern communities that lack organized mosquito control districts would be aided by baseline data on optimal breeding sites, interannual effects of climate on population emergence and abundance, and efficacy of various control options under field conditions. During 19 surveillance weeks in the summer of 2005, we sampled 100 catch basins each week that were distributed among 10 study zones. Catch basins within each study zone were subjected to 1 of 4 different mosquito control methods or were left untreated. Of the 10 study zones, 5 were in high-intensity urban areas and 5 in low-intensity urban areas. During the study period, treatment of urban catch basins with Altosid XR extended residual briquets resulted in a 69.5% reduction in mosquito larvae numbers. However, the product did not provide sustained treatment for the 120-150 days suggested by the manufacturer. Vectolex WSP, when applied according to manufacturer's suggestions, resulted in a 73.4% reduction in mosquito larvae. VectolexWSP effectiveness was impacted by heavy rainfalls early in the surveillance period. Cleaning catch basins once or twice during the surveillance period resulted in a 40.1% and a 39.9% reduction in mosquito larvae, respectively. Catch basins in high-intensity urban areas comprised 27.7% of the total collection compared to 72.3% from low-intensity urban areas. The AltosidXR extended residual briquets and the VectolexWSP products both impacted the number of mosquito larvae collected. However, a single treatment to control mosquitoes in this study area may not be sufficient. We suggest that treatment of urban catch basins is optimized when accompanied by a comprehensive surveillance plan, and that a combination of treatments or multiple treatments during the season may be necessary to mitigate risks of vector-borne infectious diseases in areas with similar climate and precipitation trends.

No abstract

There are a growing number of options at the surgeon's disposal when treating patients with EOS. As surgeons, we must continue to be vigilant in our demand for sound clinical evidence as we strive to provide optimal care for our patients. The rapidly advancing field of spinal growth modulation is exciting. More work must be done to further enhance our ability to predictably modulate growth in the pediatric spine.