Total Joint Arthroplasty: Trends in Medicare Reimbursement and Implant Prices

Total joint arthroplasty (TJA) continues to be a popular target of cost control efforts. In order to provide a unique overview of financial trends facing TJA, we analyzed Medicare databases including 100% of beneficiaries, as well as industry surveys of implant list prices. Although there was a substantial increase in TJA utilization over the period 2000–2011 (+ 26.9%), growth has been stagnant since 2005. New coding schemes have made complicated cases more lucrative for hospitals (+ 2.5% to 6.5% per year), while reimbursements for uncomplicated cases have fallen (− 0.7% to − 0.6%). Physician reimbursements have declined on all case types (− 2.5% to − 2.1% per year), while list prices of orthopedic implants have risen (+ 4.8% to 5.5%). These trends should be kept in mind while contemplating future changes to TJA payment.     

Quantitative efficacy of external and internal browpexy performed in conjunction with blepharoplasty

Browpexy surgery is a minimally invasive surgical adjunct to upper blepharoplasty. The traditional internal (IB) approach is well documented, while the newer external (EB) variant has only recently been described. To date, there is little quantitative data to evaluate the efficacy of either procedure, and no data to compare results between the two. We determine the efficacy of, and compare surgical results between, internal and external browpexy surgery in lifting the central and lateral brow. A 3.5-year retrospective review of patients undergoing internal and external browpexy surgery to assess the amount of central and lateral lift to the brow was performed. Patients undergoing blepharoplasty without brow lift were used as a control group. The Massachusetts Eye and Ear Infirmary FACE-gram program was used to quantify surgical outcome. Ninety-eight patients are included for review, with an average follow-up of 4–5 months. The average elevation in lateral/central brow position was 2.29 mm and 1.47 mm in the IB group, and 2.97 mm and 1.90 mm in the EB group. These were not statistically significant (p = 0.164, and p = 0.507, respectively). There was a statistically significant elevation in central and lateral brow height for both browpexy techniques and the control group (p < 0.001). External and internal browpexy surgery afford a similar, and non-statistically different, elevation of the central and lateral brow at 4–5 months. When compared to standalone blepharoplasty (control) the amount of lift for both procedures is statistically significant.     

Rapid radiosynthesis of [11C] and [14C]azelaic,suberic, and sebacic acids for in vivo mechanistic studies of systemic acquired resistance in plants

A recent report that the aliphatic dicarboxylic acid, azelaic acid (1,9‐nonanedioic acid) but not related acids, suberic acid (1,8‐octanedioic acid) or sebacic (1,10‐decanedioic acid) acid induces systemic acquired resistance to invading pathogens in plants stimulated the development of a rapid method for labeling these dicarboxylic acids with ¹¹C and ¹⁴C for in vivo mechanistic studies in whole plants. ¹¹C‐labeling was performed by reaction of ammonium [¹¹C]cyanide with the corresponding bromonitrile precursor followed by hydrolysis with aqueous sodium hydroxide solution. Total synthesis time was 60 min. Median decay‐corrected radiochemical yield for [¹¹C]azelaic acid was 40% relative to trapped [¹¹C]cyanide, and specific activity was 15 GBq/µmol. Yields for [¹¹C]suberic and sebacic acids were similar. The ¹⁴C‐labeled version of azelaic acid was prepared from potassium [¹⁴C]cyanide in 45% overall radiochemical yield. Radiolabeling procedures were verified using ¹³C‐labeling coupled with ¹³C‐NMR and liquid chromatography–mass spectrometry analysis. The ¹¹C and ¹⁴C‐labeled azelaic acid and related dicarboxylic acids are expected to be of value in understanding the mode‐of‐action, transport, and fate of this putative signaling molecule in plants. Copyright © 2011 John Wiley & Sons, Ltd.