Most patients gain weight in the 2 years after total knee arthroplasty: comparison to a healthy control group

SummaryObjectiveWhile joint arthroplasty improves the functional ability of persons with severe knee osteoarthritis (OA), the long-term effects of surgical intervention on body mass have not been evaluated. The objective of this study was to determine if a reduction in body mass index (BMI) was present following unilateral total knee arthroplasty (TKA) compared to an age-matched healthy control group who did not have surgery.MethodOne hundred and six adults with unilateral, end-stage knee OA and thirty-one persons without knee pain participated in the prospective longitudinal study. Subjects with OA underwent primary unilateral TKA and received post-operative out-patient physical therapy. Height, weight, quadriceps strength and self-perceived functional ability were measured at baseline and at a 2-year follow-up.ResultsThere was a significant interaction effect between body mass over time and subject group (P=0.017). BMI showed a significant increase over 2 years for the surgical group (P<0.001), but not for the control group (P=0.842). Sixty-six percent of the persons in the surgical group gained weight over the 2 years with an average weight gain of 6.4kg, or 14 pounds, 2 years after their initial physical therapy visit. Educational level, marital status, income level and activity level prior to surgery were not related to post-surgical weight gain.ConclusionThe majority of subjects gain weight after surgery and this cannot be attributed to the effects of aging. Weight gain after TKA should be treated as an independent concern and management of orthopedic impairments will not result in weight loss. Post-operative care should include access to nutrition or weight management professionals in addition to medical and physical therapy services

The facile synthesis of chiral oxazoline catalysts for the diethylzinc addition to aldehydes

A range of chiral 4-(1′-hydroxyalkyl)oxazoline catalysts can be obtained in a straightforward two step synthesis, starting from β-hydroxy amino acids like L-serine or L-threonine. Catalyst 4c forms a complex with diethylzinc, effective for the enantioselective addition to aldehydes resulting in high yields and enantiomeric excesses up to >99% even with aliphatic aldehydes. In the latter case the enantiomeric excess showed a marked dependence of the aldehyde's chain length. © 2003 Elsevier Ltd. All rights reserved

Black Soldier Fly Larvae Influence Internal and Substrate Bacterial Community Composition Depending on Substrate Type and Larval Density

Saprophagous fly larvae interact with a rich community of bacteria in decomposing organic matter. Larvae of some species, such as the black soldier fly, can process a wide range of organic residual streams into edible insect biomass and thus produce protein as a sustainable component of livestock feed. The microbiological safety of the insects and substrates remains a point of concern. Substrate-associated bacteria can dominate the larval gut microbiota, but the larvae can also alter the bacterial community in the substrate. However, the relative importance of substrate type and larval density in bacterial community dynamics is unknown. We investigated four larval densities (0 [control], 50, 100, or 200 larvae per container [520 mL; diameter, 75 mm]) and three feed substrates (chicken feed, chicken manure, and camelina substrate [50% chicken feed, 50% camelina oilseed press cake]) and sampled the bacterial communities of the substrates and larvae at three time points over 15 days. Although feed substrate was the strongest driver of microbiota composition over time, larval density significantly altered the relative abundances of several common bacterial genera, including potential pathogens, in each substrate and in larvae fed chicken feed. Bacterial communities of the larvae and substrate differed to a higher degree in chicken manure and camelina than in chicken feed. This supports the substrate-dependent impact of black soldier fly larvae on bacteria both within the larvae and in the substrate. This study indicates that substrate composition and larval density can alter bacterial community composition and might be used to improve insect microbiological safety