Postoperative deep shoulder infections following rotator cuff repair

Rotator cuff repair(RCR) is one of the most commonly performed surgical procedures in orthopaedic surgery. The reported incidence of deep soft-tissue infections after RCR ranges between 0.3% and 1.9%. Deep shoulder infection after RCR appears uncommon, but the actual incidence may be higher as many cases may go unreported. Clinical presentation may include increasing shoulder pain and stiffness, high temperature, local erythema, swelling, warmth, and fibrinous exudate. Generalized fatigue and signs of sepsis may be present in severe cases. Varying clinical presentation coupled with a low index of suspicion may result in delayed diagnosis. Laboratory findings include high erythrocyte sedimentation rate and C-reactive protein level, and, rarely, abnormal peripheral blood leucocyte count. Aspiration of glenohumeral joint synovial fluid with analysis of cell count, gram staining and culture should be performed in all patients suspected with deep shoulder infection after RCR. The most commonly isolated pathogens are Propionibacterium acnes, Staphylococcus epidermidis, and Staphylococcus aureus. Management of a deep soft-tissue infection of the shoulder after RCR involves surgical debridement with lavage and long-term intravenous antibiotic treatment based on the pathogen identified. Although deep shoulder infection after RCR is usually successfully treated, complications of this condition can be devastating. Prolonged course of intravenous antibiotic treatment, extensive soft-tissue destruction and adhesions may result in substantially diminished functional outcomes.

Treatment of intermediate-risk prostate cancer with active surveillance in the routine care—Long-term outcomes of a prospective noninterventional study(HAROW)

Background:We report here the long-term outcomes of patients with intermediate-risk prostate cancer(PCa)treated with active surveillance(AS)in a daily routine setting.Material andmethods:HAROW(2008–2013)was a noninterventional,health service research study investigating themanagement of localized PCa in a community setting.A substantial proportion of the study centers were office-based urologists.A follow-up examination of all intermediate-risk patients with AS was conducted.Overall,cancer-specific,metastasis-free,and treatment-free survival rates,as well as reasons for discontinuation,were determined and discussed.Results:Of the 2957 patients enrolled,52 with intermediate-risk PCa were managed with AS and were available for evaluation.The median follow-up was 6.8 years(interquartile range,3.4–8.6 years).Seven patients(13.5%)died of causes unrelated to PCa,of whom 4 were under AS or under watchful waiting.Two patients(3.8%)developed metastasis.The estimated 8-year overall,cancer-specific,metastasis-free,and treatment-free survival rates were 85%(95%confidence interval[CI],72%–96%),100%,93%(95%CI,82%–100%),and 31%(95%CI,17%–45%),respectively.Onmultivariable analysis,prostate-specific antigen density of≥0.2 ng/mL2 was significantly predictive of receiving invasive treatment(hazard ratio,3.29;p=0.006).Reasons for discontinuation were more often due to patient's or physician's concerns(36%)than due to observed clinical progression.Conclusions:Although survival outcome data for intermediate-risk patients managed with AS in real-life health care conditions were promising,rates of discontinuation were high,and discontinuation was often a patient's decision,even when the signs of disease progression were absent.This might be an indication of higher levels of mental burden and anxiety in this specific subgroup of patients,which should be considered when making treatment decisions.From a psychological perspective,not all intermediate-risk patients are optimal candidates for AS.

Myokine Response to Blood-Flow Restricted Resistance Exercise in Younger and Older Males in an Untrained and Resistance-Trained State:A Pilot Study

Purpose The purpose of this study was to examine the response of myokines to blood-flow restricted resistance-exercise(BFR-RE)in younger and older males before and after completing a 12-week resistance-training program.Methods There were 8 younger(24.8±3.9 yrs)and 7 older(68.3±5.0 yrs)untrained male participants completed this study.Anthropometric and maximal strength(1RM)measurements were collected before and after a 12-week,supervised,progres-sive full-body resistance-training program.As well,an acute bout of full-body BFR-RE was performed with venipuncture blood samples collected before and immediately following the BFR-RE,followed by sampling at 3,6,24 and 48 h.Results The 12-week training program stimulated a 32.2%increase in average strength and 30%increase in strength per kg of fat free mass.The response of particular myokines to the acute bout of BFR-RE was influenced training status(IL-4,untrained=78.1±133.2 pg/mL vs.trained=59.8±121.6 pg/mL,P=0.019;IL-7,untrained=3.46±1.8 pg/mL vs.trained=2.66±1.3 pg/mL,P=0.047)or both training and age(irisin,P=0.04;leukemia inhibitory factor,P<0.001).As well,changes in strength per kg of fat free mass were correlated with area under the curve for IL-4(r=0.537;P=0.039),IL-6(r=0.525;P=0.044)and LIF(r=−0.548;P=0.035)in the untrained condition.Conclusion This study identified that both age and training status influence the myokine response to an acute bout of BFR-RE with the release of IL-4,IL-6 and LIF in the untrained state being associated with changes in strength per kg of fat free mass.

Associations between concussion and risk of diagnosis of psychological and neurological disorders:a retrospective population-based cohort study

Objective To investigate associations between concussion and the risk of follow-up diagnoses of attention-deficit hyperactivity disorder(ADHD),mood and anxiety disorders(MADs),dementia and Parkinson’s disease.Design A retrospective population-based cohort study.Setting Administrative health data for the Province of Manitoba between 1990-1991 and 2014-2015.Participants A total of 47483 individuals were diagnosed with a concussion using International Classification of Diseases(ICD)codes(ICD-9-CM:850;ICD-10-CA:S06.0).All concussed subjects were matched with healthy controls at a 3:1 ratio based on age,sex and geographical location.Associations between concussion and conditions of interest diagnosed later in life were assessed using a stratified Cox proportional hazards regression model,with adjustments for socioeconomic status and pre-existing medical conditions.Results 28021 men(mean age±SD,25±18 years)and 19462 women(30±21 years)were included in the concussion group,while 81871 men(25±18 years)and 57159 women(30±21 years)were included in the matched control group.Concussion was associated with adjusted hazard ratios of 1.39(95%CI 1.32 to 1.46,p<0.001)for ADHD,1.72(95%CI 1.69 to 1.76;p<0.001)for MADs,1.72(95%CI 1.61 to 1.84;p<0.001)for dementia and 1.57(95%CI 1.41 to 1.75;p<0.001)for Parkinson’s disease.Conclusion Concussion was associated with an increased risk of diagnosis for all four conditions of interest later in life.