Prior surgical fixation of proximal humerus fractures is associated with increased complications following subsequent reverse shoulder arthroplasty

BackgroundThe objective of this study was to compare complication rates between patients undergoing reverse shoulder arthroplasty (RSA) after a prior open reduction and internal fixation (ORIF) for proximal humerus fracture (PHF) to those undergoing RSA as a primary treatment for PHFs, glenohumeral osteoarthritis, or rotator cuff tear arthropathy (CTA).MethodsPatients who underwent RSA between 2015 and 2020 were identified in the Mariner database. Patients were separated into 3 mutually exclusive groups: (1) RSA for osteoarthritis, rotator cuff tear, or CTA (Control-RSA); (2) RSA as a primary treatment for PHF (PHF-RSA); and (3) RSA for patients with prior ORIF of PHFs (ORIF-RSA). Ninety-day medical and 2-year postoperative surgical complications were identified. In addition, patients in the PHF-RSA group were subdivided into those undergoing RSA for PHF within 3 months of the fracture (acute) vs. those treated greater than 3 months from diagnosis (delayed). Multivariate regression was performed to control for differences in comorbidities and demographics.ResultsA total of 30,824 patients underwent primary RSA for arthritis or CTA, 5389 patients underwent RSA as a primary treatment for a PHF, and 361 patients underwent RSA after ORIF of a PHF. ORIF before RSA was associated with an increased risk of overall revision (odds ratio [OR] 2.45, P = .002), infection (OR 2.40, P < .001), instability (OR 2.43, P < .001), fracture (OR 3.24, P = .001), minor medical complications (OR 1.59, P = .008), and readmission (OR 2.55, P = .001) compared with the Control-RSA cohort. RSA as a primary treatment for PHF was associated with an increased risk of 2-year revision (OR 1.60, P < .001), infection (OR 1.51, P < .001), instability (OR 2.84, P < .001), and fracture (OR 2.54, P < .001) in addition to major medical complications (OR 2.02, P < .001), minor medical complications (OR 1.92, P < .001), 90-day emergency department visits (OR 1.26, P < .001) and 90-day readmission (OR 2.03, P < .001) compared with the Control-RSA cohort. The ORIF-RSA group had an increased risk of periprosthetic infection (OR 1.94, P = .002) when compared with the PHF-RSA cohort. There were no differences in medical or surgical complications in the RSA-PHF cohort between patients treated in an acute or delayed fashion.ConclusionRSA following ORIF of a PHF is associated with increased complications compared with patients undergoing RSA for nonfracture indications. Prior ORIF of a PHF is also an independent risk factor for postoperative infection after RSA compared with patients who undergo RSA as a primary operation for fracture. The timing of RSA as a primary operation for PHF does not appear to impact the rates of postoperative medical and surgical complications.     

Breast cancer risk reduction: who,why, and what?

Women at increased risk of breast cancer have options to mitigate that risk. Understanding factors that increase risk and utilizing tools for quantitative estimates are important to be able to adequately counsel and target strategies for patients. On the basis of these estimates, patients may be able to engage in risk reduction interventions and increased screening, including chemoprevention or surgical risk reduction. Multiple organizations have published guidelines supporting risk assessment, genetic assessment, increased screening, and prevention measures for these women.     

Clinical Benefit-Risk Profile of Lenalidomide in Patients With Lower-risk Myelodysplastic Syndromes Without del(5q): Results of a Phase III Trial

BackgroundIn the phase III MDS-005 study of patients with lower-risk, non-del(5q) myelodysplastic syndromes, lenalidomide was associated with a higher rate of ≥ 8 weeks red blood cell transfusion independence (RBC-TI) compared with placebo, but also with a higher risk of hematologic adverse events (AEs).Patients and MethodsThis analysis evaluated the ratio of clinical benefit-risk in patients treated with lenalidomide or placebo, and assessed the effect of lenalidomide dose reductions on response. Clinical benefit was a composite endpoint defined as RBC-TI, transfusion reduction ≥ 4 units packed red blood cells, hemoglobin increase ≥ 1.5 g/dL, or cytogenetic response.ResultsThe rate of clinical benefit was higher with lenalidomide than with placebo (31.9% vs. 3.8%). The ratio of response (RBC-TI and clinical benefit) to risk (hematologic AEs) favored lenalidomide over placebo. Patients who underwent ≥ 1 lenalidomide dose reduction had a longer duration of treatment, received a higher cumulative dose, and were more likely to experience clinical benefit versus patients without dose reductions.ConclusionDespite the occurrence of hematologic AEs, the overall benefit-risk profile supported lenalidomide treatment. Appropriate management of hematologic AEs by dose reductions may help patients with myelodysplastic syndromes to remain on treatment and achieve clinical benefit.     

八珍汤对肺癌化疗致白细胞减少症临床疗效及部分机制研究

目的:探究八珍汤对肺癌化疗所致白细胞减少症的疗效及作用机制,有助于精准治疗并提高疗效。方法:选取2017年4月至2018年4月哈尔滨医科大学附属第一医院收治的肺癌化疗所致白细胞减少症患者66例作为研究对象,采用数字随机表法按就诊顺序号,分为对照组和观察组,每组33例。对照组予利血生20 mg口服,3次/d;鲨肝醇100 mg口服,3次/d,升白治疗,观察组在对照组基础上加用八珍汤化裁治疗,均治疗4周,观察不同方法治疗后在白细胞水平含量比较,比较治疗前、治疗末神疲乏力、心悸气短、头晕目眩、面色淡白、畏寒肢冷、纳呆食少中医症候积分和免疫功能指标CD4^+、CD8^+、CD4^+/CD8^+、NK细胞变化情况,治疗过程中收集不良反应情况,结束治疗后观察疗效情况。结果:1)2组治疗1周、2周、3周、4周后白细胞计数菌显著高于治疗前(P<0.05),观察组治疗1周、2周、3周、4周后显著优于对照组(P<0.05);2)2组患者治疗前神疲乏力、心悸气短、头晕目眩、面色淡白、畏寒肢冷、纳呆食少,比较差异无统计学意义(P>0.05),完成治疗方案后,2组患者以上指标较治疗前均显著下降(P<0.05)。治疗末观察组患者以上指标显著低于对照组(P<0.05)。3)2组患者治疗前CD4^+、CD8^+、CD4^+/CD8^+、NK细胞比较,差异无统计学意义(P>0.05),完成治疗方案后,2组患者CD8^+较治疗前均显著下降,CD4^+、CD4^+/CD8^+、NK细胞较治疗前显著升高(P<0.05),治疗末观察组患者以上指标显著优于对照组(P<0.05)。4)完成治疗后观察组患者显效率、总有效率明显高于对照组(P<0.05)。5)2组在不良反应发生率上比较,差异无统计学意义(P>0.05)。结论:八珍汤对肺癌化疗所致白细胞减少症能升高白细胞水平,提高疗效,改善症状。可能和该药能提高机体免疫力,促使骨髓造血功能有关。     

Evaluating the impact of a targeted brief HIV intervention on multiple inter-related HIV risk factors of knowledge and attitudes among incarcerated drug users

Increases in HIV prevalence indicate ongoing need for HIV interventions. A brief manualized intervention called the Texas Christian University (TCU) WaySafe, which addresses multiple HIV risks, was further evaluated to determine how it addressed individual’s knowledge deficiencies in the assessed risks. The sample of 1,256 offenders in eight correctional substance abuse treatment programs participated either in treatment as usual (TAU) or TCU WaySafe. From multivariate multilevel analysis, WaySafe was more effective in improving the greatest need area, whether knowledge, motivation, or confidence regarding HIV risky behaviors. Findings underscored the importance of addressing HIV risk areas with the greatest need for change and strengthens previous findings of the intervention’s potential for individuals with varying HIV risks.