Cryptococcal Osteomyelitis of the Patella: A Case Report.

CASE: A 38-year-old woman presented to our clinic with right knee pain and difficulty ambulating. After cultures were obtained, a cryptococcal infection of the patella was identified. Subsequent workup revealed previously undiagnosed HIV/AIDS and a disseminated cryptococcal infection. CONCLUSION: Over a 20-month course, the patient was treated with fluconazole and antiretroviral therapy with very limited medication compliance. The disseminated infection caused cutaneous, hepatic, and cerebral complications. Eventually, compliance improved, and a final procedure to obtain post-treatment cultures and apply antifungal bone matrix was completed. The patient cleared the infection and will likely require lifetime antifungal treatment.

A Student-Driven Approach to Course Revitalization.

A first-year foundational science course grew beyond its scope. Revitalization of the course was driven by second and third-year medical students, who created new learning objectives and edited cases that were well-received by course facilitators and students. The students' role in the course revitalization is a novel approach.

Complications and Outcomes After Surgical Intervention in Clavicular Nonunion: A Systematic Review.

BACKGROUND: Surgical repair of clavicle fractures is being employed more frequently, although most fractures are still treated conservatively. Both can result in nonunion. Current treatments for clavicle nonunion include open reduction with internal fixation (ORIF) plating without bone graft, ORIF plating with bone graft, and intramedullary pin fixation. METHODS: We performed a systematic review and meta-analysis of studies reporting outcome, complication, and reoperation rates following surgical treatment for clavicle nonunion. Subgroup analysis was undertaken for outcome and complication rates between single plating and intramedullary pin fixation, bone graft use, and nonunion time length definition. RESULTS: Fifty-three studies met inclusion criteria (1,258 clavicle nonunions). Mean clinical follow-up was 2.6 years. Seventy-two percent of nonunions were of the middle third, 1% were proximal third, 12% were distal third, and 15% were not reported. Forty-eight percent of nonunions were atrophic or oligotrophic and 17% were hypertrophic (35% not reported). Mean time to union was 13.6 weeks. Ninety-five percent of patients achieved union after the primary nonunion surgery. Overall complication rate was 17%. Single-plating fixation had significantly faster union time (15.2 vs. 19.8 weeks), lower reoperation rate (23% vs. 37%), and hardware removal rate (20% vs. 34%) than intramedullary pin fixation. Bone graft had significantly lower rates of delayed union (0.6% vs. 3.6%) but higher complication (15% vs. 8%) and reoperation rates (29% vs. 14%) than the other groups. Studies that defined nonunion after 3 months had significantly faster union times than the 6-month studies (13 vs. 16 weeks). The 3-month group had a significantly lower overall complication rate (12% vs. 25%) and hardware/fixation failure rate (3% vs. 5.5%) than the 6-month group. CONCLUSIONS: This systematic review is the largest report of complications, reoperations, and patient outcomes of clavicle nonunions after surgical intervention in the current literature. Plating showed faster time to union and lower reoperation rates than intramedullary pin fixation. Bone graft use showed lower rates of delayed union but substantially higher rates of complications and reoperations. Reports with a definition of nonunion at 3 months showed faster union times and lower complication rates compared to reports with a definition of nonunion that was 6 months or greater. Surgery could be considered at 3 months post-injury in cases of symptomatic non-united clavicle fracture, and plating results in reliable outcomes. Adjuvant bone grafting requires further study to determine its value and risk/benefit ratio. LEVEL OF EVIDENCE: Level IV, Systematic Review. See Instructions for Authors for a complete description of levels of evidence.

Effects of acute exercise on directed forgetting.

Background: The directed forgetting paradigm involves individuals encoding a list of words(List 1; L1) and then, prior to encoding a second list of words (List 2; L2), they are given specific instructions to either remember all the words from L1 or to try and forget these words. In this paradigm, after encoding L1, those who are given the directed forgetting (DF) instructions tend tore call more words for L2 when compared to those who were given the remember (R) instructions(DF benefit effect). Similarly, those given the DF instructions tend to recall fewer words from L1(DF cost effect). This DF phenomenon may, in part, occur via attentional inhibitory mechanisms, or mental context-change mechanisms, which may be influenced via acute exercise. Methods: The present experiment investigates if acute exercise can facilitate DF when exercise occurs after L1 forgetting instructions. Participants (N = 97; Mage = 21 years) were randomly assigned into either acute exercise (15-min high-intensity aerobic exercise) plus DF (EX + DF),2) DF (directed forgetting) only (DF) or 3) R (remember) only (R). A standard two list (L1 and L2)DF paradigm was employed. Results: We observed evidence of a DF cost effect, but not a DF benefit effect. For L1, although both EX + DF and DF differed from R, there was no difference between EX + DF and DF. Further, although for L2, EX + DF was different than DF, neither of these groups differed when compared to R. Conclusion: We reserve caution in suggesting that exercise had a DF effect.

The effects of aerobic exercise on corpus callosum integrity: systematic review.

Objective: To evaluate the influence of exercise on the body and genu of the corpus callosum (CC), which is a critical brain structure involved in facilitating interhemispheric communication. Methods: Studies were identified using electronic databases, including PubMed, PsychInfo, Sports Discus and Google Scholar. The search terms, including their combinations, included exercise, physical activity, cardiorespiratory fitness, interhemispheric, and corpus callosum. To be eligible for inclusion in this review, studies had to be published in English; employ a cross-sectional, prospective or experimental design; include a measure of exercise as the independent variable; and the outcome variable had to include an integrity, volumetric or functional measure of the CC. Extraction parameters include study design, study population, exercise protocol, CC assessment, main findings regarding the relationship between exercise and the CC, and the evaluated or speculated mechanisms of this relationship. Results: 20 articles met the study inclusion criteria. Among these, 5 were conducted in animals and 15 were conducted in humans. Among the 5 animal studies, all provided suggestive evidence associating aerobic exercise with increased white matter integrity. Among the 15 human studies, 6 studies employed tract-based special statistics (TBSS), 4 utilized regions of interest (ROI) approach and 5 executed whole brain voxel wise analysis. Changes in the body was detected by 5 out of 6 TBSS studies and the genu by 3. Out of 4 ROI studies, three detected changes in the genu, but only one did in the body (out of 3 studies). One whole brain voxelwise study detected changes in the CC body of old adults and two found changes in the genu. Conclusion: This review provides evidence to suggest that aerobic exercise, and in turn, enhanced cardiorespiratory fitness, are associated with structural and functional outcomes increasing CC integrity.