SUMMARY Prosthetic joint infection (PJI) is a tremendous burden for individual patients as well as the global health care industry. While a small minority of joint arthroplasties will become infected, appropriate recognition and management are critical to preserve or restore adequate function and prevent excess morbidity. In this review, we describe the reported risk factors for and clinical manifestations of PJI. We discuss the pathogenesis of PJI and the numerous microorganisms that can cause this devastating infection. The recently proposed consensus definitions of PJI and approaches to accurate diagnosis are reviewed in detail. An overview of the treatment and prevention of this challenging condition is provided.

43 44 45 23Background: Metagenomic shotgun sequencing has the potential to transform how serious

Diabetes is associated with reduced risk of prostate cancer, but whether the metabolic syndrome is associated with prostate cancer is not established. The authors assessed this association in the Atherosclerosis Risk in Communities (ARIC) Study, comprising 6,429 men in four US communities initially with no history of cancer and aged 45-64 years. Metabolic syndrome and other risk factors were assessed in 1987-1989. Follow-up for prostate cancer incidence (n = 385 through 2000) was accomplished through cancer registry and hospital linkage. At baseline, 1,871 men (29.5%) had the metabolic syndrome. After the authors adjusted for other risk factors, men with the metabolic syndrome (> or =3 components) were significantly less likely to develop prostate cancer (relative risk = 0.77, 95% confidence interval: 0.60, 0.98) than men without the metabolic syndrome. Diabetes was negatively associated with prostate cancer, although the confidence interval included 1 (relative risk = 0.73, 95% confidence interval: 0.51, 1.05). When diabetic participants were excluded, the inverse association between metabolic syndrome and prostate cancer incidence was slightly strengthened. In this study, the metabolic syndrome was associated with decreased prostate cancer incidence. The authors hypothesize that this finding reflects a decrease in bioavailable (free and albumin-bound) testosterone with the metabolic syndrome and a concomitant reduction in prostate cancer risk.

Background Several vaccines are now clinically available under emergency use authorization in the United States and have demonstrated efficacy against symptomatic COVID-19. The impact of vaccines on asymptomatic SARS-CoV-2 infection is largely unknown. Methods We conducted a retrospective cohort study of consecutive, asymptomatic adult patients (n = 39,156) within a large United States healthcare system who underwent 48,333 pre-procedural SARS-CoV-2 molecular screening tests between December 17, 2020 and February 8, 2021. The primary exposure of interest was vaccination with at least one dose of an mRNA COVID-19 vaccine. The primary outcome was relative risk of a positive SARS-CoV-2 molecular test among those asymptomatic persons who had received at least one dose of vaccine, as compared to persons who had not received vaccine during the same time period. Relative risk was adjusted for age, sex, race/ethnicity, patient residence relative to the hospital (local vs. non-local), healthcare system regions, and repeated screenings among patients using mixed effects log-binomial regression. Results Positive molecular tests in asymptomatic individuals were reported in 42 (1.4%) of 3,006 tests performed on vaccinated patients and 1,436 (3.2%) of 45,327 tests performed on unvaccinated patients (RR=0.44 95% CI: 0.33-0.60; p<.0001). Compared to unvaccinated patients, the risk of asymptomatic SARS-CoV-2 infection was lower among those >10 days after 1 st dose (RR=0.21; 95% CI: 0.12-0.37; p<.0001) and >0 days after 2 nd dose (RR=0.20; 95% CI: 0.09-0.44; p<.0001) in the adjusted analysis. Conclusions COVID-19 vaccination with an mRNA-based vaccine showed a significant association with a reduced risk of asymptomatic SARS-CoV-2 infection as measured during pre-procedural molecular screening. The results of this study demonstrate the impact of the vaccines on reduction in asymptomatic infections supplementing the randomized trial results on symptomatic patients.