Bilateral anterior dislocation of the shoulders at the start of a backstroke competition

Bilateral anterior dislocation of the shoulders is very rare. A 20-year-old man presented with bilateral anterior shoulder dislocation as a result of a diving incident. He complained of pain and restriction of movement in both shoulders with abducted and externally rotated arms. Radiographs revealed that the shoulders were dislocated. The patient was treated with closed reduction and was able to resume swimming 3 months later. To our knowledge, this is the first bilateral anterior dislocation of the shoulders during a backstroke swimming competition that was caused by this mechanism of injury. The rarity of this lesion and its uncommon mechanism prompted us to relate this observation

Chilling requirements and dormancy evolution in grapevine buds.

Fluctuations in winter chilling availability impact bud dormancy and budburst. The objective of this work was to determine chilling requirements to induce and overcome endodormancy (dormancy controlled by chilling) of buds in different grape cultivars. "Chardonnay", "Merlot" and "Cabernet Sauvignon" shoots were collected in Veranópolis-RS vineyards in 2010, and submitted to a constant 3 °C temperature or daily cycles of 3/15 °C for 12/12h or 18/6h, until reaching 1120 chilling hours (CH, sum of hours with temperature ≤ 7.2 °C). Periodically, part of the samples in each treatment was transferred to 25 °C for budburst evaluation (green tip). Chilling requirements to induce and overcome endodormancy vary among cultivars, reaching a total of 136 CH for "Chardonnay", 298 CH for "Merlot" and 392 CH for "Cabernet Sauvignon". Of these, approximately 39, 53 and 91 CH are required for induction of endodormancy in the three cultivars, respectively. The thermal regimes tested (constant or alternating) do not influence the response pattern of each cultivar to cold, with 15 °C being inert in the CH accumulation process. In addition, time required to start budburst reduces with the increase in CH, at a rate of one day per 62 CH, without significant impacts on budburst uniformity. Index terms: Chilling hours; endodormancy; budburst; Vitis vinifera

Impact of species and antibiotic therapy of enterococcal peritonitis on 30-day mortality in critical care - An analysis of the OUTCOMEREA database

Introduction: Enterococcus species are associated with an increased morbidity in intraabdominal infections (IAI). However, their impact on mortality remains uncertain. Moreover, the influence on outcome of the appropriate or inappropriate status of initial antimicrobial therapy (IAT) is subjected to debate, except in septic shock. The aim of our study was to evaluate whether an IAT that did not cover Enterococcus spp. was associated with 30-day mortality in ICU patients presenting with IAI growing with Enterococcus spp. Material and methods: Retrospective analysis of French database OutcomeRea from 1997 to 2016. We included all patients with IAI with a peritoneal sample growing with Enterococcus. Primary endpoint was 30-day mortality. Results: Of the 1017 patients with IAI, 76 (8%) patients were included. Thirty-day mortality in patients with inadequate IAT against Enterococcus was higher (7/18 (39%) vs 10/58 (17%), p = 0.05); however, the incidence of postoperative complications was similar. Presence of Enterococcus spp. other than E. faecalis alone was associated with a significantly higher mortality, even greater when IAT was inadequate. Main risk factors for having an Enterococcus other than E. faecalis alone were as follows: SAPS score on day 0, ICU-acquired IAI, and antimicrobial therapy within 3 months prior to IAI especially with third-generation cephalosporins. Univariate analysis found a higher hazard ratio of death with an Enterococcus other than E. faecalis alone that had an inadequate IAT (HR = 4.4 [1.3-15.3], p = 0.019) versus an adequate IAT (HR = 3.1 [1.0-10.0], p = 0.053). However, after adjusting for confounders (i.e., SAPS II and septic shock at IAI diagnosis, ICU-acquired peritonitis, and adequacy of IAT for other germs), the impact of the adequacy of IAT was no longer significant in multivariate analysis. Septic shock at diagnosis and ICU-acquired IAI were prognostic factors. Conclusion: An IAT which does not cover Enterococcus is associated with an increased 30-day mortality in ICU patients presenting with an IAI growing with Enterococcus, especially when it is not an E. faecalis alone. It seems reasonable to use an IAT active against Enterococcus in severe postoperative ICU-acquired IAI, especially when a third-generation cephalosporin has been used within 3 months. © 2019 The Author(s)