Gender and prevalence of knee osteoarthritis types in elderly Koreans

We undertook to document sex differences in the prevalence of knee osteoarthritis (OA) at different disease stages in an elderly Korean population. Prevalence of 3 stages of knee OA (radiographic OA, severe radiographic OA, and candidacy for total knee arthroplasty [TKA]) was investigated in 696 elderly (≥65 years old) Korean subjects. Multivariate logistic regression was performed to evaluate associations between the risk factors of OA at these 3 disease stages. The overall prevalence of knee OA was 38.1% for radiographic OA, 26.4% for severe radiographic OA, and 6.5% for advanced OA warranting TKA. Women had much higher prevalence for all 3 stages. Female sex was found to be the strongest predictor for all 3 disease stages, but this was most remarkable for TKA candidates. This study documents that knee OA is highly prevalent among Korean elderly and that elderly Korean women are at much greater risk of requiring TKA.     

A study of the prevalence and associations of subchondral bone marrow lesions in the knees of healthy, middle-aged women

OBJECTIVE: Bone marrow lesions (BMLs) have been shown to be associated with pain and progression of knee osteoarthritis (OA) in those with disease. The natural history of BMLs in a healthy population and their role in the pathogenesis of OA are unknown. The aim of this study was to determine the risk factors for BMLs in healthy subjects and the association of BMLs with knee structure. METHODS: One hundred and seventy-six healthy, adult women with no history of knee injury, or clinical knee OA had magnetic resonance imaging performed on their dominant knee to assess BMLs, tibiofemoral cartilage defects, tibial cartilage volume and bone area. RESULTS: Thirteen percent of subjects had knee BMLs. The prevalence was higher in the medial tibiofemoral compartment. There was a significant positive association between BMLs and cartilage defects after adjusting for the potential risk factors: age, height, weight and cartilage volume [odds ratio (OR) 1.78 (95% confidence interval [CI] 1.12, 2.82), P=0.01]. BML was positively associated with tibial plateau bone area in the lateral compartment [OR 1.67 (95% CI 1.02, 2.71), P=0.04]. There was no significant association between BMLs and cartilage volume. Independent risk factors for BMLs after adjustment were increasing height [OR 1.18 (95% CI 1.02, 1.36), P=0.02 for lateral compartment] and weight [OR 1.04 (95% CI 1.01, 1.08), P=0.005 for total knee]. CONCLUSION: These data support that BMLs are present in a similar distribution to tibiofemoral knee OA. Their presence is associated with risk factors (height and weight) for knee OA, and the early structural changes of knee OA in subjects without knee pain and thus no clinical disease. Longitudinal studies will clarify whether BMLs relate to the pathogenesis of clinical knee OA.     

Relationship of limb length inequality with radiographic knee and hip osteoarthritis

OBJECTIVE: This study examined the relationship of limb length inequality (LLI) with radiographic hip and knee osteoarthritis (OA) in a large, community-based sample. METHODS: The total study group comprised 926 participants with radiographic knee OA, 796 with radiographic hip OA, and 210 (6.6%) with LLI >or=2cm. The presence of radiographic OA was defined as Kellgren/Lawrence (K/L) grade >or=2. Multiple logistic regression models were used to examine the relationship of LLI with hip and knee OA, while controlling for age, gender, race, body mass index, and history of hip or knee problems (joint injury, fracture, surgery, or congenital anomalies). RESULTS: In unadjusted analyses, participants with LLI were more likely than those without LLI to have radiographic knee OA (45.1% vs 28.3%, P<0.001) and radiographic hip OA (35.2% vs 28.7%, P=0.063). In multiple logistic regression models, knee OA was significantly associated with presence of LLI (adjusted Odds Ratio [aOR]=1.80, 95% Confidence Interval [95% CI] 1.29-2.52), but there was no significant relationship between hip OA and LLI (aOR=1.20, 95% CI 0.86-1.67). Among participants with LLI, right hip OA was more common when the contralateral limb was longer than when the ipsilateral limb was longer (30.3% vs 17.5%, P=0.070). CONCLUSION: LLI was associated with radiographic knee OA, controlling for other important variables. Future research should examine the relationship of LLI with hip or knee OA incidence, progression, and symptom severity, as well as the efficacy for LLI corrective treatments in OA.     

The relation between body mass index and waist–hip ratio in knee osteoarthritis

Background

The best measure of body habitus as a risk factor for chronic disease is not well defined. Our intent was to examine the relation between waist–hip ratio (WHR) and body mass index (BMI) as a measurement of body habitus in patients with end-stage knee osteoarthritis (OA).

Methods

We reviewed the data of 200 consecutive patients in our registry undergoing knee replacement surgery for demographic data of age, sex, BMI and WHR. We performed a stratified analysis by sex and calculated the risk ratios (RRs) to describe the risk of being classified as obese by WHR for those considered obese by the BMI criteria.

Results

A similar percentage of male and female patients were classified as obese by the BMI criteria (38% v. 42%, respectively). Men were classified as obese more often than women by WHR (92% v. 82%). The RR of being obese as determined by WHR if classified as obese by the BMI criteria was 1.04 (95% confidence interval [CI] 0.91–1.18) for men and 1.23 (95% CI 1.03–1.46) for women.

Conclusion

Among patients with knee OA, the overlap between BMI and WHR is greater in women than men. This difference has implications for defining the prevalence of metabolic syndrome in this population.     

Risk factors in familial osteoarthritis: the GARP sibling study

PURPOSE: To investigate the association between systemic and local risk factors and familial osteoarthritis (OA) at multiple sites. METHODS: Patients and their siblings had primary OA at multiple sites at middle age. OA diagnosis followed the American College of Rheumatology criteria. We recruited 345 controls (mean age 57 years (range 40-76), 64% women) by random sampling from the population by telephone and collected all data by questionnaires. Odds ratios (ORs) were adjusted for sex, age and body mass index (BMI) (kg/m(2)), 95% confidence intervals (CIs95) were computed using robust standard errors with the intra-family effect taken into account. RESULTS: Three hundred and eighty-two patients (mean age 60 years [range 43-79]), 82% women had OA in the spine (80%), hands (72%), knees (34%) and hips (24%). In women, an association of familial OA with a young age at natural menopause (<45 years), OR=2.6 (CI95 1.5-4.5) was found. Physically demanding jobs led to an increased risk of familial OA in men: OR=2.6 (CI95 1.3-5.3). Familial OA was more prevalent in individuals with a BMI>30, OR=2.0 (CI95 1.3-3.2) compared to a BMI of <25. Taller persons had a lower risk of familial OA, OR=0.33 (0.1-0.8) in the height category >180 cm relative to a height of <160 cm. A history of meniscectomy, increased the risk of familial OA at multiple sites with knee involvement, OR=6.2 (CI95 3.0-12.7). CONCLUSIONS: Systemic and local risk factors play a role in the etiology of familial OA at multiple sites.     

The efficacy of 5-HT3 receptor antagonists for the prevention of postoperative nausea and vomiting after craniotomy: a meta-analysis

The purpose of this meta-analysis was to assess the efficacy of prophylactic administration of 5-HT3 receptor antagonists for postoperative nausea and vomiting in neurosurgical patients at 24 and 48+ hours. After a systematic search, 7 published randomized placebo controlled trials involving 448 craniotomy patients (222 treatment, 226 control) were included in the meta-analysis. Study drugs included ondansetron, granisetron, and tropisetron. The cumulative incidence of emesis was significantly reduced in the treatment group at 24 hours [relative risk (RR)=0.50, 95% confidence interval (CI): 0.38-0.66] and 48+ hours (RR=0.52, 95% CI: 0.36-0.75). There were no differences between the treatment and control groups in the cumulative incidence of nausea at 24 hours (RR=0.76, 95% CI: 0.54-1.06) and 48+ hours (RR=0.81, 95% CI: 0.62-1.06). The cumulative incidence of both nausea and vomiting continued to increase after 24 hours in both groups. Despite the ability of 5-HT3 receptor antagonists to reduce emetic episodes, future investigations should seek to address the control of postoperative nausea and to reduce further postoperative emesis in this population.     

Incidence and natural history of Paget's disease of bone in England and Wales.

This study used a large, primary care, record-linkage resource (the General Practice Research Database [GPRD]) to evaluate the incidence, clinical presentation, and natural history of Paget's disease of bone in England and Wales. Between 1988 and 1999, we identified 2465 patients with the recorded diagnosis of Paget's disease of bone, within the five million subjects > or = 18 years old who were registered in the GPRD. The validity of diagnostic recording was assessed by questionnaire to individual general practitioners (GPs) in 150 patients; the diagnosis was confirmed in 93.8% of responders. The mean age of patients with Paget's disease was 75 years and 51% were men. The prevalence of the disorder was 0.3% among men and women aged > or = 55 years; incidence rates for clinically diagnosed Paget's disease rose steeply with age (men, 5 per 10,000 person-years; women, 3 per 10,000 person-years at the age of 75 years). Over the 11-year period of the study, the age- and sex-adjusted incidence rate of clinically diagnosed Paget's disease declined from 1.1 per 10,000 person-years to 0.7 per 10,000 person-years. Each patient with Paget's disease was matched to three controls matched by age, gender, and general practice. Cases had a greater risk of back pain (relative risk [RR], 2.1; 95% CI, 1.9-2.3), osteoarthritis (OA; RR, 1.7; 95% CI, 1.5-1.9), hip arthroplasty (RR, 3.1; 95% CI, 2.4-4.1), knee arthroplasty (RR, 1.6; 95% CI, 1.0-2.6), fracture (RR, 1.2; 95% CI, 1.0-1.5), and hearing loss (RR, 1.6; 95% CI, 1.3-1.9). Seven patients with Paget's disease developed a malignant bone neoplasm (0.3%). Using life table methodology, the estimated number of people who died within 5 years of follow-up was 32.7% among the patients with Paget's disease and 28.0% among the control patients.     

Prevalence and Risk Factors of Spine,Shoulder, Hand,Hip, and Knee Osteoarthritis in Community-dwelling Koreans Older Than Age 65 Years

Background

Osteoarthritis (OA) is common and disabling among older patients around the world. Data exploring the prevalence and risk factors of OA are of paramount importance in establishing healthcare policies. However, few studies have evaluated these topics among Asian populations.

Questions/purposes

This study was conducted to determine the prevalence and risk factors of radiographic OA in the spine, shoulder, hand, hip, and knee in Koreans older than age 65 years.

Methods

A simple random sample (N = 1118) was drawn from a roster of elderly individuals older than age 65 years in Seongnam. Of the 1118 invited subjects, 696 (males = 298, females = 398) participated in this study (a response rate of 62%). The mean age of respondents was 72 ± 5 years (range, 65–91 years). Radiographs of the lumbar spine, shoulder, hand, hip, and knee were taken and afterward evaluated for radiographic OA. The Kellgren-Lawrence grading system was used for all mentioned joints, and radiographic OA was defined as Grade 2 changes or higher. The association of sex, aging, and obesity with OA in each of the mentioned joints was determined with the help of multivariate logistic regression.

Results

The highest prevalence of radiographic OA was seen in the spine (number of subjects with OA/number of whole population = 462 of 696 [66%]) followed by the hand (415 of 692 [60%]), knee (265 of 696 [38%]), shoulder (36 of 696 [5%]), and hip (15 of 686 [2%]). Female sex was associated with knee OA (odds ratio [OR], 5.7; 95% confidence interval [CI], 3.9–8.4; p < 0.001) and hand OA (OR, 2.3; 95% CI, 1.6–3.1; p < 0.001), and male sex was associated with spine OA (OR, 0.7; 95% CI, 0.5–1.0; p = 0.025). Aging was associated with radiographic OA in the spine, knee, and hand (OR per 5-year increments, 1.3 [95% CI, 1.1–1.6; p = 0.001], 1.6 [95% CI, 1.4–1.9; p < 0.001], and 1.4 [95% CI, 1.2–1.7; p < 0.001]), respectively) but not associated with OA in the hip and shoulder. Obesity was associated with knee OA (OR, 3.4; 95% CI, 2.4–5.0; p < 0.001) and spine OA (OR, 1.5; 95% CI, 1.1–2.2; p = 0.014) but not with OA in other joints.

Conclusions

OA of the spine, hand, and knee is likely to become a major public health problem rather than shoulder and hip OA in Korea. Associations of demographic factors with radiographic OA differed among each joint, and that would be valuable information to assess the role and influence of risk factors of OA in various joints.

Level of Evidence

Level III, prognostic study.     

Risk factors for the incidence and progression of radiographic osteoarthritis of the knee among Japanese

This longitudinal study aimed to identify risk factors for the incidence and progression of radiographic knee osteoarthritis (OA). We examined the inhabitants of Miyagawa village aged ≥65 years every two years between 1997 and 2007. Anteroposterior radiographs of both knees were graded for OA using the Kellgren-Lawrence (K/L) grading system. Knee OA was defined as grade ≥2. We recorded the incidence of knee OA among participants in whom both knees changed from K/L grades 0 or 1 to ≥2 over a four-year follow-up period. We also recorded the progression of knee OA using this threshold among patients in whom one or both knees changed from K/L grades 2 or 3 to any higher grade over the follow-up period. Baseline data obtained from standard questionnaires, physical findings and X-rays included age, gender, body mass index (BMI), osteoporosis, Heberden’s nodes, knee range of motion (ROM), knee pain and cigarette smoking. The rates of incidence and progression of knee OA among 360 participants (241 women, 119 men) who fulfilled the study criteria were 4.0 and 6.0% per year, respectively. Female gender (odds ratio [OR] 2.849, 95% confidence interval [CI] 1.170–6.944) and high BMI (OR 1.243, 95% CI 1.095–1.411) were significantly associated with the incidence of knee OA, and restricted knee ROM (OR 0.941, 95% CI 0.892–0.992) was significantly associated with knee OA progression. Patients with a low knee ROM relative to grade of radiographic knee OA require more careful follow-up than those with a higher ROM.     

Structural abnormalities detected by knee magnetic resonance imaging are common in middle-aged subjects with and without risk factors for osteoarthritis

Background and purpose — Few data are available regarding structural changes present in knees without radiographically evident osteoarthritis (OA). We evaluated the prevalence of findings suggestive of knee OA by magnetic resonance imaging (MRI) in middle-aged subjects without radiographic OA with or without OA risk factors.

Patients and methods — 340 subjects from the Osteoarthritis Initiative, aged 45–55 years (51% women) with Kellgren–Lawrence grade 0 in both knees, who had 3T knee MR images were eligible. 294 subjects had risk factors and 46 were without risk factors. MR images were assessed using the MOAKS scoring system.

Results — At least 1 MR-detected feature was found in 96% (283/294) of subjects with risk factors and in 87% (40/46) of those without. Cartilage damage (82%), bone marrow lesions (60%), osteophytes (45%), meniscal body extrusion (32%), and synovitis–effusion (29%) were the most common findings in subjects with risk factors, while cartilage damage (67%), osteophytes (46%), meniscal body extrusion (37%), and bone marrow lesions (35%) were most common in subjects without. The prevalence of any abnormality was higher in subjects with OA risk factors than in subjects without (prevalence ratio adjusted for age and sex 1.3 [95% CI 1.1–1.6]), so was prevalence of subchondral cysts and bone marrow lesions. MR-detected structural changes were more frequent in patellofemoral joints.

Interpretation — Our findings highlight the great challenge in distinguishing pathological features of early knee OA from what could be considered part of “normal ageing.” Bone marrow lesions were more frequently found in subjects with multiple OA risk factors.     

Sex differences in outcomes following coronary artery bypass grafting: a meta-analysis

 Open in a separate windowOBJECTIVESPrevious reports have found females are a higher risk of morbidity and mortality following isolated coronary artery bypass grafting (CABG). Here, we describe the differences in outcomes following isolated CABG between males and females.METHODSFollowing a systematic literature search, studies reporting sex-related outcomes following isolated CABG were pooled in a meta-analysis performed using the generic inverse variance method. The primary outcome was operative mortality. Secondary outcomes included rates of stroke, repeat revascularization, myocardial infarction, major adverse cardiac events, and late mortality. Subgroup analyses were performed for studies published before and after the year 2000 and for the type of risk adjustment.RESULTSEighty-four studies were included with a total of 903 346 patients. Females were at higher risk for operative mortality (odds ratio: 1.77, 95% confidence interval [CI]: 1.64–1.92, P < 0.001). At subgroup analysis, there was no difference in operative or late mortality between studies published prior and after 2000 or between studies using risk adjustment. Females were at a higher risk of late mortality (incidence rate ratio [IRR]: 1.16, 95% CI: 1.06–1.26, P < 0.001), major adverse cardiac events (IRR: 1.40, 95% CI: 1.19–1.66, P < 0.001), myocardial infarction (IRR: 1.28, 95% CI: 1.13–1.45, P < 0.001) and stroke (IRR: 1.31, 95% CI: 1.15–1.51, P > 0.001) but not repeat revascularization (IRR: 0.99, 95% CI: 0.76–1.29, P = 0.95). The use of the off-pump technique or multiple arterial grafts was not associated with the primary outcome.CONCLUSIONSFemales undergoing CABG are at higher risk for operative and late mortality as well as postoperative events including major adverse cardiac events, myocardial infarction and stroke. PROSPERO registrationCRD42020187556     

Type 2 diabetes, APOE gene, and the risk for dementia and related pathologies: The Honolulu-Asia Aging Study

Type 2 diabetes may be a risk factor for dementia, but the associated pathological mechanisms remains unclear. We evaluated the association of diabetes alone or combined with the apolipoprotein E (APOE) gene with incident dementia and neuropathological outcomes in a population-based cohort of 2,574 Japanese-American men enrolled in the Honolulu-Asia Aging Study, including 216 subjects who underwent autopsy. Type 2 diabetes was ascertained by interview and direct glucose testing. Dementia was assessed in 1991 and 1994 by clinical examination and magnetic resonance imaging and was diagnosed according to international guidelines. Logistic regression was used to assess the RR of developing dementia, and log-linear regression was used to estimate the incident rate ratio (IRR) of neuropathological outcomes. Diabetes was associated with total dementia (RR 1.5 [95% CI 1.01-2.2]), Alzheimer's disease (AD; 1.8 [1.1-2.9]), and vascular dementia (VsD; 2.3 [1.1-5.0]). Individuals with both type 2 diabetes and the APOE epsilon4 allele had an RR of 5.5 (CI 2.2-13.7) for AD compared with those with neither risk factor. Participants with type 2 diabetes and the epsilon4 allele had a higher number of hippocampal neuritic plaques (IRR 3.0 [CI 1.2-7.3]) and neurofibrillary tangles in the cortex (IRR 3.5 [1.6-7.5]) and hippocampus (IRR 2.5 [1.5-3.7]), and they had a higher risk of cerebral amyloid angiopathy (RR 6.6, 1.5-29.6). Type 2 diabetes is a risk factor for AD and VsD. The association between diabetes and AD is particularly strong among carriers of the APOE epsilon4 allele. The neuropathological data are consistent with the clinical results.     

Offspring health risk after cosmetic breast implantation in Sweden

Case reports have suggested that children born to women with silicone breast implants may have an excess risk of rheumatic disease and/or esophageal disorders. In Sweden, the authors conducted a retrospective cohort study of 5,874 children born to women with cosmetic breast implants and 13,274 children born to women who had breast reduction surgery. Using national registers, they computed hospitalization rates for rheumatic and esophageal disorders, incidence rates for cancer, and prevalence rates for congenital malformations and perinatal death. Relative to children of women who had breast reduction surgery, children born to women who had cosmetic breast implants were not at excess risk of rheumatic disease (relative risk [RR] = 1.1; 95% confidence interval [95% CI], 0.2-5.3), esophageal disorders (RR = 1.0; 95% CI, 0.7-1.6), cancer (RR = 0.3; 95% CI, 0.0-2.5), congenital malformations in total (RR = 1.0; 95% CI, 0.6-1.5), or specifically involving the digestive organs (RR = 0.5; 95% CI, 0.2-1.3) or perinatal death (RR = 0.9; 95% CI, 0.5-1.8). The rates of these health outcomes among children born after a mother's implant surgery were also not significantly higher than among children born before a mother's implant surgery. This study provides no evidence that certain hypothesized health outcomes are more likely among the children of women with cosmetic breast implants.     

Total hip replacement after femoral neck fractures in elderly patients : Results of 8,577 fractures reported to the Norwegian Arthroplasty Register

Background?A total hip arthroplasty (THA) is often used as treatment for failed osteosynthesis of femoral neck fractures and is now also used for acute femoral neck fractures. To investigate the results of THA after femoral neck fractures, we used data from the Norwegian Arthroplasty Register (NAR).

Patients and methods?The results of primary total hip replacements in patients with acute femoral neck fractures (n = 487) and sequelae after femoral neck fractures (n = 8,090) were compared to those of total hip replacements in patients with osteoarthrosis (OA) (n = 55,109). The hips were followed for 0–18 years. The Cox multiple regression model was used to construct adjusted survival curves and to adjust for differences in sex, age, and type of cement among the diagnostic groups. Separate analyses were done on the subgroups of patients who were operated with Charnley prostheses.

Results?The survival rate of the implants after 5 years was 95% for the patients with acute fractures, 96% for the patients with sequelae after fracture, and 97% for the OA patients. With adjustment for age, sex, and type of cement, the patients with acute fractures had an increased risk of revision compared to the OA patients (RR 1.6, 95% CI: 1.0–2.6; p = 0.05) and the sequelae patients had an increased risk of revision (RR 1.3, 95% CI: 1.2–1.5; p < 0.001). Sequelae hips had higher risk of revision due to dislocation (RR 2.0, 95% CI: 1.6–2.4; p < 0.001) and periprosthetic fracture (RR 2.2, 95% CI: 1.5–3.3; p < 0.001), and lower risk of revision due to loosening of the acetabular component (RR 0.72, 95% CI; 0.57–0.93; p = 0.01) compared to the OA patients. The increased risk of revision was most apparent for the first 6 months after primary operation.

Interpretation?THA in fracture patients showed good results, but there was an increased risk of early dislocations and periprosthetic fractures compared to OA patients.     

Low revision rate after total hip arthroplasty in patients with pediatric hip diseases

Background The results of primary total hip arthroplasties (THAs) after pediatric hip diseases such as developmental dysplasia of the hip (DDH), slipped capital femoral epiphysis (SCFE), or Perthes’ disease have been reported to be inferior to the results after primary osteoarthritis of the hip (OA).

Materials and methods We compared the survival of primary THAs performed during the period 1995–2009 due to previous DDH, SCFE, Perthes’ disease, or primary OA, using merged individual-based data from the Danish, Norwegian, and Swedish arthroplasty registers, called the Nordic Arthroplasty Register Association (NARA). Cox multiple regression, with adjustment for age, sex, and type of fixation of the prosthesis was used to calculate the survival of the prostheses and the relative revision risks.

Results 370,630 primary THAs were reported to these national registers for 1995–2009. Of these, 14,403 THAs (3.9%) were operated due to pediatric hip diseases (3.1% for Denmark, 8.8% for Norway, and 1.9% for Sweden) and 288,435 THAs (77.8%) were operated due to OA. Unadjusted 10-year Kaplan-Meier survival of THAs after pediatric hip diseases (94.7% survival) was inferior to that after OA (96.6% survival). Consequently, an increased risk of revision for hips with a previous pediatric hip disease was seen (risk ratio (RR) 1.4, 95% CI: 1.3–1.5). However, after adjustment for differences in sex and age of the patients, and in fixation of the prostheses, no difference in survival was found (93.6% after pediatric hip diseases and 93.8% after OA) (RR 1.0, CI: 1.0–1.1). Nevertheless, during the first 6 postoperative months more revisions were reported for THAs secondary to pediatric hip diseases (RR 1.2, CI: 1.0–1.5), mainly due to there being more revisions for dislocations (RR 1.8, CI: 1.4–2.3). Comparison between the different diagnosis groups showed that the overall risk of revision after DDH was higher than after OA (RR 1.1, CI: 1.0–1.2), whereas the combined group Perthes’ disease/SCFE did not have a significantly different risk of revision to that of OA (RR 0.9, CI: 0.7–1.0), but had a lower risk than after DDH (RR 0.8, CI: 0.7–1.0).

Interpretation After adjustment for differences in age, sex, and type of fixation of the prosthesis, no difference in risk of revision was found for primary THAs performed due to pediatric hip diseases and those performed due to primary OA.     

Early endoscopic retrograde cholangiopancreatography versus conservative management in acute biliary pancreatitis without cholangitis: a meta-analysis of randomized trials

BACKGROUND: Early endoscopic retrograde cholangiopancreatography (ERCP) should be performed in all patients with acute biliary pancreatitis (ABP) and coexisting acute cholangitis. In patients without cholangitis and predicted mild ABP it is generally accepted that early ERCP should not be performed. Nevertheless, there is a controversy regarding the role of early ERCP in the treatment of patients with predicted severe ABP without cholangitis. We reviewed randomized trials on early ERCP versus conservative management in patients with ABP without acute cholangitis. METHODS: Relevant publications in 3 electronic databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials) were systematically reviewed and meta-analyzed. RESULTS: Seven randomized trials on ERCP in acute pancreatitis were found, of which 3 including a total of 450 patients (230 in the invasive arm and 220 in the control arm) qualified for a meta-analysis according to predefined criteria. In all patients with ABP (predicted mild and severe), early ERCP was associated with a nonsignificant reduction in overall complications [risk ratio (RR) 0.76; 95% confidence interval (CI) 0.41-1.04; P = 0.38] and a nonsignificant increase in mortality (RR 1.13; 95% CI 0.23-5.63; P = 0.88). Subgroup analysis based on predicted severity did not affect these outcomes (overall complications: predicted mild: RR 0.86; 95% CI 0.62-1.19; P = 0.36; predicted severe: RR 0.82; 95% CI 0.32-2.10; P = 0.68; mortality: predicted mild: RR 1.90; 95% CI 0.25-14.55; P = 0.53; predicted severe: RR 1.28; 95% CI 0.20-8.06; P = 0.80). CONCLUSION: In this meta-analysis, early ERCP in patients with predicted mild and predicted severe ABP without acute cholangitis did not lead to a significant reduction in the risk of overall complications and mortality.     

A meta-analysis of the association of physical activity with reduced risk of colorectal cancer

BACKGROUND: Physical activity may be associated with reduced risk of colorectal cancer. The main aim of this paper is to review the available evidence for a link between exercise and large bowel cancer. METHODS: A Cochrane-type methodology was performed. Data extracted included, type of study, type of physical activity measured and the numerical results. The risk ratios (RR) of the studies have been pooled according to the type of study, type of exercise, type of cancer and sex. Pooling was undertaken using fixed effect meta-analysis. A random effect meta-analysis was used where substantial heterogeneity existed. RESULT: Data from 19 cohort studies showed a statistically significant reduction in the risk of colon cancer in physically active males, RR being 0.79 (95% CI 0.72-0.87) and 0.78 (95% CI 0.68-0.91) for occupational and recreational activities, respectively. In women only recreational activities are protective against colon cancer (RR = 0.71, 95%CI 0.57-0.88). Case-control studies showed significantly reduced risks of colon cancer in both sexes irrespective of the type of activity. No protection against rectal cancer is seen in either sex. CONCLUSION: There is considerable evidence that physical activity is associated with reduced risk of colon cancer in both males and females.     

Association of collagen Ialpha 1 Sp1 polymorphism with the risk of prevalent fractures: a meta-analysis.

Several studies have addressed the effect of the Spl polymorphism of the collagen Ialpha 1 (COLIA1) gene on the prevalence of fractures. The results are not in full agreement on whether this polymorphism is associated with fracture risk. To clarify this uncertainty, we performed a meta-analysis including 13 eligible studies with 3641 subjects. The COLIA1 Spl polymorphism showed a dose-response relationship with the prevalence of fractures. The risk was 1.25-fold (95% CI, 1.09-1.45) in Ss heterozygotes versus SS homozygotes, 1.68-fold (95% CI, 1.35-2.10) in ss homozygotes versus SS homozygotes, and 1.35 (95% CI, 1.04-1.75) for ss homozygotes versus Ss heterozygotes by random effects calculations. There was modest heterogeneity for these three effect estimates (p value for heterogeneity, 0.17, 0.16, and 0.08, respectively). The Sp1 polymorphism effects possibly were larger when the analysis was limited to studies considering only vertebral fractures (pooled risk ratios [RR], 1.30, 2.07, and 1.46, respectively). Conversely, the Spl polymorphism effects tended to be smaller in studies with mean patient age > or = 65 years than in studies with younger patients on average, but the differences were not formally significant. We estimated the total average attributable fraction (AF) of fractures due to the s allele in European/U.S. populations as 9.4%. The meta-analysis suggests an important role for the Spl polymorphism in the regulation of fracture risk; however, potential heterogeneity across ethnic groups, age groups, and skeletal sites may be important to clarify in future studies. Very large studies or meta-analyses are required to document subtle genetic differences in fracture risk.     

Risk of Thyroid Cancer Among Solid Organ Transplant Recipients

Solid organ transplant recipients have an elevated incidence of thyroid cancer. We evaluated a wide range of potential risk factors in a cohort of 229 300 U.S. solid organ transplant recipients linked with 15 stage/regional cancer registries (1987–2012). Incidence rate ratios (IRRs) were adjusted for age, sex, race/ethnicity, transplanted organ, year of transplantation, and time since transplantation. Hazard ratios (HRs) for death and/or graft failure were adjusted for age, sex, race/ethnicity, transplanted organ, and year of transplantation. After transplantation, 356 thyroid cancers were diagnosed. Thyroid cancer incidence was 2.50‐fold higher in transplant recipients than the general population (95% confidence interval [CI] 2.25–2.77). Among recipients of different organs, kidney recipients had the highest incidence of thyroid cancer (IRR = 1.26, 95% CI 1.03–1.53). Elevated thyroid cancer incidence was associated with cholestatic liver disease/cirrhosis as an indication for liver transplantation (IRR = 1.69, 95% CI 1.09–2.63), hypertensive nephrosclerosis as an indication for kidney transplantation (IRR = 1.41, 95% CI 1.03–1.94), and longer prior dialysis among kidney recipients (5+ vs. <1 year, IRR = 1.92, 95% CI 1.32–2.80; p‐trend <0.01). Posttransplantation diagnosis of thyroid cancer was associated with modestly increased risk of death (HR = 1.33, 95% CI 1.02–1.73). Overall, our results suggest that end‐stage organ disease and longer duration of dialysis may contribute to higher thyroid cancer incidence in transplant recipients.     

Aceclofenac vs paracetamol in the management of symptomatic osteoarthritis of the knee: a double-blind 6-week randomized controlled trial

OBJECTIVE: To evaluate the efficacy and tolerability of aceclofenac, 200 mg/day, and paracetamol, 3000 mg/day, in the treatment of osteoarthritis (OA) of the knee. METHODS: This was a double-blind, parallel-group, multicentre clinical trial involving patients with symptomatic OA of the knee, conducted in Spain. Patients were randomly allocated to aceclofenac 100 mg twice daily (n=82) or paracetamol 1000 mg three times daily (n=86). Patients were assessed at baseline and 6 weeks. Primary efficacy measures were severity of pain (visual analogue scale, VAS), Lequesne OA knee index, and patient's and physician's global assessment of disease activity. Severity of knee pain at rest or walking, stiffness, knee swelling and tenderness, and assessment of health-related quality of life (Health Assessment Questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index, and Short Form 36) were included as secondary endpoints. RESULTS: Both treatment groups showed significant improvement compared with their baseline values in the four primary endpoints. Mean between-treatment differences favoured aceclofenac over paracetamol on pain (VAS, 7.64 mm [95% confidence interval (CI), 0.44-14.85 mm]), Lequesne OA index (1.41 [95% CI, 0.45-2.36]), and patient's (0.33 [95% CI, 0.06-0.61]) and physician's (0.23 [95% CI, 0.01-0.47]) global assessments. Adverse events were similar for both drugs (paracetamol, 29% patients vs aceclofenac, 32%; P=0.71). Four patients withdrew in each group due to adverse events. Patients tended to prefer aceclofenac to paracetamol (P=0.001), and more treated with paracetamol withdrew from the study due to lack of efficacy (n=8 vs n=1, P=0.035, for paracetamol and aceclofenac, respectively). CONCLUSION: At 6 weeks, patients with symptomatic OA of the knee showed a greater improvement in pain and functional capacity with aceclofenac than paracetamol with no difference in tolerability.