Early pregnancy IGF‐I and placental GH and risk of epithelial ovarian cancer: A nested case‐control study

Insulin‐like growth factor‐I (IGF‐I) signaling may promote ovarian tumor development by exerting mitotic, antiapoptotic and proangiogenic effects. During pregnancy, maternal production of IGF‐I is regulated by placental growth hormone (GH). Parity is an established protective factor for ovarian cancer, however, no prior study has evaluated placental GH and IGF‐I in pregnancy and epithelial ovarian cancer (EOC). Prior prospective studies on the association between IGF‐I and EOC in nonpregnant populations were inconclusive and did not address associations in subtypes of EOC. Among members of the Finnish Maternity Cohort and the Northern Sweden Maternity Cohort, we identified 1,045 EOC cases, diagnosed after recruitment (1975–2008) and before March 2011 and 2,658 individually matched controls. Placental GH and IGF‐I were measured in serum from the last pregnancy before EOC diagnosis or selection as control. We used conditional logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for tertiles and a doubling of hormone concentrations. Higher IGF‐I was associated with a nonsignificant decrease in risk for invasive [OR_{T3 vs. T1}: 0.79 (0.62–1.02); p_trend = 0.07] and endometrioid tumors [OR_{T3 vs. T1}: 0.55 (0.28–1.07); p_trend = 0.07]. The protective association between higher IGF‐I levels and risk of invasive EOC was stronger in analyses limited to women aged <55 years at diagnosis [OR_{T3 vs. T1}: 0.74 (0.57–0.96); p_trend = 0.03]. Our study provides the first data on placental GH and IGF‐I in pregnancy and EOC risk overall and by subtype. Our data suggest higher IGF‐I levels in pregnancy may be associated with lower risk of invasive and endometrioid EOC.     

Lower 5-year cup re-revision rate for dual mobility cups compared with unipolar cups: report of 15,922 cup revision cases in the Dutch Arthroplasty Register (2007–2016)

Background and purpose

For 20 years, medical treatment of rheumatoid arthritis (RA) has been improving and the incidence of joint surgery has decreased. We investigated the rates of primary ankle joint arthrodesis and total ankle arthroplasty in patients with RA in Finland between 1997 and 2010 to establish whether trends have changed during that period.

Methods

The annual figures for primary ankle joint arthrodeses and total ankle replacements performed in patients with RA were obtained from nationwide population-based registries. Incidences were calculated per population of 10⁵ and they are reported in 2-year periods.

Results

During the study period, 593 primary ankle joint arthrodeses and 318 total ankle arthroplasties were performed in patients with RA. The incidence of ankle joint arthrodesis reached its highest value (2.4/10⁵) in 1997–1998 and it was lowest in 2001–2002 (1.1/10⁵). After 2002, the incidence increased slightly but did not reach the level in 1997–1998, even though total ankle replacements almost ended in Finland during the period 2009–2010. From 1997, total ankle replacements increased until 2003–2004 (incidence 1.5/10⁵) and then gradually decreased. In 2009–2010, the incidence of total ankle replacements was only 0.4/10⁵.

Interpretation

During the observation period 1997–2010, while total ankle replacements generally became more common in patients with RA, the incidence of primary ankle joint arthrodesis decreased and did not increase in the period 2009-2010, even though total ankle replacement surgery almost ended in Finland. No change in the incidence of these operations, when pooled together, was observed from 1997 to 2010.In rheumatoid arthritis (RA), an alternative to ankle joint arthrodesis is total ankle arthroplasty (TAA). TAA preserves joint motion and function, with protection of other joints (Valderrabano et al. 2003, Doets et al. 2007, Piriou et al. 2008). Currently, the main indications for TAA are end-stage idiopathic, inflammatory, and post-traumatic osteoarthritis (Rydholm 2007, Skyttä et al. 2010, Henricson et al. 2011).During the past 2 decades, medical treatment for RA has improved. Studies from different countries have suggested that rates of joint replacement in RA have decreased in recent years (Da Silva et al. 2003, Kobelt et al. 2004, Ward 2004, Pedersen et al. 2005, Weiss et al. 2006, 2008, Sokka et al. 2007, Momohara et al. 2010, Jämsen et al. 2013). However, there have only been a few studies on the incidence of ankle joint arthrodesis and TAA in patients with RA (Fevang et al. 2007, Louie and Ward 2010).Using data from nationwide population-based registries, we determined the rates of primary ankle joint arthrodesis and TAA in patients with RA in Finland, 1997–2010.     

Survival and complications are similar after Swanson and Sutter implant replacement of metacarpophalangeal joints in patients with rheumatoid arthritis

We compared the survival, fracture, and deformation rates of Swanson and Sutter implants in a prospective series of 53 patients with rheumatoid arthritis (RA). Fifty-eight hands were operated on with 215 silastic implants. The Swanson group comprised 25 hands and 89 implants, and the Sutter group 33 and 126, respectively. Follow up was 58 (37–80) months. During a period of 48 months the survival of Swanson and Sutter prostheses did not differ significantly: 92% (95% CI 84% to 96%) and 97% (95% CI 92% to 99%), respectively. The fracture rate was high in both groups: 26 (34%) in the Swanson and 25 (26%) in the Sutter group. There was no significant difference between the groups in definite fracture rates of implants. The Sutter prosthesis appears to be at least as durable an implant in rheumatoid patients’ metacarpophalangeal arthroplasty as the Swanson.     

Clinical questionnaire study of oral health care and symptoms in diabetic vs. non-diabetic predialysis chronic kidney disease patients

This paper aims to study oral symptoms (burning mouth sensation, xerostomia, dysphagia, and dysgeusia) and background characteristics among chronic kidney disease (CKD) patients. The hypothesis was that patients experience oral discomfort and show interest towards dental care differently depending on the origin of their kidney disease. One hundred thirty-eight CKD patients at predialysis stage (94 men, 44 women, mean age 54 years) at the Helsinki University Central Hospital participated in the study. The patients were divided into a diabetic nephropathy group and a group of patients with other kidney diseases. The patients had a clinical oral examination and filled in a structured questionnaire. The data were analyzed and compared between the groups (SPSS for Windows version 15.0). T test was used for parameters normally distributed while binomial data were analyzed with cross-tabulations and chi-square test. Contrary to our study hypothesis, no statistically significant differences were seen in the questionnaire study between the diabetic vs. non-diabetic CKD patients in any other study parameter except in the use of medication (10 ± 2.3 vs. 8 ± 3.1 drugs daily, p < 0.05), and working status (23.5% vs. 50% working full time, p < 0.01). No difference was seen in the frequency of oral discomfort among the different groups. Xerostomia, however, was frequently observed among the predialysis patients investigated (41.7% in diabetic, 48.2% in non-diabetic patients). No difference was seen in the frequency of oral discomfort among the different groups of predialysis patients investigated. Clinicians should be aware of nephropathy patients who frequently suffer from oral discomfort, particularly xerostomia.