Incidence of total knee and hip replacement for osteoarthritis in relation to the metabolic syndrome and its components: A prospective cohort study

Objective

To examine whether components of metabolic syndrome (MetS), either singly or additively, were associated with the incidence of severe knee and hip OA, and whether these associations were independent of obesity assessed by body mass index (BMI).

Methods

Twenty thousand, four hundred and thirty participants who had blood lipids, anthropometric and blood pressure measurements during 2003–2007 were selected from the Melbourne Collaborative Cohort Study. MetS was defined as central obesity assessed by waist circumference and any two of raised triglyceride level, reduced HDL cholesterol level, hypertension or impaired fasting glycaemia. The incidence of total knee and hip replacement was determined by linking cohort records to the Australian Orthopaedic Association National Joint Replacement Registry.

Results

Six hundred and sixty participants had knee OA and 562 had hip OA. After adjustment for age, gender, country of birth, education, physical activity and BMI, central obesity [hazard ratio (HR) 1.59, 95% confidence interval (CI) 1.25–2.01] and hypertension (1.24, 1.05–1.48) were associated with increased risk of knee OA. The accumulation of MetS components was associated with knee OA risk, independent of BMI: one component, 2.12 (1.15–3.91); two components, 2.92 (1.60–5.33) and three or more components, 3.09 (1.68–5.69). No statistically significant associations were observed for hip OA.

Conclusion

Cumulative number of MetS components and central obesity and hypertension were associated with increased risk of severe knee OA, independent of BMI. No associations were observed with severe hip OA. These findings suggest that the pathogenesis of knee and hip OA differ and that targeting the management of MetS may reduce the risk of knee OA.     

Percutaneous coronary intervention of an anomalous coronary chronic total occlusion: The added value of three‐dimensional printing

Three‐dimensional (3D) printing has had an evolving role in cardiology, although has been largely reserved for planning of structural heart disease interventions. We present a case whereby multimodality imaging, including 3D printing, played a pivotal role in planning a technically feasible approach for complex percutaneous coronary intervention of a chronically occluded anomalous right coronary artery, with creation of a customized guide catheter.     

Modified subintimal transcatheter withdrawal: A novel technique for hematoma decompression to facilitate distal reentry during coronary chronic total occlusion recanalization

A controlled antegrade dissection and reentry technique is the most commonly employed crossing strategy for long coronary chronic total occlusions. The development of compressive hematoma is a recognized complication and results in the impairment of distal vessel visualization and hinders successful reentry attempts. We describe a novel technique utilizing a widely available microcatheter to decompress the subintimal hematoma to restore distal visualization and allow successful reentry.     

高同型半胱氨酸血症与心绞痛心肌缺血总负荷的关系

目的：研究高同型半胱氨酸水平与心绞痛心肌缺血总负荷的关系。方法：随机收集90例不稳定型心绞痛患者及90例稳定型心绞痛患者,观察高同型半胱氨酸血症与心肌缺血总负荷的关系。结果：不稳定型心绞痛组血同型半胱氨酸水平和心肌缺血总负荷显著高于稳定型心绞痛组（P〈0．05）。稳定型心绞痛患者高同型半胱氨酸血症者,其心肌缺血总负荷高于同型半胱氨酸正常组（P〈0．05）。不稳定型心绞痛组高同型半胱氨酸血症患者,其心肌缺血总负荷也明显高于血同型半胱氨酸正常者（P〈0．01）。结论：高同型半胱氨酸血症与心绞痛患者心肌缺血总负荷增加有关联。     

加速康复外科理念在人工全膝关节置换术麻醉管理中的应用进展

在人工全膝关节置换术中推广应用加速康复外科理念是近年探讨的热点,最终目的是改善患者预后并降低医疗成本。本文从围术期麻醉管理的角度重点综述国内外目前加速康复外科理念在人工全膝关节置换术管理中的临床应用进展,通过总结与麻醉相关的最佳循证医学证据,以期帮助改善现有临床认知、实践和决策。     

电针配合穴位贴敷治疗膝骨关节炎的临床观察

【目的】观察电针配合穴位贴敷对膝骨关节炎(KOA)患者的临床疗效。【方法】将60例KOA患者随机分为治疗组和对照组,每组各30例。治疗组使用电针配合穴位贴敷治疗,对照组口服塞来昔布胶囊治疗,2周为1个疗程,连续治疗2个疗程。观察2组患者治疗前后疼痛视觉模拟量表(VAS)评分及西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分的变化情况,并评价2组患者的临床疗效。【结果】(1)治疗组总有效率为90.00%,对照组为73.33%。治疗组疗效优于对照组,差异有统计学意义(P<0.05)。(2)治疗后,2组患者VAS评分明显改善(P<0.01),且治疗组在改善VAS评分方面明显优于对照组,差异有统计学意义(P<0.01)。(3)治疗后,2组患者WOMAC各项积分及总分均明显改善(P<0.01),且治疗组WOMAC各项积分及总分的改善明显优于对照组,差异均有统计学意义(P<0.05)。【结论】电针配合穴位贴敷治疗KOA效果较好,能有效减轻患者疼痛、延缓病程。