Are We Really Hypocrites ?
Increased Risk Of ‘OA’ Incase Of Knee Injury In Young-age
Injuring a knee in youth dramatically increases the risk for osteoarthritis, researchers say.
Knees injured at age 25 to 34 years were six times more likely to develop osteoarthritis within 11 years, reported Barbara Snoeker, from Lund University in Sweden, and colleagues in an article published online December 11 in the British Journal of Sports Medicine.
The risk for osteoarthritis varied with the type of injury. “Of all injury types, cruciate ligament injuries, meniscal tears and intra-articular fractures yielded the highest estimates of increased risk,” they write.
Previous studies have identified knee injury during adolescence and young adulthood as an important risk factor for osteoarthritis. But most of these studies used retrospective analysis, and those that relied on patients’ recall may be particularly unreliable, the researchers say.
There are too few studies in young people to yield reliable estimates of the magnitude of risk, they add. In addition, the existing studies have focused mostly on cruciate ligament and meniscal tears, leaving open questions about other types of knee injury.
To fill this gap, Snoeker and colleagues analyzed data from the Skåne Health Register, which includes all healthcare consultations involving the 1.3 million people who live in Skåne, Sweden. They identified 5500 people who were 25 to 34 years of age when they were diagnosed with a knee injury for the first time from 1999 to 2007. The study excluded people with existing osteoarthritis.
The researchers compared this cohort with 143,788 people of the same age range who had not injured a knee during this period but were in the database as a result of unrelated medical consultations.
After 19 years, 11.3% of the people with injured knees were diagnosed with knee osteoarthritis, compared with 4.0% of the people who had no knee injuries.
After adjusting for age, sex, residential area, education, income, diabetes, obesity, and hypertension, the hazard ratio (HR) for osteoarthritis in the injured knees compared with the uninjured knees was 5.7 11 years after the injury. The adjusted HR ratio after 11 years was 5.3 for men and 6.5 for women.
For people younger than 30 years, the adjusted HR was 7.6, whereas for people older than 30 years, it was 4.7 after 11 years. This reflects the lower baseline risk for osteoarthritis in younger people, the researchers explain.
The adjusted HRs after 11 years varied with the type of knee injury. The adjusted HRs were 8.2 for cruciate ligament injury, 7.6 for meniscal tear, 7.0 for a fracture of the upper end of the tibia/patella, 6.5 for injury to multiple structures, 5.9 for a dislocation, 5.2 for a cartilage tear/other injury, 4.9 for collateral ligament injury, and 3.2 for contusion.
On average, people with a cruciate ligament injury developed osteoarthritis 16 months faster than people without knee injuries who also developed osteoarthritis. For meniscal tears, the difference was 12 months, and for fractures, 8 months.
The researchers were surprised there was not a bigger difference in disease-free time. They speculate that those people without injuries who developed osteoarthritis must have had some other risk factor, such as a genetic predisposition or obesity.
“To the best of our knowledge, our study is the first that used a cohort from the general population of young adults to estimate the risk of a wide variety of knee injuries on the development of clinically-evident knee [osteoarthritis],” the researchers write.
Source : Medscape
Acupuncture & Acupressure Helps In Pain Management In Cancer Patients
Acupuncture and acupressure may reduce pain in cancer patients and help decrease use of pain drugs, including opioids, according to new findings.
A systematic review of 17 randomized clinical trials and a meta-analysis of 14 trials found a significant association between real acupuncture, as compared to sham acupuncture, and a reduction in pain.
In addition, acupuncture was associated with less use of analgesics.
Overall, the evidence level was “moderate,” say the authors.
“Cancer pain is inadequately managed clinically due to limited and effective therapeutic options,” explained study author Charlie Changli Xue, PhD, School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia. “This study demonstrated that acupuncture and acupressure should be considered as an option in clinical setting, particularly when pharmacotherapy alone has not offered adequate relief.”
Acupuncture and acupressure should be better integrated into practice guidelines for patients with cancer pain, he told Medscape Medical News. “Acupuncture/acupressure can be delivered by doctors with adequate acupuncture training or qualified acupuncturists accredited by regulatory bodies or members of reputable professional associations,” he said.
The study was published online December 19 in JAMA Oncology.
More than 70% of patients with cancer experience pain, but it is inadequately controlled in nearly half of patients, note the authors. The current opioid crisis in the United States has exacerbated challenges in pain management, and there has been an increasing interest in nonpharmacologic interventions to relieve pain. Both the American Society for Clinical Oncology and the National Comprehensive Cancer Network have recommended the use of nonpharmacologic methods for managing pain, including acupuncture, despite inconsistent results in studies.
The authors point out that although 20 systematic reviews have established an association between acupuncture and cancer pain relief, none reached a definitive conclusion. But more recent rigorous randomized clinical trials were not included in previous systematic reviews.
Reduction in Pain
In this study, Xue and colleagues conducted an analysis of published randomized clinical trials in order to evaluate the relationship between acupuncture and acupressure and pain reduction in cancer patients.
A total of 17 randomized trials were included in the systematic review or qualitative synthesis. Of these, results of 14 studies, which included 920 patients, were pooled through a meta-analysis. The studies were conducted globally; seven (41%) were conducted in China, six (35%) in the United States, and one (6%) each in Australia, Brazil, France, and Korea.
Of the 17 studies, nine (53%) were sham controlled, and eight (47%) were open-label trials.
Random-effects modeling was used to calculate the effect sizes of the randomized clinical trials that were included.
With regard to pain intensity, pooled results from seven blinded randomized studies that were deemed high quality by the study authors showed an association between pain reduction and real acupuncture vs sham acupuncture (mean difference, −1.38 points; 95% confidence interval [CI], −2.13 to −0.64; I 2 = 81%).
Results from six open-label trials showed that, in comparison with analgesics, pain intensity was reduced when acupuncture was combined with acupressure (mean difference, −1.44 points; 95% CI, −1.98 to −0.89; I 2 = 92%). A significant reduction in pain without heterogeneity was seen in three studies that compared acupuncture with control persons who were on a wait list (mean difference,−1.63 points; 95% CI,−2.14 to −1.13). The evidence grade was moderate because of the substantial heterogeneity among studies, say the authors.
Two of the open-label studies without heterogeneity reported that a maintenance dose of analgesics was administered during the trial period. Pooled results showed that there was a significant decrease in the dose of analgesics among patients who received acupuncture plus analgesic therapy in comparison with the patients who received only analgesics (mean difference, −30.00 mg morphine equivalent daily dose; 95% CI, −37.5 mg to −22.5 mg).
Integrating acupuncture into pain and symptom management plans for cancer patients remains a challenge. Factors include the cost of treatments and lack of insurance coverage. Both have been identified as major barriers to the use of acupuncture.
“While action is needed from insurance companies to reconsider their position — the inclusion of acupuncture for the such patients — I think, in longer term, research is also needed to demonstrate value for money by including acupuncture/acupressure for rebate,” said Xue. “As stated in the paper, we encourage further trials on specific types of cancer to further improve the level of evidence to support better clinical decision making and to assist the insurance companies’ decision making for inclusion of acupuncture/acupressure into plans.”
Source : Medscape
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Sim Swap Fraud …. Beware
Triple Negative Breast Cancer Outcomes Can Be Predicted By Blood Markers
Biomarkers of residual disease detected in the blood at surgery following neoadjuvant chemotherapy can identify which patients with triple-negative breast cancer will have a better outcome at 2 years and which will do much worse, a phase 2 randomized controlled trial indicates.
“What we know with triple-negative breast cancer is that these cancers tend to recur at a very high rate, particularly peaking in the first 3 years after surgery, and this causes an untenable situation for our patients, who live in constant fear and uncertainty of their cancer recurring after chemotherapy and surgery,” Milan Radovich, PhD, associate professor of surgery and medical and molecular genetics, Indiana University School of Medicine in Indianapolis, said at a press briefing here at the San Antonio Breast Cancer Symposium (SABCS) 2019.
“We found that the detection of circulating tumor DNA (ctDNA) as well as circulating tumor cells (CTCs) in early-stage, triple-negative breast cancer after neoadjuvant chemotherapy is an independent predictor of disease recurrence and represents, we think, an important, novel stratification factor for post-neoadjuvant trials,” he added.
The BRE12-158 trial involved 151 patients with early-stage, triple-negative breast cancer in whom there was evidence of residual disease at surgery following neoadjuvant chemotherapy.
“The first marker we focused on was a marker called ctDNA,” Radovich noted. As he explained, ctDNA is DNA that is shed from tumors into the circulation, where next-generation sequencing techniques can be used to noninvasively detect the DNA in a simple blood draw.
Investigators also studied CTCs, which are live tumor cells that float in the circulation, where, again, sensitive techniques can be used to detect them in the blood.
“ctDNA was successfully sequenced in 150 patients…. 148 of the 150 sequenced patients had clinical follow-up,” the investigators point out.
Genomic or DNA sequencing was conducted by Foundation Medicine using the FoundationOne Liquid assay, which provides profiles for 70 commonly mutated oncogenes.
Following genomic sequencing, patients were randomly assigned to receive either genomically directed therapeutics or the investigative physician’s choice of therapy.
Plasma samples of both ctDNA and CTCs were collected at cycle 1, day 1 in the genomically directed therapies arm. In the control arm, they were collected at the patient’s first routine visit.
Investigators then correlated the presence of mutated ctDNA with distant disease-free survival (DDFS) and overall survival in both univariate and multivariate analyses.
Striking Results
“Results were absolutely striking,” Radovich said.
“Patients who were positive for ctDNA in their circulation after surgery had a significantly inferior DDFS compared to patients who were ctDNA negative,” he emphasized.
At 17.2 months’ follow-up, the median DDFS rate was almost threefold higher for ctDNA-negative patients, which had not been reached at the time of data analysis, vs a median DDFS of 32.5 months in ctDNA-positive patients.
At 2 years, estimated DDFS rates were 56% for the ctDNA-positive patients vs 81% for ctDNA-negative patients (P = .005).
“The addition of CTC adds complementary information to ctDNA for detection of minimal residual disease,” Radovich continued.
For patients who tested negative to both biomarkers, the 2-year DDFS rate was more than fivefold higher, at 89%, compared to 52% for patients who tested positive for both biomarkers (P = .009).
Importantly, for the subgroup of patients who tested negative for both ctDNA and CTCs, outcomes were still significantly superior to those of other groups, even though some of them were at very high risk for relapse, as determined on the basis of standard clinical variables, Radovich emphasized.
The risk for mortality among patients who tested positive for ctDNA was also almost threefold higher than it was for those who tested negative for ctDNA (P = .022), the investigators add.
“At the end of the day, we want to use tests where we can actually act on results,” coinvestigator Bryan Schneider, MD, professor of medicine and medical and molecular genetics, Indiana University School of Medicine, and senior author of the study, told Medscape Medical News.
“We already know that the risk of relapse in these patients is really high, so the ability to take that information and understand whether we can act on it in a clinically meaningful way is really important,” he added.
Hence, investigators are now planning the BRE18-334 trial, also known as the PERSEVERE trial, another phase 2 study in which patients with triple-negative disease with minimal residual disease at surgery who test positive for ctDNA will be treated with a genomically directed, post-neoadjuvant therapy.
The therapy will target actionable genomic markers detected on sequencing among ctDNA-positive patients. Those who have no actionable tumor targets or who are ctDNA negative will be assigned to standard of care.
“The goal of our trial is not to prolong survival, it is to try and go for cure — we are going to use this ctDNA information and actual germline alternations to improve the cure rate,” Schneider said.
“And we feel our patients will be very motivated to participate, especially if they know there is a high risk of their cancer coming back,” he added.
Asked to comment on the study’s findings, the press briefing moderator, Virginia Kaklamani, MD, UT Health, San Antonio, Texas, said that she does not like disclosing test results to a patient when she can’t act on them.
“That is why we do clinical trials,” Kaklamani said. “We need this information so we can do clinical research and figure out if we can salvage these patients with our novel therapies and maybe make a difference to their outcomes,” she added.
Radovich concurred, saying that although he believes it is important that they now have the technology that can identify which patients with triple-negative breast cancer will do poorly, “I think the more important thing now is that we have to learn how to act on it,” he said.
Source : Medscape
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