A selection of three essential articles read aloud from the latest issue of The Economist. This week, covid-19 presents grim choices between life, death and, ultimately, the economy (11:02), lockdowns in Asia have sparked a stampede home (17:52) And, Formula 1 comes up with a breathing machine for covid-19 patients.
Conclusion: The study was inconclusive with respect to potential differences in progression of individual radiographic features after surgical and non-surgical treatment for degenerative meniscal tear. Further, we found no strong evidence in support of differences in development of incident radiographic knee osteoarthritis or patient-reported outcomes between exercise therapy and arthroscopic partial meniscectomy.
Objective: To evaluate progression of individual radiographic features 5 years following exercise therapy or arthroscopic partial meniscectomy as treatment for degenerative meniscal tear.
Design: Randomized controlled trial including 140 adults, aged 35-60 years, with a magnetic resonance image verified degenerative meniscal tear, and 96% without definite radiographic knee osteoarthritis. Participants were randomized to either 12-weeks of supervised exercise therapy or arthroscopic partial meniscectomy. The primary outcome was between-group difference in progression of tibiofemoral joint space narrowing and marginal osteophytes at 5 years, assessed semi-quantitatively by the OARSI atlas. Secondary outcomes included incidence of radiographic knee osteoarthritis and symptomatic knee osteoarthritis, medial tibiofemoral fixed joint space width (quantitatively assessed), and patient-reported outcome measures. Statistical analyses were performed using a full analysis set. Per protocol and as treated analysis were also performed.
Results: The risk ratios (95% CI) for progression of semi-quantitatively assessed joint space narrowing and medial and lateral osteophytes for the surgery group were 0.89 (0.55-1.44), 1.15 (0.79-1.68) and 0.77 (0.42-1.42), respectively, compared to the exercise therapy group. In secondary outcomes (full-set analysis) no statistically significant between-group differences were found.
From Bob Grant, The Scientist Magazine (April 1, 2020):
Prevention has been playing a growing role in other diseases, infectious and otherwise, long before this latest global pandemic. Cancer, the focus of this issue, is ubiquitous, and one would be hard pressed to find a person anywhere on Earth whose life wasn’t in some way touched by the complex and vexing malady.
This cancer-focused issue features a cover story in which we explore one facet of cancer prevention: exercise. In this feature story, Danish researcher Bente Klarlund Pedersen explains that studies have shown frequent exercise to be useful in avoiding cancer as well as in helping cancer patients lessen the side effects of their cancers and treatments. Her research and that of others is seeking to enumerate the molecular and cellular mechanisms that underlie the benefits exercise seems to offer cancer patients.
But when one considers the practical ripples that biology sends through societies—issues of public health and the shared goal of minimizing the impact of diseases on a global scale—human behavior and prevention become vitally important.
Food and medicine shopping is essential during the COVID-19 pandemic, but requires getting out and standing close to strangers at a time when social distancing and sheltering-in-place are recommended to slow spread of disease.
David Aronoff, MD, director of the Division of Infectious Diseases at Vanderbilt University in Nashville, explains how to minimize COVID-19 risk while shopping.
From a MedPage Today online article (April 2, 2020):
This relationship between higher glucose levels and poorer cognitive functioning extended beyond just CASI z-score, as well, Cukierman-Yaffe noted. Higher HbA1c levels were also tied to significantly poorer performance in other psychological tests, including the clock making test of executive functioning, test of discriminative ability, and for the test of verbal fluency.
Poorer glycemic control was tied to cognitive decline following a lacunar stroke in a prospective cohort study.
Among 942 individuals with type 2 diabetes who had a lacunar stroke, every 1% higher HbA1c was tied to a 0.06 drop in cognitive function at baseline measured by Cognitive Assessment Screening Instrument (CASI) z-score (95% CI -0.101 to -0.018), reported Tali Cukierman-Yaffe, MD, MSc, of Sheba Medical Center and the Sackler School of Medicine of Tel Aviv University in Israel.