New developments in osteoarthritis. Posttraumatic osteoarthritis: pathogenesis and pharmacological treatment options

Joint trauma can lead to a spectrum of acute lesions, including osteochondral fractures, ligament or meniscus tears and damage to the articular cartilage. This is often associated with intraarticular bleeding and causes posttraumatic joint inflammation. Although the acute symptoms resolve and some of the lesions can be surgically repaired, joint injury triggers a chronic remodeling process in cartilage and other joint tissues that ultimately manifests as osteoarthritis in a majority of cases. The objective of the present review is to summarize information on pathogenetic mechanisms involved in the acute and chronic consequences of joint trauma and discuss potential pharmacological interventions. The focus of the review is on the early events that follow joint trauma since therapies for posttraumatic joint inflammation are not available and this represents a unique window of opportunity to limit chronic consequences

Lymph Node Metastases do not Impact Survival in Follicular Variant Papillary Thyroid Cancer

INTRODUCTION: Follicular variant of papillary thyroid cancer (FVPTC) is the most common and fastest growing subtype of papillary thyroid cancer (PTC) with features of both PTC and follicular thyroid cancer (FTC). The purpose of this study was to determine the patient and tumor features associated with lymph node metastases (LNM) in FVPTC. METHODS: This was a retrospective review of adult (≥18) patients with histologically confirmed diagnoses of FVPTC within the SEER database between 1988 and 2009. LNM were defined by at least two lymph nodes with metastatic disease. To determine factors associated with LNM, we constructed a multivariate logistic regression model from significant variables (p<0.05) identified on univariate analysis. Similarly, we used a Cox proportional hazards model to understand the relative importance of LNM in determining disease specific mortality (DSM). RESULTS: Of the 20,357 cases of FVPTC with lymph node data available, 1,761 (8.7%) had LNM. 61.1% of these LNM were located in the central neck and 38.9% were in the lateral neck. Extrathyroidal extension (OR 2.6, 95% C.I. 2.2–3.0, p<0.01) and multifocality (OR 3.0, 95% C.I. 2.5–3.6, p<0.01) were the strongest predictors of LNM. Importantly, LNM did not independently predict DSM (p = 0.52). Tumor size > 4 cm (HR 5.3, 95% C.I. 2.2–12.8, p<0.01) and extrathyroidal extension (HR 8.2, 95% C.I. 3.0–22.0, p<0.01) were the strongest predictors of DSM. CONCLUSIONS: LNM occur in less than 10% of patients with FVPTC but do not impact DSM. Instead, DSM in FVPTC is related to size and local invasion