Colchicine effectiveness in symptom and inflammation modification in knee osteoarthritis (COLKOA): study protocol for a randomized controlled trial.

BACKGROUND: Despite the high prevalence and global impact of knee osteoarthritis (KOA), current treatments are palliative. No disease modifying anti-osteoarthritic drug (DMOAD) has been approved. We recently demonstrated significant involvement of uric acid and activation of the innate immune response in osteoarthritis (OA) pathology and progression, suggesting that traditional gout therapy may be beneficial for OA. We therefore assess colchicine, an existing commercially available agent for gout, for a new therapeutic application in KOA. METHODS/DESIGN: COLKOA is a double-blind, placebo-controlled, randomized trial comparing a 16-week treatment with standard daily dose oral colchicine to placebo for KOA. A total of 120 participants with symptomatic KOA will be recruited from a single center in Singapore. The primary end point is 30% improvement in total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at week 16. Secondary end points include improvement in pain, physical function, and quality of life and change in serum, urine and synovial fluid biomarkers of cartilage metabolism and inflammation. A magnetic resonance imaging (MRI) substudy will be conducted in 20 participants to evaluate change in synovitis. Logistic regression will be used to compare changes between groups in an intention-to-treat analysis. DISCUSSION: The COLKOA trial is designed to evaluate whether commercially available colchicine is effective for improving signs and symptoms of KOA, and reducing synovial fluid, serum and urine inflammatory and biochemical joint degradation biomarkers. These biomarkers should provide insights into the underlying mechanism of therapeutic response. This trial will potentially provide data to support a new treatment option for KOA. TRIAL REGISTRATION: The trial has been registered at clinicaltrials.gov as NCT02176460 . Date of registration: 26 June 2014.

The accuracy and completeness for receipt of colorectal cancer care using Veterans Health Administration administrative data.

BACKGROUND: The National Comprehensive Cancer Network and the American Society of Clinical Oncology have established guidelines for the treatment and surveillance of colorectal cancer (CRC), respectively. Considering these guidelines, an accurate and efficient method is needed to measure receipt of care. METHODS: The accuracy and completeness of Veterans Health Administration (VA) administrative data were assessed by comparing them with data manually abstracted during the Colorectal Cancer Care Collaborative (C4) quality improvement initiative for 618 patients with stage I-III CRC. RESULTS: The VA administrative data contained gender, marital, and birth information for all patients but race information was missing for 62.1% of patients. The percent agreement for demographic variables ranged from 98.1-100%. The kappa statistic for receipt of treatments ranged from 0.21 to 0.60 and there was a 96.9% agreement for the date of surgical resection. The percentage of post-diagnosis surveillance events in C4 also in VA administrative data were 76.0% for colonoscopy, 84.6% for physician visit, and 26.3% for carcinoembryonic antigen (CEA) test. CONCLUSIONS: VA administrative data are accurate and complete for non-race demographic variables, receipt of CRC treatment, colonoscopy, and physician visits; but alternative data sources may be necessary to capture patient race and receipt of CEA tests.

Impacts of land use change and climate variations on annual inflow into Miyun Reservoir,Beijing, China

The Miyun Reservoir, the only surface water source for Beijing city, has experienced water supply decline in recent decades. Previous studies suggest that both land use change and climate contribute to the changes of water supply in this critical watershed. However, the specific causes of the decline in the Miyun Reservoir are debatable under a non-stationary climate in the past 4 decades. The central objective of this study was to quantify the separate and collective contributions of land use change and climate variability to the decreasing inflow into the Miyun Reservoir during 1961–2008. Different from previous studies on this watershed, we used a comprehensive approach to quantify the timing of changes in hydrology and associated environmental variables using the long-term historical hydrometeorology and remote-sensing-based land use records. To effectively quantify the different impacts of the climate variation and land use change on streamflow during different sub-periods, an annual water balance model (AWB), the climate elasticity model (CEM), and a rainfall–runoff model (RRM) were employed to conduct attribution analysis synthetically. We found a significant (p  <  0.01) decrease in annual streamflow, a significant positive trend in annual potential evapotranspiration (p  <  0.01), and an insignificant (p  >  0.1) negative trend in annual precipitation during 1961–2008. We identified two streamflow breakpoints, 1983 and 1999, by the sequential Mann–Kendall test and double-mass curve. Climate variability alone did not explain the decrease in inflow to the Miyun Reservoir. Reduction of water yield was closely related to increase in actual evapotranspiration due to the expansion of forestland and reduction in cropland and grassland, and was likely exacerbated by increased water consumption for domestic and industrial uses in the basin. The contribution to the observed streamflow decline from land use change fell from 64–92 % during 1984–1999 to 36–58 % during 2000–2008, whereas the contribution from climate variation climbed from 8–36 % during the 1984–1999 to 42–64 % during 2000–2008. Model uncertainty analysis further demonstrated that climate warming played a dominant role in streamflow reduction in the most recent decade (i.e., 2000s). We conclude that future climate change and variability will further challenge the water supply capacity of the Miyun Reservoir to meet water demand. A comprehensive watershed management strategy needs to consider the climate variations besides vegetation management in the study basin.