The effect of bicycling on PSA levels: a systematic review and meta-analysis.

BACKGROUND: Recent literature has suggested that bicycling may be associated with increases in serum PSA levels, a diagnostic and prognostic marker for prostate cancer. To further investigate this relationship, we conducted a systematic review and meta-analysis of current literature in this field. METHODS: MEDLINE, CENTRAL, CINAHL and SPORTDiscus were searched using MeSH terms and keywords for English publications related to bicycle riding and PSA. Studies were included if PSA was measured relative to cycling activity in healthy men who were free of any prostatic condition. Case studies were excluded. RESULTS: Eight studies met our inclusion criteria, comprising 912 participants that engaged in, or self-reported, bicycling activity. Six studies investigated the acute pre-post change in PSA following bicycling activity that ranged from a single cycling bout of 15 min to a 4-day cycling event. Following cycling activity, two studies reported total PSA increased from baseline by up to 3.3-fold, free PSA increased in one study by 0.08±0.18 ng ml(-)(1) and did not change in four studies. One study compared PSA in elite/professional cyclists versus non-cyclists and demonstrated no significant difference in PSA measurements between groups. Data from six studies were meta-analyzed and demonstrated no significant increase in PSA associated with cycling from pre to post (mean change +0.027 ng ml(-)(1), s.e.m.=0.08, P=0.74, 95% confidence interval (CI)=-0.17-0.23). CONCLUSIONS: Our findings suggest that there is no effect of cycling on PSA; however, the limited number of trials and the absence of randomized controlled trials limit the interpretation of our results. Additionally, the median sample size only consisted of 42 subjects. Therefore, our study may have low statistical power to detect a difference in PSA. Although, a higher sample size may demonstrate statistical significance, it may not be clinically significant. Studies of higher empirical quality are needed.

Fractured femur in infancy: the role of child abuse.

Analysis of 80 femoral fracture episodes in children under 4 years of age revealed that 8.5% were due to violent trauma, 12.5% were "pathologic" fractures, 30% were related to child abuse, and 49% resulted from normal trauma to normal children. Child abuse as a cause of femoral fracture is more common in children under 1 year of age, first-born children, those with preexisting brain damage, and those with bilateral fractures. The fracture configuration was not usually pathognomonic of abuse, although fractures at the subtrochanteric level and chip fracture of the distal metaphysis were more common in abused children. This study suggests that if there is a reasonable history of cause of fracture, appropriate timing in seeking medical care, and no evidence of additional trauma, further evaluation will not be likely to provide evidence of abuse. If any of these criteria is lacking, a skeletal survey and further evaluation are indicated.

Periosteal thickening as a manifestation of trauma in infancy.

This paper reports the findings in a study of the incidence of periosteal elevation in children and its possible relationship to child abuse. Two separate sets of radiographs of the skeleton of children were taken for a variety of diagnostic purposes. The suspected abuse set consisted of 59 radiographs taken for suspected child abuse. The mean age for all patients examined was 1.22 years whereas, the mean age for patients with cortical thickening was 0.5 years, suggesting that cortical thickening occurs in a relatively young population. Cortical thickening was assessed by reason for examination. A significant difference (p = .05) was detected with 6/8 (75%) of the patients with cortical thickening from the suspected child abuse groups and only 2/8 (25%) of the patients from the seizure-diagnostic category. The two infants who were noted to have periosteal elevation but were not suspected of abuse had experienced unusual circumstances, one was wearing an abduction splint and the other was a severely hypotonic premature. It is our impression that periosteal thickening is not a normal finding in infants and does not represent a consequence of normal infant care practices. In each case in which cortical thickening was detected, there was evidence to suggest that the child had experienced abnormal or rough handling. As a result of these findings, we believe that cortical thickening of the long bones detected on radiograph is an indication of child abuse.

Intrauterine rubella, head size, and intellect.

The assumption that congenital rubella is commonly associated with microcephaly and mental retardation was examined. Among a rubella clinic population of 111 children, 92 children had vision sufficient to allow testing by the Leiter International Scale. The mean IQ for this group was 99.46 (SD, 19.5). Head circumference in this group correlated well with stature but poorly with intellect. The authors conclude that children with intrauterine rubella should be viewed as small children rather than children with small heads and that such children are poorly served if mental subnormality is assumed without careful study.