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Patients with chronic myeloproliferative neoplasms, including essential thrombocythemia (ET), polycythemia vera (PV), and chronic myeloid leukemia (CML), are at increased risk of new hematologic malignancies, but their risk of nonhematologic malignancies remains unknown. In the present study, we assessed the risk of both types of malignancies after an ET, PV, or CML diagnosis. We linked 2 population-based nationwide registries, the Dan-

With the aim of determining the incidence of idiopathic thrombocytopenic purpura (ITP) in adults, we searched all adult ITP patients diagnosed from April 1, 1973 to December 31, 1995 in the County of Funen in Denmark. This county comprises 9% of the total Danish adult population. A total of 221 patients fulfilled the inclusion criteria, yielding an annual standardized incidence rate of 2.68 per 100,000. The median age of the patient population was 56 years, and the female to male ratio was 1.7. Changing the platelet count cut-off point from 100 × 109/L to 50 × 109/L changed the incidence rate to 2.25 per 100,000. Comparing patients less and more than 60 years old, the incidence rate more than doubled and the sex difference was eliminated in the older age group. These two age groups were almost identical regarding platelet count at diagnosis and number of asymptomatic cases. The incidence rate increased in the study period. This increase in particular involved asymptomatic patients and old males who were both symptomatic or not symptomatic. Including additional patients identified by a questionnaire study of the contribution from the primary care physicians and the practicing specialists in the second half of the study period, a reliable estimate of the annual ITP incidence in Danish adults, using a platelet concentration cut-off point of 50 × 109/L, is 3.2 per 100,000 persons.

Grip strength (GS) has an age-and genderdependent decline with advancing age. One study comparing GS among extremely old show a North-South gradient with lowest GS in Italy compared to France (intermediary) and Denmark (highest) even after adjusting for confounders. As GS is associated with higher rates of functional decline and mortality, and thus may be used as a health indicator, it is of interest to examine whether the results on extremely old can be reproduced in a large-scale European survey. GS was measured in a cross-sectional population-based sample of 27,456 individuals aged 50? in 11 European countries included in the SHARE survey. We made a cross-country comparison of the age trajectory of GS in both genders. Northern-continental European countries had higher GS than southern European countries even when stratifying by age and gender and controlling for height, weight, education, health and socioeconomic status. The relative excess was found to be 11% and the absolute difference 5.0 kg for 50-to 54-year-old men, increasing to 28% and 6.9 kg among 80? year-old men. The corresponding figures for women were 16% and 4.3 kg, and 21% and 3.5 kg, respectively. Southern European countries have lower GS in the age range 50? year. Gene-environment interactions may explain country-specific differences. The use of GS in cross-national surveys should control not only for age and gender, but also for nationality.

Physical functioning late in life has been shown to be affected by genetic factors. Only a few genetic variants have been suggested to be associated with physical functioning, and this only in selected populations (e.g., young healthy males and elite athletes). Declining physical functioning late in life is a major problem in terms of prevalence, morbidity, functional limitations, and quality of life. It is therefore of interest to find a phenotype reflecting physical functioning which has a relatively high heritability and which can be measured in large samples. Hand grip strength is known to be associated with muscular functioning in other muscle groups and with activities of daily living (ADL) functioning, and it predicts incident disability. We studied 1,757 Danish twin pairs aged 45-96 years, and found that this phenotype has a heritability of 52% (95% confidence interval (CI), 48-55%). A powerful design to detect genes associated with a phenotype is obtained using the extreme discordant and concordant sib pairs, of whom 28 and 77 dizygotic twin pairs, respectively,

Key Points• In newly diagnosed ITP, addition of rituximab to dexamethasone yields higher sustained response rates than dexamethasone alone.In this study, we report the results from the largest cohort to date of newly diagnosed adult immune thrombocytopenia patients randomized to treatment with dexamethasone alone or in combination with rituximab. Eligible were patients with platelet counts £25310/L with bleeding symptoms. A total of 133 patients were randomly assigned to either dexamethasone 40 mg/day for 4 days (n 5 71) or in combination with rituximab 375 mg/m 2 weekly for 4 weeks (n 5 62). Patients were allowed supplemental dexamethasone every 1 to 4 weeks for up to 6 cycles. Our primary end point, sustained response (ie, platelets ‡50310 9 /L) at 6 months follow-up, was reached in 58% of patients in the rituximab 1 dexamethasone group vs 37% in the dexamethasone group (P 5 .02). The median follow-up time was 922 days. We found longer time to relapse (P 5 .03) and longer time to rescue treatment (P 5 .007) in the rituximab 1 dexamethasone group. There was an increased incidence of grade 3 to 4 adverse events in the rituximab 1 dexamethasone group (P 5 .04). In conclusion, rituximab 1 dexamethasone induced higher response rates and longer time to relapse than dexamethasone alone. This study is registered at