Global Guidelines in Dermatology Mapping Project (GUIDEMAP): a scoping review of dermatology clinical practice guidelines

BACKGROUND

Clinical practice guidelines (CPGs) play a critical role in standardizing and improving treatment outcomes based on the available evidence. It is unclear how many CPGs are available globally to assist clinicians in the management of patients with skin disease.

OBJECTIVES

To search for and identify CPGs for dermatological conditions with the highest burden globally.

METHODS

We adapted a list of 12 dermatological conditions with the highest burden from the Global Burden of Disease (GBD) study 2019. A systematic literature search was done to identify CPGs published between October 2014 to October 2019. The scoping review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework.

RESULTS

A total of 226 CPGs were included. Melanoma had the greatest representation in the CPGs, followed by dermatitis and psoriasis. Skin cancers had a relatively high CPG representation but with lower GBD disease burden ranking. There was an uneven distribution by geographical region, with resource-poor settings being under-represented. The skin disease categories of the CPGs correlated weakly with the GBD disability-adjusted life-years metrics. Eighty-nine CPGs did not have funding disclosures and 34 CPGs were behind a paywall.

CONCLUSIONS

The global production of dermatology CPGs showed wide variation in geographical representation, article accessibility and reporting of funding. The number of skin disease CPGs were not commensurate with its disease burden. Future work will critically appraise the methodology and quality of dermatology CPGs and lead to the production of an accessible online resource summarizing these findings.

Is psoriasis associated with dementia or cognitive impairment? A Critically Appraised Topic

CLINICAL QUESTION

Is psoriasis associated with dementia or cognitive impairment?

BACKGROUND

Psoriasis is a multisystemic inflammatory disorder that has an unclear association with cognitive dysfunction.

OBJECTIVES

To conduct a Critically Appraised Topic that synthesizes the results from relevant observational studies.

METHODS

A systematic literature search of PubMed and Embase was conducted on 12 July 2019 to identify case-control, cross-sectional or cohort studies that investigated the association between psoriasis and cognitive impairment or dementia. Risk of bias was assessed for each study, and the results presented in a narrative synthesis.

RESULTS

Eleven studies were included for critical appraisal. Of the 11 studies, 10 compared a total of 16 574 psoriasis cases with over 45 078 controls for risk of dementia or cognitive impairment. One of the 11 studies evaluated 7118 patients with dementia for odds of psoriasis compared with 21 354 controls. Six studies were assessed to have higher risk of bias. Nine of the 11 included studies found a significant positive association between the two diseases, one study a null association, and one study an inverse association.

DISCUSSION AND RECOMMENDATION

Most of the 11 included studies found a positive association between psoriasis and either mild cognitive impairment or dementia. Brief cognitive assessments have been suggested to screen older patients with psoriasis who present with subjective cognitive complaints.

Obscure gastrointestinal bleeding with negative abdominal computed tomography study: The importance of enteroscopy for early diagnosis of small bowel malignancy

Small bowel tumors are rare among all gastrointestinal (GI) cancers. The most common histological subtype is adenocarcinoma. Adenocarcinoma of the small bowel is difficult to diagnose, often presents at a late stage, and has a poor prognosis. We describe a case of a patient with adenocarcinoma of the small intestine who presented to the hospital with nonspecific GI symptoms and obscure GI bleeding. An initial examination using abdominal computed tomography revealed negative findings. The patient underwent subsequent enteroscopy with capsule endoscopy and double‐balloon endoscopy, and an early‐stage jejunal adenocarcinoma was finally diagnosed.

Serum homocysteine, folate and vitamin B12 levels in patients with psoriasis: a systematic review and meta-analysis

BACKGROUND

Patients with psoriasis are at increased risk for cardiovascular comorbidities. Previous studies examined the possible contribution of serum homocysteine, folate and vitamin B₁₂ to cardiovascular risks in patients with psoriasis but had conflicting conclusions.

OBJECTIVES

To perform a systematic review and meta-analysis of studies on serum homocysteine, folate and vitamin B₁₂ levels in patients with psoriasis.

METHODS

Online databases were searched on 15 February 2018 to include studies comparing serum homocysteine, folate and vitamin B₁₂ levels between patients with psoriasis and controls. A random effects model was adopted to estimate odds ratios for dichotomous data and standardized mean differences (SMDs) for continuous data.

RESULTS

A comprehensive literature search identified 24 studies eligible for inclusion. Compared with controls, patients with psoriasis had a significantly higher serum homocysteine level [SMD 0·41, 95% confidence interval (CI) 0·21-0·61; I² = 76·7%, 18 studies], a higher prevalence of hyperhomocysteinaemia (odds ratio 3·48, 95% CI 2·08-5·83; I² = 41·1%, seven studies) and a lower serum folate level (SMD -0·94, 95% CI -1·49 to -0·40; I² = 95·6%, 14 studies). However, there was no difference in serum vitamin B₁₂ levels between patients with psoriasis and the control group (SMD 0·004, 95% CI -0·49 to 0·50; I² = 92%, 11 studies). Metaregression analysis revealed a significant inverse correlation between the SMD of homocysteine levels and folate levels.

CONCLUSIONS

Patients with psoriasis might have higher serum homocysteine and lower folate levels than control patients without psoriasis. However, due to significant heterogeneity and other limitations, the associations require further examinations in more studies.

Alcohol intake and risk of nonmelanoma skin cancer: a systematic review and dose-response meta-analysis

Nonmelanoma skin cancer (NMSC) comprises mainly basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC). The association between alcohol intake and NMSC has been inconclusive; therefore the objective of this study is to quantify the relationship between alcohol intake and NMSC using meta-analyses. A systematic literature search of PubMed and Embase was performed on 30 October 2016. Eligible articles were case-control or cohort studies that examined alcohol intake and risk of BCC or cSCC and reported relative risks (RRs) with 95% confidence intervals (CIs). Of the 307 articles identified, 13 case-control and cohort studies were included in the systematic review, including 95 241 NMSC cases (91 942 BCC and 3299 cSCC cases). A random-effects model was used to obtain summary RRs and 95% CIs for dose-response meta-analyses. For every 10-gram increase in ethanol intake per day, a positive association was found for both BCC (summary RR of 1·07; 95% CI 1·04-1·09) and cSCC (summary RR of 1·11; 95% CI 1·06-1·16). While there was evidence suggesting a nonlinear association for BCC, it may be due to the sparse data at higher alcohol intake levels. This meta-analysis found evidence that alcohol drinking is positively associated with both BCC and cSCC risk in a dose-dependent manner. These results should be interpreted with caution due to potential residual confounding. Nonetheless, because alcohol drinking is a prevalent and modifiable behaviour, it could serve as an important public health target to reduce the global health burden of NMSC.

Correlating 2-MIB and microcystin concentrations with environmental parameters in two reservoirs in South Taiwan

Cyanobacteria are present in many drinking water reservoirs in Taiwan, and some of them may produce off-flavour compounds and natural toxins. To investigate the correlation among two groups of cyanobacterial metabolites, microcystins and 2-methylisoborneol (2-MIB), and other environmental parameters, approximately 22 water quality and meteorological parameters were monitored for two source waters (Moo-Tan and Tseng-Wen reservoirs) in south Taiwan from August 2003 to April 2005. Monitoring results showed that the two groups of cyanobacterial metabolites were present in the source waters. Concentrations of 2-30 ng/L of 2-MIB was observed for the two reservoirs, while that of the total concentrations of the five microcystin congeners measured were between 30 and 340 ng/L. The concentration of both 2-MIB and microcystins showed higher concentrations in warmer seasons. A stepwise regression technique was employed to correlate 2-MIB and microcystins concentrations with all the corresponding water quality and meteorological parameters. Correlations among 2-MIB concentration, microcystin concentration, water temperature and air temperature were found in the water samples collected from both reservoirs. The correlations may provide a simple means for the water utility to anticipate the two groups of cyanobacterial metabolites in the two source waters.

Analysis of the ethylene response in the epinastic mutant of tomato

Ethylene can alter plant morphology due to its effect on cell expansion. The most widely documented example of ethylene-mediated cell expansion is promotion of the "triple response" of seedlings grown in the dark in ethylene. Roots and hypocotyls become shorter and thickened compared with controls due to a reorientation of cell expansion, and curvature of the apical hook is more pronounced. The epinastic (epi) mutant of tomato (Lycopersicon esculentum) has a dark-grown seedling phenotype similar to the triple response even in the absence of ethylene. In addition, in adult plants both the leaves and the petioles display epinastic curvature and there is constitutive expression of an ethylene-inducible chitinase gene. However, petal senescence and abscission and fruit ripening are all normal in epi. A double mutant (epi/epi;Nr/Nr) homozygous for both the recessive epi and dominant ethylene-insensitive Never-ripe loci has the same dark-grown seedling and vegetative phenotypes as epi but possesses the senescence and ripening characteristics of Never-ripe. These data suggest that a subset of ethylene responses controlling vegetative growth and development may be constitutively activated in epi. In addition, the epi locus has been placed on the tomato RFLP map on the long arm of chromosome 4 and does not demonstrate linkage to reported tomato CTR1 homologs.

Fine-needle aspiration of a metaplastic breast carcinoma with extensive melanocytic differentiation: a case report

Metaplastic carcinomas of the breast are uncommon breast tumors with aberrant cellular differentiation, most commonly showing ductal, squamous, and mesenchymal components. A breast carcinoma composed of both epithelial and melanocytic differentiation is rare, with only four previously reported cases in the literature. We present the fifth reported case, where the diagnosis was suggested by fine-needle aspiration (FNA) and later confirmed after the surgical specimen was excised. Histologically, this neoplasm revealed multidirectional differentiation, consisting primarily of squamous and melanocytic cell types, with focal glandular and osseous metaplasia. Based on the morphologic, immunohistochemical, and ultrastructural findings, we conclude that such tumors fall within the spectrum of metaplastic carcinomas of the breast. We believe that this case will further contribute to the understanding of this enigmatic tumor.

[Karyotype analysis of Carpesium cernuum]

The paper reported the chromosome number, karyotype and chromosome volume of Carpesium cernuum. The normal diploid was 2n = 40, karyotype formula based on Levan's publication was k(2n) = 40 = 24 m + 12 sm + 2 st + 2T. According to the method of S. R. Kuo, the chromosome relative length was 2n = 40 = 8L + 6M2 + 16M1 + 10S, which belong to "2B" type according to the Stebbins' karyotype classification. The AS.K% was 62.35% from Arano's method. The total volume of chromosome groups was 13.76 microns 3.

Retroperitoneal ganglioneuroma: a report of diagnosis by fine-needle aspiration cytology

Ganglioneuroma is a rare benign tumor composed of nerve fibers and mature ganglion cells. Because it shares morphologic features with other neural tumors, both benign and malignant, accurate preoperative diagnosis is often difficult, but nonetheless, critical for proper management. The use of fine-needle aspiration (FNA) cytology in the diagnosis of ganglioneuroma has been rarely documented. In this report, a 25-yr-old man presented with a large retroperitoneal ganglioneuroma that was initially diagnosed by FNA cytology. This case illustrates the utility of FNA cytology in the diagnosis of ganglioneuroma and supports the routine incorporation of FNA cytology in the evaluation of retroperitoneal masses.

[Karyotype analysis on Iris lactea ssp. chinensis]

In this paper, the chromosome number, karyotype and chromosome volume of Iris lactea ssp. chinensis were reported. The normal diploid was 2n = 32. Karyotype formula was based on Levan's publication in 1964, k (2n) = 32 = 22 m + 8 sm + 2T. According to the method of Kuo SR, the species chromosome based on the relative length was 2n = 32 = 6L + 4 M2 + 18 M1 + 4 S which belong to "2A" type according to the Stebbins' karyotype classification. The AS.K% was 62.5% from Arano's method. The total volume of chromosome groups was 34.95 micron 3.

Amino acid residues in both the protein splicing and endonuclease domains of the PI-SceI intein mediate DNA binding

A structure-based model describing the interaction of the two-domain PI-SceI endonuclease with its 31-base pair DNA substrate suggests that the endonuclease domain (domain II) contacts the cleavage site region of the substrate, while the protein splicing domain (domain I) interacts with a distal region that is sufficient for high affinity binding. To support this model, alanine-scanning mutagenesis was used to assemble a set of 49 PI-SceI mutant proteins that were purified and assayed for their DNA binding and cleavage properties. Fourteen mutant proteins were 4- to >500-fold less active than wild-type PI-SceI in cleavage assays, and one mutant (T225A) was 3-fold more active. Alanine substitution at two positions in domain I reduces overall binding >60-fold by perturbing the interaction of PI-SceI with the minimal binding region. Conversely, mutations in domain II have little effect on binding, reduce binding to the cleavage site region only, or affect binding to both regions. Interestingly, substitutions at Lys301, which is part of the endonucleolytic active site, eliminate binding to the cleavage site region but permit contact with the minimal binding region. This experimental evidence demonstrates that the protein splicing domain as well as the endonuclease domain is involved in binding of a DNA substrate with the requisite length.

MCP-1-mediated chemotaxis requires activation of non-overlapping signal transduction pathways

Monocyte chemoattractant protein-1 (MCP-1) is a CC chemokine that attracts monocytes and T lymphocytes. Its receptor (CCR2) is a heptahelical G-protein-coupled receptor (GPCR) whose signal transduction pathways for chemotaxis have not been completely defined. Because other GPCRs stimulate the mitogen-activated protein kinase (MAPK) cascade, we examined this pathway's activity in response to MCP-1. MCP-1 induced rapid and transient activation of MAPK in human monocytes and in Chinese hamster ovary cells expressing CCR2B. This effect was largely insensitive to pertussis toxin and wortmannin, and was protein kinase C-dependent and protein tyrosine kinase-independent. PD 098059, an inhibitor of MEK activation, not only prevented MAPK activation but also inhibited MCP-1-induced chemotaxis. Because pertussis toxin and wortmannin also efficiently inhibit chemotaxis but do not completely inhibit MAPK activation, these data may define non-overlapping signal transduction pathways that all must be activated to produce chemokine-mediated chemotaxis.

[An immunocytochemical study of neuropeptide-like in a ciliated protozoan, Stylonychia mytilus]

An immunocytochemical investigation with both B-SA and ABC methods, under LM and EM, was carried out on Stylonychia mytilus by using 7 antisera to vertebrate neuropeptides, hormones and TH. The immunotests showed the presence of substance p-, neuropeptide y-, cck-8-, somatostatin-, beta-endorphin, adrenocorticotropic hormone-, and TH-like immunoreactive molecules in Stylonychia mytilus. The distributions of these immunoreactive substances in Stylonychia mytilus were described.

On-line sensors for coagulation proteins: concept and progress report

The assessment of blood damage and of the activation of the coagulation, complement and/or inflammatory systems by cardiovascular and extracorporeal devices is difficult at best. Immunoassay methods are now available for the measurement of many of the proteins, enzymes and peptides involved in coagulation, thrombosis, complement and inflammation. We present a long-range project and plan to develop an array of remote, on-line, semicontinuous immunosensors for selected coagulation proteins, based on fluoroimmunoassay principles. The free/bound separation step is performed optically. Excitation of fluorescence is performed via an evanescent wave produced by total internal reflection and waveguide optics. Fluorescence emission is collected only in the near field. Means to deliver fluorescently-labelled reagent and to modify the antigen-antibody binding constant are presented and discussed. The results of non-specific binding, plasma-blood fluorescence, and blood compatibility are also discussed.

Uterine contractility and oxytocin sensitivity in preterm, term, and postterm pregnancy

The records of 117 patients who had serial nonstress tests (N = 285) and oxytocin challenge tests (N = 268) were analyzed to determine whether baseline uterine contractility and/or oxytocin sensitivity changed with increasing gestational age. The results obtained in patients who were delivered before, at, and after term were compared. Uterine contractility and oxytocin sensitivity increased in all groups as gestational age progressed. No significant differences in uterine contractility were noted among groups; however, oxytocin sensitivity was significantly increased in the preterm group (p less than 0.001) and decreased in the postterm group (p less than 0.001). Our results suggest that the response of the uterus to oxytocin early in pregnancy may help to identify patients who will be delivered before or after term.