OBJECTIVETo develop evidence- and experience-based recommendations for the management of psoriasis during preconception, pregnancy, postpartum, and breastfeeding.METHODSThe nominal group technique ...and the Delphi method were used. Fifteen experts (12 dermatologists, 2 of whom were appointed coordinators; 1 rheumatologist; and 2 gynecologists) were selected to form an expert panel. Following a systematic review of the literature on fertility, pregnancy, postpartum, and breastfeeding in women with psoriasis, the coordinators drew up a series of preliminary recommendations for discussion by the panel at a nominal group meeting. The experts defined the scope, sections, and intended users of the statement and prepared a final list of recommendations. Consensus was obtained using a Delphi process in which an additional 51 dermatologists rated their level of agreement with each recommendation on a scale of 1 (total disagreement) to 10 (total agreement). Consensus was defined by a score of 7 or higher assigned by at least 70% of participants. Level of evidence and strength of recommendation were reported using the Oxford Center for Evidence-Based Medicine categories. The final statement was approved by the expert panel.RESULTSThe resulting consensus statement includes 23 recommendations on preconception (fertility and contraception), pregnancy (planning, pharmacological management, and follow-up), and breastfeeding (management and follow-up). Consensus was achieved for all recommendations generated except one.CONCLUSIONSThese recommendations for the better management of psoriasis in women of childbearing age could improve outcomes and prognosis.
Abstract
Background
Growing evidence suggests an increased prevalence of metabolic associated steatotic liver disease (MASLD) in the context of immune-mediated inflammatory diseases (IMIDs). The risk ...of incident extrahepatic cancers is higher in MASLD. We aimed to clinically and mechanistically characterize IMID-MASLD patients compared to classic-MASLD, and its relation to cancer risk in IBD.
Methods
Ambidirectional, case‒control study including a prospective cohort of IMID patients (IBD, psoriasis, hidradenitis, and spondyloarthritis). MASLD and advanced-MASLD was established by the controlled attenuation parameter and transient elastography, respectively. Controls from the general population were age-, sex-, type 2 diabetes-, and BMI-matched in a 1:2 ratio. Liver biopsies were collected when significant liver fibrosis was suspected. Total RNA was obtained from freshly frozen cases and analyzed by RNA-seq. Differential gene expression was performed with‘limma-voom’. Gene set enrichment analysis was performed using the fgsea R package with a preranked “limma t-statistic” gene list. Data on global cancer prevalence was retrospectively collected on a multicenter IBD cohort.
Results
1435 IMID patients and 2918 controls were initially included. Advanced-MASLD prevalence was significantly higher among IMID patients than controls(p<0.0001). In multivariate analysis, concomitant IMID was an independent and the strongest predictor of advanced-MASLD (adjusted OR 2.587; < 0.001).Transcriptomic data was obtained in 109 patients and showed 87 significant genes differentially expressed between IMID- and classic-MASLD. IMID-MASLD cases displayed an enriched expression of genes implicated in pro-tumoral activities or the control of the cell cycle concomitant with a negative expression of genes related to metabolism (figure 1). A comparable transcriptomic signature was observed in IBD-MASLD, involving genes as IGFBP2, PLEKHA4, or metallothioneins, all of them associated to pour prognosis in renal cell carcinoma (RCC). In the multicentre IBD cohort (n=1905; female 50.5%; mean age 50.7 years, mean follow up: 13.3 years) we observed a global cancer prevalence of 9.0%, with a higher-than-expected RCC prevalence (table 1). Whereas RCC represents 3.2% of all cancers in the general population, it accounts for 8.7% in our IBD cohort, in agreement with our molecular data.
Conclusion
Advanced MASLD has a disproportionately high prevalence in IMID populations. Both conditions can trigger a protumoral condition that can lead to an accelerated form of MASLD independent of classic metabolic pathways and a higher cancer risk, as is the case of RCC in the IBD population.
To develop evidence- and experience-based recommendations for the management of psoriasis during preconception, pregnancy, postpartum, and breastfeeding.
The nominal group technique and the Delphi ...method were used. Fifteen experts (12 dermatologists, 2 of whom were appointed coordinators; 1 rheumatologist; and 2 gynecologists) were selected to form an expert panel. Following a systematic review of the literature on fertility, pregnancy, postpartum, and breastfeeding in women with psoriasis, the coordinators drew up a series of preliminary recommendations for discussion by the panel at a nominal group meeting. The experts defined the scope, sections, and intended users of the statement and prepared a final list of recommendations. Consensus was obtained using a Delphi process in which an additional 51 dermatologists rated their level of agreement with each recommendation on a scale of 1 (total disagreement) to 10 (total agreement). Consensus was defined by a score of 7 or higher assigned by at least 70% of participants. Level of evidence and strength of recommendation were reported using the Oxford Center for Evidence-Based Medicine categories. The final statement was approved by the expert panel.
The resulting consensus statement includes 23 recommendations on preconception (fertility and contraception), pregnancy (planning, pharmacological management, and follow-up), and breastfeeding (management and follow-up). Consensus was achieved for all recommendations generated except one.
These recommendations for the better management of psoriasis in women of childbearing age could improve outcomes and prognosis.
Desarrollar recomendaciones basadas en la mejor evidencia y experiencia sobre el manejo de pacientes con psoriasis durante la edad fértil, el embarazo, el posparto y la lactancia.
Se siguió la metodología de grupos nominales y Delphi. Se seleccionó un grupo director de expertos (12 dermatólogos —de los cuales 2 fueron los coordinadores—, 1 reumatólogo, 2 ginecólogos). Se realizó una revisión sistemática de la literatura sobre fertilidad, embarazo, posparto y lactancia en pacientes con psoriasis. Con esta información los coordinadores generaron una serie de recomendaciones preliminares. Todo ello se presentó y discutió con el resto de expertos en una reunión de grupo nominal donde se definió el alcance, los usuarios, los apartados del documento, y donde se generaron las recomendaciones definitivas. El grado de acuerdo con las recomendaciones se votó siguiendo la metodología Delphi, que se extendió a 51 dermatólogos más, según una escala de 1 (total desacuerdo) a 10 (total acuerdo), definiéndose el acuerdo como una puntuación ≥ 7 por al menos el 70% de los participantes. El nivel de evidencia y el grado de recomendación se clasificaron según el modelo del Center for Evidence Based Medicine de Oxford. El documento completo final fue aprobado por el panel de expertos.
Se generaron 23 recomendaciones sobre el periodo pre-concepcional (fertilidad y anticoncepción), el embarazo (planificación, manejo farmacológico y seguimiento) y la lactancia (manejo y seguimiento). Todas las recomendaciones menos una alcanzaron el nivel de acuerdo definido.
En los pacientes con psoriasis en edad fértil estas recomendaciones pueden mejorar el manejo, los resultados y el pronóstico.
In 2017, the Spanish Academy of Dermatology and Venereology Psoriasis Working Group (PWG) designed the Minimal Disease Activity (MDA) criteria to determine the level of disease activity. We hereby ...present the results of an observational, cross-sectional, multicenter study of the nationwide application of these criteria.INTRODUCTIONIn 2017, the Spanish Academy of Dermatology and Venereology Psoriasis Working Group (PWG) designed the Minimal Disease Activity (MDA) criteria to determine the level of disease activity. We hereby present the results of an observational, cross-sectional, multicenter study of the nationwide application of these criteria.We conducted a non-randomized sampling, stratified to achieve autonomic and provincial representation of consecutive patients with psoriasis (Ps) vulgaris without active arthritis. A total of 830 patients were included: 493 men (59.5%), with a mean age of 51.4 years (SD, 14.2), from all autonomous regions of Spain (except for Ceuta and Melilla) and 44 (88%) out of the 50 provinces. A questionnaire was obtained with demographic data, DLQI, subjective assessment-on a scale from 0 to 10-of itching, erythema, desquamation, visibility, and the patients' PASI and BSA.MATERIAL AND METHODSWe conducted a non-randomized sampling, stratified to achieve autonomic and provincial representation of consecutive patients with psoriasis (Ps) vulgaris without active arthritis. A total of 830 patients were included: 493 men (59.5%), with a mean age of 51.4 years (SD, 14.2), from all autonomous regions of Spain (except for Ceuta and Melilla) and 44 (88%) out of the 50 provinces. A questionnaire was obtained with demographic data, DLQI, subjective assessment-on a scale from 0 to 10-of itching, erythema, desquamation, visibility, and the patients' PASI and BSA.More than 50% failed to meet the MDA criteria (491; 59.2%), with significant differences being reported by region, sex, and age. Additionally, significant differences were reported based on the therapy used (P<.001). The use of biological therapies was associated with higher MDA compliance compared to other therapies (59.4% vs 23.3%). No differences were reported among various biological therapies.RESULTSMore than 50% failed to meet the MDA criteria (491; 59.2%), with significant differences being reported by region, sex, and age. Additionally, significant differences were reported based on the therapy used (P<.001). The use of biological therapies was associated with higher MDA compliance compared to other therapies (59.4% vs 23.3%). No differences were reported among various biological therapies.The overall rate of MDA compliance is low, with differences being based on geographic location, sex, age, and drug used, yet none of these factors separately justify them.CONCLUSIONSThe overall rate of MDA compliance is low, with differences being based on geographic location, sex, age, and drug used, yet none of these factors separately justify them.
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El Grupo de Psoriasis de la Academia Española de Dermatología y Venereología (GPs) diseño en 2017 la medida Actividad Mínima de Enfermedad en Psoriasis (AME). Se presentan los ...resultados de un estudio observacional, transversal y multicéntrico de la aplicación de esta escala a nivel nacional.
Se realizó un muestreo no aleatorizado, estratificado para alcanzar representación autonómica y provincial, de pacientes consecutivos con psoriasis (Ps) vulgar sin artritis activa. Se incluyeron 830 pacientes: 493 eran varones (59,5%), con una edad media de 51,4 años (DE=14,2), de todas las autonomías del país (excepto Ceuta y Melilla) y 44 (88%) de las 50 provincias. Se obtuvo un cuestionario recogiendo datos demográficos, DLQI, valoración subjetiva en escalas de 0 a 10 de picor, eritema, descamación y visibilidad; y el PASI y el BSA del paciente.
Más de la mitad no cumplían criterio de AME (491; 59,2%), con diferencia significativa entre regiones, por el sexo y por la edad. También había diferencias según el tratamiento realizado (p<0,001). El uso de un medicamento biológico se asoció a un mayor cumplimiento AME frente al uso de otro tipo de medicamentos (59,4 vs. 23,3%). No se observaron diferencias entre los tratamientos biológicos.
El porcentaje global de cumplimiento AME es bajo, con diferencias por la localización geográfica, el sexo, la edad y el fármaco utilizado, si bien ninguno de esos factores por separado las justifica.
In 2017, the Spanish Academy of Dermatology and Venereology Psoriasis Working Group (PWG) designed the Minimal Disease Activity (MDA) criteria to determine the level of disease activity. We hereby present the results of an observational, cross-sectional, multicenter study of the nationwide application of these criteria.
We conducted a non-randomized sampling, stratified to achieve autonomic and provincial representation of consecutive patients with psoriasis (Ps) vulgaris without active arthritis. A total of 830 patients were included: 493 men (59.5%), with a mean age of 51.4 years (SD, 14.2), from all autonomous regions of Spain (except for Ceuta and Melilla) and 44 (88%) out of the 50 provinces. A questionnaire was obtained with demographic data, DLQI, subjective assessment—on a scale from 0 to 10—of itching, erythema, desquamation, visibility, and the patients’ PASI and BSA.
More than 50% failed to meet the MDA criteria (491; 59.2%), with significant differences being reported by region, sex, and age. Additionally, significant differences were reported based on the therapy used (P<.001). The use of biological therapies was associated with higher MDA compliance compared to other therapies (59.4% vs 23.3%). No differences were reported among various biological therapies.
The overall rate of MDA compliance is low, with differences being based on geographic location, sex, age, and drug used, yet none of these factors separately justify them.
Resumen: Objetivo: Desarrollar recomendaciones basadas en la mejor evidencia y experiencia sobre el manejo de pacientes con psoriasis durante la edad fértil, el embarazo, el posparto y la lactancia. ...Métodos: Se siguió la metodología de grupos nominales y Delphi. Se seleccionó un grupo director de expertos (12 dermatólogos —de los cuales 2 fueron los coordinadores—, 1 reumatólogo, 2 ginecólogos). Se realizó una revisión sistemática de la literatura sobre fertilidad, embarazo, posparto y lactancia en pacientes con psoriasis. Con esta información los coordinadores generaron una serie de recomendaciones preliminares. Todo ello se presentó y discutió con el resto de expertos en una reunión de grupo nominal donde se definió el alcance, los usuarios, los apartados del documento, y donde se generaron las recomendaciones definitivas. El grado de acuerdo con las recomendaciones se votó siguiendo la metodología Delphi, que se extendió a 51 dermatólogos más, según una escala de 1 (total desacuerdo) a 10 (total acuerdo), definiéndose el acuerdo como una puntuación ≥ 7 por al menos el 70% de los participantes. El nivel de evidencia y el grado de recomendación se clasificaron según el modelo del Center for Evidence Based Medicine de Oxford. El documento completo final fue aprobado por el panel de expertos. Resultados: Se generaron 23 recomendaciones sobre el periodo pre-concepcional (fertilidad y anticoncepción), el embarazo (planificación, manejo farmacológico y seguimiento) y la lactancia (manejo y seguimiento). Todas las recomendaciones menos una alcanzaron el nivel de acuerdo definido. Conclusiones: En los pacientes con psoriasis en edad fértil estas recomendaciones pueden mejorar el manejo, los resultados y el pronóstico. Abstract: Objective: To develop evidence- and experience-based recommendations for the management of psoriasis during preconception, pregnancy, postpartum, and breastfeeding. Methods: The nominal group technique and the Delphi method were used. Fifteen experts (12 dermatologists, 2 of whom were appointed coordinators; 1 rheumatologist; and 2 gynecologists) were selected to form an expert panel. Following a systematic review of the literature on fertility, pregnancy, postpartum, and breastfeeding in women with psoriasis, the coordinators drew up a series of preliminary recommendations for discussion by the panel at a nominal group meeting. The experts defined the scope, sections, and intended users of the statement and prepared a final list of recommendations. Consensus was obtained using a Delphi process in which an additional 51 dermatologists rated their level of agreement with each recommendation on a scale of 1 (total disagreement) to 10 (total agreement). Consensus was defined by a score of 7 or higher assigned by at least 70% of participants. Level of evidence and strength of recommendation were reported using the Oxford Center for Evidence-Based Medicine categories. The final statement was approved by the expert panel. Results: The resulting consensus statement includes 23 recommendations on preconception (fertility and contraception), pregnancy (planning, pharmacological management, and follow-up), and breastfeeding (management and follow-up). Consensus was achieved for all recommendations generated except one. Conclusions: These recommendations for the better management of psoriasis in women of childbearing age could improve outcomes and prognosis.
Desarrollar recomendaciones basadas en la mejor evidencia y experiencia sobre el manejo de pacientes con psoriasis durante la edad fértil, el embarazo, el posparto y la lactancia.
Se siguió la ...metodología de grupos nominales y Delphi. Se seleccionó un grupo director de expertos (12 dermatólogos —de los cuales 2 fueron los coordinadores—, 1 reumatólogo, 2 ginecólogos). Se realizó una revisión sistemática de la literatura sobre fertilidad, embarazo, posparto y lactancia en pacientes con psoriasis. Con esta información los coordinadores generaron una serie de recomendaciones preliminares. Todo ello se presentó y discutió con el resto de expertos en una reunión de grupo nominal donde se definió el alcance, los usuarios, los apartados del documento, y donde se generaron las recomendaciones definitivas. El grado de acuerdo con las recomendaciones se votó siguiendo la metodología Delphi, que se extendió a 51 dermatólogos más, según una escala de 1 (total desacuerdo) a 10 (total acuerdo), definiéndose el acuerdo como una puntuación ≥7 por al menos el 70% de los participantes. El nivel de evidencia y el grado de recomendación se clasificaron según el modelo del Center for Evidence Based Medicine de Oxford. El documento completo final fue aprobado por el panel de expertos.
Se generaron 23 recomendaciones sobre el periodo pre-concepcional (fertilidad y anticoncepción), el embarazo (planificación, manejo farmacológico y seguimiento) y la lactancia (manejo y seguimiento). Todas las recomendaciones menos una alcanzaron el nivel de acuerdo definido.
En los pacientes con psoriasis en edad fértil estas recomendaciones pueden mejorar el manejo, los resultados y el pronóstico.
To develop evidence- and experience-based recommendations for the management of psoriasis during preconception, pregnancy, postpartum, and breastfeeding.
The nominal group technique and the Delphi method were used. Fifteen experts (12 dermatologists, 2 of whom were appointed coordinators; 1 rheumatologist; and 2 gynecologists) were selected to form an expert panel. Following a systematic review of the literature on fertility, pregnancy, postpartum, and breastfeeding in women with psoriasis, the coordinators drew up a series of preliminary recommendations for discussion by the panel at a nominal group meeting. The experts defined the scope, sections, and intended users of the statement and prepared a final list of recommendations. Consensus was obtained using a Delphi process in which an additional 51 dermatologists rated their level of agreement with each recommendation on a scale of 1 (total disagreement) to 10 (total agreement). Consensus was defined by a score of 7 or higher assigned by at least 70% of participants. Level of evidence and strength of recommendation were reported using the Oxford Center for Evidence-Based Medicine categories. The final statement was approved by the expert panel.
The resulting consensus statement includes 23 recommendations on preconception (fertility and contraception), pregnancy (planning, pharmacological management, and follow-up), and breastfeeding (management and follow-up). Consensus was achieved for all recommendations generated except one.
These recommendations for the better management of psoriasis in women of childbearing age could improve outcomes and prognosis.
•Efficient forest changes detection in areas with high stand fragmentation.•The methodology does not require analyzing very long time-series of data.•It can be easily integrated with different land ...cover mapping methodologies.•It can aid in the integration of LC map production and LCC detection.
Land cover mapping is fundamental for national and international agencies to monitor forest resources. However, monitoring forest disturbances by direct comparison of these maps poses several difficulties and challenges. As a result, different methodologies have been explored to detect forest disturbances. However, most of them cannot be fully integrated with land cover map production since they require additional input data, while others are not suitable for monitoring small land parcels. This study presents a methodology that fulfils the need to integrate land cover mapping with land cover change detection. Specifically, this methodology was designed to complement the Sentinel-2-based land cover mapping used in Galicia, northwest Spain, a region characterized by small land parceling. First, two previously obtained land cover maps from 2019 and 2020 were compared to identify all the pixels with potential land cover changes using QGIS. The behavior of spectral indexes in a time series were then analyzed to identify which of the previously identified pixels correspond to forest disturbances. This step was implemented in the software R. Using the Normalized Difference Vegetation Index (NDVI) to detect different land cover changes it was obtained an overall accuracy of 82%, considering the existence of varying phenologies, diverse topographic conditions, and areas with a high level of stand fragmentation. This study could help agencies that have already developed their own land cover maps to easily advance the integration of their maps with land cover change detection, since this technique can be applied with any land cover mapping methodology based on multitemporal analysis of satellite images, without the need for additional input data.
Over the last several decades, thanks to improvements in and the diversification of open-access satellite imagery, land cover mapping techniques have evolved significantly. Notable changes in these ...techniques involve the automation of different steps, yielding promising results in terms of accuracy, class detection and efficiency. The most successful methodologies that have arisen rely on the use of multi-temporal data. Several different approaches have proven successful. In this study, one of the most recently developed methodologies is tested in the region of Galicia (in Northwestern Spain), with the aim of filling gaps in the mapping needs of the Galician forestry sector. The methodology mainly consists of performing a supervised classification of individual images from a selected time series and then combining them through aggregation using decision criteria. Several of the steps of the methodology can be addressed in multiple ways: pixel resolution selection, classification model building and aggregation methods. The effectiveness of these three tasks as well as some others are tested and evaluated and the most accurate and efficient parameters for the case study area are highlighted. The final land cover map that is obtained for Galicia has high accuracy metrics (an overall accuracy of 91.6%), which is in line with previous studies that have followed this methodology in other regions. This study has led to the development of an efficient open-access solution to support the mapping needs of the forestry sector.
The present study addresses the tree counting of a Eucalyptus plantation, the most widely planted hardwood in the world. Unmanned aerial vehicle (UAV) light detection and ranging (LiDAR) was used for ...the estimation of Eucalyptus trees. LiDAR-based estimation of Eucalyptus is a challenge due to the irregular shape and multiple trunks. To overcome this difficulty, the layer of the point cloud containing the stems was automatically classified and extracted according to the height thresholds, and those points were horizontally projected. Two different procedures were applied on these points. One is based on creating a buffer around each single point and combining the overlapping resulting polygons. The other one consists of a two-dimensional raster calculated from a kernel density estimation with an axis-aligned bivariate quartic kernel. Results were assessed against the manual interpretation of the LiDAR point cloud. Both methods yielded a detection rate (DR) of 103.7% and 113.6%, respectively. Results of the application of the local maxima filter to the canopy height model (CHM) intensely depends on the algorithm and the CHM pixel size. Additionally, the height of each tree was calculated from the CHM. Estimates of tree height produced from the CHM was sensitive to spatial resolution. A resolution of 2.0 m produced a R2 and a root mean square error (RMSE) of 0.99 m and 0.34 m, respectively. A finer resolution of 0.5 m produced a more accurate height estimation, with a R2 and a RMSE of 0.99 and 0.44 m, respectively. The quality of the results is a step toward precision forestry in eucalypt plantations.
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