Summary
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.
What is already known about this topic?
Psoriasis and dementia are complex diseases with multifactorial pathogenesis, but share common inflammatory characteristics.
There is evidence for a shared genetic and inflammatory pathogenesis between the two entities.
What does this study add?
Most observational studies found a significant positive association between psoriasis and cognitive impairment or dementia, and cognitive screening can be considered for patients with psoriasis who present with cognitive complaints.
There is currently not enough evidence to suggest one specific systemic antipsoriatic treatment over another for patients with psoriasis showing mild cognitive impairment or dementia.
Plain language summary available online
Lichen sclerosus (LS) is an inflammatory skin disease that usually involves the anogenital area. All patients with symptoms or signs suspicious of lichen sclerosus should be seen at least once ...initially by a physician with a special interest in the disease in order to avoid delay in diagnosis, as early treatment may cure the disease in some and reduce or prevent scarring. The diagnosis is made clinically in most cases. Biopsies should only be performed under certain circumstances. The gold standard for treatment remains potent to very potent topical steroids; however, mild and moderate disease in boys and men may be cured by circumcision. Certain triggers should be avoided. http://www.euroderm.org/images/stories/guidelines/2014/S3-Guideline-on-Lichen-sclerosus.pdf http://www.awmf.org/fachgesellschaften/mitgliedsgesellschaften/visitenkarte/fg/deutsche-gesellschaft-fuer-gynaekologie-und-geburtshilfe-dggg.html.
Summary
Background
Indigo naturalis and its refined formulation, Lindioil, are effective in treating psoriatic symptoms topically. Indirubin is the active ingredient in indigo naturalis.
Objectives
...To determine the efficacy and safety of different concentrations of indirubin in Lindioil ointment for treating psoriasis.
Methods
In this randomized, double‐blind trial, adult patients presenting with chronic plaque psoriasis for > 1 year and with < 20% of the body surface area (BSA) affected were randomized to apply Lindioil ointment containing 200, 100, 50 or 10 μg g−1 of indirubin twice daily for 8 weeks followed by an additional 12‐week safety/extension period. The primary end point was the mean percentage change in Psoriasis Area and Severity Index (PASI) score along with the proportion of participants achieving 75% and 90% reductions in PASI scores (PASI 75 and PASI 90, respectively) from baseline to week 8.
Results
The results from week 8 revealed that the 200 μg g−1 group had the greatest reduction in PASI score 69·2%, 95% confidence interval (CI) 55·5–82·8, followed by the 100 μg g−1 group (63·1%, 95% CI 52·8–73·5), the 10 μg g−1 group (53·4%, 95% CI 42·8–64·0) and the 50 μg g−1 group (50·3%, 95% CI 37·4–63·2), with a between‐group comparison of P = 0·0445. The group with the highest proportion of the patients achieving PASI 75 (57%, P = 0·0474) and PASI 90 (30%, P = 0·0098) was the 200 μg g−1 group. No severe treatment‐related adverse events were reported during the 20‐week evaluation.
Conclusions
An amount of 200 μg g−1 of indirubin in Lindioil ointment is the most effective concentration studied so far for treating psoriasis topically, and is safe.
What's already known about this topic?
As a result of safety concerns about the long‐term use of corticosteroids and other standard treatments, there is a growing demand for herbal treatments for psoriasis.
Indigo naturalis, a herb used in Chinese medicine, is effective for the topical treatment of psoriasis when used as a crude ointment or in its refined form, Lindioil.
What does this study add?
Indirubin is the active ingredient in indigo naturalis, and different concentrations of indirubin in indigo naturalis ointment yield different results in treating psoriasis.
This study provides evidence that 200 μg g−1 of indirubin, the highest concentration studied so far, is the most effective concentration and is safe.
Linked Comment: Sekhon and Koo. Br J Dermatol 2018; 178:21.
Plain language summary available online
Respond to this article
Although strain underpins the behavior of many transition‐oxide‐based magnetic nanomaterials, it is elusive to quantify. Since the formation of orbital molecules is sensitive to strain, a ...metal–insulator transition should be a window into nanocrystallite strain. Using three sizes of differently strained Fe3O4 polycrystalline nanorods, the impact of strain on the Verwey transition and the associated formation and dissolution processes of quasiparticle trimerons is tracked. In 40 and 50 nm long nanorods, increasing isotropic strain results in Verwey transitions going from TV ≈ 60 K to 20 K. By contrast, 700 nm long nanorods with uniaxial strain along the (110) direction have TV ≈ 150 K—the highest value reported thus far. A metal–insulator transition, like TV in Fe3O4, can be used to determine the effective strain within nanocrystallites, thus providing new insights into nanoparticle properties and nanomagnetism.
Tracking the orbital molecule formation through the Verwey transition temperature (TV) in nanorods provides a unique window into nanocrystallite strain. Particles with uniaxial tensile strain show the highest TV = 150 K reported to date.
Tremors are a type of slow earthquake with long‐duration signals compared to ordinary earthquakes. The long signals have been considered to solely reflect their long source process. However, here, we ...provide evidence suggesting that the source processes of tremors are not always long. We refer to these observations as short‐duration tremors. They were recorded by ocean‐bottom seismometers placed very close to the source. Although these tremors exhibit a short‐duration signal when recorded near the source, they exhibit a typical long‐duration signal elsewhere. Our numerical simulations demonstrate that the features can be captured by considering a strongly scattering medium around their source. One such structure could be small low‐velocity inclusions distributed around the seismic source. The inclusions may represent the seismic expression of geologically detected aquifers in tremor source regions. Furthermore, this medium could be embedded along the slow earthquake fault zone and play a critical role in their source process.
Plain Language Summary
At least two types of earthquakes occur in shallow subduction zones: ordinary earthquakes and tremors. Tremors are known to exhibit long signal duration compared to ordinary earthquakes. To date, tremors' long‐duration signal has been solely interpreted by their source process. Here, we discovered tremors that exhibit short duration signals when recorded close from the source which we referred to as "short‐duration tremors". They suggest that tremors' source process is not always long and structural effects may partially form the typical long‐duration signals. We performed numerical simulations on elastic wave propagation and demonstrated that the observations can be qualitatively reproduced by assuming a strongly scattering material surrounding the seismic source. On the other hand, it has been reported based on ocean bottom drilling project that tremor source region may consist of patchily distributed aquifers. The inclusions in our model may be the seismic expressions of the geologically detected aquifers. Further, such a structure could be embedded along the slow‐earthquake fault zone and play a key role in their source process.
Key Points
Short‐duration tremors in ocean‐bottom seismometer records suggest that the source process of tremors is not always long
Short‐duration tremors can be interpreted by placing a strongly scattering medium around their source
Such a medium embedded along the slow earthquake fault zone could play a key role in the tremor source process
Abstract Background Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength. This study aims to explore the prevalence of sarcopenia in ...overweight and obese gastric cancer (GC) patients and figured out the impacts of sarcopenia on the postoperative complication of overweight and obese GC patients. Methods According to the recommended body-mass index (BMI) for Asian populations by WHO, we conducted a prospective study of overweight and obese gastric cancer patients (BMI ≥ 23kg/m2 ) under curative gastrectomy from August 2014 to December 2015. Including lumbar skeletal muscle index, handgrip strength and gait speed as the sarcopenic components were measured before surgery. Patients were followed up after gastrectomy to gain the actual clinical outcomes. Factors contributing to postoperative complications were analyzed by univariate and multivariate analysis. Results Total of 206 overweight or obese patients were enrolled in this study, 14 patients were diagnosed sarcopenia and were demonstrated having significantly association with higher risk of postoperative complications, higher hospital costs, and higher rate of 30-days readmission compared with the non-sarcopenic ones. On the basis of univariate and multivariate analysis, sarcopenia was an independent risk factor for postoperative complication of overweight and obese patients with gastric cancer ( P = 0.002). Conclusion Sarcopenia is an independent predictor of postoperative complications in overweight or obese patients with gastric cancer after radical gastrectomy.
PDF
