Biologics recommendations for patients with psoriasis: a critical appraisal of clinical practice guidelines for psoriasis.

PURPOSE: This review article serves to assess the consistency of recommendations from guidelines on biologic agents for psoriasis, based on the quality evaluation of psoriasis Clinical Practice Guidelines (CPGs). METHODS: We conducted a systematic literature search to identify CPGs that provide recommendations on diagnosis and treatment for psoriasis. Four reviewers performed a quality assessment of the included CPGs with the Appraisal of Guidelines Research and Evaluation II (AGREE II) Instrument. RESULTS: A total of 51 sets of CPGs from 22 medical societies or separate working groups fulfilled the inclusion criteria. The overall quality of the eligible sets of guidelines was moderate to high, with an overall average score of 55%. The highest domain scores were Score and Purpose (70%) and Clarity of Presentation (68%). A total of 95 biologic agent recommendations were extracted from the 18 recommended CPGs. Three biologic agents (Etanercept, Adalimumab, Ustekinumab) were recommended for pediatric patients. Three biologic agents (Adalimumab, Ustekinumab, Secukinumab) were recommended as first-line biologic agents for adults with psoriasis. CONCLUSION: The overall methodological quality of CPGs for psoriasis is medium to high. More attention should be paid to applicability in guideline development. The recommendations and the basis for them among various sets guidelines were almost consistent.

Prevalence of and Risk Factors for Type 2 Diabetes Mellitus in Hyperlipidemia in China.

BACKGROUND: We explored the prevalence of and risk factors for type 2 diabetes in the adult population of Shanghai (China) with and without dyslipidemia. MATERIAL AND METHODS: We conducted a cross-sectional survey including 14 385 adults (aged 16 to 88 years) in Shanghai using a stratified, multistage cluster sampling approach. RESULTS: Type 2 diabetes and hyperlipidemia were found in 1456 (10.1%) and 4583 (31.9%) subjects, respectively. Type 2 diabetes was more common in males (11.4%) than in females (9.2%, P<0.01), in the elderly (> or =65 years, 22.5%) than in younger (<55 years, <10%, P<0.01) individuals, and in urban (12.8%) than in rural populations (5.2%, P<0.01). Diabetes incidence was higher among patients with hyperlipidemia than in controls (16.9% vs. 7.0%, P<0.01; OR=2.72, 95% CI 2.44-3.03). Compared with controls, the risk for diabetes in subjects with isolated hypertriglyceridemia, isolated hypercholesterolemia, and mixed hyperlipidemia increased 1.75-fold (95% CI 1.53-1.99), 1.53-fold (95% CI 1.17-2.01), and 2.93-fold (95% CI 2.37-3.63), respectively. The fasting plasma glucose (FPG) and 2h-postprandial plasma glucose (2h-PG) increased with age in both sexes. The age- and sex-adjusted FPG and 2h-PG levels in hyperlipidemia were significantly higher than in controls (P<0.01). CONCLUSIONS: A high prevalence of type 2 diabetes in hyperlipidemia patients exists in Shanghai. Hyperlipidemia is associated with elevated blood glucose levels and therefore requires prompt intervention for prevention and treatment of diabetes in patients with dyslipidemia.

Dyslipidemia in Shanghai, China.

OBJECTIVES: To determine the prevalence of and risk factors for dyslipidemia in Shanghai. METHODS: A cross-sectional survey of 14,385 subjects (6150 men) with mean age of 49.5 (14.5) years was conducted between October 2002 and April 2003 using randomized, stratified cluster sampling. Serum triglyceride, total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) were measured. RESULTS: Dyslipidemia, as defined by NCEP ATP III criteria, occurred in 5255 subjects (36.5%). The prevalences of mixed hyperlipidemia (elevated TC and triglycerides), isolated hypertriglyceridemia, isolated hypercholesterolemia and isolated low HDL-C were 3.8%, 24.9%, 3.2% and 4.7%, respectively. The prevalence of dyslipidemia increased with age, with the peak prevalence (43%) occurring after age 55. Dyslipidemia was more common in males than females (40.2% vs. 33.8%) and in rural than urban populations (44.2% vs. 32.3%). Serum triglyceride and TC increased with body mass index (BMI) and waist circumference. Mean serum triglyceride concentrations in males and rural residents were higher than those in females and urban residents, respectively, whereas the reverse was true for HDL-C values. Multivariate analysis revealed that dyslipidemia was associated with age, gender, area of residence, BMI and waist circumference. CONCLUSIONS: There is a high prevalence of dyslipidemia, mainly hypertriglyceridemia and low HDL-C, in Shanghai.

[The expression and clinical significance of Wnt-1 induced secreted protein-1 in breast carcinoma].

OBJECTIVE: To investigate the expression of Wnt-1 induced secreted protein-1 (WISP-1) between breast cancer and paired normal breast tissues and to explore the significance of WISP-1 in breast cancer tumorigenesis. METHODS: The mRNA and protein expressions of WISP-1 in human breast cancer were measured by Quantitative Real-Time RT-PCR and immunohistochemical staining and further analyzed the relationship between WISP-1 expression and clinic pathologic characters. RESULTS: WISP-1 expression in breast cancer was higher than that in normal breast tissue (P = 0.001). The mRNA expression level of WISP-1 was correlated with tumor size, staging, lymph node status, differentiated degree and HER-2 status (P < 0.05). WISP-1 protein expression level was correlated with lymph node status, differentiated degree and HER-2 status (P < 0.05). CONCLUSION: WISP-1 expression in human breast cancer increases significantly and may play a key role in the invasion and metastasis of human breast cancer.

Alcohol consumption and metabolic syndrome among Shanghai adults: a randomized multistage stratified cluster sampling investigation.

AIM: To examine the relations of alcohol consumption to the prevalence of metabolic syndrome in Shanghai adults. METHODS: We performed a cross-sectional analysis of data from the randomized multistage stratified cluster sampling of Shanghai adults, who were evaluated for alcohol consumption and each component of metabolic syndrome, using the adapted U.S. National Cholesterol Education Program criteria. Current alcohol consumption was defined as more than once of alcohol drinking per month. RESULTS: The study population consisted of 3953 participants (1524 men) with a mean age of 54.3 +/- 12.1 years. Among them, 448 subjects (11.3%) were current alcohol drinkers, including 405 males and 43 females. After adjustment for age and sex, the prevalence of current alcohol drinking and metabolic syndrome in the general population of Shanghai was 13.0% and 15.3%, respectively. Compared with nondrinkers, the prevalence of hypertriglyceridemia and hypertension was higher while the prevalence of abdominal obesity, low serum high-density-lipoprotein cholesterol (HDL-C) and diabetes mellitus was lower in subjects who consumed alcohol twice or more per month, with a trend toward reducing the prevalence of metabolic syndrome. Among the current alcohol drinkers, systolic blood pressure, HDL-C, fasting plasma glucose, and prevalence of hypertriglyceridemia tended to increase with increased alcohol consumption. However, low-density-lipoprotein cholesterol concentration, prevalence of abdominal obesity, low serum HDL-C and metabolic syndrome showed the tendency to decrease. Moreover, these statistically significant differences were independent of gender and age. CONCLUSION: Current alcohol consumption is associated with a lower prevalence of metabolic syndrome irrespective of alcohol intake (g/d), and has a favorable influence on HDL-C, waist circumference, and possible diabetes mellitus. However, alcohol intake increases the likelihood of hypertension, hypertriglyceridemia and hyperglycemia. The clinical significance of these findings needs further investigation.

Fatty liver and the metabolic syndrome among Shanghai adults.

BACKGROUND AND AIM: To explore the relationship between fatty liver and the metabolic syndrome in the adults of Shanghai and evaluate the value of fatty liver as a marker for risk factor clustering. METHODS: Questionnaires, physical examinations, laboratory tests (blood lipid and glucose) and real-time liver ultrasonographies were performed in Shanghai adults and analyzed using randomized, multistage, stratified cluster sampling. Prevalence of the metabolic syndrome was defined by the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII) criteria with the exception of abdominal obesity (waist circumference > 90 cm in men and > 80 cm in women); fatty liver was diagnosed in accordance with the presence of an ultrasonographic pattern consistent with 'bright' liver (brightness and posterior attenuation of liver). RESULTS: The study population consisted of 3175 subjects (1218 men) with a mean (+/- SD) age of 52.4 +/- 15.1 years. Metabolic syndrome and fatty liver were found in 726 (22.87%) and 661 (20.82%) of sampled cases, respectively. After adjustment by age and sex, the prevalence of the metabolic syndrome and fatty liver in the general population of Shanghai were 15.30 and 17.29%, respectively. The risk for fatty liver in subjects with abdominal obesity, diabetes, dyslipidemia and hypertension increased 32.78-fold (95% confidence interval (CI) 14.85-72.35), 31.58-fold (95% CI 14.18-70.35), 22.64-fold (95% CI 10.26-49.99) and 23.25-fold (95% CI 10.54-51.30), respectively, compared with controls, whereas the risk for fatty liver in subjects with metabolic syndrome was increased by 39.33-fold (95% CI 17.77-87.05). After the 661 patients with fatty liver had been stratified by body mass index (BMI), the prevalence of abdominal obesity, hypertension and the metabolic syndrome were increased from 25.0, 47.2 and 36.1%, respectively, in people with normal BMI to 81.0, 73.8 and 55.4%, respectively, in obese persons. However, the prevalence of hypertriglyceridemia, high fasting glucose and low high-density lipoprotein-cholesterol showed no significant changes with increased BMI. Moreover, among fatty liver patients with normal BMI, the detection rate for one or more features of metabolic disorders was as high as 83.3% and that for five features was 2.8%. Compared with obesity (BMI > or = 25 kg/m2) and abdominal obesity, fatty liver had the highest clustering rate, specificity, positive predictive value and attributable risk percentage in detecting risk factor clustering in both sexes. CONCLUSIONS: There is a high prevalence of metabolic syndrome and fatty liver among Shanghai adults. Metabolic disorders are closely related to fatty liver; moreover, fatty liver appears to be a good predictor for the clustering of risk factors for metabolic syndrome.

Prevalence of and risk factors for fatty liver in a general population of Shanghai, China.

BACKGROUND/AIMS: To determine the prevalence and risk factors of fatty liver (FL) among Shanghai adults. METHODS: A cross-sectional ultrasonographic survey with randomized multistage stratified cluster sampling was used. RESULTS: The study included 3175 subjects (1218 men) with a mean age of 52 years. FL was found in 661 (20.82%) subjects. After adjustment by age and sex, FL prevalence was found to be 17.29%, and the prevalences of alcoholic, suspected alcoholic and nonalcoholic FL were determined to be 0.79, 1.15 and 15.35%, respectively. Generally, age, body mass index (BMI), waist circumference, blood pressure, and the prevalences of obesity, diabetes, hypertension and dyslipidemia were all significantly higher in FL patients than in controls; In contrast, the levels of high-density-lipoprotein cholesterol (HDL-C), education and physical activity were markedly lower. Multiple regression analyses showed that only nine factors (male, educational level, waist circumference, BMI, HDL-C, triglyceride, fasting plasma glucose, diabetes and hypertension) were closely related to FL. In excessive drinkers, obesity increased the risk for FL by 4.8-fold, but excessive drinking was associated with only a 1.5-fold increased risk in obese subjects. CONCLUSIONS: FL in Shanghai is highly prevalent and mainly related to multiple metabolic disorders.