Frailty screening in dermato-oncology practice: a modified Delphi study and a systematic review of the literature.

BACKGROUND: Appropriate management and prevention of both under- and overtreatment in older skin cancer patients can be challenging. It could be helpful to incorporate frailty screening in dermato-oncology care, since frailty is associated with adverse health outcomes. OBJECTIVES: This study aimed to identify and prioritize the requirements a frailty screening tool (FST) should fulfil in dermato-oncology practice and to select the best existing FST(s) for this purpose. METHODS: A modified two-round Delphi procedure was performed among 50 Italian and Dutch specialists and patients to review and prioritize a list of potential FST requirements, using a 5-point Likert scale. Consensus was defined as a mean score of ≥4.0. A systematic literature search was performed to identify existing multidomain FSTs, which were then assessed on the requirements resulting from the modified Delphi procedure. RESULTS: Consensus was achieved on evaluation of comorbidities (4.3 ± 0.7), polypharmacy (4.0 ± 0.9) and cognition (4.1 ± 0.8). The FST should have appropriate measurement properties (4.0 ± 1.0), be quickly executed (4.2 ± 0.7), clinically relevant (4.3 ± 0.7), and both easily understandable (4.1 ± 1.2) and interpretable (4.3 ± 0.7). Of the 26 identified FSTs, four evaluated the content-related domains: the Geriatric-8 (G8), the modified Geriatric-8 (mG8), the Groningen Frailty Indicator (GFI) and the Senior Adult Oncology Program 2 (SAOP2) screening tool. Of these, the G8 was the most extensively studied FST, with the best psychometric properties and execution within 5 min. CONCLUSIONS: The G8 appears the most suitable FST for assessing frailty in older adults with skin cancer, although clinical studies assessing its use in a dermato-oncology population are needed to further assess whether or not frailty in this particular patient group is associated with relevant outcomes (e.g. complications and mortality), as seen in previous studies in other medical fields.

Reliability of the Patient and Observer Scar Assessment Scale and a 4-point scale in evaluating linear facial surgical scars.

BACKGROUND: In order to evaluate and improve aesthetic outcome for patients undergoing dermatological surgery, a reliable evaluation tool must be used. The 4-point scale and the Patient and Observer Scar Assessment Scale (POSAS) were both developed for this purpose. OBJECTIVE: To compare the reliability of the POSAS scale with the 4-point scale for facial linear surgical scars and to assess the influence of different scar characteristics on the overall impression. METHODS: Patients visiting the outpatient clinics of the Maastricht University Medical Centre with linear facial scars were included. The 4-point scale and the Observer Scar Assessment Scale (OSAS) were completed by three independent observers. The Patient Scar Assessment Scale (PSAS) was completed by the patient on the day of the visit and 2 weeks later. The intra-class correlation coefficient (ICC) with corresponding 95% confidence intervals (CI) were calculated to assess the reliability of the scales. Linear multivariate regression analyses were performed to evaluate how the score on each aspect affected the overall opinion. RESULTS: Fifty scars in 50 patients were included. The ICC of the 4-point scale was 0.819 (95% CI: 0.708-0.892) for multiple observers and 0.602 (95% CI: 0.447-0.734) for single observer. These were superior to the ICCs of total OSAS scores (0.783 95% CI: 0.547-0.888 for multiple observers and 0.546 95% CI: 0.287-0.726 for single observer). ICCs of individual sub-items on the OSAS scored even lower. The sub-items contributed differently to the overall opinion among the different observers or patient. CONCLUSION: In terms of reliability, the overall opinion and the 4-point scale were superior to the total POSAS score or the sub-items. Observers do not weight individual scar characteristics equally to arrive at an overall opinion, which challenges the assumption that calculating a total POSAS score by summing of the scores on the individual items is a valid approach.

The relevance of respiratory viral infections in the exacerbations of chronic obstructive pulmonary disease­a systematic review.

BACKGROUND: Despite the increasing knowledge on the role of viruses in exacerbations of COPD (AECOPD), it is less clear which viruses are involved and to what extent they contribute to exacerbations. This review aims to systematically combine and evaluate the available literature of the prevalence of respiratory viruses in patients with AECOPD, detected by PCR. METHODS: An electronic search strategy was performed on PubMed and Embase and reference lists were screened for eligible studies. Cross-sectional, prospective studies and case-control studies were included. The primary outcome measure was the prevalence of respiratory viruses (adenovirus, bocavirus, coronavirus, EBV, hMPV, influenza, parainfluenza, rhino-/enterovirus, RSV) in respiratory secretions of patients during an AECOPD. Secondary outcomes were the odds of the presence of the viruses in different respiratory secretions and the odds of the presence of viruses in upper and lower respiratory tract (URT/LRT) samples. RESULTS: Nineteen studies with 1728 patients were included. Rhino-/enteroviruses (16.39%), RSV (9.90%) and influenza (7.83%) were the most prevalent viruses detected with lower detection rates of coronaviruses (4.08%) and parainfluenza (3.35%). Adenovirus (2.07%), hMPV (2.78%) and bocaviruses (0.56%) appear to be rare causative agents of AECOPD. Definitive conclusions regarding the role of EBV cannot be made. Seven of the eight analyzed viruses had a higher prevalence in LRT samples. Coronaviruses were detected more frequently in the URT. CONCLUSIONS: Respiratory viruses are frequently detected in both URT and LRT samples in AECOPD with rhino-/enteroviruses, RSV and influenza viruses the most prevalent viruses. Detection rates vary between the two sites for different viruses.

Comparison of various immunochemical assays for the detection of ethylene oxide-DNA adducts with monoclonal antibodies against imidazole ring-opened N7-(2-hydroxyethyl)guanosine: application in a biological monitoring study.

Monoclonal antibodies have been developed for the analysis of the predominant lesion in DNA induced by ethylene oxide (EtOx), namely N7-(2-hydroxyethyl)guanine (N7-EtOHGua). Two monoclonal antibodies raised against imidazole ring-opened N7-(2-hydroxyethyl)guanine (RON7-EtOHGua), N7EO-E and N7EO-11, and the previously isolated antibody N7E-102 were characterized by competitive ELISA with various inhibitors. N7EO-E and N7EO-11 recognize 2-hydroxyethyl lesions better than ethyl or methyl lesions, while N7E-102 recognizes 2-hydroxyethyl and ethyl modifications equally well. All antibodies show a preference for imidazole ring-opened adducts, bind better to adducts in DNA compared to alkylated nucleosides or bases and bind 10(6)- to 3 x 10(6)-fold less well to unmodified DNA. The sensitivity of detection of RON7-EtOHGua in DNA and in the nuclei of cells in situ by antibody N7EO-E was investigated in several assays. The immunoslot blot assay was the most sensitive method (0.34 RON7-EtOHGua per 10(6) nucleotides was detectable), followed by competitive ELISA, direct ELISA and in situ detection by immunofluorescence microscopy. The immunoslot blot assay was used to analyse N7-EtOHGua levels in white blood cell DNA from individuals exposed to EtOx (2-5 p.p.m.) and of controls. This exposure did not result in a statistically significant increase in the N7-EtOHGua level.

Determining N7-alkylguanine adducts by immunochemical methods and HPLC with electrochemical detection: applications in animal studies and in monitoring human exposure to alkylating agents.

Many xenobiotics exert their toxic effects through interaction with DNA in the cells of the exposed organism. This interaction may lead to the formation DNA adducts. Some of these may give rise to mutations that initiate cell transformation and, ultimately, the formation of tumors. Sensitive methods for determining DNA adducts are indispensable for the study of chemical mutagenesis and carcinogenesis and for biomonitoring human exposure to genotoxic agents. Alkylating agents form an important class of genotoxic compounds. They react preferentially at the N7-position of guanine. Under neutral or acidic conditions, the adducts can be readily released from the DNA backbone as the free base N7-alkylguanine (N7-AlkGua). The imidazole ring of N7-alkyldeoxyguanosine (N7-AlkdGuo) can be opened under alkaline conditions, which results in formation of a more stable adduct in DNA. To develop immunochemical methods for the detection of N7-alkylations, we immunized mice with various alkylguanosines in the ring-opened form (RON7-AlkdGuo). Antibodies were selected to detect adducts in isolated DNA by competitive ELISA and in single cells by immunofluorescence microscopy (IFM). Various monoclonal antibodies were characterized in detail with respect to specificity and sensitivity toward methylated, ethylated, and hydroxyethylated DNAs. The antibodies showed extensive cross-reactivity toward N7-(m)ethyl- and N7-(2-hydroxyethyl)guanine modifications in the ring-opened form. The limits of detection in the direct and competitive ELISA were 5-10 and 1-2 adducts per 10(6) nucleotides, respectively. The detection limit of the IFM method was about 20 adducts per 10(6) nucleotides(ABSTRACT TRUNCATED AT 250 WORDS)

Determination of N7-(2-hydroxyethyl)guanine by HPLC with electrochemical detection.

A method has been developed for the determination of N7-(2-hydroxyethyl)-guanine (N7-EtOHGua) via HPLC with electrochemical detection (EC). N7-EtOHGua is the major base adduct formed in DNA upon exposure to ethylene oxide. N7-EtOHGua, released from DNA, was separated from the unmodified nucleobases by chromatography on a reversed-phase column. For electrochemical detection, an amperometric detector cell was used with a glassy carbon working electrode, set at 1.35 V relative to an Ag/AgCl reference electrode. With purified N7-EtOHGua a linear dose-response relation was observed in the range between 0.11 and 13 pmol. The signal-to-noise ratio during analysis of 0.11 pmol N7-EtOHGua was about 8 to 1. Determination of adducts in a series of DNA samples treated with 0.16-10 mM ethylene oxide showed a linear dose-dependent increase in the level of N7-modifications. For DNA samples, the detection limit of this HPLC-EC analysis is 1 N7-EtOHGua per 6 x 10(6) nucleotides.