bluuebunny/crossref_metadata_2025 huggingface dataset:
Printing thermal performance: an experimental exploration of 3DP polymers for facade applications
Authors: Piccioni V , Leschok M , Lydon G , Cheibas I , Hischier I , Dillenburger B , Kohler M , Gramazio F , Schlueter A
Published: June 2023

The decarbonisation of the building sector requires the development of building components that provide energy efficiency while producing minimal environmental impact. We investigate the potential of polymer 3D printing (3DP) for the fabrication of mono-material translucent facade components, whose properties can be tailored according to climatic conditions and functional requirements. These components bear the potential to reduce energy consumption in buildings and, at the same time, can be fabricated with minimal environmental impact thanks to the recyclability of the feedstock material. In this study, we explore the effect of component geometry on the thermal insulation properties of 3DP objects with bespoke internal structures. Different prototypes are fabricated using a robotic polymer extruder, and their thermal properties are measured following a hot-box test method. The experimental results are then used to calibrate a heat transfer simulation model describing the joint effects of conduction, natural convection and infrared radiation through the components. We show that it is possible to fabricate insulating polymer components providing thermal transmittance ranging from 1.7 to 1 W/m2 K only by changing the internal cavity distribution and size. This proves the possibility of designing 3DP thermally-insulating components for different climatic conditions and requirements. This study provides the first insights into the thermal behaviour of polymer 3DP facades on a large scale. The results suggest that this innovative manufacturing technique is promising for application in facades and encourages further research toward performant and low-embodied energy 3DP building components.
Wood fibres as additives in mortars: a sustainable reinforcement
Authors: Stefanidou M , Kampragkou P , Kamperidou V
Published: June 2023

In mortars, the use of fibres has been diachronically a commonly used technique. In Ancient Greece, wood and straw fibres were particularly used to increase volume stability in clay and lime mortars. Overtime, with the evolution of technology, natural fibres were replaced by modern materials like polypropylene, steel, glass and carbon fibres. Recently, the climate change and the strong demand for independence from non-renewable mineral resources have urged the search for alternative ways to utilize bio-materials to produce innovative, high value-added products. The wood waste material, coming from loggings or trunks mechanical processing, constitutes valuable bio-degradable, non-toxic material of low environmental impact that could be utilized as reinforcements to produce advanced wood polymer composites. In the current study, fibres of two widely available wood species (black pine and beech) have been used (1-2 cm length). The fibres were added in lime-based and cement-based mortars in proportion 1.5% v/v of the mortar. Physical, thermal and mechanical properties were tested at the age of 28 and 90 days, while at fresh state, workability of the mixtures was recorded. It was found that in traditional systems, the formulations with black pine required higher amount of water for the same workability probably due to the higher hygroscopicity of the fibres. This was not the case in cement-based systems. Small reduction of the mechanical properties was recorded, as well as an increase of the water capillary absorption of the bio-fibres reinforced samples. Thermal conductivity was improved probably due to the porosity increase. In all cases, the shape of the samples was retained even after fracture and crack formation. Between the two wood species used, the black pine gave more beneficiary results. In general, wood-fibres revealed a high potential to upgrade the lime- and cement-based mortars performance and be further promoted in the construction sector.
Energy performance assessment of building stocks using earth observations
Authors: Dascalaki E G , Koutsantoni P , Balaras C A , Patsioti M
Published: June 2023

In Europe, about 40% of the final energy consumption and 30% of the total CO2 emissions are attributed to the operation of buildings. National energy and climate plans focus on large scale implementation of different renovation scenarios in existing buildings to meet the 2030 and 2050 targets for energy efficiency and decarbonization. Building stock modeling (BSM) offers a useful tool for the assessment of scenarios to support decision makers in setting up effective strategies for meeting European and national targets. One of the challenges faced for the reliable application of this modeling approach is the limited availability of detailed data for the investigated stocks. In the framework of the European project – EIFFEL there is ongoing work to complement data from Earth Observations with in-situ and statistical data from different sources (e.g. Hellenic Statistical Authority, energy performance certificate registry) in order to derive a bottom-up BSM of increased reliability for applications in medium scale (municipality) to large scale (prefecture) areas. The enhanced BSM is based on the representation of the entire building stock by a set of building types defined in line with the TABULA methodology according to their use, size and age of the buildings. The results presented herein come from a pilot application for a municipality in northern Attica.
Design proposal development for a more liveable open public space
Authors: Vukmirović Milena , Radić Boris , Gavrilović Suzana , Jovanović Aleksa
Published: June 2023

As a vital element of successful cities, public spaces play an important role in achieving sustainable development goals. The New urban agenda considers public spaces as a need in sustaining the productivity of cities, eco-social cohesion and inclusion, civic identity, and quality of urban life. This is also in line with the New European Bauhaus, as a part of European Green Deal, need to create beautiful places, practices and experiences that are enriching, sustainable and inclusive. In accordance with that there is undoubted importance of the public spaces, while its quality is generated in the symbiosis of various elements. On the basis of normative theories in urban design, SCORELINE framework for public space quality evaluation was developed and tested at the research group for planning and design in landscape architecture at the University of Belgrade - Faculty of Forestry. The framework covers six criteria which illuminate key aspects of public spaces such as safety and security, convenience, legibility, comfort, inspiration and sensitivity and liveability. For the purpose of this research, special attention is given to the criteria of liveability. It will be presented through its quantitative and qualitative indicators and its application in practice that cover the investigation carried out on Cara Urosa Street within the Lower Dorcol quarter in Belgrade, Serbia. The results of this analysis defined the inputs for street renewal design proposal, that was additionally tested using Space Syntax method, precisely Depthmap X simulation software to map potential issues and potentials that will be developed through design in order to achieve the defined goals concerning the liveability of open public space.
The Ventilation Capacity of Earthen Vernacular Buildings With Timber Projections (Sachnisi) in Dense Urban Canyons – Findings From a Field Study in the Mediterranean
Authors: Thravalou S , Michael A , Neophytou M , Philokyprou M
Published: June 2023

Vernacular architecture employs numerous elements for enhancing natural ventilation, especially in the Mediterranean climate. However, the cooling effectiveness of natural ventilation also relies on occupant behaviour and is highly determined by urban scale attributes. Still, airflow in real, inhomogeneous historic urban settings is rarely integrated in the thermal comfort studies of historic buildings. In this study, a multi-scale approach is adopted in order to assess the role of ventilation in establishing thermal comfort in earthen buildings, in real field conditions. This is achieved by addressing field monitoring of air velocity, temperature and relative humidity in: a) a dense (packing density λp=0.60) and inhomogeneous historic neighbourhood in Nicosia, Cyprus (measurement at a reference height); b) the street-canyon (measured at the mid-height of a narrow canyon with aspect ratio 2); and c) the interior of a typical adobe building with semi-open, pass-through spaces (portico) and closed timber projections with multiple openings, called sachnisi. Building ventilation was addressed as a function of in-street and rooftop airflow. Indoor thermal comfort was assessed in the case of specific ventilation patterns, comparing three adaptive comfort models. The results highlight the complexity of airflow in real inhomogeneous urban canopies and demonstrate that air velocity level in the street canyon is approximately one third of the reference free-stream wind velocity, while indoor air velocity remains at minimum levels. The study also reveals the contribution of night-time ventilation in cooling. Finally, spatial differentials of indoor environmental conditions in the portico were recorded for the first time, demonstrating the role of the sachnisi as a wind-capture element.
Conceptual steps to minimize energy consumption of exterior lighting in Greece: The role of façade and road lighting
Authors: Skandali C , Tomasovits M , Zerefos S , Tsangrassoulis A , Doulos L T
Published: June 2023

In our days, the urgent need for minimizing energy consumption, forces governments to take immediate actions in all directions. A review of the existing norms along with a SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis has been conducted, with reference to façade and road lighting in the urban structure. This methodology was selected as a tool for outlining energy issues of high importance in these two areas that consist a major component of the total energy consumption in the urban environment and provide helpful insights. This approach shows that there is a wide range of steps that could be followed towards this direction, not only in terms of proposals through the norms, but also through the implementation of the LED technology along with the use of the latest management systems can support the reduction of energy consumption to a large extent.
The energy performance upgrade of the historical building of “Loggia”, in Heraklion Crete, Greece
Authors: Katsaprakakis D A , Yiannakoudakis Y , Tsekouras A , Zidianakis G , Dakanali E , Spyridakis G
Published: June 2023

This article presents the process of the energy performance upgrade for the historical, Venetian building of “Loggia”, in Heraklion Crete, Greece. The building is currently used as Town Hall of the Municipality of Heraklion. The original Venetian building was constructed and renovated between the 13th century and 1628 during the Venetian occupation of Crete (1205-1669). Through the centuries, the building was gradually and partially destroyed, resulting to its total destruction in the Second World War. The construction of the existing building as a faithful copy of the original started in the ’60s and was completed in the late ’70s. Due to the special protection and conservative regime applied for the “Loggia” building, although, practically, a new one, the possible energy performance upgrade interventions were remarkably restricted. Any alteration of the building’s outer views is strictly prohibited. Eventually, the proposed measures were the installation of new openings, faithful copies of the existing ones, the installation of a new air-to-water heat pump with a hydraulic distribution network and hydronic terminal units for indoor space conditioning, installation of new luminaires and LED lamps and floodlights and a photovoltaic plant on the building’s roof. The building was upgraded to a zero-energy consumption facility.
Adopting BIM to Enhance Sustainability. The Saudi Arabia Construction Projects case study
Authors: Alasmari E , Martinez-Vazquez P , Baniotopoulos C
Published: June 2023

Building information modelling (BIM) has become an efficient tool to contribute more effectively to achieving sustainability development goals. BIM utilities have progressively revealed efficient environments to share data amongst stakeholders. The present paper aims to evaluate levels of awareness around BIM capabilities amongst engineers and project managers, focusing on the Saudi Arabia construction industry. The study targeted individuals registered with the Saudi Council of Engineers until the year 2020, who were invited to engage with a questionnaire survey. The study targeted individuals registered with the Saudi Council of Engineers, who were invited to engage with a questionnaire survey. A sample of 940 participants was taken by the survey out of a total population of the study of 55776 engineers whose responses materialised in a robust statistical analysis. According to the survey, 61% (circa 572) have developed awareness of BIM, whereas 39% (368) confirmed that they had never heard of it. A descriptive Statistics framework with the aid of SPSS has been developed to complete the statistical study. Analyses of data indicated that the benefit of using BIM is significant in the broad sustainability realm, Life Cycle Cost (LCC), operations and maintenance, efficient use of energy, daylight analysis, thermal design, and transparency in cost.
Prediction of strand-specific and cell-type-specific G-quadruplexes based on high-resolution CUT&Tag data
Authors: Cui Yizhi , Liu Hongzhi , Ming Yutong , Zhang Zheng , Liu Li , Liu Ruijun
Published: June 2023

G-quadruplex (G4), a non-classical deoxyribonucleic acid structure, is widely distributed in the genome and involved in various biological processes. In vivo, high-throughput sequencing has indicated that G4s are significantly enriched at functional regions in a cell-type-specific manner. Therefore, the prediction of G4s based on computational methods is necessary instead of the time-consuming and laborious experimental methods. Recently, G4 CUT&Tag has been developed to generate higher-resolution sequencing data than ChIP-seq, which provides more accurate training samples for model construction. In this paper, we present a new dataset construction method based on G4 CUT&Tag sequencing data and an XGBoost prediction model based on the machine learning boost method. The results show that our model performs well within and across cell types. Furthermore, sequence analysis indicates that the formation of G4 structure is greatly affected by the flanking sequences, and the GC content of the G4 flanking sequences is higher than non-G4. Moreover, we also identified G4 motifs in the high-resolution dataset, among which we found several motifs for known transcription factors (TFs), such as SP2 and BPC. These TFs may directly or indirectly affect the formation of the G4 structure.
TopNEXt: automatic DDA exclusion framework for multi-sample mass spectrometry experiments
Authors: McBride Ross , Wandy Joe , Weidt Stefan , Rogers Simon , Davies Vinny , Daly Rónán , Bryson Kevin
Published: June 2023

Motivation

Liquid Chromatography Tandem Mass Spectrometry experiments aim to produce high-quality fragmentation spectra, which can be used to annotate metabolites. However, current Data-Dependent Acquisition approaches may fail to collect spectra of sufficient quality and quantity for experimental outcomes, and extend poorly across multiple samples by failing to share information across samples or by requiring manual expert input.

Results

We present TopNEXt, a real-time scan prioritization framework that improves data acquisition in multi-sample Liquid Chromatography Tandem Mass Spectrometry metabolomics experiments. TopNEXt extends traditional Data-Dependent Acquisition exclusion methods across multiple samples by using a Region of Interest and intensity-based scoring system. Through both simulated and lab experiments, we show that methods incorporating these novel concepts acquire fragmentation spectra for an additional 10% of our set of target peaks and with an additional 20% of acquisition intensity. By increasing the quality and quantity of fragmentation spectra, TopNEXt can help improve metabolite identification with a potential impact across a variety of experimental contexts.

Availability and implementation

TopNEXt is implemented as part of the ViMMS framework and the latest version can be found at https://github.com/glasgowcompbio/vimms. A stable version used to produce our results can be found at 10.5281/zenodo.7468914.
003 Utility of plucked hair direct immunofluorescence as a possible replacement for conventional skin biopsy direct immunofluorescence in immunological activity monitoring and prediction of relapse in pemphigus
Authors: Malhi Kittu , De Dipankar , Chatterjee Debajyoti , Handa Sanjeev , Mahajan Rahul
Published: June 2023

Pemphigus vulgaris (PV) is a potentially lethal chronically relapsing autoimmune bullous disorder with intraepithelial lesions affecting the skin and mucous membranes. The prediction of clinical relapse has been studied with conventional skin biopsy and plucked hair direct immunofluorescence (DIF; Daneshpazhooh M, Naraghi ZS, Ramezani A et al. Direct immunofluorescence of plucked hair for evaluation of immunologic remission in PV. J Am Acad Dermatol 2011; 65:173–7) which can be of use in timing treatment withdrawal and helping with better management. The aims of our study were to determine the association of plucked hair root DIF positivity status at baseline with clinical relapse within the study duration, and to determine the correlation between skin biopsy and plucked hair DIF. Seventy-eight consecutive patients diagnosed with PV in clinical remission on therapy, on minimal therapy or off therapy, were included after obtaining informed consent. Three-monthly follow-up was carried out for 12 months. Immunological monitoring with plucked hair DIF was done at baseline and repeated every 3 months for 1 year or a relapse was experienced, whichever occurred earlier. Conventional skin biopsy DIF was performed at baseline, at 3 months and at the time of relapse. In patients receiving adjuvant therapy during their present remission episode, discontinuation of therapy was done at inclusion, at 3 months and at 6 months, and occurrence of relapse in relation to the time point of discontinuation was assessed. Of 78 patients, 22 had disease relapse and 56 remained in complete remission. Clinical relapse during the study duration was significantly more frequent in patients who had higher mean Autoimmune Bullous Skin Disorder Intensity Score during the preceding active disease episode (P = 0.033), pruritus during the present clinical remission episode (P = 0.007) and early discontinuation (within 3 months of study inclusion) of concomitant adjuvant therapy (P = 0.007). Immunological parameters associated with clinical relapse were baseline IgG (P = 0.005) and C3 positivity (P = 0.047) in plucked hair, greater intensity of IgG and C3 positivity at baseline in plucked hair (IgG, P = 0.002; C3, P = 0.033) and skin biopsy specimens (IgG, P = 0.004; C3, P = 0.0.002), and positive hair DIF at the time of adjuvant therapy withdrawal (P = 0.017). Plucked hair DIF is a reliable technique to assess immunological remission in patients with PV who are in clinical remission and helps to guide treatment according to immunological remission status.
009 Comparing the number needed to biopsy (NNB) ratio for melanoma diagnosis between teledermatology and face-to-face models of care
Authors: Hussain Khawar , Khalil Nada , Amini Amir , Patel Neil
Published: June 2023

The Elective Recovery Plan, published by NHS England (2022), has advocated that teledermatology (TD) should be available in every service receiving urgent suspected skin cancer referrals. However, evidence supporting the effectiveness of TD for the accurate diagnosis and triage of skin lesions remains limited. A 2018 Cochrane review found variable agreement between TD and face-to-face (FTF) assessment of lesions considered to be of low concern when seen FTF, with remote assessment more likely to recommend intervention (including excision) for low-risk lesions. The number needed to biopsy (NNB) ratio, calculated by dividing the total number of biopsies by the number of biopsied skin cancers, is increasingly used as a metric for the diagnostic accuracy for melanoma detection, with a low ratio suggesting high specificity and vice versa. We undertook a study to compare the NNB ratio for melanoma detection between TD and FTF models for assessing new 2-week-wait (2WW) skin cancer referrals within our service. Over 2019–2020, the service switched over from FTF to a full TD consultant-run model for 2WW referrals. Retrospective analysis of the FTF 2WW model between August and November 2018 identified 53 cases suspicious for melanoma referred for biopsy [30 women and 23 men; median age 44 years (range 27–90)]. Of these, six patients received a histopathological diagnosis of melanoma (NNB 8.8). Retrospective analysis of the TD model between August and November 2022 identified 62 cases suspicious for melanoma triaged directly to a biopsy appointment [37 women and 25 men; median age 49.5 years (range 18–90)]. Of these, three patients received a histopathological diagnosis of melanoma (NNB 20.7). NNB in the TD model was 2.3 times higher than in the FTF model. The NNB of 8.8 in our FTF 2WW model is comparable to a review of 46 studies, which generated an NNB of 7.5 for dermatologists worldwide. The higher NNB of 20.7 for TD indicates poorer diagnostic accuracy for melanoma in this model. The higher NNB in TD is consistent with previous findings that remote assessment is more likely to lead to the excision of low-risk lesions. Further large-scale studies are needed to compare NNB in teledermatology vs. FTF models of skin cancer assessment. TD brings considerable advantages of convenience and increased clinic capacity but may come at a cost of lower specificity for melanoma diagnosis and an increase in the number of biopsies of benign lesions.
CPC04 A rare rupioid rash
Authors: Watson Nicola , Charlton Fraser , Muthiah Siobhan
Published: June 2023

A 59-year-old man was referred to an urgent skin cancer dermatology clinic with a 4-month history of multiple skin lesions on his trunk, arms and face. The lesions were painful, increasing in size, bleeding and oozing serous fluid. The patient reported being otherwise systemically well, with a history of mild eczema and a background of high alcohol intake. On examination, he had a striking rash with numerous large rupioid plaques with thick crusting and surrounding erythema on the trunk and limbs. Smaller plaques were seen on the face and neck. An infective aetiology was favoured with an initial differential diagnosis of ecthyma or atypical mycobacterial infection. A biopsy was taken, as well as screening blood tests. Treponemal antibodies were detected; rapid plasma reagin was reactive (1 : 32), as was Serodia Treponema pallidum particle agglutination test (1 : 1280), suggesting active syphilis infection. His biopsy demonstrated granulomatous inflammation, associated with neutrophils, plasma cells and increased mucin deposition. Immunohistochemical staining for T. pallidum confirmed corkscrew-like organisms within the basal epidermis and upper dermis, consistent with secondary syphilis; screening for concurrent HIV infection was negative. The patient was referred to a local genitourinary clinic for treatment with benzylpenicillin and for full sexual health screening. The word ‘rupioid’ describes oyster or limpet shell-shaped thick keratotic lesions and is derived from the Greek word rhupos, meaning ‘filth’. Differential causes for rupioid lesions include cutaneous T-cell lymphoma, psoriasis, scabies and syphilis. Rupioid syphilis is also termed ‘malignant syphilis’ or ‘Lues maligna’, describing well-demarcated plaques with thick, lamellate and adherent crusts. It is most frequently encountered in HIV-positive patients; in HIV-negative patients, the associated comorbidities are diabetes, alcoholism, drug abuse, psoriasis and hepatitis. Typically, there is rapid clinical improvement once antibiotic treatment is administered, but episodes of Jarisch Herxheimer reaction are reported. Syphilis diagnoses have tripled over the last 10 years, with cases in the heterosexual population rising most rapidly. Dermatologists have a pivotal role to play in diagnosing primary and secondary syphilis, thereby preventing the long-term sequelae of tertiary syphilis and controlling the rising prevalence of the disease in the general population. This case highlights a striking and rare manifestation of secondary syphilis which, once seen, will not be forgotten.
CPC12 Coinheritance of BRCA2 and CYLD germline pathogenic variants associated with targetable metastatic malignant cylindroma
Authors: Fostier William , Husain Akhtar , Namini Shirin , Nik-Zainal Serena , Rajan Neil
Published: June 2023

CYLD cutaneous syndrome (CCS) presents during puberty with the development of hair follicle tumours, including cylindromas, spiradenomas or trichoepitheliomas, and is associated with pathogenic variants in the tumour suppressor gene CYLD. Germline pathogenic variants of BRCA2 are associated with an increased risk of breast, ovarian, pancreatic and prostate cancer. Coinheritance of pathogenic variants in both genes has not been previously reported, and here, we present a 29-year-old man with metastatic malignant cylindroma, where knowledge of the germline variants has targetable therapeutic implications. The proband presented with cylindromas on his scalp from the age of 8 years, inherited from his mother who had CCS. The proband’s father and paternal grandmother both had early-onset breast cancer. The proband’s 33-year-old sister had been diagnosed with breast cancer and CCS; genetic testing revealed germline pathogenic variants in both BRCA2 and CYLD. Aged 28 years, the proband presented with a growing, ulcerated cylindroma on the scalp. Histology revealed a biphasic neoplasm, showing malignant cylindroma with high-grade features arising within a pre-existing benign cylindroma. The malignant epithelioid component of the tumour showed brisk mitotic activity (25 mitoses per mm2) and large infiltrative nests with central comedo-type necrosis. Immunohistochemistry showed positivity for epithelial membrane antigen, CK7, p63 and patches of CK5/6, whereas carcinoembryonic antigen, S100 and human melanoma black-45 were negative. Several weeks after excision of the malignant scalp cylindroma, a lump presented on the left side of the patient’s neck; biopsy revealed histology consistent with the malignant scalp cylindroma. Radiological imaging revealed metastatic deposits of malignant cylindroma in the right axilla, both lungs and the brain. Genetic testing of the proband revealed germline pathogenic variants in both BRCA2 and CYLD, as seen in his sister. The patient received radiotherapy for the tumour in his neck, with partial resolution of symptoms and gamma-knife ablation of brain metastases. DNA extracted from the patient’s tumour was analysed using a high-resolution single-nucleotide polymorphism array, which demonstrated loss of heterozygosity including the BRCA2 and CYLD loci. The germline and somatic pathogenic variants in this patient support the use of unlicensed therapeutics that target BRCA deficiency, such as poly-ADP ribose polymerase inhibitors, which have not previously been used to treat malignant cylindroma. This case emphasizes the importance of recognizing coinheritance of tumour suppressor genes in rare genetic conditions, as this can provide novel management options and improve patient outcomes.
P05 A rare presentation of blistering in an adolescent
Authors: Watson Nicola , Charlton Fraser , Hampton Philip , Dubois Anna , Leech Suzy
Published: June 2023

A previously well 16-year-old male presented with florid and widespread tense bullae and erosions. He gave a 2-week history of an erythematous rash consisting of crusted erosions that started on his chest and face. He denied any new medications or over-the-counter preparations. There was no preceding systemic illness, and no history of cold sores or sexual contacts. In the 24 h prior to his admission, his rash had become widespread, involving his trunk, limbs, hands, ears, face, lips, oral and genital mucosa. He had started to feel systemically unwell and was in significant pain. On examination, he had a combination of heavily crusted erosions and extensive tense bullae containing straw-coloured fluid on a background of inflamed skin. The morphology was herpetiform in some areas. There was notable extension of bullae onto the palms and penis, as well as intraoral and labial erosions. Viral skin swabs were negative, and his biopsy subsequently demonstrated subepidermal blistering with neutrophil-rich inflammation and positive direct immunofluorescence (IMF) for C3 and IgG only. Serum autoantibodies were negative. Childhood bullous pemphigoid (BP) was initially the working diagnosis, but indirect IMF showed localization to the base of the blister and anticollagen VII antibodies later proved positive, consistent with a diagnosis of epidermolysis bullosa acquisita (EBA). Given the clinical features, it was classified as BP-like EBA. He was initially treated with high-dose oral prednisolone, superpotent topical steroids and analgesia as an inpatient. Mycophenolate mofetil (MMF) was initiated and his corticosteroid dose was slowly tapered. His condition was completely controlled with MMF 500 mg twice daily at 4 months. The patient then elected to stop taking MMF and remains in complete remission at 7 months. EBA is rare in adults and even more so in children. The mean age of onset is 44–54 years, but up to 5% of reported cases are in children/adolescents. Four subtypes are described: classic mechanobullous, BP-like, mucous membrane pemphigoid-like and linear IgA bullous dermatosis-like. BP-like EBA is characterized by widespread vesicles and tense bullae, commonly on an inflammatory background and lacking skin fragility, scarring or milia. Oral and genital mucosae are frequently affected in paediatric cases of EBA. Various steroid-sparing treatment modalities are described, including dapsone, colchicine and MMF. The prognosis in the paediatric population is favourable compared with that of adults: the majority achieve complete remission or complete control on treatment.
P09 A case of suspected COVID-19 vaccine-induced antiphospholipid syndrome
Authors: Bryan Patrick , Williams Namor , Haebich Geraldine
Published: June 2023

A 50-year-old man presented with an acute onset, painful leg ulcer affecting his right calf. This developed 2 weeks after his second COVID-19 vaccine. It started with a painful erythematous plaque, which evolved slowly into a deep-seated 5-cm ulcer over a 6-week period. A thorough review was unremarkable. He had no significant medical history and was a keen athlete and nonsmoker. His father had an unspecified stroke in his 80s. Examination revealed no signs of chronic venous insufficiency or discoloration to his foot, and his neurovascular examination was unremarkable. Investigations for antineutrophil cytoplasm antibodies, antinuclear antibody, complement, paraprotein, HIV and hepatitis were all unremarkable. Biopsy demonstrated nonspecific inflammatory changes, and wound swabs were unremarkable. Initial treatment with oral antibiotics, regular dressings, compression, topical emollients, Dermovate® and prednisolone (0.5 mg kg−1) was only partially effective. He subsequently developed additional painful superficial erosions and ulcers affecting the same limb involving the calf and shin, with a surrounding erythematous livedoid-like rash involving his shin. Rebiopsy demonstrated superficial and deep dermal and subcutaneous thrombosis without vasculitis. Direct immunofluorescence showed the presence of fibrinogen within dermal vessels. Further investigations demonstrated the presence of lupus anticoagulant. Factor V Leiden, protein C and S, anti-B2-GP1 and anticardiolipin antibodies, antithrombin III, homocysteine and coagulation profile were all unremarkable. Histological confirmation of thrombosis and the presence of serum lupus anticoagulant confirmed the diagnosis of antiphospholipid syndrome (APS). He was started on warfarin and the ulcers improved. APS is a rare autoimmune disorder characterized by recurrent miscarriage, thrombophilia and the presence of antiphospholipid autoantibodies (either serum lupus anticoagulant, anti-B2-GP1 or anticardiolipin autoantibodies). Positivity for APS antibodies can be found in up to 5% of the general population. An individual must have the clinical features and antibody positivity to be diagnosed with APS. The temporal relationship with his second COVID-19 vaccine raises the possibility of vaccine-induced APS. COVID-19 vaccine-induced APS is limited to just a few case reports (Moreno-Torres V, Gutiérrez A, Valdenbro M et al. Catastrophic antiphospholipid syndrome triggered by mRNA COVID-19 vaccine. Clin Exp Rheumatol 2022; 40:1054–5). It is postulated that mRNA vaccines may induce a rare complex immunogenic response characterized by a type 1 interferon reaction. This results in a prothrombotic cascade in individuals with pre-existing APS autoantibody positivity (Talotta R, Robertson E. Antiphospholipid antibodies and risk of post-COVID 19 vaccination thrombophilia: the straw that breaks the camel’s back? Cytokine Growth Factor Rev 2021; 60:52–60).
P10 Blastic plasmacytoid dendritic cell neoplasm: two representative cases
Authors: Taneja Neha
Published: June 2023

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a malignant proliferation of plasmacytoid dendritic cells, representing < 1% of primary cutaneous lymphomas. It most commonly presents in the skin and has a poor prognosis with median survival of 1 year. The fifth World Health Organization classification of haematolymphoid tumours encompasses two entities in plasmacytoid dendritic cell neoplasms: BPDCN and ‘mature plasmacytoid dendritic cell neoplasm associated with myeloid neoplasm’. We present two cases, one representing each subset. Our first case was a 58-year-old man who presented with an asymptomatic, rapidly progressive, skin coloured-to-ery­thematous and hyperpigmented firm papules, nodules and plaques over the trunk, upper limbs and face of 2.5 months’ duration. This was associated with loss of appetite, loss of weight and leucopenia (2180 cells μL−1). Skin biopsy revealed a grenz zone with pandermal infiltration by large cells with high nuclear : cytoplasmic ratio, vesicular nuclei and prominent nucleoli, and frequent mitotic figures. Immunohistochemistry (IHC) was leucocyte common antigen (LCA)+ but CD3–, CD20–, myeloperoxidase (MPO)– and CD117–. Bone marrow biopsy showed a similar infiltrate of cells, but the peripheral blood smear and flow cytometry was within normal limits. Further IHC was CD4+, CD56+, CD43+ and CD123+, establishing a diagnosis of BPDCN, and the patient was initiated on the Hoelzer protocol with 80% clearance of lesions after two cycles of chemotherapy. The second case was a 60-year-old woman who presented with asymptomatic firm skin-coloured nodules on her scalp, trunk, extremities and oral mucosa, associated with a low-grade fever, fatigability, weight loss, generalized lymphadenopathy and hepatosplenomegaly of 4 months’ duration. Histopathology showed similar features to the first case, with IHC being negative for CD3, CD20, CD138 and MPO. However, cells were LCA+, CD4+, CD56+ and CD43+. Bone marrow showed 77% acute leukaemia blasts with a MPO+ result, establishing diagnosis of acute myeloid leukaemia, suggestive of a mature plasmacytoid dendritic cell neoplasm associated with myeloid neoplasm. To conclude, BPDCN is an aggressive neoplasm that commonly presents in the skin and should be suspected by dermatologists when screening IHC for lymphoid and myeloid cell lines is negative in a suspected case of leukaemia cutis. A panel of CD4/CD56/CD43/CD123 may be used to establish the diagnosis.
P49 Epidemiology of skin cancer by ethnicity in England, 2013–2020: a cohort study
Authors: Ascott Anna , van Bodegraven Birgitta , Ahmed Shehnaz , Harwood Catherine , Proby Charlotte , Sommerlad Mary , Vernon Sally , Welsh Claire , Venables Zoe
Published: June 2023

Skin cancer rates are increasing worldwide and predominantly affect people of white ethnicity. Although less common, skin cancers in people with skin of colour (SOC) are more likely to experience diagnostic delays and higher mortality. High-quality epidemiological data on skin cancers in SOC are limited. SOC and skin phototype are not recorded in registry data; however, the ethnic group can be used as a somewhat limited proxy. The aim of this retrospective national cancer registry cohort study was to describe skin cancer epidemiology by the ethnic group. We identified a cohort of patients diagnosed with skin cancer in England (2013–2020) from the National Disease Registration Service (NDRS). The ethnic group is routinely recorded as self-reported during hospital visits in Patient Administration System and Hospital Episode Statistics datasets collected by the NDRS. We analysed data by the broad ethnic group [White, Asian (excluding Chinese), Black, Chinese, mixed, other, unknown]. We report counts, incidence, stage at presentation (melanoma only), referral pathway, anatomical location and geographical variation. The first basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) per patient were reported. More cases of skin cancers were diagnosed in Asian ethnicities than in Black and Chinese ethnicities, except for melanoma, which was more frequently diagnosed in Black ethnicities. Of 713 615 BCCs, 571 396 (80.1%) were reported in White, 799 (0.1%) in Asian, 634 (0.1%) in mixed, 413 (0.1%) in Black, 156 (0.02%) in Chinese and 3122 (0.4%) in people of ‘other’ ethnicities; 137 095 (19.2%) were of ‘unknown’ ethnicity. Of 244 072 cSCCs, 225 534 (92.4%) were in White, 609 (0.2%) in Asian, 354 (0.1%) in Black, 279 (0.1%) in mixed, 66 (0.03%) in Chinese and 1137 (0.5%) in people of ‘other’ ethnicity; 16 093 (6.6%) were of ‘unknown’ ethnicity. Of 111 676 melanomas, 102 273 (91.6%) were in White, 199 (0.2%) in Black, 180 (0.2%) in Asian, 125 (0.1%) in mixed, 25 (0.02%) in Chinese and 695 (0.6%) in ‘other’ ethnicities; 8179 (7.3%) were of ‘unknown’ ethnicity. This is the first national study of skin cancer types by ethnicity in England. National datasets allow for the better evaluation of rare subgroups of patients. The main limitation is the high proportion of unknown ethnicity reporting, which is higher for keratinocyte cancers than for other cancers, presumably due to their automated processing and lack of data sources (i.e. inpatient or multidisciplinary team datasets). These data will support a better understanding of unmet clinical needs in underserved populations.
P60 Intralesional steroids vs. liquid nitrogen cryotherapy vs. 595 nm pulsed dye laser in the management of chest keloids: a comparative study
Authors: Shekhar K C , Mishra Aditi , Shrestha Elisha , Pradhan Namrata , Karn Dharmendra
Published: June 2023

Chest keloids often result in cosmetic disfigurement, contractures, pruritus and pain. Inflammatory truncal acne often triggers chest keloid. Management is often challenging as they are relatively resistant to treatment and recurrence rates are high. The objective of the study was to compare the clinical efficacy and safety of intralesional triamcinolone acetonide (40 mg mL−1) vs. liquid nitrogen cryotherapy vs. 595 nm pulsed dye laser in the management of chest keloids. We conducted a comparative prospective study in a total of 42 patients with chest keloids from July 2021 to July 2022. These patients were randomly divided into three treatment groups via the envelope method. The Vancouver Scar Scale (VSS) was used to assess the clinical efficacy of the treatment modality. Patients were scored at the initiation of therapy and every 4 weeks until 16 weeks. Seven patients were lost to follow-up (response rate 83%). Treatment arms consisted of intralesional triamcinolone acetonide (n = 10), liquid nitrogen cryotherapy (n = 11) and pulsed dye laser (n = 14). There was a near-equal sex distribution of chest keloids (male-to-female ratio 1.21 : 1), with 15 patients (35.7%) having additional keloids in other body parts. The mean (SD) age of patients with chest keloids was 27.2 (13.6) years with a common incidence in those aged 20–30 years. Comparison of mean VSS as baseline and at 16 weeks revealed a statistically significant decrease in the score in all three treatment arms (P < 0.05). Comparison between the three different treatment arms revealed pulsed dye laser to be the most effective modality in decreasing VSS at the 16-week follow-up (Anova followed by post hoc analysis with Tukey’s test). With regard to the adverse clinical event profile, acneiform eruptions were reported following steroid injections, blistering and depigmentation were reported following liquid nitrogen cryotherapy, and blistering was reported following pulsed dye laser therapy. Thus, the pulsed dye laser (595 nm) appears to be a safe and efficacious treatment modality in the management of chest keloids.
P61 Cutaneous malignant melanoma diagnosed on nonvisible body sites and the importance of total body examination: a retrospective cohort study
Authors: Wolinska Anna , Bowe Stephanie , Murray Gregg , Collins Sinead , Feighery Cliona , Roche Muireann , Murad Aizuri
Published: June 2023

The incidence of cutaneous malignant melanoma (MM) is increasing worldwide. Regular self-skin examination can assist in the early detection of MM. However, identifying new or changing lesions on nonvisible body sites (NVBS) can be difficult. Research investigating MM on NVBS is limited. The aim of this study was to compare the features of MM on NVBS with visible body sites (VBS) to add data to this patient cohort. We performed a retrospective chart review to identify patients diagnosed with MM in our institution from 2019 to 2021. Clinicopathological features were extracted and analysed. NVBS was defined as areas including the posterior scalp, ears and neck, posterior shoulder, back, buttocks, posterior thigh and plantar aspect of the feet. Statistical analysis was performed using SPSS (IBM). A total of 162 patients were included in this study; 45.1% (n = 73) were male. Patients with MM on NVBS were statistically significantly younger (median age 59 years) compared with patients with MM on VBS (median age 66.5 years; P < 0.05). Thirty-seven per cent (n = 60) of lesions were found on NVBS. Twenty-eight per cent (n = 17) of MMs on NVBS were identified incidentally on total body examination (TBE) in the clinic by a dermatologist. There was a statistically significantly higher number of patients with melanoma in situ on VBS (n = 44; 27.1%) compared with NVBS [n = 17; 10.5% (P < 0.01)]. A higher proportion of patients with MM on NVBS had a Breslow thickness > 1 mm (n = 23; 38.3%) vs. VBS (n = 30; 29.4%). This study demonstrates a higher number of MM diagnosed incidentally following TBE compared with previous research. Our study focused on a MM-specific cohort who may, potentially, have had lethal skin cancers missed in 28% of cases if TBE was not carried out. Our findings also show that patients are more likely to have noninvasive tumours detected on VBS but more advanced disease on NVBS, further emphasizing the importance of TBE. This study suggests that high-risk patients could benefit from specific surveillance programmes that encourage regular self-skin examination and periodic TBE by a consultant dermatologist to enable early detection and treatment of MM. This study was limited by its retrospective design and a small number of patients from a single institution. We recommend an increased emphasis on patient education on the importance of self-examination which, when complemented by physician-directed TBE, plays a valuable role in the early detection of MM on NVBS. This study provides guidance in designing pathways to target high-risk groups to avoid delays in the diagnosis of MM. Further research to explore trends of MM on NVBS may enable targeted education campaigns in the future.
P62 The environmental impact of skin cancer surgery
Authors: Fleming Sarah , Drumm Ciara , O’Donnell Ciara , Lynch Sorcha , Lally Aoife , Moriarty Blaithin
Published: June 2023

The climate crisis has been described as the greatest global health threat by the World Health Organization. In 2019, healthcare-related emissions accounted for 25 mega-tonnes CO2 equivalent (CO2e), 10% of which was related to staff and patient travel. In the UK, 3.5% of road use is related to the National Health Service. The healthcare sector must recognize its role in contributing to carbon emissions and commit to taking decisive action to reduce these. Health-care generates a significant proportion of global emissions; a 2021 report by the Lancet estimated that the healthcare sector contributes to 4.9% of greenhouse gas emissions. As the impact of these numbers is coming to the fore, sustainable health care is becoming a necessity. This study aimed to determine the reduction in CO2e from same-day surgery for patients at skin cancer clinics. CO2e from travel by patients undergoing surgical procedures in a 6-month period (July–December 2020) were calculated. Data collected included age, diagnosis, site of lesion and total number of visits. The distance from the patient’s address was calculated using Google Maps. Total CO2e was calculated using an online calculator recommended by the Environmental Protection Agency of Ireland. A total of 299 patients had 319 procedures between July and December 2020. The median (SD) patient age was 68 (18.5) years (range 16–97). The total distance travelled by patients was 26 069 km, with a mean of 86 km travelled per patient (range 1.2–789). This generated 4.47 tonnes of CO2e emissions (range 0.0–0.6 tonnes). In total, 225/299 patients (75.2%) had surgery on the same day as their clinic appointment. They travelled a total average distance of 72 km (range 1.2–464), with a median of one hospital visit (range 1–2). Seventy-four of 299 patients (24.7%) had alternative day surgery, travelling an average distance of 129 km (range 8.4–789 km), with a median of two hospital visits (range 1–5). The mean CO2e for patients attending for same-day procedures was 0.017 tonnes (range 0–0.6) vs. 0.024 tonnes (range 0–0.16) for alternate-day procedures, a reduction of 0.007 tonnes (30%) per patient (P = 0.3). The introduction of same-day surgery for patients resulted in a 2.93-tonne (55%) reduction in CO2e, the equivalent to driving from the north to the south of Ireland 13 times (8000 km). We have demonstrated a reproducible innovative approach to the reduction of the carbon footprint generated by the management of skin cancer. With ever-increasing demands on the healthcare system, it is vital that we use innovative ways to reduce the carbon footprint generated. The actions of the healthcare sector now will affect the health and wellbeing of generations to come.