bluuebunny/crossref_metadata_2025 huggingface dataset:
Resilience and future heritage – the central market area of Thessaloniki; Hersus project’s 3rd International Design Workshop
Authors: Sakantamis K , Chatzidimitriou A , Dousi M , Kotsopoulos S , Paka A , Axarli K , Chrysikou N , Sakkos D , Apotsos S , Sinamidis I
Published: June 2023

Culture has recently been acknowledged as the fourth pillar of sustainability, next to Environment, Economy and Society. Built heritage preservation is considered crucial for sustainable urban development and resilience. The Erasmus+ supported Hersus project brings together five academic institutions across Europe to explore the potential for enhancing cultural heritage awareness and sustainable development of the built environment. The 3rd international student workshop, which took place in Thessaloniki in October 2022, within the project’s framework, explored the resilient and sustainable preservation of built heritage in Thessaloniki’s historic centre, focusing on the traditional central market area which constitutes an exemplary continuation of use in the diachrony of the city. Hebrard’s plan, envisioned the future built heritage that the workshop dealt with; shaped by the pressures of private and public economic agendas, the original plan has evolved, after gradual transformations of the area, in the shape of two superblocks – off the main Aristotelous Axis, delineated on their periphery by large building blocks while maintaining an internal reference to a human scale, whereby the perceived foreground is dominated by listed single or two-storey volumes and narrow pedestrianized passageways. The reality of occupancy in the greater area, shaped by economic, political and societal stress during the last 20 years, is gradually evolving into a mixed use paradigm whereby restaurants coexist with creative spaces, butchers, grocers, retail and craftsmen who co-create the variable, rich and colourful sensescape of the area. Most building stock is in need of restoration but has nonetheless been in constant use. The workshop views the area as a useful resource in achieving social, economic, cultural and environmental sustainability and resilience for the city. The case study employs sustainability and resilience indicators to evaluate recent major interventions in the area, and emerging bottom-up approaches, cultural events and actions aiming to regenerate the area.
A systematic review of time user surveys-questionnaires and monitoring variables used to track occupant behaviour in residential buildings
Authors: Mylonas A , Tsangrassoulis A , Pascual J
Published: June 2023

In recent years, a growing body of literature has revealed that occupants and their interactions with the building systems and controls (window opening, thermostats, solar shading, etc.) have become a key factor influencing the building’s energy performance and their Indoor Environment Quality. Occupant behaviour can lead to major disparities between the predicted-simulated and the actual energy use in buildings, described by the term Energy Performance Gap, affecting possible strategies to reduce energy consumption. A potential solution to minimize the differences between the simulated and the real performance is by designing realistic models of occupants, which can be incorporated in a simulation code providing useful information for the design and/or assessment of new or existing buildings. Usually, occupant behaviour models are treated as static-deterministic schedules in building simulations, disregarding their stochastic and diverse nature. Accurate configuration of occupant models leads to fine-tuned simulations, enhancing the operation of building control systems. An occupant-centric building design results in building systems capable to meet occupants’ health and comfort requirements, minimizing at the same time the energy use. Although a number of techniques have been used to model occupancy behaviour, such as probabilistic and statistical models, in the present work, we systematically review the most recent techniques based on questionnaires and monitoring variables. These techniques are quite common and their application could help to better understand what drives occupants to interact with a building and its systems, making possible the design of more robust and realistic occupant models.
Toward a sustainable urban regeneration? Urban heritage between neoliberal forces and community preferences
Authors: Stupar Aleksandra , Mihajlov Vladimir , Simic Ivan , Grujicic Aleksandar , Cvetkovic Marija
Published: June 2023

The paper discusses a relationship between the neoliberal forces shaping contemporary urban transformations and the social sustainability of recent regeneration projects focused on urban heritage. Analysing two post-transitional cases, based on two different approaches, the paper will provide an insight into the dominant processes influencing both practices, as well as their anticipated/announced social sustainability and its achieved level. The first case is from Serbia - the Power Plant “Power and Light” - which was the first one generating alternating current in Belgrade. Located in the Dorcol area, this ex-industrial setting is situated close to the city center. Since 2005, the entire area has undergone a significant transformation into a luxurious residential and commercial complex, initiated by private investors and directed by city authorities in order to change the previous urban image. The second case, the Contemporary Art Center in Plovdiv, Bulgaria, represents different approach. Created in 1997, the center is a non-governmental organisation of public interest. In 1995 the Municipality of Plovdiv obtained the right to locate the center within the remains of the ancient baths of Rome, which were rebuilt under the Turkish Empire. As the 16th century monument, the building belonged to the municipality and in 2004, the three-year period of support started, provided by the association Art Today (the Swiss cultural program), as well as the National Heritage Fund in Bulgaria. The analysis will be based on the selected principles of social sustainability, simultaneously highlighting the problems of heritage (re)use and regeneration in a challenging global environment of uncertain financial flows and shifting local governmental priorities, which could put on hold or totally ignore the aspect of social sustainability.
Study of a collisionless magnetized plasma sheath with nonextensively distributed species
Authors: PAUL R , DEKA K , SHARMA G , MOULICK R , ADHIKARI S , KAUSIK S S , SAIKIA B K
Published: June 2023

A weakly magnetized sheath for a collisionless, electronegative plasma comprising positive ions, electrons, and negative ions is investigated numerically using the fluid approach. The electrons are considered to be non-Maxwellian in nature and are described by Tsalli’s distribution. Such electrons have a substantial effect on the sheath properties. The study also reveals that non-Maxwellian distribution is the most realistic description for negative ions in the presence of an oblique magnetic field. In addition to the negative ion temperature, the sheath potential is also affected by the nonextensive parameters. The present research finds application in the plasma processing and semiconductor industry as well as in space plasmas.
A network approach to atomic spectra
Authors: Wellnitz David , Kekić Armin , Heiss Julian , Gertz Michael , Weidemüller Matthias , Spitz Andreas
Published: June 2023

Network science provides a universal framework for modeling complex systems, contrasting the reductionist approach generally adopted in physics. In a prototypical study, we utilize network models created from spectroscopic data of atoms to predict microscopic properties of the underlying physical system. For simple atoms such as helium, ana posterioriinspection of spectroscopic network communities reveals the emergence of quantum numbers and symmetries. For more complex atoms such as thorium, finer network hierarchies suggest additional microscopic symmetries or configurations. Furthermore, link prediction in spectroscopic networks yields a quantitative ranking of yet unknown atomic transitions, offering opportunities to discover new spectral lines in a well-controlled manner. Our work promotes a genuine bi-directional exchange of methodology between network science and physics, and presents new perspectives for the study of atomic spectra.
The 𝐴₂ Andrews–Gordon identities and cylindric partitions
Authors: Warnaar S.
Published: June 2023

Inspired by a number of recent papers by Corteel, Dousse, Foda, Uncu and Welsh on cylindric partitions and Rogers–Ramanujan-type identities, we obtain theA2\mathrm {A}_2(orA2(1)\mathrm {A}_2^{(1)}) analogues of the celebrated Andrews–Gordon identities. We further proveqq-series identities that correspond to the infinite-level limit of the Andrews–Gordon identities forAr−1\mathrm {A}_{r-1}(orAr−1(1)\mathrm {A}_{r-1}^{(1)}) for arbitrary rankrr. Our results forA2\mathrm {A}_2also lead to conjectural, manifestly positive, combinatorial formulas for the22-variable generating function of cylindric partitions of rank33and leveldd, such thatddis not a multiple of33.
Sex Moderates the Relationship Between Social Support and Cardiovascular Prevention Behaviors in Middle-aged and Older Adults
Authors: Blakoe Mitti , Petrova Dafina , Garcia-Retamero Rocio , Gonçalves Karen , Catena Andrés , Ramírez Hernández José Antonio , Sánchez Maria José
Published: June 2023

Background

Most risk factors for cardiovascular disease (CVD) are modifiable, suggesting that the burden of CVD could be substantially reduced through cardiovascular screening and healthier lifestyle. People who have social support are more likely to adhere to cardiovascular prevention recommendations, but it is not clear whether the benefit of social support is equal for men and women.

Purpose

We investigated whether sex moderates the relationship between social support and adherence to cardiovascular prevention recommendations in a nationally representative sample.

Methods

Participants were 17,287 adults (n = 10,264 middle-aged adults 40–64 years old and n = 7,023 older adults ≥ 65 years old) who participated in the National Health Survey of Spain in 2017. Social support was measured with the Functional Social Support Questionnaire of Duke-UNC. Adherence to cardiovascular screening recommendations was assessed based on self-reported testing of cholesterol, blood pressure, and blood sugar by a health professional in the past 12 months. Adherence to recommended health-related behaviors was assessed based on the guidelines of the European Society of Cardiology regarding diet, alcohol consumption, smoking, and physical activity.

Results

Multiple regression models adjusted for socio-demographic and cardiovascular history and risk variables showed that social support was more strongly associated with adherence to cardiovascular prevention recommendations in men than in women. In particular, low social support levels were especially detrimental for both middle-aged men (screening: B = 0.13, 95% CI [0.06–0.20], p < .001; behaviors: B = 0.33 [0.26–0.41], p < .001) and older men (screening: B = 0.10 [0.04–0.17], p = .001; behaviors: B = 0.16 [0.08–0.25], p < .001), whereas older women had comparatively high adherence, which was unrelated to social support (screening: B = 0.02 [−0.03 to 0.08], p = .433; behaviors: B = 0.03 [−0.03 to 0.10], p = .342).

Conclusions

Social support is more strongly associated with cardiovascular prevention in men than in women, such that men who lack social support have the lowest adherence to cardiovascular screening and lifestyle recommendations.
Efficacy and Safety of Stylage XL Lidocaine for the Restoration and/or Augmentation of Facial Volume: The Beauty Volume Study
Authors: Mojallal Ali
Published: June 2023

Background

Hyaluronic acid (HA)-based gel fillers help correct facial volume deficits through their volumizing effect.

Objectives

This postmarket clinical follow-up study was a single-center prospective cohort study designed to evaluate the efficacy and safety of Stylage XL Lidocaine (Laboratoires VIVACY, Paris, France) for the augmentation and/or restoration of facial volume.

Methods

Healthy patients aged between 30 and 65 years with a facial volume grade of 3 to 5 according to the facial volume loss scale (FVLS) were considered eligible. Participants were injected subcutaneously in the area of the cheekbones (essential area). If necessary, patients were also injected in the chin, the temples, and the facial oval (optional areas). Outcomes were assessed at 1, 3, 6, 12, and 18 months following the initial treatment. A touch-up was possible at 1 month following the initial injection. The primary endpoint was the variation in the mean FVLS scores at M6 compared to baseline as evaluated by an independent assessor.

Results

A total of 40 female patients (mean age of 52.5 years) were recruited between November 2019 and July 2021. There was a significant improvement in the mean FVLS score at 6 months compared to baseline (2.3 [0.6] vs 3.1 [0.6]; P < .0001). Patients were satisfied with the achieved aesthetic improvements and results were still observed at 12 and 18 months. Stylage XL Lidocaine also had a good safety profile and was well tolerated by the study cohort.

Conclusions

The results of the 18-month Beauty Volume study confirmed the efficacy and safety of the Stylage XL Lidocaine HA-based gel filler in the augmentation and/or restoration of facial volumes.

Level of Evidence: 3
Applying Principles of Evolutionary Biology to Plastic Surgery at an Organizational Level Predicts an Extinction Event
Authors: Zbar Ross I S , Taylor Lisa D , Canady John W
Published: June 2023

As an organized profession, plastic surgery struggles delivering a clear message regarding scope of practice to patients given the diversity of procedures performed. Whereas granting licensure to practice medicine resides with governmental bodies, certification rests with organizations. However, certification is not required to practice plastic surgery. Since plastic surgery operationalizes techniques rather than working within a defined body organ, competition for patients is intense. Mapping territorial interactions between healthcare providers while parsing taxonomy elucidates individual, community, organizational, and governmental levels, creating various selection pressures. Applying evolutionary biology as a framework predicts the termination of plastic surgery over time as a unique specialty. An entirely new domain, Restorative Healthcare, is proposed which circumvents an extinction outcome.
P04 Leg ulceration in a patient with antisynthetase syndrome
Authors: Wang Xingyue Maria , Pearce Julian , Wijesuriya Nilukshi , Griffiths Richard , Jiyad Zainab
Published: June 2023

A 42-year-old woman presented with leg ulceration on a background of antisynthetase syndrome and immunosuppression with rituximab, azathioprine and prednisolone. The initial lesion was an erythematous patch on the lower leg, which increased in size with violaceous changes. The area subsequently broke down to form an ulcer. On examination, she had a 7-cm ulcerating lesion with central necrosis. Clinically, the appearance was suspicious of pyoderma gangrenosum; biopsy demonstrated scarring without features of vasculitis, atypia or malignancy. The ulcer did not show improvement as expected after oral and topical steroid treatment, with new fleshy nodular growth. Repeat biopsy showed angiocentric atypical lymphocytes with positive Epstein–Barr virus (EBV)-encoded RNA (EBER) staining. Further incisional biopsy demonstrated large, atypical B lymphocytes with a diffuse sheet-like morphology and a poorly circumscribed base. Immunohistochemistry was positive for CD79a, CD30, CD20, MUM1, BCL6, and EBER. Overall, the findings were consistent with EBV-positive diffuse large B-cell lymphoma (DLBCL). The main differential diagnosis was EBV-positive mucocutaneous ulcer (MCU), another EBV-associated lymphoproliferative disorder, albeit with an indolent course (Dojcinov SD, Venkataraman G, Raffeld M et al. EBV positive mucocutaneous ulcer—a study of 26 cases associated with various sources of immunosuppression. Am J Surg Pathol 2010; 34:405–17). In this case, the diffuse sheet-like morphology and poorly circumscribed base favoured EBV-positive DLBCL. The lesion fully healed with withdrawal of immunosuppression and treatment with rituximab therapy, and involved field radiotherapy. First described in 2003, EBV-positive DLBCL is a rare, classically aggressive lymphoma initially believed to only occur in patients older than 50 years of age (Oyama T, Ichimura K, Suzuki R et al. Senile EBV+ B-cell lymphoproliferative disorders. Am J Surg Pathol 2003; 27:16–26). Since the revision of the World Health Organization classification in 2016, it is also recognized to present in younger patients, with an associated better prognosis. EBV-positive DLBCL occurs in both nodal and extranodal sites. Therefore, cutaneous presentations must complete staging investigations to rule out skin involvement secondary to a nodal lymphoma. Our patient highlights a rare complication of immunosuppression. We illustrate the relevance of considering rare causes of ulceration in patients with autoimmune conditions and immunosuppression and demonstrate the importance of considering malignancy in a nonhealing ulcer. Multiple biopsies may be needed in ulcers that poorly respond to treatment. While EBV-positive DLBCL and EBV-positive MCU can be difficult to differentiate, it is vital for prognostication.
P12 A flare of dermatitis herpetiformis precipitated by etanercept
Authors: Wasson Elizabeth , Vincent Rosie , Dunhill Michael Giles
Published: June 2023

We report the case of a 79-year-old man who presented with an acute, intensely pruritic, widespread rash, which, on examination, consisted of symmetrical, haemorrhagic nodules and vesicles with some desquamation affecting the extensor surfaces of the arms, flexor surfaces of the legs and the natal cleft. He had a history of coeliac disease (for which he had adhered to a strict gluten-free diet since 1997) and rheumatoid arthritis. He had his first dose of the anti-tumour necrosis factor (TNF) agent etanercept prior to this episode to manage his arthritis. A punch biopsy for histopathology showed subepidermal blisters with a predominance of neutrophils. Eosinophils were also present to the level of the eccrine coils within the dermis, with eosinophilic flame figures but no eosinophil spongiosis at the edges of the blister. Direct immunofluorescence showed granular IgM and IgA in the dermal papillae, and a similar reaction was seen with fibrinogen. These histological findings were strongly suggestive of dermatitis herpetiformis (DH). Owing to diagnostic uncertainty on presentation, initial treatment was with high-dose topical steroids and emollient. and a yellow card was completed. Since this presentation, he has had no further flares and has not required dapsone. Multidisciplinary team discussion decided that the patient should avoid other anti-TNF treatments, but he has found relief for multiple months with rituximab and has had no cutaneous adverse events on this agent. The aetiology of DH following anti-TNF treatment is not immediately clear. Increased immunogenicity and cytokine release have been hypothesized to be part of the pathology of many adverse reactions to anti-TNF agents. It is conceivable that the cytokine release ordinarily seen in DH is replicated by the administration of anti-TNF agents. There have been many cases of anti-TNF agents leading to worsening eczema and psoriasis. Interestingly, these conditions have been found to upregulate TNF-α, a feature that is also seen in DH. This appears to be the first case described in the literature of etanercept-induced DH. A reaction with infliximab was reported in 2008, with a similar rash and histology consistent with DH, but it differed as the patient had no prior diagnosis of coeliac disease and presented after their second dose (Marakli SS, Uzun S, Ozbek S, Tuncer I. Dermatitis herpetiformis in a patient receiving infliximab for ankylosing spondylitis. Eur J Dermatol 2008; 18:88–9).
P80 Real-world evidence of the effectiveness of secukinumab in patients with psoriasis with and without scalp involvement from the British Association of Dermatologists Biologics and Immunomodulators Register
Authors: Savage Laura , Hughes Jenny , Matthews Kia , Rhodes Laura
Published: June 2023

Secukinumab is a fully human anti-interleukin-17A monoclonal antibody approved for the treatment of moderate-to-severe plaque psoriasis in adults, adolescents and children aged ≥ 6 years. The British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR) is an ongoing prospective observational registry that collects long-term data from patients receiving biologics for psoriasis in the UK and the Republic of Ireland. We report the clinical effectiveness, drug survival and patient-reported outcomes of secukinumab treatment in patients from BADBIR with psoriasis with and without scalp involvement. Patients aged ≥ 18 years who had one or more follow-up visit(s) after enrolment in BADBIR and were receiving secukinumab according to label (300 mg weekly loading dose for 5 weeks, followed by monthly dosing) were included (data cutoff 31 August 2021). Baseline Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) scores recorded between 4 and 8 months and 10 and 14 months of secukinumab initiation were used as 6- and 12-month time points, respectively. Overall mean drug survival was calculated at 12, 24 and 36 months for patients with and without scalp involvement. Outcomes of interest were the proportion of patients with PASI scores of ≤ 2 and DLQI scores of 0/1. Drug survival up to 36 months (Kaplan–Meier method) was defined as the duration between the date of first exposure to secukinumab and date of stopping secukinumab or the end of the study censoring period. The analysis included 1298 patients with psoriasis with scalp (n = 883; 68.0%) and without scalp (n = 415; 32.0%) involvement. The mean duration of follow-up was 2.9 and 2.8 years in patients with and without scalp involvement, respectively. The majority were male (60.4% and 61.5%), mean age was 45.9 and 49.5 years, mean age at disease onset was 24.7 and 26.8 years, mean baseline PASI scores were 15.2 and 14.5, and mean baseline DLQI scores were 17.4 and 17.0 in patients with and without scalp involvement, respectively. Overall, the drug survival rates at 12, 24 and 36 months were 86%, 73% and 63% and 86%, 77% and 69% in patients with psoriasis with and without scalp involvement, respectively. At 6 and 12 months of treatment, 73.9% and 70.4% and 72.1% and 68.4% of patients with and without scalp involvement, respectively, achieved PASI scores ≤ 2. At 6 and 12 months of treatment, 56.9% and 59.2% and 52.0% and 55.4% of patients with and without scalp involvement, respectively, achieved DLQI scores of 0/1. This analysis of real-world data from BADBIR shows that treatment with secukinumab resulted in high drug survival and sustained and consistent improvements in PASI and DLQI in most patients with psoriasis with and without scalp involvement.
P86 Are symptoms of cardiac ischaemia different in patients who have psoriasis than in those who do not?
Authors: Moshtael Sebastian , Venetucci Luigi , Young Helen
Published: June 2023

Patients with psoriasis have an increased risk of cardiovascular disease (CVD) for reasons that remain unknown. However, it may result from a complex interplay of contributory factors, including lifestyle and shared pathological mechanisms, as seen with other immune-mediated inflammatory diseases (IMIDs). Furthermore, in addition to epicardial coronary artery disease, patients with IMIDs have high levels of coronary microvascular dysfunction, which also contribute to cardiovascular morbidity and mortality. Our objective was to investigate whether the presentation of CVD may be different and therefore unrecognized in patients with psoriasis vs. those who do not have psoriasis. Sixty-six individuals with psoriasis and 112 age- and sex-matched individuals without psoriasis were recruited from the Chest Pain Clinic at a Regional Heart Care Centre. Traditional risk factors for CVD (smoking, body mass index, type 2 diabetes, blood pressure and lipid profile) were comparable between groups. Patients with psoriasis were statistically significantly older (P < 0.04) and more likely to have a family history of premature CVD (P < 0.01) than those without psoriasis. Individuals with psoriasis described poorly localized (P < 0.02), aching-type chest pain (P < 0.04) that radiated to the back (P < 0.01). The psoriasis group was significantly less likely to be investigated for coronary microvascular dysfunction with myocardial perfusion scanning (P < 0.002). However, 67% of patients with psoriasis were found to have flow-limiting disease (vs. 60% without psoriasis), classified as severe in 50% (vs. 43% without psoriasis), and were four times more likely to have two-vessel coronary disease, although this did not reach statistical significance. Individuals with both skin and joint psoriasis were more likely to have flow-limiting epicardial disease (14%) than those without arthropathy (10%; not significant). In conclusion, patients with psoriasis exhibit key differences in their presentation to heart care services than those who do not have psoriasis. Further research to individualize risk stratification for CVD in individuals with psoriasis is important.
BI19 Cutaneous post-transplant lymphoproliferative disorder in an immunosuppressed patient
Authors: Vetsiou Evangelia , Smith Steve , Van-de-Velde Vanessa
Published: June 2023

Post-transplant lymphoproliferative disorders (PTLDs) are a common form of de novo neoplasia developing in patients with immunosuppression following a transplant. The majority are associated with Epstein–Barr virus (EBV) infection. Cutaneous PTLD manifestations are rare and not well documented in literature. We present a case of systemic PTLD with secondary extensive cutaneous involvement 4 months after allogenic stem cell transplant for JAK2-mutated myelofibrosis. A 68-year-old man was admitted to the haematology department with fevers, diarrhoea, cytopenia, EBV viraemia and a nodular rash behind his ears. Biopsies from colonoscopy confirmed monomorphic PTLD with subsequent extensive ileocalceal lymphadenopathy area detected on computed tomography. Asymptomatic, large, hardened violaceous nodules on the head and neck worsened further. Skin biopsy showed an infiltrate of atypical lymphocytes in the dermis, composed predominantly of large lymphoid cells with visible prominent nucleoli. A limited immunohistochemical panel showed positivity for BCL-2 but not CD20. EBV-encoded RNA in situ hybridization was also positive. Features were compatible with cutaneous involvement by the known monomorphic PTLD. Unfortunately, the patient deteriorated with haemodynamic instability due to sepsis, despite two further infusions of rituximab, and was directed to the palliative team. He died soon after the discontinuation of all treatments. PTLD has a wide spectrum of clinical manifestations. It is classified into three nondestructive types: polymorphic, monomorphic and classic Hodgkin lymphoma type. It can have a poor prognosis so it should always be considered as a diagnosis in transplant patients. Monomorphic PTLDs tend to be more aggressive and rarely respond to immunosuppression reduction. On the contrary, primary cutaneous involvement is rare and seems to have a favourable outcome. Treatment depends on the severity of the disease, and both localized and systemic therapies have been used. Transplant patients should have long-term follow-up to diagnose and promptly treat possible complications.
BI24 Cutaneous pseudolymphoma secondary to pembrolizumab
Authors: Srenathan Hareni , Gao Jing , Kokohaare Eva Kolson , Ismail Ferina
Published: June 2023

A 35-year-old man presented with a 7-week history of itchy, nontender, indurated erythematous plaques and nodules on his forehead and upper back, with no discriminatory clinical features. He was systemically well. Three months previously, he had completed a 12-month course of adjuvant pembrolizumab for stage IIIC melanoma. The primary melanoma had been excised from his left cheek, with involvement of left parotid and supraclavicular lymph nodes, treated with clearance via superficial parotidectomy and left neck dissection. Clinical and imaging surveillance revealed no evidence of melanoma recurrence. Incisional biopsies of the lesions on his back and forehead both demonstrated a superficial and deep dermal perivascular and periadnexal infiltrate of small- and medium-sized lymphoid cells. There was no epidermotropism and B- and T-cell clonality studies were negative. Morphological appearance and immunophenotype favoured a CD4+-reactive lymphoid process in keeping with cutaneous pseudolymphoma (CPL), secondary to pembrolizumab. The conspicuous forehead lesion was unresponsive to clobetasol propionate under occlusion. A single course of intralesional triamcinolone acetonide 10 mg mL–1 resulted in significant improvement within days, with subsequent complete resolution. The lesion on the back resolved spontaneously. Drug-induced CPL describes an adverse cutaneous drug reaction mimicking B- or T-cell lymphomas clinically and/or histologically. It has been described with anticonvulsants, antidepressants and biologic agents, often with resolution on cessation of the responsible drug (Etesami I, Kalantari Y, Tavakolpour S et al. Drug-induced cutaneous pseudolymphoma: a systematic review of the literature. Australas J Dermatol 2023; 64:41–9). It has been proposed that the drugs affect immune surveillance, leading to an abnormal cutaneous lymphocyte response. A case report (Ayoubi N, Haque A, Vera N et al. Ipilimumab/nivolumab-induced pseudolymphoma in a patient with malignant melanoma. J Cutan Pathol 2020; 47:390–3) has described drug-induced CPL secondary to ipilimumab and nivolumab in a 38-year-old man presenting with erythematous plaques on the hands and face, similar to the presentation of our patient, which responded to prednisolone. As with the other adverse effects of immunotherapy, it is likely that CPL in this cohort is due to an iatrogenic immune dysregulation leading to T-cell overactivity. We present the first reported case of CPL secondary to pembrolizumab and highlight the successful use of intralesional steroid as a treatment option. It is important to recognize CPL as an adverse cutaneous effect of immunotherapy and be aware that it can present after completing treatment due to an ongoing immune response.
BI30 Remission of a large plantar verruca vulgaris in an immunocompromised patient postincisional punch biopsy
Authors: Beatty Paula , Blasco Marta Costa , Murphy Lisa , Wolinska Anna , McFeely Orla , Doyle Claire , Andrawis Madonna , Tobin Anne-Marie , Hackett Caitriona
Published: June 2023

We report the case of a 41-year-old renal transplant recipient who has been attending dermatology for skin surveillance following a cadaveric renal transplant. His immunosuppressive treatment consists of tacrolimus, mycophenolate mofetil and prednisolone 5 mg once daily. His primary dermatological complaint was that of a large wart on the plantar aspect of his right foot. Given the location of this lesion, there was significant associated pain, which also resulted in a functional impediment, impacting on his ability to exercise or work. On examination, he had a large, hyperkeratotic, papillomatous nodule measuring 3.5 × 3 cm on the plantar aspect of his right foot, clinically in keeping with verruca vulgaris. This had been recalcitrant to extensive treatment, including topical salicylic acid, 5-fluorouracil, cantharidin and numerous courses of cryotherapy and paring over the previous 6 years. Following administration of xylocaine 1% with adrenaline as the local anaesthetic, we performed three incisional 4-mm punch biopsies through the centre of the wart to the depth of the dermis. We ensured visualization of haemorrhage at the base of each punch incision. The biopsy cores were left in situ and the wound was dressed with petroleum jelly, Kaltostat® and Opsite. At his 6-week follow-up review, the verruca vulgaris had completely resolved. No postprocedural complications were noted by the patient. Further skin surveillance was scheduled for 6 months later, at which time no recurrence of this verruca vulgaris had occurred. Verruca vulgaris is a benign papillomatous proliferation of epidermal cells driven by human papillomavirus (HPV) infection, commonly acquired in childhood. For many patients, verruca vulgaris will spontaneously regress. However, it can represent a therapeutic challenge when persistent, as it is recalcitrant to multiple treatment modalities, particularly in immunosuppressed patients. To our knowledge, our case is the first documented resolution of a giant plantar wart in an immunocompromised patient using such an approach. Renal transplant patients represent a unique cohort in relation to verruca vulgaris, whereby impaired cell-mediated immunity can increase their susceptibility to HPV, thereby reducing effective treatment options and meaning definitive clearance may never be achieved. Our case highlights that incisional punch biopsy may represent an accessible and cost-effective approach to the treatment of verruca vulgaris in immunosuppressed patients, where alternative treatment options would necessitate numerous hospital visits.
CD12 Citalopram-induced drug reaction with eosinophilia and systemic reaction confirmed by patch testing
Authors: Kanji Alpa , Kapadia Sharan , Wakelin Sarah
Published: June 2023

A 46-year-old man was referred for investigation of an acute widespread rash and fever that started 4 weeks after commencing citalopram. Clinical and histological features were consistent with drug reaction with eosinophilia and systemic reaction (DRESS). He was not on any other medication, had no known allergies and had not previously taken a selective serotonin reuptake inhibitor (SSRI). Six months after resolution, he was patch tested to the extended British Baseline Series and citalopram (crushed tablet in 50% petrolatum). Readings on days 2 (D2) and 4 (D4) were positive for citalopram (D2 ++ and D4 +++). To investigate possible crossreactivity, he was subsequently patch tested to fluoxetine, paroxetine and sertraline (crushed tablets in 50% petrolatum), which showed a positive reaction to paroxetine [D2 (–) and D4 (+)]. Patch tests to citalopram and paroxetine were negative with no irritancy in a normal volunteer. SSRIs are extensively and increasingly used for depression and other mental health problems; 45 000 000 UK prescriptions were issued in the last financial year. Despite such widespread use, cutaneous adverse drug reactions (CADRs) appear to be rare. From 1998 to 2022, the Medicines and Healthcare products Regulatory Agency recorded 16 586 adverse reactions to citalopram, of which only 1077 (6.5%) were cutaneous. Various rashes have been reported to arise from SSRI treatment, ranging from maculopapular eruptions to toxic epidermolysis necrolysis/Stevens–Johnson syndrome. There have been isolated reports of DRESS from fluoxetine, sertraline and escitalopram (the S-enantiomer of citalopram). To our knowledge, this is the first reported case of citalopram-induced DRESS. The sensitivity and specificity of patch tests in the diagnosis of delayed CADR varies according to the drug and rash. We have found case reports of positive patch tests to sertraline and paroxetine following maculopapular exanthems. Our findings highlight a diagnostic role for patch tests with an extemporaneous preparation in SSRI-induced DRESS. SSRIs have diverse chemical structures, and we speculate that patch tests may be of benefit in identifying a safer alternative should further SSRI treatment be needed.
DP23 Paraprotein negative Schnitzler syndrome: a new clinical entity?
Authors: Fagan Nicole , Conlon Niall , Ridge Katie
Published: June 2023

Schnitzler syndrome (SchS) is a rare autoinflammatory condition with prominent cutaneous features. The genetic basis of the condition is not understood. The Strasbourg Criteria outline the clinical diagnosis of SchS, requiring an IgM or IgG monoclonal gammopathy and an urticarial rash (Simon A, Asli B, Braun-Falco M et al. Schnitzler’s syndrome: diagnosis, treatment, and follow-up. Allergy 2013; 68:562–8). We report two cases of SchS, the first with a 5-year delay in the development of a paraprotein and the second with complete absence of a paraprotein, despite 12 years of symptoms. Case one was a 47-year-old female who attended with a 4-year history of a dusky-red urticarial rash and polyarthralgia. Inflammatory markers were persistently raised, in the absence of any identified cause. Investigations demonstrated thrombocytosis, hypocomplementaemia and an isolated elevated IgM (3.07 g L–1), with no monoclonal band. Serum free light chain κ : λ ratio was normal. The patient had a working diagnosis of hypocomplementaemic urticarial vasculitis, despite skin biopsy demonstrating a lack of fibrinoid necrosis. She failed to improve symptomatically on high-dose antihistamines, corticosteroids or azathioprine and had minimal improvement with omalizumab. Repeat serum electrophoresis identified the development of a new IgM κ paraprotein 5 years after the initial symptom onset. Interleukin (IL)-1 blockade resulted in rapid clinical and biochemical improvement. Case 2 was a 55-year-old woman with a 4-year history of recurrent urticaria. A diagnosis of urticarial vasculitis was made; skin biopsy was incongruent but displayed a neutrophilic infiltrate. She had a poor response to high-dose antihistamines and withdrew from services for 3 years. Subsequent therapy with ciclosporin, azathioprine, omalizumab, dapsone and colchicine yielded no clinical benefit. Laboratory investigations repeatedly showed elevated inflammatory markers and an elevated IgA (3.9 g L–1) in the context of inflammatory bowel disease but no IgM or IgM paraprotein. Serum free light chain κ : λ ratio was normal. Clinical suspicion of an autoinflammatory condition was high given the longstanding treatment-resistant urticaria and systemic inflammation. A trial of IL-1 blockade led to immediate clinical and biochemical resolution. This treatment was continued and has resulted in the eradication of a cumulative 12 years of symptoms. There are several reports of SchS with no monoclonal band responding to IL-1 antagonism. As these cases do not fulfil the obligatory criteria for SchS, we propose a new clinical entity, paraprotein-negative IL-1-mediated inflammatory dermatosis (PANID). It is not yet clear if PANID is a precursor to SchS, although published cases demonstrating delayed paraprotein development could support this. Clinicians should consider this diagnosis in patients with treatment-refractory urticaria and systemic inflammation.
DS08 (P26) Risk factors for complications in cutaneous squamous cell carcinoma and proposal of a simplified follow-up strategy: making use of available healthcare resources
Authors: Micallef Daniel , Dimech Alicia , Pisani David , Camilleri Liberato , Scerri Lawrence
Published: June 2023

Cutaneous squamous cell carcinoma (cSCC) is a common malignancy, generally cured by surgical excision. A minority of such tumours recur, metastasize or even cause death. The 2021 British Association of Dermatologists (BAD) guidelines outline high-risk features that are used to guide the follow-up of patients after a primary cSCC. The aims of this study were to identify histological features of cSCC that are significantly associated with the development of complications and to compare the sensitivity, specificity and number of appointments required to follow-up patients using different follow-up criteria. In total, 556 cases of primary invasive cSCCs excised between January 2014 and March 2018 were included and followed-up for a minimum of 4 years. Five per cent (n = 26) of tumours were associated with at least one cSCC-related complication, namely, local recurrence 3.8% (n = 21), nodal metastasis 1.6% (n = 9), distant metastasis 0.4% (n = 2) and disease-specific death 0.7% (n = 4). The initial diagnosed complication was local recurrence in 20 of 26 cases. Only two patients had the first complication beyond 2 years of the original cSCC. Factors that were statistically significantly associated with the development of a complication (P < 0.001) were larger diameter, larger depth of invasion, tumour invasion beyond the dermis, perineural invasion (irrespective of size), lymphovascular invasion, gross bone erosion and deep margin < 1 mm. Differentiation and peripheral margin were not significantly associated with complications. Therefore, it may be proposed that patients with tumours with at least one of the following risk factors be followed-up: diameter > 40 mm, depth of invasion > 6 mm, invasion beyond the dermis, presence of perineural or lymphovascular invasion or deep margin < 1 mm. In adopting these criteria, 739 appointments in 156 patients would be required over 2 years (4-monthly during the first year and 6-monthly during the second year). Twenty of the patients who developed a complication would be followed-up (sensitivity 76.9%, specificity 69.4%). Using the BAD guidelines, up to four more patients with complications would have been followed-up (sensitivity 92.3%, specificity 44.7%), but this would have required a total of 1556 follow-up visits in 242 patients. Given the limited resources, patient burden and the fact that local recurrence is most often the first complication, it may be reasonable to offer routine follow-up only to patients who have at least one of the proposed criteria. Coupled with patient education, this strategy could greatly reduce the number of follow-up visits required. Such a strategy may allow resources to be utilized to reduce waiting times, particularly for 2-week wait referrals, decreasing the delay in new skin cancer diagnoses.
Evolution, divergence, and convergence in the mandibles of opossums (Didelphidae, Didelphimorphia)
Authors: Silva-Neto Francisco das Chagas , Pavan Silvia E , Astúa Diego
Published: June 2023

Didelphid marsupials are considered a morphologically unspecialized group with a generalist diet that includes vertebrates, invertebrates, and plant matter. While cranium and scapula variation has already been examined within Didelphidae, variation in mandible shape, usually associated with diet or phylogeny in other mammalian groups, has not yet been properly assessed in the family. We evaluated the variation in mandible shape and size of didelphids (2470 specimens belonging to 94 species) using 2D geometric morphometrics. We classified the diet of the didelphids into four broad categories to assess whether morphospace ordination relates to dietary habits. We also provided the most comprehensive phylogeny for the family (123 out of the 126 living species) using 10 nuclear and mitochondrial genes. We then mapped mandible size and shape onto that phylogeny for 93 selected taxa and ancestral size and shapes were reconstructed by parsimony. We found phylogenetically structured variation in mandible morphology between didelphid groups, and our results indicate that they have a significant phylogenetic signal. The main axis of shape variation is poorly related to size, but the second is strongly allometric, indicating that allometry is not the main factor in shaping morphological diversity on their mandibles. Our results indicate that the shape and size of the ancestral mandible of didelphids would be similar to that of the current species of the genus Marmosa.
Brain Gene Expression of Foraging Behavior and Social Environment inCeratina calcarata
Authors: Huisken Jesse L , Rehan Sandra M
Published: June 2023

Rudimentary social systems have the potential to both advance our understanding of how complex sociality may have evolved and our understanding of how changes in social environment may influence gene expression and cooperation. Recently, studies of primitively social Hymenoptera have greatly expanded empirical evidence for the role of social environment in shaping behavior and gene expression. Here, we compare brain gene expression profiles of foragers across social contexts in the small carpenter bee, Ceratina calcarata. We conducted experimental manipulations of field colonies to examine gene expression profiles among social contexts including foraging mothers, regular daughters, and worker-like dwarf eldest daughters in the presence and absence of mother. Our analysis found significant differences in gene expression associated with female age, reproductive status, and social environment, including circadian clock gene dyw, hexamerin, and genes involved in the regulation of juvenile hormone and chemical communication. We also found that candidate genes differentially expressed in our study were also associated with division of labor, including foraging, in other primitively and advanced eusocial insects. Our results offer evidence for the role of the regulation of key developmental hormones and circadian rhythms in producing cooperative behavior in rudimentary insect societies.
Role of the ST6GAL1 sialyltransferase in regulating ovarian cancer cell metabolism
Authors: Jones Robert B , Silva Austin D , Ankenbauer Katherine E , Britain Colleen M , Chakraborty Asmi , Brown Jamelle A , Ballinger Scott W , Bellis Susan L
Published: June 2023

The ST6GAL1 sialyltransferase, which adds α2–6-linked sialic acids to N-glycosylated proteins, is upregulated in many malignancies including ovarian cancer. Through its activity in sialylating select surface receptors, ST6GAL1 modulates intracellular signaling to regulate tumor cell phenotype. ST6GAL1 has previously been shown to act as a survival factor that protects cancer cells from cytotoxic stressors such as hypoxia. In the present study, we investigated a role for ST6GAL1 in tumor cell metabolism. ST6GAL1 was overexpressed (OE) in OV4 ovarian cancer cells, which have low endogenous ST6GAL1, or knocked-down (KD) in ID8 ovarian cancer cells, which have high endogenous ST6GAL1. OV4 and ID8 cells with modulated ST6GAL1 expression were grown under normoxic or hypoxic conditions, and metabolism was assessed using Seahorse technology. Results showed that cells with high ST6GAL1 expression maintained a higher rate of oxidative metabolism than control cells following treatment with the hypoxia mimetic, desferrioxamine (DFO). This enrichment was not due to an increase in mitochondrial number. Glycolytic metabolism was also increased in OV4 and ID8 cells with high ST6GAL1 expression, and these cells displayed greater activity of the glycolytic enzymes, hexokinase and phosphofructokinase. Metabolism maps were generated from the combined Seahorse data, which suggested that ST6GAL1 functions to enhance the overall metabolism of tumor cells. Finally, we determined that OV4 and ID8 cells with high ST6GAL1 expression were more invasive under conditions of hypoxia. Collectively, these results highlight the importance of sialylation in regulating the metabolic phenotype of ovarian cancer cells.