bluuebunny/crossref_metadata_2025 huggingface dataset:
BG04 Oleogel-S10 (birch triterpenes) in the treatment of epidermolysis bullosa wounds: 24-month efficacy and safety data from the EASE study
Authors: Murrell Dedee , L. Bruckner Anna , Sprecher Eli , Kiritsi Dimitra , Maher Laura , Cunningham Tracy , Kern Johannes S.
Published: June 2023

Epidermolysis bullosa (EB) is a rare debilitating disorder characterized by skin fragility, blister formation and impaired wound healing. The abnormal wound healing seen in EB is a key driver for systemic disease and can lead to serious clinical complications, deformities and symptoms with a devastating impact on quality of life (QoL). The 90-day double-blind phase (DBP) of the phase III EASE study previously demonstrated accelerated wound healing for oleogel-S10 (birch triterpenes) vs. control gel in EB. Here, we report the safety and total wound burden results from the 24-month open-label phase (OLP), in which all patients received treatment with oleogel-S10. EB Disease Activity and Scarring Index (EBDASI) and body surface area percentage (BSAP) data are reported without visit windows to reflect a real-world situation more accurately, particularly considering the COVID-19 pandemic. The patient population was made up of those with dystrophic EB (n = 178; 86.8%) and junctional EB (n = 25; 12.2%). Further baseline characteristics are available in Table 1. In total, 141 patients (68.8%) completed the OLP. The mean (SD) treatment duration for all patients was 584.7 (246.1) days. Adverse events were reported in 77.1% of all patients in the OLP vs. 81.7% of those receiving oleogel-S10 in the DBP. Mean BSAP for patients treated with oleogel-S10 in the DBP reduced from 12.1% at study entry to 6.1% on completion of the EASE study. Similarly, the mean EBDASI skin activity score in the oleogel-S10 group improved from 19.6 to 15.1 at the end of the OLP. In addition, reductions in both BSAP and EBDASI from OLP baseline were observed in patients who transitioned from control gel to oleogel-S10 in the OLP. Oleogel-S10 has a reassuring long-term safety profile. Furthermore, the long-term impact of accelerated wound healing is evident through the sustained reduction in wound burden over time. This is encouraging given the regular reoccurrence of patients’ fragile wounds in the natural course of this chronic disease. Table 1Baseline characteristics
BI31 Hereditary haemochromatosis: a risk factor for nonmelanoma skin cancer?
Authors: Barry Rory , Murray Gregg , Hazel Karl , Ryan John , Watchorn Richard
Published: June 2023

Hereditary haemochromatosis (HH) is an autosomal recessive disease resulting in excessive levels of iron. In a recent study, in a US population of 448 patients diagnosed with HH, a positive association between HH and nonmelanoma skin cancers (NMSCs) was observed (Pan CX, Yang K, Lau CB et al. Non-melanoma skin cancer in patients with hereditary hemochromatosis: a case–control study. J Am Acad Dermatol 2023; 88:692–4). The authors also reported that, among those who required more frequent venesection, the risk of basal cell carcinoma (BCC) was particularly elevated. In terms of the possible pathomechanism, the authors noted that oxidative stress represents a key component in the pathogenesis of both HH and BCC. Ireland has the highest prevalence of HH in the world, with research suggesting approximately 1 in 83 people is predisposed. For this reason, a study was undertaken to determine if a similar association could be observed in an Irish population. A single-centre retrospective cross-sectional analysis was undertaken on a database of patients with haemochromatosis attending the venesection department of a tertiary referral centre over 25 years (1997–2022). All histologically diagnosed NMSCs within this patient group were then recorded. Ethical approval was granted by the local hospital ethics committee. There were a total 1480 patients in the database, 65% Male (n = 956). Five were excluded due to insufficient data. Thus, 1475 patients were analysed, 64% male (n = 949). The mean current age was 60 years (range: 19–100). Only 52/1475 patients (3.5%) had a histologically diagnosed NMSC, 52% male (n = 27). HH genetic mutation: C282Y homozygous (n = 29); H63D homozygous (n = 5); C282Y/H63D compound heterozygous (n = 11); and data not recorded (n = 7). Mean ferritin at HH diagnosis 575 (range: 0–8413). Forty-three patients were diagnosed with a BCC, 58% male (n = 25), with a total of 94 BCCs. Mean age was 67 years at first NMSC diagnosis. Histological classification: nodular (n = 48); superficial (n = 19); unclassified (n = 18); infiltrative (n = 5); micronodular (n = 3); and basosquamous (n = 1). Eleven patients were diagnosed with a squamous cell carcinoma (SCC), with a total of 21 SCCs. This study had limitations. It was a single-centre, retrospective study analysing only histologically confirmed NMSCs. It is acknowledged that a small proportion of NMSCs may be diagnosed clinically, specifically superficial BCCs without histological confirmation. Only records with histology available in our institution were recorded, and it is possible that NMSCs were excised in other institutions, potentially leading to an under-representation of NMSC incidence. The proportion of patients diagnosed with NMSCs in this cohort was relatively low, in contrast to the findings reported by Pan et al. This study indicates that HH is unlikely to represent an independent risk factor.
CD14 Mouth ulcer mayhem secondary to dental fillings
Authors: Ananthan Lokapriya , Godor Dorottya , Stone Natalie
Published: June 2023

Dental amalgam contains mercury, which may cause an uncommon lichenoid allergic contact dermatitis (ACD) affecting the oral mucosa in direct contact with the amalgam filling. Distinguishing a lichenoid amalgam reaction from oral lichen planus is challenging, both clinically and histopathologically. This case illustrates the important role that patch testing to dental materials can play in providing a simple answer in the management of resistant cases of mouth ulceration, protecting patients from exposure to potentially toxic immunosuppressive treatments. A 64-year-old woman presented with a 5-year history of oral ulceration affecting the buccal mucosa and tongue bilaterally. These ulcers were persistent, very painful and bled intermittently, causing a significant adverse effect on her quality of life. She worked as a manager at a local wildlife sanctuary, and hobbies included walking, writing and artwork. An incisional biopsy taken from an ulcer in the left buccal mucosa demonstrated a dense lichenoid inflammatory cell infiltrate. The oral surgical team treated her for presumed ulcerative oral lichen planus with multiple treatments, including topical steroids, high doses of oral prednisolone, hydroxychloroquine, mycophenolate mofetil and azathioprine. She gained only very minimal benefit. The oral surgeons then requested dermatological advice for the next potential treatment option, which was suggested to be rituximab. At this point, the surgeons noticed that the ulcers seemed to be most prominent at sites of the patient’s longstanding amalgam fillings and she was referred for patch testing. Patch tests were performed to the British Standard series, medicaments series and oral and dental series. Positive reactions were noted to both amalgam (D2+/D4+) and mercury (D2+/D4+). The patient had her amalgam fillings replaced with white acrylate fillings, and her oral ulceration completely healed without the need for any further immunosuppression. Clinically and histologically, lichenoid ACD secondary to dental fillings can be indistinguishable from idiopathic oral erosive lichen planus. However, the proximity of ulceration to dental filling materials should always raise the possibility of a lichenoid ACD and trigger referral for patch testing, preferably prior to systemic medications being tried. This case highlights the importance of patch testing in patients with localized, asymmetrical, difficult-to-treat oral ulcers adjacent to amalgam fillings, which could spare the patient from exposure to potentially harmful immunosuppressive treatments.
DP01 Survey on the management of dysplastic naevus
Authors: Hussain Fazleenah , Bakshi Arti , Yesudian Paul Devakar , Cohen Stuart N
Published: June 2023

Although dysplastic naevus (DN) is a frequent diagnosis, there is significant controversy on its definition and gradation and its relationship to melanoma risk. Therefore, there is no consensus over optimal management, and surveys from Australia, Canada and the USA have shown variation in clinical practice. Dysplastic naevus with involved histological margins has not been shown to progress to melanoma. To assess UK management of DN depending on the grade of atypia and reported excision margin, we circulated a questionnaire via email to dermatologists in Scotland, north Wales, Liverpool and Manchester. Seventy-two responded, of whom 46 (64%) were consultants. The cohort was generally highly experienced, with 10 (14%) responders with 1–5 years’ dermatology experience, 15 (21%) with 6–10 years, 27 (37%) with 11–20 years and 20 (28%) with > 20 years’ experience. Management of DN varied greatly. For mild DN excised with < 1-mm margin, 59 (82%) agreed that no further management was required. Opinions were divided when margins were involved in mild DN, with 14 (19%) agreeing that no further management was required, 42 (58%) choosing to re-excise and six (8%) to re-excising only any residual pigmentation. Most dermatologists reassured patients with moderately DN with margins < 1 mm (49, 68%); 18 (25%) preferred to re-excise. For moderate DN with involved margins, six respondents (8%) felt that no further management was necessary and 54 (75%) would re-excise. For severe DN with margins > 1 mm, 16 (22%) would still re-excise and six (8%) would agree management in the multidisciplinary team meeting (MDT). For severe DN with margins < 1 mm, 41 (57%) would re-excise and seven (10%) would agree management in the MDT. Lastly, for severe DN with involved margins, 62 (86%) would re-excise and seven (10%) would agree management in the MDT. This study has shown comparable results with those from Australia and the USA, whereby most dermatologists would re-excise moderate and severe DN with involved margins. Significant numbers indicated that they would re-excise in the case of close histological margins: this is unnecessary, and more standardized management may reduce expenditure. Limitations of the study include the usual potential sources of bias in a questionnaire survey; it should be noted that reported behaviour may differ from actual practice. However, this is the first UK study on this common clinical scenario. The move to report DN as low- or high-grade may help to reduce variation, but our survey suggests that some patients are currently undergoing unnecessary procedures.
DP05 (P53) Incidence of Merkel cell carcinoma in the Republic of Ireland (1994–2019)
Authors: Doyle Claire , Blasco Marta Costa , McFeeley Orla , Beatty Paula , O’Mahoney Sarah , Murphy Lisa , Andrawis Madonna , Tobin Anne Marie
Published: June 2023

Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine cutaneous malignancy most commonly observed in those aged over 65 years. Merkel cell carcinoma is twice as common in males as in females and is 25 times more common in those with fair skin than in those with darker skin types. Solid organ transplant recipients have a 24-fold increased risk of developing MCC. There was a 95% increase in the incidence of MCC in the USA from 2000 to 2013, with further increases predicted. The aim of this study was to investigate the trends of incidence of MCC in the Republic of Ireland. Age-standardized rates were calculated using the 2013 European standard population. There were 447 histologically confirmed MCCs diagnosed between 1994 and 2019. Forty-nine per cent of cases (n = 220) were in males. Median age was 80 years (range 15–19 to 95+). The median age for males was 78 years and the median age for females was 82 years. On average, there were seven cases of MCC diagnosed annually between 1994 and 1998 vs. 27 cases of MCC annually diagnosed between 2015 and 2019—almost a quadrupling of case numbers. The age-adjusted incidence rate of MCC for both male and females is detailed in Table 1. Previous literature has indicated that MCC is twice as common in males than in females. Our cohort differed in that there was a slight female predominance in patients diagnosed with MCC. This is in keeping with published literature from Northern European groups, which have also demonstrated a female predominance in MCC. While the absolute number of MCC diagnosed in Ireland has increased in both males and females, the age-adjusted incidence rate is increasing in males, but there has not been a significant change in females. Other Northern European groups have also demonstrated an increase in the incidence of MCC in males that was not observed in females. This study adds to the body of epidemiological data on MCC. Table 1Age-adjusted incidence rates of Merkel cell carcinoma (MCC)Cases of MCCAge-standardized rate (per 100 000 person-years)SE95% confidence intervalMales 1994–1999230.520.130.27–0.77 2000–2004210.370.080.21–0.53 2005–2009350.790.150.50–1.08 2010–2014661.190.160.88–1.50 2015–2019751.050.120.81–1.29Females 1994–1999260.360.070.22–0.50 2000–2004440.670.100.47–0.87 2005–2009540.790.110.57–1.01 2010–2014450.570.090.39–0.75 2015–2019580.650.090.47–0.83
DS03 Lentigo maligna: is it time to put down the scalpel?
Authors: Paul Navreet , Lecamwasam Kami , Fadhil May , Garioch Jennifer
Published: June 2023

Lentigo maligna (LM) is a subtype of melanoma in situ that often proves to be a diagnostic and therapeutic challenge. Treatment aims to prevent progression to an invasive tumour called lentigo maligna melanoma (LMM). In the UK, common treatment modalities include conventional excision, staged re-excisions, slow Mohs surgery or expectant monitoring. Although considered the ‘gold standard’, surgical excision of LM can be disfiguring as it frequently affects cosmetically sensitive areas requiring complex surgical reconstructions. Topical imiquimod 5% presents a pragmatic alternative treatment modality without the need for surgery. In vivo reflectance confocal microscopy (RCM) allows real-time noninvasive delineation of LM. Evidence suggests this is an effective diagnostic tool for pre- and post-treatment evaluation (Brand FL, Jafari SM, Hunger RE. Confocal microscopy and lentigo maligna: an in vivo pilot study for the assessment of response to imiquimod therapy. Dermatology 2019; 235:150–5). We retrospectively analysed 35 cases of histologically confirmed LM that completed treatment with imiquimod between 2018 and 2022. The average patient age at diagnosis was 73.9 years, with a female : male ratio of 18 : 17. Following assessment with RCM, patients were prescribed a protocol of topical imiquimod 5% once a day, 5 days per week for 12 weeks, along with instructions to apply this 10 mm beyond the mapped area or a cosmetic unit (Australia and New Zealand Melanoma Trials Group RADICAL trial). Patients were counselled about expected side-effects; all completed the course and achieved significant inflammation and superficial ulceration. To ensure a response was achieved, the following stepwise interventions were used: application increased to 7 days per week, occlusion with a dressing and addition of a topical retinoid. Repeat RCM was performed 6 months after treatment completion. At this point, 30 of 35 (86%) patients responded with no evidence of residual LM on RCM. Three cases required a second course of treatment. Two of these were shown to be clear on RCM, while the third is clinically clear and awaiting RCM confirmation. A fourth patient was lost to follow-up. A further patient has failed two courses and is about to embark on a third round of treatment. In total, 16 cases completed the 12-month review and maintained clearance. We demonstrate that imiquimod is an effective treatment for LM, potentially avoiding extensive surgery and complex reconstruction. Reflectance confocal microscopy can be used to delineate the extent of the LM and assess the post-treatment response. Our preliminary data suggest a significant proportion of LM cases achieved clearance with no recurrences to date. Follow-up of these patients will help evaluate the long-term efficacy of imiquimod, but our data suggest this treatment protocol provides a promising alternative to surgical intervention.
DS05 Future guidelines should consider time needed to treat in clinics
Authors: Rabindranathnambi Aswatha , Sharma Ashish , Moledina Zahra , Varma Sandeep
Published: June 2023

The British Association of Dermatologists (BAD) published comprehensive guidelines on the management of cutaneous squamous cell carcinomas (cSCC) in 2021, outlining 46 recommendations over 32 pages. These recommendations include a full skin check or total body skin exam (TBSE) for the detection of new malignancies in this at-risk group. We present our experience in implementing this new guidance and the importance of considering the estimated clinician time needed to improve the outcome for one person in the target population (i.e. TNTNNT) when formulating new guidelines (Johansson M, Guyatt G, Montori V. Guidelines should consider clinicians’ time needed to treat. BMJ 2023; 380:e072953). A prospective audit of a skin cancer clinic found that the average consultation time for a patient with a newly diagnosed cSCC was 31 min (range 22–60 min). Follow-up appointments are routinely scheduled at 15 min; therefore, on average, a further 16 min is required to implement the new guidelines for each patient correctly. Recent evidence shows that one new SCC can be diagnosed per 57 TBSEs performed (Harding T, Seyffert J, Maner B et al. Exploring the clinical efficacy of the TBSE. J Clin Oncol 2020. DOI: 10.1200/JCO.2020.38.15_suppl.10078). Therefore, the approximate TNTNNT is 912 min (16 min × 57) or 15.2 h of clinical examination to detect one extra cSCC. This equates to nearly four consultant clinics (one clinic represents 4 h of activity) to detect an additional SCC in a patient group that is already attending for frequent review. There is a paucity of evidence to support the hypothesis that screening and removal of these lesions leads to reduced morbidity and mortality as compared with routine presentation and subsequent management. This lack of evidence is reflected in the US Preventive Services Task Force guidance on TBSE for skin cancer screening, where they provide ‘no recommendation’. Implementing the BAD guidelines has an effect on clinic times and generates an increased surgical caseload. We recommend that future guideline committees should indicate how much extra time in clinic would be required per patient to implement their advice adequately. The TNTNNT is one method to consider the clinical impact of such guidance.
DS12 Experience of electrochemotherapy in cutaneous tumours and skin metastases within a UK specialist tertiary centre
Authors: Salence Brogan Kelly , Shetty Meghna , Mackenzie-Ross Alastair , Craythorne Emma
Published: June 2023

Electrochemotherapy (ECT) has gained recognition as an effective treatment that uses electrical pulses to permeabilize cell membranes in tumours, enhancing the cytotoxicity of anticancer agents. The National Institute for Health and Care Excellence suggests use of ECT for the management of primary basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) in selected patients after discussion within a specialist skin cancer multidisciplinary team. It also supports ECT as a palliative treatment for metastases in the skin from tumours of nonskin origin and malignant melanoma (MM). The objective of the study was to evaluate the outcomes and complications of ECT with bleomycin when used for palliative and curative intent. A retrospective cohort study of all patients who underwent ECT in a UK tertiary centre was performed between June 2016 and December 2022. Seventy-one patients (28 men and 43 women) with a total of 89 tumours were included in the study (mean age 69 years; range 29–99). Prior treatments included surgery (n = 9; 13%), immunotherapy (n = 14; 20%), radiotherapy (n = 26; 37%) and chemotherapy (n = 18; 25%). The linear array electrode was used in most cases with median sequence of 47 (range 1–500). Electrochemotherapy was used for palliative intent in 73% (n = 52) and for curative intent in 27% (n = 19). For palliation, ECT was used to treat patients with MM (n = 18/52; 35%), SCC (n = 17/52; 33%) and breast cancer metastases (n = 11/52; 21%), often in patients who had progressed despite conventional management. The most common site treated was the lower limb (n = 16/52; 31%). Twenty-two patients in this group had a good or partial response, with reduction in tumour size, and 52% had improvement in their symptoms (n = 27/52). The crude 1-year survival in this group was 83% (n = 43/52). Complications of ECT when used for palliation included pain, ulceration, tonic–clonic seizure and pneumothorax. In those where ECT was used for curative intent, the majority had ECT for BCCs (n = 12/19; 63%). The most common site treated was the head and neck. Resolution was reported in 58% (n = 11/19) and partial response in 11% (n = 2/19), while two patients underwent excision following recurrence. Complications when used for curative intent included ectropion, indented scarring, nerve palsy, ulceration, pain and webbing. In our opinion, ECT may represent a robust and efficacious treatment option particularly for smaller, lower-risk tumours which may produce improved outcomes. Electrochemotherapy may serve as an alternative to surgical intervention, particularly in patients with multiple comorbidities, and can be used for primary tumour management.
DS25 Postsurgical pyoderma gangrenosum successfully managed with skin grafting in a breastfeeding postpartum patient
Authors: Lyons Daniel , Ni Raghallaigh Siona
Published: June 2023

A 32-year-old woman who was breastfeeding presented 7 weeks postpartum with right breast pain, swelling and erythema. A clinical diagnosis of mastitis was confirmed on ultrasound, and she was started on intravenous (IV) flucloxacillin. Initial cultures grew methicillin-sensitive Staphylococcus aureus, and clindamycin was added. She failed to improve and 6 days later an abscess was incised and drained. A vacuum-assisted closure (VAC) dressing was placed over the wound postoperatively. Over the following 3 days, she deteriorated clinically with markedly increased pain, spiking temperatures and malaise. Linezolid and metronidazole were added. On return to theatre for wound review, she had an 18 cm × 10 cm deep necrotic ulcer with purulent discharge, sparing the nipple. The breast surgeon’s concern was that of necrotizing fasciitis, and an immediate wider debridement was performed, removing all breast skin except for the nipple. Dermatology was then consulted, and a diagnosis of pyoderma gangrenosum (PG) was made. The patient was commenced on IV methylprednisolone 1 g daily for 3 days. Her temperature normalized immediately, and her C-reactive protein dropped from 141 to 27 mg L−1 in 24 h. The previously rolled, violaceous wound edges settled with no further progression. Following 3 days of steroid, ciclosporin 5 mg kg−1 daily was commenced. The right breast continued to lactate, and the very large defect now present was anticipated to pose many difficulties for the young mother. Five weeks after the initial presentation, and following multidisciplinary discussion, a biodegradable temporizing matrix (BTM; NovoSorb®) was applied, under continued dermatologist-supervised immunosuppression. The BTM took with good effect. Two weeks later, a split-thickness skin graft was applied to the BTM. The skin grafting took successfully, with no reactivation of PG postoperatively. Three months postgrafting, the patient is now being weaned off ciclosporin and remains well. Postpartum PG is rare and is predominantly reported at the site of caesarean section incision. Surgery is typically discouraged in PG owing to the risk of disease reactivation. However, surgery in this case was considered appropriate due to the rapid disease control with immunosuppression, the extent of ulceration, the expected prolonged healing period requiring exposure to the toxicity of ciclosporin and the avoidance of cribriform scarring often seen with PG. This case highlights how PG should always be considered in postpartum patients presenting with rapidly progressing, nonhealing ulcers. It also shows that, despite our usual treatment practices, in certain cases, early surgical intervention can be considered alongside ongoing immunosuppression resulting in positive patient outcomes.
PA16 Gynaecomastia associated with isotretinoin
Authors: Phillips Peter , Aplin Carolyn
Published: June 2023

Isotretinoin routinely causes mucocutaneous side-effects, such as cheilitis. Endocrine side-effects are not well documented, although reduced libido has been recognized recently. A 19-year-old male (weighing 60 kg and with a body mass index of 20.4 kg m−2) with no previous medical history developed unilateral left-sided gynaecomastia while taking oral isotretinoin for acne vulgaris (daily dose 20 mg for 1 month, 30 mg for 1 month, then 40 mg). He was taking no other medication or supplements, had never taken anabolic steroids and exercised daily. After 3 months of treatment, he noticed a firm, tender, left-sided subareolar mass, enlarging to 4.5-cm diameter, causing the areola to protrude approximately 5 mm above the level of the contralateral areola. Serum testosterone was 35.9 nmol L−1 (reference interval 8.7–29); a-fetoprotein and human chorionic gonadotropin were normal. Isotretinoin was discontinued, and the breast tissue returned to normal within 2 months, with no recurrence after 3 years of follow-up. Gynaecomastia in young adult males is uncommon, usually bilateral and is typically idiopathic in origin. Potential causes include hypogonadism and medications such as oestrogens, cimetidine, methyldopa, ketoconazole, spironolactone and tricyclic antidepressants. Obesity may lead to a similar appearance (pseudogynaecomastia). Isotretinoin has recently been linked to sexual dysfunction in both sexes, but a link is not proven: symptoms may have started after discontinuing isotretinoin and be long-lasting. Erectile dysfunction, loss of libido, anorgasmia and genital anaesthesia are reported; a minority of male patients have reduced testosterone. Gynaecomastia appears to be a very rare complication of isotretinoin use; only four previous cases have been reported in the literature. It is not listed as a potential side-effect in the Summary of Product Characteristics (SPC) leaflets for generic forms of isotretinoin, only being mentioned in the Roaccutane® SPC. The Medicines and Health products Regulatory Authority, in its updated online information leaflet (March 2022), lists gynaecomastia as a potential side-effect. The British National Formulary’s listing and the British Association of Dermatologists’ isotretinoin patient information leaflet do not mention gynaecomastia; however, reduced libido is stated. The European Medicines Agency and the National Health Service’s isotretinoin information webpage mention no endocrine side-effects. Cessation of isotretinoin was associated with resolution of the gynaecomastia; hence, we believe that it was responsible for it, although the mechanism of induction is unclear. An androgen–oestrogen imbalance has been suggested, leading to relative androgen deficiency. However, our patient had a high level of endogenous androgen, thought to be due to a high muscle mass, and entirely normal sexual function. Although uncommon, we would like to alert colleagues to the possibility of gynaecomastia resulting from isotretinoin treatment.
PA30 The modifying effect of maternal body mass index on the influence of maternal vitamin D supplementation on offspring risk of atopic eczema
Authors: El-Heis Sarah , D’Angelo Stefania , Curtis Elizabeth , Healy Eugene , Moon Rebecca , Crozier Sarah , Inskip Hazel , Cooper Cyrus , Harvey Nicholas , Godfrey Keith
Published: June 2023

We recently published evidence from a randomized controlled trial of the protective effect of antenatal cholecalciferol supplementation on the risk of infantile atopic eczema in infants that were breastfed for > 1 month. Reports that cholecalciferol supplementation has a smaller effect on circulating 25-hydroxyvitamin D levels in individuals with a higher body mass index (BMI) led us to examine whether maternal BMI modifies the effect of vitamin D supplementation on offspring atopic eczema in the first 4 years of life. In the Maternal Vitamin D Osteoporosis Study, which was a double-blind, randomized, placebo-controlled trial, mothers were supplemented (from 14 weeks’ gestation until delivery) with cholecalciferol 1000 IU daily or matched placebo. Maternal characteristics, including BMI, were recorded from pre-pregnancy, and offspring atopic eczema was ascertained based on the UK Working Party Criteria for the Definition of Atopic Dermatitis at the age of 12 (n = 636), 24 (n = 611) and 48 (n = 450) months. Mothers and offspring characteristics did not differ between the intervention and placebo groups except for longer breastfeeding duration in the intervention group. Maternal pre-pregnancy BMI was found to modify the effect of intervention on offspring eczema, so associations between maternal cholecalciferol supplementation and offspring eczema were stratified by categories of BMI (< 25, 25–30 and > 30 kg m−2), with findings expressed as odds ratios (ORs). Models were adjusted for breastfeeding duration, and infant sex as sensitivity analysis showed that the intervention had an impact on male infants that were breastfed. As reported previously, the offspring of mothers who received 1000 IU cholecalciferol had lower ORs of atopic eczema at 12 months of age [OR 0.57, 95% confidence interval (CI) 0.33–0.98]; the intervention did not affect the risk of atopic eczema in offspring at 24 and 48 months. Stratified analysis demonstrated reduced odds of atopic eczema at 12 months of age in the intervention group in infants whose mothers had a BMI < 25 kg m−2 (OR 0.28, 95% CI 0.09–0.92) and 25–30 kg m−2 (OR 0.20, 95% CI 0.04–1.06) but not for those with a maternal BMI > 30 kg m−2. The risk of atopic eczema at 24 and 48 months of age in offspring in the intervention group was not modified by maternal baseline BMI, and interaction terms between intervention and BMI were not statistically significant (P > 0.2). These RCT findings support evidence of an attenuated effect of cholecalciferol supplementation in mothers with a higher BMI and point toward potential preventative strategies for offspring eczema where maternal cholecalciferol supplementation can be considered and doses adjusted for BMI.
BT26 Safe use of mobile photographic devices in dermatology: a multicentre quality-improvement project
Authors: Bala Laksha , Narang Isha
Published: June 2023

Mobile devices are increasingly being used in dermatology to take clinical images, particularly in settings where medical photography services are not readily available. Healthcare professionals are expected to use mobile technology safely to improve patient care. Published UK guidance on the use of mobile photographic devices in dermatology details standards in three key areas: gaining patients’ informed consent, safe use of mobile devices to capture patient images, and safe transfer and storage of these images. A quality-improvement project was conducted across three UK centres. Baseline data were collected over a 2-week period in January 2023 using an anonymous staff survey and analysis of 50 outpatient encounters where mobile devices were used to take clinical images. Our survey achieved a response rate of 77% (n = 20) from consultants (60%), specialty doctors/fellows (30%) and nurses/advanced care practitioners (10%). All respondents sought patient consent prior to taking images on their personal devices, with only 10% using written consent forms (remainder using verbal consent). Thirty-five per cent reported always documenting consent in patient notes and only 20% discussed the risks and benefits of using mobile devices to take patient images. Eighty-five per cent used devices with strong passcodes (six or more characters), but only 50% confirmed that data encryption was enabled on the device. Thirty-five per cent disabled cloud-based back-up systems, 55% disabled Bluetooth and only 5% switched off global positioning system information before taking patient images. For image transfer, 80% used NHS.net email and 20% used a secure clinical image transfer application. Seventy per cent confirmed using a secure network server for image storage and that they always removed patient images from their device after transfer. Analysis of 50 patient encounters revealed that verbal consent was only documented in 8% of cases and a discussion around the risks and benefits of using mobile devices was not documented in any case. National guidance states that it is the healthcare professional’s responsibility to give patients clear information on the risks and benefits of using mobile devices to capture and transfer clinical images for storage, without which there is no informed consent. Our findings highlight a lack of awareness and adaptation of practice to these standards. We will ascertain reasons for this and implement interventions to meet guidance, including an educational meeting and introduction of a standardized written consent form to ensure patient safety and appropriate informed consent. We will present our findings on the impact of these interventions following subsequent rounds of data collection.
Genomic and transcriptomic analyses illuminate the molecular basis of the unique lifestyle of a tubeworm, Lamellibrachia satsuma
Authors: Uchida Taiga , Yoshioka Yuki , Yoshida Yu , Fujie Manabu , Yamaki Ayuta , Sasaki Akira , Inoue Koji , Shinzato Chuya
Published: June 2023

Vestimentiferan tubeworms are representative members of deep-sea chemosynthetic ecosystems. In this study, we developed a draft genome and gene models and performed genomic and transcriptomic analyses of Lamellibrachia satsuma, the only vestimentiferan reported from the euphotic zone. The quality of the genome assembly and gene models is comparable to or higher than those of previously reported vestimentiferan tubeworms. Tissue-specific transcriptome sequencing revealed that Toll-like receptor genes and lineage-specific expanded bacteriolytic enzyme genes are highly expressed in the obturacular and vestimental regions, respectively, suggesting the importance of these tissues in defense against pathogens. On the other hand, globin subunit genes are expressed almost exclusively in the trunk region, supporting the hypothesis that the trophosome is the site of haemoglobin biosynthesis. Vestimentiferan-specific expanded gene families included chitinases, ion channels, and C-type lectins, suggesting the importance of these functions for vestimentiferans. C-type lectins in the trunk region, in particular, may be involved in recognition of pathogens, or in interactions between tubeworms and symbiotic bacteria. Our genomic and transcriptomic analyses enhance understanding of molecular mechanisms underlying the unique lifestyle of vestimentiferan tubeworms, particularly their obligate mutualism with chemosynthetic bacteria.
In vivo characterization of the maturation steps of a pigment dispersing factor neuropeptide precursor in the Drosophila circadian pacemaker neurons
Authors: Lee Gyunghee G , Zeng Kevin , Duffy Cole M , Sriharsha Yadali , Yoo Siuk , Park Jae H
Published: June 2023

Pigment dispersing factor (PDF) is a key signaling molecule coordinating the neuronal network associated with the circadian rhythms in Drosophila. The precursor (proPDF) of the mature PDF (mPDF) consists of 2 motifs, a larger PDF-associated peptide (PAP) and PDF. Through cleavage and amidation, the proPDF is predicted to produce cleaved-PAP (cPAP) and mPDF. To delve into the in vivo mechanisms underlying proPDF maturation, we generated various mutations that eliminate putative processing sites and then analyzed the effect of each mutation on the production of cPAP and mPDF by 4 different antibodies in both ectopic and endogenous conditions. We also assessed the knockdown effects of processing enzymes on the proPDF maturation. At the functional level, circadian phenotypes were measured for all mutants and knockdown lines. As results, we confirm the roles of key enzymes and their target residues: Amontillado (Amon) for the cleavage at the consensus dibasic KR site, Silver (Svr) for the removal of C-terminal basic residues from the intermediates, PAP-KR and PDF-GK, derived from proPDF, and PHM (peptidylglycine-α-hydroxylating monooxygenase) for the amidation of PDF. Our results suggest that the C-terminal amidation occurs independently of proPDF cleavage. Moreover, the PAP domain is important for the proPDF trafficking into the secretory vesicles and a close association between cPAP and mPDF following cleavage seems required for their stability within the vesicles. These studies highlight the biological significance of individual processing steps and the roles of the PAP for the stability and function of mPDF which is essential for the circadian clockworks.
Effects of different processing techniques of palm kernel cake on processing quality of pellet feed, nutrient digestibility, and intestinal microbiota of pigs
Authors: Wang Tongxin , Li Shimin , Ning Jiaxin , Li Jiaming , Han Yanxu , Yin Xinyi , Huang Xinlei , Huang Feiruo
Published: June 2023

The present study was conducted to investigate the effects of extrusion, fermentation, and enzymolysis of palm kernel cake on processing quality of pellet feed, nutrient digestibility, and intestinal microbiota of pigs. First, the pretreatment parameters of extrusion, enzymolysis, and fermentation of palm kernel cake were optimized. Then, PKC after three processing techniques were used to prepare pellet feed. A total of 160 crossbred piglets (Duroc × Landrace × Yorkshire) with an average body weight of 28 ± 0.5 kg were used in an 8-wk feeding experiment. Pigs were randomly assigned to five treatments with four replicates per treatment and eight pigs per replicates. The five experimental groups were as follows: basal diet group (whole corn–soybean meal), 10% PKC group (PKC), 10% extrusion PKC group (PPKC), 10% enzymolysis PKC group (EPKC), and 10% fermented PKC group (FPKC), respectively. At the end of the experiment, four pigs from each treatment (randomly collected one pig per pen) were sacrificed by administering a pentobarbital overdose, the gut and blood samples were collected for the quantification analysis of microbiota, hematological parameters, and apparent total tract nutrient digestibility. The results showed that all three processing techniques significantly decreased the contents of crude fiber of PKC (P < 0.01), pulverization rate (P < 0.01), powder content (P < 0.01), and increased the hardness and gelatinization starch of pellet feed (P < 0.05) compared to PKC group. In addition, PPKC significantly improved the dry matter, crude protein, and ether extract content, blood indices and average daily feed intake compared to PKC group (P < 0.01), while the parameters were similar among FPKC, EPKC, and control group (P > 0.01). Furthermore, all three processing techniques significantly increased the Lactobacillus and decreased the Escherichia levels in feces or gut compared to PKC. Collectively, extrusion, fermentation, and enzymolysis of PKC had positively enhanced the pellet quality, growth performance, nutrient digestibility, and gut microbiota, extrusion exhibited a superior feeding effect compared to fermentation and enzymolysis.
The complete mitochondrial genome of the freshwater crab Tzotzilthelphusa villarosalensis Villalobos & Álvarez, 2013 (Brachyura: Decapoda: Pseudothelphusidae: Raddausinae) from Mexico
Authors: Moreno-Juárez Eric G , Jiménez-Marin Andrea , Vera-Paz Sandra I , Álvarez Fernando
Published: June 2023

We present the complete mitochondrial genome of Tzotzilthelphusa villarosalensisVillalobos & Álvarez, 2013, a freshwater crab from Mexico. This is the first mitochondrial genome reported for the superfamily Pseudothelphusoidea. We performed a de novo assembly from genome skimming reads. The mitochondrial genome of T. villarosalensis has a length of 17,203 bp and its gene topology is similar to other freshwater and marine families, e.g., the position of the cytochrome oxidase complex subunits and ATA synthetase, even the order of nad3, nad5, nad4, nad4L, nad6, and cytb. By contrast, the order and organization of genes like the 16S, 12S, and nad1 are different depending on the phylogenetic group with which they are compared. The phylogenetic analyses placed T. villarosalensis as a sister group of all freshwater crabs reported until now and as part of the subsection Heterotremata. This complete mitochondrial genome could be a reference for further genomic studies of the family Pseudothelphusidae and other primary freshwater crabs.
Insecticide resistance and its potential mechanisms in field-collected German cockroaches (Blattodea: Ectobiidae) from Thailand
Authors: Tisgratog Rungarun , Panyafeang Chanikarn , Lee Shao-Hung , Rust Michael K , Lee Chow-Yang
Published: June 2023

We investigated insecticide resistance profiles of field populations of the German cockroach, Blattella germanica (L.), collected from central regions of Thailand. Seven strains (PW, RB, MTH, MTS, TL, AY, and SP) were evaluated with diagnostic doses (DD; 3 × LD95 generated from a susceptible strain) of deltamethrin, fipronil, and imidacloprid using topical assays and compared with a susceptible strain (DMSC). Results showed fipronil (2–27% mortality), deltamethrin (16–58% mortality), and imidacloprid (15–75% mortality) resistance in the field strains. Synergism studies with piperonyl butoxide (PBO) and S,S,S-tributyl phosphorotrithioate (DEF) in combination with the DD of insecticides significantly increased (P < 0.05) mortality of the test insects of the field strains suggesting the involvement of P450 monooxygenase and esterase pathways of detoxification. Gel bait evaluations demonstrated that all field-collected strains were resistant to Maxforce Forte (0.05% fipronil), Maxforce Fusion (2.15% imidacloprid), and Advion Cockroach Gel Bait (0.6% indoxacarb) with mean survival times ranging from 1.87–8.27, 1.77–11.72, and 1.19–3.56 days, respectively. Molecular detection revealed that the Rdl mutation was completely homozygous in all field-collected strains except in the PW strain. Field-collected strains were screened for 3 voltage-gated sodium channel (VGSC) mutations associated with pyrethroid resistance. The L993F mutation was present in 5 strains, but no C764R and E434K mutations were detected.
Efficacy and nontarget effects of broadcast treatments to manage spotted lanternfly (Hemiptera: Fulgoridae) nymphs
Authors: Keller Joseph A , Walsh Brian , Johnson Anne , Jenkins Nina , Rost John , Treichler Brianna , Biddinger David , Calvin Dennis D , Hoover Kelli , Urban Julie , Roush Richard T
Published: June 2023

Management to control the spotted lanternfly, Lycorma delicatula (White), would ideally achieve managers’ goals while limiting impacts on nontarget organisms. In a large-scale field study with 45 plots at least 711 m2, we tested foliar applications of dinotefuran and 2 formulations of Beauveria bassiana (Balsamo) Vuillemin, each applied from the ground and separately by helicopter. Applications targeted early instar nymphs. For both application methods, a single treatment with dinotefuran significantly reduced L. delicatula numbers, as measured by catch on sticky bands (91% reduction by air and 84% reduction by ground 19 days after application) and by timed counts (89% reduction by air and 72% reduction by ground 17 days after application). None of the B. bassiana treatments significantly reduced L. delicatula numbers, even after 3 applications. Beauveria bassiana infection in field-collected nymphs ranged from 0.4% to 39.7%, with higher mortality and infection among nymphs collected from ground application plots. Beauveria bassiana conidia did not persist for long on foliage which probably contributed to low population reduction. Nontarget effects were not observed among arthropods captured in blue vane flight intercept traps, San Jose Scale pheromone sticky traps or pitfall traps, but power analysis revealed that small reductions of less than 40% may not be detected despite extensive sampling of 48,804 specimens. These results demonstrate that dinotefuran can markedly reduce local abundance of L. delicatula with little apparent effect on nontarget insects when applied shortly after hatch, and that aerial applications can match or exceed the effectiveness of applications from the ground.
Forest Disturbances and Nonindustrial Forest Landowners: Management of Invasive Plants, Fire Hazards and Wildlife Habitats After a Hurricane
Authors: Clarke Mysha , Sharma Ajay , Stein Taylor , Vogel Jason , Nowak Jarek
Published: June 2023

There is limited research about the interacting impacts of hurricane damage and forest disturbances like invasive species and wildfires on nonindustrial forest land management. We administered a mail survey to 1,000 randomly selected nonindustrial private forest landowners in the Panhandle of Florida who owned forestlands in the counties most severely affected by Hurricane Michael. Results show that most landowners did little to no forest management to prepare for the hurricane. Following Hurricane Michael, 34% of respondents reported increased invasive plants whereas 82% experienced timber loss, 62% had damaged wildlife habitats, and 53% had increased vulnerability to wildfire hazards. Landowners who experienced timber damage from Hurricane Michael were more likely to reduce fire hazard, eliminate or reduce invasive plants, perform road and trail maintenance, improve wildlife habitat, reforest both salvage harvested and areas that were not salvage harvested, search for information on the internet about forest management, and pass their forestland to family.

Study Implications: Forest disturbances such as hurricanes, invasive species, and wildfires are predicted to increase in severity and frequency, consequently affecting forest productivity, sustainability, and management. Despite significant impacts on forest lands, there is limited understanding of how these disturbances may affect nonindustrial private forest landowner management behaviors. This article highlights the attitudes, experiences, and perceptions of nonindustrial private forest landowners, including their awareness and overall forest management plans regarding invasive species control, wildlife habitat improvement, and reducing wildfire hazards after a hurricane. We assessed the important factors that contribute to landowners’ willingness to take action to address these interacting forest disturbances.