bluuebunny/crossref_metadata_2025_split huggingface dataset:
BH08 A clinical case of retronychia, a rarely described post-traumatic proximal ingrown nailplate: a condition of the ‘nail’
Authors: Cathcart Charles , Walker-Date Sarah , Belgi Avinash , Jeyakanth Prashanthi 
Published: June 2023

Abstract
Retronychia is a recently described inflammatory disorder that leads to proximal ingrowth of the nail and paronychia. There are fewer than 100 published cases of retronychia, leading to a poor understanding of the disorder and a delay in diagnosis and treatment. Increased understanding for clinicians will be critical in avoiding misdiagnosis and effective management (Costa TPE. Retronychia: a paradigm shift? Skin Appendage Disord 2020; 6:268–71). A 36-year-old woman presented to dermatology with a near three-decade history of treatment-resistant painful, thickened yellow nails of both greater toes. Past medical history included bilateral bunions since the age of 14 years, which were surgically corrected. In the community, she had undergone partial nail avulsion by chiropodists. Subsequently, she received multiple courses of antifungal lacquer and oral terbinafine, all with no effect, and continued regrowth of abnormal thickened nails. On examination of her greater toes, the proximal nailfolds lacked cuticles. The nails showed horizontal ridges, were thickened by stacking of nailplates and had a yellow discoloration. Investigations for fungal nail were negative. A clinical diagnosis of retronychia was made. Retronychia was first recognized in 1999 and is a combination of nailplate ingrowth into the proximal nailfold and the generation of multiple misaligned proximal nailplate lamellae. It is more common in women, typically affects the great toes and is triggered by repetitive microtrauma related to sports, inadequate footwear or, in this case, bunions (de Berker D, Richert B, Duchard E et al. Retronychia: proximal ingrowing of the nail plate. J Am Acad Dermatol 2008; 58:978–83). As in this case, most patients are inadequately treated with antifungals and antibiotics, perhaps due to signs of paronychia resulting in treatment failure and significant psychological impact. If cases are recognized early, conservative management with topical steroids applied to the proximal nailfold is effective. In advance cases, as with this patient, surgical nailplate avulsion with nail matrix ablation is the only curative management. Awareness of the clinical signs would be a valuable learning point for clinicians.
BH13 Is this dissecting cellulitis of the scalp in a White child?
Authors: Khan Farishta , Peng Chenjing 
Published: June 2023

Abstract
Dissecting cellulitis of the scalp (DCS) is characterized by recurrent pustules and sinus tract formation leading to scarring and alopecia. Follicular obstruction is a key pathogenic event and is associated with hidradenitis suppurativa and acne conglobate. Commonly, DCS is found in adult men of Afro-Caribbean descent (Arneja J, Vashi C, Gursel E, Lelli J. Management of fulminant dissecting cellulitis of the scalp in the pediatric population: case report and literature review. Can J Plast Surg 2007; 15:211–14). We describe a rare case of a White child who presented with features suggestive of DCS. An 11-year-old boy was referred with a 2-year history of patches of alopecia affecting the occipital scalp which was initially treated as tinea capitis with antifungal creams, but this was ineffective. On examination, there was diffuse, boggy subcutaneous swelling with scarring, overlying erythema and patches of alopecia on the occipital scalp. A course of erythromycin and oral terbinafine showed a partial response of the affected areas, although subsequent new patches of alopecia were noted with a similar manifestation of bogginess and overlying erythema. Systemic examination, blood tests and skin scrapings were unremarkable. While continuing erythromycin, he was counselled for isotretinoin and a referral to a tertiary centre has been made to guide further management. Paediatric scarring alopecia encompasses congenital and acquired causes (Imhof R, Cantwell H, Proffer S et al. The spectrum of pediatric scarring alopecia: a retrospective review of 27 patients seen at Mayo Clinic. Pediatr Dermatol 2021; 38:580–4). The differential diagnosis for our patient included tinea capitis causing irreversible alopecia, and being aware of this phenomenon with late presentations and delayed treatment is vital. Other differentials are discoid lupus and cutaneous morphoea. However, the clinical features in this case are more in keeping with DCS, which is scarcely reported in the paediatric literature. Histological confirmation is not always practical with children, and follow-up to assess course of the disease is prudent. Importantly, the discussion of permanent hair loss with a child and parent remains challenging, and clinicians should be aware of the associated psychosocial impact.
PS10 Can an aerobic exercise intervention for patients with psoriasis improve health outcomes and support lifestyle behaviour change?
Authors: Sheppard Rory , Kiat Gan Wei , Onambele-Pearson Gladys , Young Helen 
Published: June 2023

Abstract
Patients with psoriasis do not exercise to the extent recommended for cardiovascular health, due to significant disease-specific barriers, which may augment their increased risk of CVD and metabolic syndrome. Therefore, we developed a bespoke, evidenced-based exercise programme for patients with psoriasis, hypothesizing that it may have utility in the management of psoriasis. Eight patients with psoriasis (32.5 ± 12.02 years old, BMI 26.7 ± 3.3 kg m-2) completed a 20-week physical activity intervention. The first 10 weeks of the intervention comprised two walking sessions per week. Each session was of 1h duration and led by a sports-scientist for small-groups of patients with psoriasis. The volume of exercise per session was calculated so that participants would incrementally progress to heart-healthy levels of exercise over the programme. During weeks 10–20 of the programme, participants engaged in independent activities. Warm-ups, pre-exercise stretching, and cool-downs were incorporated into each of the sports-scientist led sessions. Step counts were recorded using a Newfeel Onwalk 900 pedometer throughout the study. Measurements at pre-, mid-, and post-intervention endpoints (week 0, 10 and 20) included assessment of (i) psoriasis: Psoriasis Area and Severity (PASI); Physicians Global Assessment (PGA); (ii) quality of life: Dermatology Life Quality Index (DLQI), Short Form 36 (SF-36); and (iii) cardiometabolic disease/risk – pulse wave velocity (PWV); blood pressure (BP); body weight and BMI. In addition, cardiorespiratory fitness (CRF) was assessed by: 30-s sit-to-stand (30STS); timed up and go (TUG); single leg balance (SLB); static body-weight wall-squat (SBWS); and step count. Recruitment to the study is ongoing. We observed a significant reduction in both Psoriasis Area and Severity Index and systolic BP at the weeks 10 and 20 timepoints (P &lt; 0.05). We also observed a statistically significant improvement in the SF-36 mental health domain between the weeks 10 and 20 timepoints (P = 0.035). The CRF statistically significantly improved across the duration of the study, with a statistically significant improvement in exercise performance, as evidenced by 30STS, TUG and pedometer step counts at week 10 (P &lt; 0.05), SLB between baseline and week 20 (P = 0.043) and SBWS performance across all timepoints. Exercise induces health benefits, including reduced skin inflammation and systolic BP, and increased CRF, and may improve some aspects of quality of life in those with psoriasis. The impact of lifestyle on psoriasis warrants further investigation. Our data suggest that exercise could represent an adjuvant therapy in the future management of psoriasis.
BT06 Using artificial intelligence to triage skin cancer referrals: outcomes from a pilot study
Authors: Abu Baker Karmel , Roberts Elizabeth , Harman Karen , Mullarkey Dan , Kalsi Dilraj 
Published: June 2023

Abstract
Artificial intelligence (AI) is a rapidly emerging field in dermatology, aimed at delivering efficient and effective patient care. To date, there is a lack of substantial evidence for the use of this technology in a clinical setting. However, the pandemic era has placed significant pressures on dermatology services, specifically the skin cancer clinics at our trust, which has experienced a 30% increase in demand compared with prepandemic levels. A novel solution for urgent referrals was to test the use of AI teledermatology software using a UK Conformity Assessed marked Class IIa Medical Device (and therefore regulated by the Medicines and Healthcare products Regulatory Agency). Appropriate cases are selected and booked for a teledermatology appointment at one of our four community-based hubs. Clinical and dermoscopic images, together with a short questionnaire, are uploaded to the software by a healthcare assistant. The AI immediately assesses the dermoscopic images of the lesion, and those cases identified as benign are discharged back to the general practitioner (GP), following a safety check by a consultant dermatologist employed by the AI provider. The trust dermatology consultants have chosen to further triage all cases suspected to be nonbenign. Patients with suitable small lesions at low-risk sites receive a telephone appointment to discuss surgery and obtain consent. Those with precancerous lesions can be discharged back to the GP with management advice. Low-risk basal cell carcinomas case are transferred to a routine pathway. Selected cases may be referred directly to other teams. The pilot started in March 2022 and now processes 5–600 cases per month at four photography hubs. To date, 19% of cases have been discharged back to the GP with a benign diagnosis. A further 15% of cases have been discharged back to the GP by the trust dermatologists, giving an overall discharge rate of 34%. Ten per cent of patients have received a telephone call to take consent for biopsy, and 2% have been referred directly to another speciality. Thirteen per cent of cases have been triaged to a routine pathway, and 38% of patients have required an urgent face-to-face appointment with a dermatologist. The trust has seen &gt; 90% 2-week wait referrals within 2 weeks in the last two quarters. Since the introduction of this AI teledermatology service, we have seen a 62% reduction in the number of patients requiring an urgent face-to-face appointment with a dermatologist. Ongoing audit work is focused on the safety, acceptability and cost-effectiveness of this pathway, and will shape decision-making in the ongoing use of this technology both locally and across the UK.
Hypereosinophilic syndrome presenting with progressive cardiac cachexia: a case report
Authors: Teringová Elena , Penz Peter , Mištinová Jana Poláková , Orban Marek 
Published: June 2023

Abstract

Background
Hypereosinophilic syndrome (HES) is a rare haematologic disorder defined by persistent eosinophilia associated with organ damage. Cardiac involvement occurs in HES patients frequently and represents major cause of their morbidity and mortality.

Case summary
A 66-year-old female patient underwent comprehensive cancer screening due to significant weight reduction. Screening showed negative results except for echocardiography, which revealed a large right ventricular mass imitating malignant cardiac tumour. Patient thus underwent biopsy of the intracardial mass. The procedure was complicated with right ventricular perforation causing cardiac tamponade, successfully resolved by immediate pericardiocentesis. Subsequent echocardiography revealed an echodense mass also in left ventricular apex, resembling a thrombus. Laboratory findings with mildly elevated eosinophil count and presence of formations in both ventricular apexes arose suspicion of non-malignant disease origin, specifically eosinophilic endomyocarditis. The presumption was supported by medical history of bronchial asthma, pansinusitis, and hypereosinophilia. Cardiac magnetic resonance (CMR) confirmed signs of eosinophilic endomyocarditis of both ventricles, together with presence of several intracardiac thrombi. However, despite intensive treatment, patient died due to progressive heart failure 3 months later.

Discussion
As seen in our case, establishing diagnosis of eosinophilic endomyocarditis may represent a challenge in clinical practice, since it represents a rare disease with variable clinical manifestations. However, presence of formations in both ventricles together with peripheral eosinophilia should raise suspicion of this diagnosis. Our case also highlights the importance of CMR imaging in diagnostic process of eosinophilic endomyocarditis, since it represents a non-invasive diagnostic modality able to detect distinctive signs of eosinophilic endomyocarditis.
Antagonic effect of ghrelin and LEAP-2 on hepatic stellate cell activation and liver fibrosis in obesity-associated nonalcoholic fatty liver disease
Authors: Ezquerro Silvia , Tuero Carlota , Becerril Sara , Valentí Víctor , Moncada Rafael , Landecho Manuel F , Catalán Victoria , Gómez-Ambrosi Javier , Mocha Fátima , Silva Camilo , Hanley Karen Piper , Escalada Javier , Frühbeck Gema , Rodríguez Amaia 
Published: June 2023

Abstract

Background
Growing evidence suggests the key role of ghrelin in the onset and progression of nonalcoholic fatty liver disease (NAFLD). The potential participation of ghrelin and the ghrelin receptor antagonist, LEAP-2, in the onset of liver fibrosis in patients with severe obesity and NAFLD through the regulation of TGF-β1-induced hepatic stellate cell (HSC) activation was investigated.

Methods
Circulating (n = 179) and hepatic expression (n = 95) of ghrelin and LEAP-2 were measured in patients with severe obesity and available liver pathology analysis undergoing Roux-en-Y gastric bypass (RYGB). The effect of ghrelin isoforms and LEAP-2 on TGF-β1-induced HSC activation, fibrogenic response, and contractile properties was evaluated in vitro in human LX-2 cells.

Results
Plasma and hepatic ghrelin were negatively associated, while LEAP-2 exhibited a positive association with liver fibrosis in patients with obesity and NAFLD. Six months after RYGB, hepatic function was improved and, although acylated ghrelin and LEAP-2 concentrations remained unchanged, both hormones were inversely related to post-surgical levels of profibrogenic factors TGF-β1 and TIMP-1. Acylated ghrelin treatment reversed TGF-β1-induced myofibroblast-like phenotype, collagen contractile properties, and the upregulation of factors involved in HSC activation and fibrogenesis via PI3K/Akt/mTOR pathway. Moreover, acylated ghrelin inhibited the mild HSC activation induced by LEAP-2.

Conclusions
Ghrelin is an anti-fibrogenic factor blocking HSC activation induced by the most potent fibrogenic cytokine, TGF-β1, and LEAP-2. The imbalance between acylated ghrelin and ghrelin receptor antagonist LEAP-2 might contribute to maintain liver fibrosis in patients with obesity and NAFLD.
Life Course Socioeconomic Position and Cognitive Aging Trajectories: A Cross-National Cohort Study in China and England
Authors: Ruiz Milagros , Hu Yaoyue , Martikainen Pekka , Bobak Martin 
Published: June 2023

Abstract

Background and Objectives
Cross-national research on cognitive aging inequality has largely concentrated on Western countries. It is unclear whether socioeconomic position (SEP) has similar effects on cognitive decline in emerging economies. We compared the association between life course SEP and cognitive function trajectories between China and England, the largest nation under state socialism and one of the oldest capitalist countries.

Research Design and Methods
This cross-cohort study examined participants aged 50 years and older from the China Health and Retirement Longitudinal Study (n = 12,832) and the English Longitudinal Study of aging (n = 8,875). Cognition z-scores were derived using comparable measures of memory and time orientation on 4 occasions. Life course SEP was self-reported by participants at baseline. Seven- to 8-year trajectories of cognition z-scores were estimated using latent growth curve modeling. Country- and gender-specific associations between childhood/adolescent deprivation, education, material wealth, and home ownership were evaluated in relation to model intercept (baseline level) and linear slope (annual rate of change) of cognition.

Results
After multivariable adjustment, education was positively associated with the greatest differences in baseline cognition across country and gender. Education was further linked to a slower rate of cognitive decline (z-score units per year); but compared with those with low education, Chinese men (b = 0.032) and women (b = 0.065) with high education had significantly slower declines than English men (b = −0.004) and women (b = 0.010) with high education.

Discussion and Implications
Despite substantial between-cohort differences in downstream and upstream determinants of dementia, education provided the greatest benefits to cognitive aging in England but particularly in China.
Assessing the in vivo efficacy of rational antibiotics and combinations against difficult-to-treat Pseudomonas aeruginosa producing GES β-lactamases
Authors: Abouelhassan Yasmeen , Gill Christian M , Nicolau David P 
Published: June 2023

Abstract

Objectives
We evaluated the in vivo efficacy of human-simulated regimens (HSRs) of cefiderocol, ceftazidime/avibactam, meropenem and ceftazidime/avibactam/meropenem combination against Guiana-extended spectrum (GES)-producing Pseudomonas aeruginosa isolates.

Methods
Eighteen P. aeruginosa isolates producing GES-1 (n = 5), GES-5 (n = 5) or miscellaneous GESs (combinations of GES-19, GES-20 and/or GES-26; n = 8) were evaluated. In vitro MIC testing was determined using broth microdilution. In a validated murine thigh infection model, HSRs of cefiderocol 2 g q8h as a 3 h IV infusion, ceftazidime/avibactam 2.5 g q8h as a 2 h IV infusion, meropenem 2 g q8h as a 3 h IV infusion or ceftazidime/avibactam/meropenem were administered. Change in bacterial burden relative to baseline and the proportion of isolates in each genotypic group meeting 1-log10 kill endpoint were assessed.

Results
Modal MICs (mg/L) ranged from 0.125 to 1 for cefiderocol, 4 to &gt;64 for ceftazidime/avibactam and 2 to &gt;64 for meropenem. Cefiderocol produced &gt;1-log10 of kill against all 18 tested isolates. Meropenem was active against all GES-1 isolates whereas activity against GES-5 and miscellaneous GESs was lacking, consistent with the MICs. Ceftazidime/avibactam was active against all GES-1 and GES-5 isolates and retained activity against 62.5% of miscellaneous GESs including isolates with elevated MICs. For isolates where ceftazidime/avibactam failed, the addition of meropenem restored the in vivo efficacy.

Conclusions
As monotherapy, cefiderocol was active in vivo against all tested isolates. The activities of meropenem or ceftazidime/avibactam alone were variable; however, a combination of both was active against all isolates. Cefiderocol and ceftazidime/avibactam/meropenem could be valuable therapeutic options for GES-producing P. aeruginosa infections. Clinical confirmatory data are warranted.
Uropathogenic Escherichia coli population structure and antimicrobial susceptibility in Norfolk, UK
Authors: Carter Cailean , Hutchison Alexandra , Rudder Steven , Trotter Elizabeth , Waters Emma V , Elumogo Ngozi , Langridge Gemma C 
Published: June 2023

Abstract

Background
Urinary tract infections (UTIs) are a frequent cause for visits to primary care providers. In alignment globally, uropathogenic Escherichia coli (UPEC) are the main aetiological agent for UTIs in Norfolk and are increasingly difficult to treat due to multi-drug resistance.

Objectives
We set out to identify which clonal groups and resistance genes are disseminating in the community and hospitals in Norfolk, the first study of its kind for UPEC in this region.

Methods
We collected 199 clinical E. coli isolates causing UTIs in the community and hospital from the Clinical Microbiology laboratory at Norfolk and Norwich University Hospital between August 2021 and January 2022. These were whole-genome sequenced using the Illumina and MinION platforms for in silico MLST and antibiotic resistance determinant detection.

Results
The isolates were composed of 70 STs; 8 lineages represented 56.7% of this population: ST73, ST12, ST69, ST131, ST404, ST95, ST127 and ST1193. Importantly, primary UTI screening deemed 6.5% of isolates to be multidrug resistant (MDR), with high rates of resistance to ampicillin (52.1%) and trimethoprim (36.2%) in hospitals. Of concern is the probable clonal expansion of MDR groups ST131 and ST1193 in hospitals and community settings with chromosomally encoded blaCTX-M-15, blaOXA-1 and aac(6′)-Ib-cr5.

Conclusions
The burden of reported UTIs in Norfolk is largely caused by non-MDR isolates and mirrors similar UPEC studies nationally and internationally. Continually monitoring samples with consideration of sources will help reduce burden of disease.
Persistence of the Staphylococcus aureus epidemic European fusidic acid-resistant impetigo clone (EEFIC) in Belgium
Authors: Deplano Ariane , Hallin Marie , Bustos Sierra Natalia , Michel Charlotte , Prevost Benoit , Martiny Delphine , Yin Nicolas 
Published: June 2023

Abstract

Objectives
In August 2018, a public health alert was issued in Belgium regarding clusters of impetigo cases caused by the epidemic European fusidic acid-resistant impetigo clone (EEFIC) of Staphylococcus aureus. As a result, the Belgian national reference centre (NRC) was commissioned to update the epidemiology of S. aureus causing community-onset skin and soft tissues infection (CO-SSTI) to assess the proportion of EEFIC among them.

Methods
For 1 year, Belgian clinical laboratories were asked to send their first three S. aureus isolated from CO-SSTI each month. Isolates were tested for antimicrobial susceptibility to oxacillin, mupirocin and fusidic acid. Resistant isolates were also spa typed and tested for the presence of the genes encoding the Panton–Valentine leucocidin, the toxic shock syndrome toxin and the exfoliatins A and B. MLST clonal complexes were deduced from the spa types.

Results
Among the 518 S. aureus strains analysed, 487 (94.0%) were susceptible to oxacillin. Of these, 79 (16.2%) were resistant to fusidic acid, of which 38 (48.1%) belonged to the EEFIC. EEFIC isolates were mostly isolated from young patients with impetigo and showed a seasonal late summer peak.

Conclusions
These results suggest the persistence of EEFIC in Belgium. Furthermore, its prevalence may lead to reconsideration of the treatment guidelines for impetigo.