bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract
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

Abstract
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

Abstract
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

Abstract
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 &lt; 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 &lt; 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 &gt; 40 mm, depth of invasion &gt; 6 mm, invasion beyond the dermis, presence of perineural or lymphovascular invasion or deep margin &lt; 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

Abstract
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

AbstractRudimentary 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

Abstract
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.
Real-world Evidence Comparing Tofacitinib and Vedolizumab in Anti-TNF-experienced Patients With Ulcerative Colitis
Authors: Adimadhyam Sruthi , Lewis James D , Simon Andrew L , Wolfe Audrey E , Smith Samantha , Hou Laura , Moyneur Érick , Reynolds Juliane S , Toh Sengwee , Dobes Angela , Parlett Lauren , Haynes Kevin , Burris Jessica , Dorand Jennifer E , Long Millie D , Kappelman Michael D 
Published: June 2023

Abstract

Background
Antitumor necrosis factor (anti-TNF) inhibitors are first-line treatment among patients with ulcerative colitis (UC). With time, patients tend to lose response or become intolerant, necessitating switching to small cell biologics such as tofacitinib or vedolizumab. In this real-world study of a large, geographically diverse US population of TNF-experienced patients with UC, we evaluated the effectiveness and safety of newly initiating treatment with tofacitinib vs vedolizumab.

Methods
We conducted a cohort study using secondary data from a large US insurer (Anthem, Inc.). Our cohort included patients with UC newly initiating treatment with tofacitinib or vedolizumab. Patients were required to have evidence of treatment with anti-TNF inhibitors in the 6 months prior to cohort entry. The primary outcome was treatment persistence &gt;52 weeks. Additionally, we evaluated the following secondary outcomes as additional measures of effectiveness and safety: (1) all-cause hospitalization; (2) total abdominal colectomy; (3) hospitalization for infection; (4) hospitalization for malignancy; (5) hospitalization for cardiac events; and (6) hospitalization for thromboembolic events. We used fine stratification by propensity scores to control for confounding by demographics, clinical factors, and treatment history at baseline.

Results
Our primary cohort included 168 new users of tofacitinib and 568 new users of vedolizumab. Tofacitinib was associated with lower treatment persistence (adjusted risked ratio, 0.77; 95% CI, 0.60 -0.99). Differences in secondary measures of effectiveness or safety between tofacitinib initiators vs vedolizumab initiators were not statistically significant (all-cause hospitalization, adjusted hazard ratio, 1.23; 95% CI, 0.83-1.84; total abdominal colectomy, adjusted HR, 1.79; 95% CI, 0.93-3.44;and hospitalization for any infection, adjusted HR, 1.94; 95% CI, 0.83-4.52).

Discussion
Ulcerative colitis patients with prior anti-TNF experience initiating tofacitinib demonstrated lower treatment persistence compared with those initiating vedolizumab. This finding is in contrast to other recent studies suggesting superior effectiveness of tofacitinib. Ultimately, head-to-head randomized, controlled trials that focus on directly measured end points may be needed to best inform clinical practice.
Optimal adaptive nonpharmaceutical interventions to mitigate the outbreak of respiratory infections following the COVID-19 pandemic: a deep reinforcement learning study in Hong Kong, China
Authors: Yao Yao , Zhou Hanchu , Cao Zhidong , Zeng Daniel Dajun , Zhang Qingpeng 
Published: June 2023

Abstract

Background
Long-lasting nonpharmaceutical interventions (NPIs) suppressed the infection of COVID-19 but came at a substantial economic cost and the elevated risk of the outbreak of respiratory infectious diseases (RIDs) following the pandemic. Policymakers need data-driven evidence to guide the relaxation with adaptive NPIs that consider the risk of both COVID-19 and other RIDs outbreaks, as well as the available healthcare resources.

Methods
Combining the COVID-19 data of the sixth wave in Hong Kong between May 31, 2022 and August 28, 2022, 6-year epidemic data of other RIDs (2014–2019), and the healthcare resources data, we constructed compartment models to predict the epidemic curves of RIDs after the COVID-19-targeted NPIs. A deep reinforcement learning (DRL) model was developed to learn the optimal adaptive NPIs strategies to mitigate the outbreak of RIDs after COVID-19-targeted NPIs are lifted with minimal health and economic cost. The performance was validated by simulations of 1000 days starting August 29, 2022. We also extended the model to Beijing context.

Findings
Without any NPIs, Hong Kong experienced a major COVID-19 resurgence far exceeding the hospital bed capacity. Simulation results showed that the proposed DRL-based adaptive NPIs successfully suppressed the outbreak of COVID-19 and other RIDs to lower than capacity. DRL carefully controlled the epidemic curve to be close to the full capacity so that herd immunity can be reached in a relatively short period with minimal cost. DRL derived more stringent adaptive NPIs in Beijing.

Interpretation
DRL is a feasible method to identify the optimal adaptive NPIs that lead to minimal health and economic cost by facilitating gradual herd immunity of COVID-19 and mitigating the other RIDs outbreaks without overwhelming the hospitals. The insights can be extended to other countries/regions.
Mixed-reality for quadruped-robotic guidance in SAR tasks
Authors: Cruz Ulloa Christyan , del Cerro Jaime , Barrientos Antonio 
Published: June 2023

Abstract
In recent years, exploration tasks in disaster environments, victim localization and primary assistance have been the main focuses of Search and Rescue (SAR) Robotics. Developing new technologies in Mixed Reality (M-R) and legged robotics has taken a big step in developing robust field applications in the Robotics field. This article presents MR-RAS (Mixed-Reality for Robotic Assistance), which aims to assist rescuers and protect their integrity when exploring post-disaster areas (against collapse, electrical, and toxic risks) by facilitating the robot’s gesture guidance and allowing them to manage interest visual information of the environment. Thus, ARTU-R (A1 Rescue Tasks UPM Robot) quadruped robot has been equipped with a sensory system (lidar, thermal, and RGB-D cameras) to validate this proof of concept. On the other hand, Human-Robot interaction is executed by using the Hololens glasses. This work’s main contribution is the implementation and evaluation of a Mixed-Reality system based on a ROS-Unity solution, capable of managing at a high level the guidance of a complex legged robot through different interest zones (defined by a Neural Network and a vision system) of a post-disaster environment (PDE). The robot’s main tasks at each point visited involve detecting victims through thermal, RGB imaging, and neural networks and assisting victims with medical equipment. Tests have been carried out in scenarios that recreate the conditions of PDE (debris, simulation of victims, etc.). An average efficiency improvement of 48% has been obtained when using the immersive interface and a time optimization of 21.4% compared to conventional interfaces. The proposed method has proven to improve rescuers’ immersive experience of controlling a complex robotic system.