bluuebunny/crossref_metadata_2025_split huggingface dataset:
DS05 Future guidelines should consider time needed to treat in clinics
Authors: Rabindranathnambi Aswatha , Sharma Ashish , Moledina Zahra , Varma Sandeep 
Published: June 2023

Abstract
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

Abstract
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

Abstract
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

Abstract
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

Abstract
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 &gt; 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 (&lt; 25, 25–30 and &gt; 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 &lt; 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 &gt; 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 &gt; 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

Abstract
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

Abstract
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

Abstract
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

Abstract
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 &lt; 0.01), pulverization rate (P &lt; 0.01), powder content (P &lt; 0.01), and increased the hardness and gelatinization starch of pellet feed (P &lt; 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 &lt; 0.01), while the parameters were similar among FPKC, EPKC, and control group (P &gt; 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.