A national clinician survey on the British Society for Dermatological Surgery guidelines on antithrombotic agent use in skin surgery.

Antithrombotic medication is taken by 14-22% patients undergoing skin surgery, with more patients now taking direct oral anticoagulants (DOACs). The latest evidence suggests that the risk of stopping DOACs perioperatively is low in skin surgery, particularly for primary closures, but remains unclear for more complex procedures. The 2016 British Society for Dermatological Surgery (BSDS) guidelines suggest that clinicians could consider stopping DOACs in patients for 24-48 h, based on individual bleeding risk. We surveyed BSDS members to better understand clinical practice and guideline adherence with a view to updating the guidance. The results demonstrated that there is consistency among clinicians in the management of patients on more established antithrombotic agents, such as aspirin, clopidogrel and warfarin. However, there is a higher perceived risk of significant haematomas following higher-risk procedures such as larger flaps or grafts with DOACs vs. other antithrombotics postoperatively. Stopping DOACs perioperatively for 24-48 h for higher-risk procedures can be cautiously considered following an individual risk assessment and informed discussion with the patient.

Three-Dimensional Time-Lapse Analysis Reveals Multiscale Relationships in Maize Root Systems with Contrasting Architectures.

Understanding how an organism's phenotypic traits are conditioned by genetic and environmental variation is a central goal of biology. Root systems are one of the most important but poorly understood aspects of plants, largely due to the three-dimensional (3D), dynamic, and multiscale phenotyping challenge they pose. A critical gap in our knowledge is how root systems build in complexity from a single primary root to a network of thousands of roots that collectively compete for ephemeral, heterogeneous soil resources. We used time-lapse 3D imaging and mathematical modeling to assess root system architectures (RSAs) of two maize (Zea mays) inbred genotypes and their hybrid as they grew in complexity from a few to many roots. Genetically driven differences in root branching zone size and lateral branching densities along a single root, combined with differences in peak growth rate and the relative allocation of carbon resources to new versus existing roots, manifest as sharply distinct global RSAs over time. The 3D imaging of mature field-grown root crowns showed that several genetic differences in seedling architectures could persist throughout development and across environments. This approach connects individual and system-wide scales of root growth dynamics, which could eventually be used to predict genetic variation for complex RSAs and their functions.

Factors that predict complex reconstructions in facial skin cancer surgery.

There is a paucity of high-quality evidence and guidelines on the prediction of skin defect reconstruction, and the type of repair rests on the operating surgeon's experience and skill. Mismatches between planning and execution can have negative consequences on resources, staff, and patient counseling. To investigate the factors that predict complex reconstruction in facial skin cancer surgery, we performed a retrospective study collecting information on the several parameters that may affect the method of reconstruction. A total of 325 cases were included. Only the factors tumor size (Z = 2.54; P < .05) and predicted repair plan (Z = 2.73; P < .01) were found to be significant predictors of complex repairs. When broken down by site and size, only the nose, scalp, and temple demonstrated a significant correlation between tumor size and the need for complex repairs. Clinical judgment at the time of initial examination is by far the greatest predictor of complex repairs. This occurs even when clinicians have heterogeneous surgical skills, and most are not technically versed in complex repairs. Increasing tumor size was also found to be an independent risk factor albeit only at certain body sites such as the temple, scalp, and nose.

WHO Surgical Checklist in Dermatology: Compliance, Barriers, and Attitudes.

BACKGROUND: The World Health Organization (WHO) surgical checklist is associated with reduced morbidity and mortality. Efficacy correlates with compliance. OBJECTIVE: This study aims to (1) establish completion rate and (2) identify and address barriers to use. METHODS: Records of patients undergoing dermatological surgery were studied. Staff completed attitude and barriers questionnaires. Checklist process was modified, and use was reassessed twice. RESULTS: Cycle 1 involved 217 subjects; 72% had excisions. Thirteen percent had surgery to multiple sites. Five percent of checklists were fully completed, with an average of 76% of available points per checklist marked as checked. The lowest single field use included "patient identity" (76%) and "surgical site" (72%). Questionnaire responses from 25 staff showed the checklist to be "important" and "relevant" in dermatology; key barrier to completion was lack of time. Checklist modifications and educational sessions were undertaken; checklist use was reassessed twice more with 103 and 134 patients. Average use increased to 96% and 98%; full completion increased to 71% and 70%; "surgical site" and "identity" completion increased to 100%. CONCLUSION: The WHO checklist is relevant and important in dermatology. Introduction must be supported by repeated training sessions. Adequate time and training can significantly improve checklist completion and patient safety.

The Quantitative Genetic Control of Root Architecture in Maize.

Roots remain an underexplored frontier in plant genetics despite their well-known influence on plant development, agricultural performance and competition in the wild. Visualizing and measuring root structures and their growth is vastly more difficult than characterizing aboveground parts of the plant and is often simply avoided. The majority of research on maize root systems has focused on their anatomy, physiology, development and soil interaction, but much less is known about the genetics that control quantitative traits. In maize, seven root development genes have been cloned using mutagenesis, but no genes underlying the many root-related quantitative trait loci (QTLs) have been identified. In this review, we discuss whether the maize mutants known to control root development may also influence quantitative aspects of root architecture, including the extent to which they overlap with the most recent maize root trait QTLs. We highlight specific challenges and anticipate the impacts that emerging technologies, especially computational approaches, may have toward the identification of genes controlling root quantitative traits.

How can we harness quantitative genetic variation in crop root systems for agricultural improvement?

Root systems are a black box obscuring a comprehensive understanding of plant function, from the ecosystem scale down to the individual. In particular, a lack of knowledge about the genetic mechanisms and environmental effects that condition root system growth hinders our ability to develop the next generation of crop plants for improved agricultural productivity and sustainability. We discuss how the methods and metrics we use to quantify root systems can affect our ability to understand them, how we can bridge knowledge gaps and accelerate the derivation of structure-function relationships for roots, and why a detailed mechanistic understanding of root growth and function will be important for future agricultural gains.

Full-thickness skin grafts for lower leg defects: an effective repair option.

BACKGROUND: Repair of lower leg defects after excision of skin lesions that are not amenable to primary closure can be challenging. OBJECTIVE: To evaluate the outcome of full-thickness skin grafts (FTSG) to repair lower leg defects after excision of cutaneous lesions. To assess graft take at Days 7 and 30 and the number of visits to secondary care after procedure. MATERIALS AND METHODS: Retrospective review of 50 consecutive patients who underwent FTSG to cover defects below the knee between January 2009 and February 2014. Graft take was defined as good (90% healing and pink/purple), moderate (50% healing and pink/purple and >50% graft take), or poor (>50% graft failure). RESULTS: Mean age was 75 years (range, 49-96 years). The mean area of the defect was 52.4 cm. The mean maximum and minimum diameters of the defect were 2.8 and 2.3 cm. Graft take was good in 44 patients (88%), moderate in 5 patients (10%), and poor in 1 patient (2%) at Day 30. Complications were infrequent and included infection and ulceration. There was no significant association between the graft size and graft take. CONCLUSION: Full-thickness skin graft is an effective method of repairing defects on the lower leg after removal of cutaneous lesions. The aftercare of FTSG was acceptable with 86% of patients requiring 5 or fewer visits to secondary care.

Biolistic transformation of elite genotypes of switchgrass (Panicum virgatum L.).

Transformation of elite switchgrass (Panicum virgatum L.) genotypes would facilitate the characterization of genes related to cell wall recalcitrance to saccharification. However, transformation of explants from switchgrass plants has remained difficult. Therefore, the objective of this study was to develop a biolistic transformation protocol for elite genotypes. Three switchgrass genotypes (ST1, ST2, and AL2) were previously selected for tissue culture responsiveness. One genotype, SA37, was selected for further use due to its improved formation of callus amenable to transformation. Various medium sets were compared and a previously published medium set provided cultures with >96 % embryogenic callus, and data on transient and stable gene expression of RFP were used to optimize biolistic parameters, and further validate the switchgrass (PvUbi1) promoter. SA37 proved to be the most transformable, whereas eight transgenic calli on average were recovered per bombardment of 20 calli (40 % efficiency) when using a three-day day preculture step, 0.6 M osmotic adjustment medium, 4,482 kPa rupture disks and 0.4 µm gold particles which traveled 9 cm before hitting the target callus tissue. Regenerability was high, especially for ST2, for which it is possible to recover on average over 400 plants per half-gram callus tissue. It is now possible to routinely and efficiently engineer elite switchgrass genotypes using biolistic transformation.

A novel cause of erythromelalgia due to pseudoephedrine.

Objective: Erythromelalgia is a rare, highly debilitating disorder characterised by severe episodes of discomfort, erythema, and desquamation of the extremities. Its causes include genetic factors, medications, and several underlying medical conditions. This paper describes a novel cause of erythromelalgia through a case report and literature review. Case description: A 47-year-old Caucasian man presented with a two-year history of intermittent pain, redness and desquamation of the hands. He experienced several such episodes, each lasting 3-4 weeks. A skin biopsy confirmed the diagnosis of erythromelalgia. After several recurrences, he admitted to the intermittent use of pseudoephedrine as a nasal decongestant, which coincided with the episodes of erythromelalgia. Complete resolution of symptoms was reported on cessation of this medication. Conclusion: Pseudoephedrine has been reported to cause a wide range of cutaneous reactions but has not been known to precipitate erythromelalgia. Recognition of this rare side effect may offer early diagnosis and reduced morbidity.

Photodegradation of indomethacin and naproxen contained within commercial products for skin - RAP.

Patient can be exposed to the photodegradation products of a drug after skin application of topical formulations. NSAIDs, with analgesic and anti-inflammatory properties, are known for the potential photoinstability, and are applied often in the form of creams, gels or liquids, commonly used among athletes, elderly people, geriatric patients and patients treated with multidrug therapies. Susceptibility to photodegradation hazard of those group arises the need for development of a new approach, with the ability to evaluate the patient safety. We planned to use a rapid assessment procedure (RAP) of safety by testing the photostability of popular skin medicinal products. This method, proposed many years ago by WHO, is now reintroduced to analytical applications in industry, when emergency drugs (e.g. for Covid) are implemented to the market in accelerated procedures. In the health care system, qualitative evaluation of drugs is extremely valuable, therefore we have planned to identify photodegradation using the FTIR method - infrared spectroscopy and DSC - differential scanning calorimetry, whilst the risk of formation of genotoxic products using the Ames test. We have successfully demonstrated that changes in the chemical structure and physical form of both pure APIs and drug products containing the API be assessed in a short time. Another advantage of our work is the combination of the developed results from FTIR/NIR spectra with statistical analysis. As a result, full and quick qualitative assessment of the effects of photoexposure of selected NSAIDs is performed, fortunately showing no mutagenicity. Due to the popularity of NSAIDs applied to the skin, a gel containing naproxen and spray with indomethacin were selected for testing. The analysis carried out for various formulations of both preparations allows us to demonstrate the universality of the applied RAP methods in assessing the risk of hazard to the patient, thus we present research results that expand or widen the knowledge and assessment of risks related to the use of drugs on the skin.

Is there an association between isotretinoin therapy and adverse mood changes? A prospective study in a cohort of acne patients.

Background: Treatment with isotretinoin has been associated with adverse mood changes. However, even though a number of studies support this association, others refute it, and a concrete causal link has yet to be proven. Acne itself is associated with depressive symptoms, thus making studies on the topic difficult to design and interpret. Objectives and methods: Using validated tools, we performed a prospective study in order to assess the effects of treatment with isotretinoin on the mood of patients with acne vulgaris. Results: Fifty-six patients were included with a mean age of 21 years. At baseline, questionnaire scores for all measured parameters were indicative of lower mood than published norms. During and after treatment, values of either stable or improving mood were displayed across all questionnaires. Three patients developed significantly deteriorating moods, two of whom also experienced severe physical adverse effects. Conclusion: The relationship between isotretinoin and depression is the most debated aspect of isotretinoin therapy. Our results link isotretinoin to an overall improvement in psychological wellbeing, even in patients suffering with stable mental illness. However, we also found that a small minority of patients are susceptible to severe mood deterioration, particularly in conjunction with severe physical side effects.

A rare cutaneous adverse effect secondary to cabozantinib therapy.

Cabozantinib is a tyrosine kinase inhibitor which is increasingly being used for the treatment of metastatic renal cell cancer. Skin toxicity such as palmar-plantar erythrodysesthesia is not uncommon with such agents. However, bullous skin reactions are not common and we report the case of a patient with metastatic renal cell cancer who experienced such cutaneous toxicity.

Sugar release and growth of biofuel crops are improved by downregulation of pectin biosynthesis.

Cell walls in crops and trees have been engineered for production of biofuels and commodity chemicals, but engineered varieties often fail multi-year field trials and are not commercialized. We engineered reduced expression of a pectin biosynthesis gene (Galacturonosyltransferase 4, GAUT4) in switchgrass and poplar, and find that this improves biomass yields and sugar release from biomass processing. Both traits were maintained in a 3-year field trial of GAUT4-knockdown switchgrass, with up to sevenfold increased saccharification and ethanol production and sixfold increased biomass yield compared with control plants. We show that GAUT4 is an α-1,4-galacturonosyltransferase that synthesizes homogalacturonan (HG). Downregulation of GAUT4 reduces HG and rhamnogalacturonan II (RGII), reduces wall calcium and boron, and increases extractability of cell wall sugars. Decreased recalcitrance in biomass processing and increased growth are likely due to reduced HG and RGII cross-linking in the cell wall.

Whole-Plant Manual and Image-Based Phenotyping in Controlled Environments.

Phenotypic measurements and images of crops grown under controlled-environment conditions can be analyzed to compare plant growth and other phenotypes from diverse varieties. Those demonstrating the most favorable phenotypic traits can then be used for crop improvement strategies. This article details a protocol for image-based root and shoot phenotyping of plants grown in the greenhouse to compare traits among different varieties. Diverse maize lines were grown in the greenhouse in large 8-gallon treepots in a clay granule substrate. Replicates of each line were harvested at 4 weeks, 6 weeks, and 8 weeks after planting to capture developmental information. Whole-plant phenotypes include biomass accumulation, ontogeny, architecture, and photosynthetic efficiency of leaves. Image analysis was used to measure leaf surface area and tassel size and to extract shape variance information from complex 3D root architectures. Notably, this framework is extensible to any number of above- or below-ground phenotypes, both morphological and physiological. © 2017 by John Wiley & Sons, Inc.