Triage of patients with venous and lymphatic diseases during the COVID-19 pandemic - The Venous and Lymphatic Triage and Acuity Scale (VELTAS) : A consensus document of the International Union of Phlebology (UIP), Australasian College of Phlebology (ACP), American Vein and Lymphatic Society (AVLS), American Venous Forum (AVF), European College of Phlebology (ECoP), European Venous Forum (EVF), Interventional Radiology Society of Australasia (IRSA), Latin American Venous Forum, Pan-American Society of Phlebology and Lymphology and the Venous Association of India (VAI) This consensus document has been co-published in Phlebology [DOI: 10.1177/0268355520930884] and Journal of Vascular Surgery: Venous and Lymphatic Disorders [DOI: 10.1016/j.jvsv.2020.05.002]. The publications are identical except for minor stylistic and spelling differences in keeping with each journal's style. The contribution has been published under a Attribution-Non Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0), (https://creativecommons.org/licenses/by-nc-nd/4.0/)

The coronavirus disease 2019 (COVID-19) global pandemic has resulted in diversion of healthcare resources to the management of patients infected with SARS-CoV-2 virus. Elective interventions and surgical procedures in most countries have been postponed and operating room resources have been diverted to manage the pandemic. The Venous and Lymphatic Triage and Acuity Scale was developed to provide an international standard to rationalise and harmonise the management of patients with venous and lymphatic disorders or vascular anomalies. Triage urgency was determined based on clinical assessment of urgency with which a patient would require medical treatment or surgical intervention. Clinical conditions were classified into six categories of: (1) venous thromboembolism (VTE), (2) chronic venous disease, (3) vascular anomalies, (4) venous trauma, (5) venous compression and (6) lymphatic disease. Triage urgency was categorised into four groups and individual conditions were allocated to each class of triage. These included (1) medical emergencies (requiring immediate attendance), example massive pulmonary embolism; (2) urgent (to be seen as soon as possible), example deep vein thrombosis; (3) semi-urgent (to be attended to within 30-90 days), example highly symptomatic chronic venous disease, and (4) discretionary/non-urgent- (to be seen within 6-12 months), example chronic lymphoedema. Venous and Lymphatic Triage and Acuity Scale aims to standardise the triage of patients with venous and lymphatic disease or vascular anomalies by providing an international consensus-based classification of clinical categories and triage urgency. The scale may be used during pandemics such as the current COVID-19 crisis but may also be used as a general framework to classify urgency of the listed conditions.

Plant defense metabolism is increased by the free radical-generating compound AAPH

Effects of the free radical-generating substance 2,2'-azobis(2-amidinopropane) dihydrochloride (AAPH) on defense systems in plant tissue cultures were investigated. Exposure of Catharanthus roseus, C. tricophyllus, and Pisum sativum cultures to AAPH caused altered levels of reduced and oxidized glutathione. An increased total glutathione content in C. roseus was prevented by the glutathione biosynthesis inhibitor buthionine-sulfoximine. The specific phenylalanine ammonia-lyase activity in a C. roseus culture was increased from 4 to 34 mukat(kg protein)-1 by 1 mM AAPH. 5 mM AAPH increased the excretion of phenolic substances into the culture medium of a Pisum sativum culture, from 18 to 67 micrograms ml-1. The level of thiobarbituric acid reactants in a C. tricophyllus culture was increased from 46 to 93 nmol(g fresh weight)-1 by 0.4 mM AAPH. The present results, which constitute the first report on effects of the radical-generator AAPH on plant tissue, were achieved with cultures of various plant species and various types of tissue differentiation and demonstrate that AAPH is a suitable agent for the stimulation of the defensive and secondary metabolism in plant tissue cultures. It is proposed that the effects caused by AAPH are mediated by the generation of free radicals and oxidative stress, and that this agent may be used as a model substance for ozone and UV-B exposure.