68Ga-PSMA PET/CT for Patients with PSA Relapse after Radical Prostatectomy or External Beam Radiotherapy

The study aimed to summarize clinical characteristics associated with Gallium-68-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (68Ga-PSMA PET/CT) scans as patients were restaged for prostate-specific antigen (PSA) relapse after radical prostatectomy (RP) or external beam radiotherapy (EBRT). Our analyses included multiple cox regression analyses. The study evaluated 95 patients with rising values of PSAs after RP and after EBRT. Sixty 63% of patients had a positive 68Ga-PSMA PET/CT scan. Twelve patients (13%) had a positive site in the prostate bed, 29 patients (30%) had a positive site in the regional lymph nodes, and 19 (20%) had positive sites in distant organs. After four years follow-up, 21 patients (22%) died. Using multiple Cox regression analyses, the number of positive sites on the 68Ga-PSMA PET/CT scan significantly predicted overall survival (OS) (p = 0.0001), whereas risk score and regional locations of the positive sites were not significant in the multiple Cox regression analyses. Our study indicates that the specific findings of 68Ga-PSMA PET/CT scans are important because detailed findings of the scans predict the outcome after salvage treatment of patients with PSA relapse examined with 68Ga-PSMA PET/CT scans.

Working towards a Co-Ordinated Approach to Invasive Mosquito Detection, Response and Control in the UK

The United Kingdom (UK) has reported a single detection of the eggs of the invasive mosquito vector Aedes albopictus in each of the three years from 2016 to 2018, all in southeast England. Here, we report the detection of mosquito eggs on three occasions at two sites in London and southeast England in September 2019. Mosquito traps were deployed at 56 sites, in England, Scotland, Wales, and Northern Ireland, as part of a coordinated surveillance programme with local authorities, Edge Hill University, and government departments. Response to each detection was coordinated by Public Health England’s (PHE) local health protection teams, with technical support from PHE’s Medical Entomology group, and control conducted by the respective local authority. Control, including source reduction and larviciding, was conducted within a 300 metre radius of the positive site. The response followed a National Contingency Plan for Invasive Mosquitoes: Detection of Incursions. Although the response to these incidents was rapid and well co-ordinated, recommendations are made to further develop mosquito surveillance and control capability for the UK.

Determining multi-species site use outside the protected areas of the Maasai Mara, Kenya, using false positive site-occupancy modelling

Although protected areas are the basis for many conservation efforts they are rarely of an adequate size for the long-term survival of populations of large, wide-roaming mammals. In the Maasai Mara, Kenya, communally owned wildlife conservancies have been developed to expand the area available for wildlife. As these continue to develop it is important to ensure that the areas chosen are beneficial to wildlife. Using presence data for cheetahs Acinonyx jubatus, elephants Loxodonta africana, spotted hyaenas Crocuta crocuta, leopards Panthera pardus, lions Panthera leo and wild dogs Lycaon pictus, collected through interviews with 648 people living outside protected areas, we identify key wildlife areas using false positive site-occupancy modelling. The probabilities of site use were first determined per species based on habitat, distance to protected area, human presence and rivers, and these probabilities were then combined to create a map to highlight key wildlife areas. All species, except hyaenas, preferred sites closer to the protected areas but site use varied by species depending on habitat type. All six species avoided human presence. Leopards, elephants, lions and wild dogs preferred sites closer to rivers. The resulting combined map highlights areas that could potentially benefit from conservation efforts, including the expansion of wildlife areas, and areas where human development, such as a newly tarmacked road, could have an impact on wildlife.

Cost analysis of inappropriate treatments for suspected dermatomycoses

Superficial mycoses are estimated to affect more than 20-25% of the world’s population with a consistent increase over the years. Most patients referred to our clinic for suspected dermatomycoses have already been treated with pharmacotherapy, without a previous mycological examination and many show changes in the clinical manifestations. Indeed, some medications, such as steroids, antiviral, antibiotics and antihistamines are not able to erase a fungal infection, but also they can cause atypical clinical manifestations. The consequences of inappropriate treatment include delayed diagnosis, prolonged healing time, and additional costs. The aims of this study were (1) to evaluate the incidence of increased costs attributable to inappropriate therapy sustained by the National Health Service and patients and (2) to highlight the importance of mycological evaluation before starting treatment, in order to improve diagnostic accuracy. An observational retrospective and prospective study was performed from September 2013 to February 2014, in 765 patients referred to our center (University Hospital “ Federico II”) in Naples, Italy, for suspected mycological infection. The following treatments (alone or in combination) were defined as inappropriate: (1) cortisone in a patient with at least one positive site; (2) antifungals in (a) patients with all negative sites or (b) ineffective antifungal treatment (in terms of drug chosen, dose or duration) in those with all positive sites; or (3) antibiotics; (4) antivirals or (5) antihistamines, in patients with ≥ 1 positive site. Five hundred and fifty patients were using medications before the assessment visit. The total amount of avoidable costs related to inappropriate previous treatments was € 121,417, representing 74% of the total treatment costs. 253/550 patients received drugs also after the visit. For these patients, the cost of treatment prescribed after mycological testing was € 42,952, with a decrease with respect to the total consumption of drugs at the time of access to the Mycology Laboratory of € 34,781. Thus, our cost analysis shows that it is important to obtain a reduction of costs for pathologies that need to be confirmed by examinations before starting treatment.

Ortho substituent effects on transfer of aryl groups from oxygen to carbon in adducts from diaryloxycarbenes and DMAD

Diaryloxycarbenes, generated by thermolysis of 2,2-diaryloxy-5,5-dimethyl-Δ3-1,3,4-oxadiazolines in benzene, reacted with dimethyl acetylenedicarboxylate (DMAD) to afford triesters. The triesters arose by aryl-group transfer from oxygen to carbon (ipso substitution). A cyano group in the para position had been shown earlier to favour the ipso substitution whereas a para-methoxy group disfavoured it. Surprisingly, the ortho-methoxy substituent also favoured ipso substitution. As a tentative rationale, we had proposed that a vinylogous diaryloxycarbene intermediate, with dipolar properties, is formed when a diaryloxycarbene attacks at the sp-carbon of DMAD and that an ortho substituent, with one or more unshared electron pairs, can stabilize the intermediate by donating electron density to the positive site. In the present work, support for that interpretation and for the importance of a steric effect, was provided by examining the competition between (i) p-tolyl and phenyl; (ii) o-tolyl and phenyl; (iii) o-iodophenyl and phenyl; (iv) o-iodophenyl and p-chlorophenyl; and (v) o-bromophenyl and p-chlorophenyl as potential migrating groups.Key words: aromatic substitution, carbene, ipso, diaryloxycarbene, oxadiazoline.