Thermographic Mapping of Arterial Perforators in the Leg.

Background: Preoperative localisation of perforators aids in easy intraoperative dissection. Infrared thermography is a simple, safe, and effective tool with a short learning curve that is useful in identifying perforators. It has been found to have a high concordance rate when compared with computed tomography angiography and is useful in identifying arterial perforators in the leg. Objectives: To create a thermographic map of arterial perforators in the leg and to determine the correlation between the number of perforators identified and the length of the leg. Materials and Methods: This was a cross-sectional study. The length of the leg was measured and the location of perforators corresponding to the distribution of the anterior tibial, posterior tibial, and peroneal arteries was identified using thermography. The mean number of perforators corresponding to the different surfaces of the leg was noted, this was then correlated with the length of the leg using the Pearson correlation coefficient. Results: Using thermography, perforators were identified along a line drawn from the medial malleolus to the medial tibia plateau and from the lateral malleolus to the head of the fibula and within 2 cm of these lines. More perforators were found in the middle third of the leg and there was no significant correlation between the number of perforators and the length of the leg. Conclusion: A useful surface marking to aid the identification of perforators in the leg using infrared thermography was found. There was no significant correlation between the length of the leg and the number of perforators.

Presentation, Clinical Outcome, and Quality of Life of Patients Treated for Head and Neck Skin Cancer at the University College Hospital, Ibadan.

Introduction: Patients with head and neck skin cancer experience adverse functional, psychosocial, and financial impacts as a result of the disease and/or its treatment. This study aimed at evaluating the pattern of presentation, clinical outcomes, and quality of life of patients with head and neck skin cancer. Materials and Methods: A retrospective cross-sectional study of patients with head and neck skin cancer presenting to the Department of Plastic, Reconstructive & Aesthetic Surgery of the University College Hospital, Ibadan, from January 2017 to December 2021. Data obtained from the clinical records included sociodemographic characteristics, clinical and surgical details, as well as clinical outcomes. Quality of life was assessed using EORTC QLQ-C30 questionnaires. Data were summarized using descriptive statistics. Results: Nineteen patients were reviewed with a median age of 38 years (ranging from 18 to 85 years) and a male-to-female ratio of 1:1.4. Eight (42.1%) of the patients were albinos. Squamous cell carcinoma was the predominant histologic type (63.2%), while the scalp was the commonest location (42.1%). Only one patient (5.3%) presented with metastatic disease. A greater percentage of treated patients, eight (61.5%), had surgery as the only treatment modality. After a mean follow-up period of 33 months, a recurrence rate of 10.5% (two patients) and a mortality rate of 15.8% (three patients) were recorded. Quality of life assessment revealed an adverse financial impact of the disease on our patients. Conclusion: Although albinism is a recognized risk factor for skin cancers, head and neck skin cancers can occur in the dark-skinned.

Classic human astrovirus 4, 8, MLB-3, and likely new genotype 5 sublineage in stool samples of children in Nigeria.

Human astrovirus (HAstV) is a nonenveloped RNA virus and has been implicated in acute gastroenteritis among children and elderly. However, there exists a substantial dearth of information on HAstV strains circulating in Nigeria. Viral-like particles were purified from archived 254 stool samples of children with acute flaccid paralysis between January and December 2020 from five states in Nigeria, using the NetoVIR protocol. Extracted viral RNA and DNA were subjected to a reverse transcription step and subsequent random polymerase chain reaction amplification. Library preparation and Illumina sequencing were performed. Using the virome paired-end reads pipeline, raw reads were processed into genomic contigs. Phylogenetic and pairwise identity analysis of the recovered HAstV genomes was performed. Six near-complete genome sequences of HAstV were identified and classified as HAstV4 (n = 1), HAstV5 (n = 1), HAstV8 (n = 1), and MLB-3 (n = 3). The HAstV5 belonged to a yet unclassified sublineage, which we tentatively named HAstV-5d. Phylogenetic analysis of open reading frames 1a, 1b, and 2 suggested recombination events inside the MAstV1 species. Furthermore, phylogenetic analysis implied a geographic linkage between the HAstV5 strain from this study with two strains from Cameroon across all the genomic regions. We report for the first time the circulation of HAstV genotypes 4, 8, and MLB-3 in Nigeria and present data suggestive for the existence of a new sublineage of HAstV5. To further understand the burden, diversity, and evolution of HAstV, increased research interest as well as robust HAstV surveillance in Nigeria is essential.

Student nurses' practices and willingness to teach relatives breast self-examination in Nigeria.

Background: Breast cancer is the most common cancer and the leading cause of cancer-related death for women worldwide. Breast self-examination (BSE) is an essential, low-cost, and simple tool for detecting breast cancer early. Employing the idea of 'charity begins at home' by involving student nurses in teaching BSE to relatives will improve early detection. Aim: To assess nursing students' practice and willingness to teach BSE to their relatives. Setting: A college of nursing and midwifery in one state under North-Central Nigeria. Methods: A cross-sectional descriptive design was employed. Through incidental sampling technique 197 respondents were selected from the first to the third year. Data were collected using a structured questionnaire. Descriptive and inferential analyses, with a p-value of 0.05 were conducted. Results: Respondents indicated where they learned about BSE. There were 98.5% respondents who had heard about BSE, and 89.8% of them had good practice of BSE. However, a quarter did not teach BSE to relatives. There were no statistically significant associations noted. Conclusion: Most of the nursing students were aware of BSE and knew how to perform it, although a quarter did not teach BSE to their relatives. Therefore, it may be necessary to sensitise nurses to cultivate the habit of teaching BSE to relatives and women in the community. Contribution: It is crucial to provide nurses with the skills and knowledge required to carry out BSE effectively, as well as teach women how to perform it on themselves, to improve breast cancer detection rates in Nigeria.

The Impact of Covid-19 Pandemic on Acute Burn Admissions at the University College Hospital, Ibadan, Nigeria.

The coronavirus disease and the subsequent pandemic that followed drastically changed human civilization with disruptive effects on health and overall wellbeing of mankind. This disruptive effect has been shown to include changes in epidemiology of burn injuries. This study therefore aimed to determine the impact of covid-19 on acute burn presentation at the University College Hospital (UCH), Ibadan. This was a retrospective study carried out between April 1, 2019 and March 31, 2021. The period was divided into two: April 1, 2019 to March 31, 2020 and April 1, 2020 to March 31, 2021. Data obtained from the burn unit registry were analyzed using the Scientific Package For Social Sciences version 25. The only statistically significant finding from this study was the marked reduction in burn ICU admission during the pandemic (P < 0.001). A total of 144 patients presented to the burn intensive care unit at UCH, Ibadan during the period under review with 92 patients in the prepandemic year, and 52 patients in the pandemic year. Patient group from 0- to 9-year-olds representing 42% in prepandemic, and 30.8% in the pandemic period was the most affected age group. Scald was predominantly among the pediatric age group in both groups. Males were more likely to suffer flame burn in both study periods with a near gender equilibration during the pandemic. Burn injury during the pandemic resulted in more total body surface area burned. The lockdown effect of the pandemic resulted in a significant reduction in acute burn admissions at the UCH, Ibadan.

Integrated Genomic Analysis of Primary Prostate Tumor Foci and Corresponding Lymph Node Metastases Identifies Mutations and Pathways Associated with Metastasis.

Prostate cancer is a highly heterogeneous disease and mortality is mainly due to metastases but the initial steps of metastasis have not been well characterized. We have performed integrative whole exome sequencing and transcriptome analysis of primary prostate tumor foci and corresponding lymph node metastases (LNM) from 43 patients enrolled in clinical trial. We present evidence that, while there are some cases of clonally independent primary tumor foci, 87% of primary tumor foci and metastases are descended from a common ancestor. We demonstrate that genes related to oxidative phosphorylation are upregulated in LNM and in African-American patients relative to White patients. We further show that mutations in TP53, FLT4, EYA1, NCOR2, CSMD3, and PCDH15 are enriched in prostate cancer metastases. These findings were validated in a meta-analysis of 3929 primary tumors and 2721 metastases and reveal a pattern of molecular alterations underlying the pathology of metastatic prostate cancer. We show that LNM contain multiple subclones that are already present in primary tumor foci. We observed enrichment of mutations in several genes including understudied genes such as EYA1, CSMD3, FLT4, NCOR2, and PCDH15 and found that mutations in EYA1 and CSMD3 are associated with a poor outcome in prostate cancer.

Train-the-trainers intervention for national capacity building in infection prevention and control for COVID-19 in Nigeria.

Background: The first case of COVID-19 in Nigeria was reported on February 27, 2020, and over time, spread across the country leading to many healthcare worker infections. The risk of transmission of COVID-19 within healthcare facilities makes it necessary to establish infection prevention and control measures. The World Health Organisation supported the Nigeria Centre for Disease Control to conduct a train-the-trainers workshop on infection prevention and control for key healthcare workers across Nigeria. Aim/Objectives: This study aims to describe the process and results of train-the-trainers as an intervention for national capacity building in infection prevention and control for COVID-19 among healthcare workers in Nigeria. Methods: Eight-hour sessions were held over three days with face-to-face instruction and practical hands-on experience in April 2020. A total of 61 healthcare workers participated across the six geographic zones of Nigeria: North Central, North East, North West, South West, South East, and South South. The training included slide presentations, case-based scenarios, and practical hands-on sessions with plenary discussions. Pre- and post-test assessments were used to evaluate knowledge of COVID-19, triage, and infection prevention and control among healthcare workers. Finding/Results: 69 % (42) of the participants were male 31 % (19) were female, and the majority (67 %) were medical doctors. Others attending were nurses or health administrators. Of the 70 % (26) of the states with existing infection prevention and control structures within the COVID emergency response, only 40 % were functional. The average percentage of pre-test and post-test scores were 60.8 ± 13.4 and 67.8 ± 9 0.3 respectively, showing a statistically significant difference (p > 0.001) in trainee knowledge. Additionally, 70 % of participants evaluated the training workshop as "satisfactory" or higher in training format, relevance for daily clinical work, active participation, learning new concepts, and logistics. Conclusion: Nationwide infection prevention and control training is feasible during a national health crisis. Infection prevention and control is cardinal in the containment of epidemic-prone diseases like COVID-19 and is invaluable in the prevention of healthcare-associated infections in healthcare settings.

Knowledge of the effects of regular pelvic floor exercises on maternal health among women in a comprehensive health centre in Ado-Ekiti, Nigeria.

Regular pelvic floor exercise is essential for maternal health among women because it is a proven conservative treatment and prevention for pelvic organ prolapse. This study aimed at investigating the knowledge of women on the effects of regular pelvic floor exercise on the maternal health among women attending a primary health centre in Ado - Ekiti. It also assessed the women's attitude towards and the practice of pelvic floor exercises. The study was predicated on reasoned action theory, while a descriptive cross-sectional design was adopted using total enumerative sampling technique. Data was collected from 248 respondents using researcher-administered questionnaires. Data were analyzed using descriptive and inferential statistics. Findings from the study showed that the majority (72.20%) of the respondents had a low level of awareness of pelvic floor exercises, 74.2% perceived pelvic floor exercises as very necessary to maternal health, 75.4% showed a negative attitude to pelvic floor exercises, less than half (48.7) claimed to be practicing pelvic floor exercises. No significant association was found between women's attitude and the practice of pelvic floor exercises (P > 0.05). More education should be given to women seeking primary health care on the benefits of pelvic floor exercises.

Case study of a model primary health care program in Nigeria: History, evolution, challenges, and future perspectives.

This short report describes the historical evolution of a pioneer Model PHC programme located in Ogun State, southwest Nigeria, as a direct result of the vision and effort of Professor Olikoye Ransome-Kuti, and his drive to entrench the delivery of primary health care (PHC) in Nigeria. It describes some of the programmes inspired by the PHC philosophy at the Model PHC Centre, some of the challenges faced over the years, and the need to reposition the programme. It exemplifies key principles in PHC and its philosophy that are instructive for health practitioners, policymakers and development practitioners, especially those with interest in resource-poor countries.

Non-compartmental and population pharmacokinetic analysis of dapsone in healthy NIGERIANS: A pilot study.

Dapsone is employed for both non-dermatological and dermatological indications but with non-existent population pharmacokinetics (popPK) data in Nigerians. This study was therefore designed to develop a popPK model in Nigerians. Non-compartmental analysis and nonlinear mixed effects modelling were utilized for data analysis. Eleven participants administered 50 mg dapsone tablet were included in the analysis. Derived pharmacokinetic parameters were: Cmax = 1.16 ± 0.32 µg/mL, Tmax = 3.77 ± 2.40 h, and t1/2z = 30.23 ± 11.76 h. PopPK model parameter estimates with inter-individual variability were Tlag = 0.40 h (10.0%, fixed); ka = 1.78 h-1 (75.9%); V/F = 89.25 L (21.6%); and Cl/F = 1.32 Lh-1 (27.7%). Sex was significantly associated with Cl/F, and body weight with V/F. Best popPK model was one-compartment with lag time, and first-order absorption and elimination. Sex and body weight significantly influenced the clearance and distribution volume of dapsone respectively.

Virulence Signatures, Integrons, and Antibiotic Resistance Genes in Bacterial Strains Recovered from Selected Commercial Dairy Products and Fresh Raw Meat.

Bacterial species responsible for food infections and intoxication are sometimes carried through the food production and processing. Very few published literatures exist on integrons among antibiotic-resistant staphylococcal strains from foods of animal origin in Gauteng Province, South Africa, hence this study. A total of 720 samples (360 meat and 360 dairies) from a community abattoir of a research farm in South Africa, using conventional bacteriological and molecular methods. Nine (9) bacterial strains, including Bacillus subtilis AYO-123, Acinetobacter baumannii AYO-241, Staphylococcus lentus AYO-352, among others were identified and submitted to GenBank. More bacterial strains were recovered from raw meat (90.5%) than dairy products (9.5%). Resistance was shown (0-100%) to Imipenem, Meropenem, Norfloxacin, Clindamycin, and 22 other antibiotics, without any carbapenem-resistant Acinetobacter baumannii and methicillin/vancomycin-resistant Staphylococcus species (MRSS/VRSS). Virulence genes for fibronectin-binding protein A (FnbA) were predominant (56.24%) followed by the circulating nucleic acids (cna) gene (43.75%). Others were staphylococcal enterotoxin A (sea, 41%), staphylococcal enterotoxin B (seb, 23.5%). Co-presence of sea and seb genes occurred in 11.76% of the isolates, but no coa genes was amplified. Antibiotic resistance genes (ARGs), tetK (70.58%), linA (29.4%), and ermA (11.76%) were detected, but none of the mecA and vat genes was amplified. Class 2 integron (50%) was more predominantly detected than integron 1 (25%), but no Class 3 integron was detected. Bacteria with both the detected virulence and antibiotic resistance genes are of potential risks to human health.

Impact of 18 F-Fluciclovine PET/CT Findings on Failure-Free Survival in Biochemical Recurrence of Prostate Cancer Following Salvage Radiation Therapy.

PURPOSE: We aimed to evaluate the impact of 18 F-fluciclovine PET/CT imaging on failure-free survival (FFS) post-salvage radiotherapy (SRT) for prostate cancer (PCa) recurrence. METHODS: Seventy-nine patients were recruited in a phase 2/3 clinical trial to undergo 18 F-fluciclovine PET/CT before SRT for PCa. Four patients with extrapelvic disease were excluded. All patients were followed up at regular intervals up to 48 months. Treatment failure was defined as a serum prostate-specific antigen level of ≥0.2 ng/mL above the nadir after SRT, confirmed with an additional measurement, requiring systemic treatment or clinical progression. Failure-free survival was computed and compared between patients grouped according to 18 F-fluciclovine PET/CT imaging findings. RESULTS: Eighty percent (60/75) of patients had a positive finding on 18 F-fluciclovine PET/CT, of which 56.7% (34/60) had prostate bed-only uptake, whereas 43.3% (26/60) had pelvic nodal ± bed uptake. Following SRT, disease failure was detected in 36% (27/75) of patients. There was a significant difference in FFS between patients who had a positive versus negative scan (62.3% vs 92.9% [ P < 0.001] at 36 months and 59.4% vs 92.9% [ P < 0.001] at 48 months). Similarly, there was a significant difference in FFS between patients with uptake in pelvic nodes ± bed versus prostate bed only at 36 months (49.8% vs 70.7%; P = 0.003) and at 48 months (49.8% vs 65.6%; P = 0.040). Failure-free survival was also significantly higher in patients with either negative PET/CT or prostate bed-only disease versus those with pelvic nodal ± prostate bed disease at 36 (78% vs 49.8%, P < 0.001) and 48 months (74.4% vs 49.8%, P < 0.001). CONCLUSIONS: Findings on pre-SRT 18 F-fluciclovine PET/CT imaging, even when acted upon to optimize the treatment decisions and treatment planning, are predictive of post-SRT FFS in men who experience PCa recurrence after radical prostatectomy. A negative 18 F-fluciclovine PET/CT is most predictive of a lower risk of failure, whereas the presence of pelvic nodal recurrence portends a higher risk of SRT failure.

The Transfer Hydrogenation of Cinnamaldehyde Using Homogeneous Cobalt(II) and Nickel(II) (E)-1-(Pyridin-2-yl)-N-(3-(triethoxysilyl)propyl)methanimine and the Complexes Anchored on Fe3O4 Support as Pre-Catalysts: An Experimental and In Silico Approach.

The imino pyridine Schiff base cobalt(II) and nickel(II) complexes (C1 and C2) and their functionalised γ-Fe3O4 counterparts (Fe3O4@C1 and Fe3O4@C2) were synthesised and characterised using IR, elemental analysis, and ESI-MS for C1 and C2, and single crystal X-ray diffraction for C1, while the functionalised materials Fe3O4@C1 and Fe3O4@C2 were characterized using IR, XRD, SEM, TEM, EDS, ICP-OES, XPS and TGA. Complexes C1, C2 and the functionalised materials Fe3O4@C1 and Fe3O4@C2 were tested as catalysts for the selective transfer hydrogenation of cinnamaldehyde and all four pre-catalysts showed excellent catalytic activity. Complexes C1 and C2 acted as homogeneous catalysts with high selectivity towards the formation of hydrocinnamaldehyde (88.7% and 92.6%, respectively) while Fe3O4@C1 and Fe3O4@C2 acted as heterogeneous catalysts with high selectivity towards cinnamyl alcohol (89.7% and 87.7%, respectively). Through in silico studies of the adsorption energies, we were able to account for the different products formed using the homogeneous and the heterogeneous catalysts which we attribute to the preferred interaction of the C=C moiety in the substrate with the Ni centre in C2 (-0.79 eV) rather than the C=O (-0.58 eV).

In vitro profiling and functional assessments of the anti-diabetic capacity of phenolic-rich extracts of Bulbine natalensis and Bulbine frutescens.

AIMS: Bulbine natalensis (BN) and Bulbine frutescens (BF) are recommended in South African traditional medicine to treat diabetes, but their modes of action are unknown. This study assessed the phenolic acid profiles, mineral composition and in vitro functional effects of BN and BF to better understand their glucose-lowering capabilities. METHODS: Phenolic acid and mineral composition of BN and BF methanolic extracts were determined by HPLC and inductively coupled plasma optical emission spectroscopy respectively. Antioxidant capacity was assessed by potassium ferricyanide reducing power and 2,2-diphenyl-2-picrylhydrazyl radical scavenging assays, and inhibition of alpha-amylase, alpha-glucosidase, pancreatic lipase and DPP4 was evaluated by standard enzyme assays. The effects of BN and BF extracts on insulin secretion were investigated using static incubations of isolated mouse islets and molecular docking analysis was used to identify interactions of BN and BF with partners that could mediate stimulatory effects on insulin secretion. RESULTS: Methanolic extracts of BN and BF contained high concentrations of protocatechuic and gallic acids, and high levels of Zn, Mn and Cr. The extracts inhibited alpha-glucosidase, alpha-amylase, pancreatic lipase and DPP4 activities, and they also inhibited free radical generation. Both extracts significantly potentiated glucose-stimulated insulin secretion without significantly affecting basal insulin secretion or islet cell viability. Protocatechuic acid, the most abundant phenolic acid in the extracts, showed high affinity for PKA, PKC, DPP4 and CaMK II in the docking analysis. CONCLUSIONS: BN and BF have multiple beneficial effects on glucoregulatory pathways and they, or their derivatives, could be developed to treat type 2 diabetes.

Phenolic, flavonoid, and ß-carotene contents of provitamin A cassava hydrolysate with free and encapsulated Lactobacillus rhamnosus GG improves antioxidant biomarkers in kidney, heart and liver of Wistar rats.

In vitro antioxidant activity and possible in vivo antioxidative effects of provitamin A cassava hydrolysate inoculated with free or encapsulated Lactobacillus rhamnosus GG (LGG), a ready-to-drink probiotic beverage containing natural ß-carotene and other phytochemicals, were evaluated. Provitamin A cassava was orally administered to male Wistar rats (n = 40, 120-150 g) for 30 days. Regression analysis showed the phenolic and total flavonoid contents of provitamin A cassava hydrolysate contributed 68% and 95%, respectively, to the antioxidant activity (by 1,1-diphenyl-2-picrylhydrazyl assay) (83.3 ± 1.8-87 ± 1.8%). in vivo study showed that malondialdehyde and superoxide dismutase activities were lowered or unchanged with a significant increase in antioxidant biomarkers (reduced glutathione, glutathione-S-transferase, and glutathione peroxidase) in the kidney, heart, and liver of all rats administered provitamin A cassava hydrolysate with LGG, especially at doses 2 × 1010 CFU, compared to control. Provitamin A cassava hydrolysate with LGG showed significant antioxidant activity In vitro and in vivo, thus indicating its potential usefulness in the food industry as an antioxidant beverage. PRACTICAL APPLICATION: This study reports the antioxidant properties of provitamin A cassava hydrolysate, which can be consumed as a refreshing beverage while also delivering antioxidant benefits. In the food and beverage industry, provitamin A cassava hydrolysate could be applied as a nutraceutical beverage with therapeutic functions. This product innovation increases the value-addition of cassava and expands the nondairy food matrix options used as probiotic carriers.

Differences in Failure-Free Survival After Salvage Radiotherapy Guided by Conventional Imaging Versus 18F-Fluciclovine PET/CT in Postprostatectomy Patients: A Post Hoc Substratification Analysis of the EMPIRE-1 Trial.

The EMPIRE-1 (Emory Molecular Prostate Imaging for Radiotherapy Enhancement 1) trial reported a survival advantage in recurrent prostate cancer salvage radiotherapy (SRT) guided by 18F-fluciclovine PET/CT versus conventional imaging. We performed a post hoc analysis of the EMPIRE-1 cohort stratified by protocol-specified criteria, comparing failure-free survival (FFS) between study arms. Methods: EMPIRE-1 randomized patients to SRT planning via either conventional imaging only (bone scanning plus abdominopelvic CT or MRI) (arm A) or conventional imaging plus 18F-fluciclovine PET/CT (arm B). Randomization was stratified by prostate-specific antigen (PSA) level (<2.0 vs. ≥ 2.0 ng/mL), adverse pathology, and androgen-deprivation therapy (ADT) intent. We subdivided patients in each arm using the randomization stratification criteria and compared FFS between patient subgroups across study arms. Results: Eighty-one and 76 patients received per-protocol SRT in study arms A and B, respectively. The median follow-up was 3.5 y (95% CI, 3.0-4.0). FFS was 63.0% and 51.2% at 36 and 48 mo, respectively, in arm A and 75.5% at both 36 and 48 mo in arm B. Among patients with a PSA of less than 2 ng/mL (mean, 0.42 ± 0.42 ng/mL), significantly higher FFS was seen in arm B than arm A at 36 mo (83.2% [95% CI, 70.0-91.0] vs. 66.5% [95% CI, 51.6-77.8], P < 0.001) and 48 mo (83.2% [95% CI, 70.0-91.0] vs. 56.2% [95% CI, 40.5-69.2], P < 0.001). No significant difference in FFS between study arms in patients with a PSA of at least 2 ng/mL was observed. Among patients with adverse pathology, significantly higher FFS was seen in arm B than arm A at 48 mo (68.9% [95% CI, 52.1-80.8] vs. 42.8% [95% CI, 26.2-58.3], P < 0.001) though not at the 36-mo follow-up. FFS was higher in patients without adverse pathology in arm B versus arm A (90.2% [95% CI, 65.9-97.5] vs. 73.1% [95% CI, 42.9-89.0], P = 0.006) at both 36 and 48 mo. Patients in whom ADT was intended in arm B had higher FFS than those in arm A, with the difference reaching statistical significance at 48 mo (65.2% [95% CI, 40.3-81.7] vs. 29.1 [95% CI, 6.5-57.2], P < 0.001). Patients without ADT intent in arm B had significantly higher FFS than patients in arm A at 36 mo (80.7% [95% CI, 64.9-90.0] vs. 68.0% [95% CI, 51.1-80.2]) and 48 mo (80.7% [95% CI, 64.9-90.0] vs. 58.6% [95% CI, 41.0-72.6]). Conclusion: The survival advantage due to the addition of 18F-fluciclovine PET/CT to SRT planning is maintained regardless of the presence of adverse pathology or ADT intent. Including 18F-fluciclovine PET/CT to SRT leads to survival benefits in patients with a PSA of less than 2 ng/mL but not in patients with a PSA of 2 ng/mL or higher.

Comparison of efavirenz levels in blood and hair with pharmacy refills as measures of adherence and predictors of viral suppression among people living with HIV in Nigeria.

BACKGROUND: Strategies to support adherence are constrained by the lack of tools to objectively monitor medication intake in low-resource settings. Pharmacologic measures are objective, but pharmacy refill data is more accessible and cost-efficient. This study compared short-term and long-term efavirenz (EFV) drug levels with pharmacy refill adherence data (PRA) and evaluated their ability to predict viral suppression among people living with HIV in Nigeria. METHODS: Paired hair and dried blood spot (DBS) samples were obtained from 91 adults living with HIV receiving 600 mg EFV-based antiretroviral therapy (ART) and EFV concentrations were measured via validated methods using liquid-chromatography-mass-spectrometry. PRA was estimated from pharmacy records, based on the number of days a patient collected medication before or after the scheduled pick-up date. PRA was categorized into ≤ 74%, 75-94% and ≥ 95%, defined as poor, medium and high adherence, respectively. HIV viral loads closest to the hair sampling time (within 6 months) were also abstracted. Receiver Operating Characteristics (ROC) curve analyses compared the ability of adherence metrics to predict viral suppression. RESULTS: Based on PRA, 81% of participants had high adherence while 11% and 8% had medium and poor adherence, respectively. The median (IQR) EFV concentrations were 6.85 ng/mg (4.56-10.93) for hair and 1495.6 ng/ml (1050.7-2365.8) for DBS. Of the three measures of adherence, hair EFV concentration had the highest Area Under Curve (AUC) to predict viral suppression. Correlations between EFV concentrations in DBS and hair with PRA were positive (r = 0.12, P = 0.27 and r = 0.21, P = 0.05, respectively) but not strong. CONCLUSIONS: EFV concentrations in hair were the strongest predictor of viral suppression and only weakly correlated with pharmacy refill adherence data in Nigeria. This study suggests that resource-limited settings may benefit from objective adherence metrics to monitor and support adherence.

MRI-based prostate and dominant lesion segmentation using cascaded scoring convolutional neural network.

PURPOSE: Dose escalation to dominant intraprostatic lesions (DILs) is a novel treatment strategy to improve the treatment outcome of prostate radiation therapy. Treatment planning requires accurate and fast delineation of the prostate and DILs. In this study, a 3D cascaded scoring convolutional neural network is proposed to automatically segment the prostate and DILs from MRI. METHODS AND MATERIALS: The proposed cascaded scoring convolutional neural network performs end-to-end segmentation by locating a region-of-interest (ROI), identifying the object within the ROI, and defining the target. A scoring strategy, which is learned to judge the segmentation quality of DIL, is integrated into cascaded convolutional neural network to solve the challenge of segmenting the irregular shapes of the DIL. To evaluate the proposed method, 77 patients who underwent MRI and PET/CT were retrospectively investigated. The prostate and DIL ground truth contours were delineated by experienced radiologists. The proposed method was evaluated with fivefold cross-validation and holdout testing. RESULTS: The average centroid distance, volume difference, and Dice similarity coefficient (DSC) value for prostate/DIL are 4.3 ± 7.5/3.73 ± 3.78 mm, 4.5 ± 7.9/0.41 ± 0.59 cc, and 89.6 ± 8.9/84.3 ± 11.9%, respectively. Comparable results were obtained in the holdout test. Similar or superior segmentation outcomes were seen when compared the results of the proposed method to those of competing segmentation approaches. CONCLUSIONS: The proposed automatic segmentation method can accurately and simultaneously segment both the prostate and DILs. The intended future use for this algorithm is focal boost prostate radiation therapy.

Understanding the Interactions between Triolein and Cosolvent Binary Mixtures Using Molecular Dynamics Simulations.

Biodiesel is one of the emerging renewable sources of energy to replace fossil-fuel-based resources. It is produced by a transesterification reaction in which a triglyceride reacts with methanol in the presence of a catalyst. The reaction is slow because of the low solubility of methanol in triglycerides, which results in low concentrations of methanol available to react with triglyceride. To speed up the reaction, cosolvents are added to create a single phase which helps to improve the concentration of methanol in the triglyceride phase. In this study, molecular dynamics simulations are used to help understand the role of cosolvents in the solvation of triglyceride (triolein). Six binary mixtures of triolein/cosolvent were used to study the solvation of triolein at 298.15 K. Results of 100 ns simulations at constant temperature and pressure to simulate mixing experiments show that in the first 10 ns all the binary mixtures remain largely unmixed. However, for the cosolvents that are fully miscible with triolein, the partial densities across the simulation boxes show that the systems are fully mixed in the final 10 ns. Some solvents were found to interact strongly with the polar part of triolein, while others interacted with the aliphatic part. The radial distribution functions and clustering of the solvents around triolein were also used as indicators for solvation. The presence of cosolvents also influenced the conformation of triolein molecules. In the presence of solvents that solubilize it, triolein preferred a propeller conformation but took up a trident conformation when there is less or no solubilization. The results show that tetrahydrofuran is the best solvent at solubilizing triolein, followed by cyclopentyl methyl ether, diethyl ether, and hexane. With 1,4-dioxane, the solubility improves with an increase in temperature. The miscibility of a solvent in triolein is aided by its ability to interact with both the polar and nonpolar parts of triolein.