Second-line tests in the differential diagnosis of neoplastic and non-neoplastic hypercortisolism: a systematic review and meta-analysis.

PURPOSE: The clinical and hormonal overlap between neoplastic (CS) and non-neoplastic (NNH/pCS) hypercortisolism is a challenge. Various dynamic tests have been proposed to allow an early discrimination between these conditions, but to date there is no agreement on which of them should be used. AIM: To provide an overview of the available tests and to obtain a quantitative synthesis of their diagnostic performance in discriminating NNH/pCS from CS. METHODS: The included articles, published between 1990 and 2022, applied one or more second line tests to differentiate NNH/pCS from CS patients. For the NNH/pCS group, we admitted the inclusion of patients presenting clinical features and/or biochemical findings suggestive of hypercortisolism despite apparent lack of a pCS-related condition. RESULTS: The electronic search identified 339 articles. After references analysis and study selection, we identified 9 studies on combined dexamethasone-corticotropin releasing hormone (Dex-CRH) test, 4 on Desmopressin test and 3 on CRH test; no study on Dex-Desmopressin met the inclusion criteria. Dex-CRH test provided the highest sensitivity (97%, 95 CI% [88%; 99%]). CRH tests showed excellent specificity (99%, 95% CI [0%; 100%]), with low sensitivity. Although metaregression analysis based on diagnostic odds ratio failed to provide a gold standard, CRH test (64.77, 95% CI [0.15; 27,174.73]) seemed to lack in performance compared to the others (Dex-CRH 138.83, 95% CI [49.38; 390.32] and Desmopressin 110.44, 95% CI [32.13; 379.63]). DISCUSSION: Both Dex-CRH and Desmopressin tests can be valid tools in helping discrimination between NNH/pCS and CS. Further studies are needed on this topic, possibly focusing on mild Cushing's Disease and well-characterized NNH/pCS patients. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022359774 , identifier CRD42022359774.

A synergic approach of X-ray powder diffraction and Raman spectroscopy for crystal structure determination of 2,3-thienoimide capped oligothiophenes.

This work presents a Raman based approach for the rapid identification of the molecular conformation in a series of new 2,3-thienoimide capped quaterthiophenes, whose crystal structures were determined by synchrotron radiation X-ray powder diffraction. These systems display two conformational polymorphs, known as forms A and B, as a result of the anti-anti-anti and syn-anti-syn arrangements of the quaterthiophene cores. In a micro-Raman and computational study, the spectroscopic differences between the conformers were detected and proved to be suitable markers for polymorph identification. Thus, the synergic employment of diffraction and Raman spectroscopy techniques yields a full and reliable characterization of 2,3-thienoimide capped quaterthiophene compounds in their solid state.

Surgical issues after neoadjuvant treatment for gastric cancer.

Gastric carcinoma is one of the most frequent malignancies in the world and its clinical behavior depends on the metastatic potential of the tumour. Particularly, lymphatic metastasis is one of the main predictor of tumour recurrence and survival and current pathologic staging systems reflect the concept that lymphatic spread is the most relevant prognostic factor in patients resected with curative intent. This is deducted by the observation that two thirds of gastric cancers in the western world present at an advanced stage, with nearly 85% of tumors accompanied by lymph node metastasis at diagnosis. To date most therapeutic efforts are directed toward individualization of therapeutic protocols, tailoring the extent of resection integrated by the administration of preoperative and postoperative treatment. The goal of such strategies is to improve prognosis towards the achievement of a curative resection (R0-resection) with minimal morbidity and mortality, with better postoperative quality of life. A brief review of literature about preoperative therapy for gastric carcinoma will be herein illustrated. The rationale and the general drawbacks of preoperative treatments will be both discussed in order to demonstrate its value in terms of safety and efficacy.

White luminescence achieved by a multiple thermochromic emission in a hybrid organic-inorganic compound based on 3-picolylamine and copper(i) iodide.

Three copper(i) complexes have been obtained by the reaction of CuI with 3-picolylamine in acetonitrile solution and characterized by X-ray powder diffraction, both from synchrotron and laboratory radiation. Photophysical investigations in the solid state revealed highly efficient thermally-activated delayed fluorescence (TADF) with photoluminescence quantum yields (PLQYs) up to 18%. Notably, the complex [Cu2I2(3pica)]∞ displays a strong luminescence thermochromism due to the presence of both 1,3(X + M)LCT excited states and a lower-lying cluster-centered (3CC) one, leading to multiple emission at room temperature; as a result, a white luminescence is achieved with a PLQY of 4.5%.

Determination of hydrochlorothiazide and irbesartan in pharmaceuticals by fourth-order UV derivative spectrophotometry.

The fourth-order derivative spectrum from the alcoholic sample is used. HCT can be determined by a specific peak-trough, of low intensity, at 330-340 nm. For IST evaluation, a peak-trough around 250-310 nm is available, common to both products, whose amplitude increases linearly only for low concentration values, while it decreases at higher values. The most difficult aspect of the analysis lies in how to find the optimal concentration range, so that both signals can be evaluated simultaneously. The best results were achieved by using a linear regression for HCT and a regression plane for IST.

Dual luminescence in solid CuI(piperazine): hypothesis of an emissive 1-D delocalized excited state.

Solid [CuI(piperazine)0.5]∞, characterized by a structure with an infinite double chain of CuI, presents an unexpected dual luminescence. The short copper-copper distances allow the existence of both cluster-centered and 1-D delocalized electronic transitions, as emerged from theoretical calculations. Beyond the more common cluster-centered emission a higher energy band, which differs in lifetime and in temperature dependence, is observed.

The Clomethiazole Acute Stroke Study in tissue-type plasminogen activator-treated stroke (CLASS-T): final results.

OBJECTIVE: To assess the safety of tissue-type plasminogen activator (t-PA) plus clomethiazole in patients with acute ischemic stroke and determine the feasibility of combination stroke therapy. BACKGROUND: Clomethiazole is a neuroprotectant that appeared to improve outcome in patients with clinical deficits of a major stroke (total anterior circulation syndrome [TACS]) in a previous study, the Clomethiazole Acute Stroke Study (CLASS). Combining a neuroprotectant such as clomethiazole with thrombolysis may augment the beneficial effects of the two agents. CLASS-t-PA (CLASS-T) was a pilot study to explore the safety of the combination and the feasibility of performing combination treatment in the setting of acute ischemic stroke. METHODS: In a randomized, double-blind design (stratified for age, severity at admission, and time since onset of stroke), all patients received 0.9 mg/kg t-PA beginning within 3 hours of stroke onset and then either 68 mg/kg clomethiazole (n = 97) IV over 24 hours or placebo (n = 93) beginning within 12 hours of stroke onset. Patients were followed for 90 days. The main measures of safety were mortality and serious adverse events, and the main measure of functional outcome was the Barthel Index. RESULTS: The number of serious adverse event reports was 47 in the clomethiazole group and 48 in the placebo group. Death during the 90 days after treatment occurred in 15 clomethiazole and nine placebo patients (p = 0.26). Sedation was reported as an adverse event during therapy in 42% of clomethiazole patients vs 13% of placebo patients. The proportion of patients with TACS was 53% in the clomethiazole group and 41% in the placebo group. In the TACS subgroup, 52.9% of the clomethiazole patients scored a Barthel Index greater than 60 vs 44.7% of placebo patients (odds ratio 1.39; 95% CI 0.60 to 3.23). CONCLUSION: In this pilot study, there were no safety concerns related to the combination of t-PA and clomethiazole. The combination paradigm proved feasible, although many patients received clomethiazole several hours after thrombolysis; future studies must require prompt administration of the neuroprotectant either before or during administration of the thrombolytic. Patients with major strokes (TACS) may have the potential to benefit from the combination of t-PA and clomethiazole.

Liquid chromatographic method for the analysis of tocopherols in malt sprouts with supercritical fluid extraction.

A simple, specific and sensitive high-performance liquid chromatographic method has been developed for the determination of tocopherols in malt sprouts. A supercritical fluid extraction (SFE) procedure was used to isolate tocopherols from the vegetal matrix before quantitative analysis. The analytes were separated on a Zorbax reversed-phase column using methanol-water as mobile phase and quantified by measuring its fluorescence at lambda(em)=328 nm after excitation of the analytes at lambda(exc)=303 nm. The limits of detection for alpha-, gamma- and delta-tocopherols were 0.04, 0.05, and 0.05 microg/ml, respectively. The calibration graphs of the method were linear from 0.1 to 1.5, 0.2 to 2.5, and 0.2 to 2.0 microg/ml, for alpha-, gamma- and delta-tocopherols, respectively. This SFE and HPLC procedure is simple, precise and accurate for the determination of tocopherols in malt sprouts.

Determination of p-aminosalicylic acid and m-aminophenol by derivative UV-spectrophotometry.

A direct method for the simultaneous determination of p-aminosalicylic acid (PAS) and its major decomposition product, m-aminophenol (MAP), is described. The analysis is based on the use of derivative UV-spectrophotometry and is a rapid procedure which gives accurate and precise results. A simple purity test which utilizes the third derivative spectrum is also reported and compared with the USP XX spectrophotometric method for the estimation of MAP in PAS formulations.

Determination of lomefloxacin in human plasma by solid-phase extraction and high-performance liquid chromatography with UV detection.

A high-performance liquid chromatographic method for the determination of lomefloxacin in human plasma has been developed and validated. A solid-phase extraction procedure was used to isolate lomefloxacin from the biological matrix prior to the quantitative analysis. The compound was separated on a Vydac anion-exchange column using acetonitrile-phosphate buffer (pH 7.0) as the mobile phase and quantified by measuring its UV absorbance at 280 nm. The lower limit of detection for the analyte was 0.05 micrograms ml-1. Enoxacin was used as the internal standard. The calibration graph of the method was linear from 0.1 to 10 micrograms ml-1 of lomefloxacin in human plasma. This procedure is suitable for pharmacological and pharmacokinetic studies of lomefloxacin.

Simultaneous determination of simvastatin and its hydroxy acid form in human plasma by high-performance liquid chromatography with UV detection.

Simvastatin (SV), an analogue of lovastatin, is the lactone form of 1',2',6',7',8',8a'-hexahydro-3,5-dihydroxy-2',6'-dimethyl-8'(2'',2''-di met hyl-1''-oxobutoxy)-1'-naphthalene-heptanoic acid (SVA) which lowers plasma cholesterol by inhibiting 3-hydroxy-3-methylglutaryl-CoA reductase. A fast, simple and accurate method for determining SV and SVA concentrations in human plasma has been developed and validated for use in the analysis of plasma samples from patients and healthy volunteers. This method involves an extraction procedure using a mixture of acetonitrile-water and reversed-phase high-performance liquid chromatography with UV detection. The procedure was linear from 20 to 1000 ng ml-1 for SV and from 25 to 1000 ng ml-1 for SVA, respectively. The method was accurate with relative errors of 5.0, 2.1 and 3.2% for human plasma controls containing 50, 250 and 500 ng ml-1 of SV, respectively. The corresponding precision was 2.3, 1.8 and 1.0% (RSD%). Similarly, relative standard deviations less than 2.3% and relative errors of less than 5.2% were obtained from human plasma controls containing SVA at identical concentrations. The method is suitable for pharmacology and pharmacokinetic studies of simvastatin.

Determination of losartan and hydrochlorothiazide in tablets by CE and CEC.

Capillary Electrophoresis (CE) and Capillary Electrochromatography (CEC) have been used to determine losartan and hydrochlorothiazide. The CE separation was carried out in an uncoated capillary filled with a 100 mM sodium borate pH 9 solution containing trimethyl-beta-cyclodextrins. CEC was performed using a capillary packed with a RP-18 stationary phase. The mobile phase was a mixture of 50 mM ammonium acetate pH 7, water, acetonitrile (1/1.5/7.5). By CE and CEC suitable methods to determine simultaneously losartan and hydrochlorothiazide in working standard mixture or pharmaceutical form were obtained. The proposed methods are very simple and both gave accurate and precise results.

Simultaneous determination of losartan and hydrochlorothiazide in tablets by high-performance liquid chromatography.

A method for the simultaneous determination of losartan potassium and hydrochlorothiazide in tablets is described. The procedure, based on the use of reversed-phase high-performance liquid chromatography, is linear in the concentration range 3.0-7.0 microg ml(-1) for losartan and 0.5-2.0 microg ml(-1) for hydrochlorothiazide, is simple and rapid and allows accurate and precise results. The limit of detection was 0.08 microg ml(-1) for losartan and 0.05 microg ml(-1) for hydrochlorothiazide.

The ultraviolet derivative spectrophotometric determination of neutral liposome-entrapped beta-lactam antibiotics.

A simple, non-invasive spectrophotometric assay to measure the concentration of some beta-lactam antibiotics in turbid solutions containing liposomes was carried out. Since zero-order spectra gave strong interference because of sample turbidity, derivative spectrophotometry was used to enhance the spectral details. Derivative spectra showed bands in the ultraviolet region due to the presence of the cephalosporin and penicillin beta-lactams. A linear relationship between derivative amplitudes and antibiotic concentration was found when antibiotic-containing liposome solutions were measured. A saturative trend in the liposome-encapsulation was observed. The antibiotic entrapment was lowered by increasing the cholesterol-phospholipid ratio in the mixture used for liposome preparation. After treatment of antibiotic-loaded liposomes with beta-lactamase, a hydrolytic enzyme specific for beta-lactams, the remaining antibiotic concentration decreased significantly, showing that some of the antibiotic was retained on the outer surface of the vesicles.

Simultaneous determination of 5-aminosalicylic acid, acetyl-5-aminosalicylic acid and 2,5-dihydroxybenzoic acid in endoscopic intestinal biopsy samples in humans by high-performance liquid chromatography with electrochemical detection.

A high-performance liquid chromatographic method for the simultaneous determination of 5-aminosalicylic acid (5-ASA), acetyl-5-aminosalicylic acid (Ac-5-ASA) and 2,5-dihydroxybenzoic acid (5-HSA) in human endoscopic intestinal biopsy with electrochemical detection has been developed and validated. A liquid-liquid extraction procedure was used to isolate these drugs from the biological material prior to analysis. The compounds were separated on an Erbasil S reversed-phase column using methanol-critic acid-sodium hydrogenphosphate-heptane-sulfonic acid-disodium ethylenediaminetetraacetate (pH 3) as mobile phase. The method was linear from 1.0 to 300 ng ml-1 for 5-ASA, from 10 to 1000 ng ml-1 for Ac-5ASA and from 0.1 to 10 ng m-1 for 5-HSA. The limit of detection for 5-ASA and for Ac-5-ASA was 1 ng ml-1 and that for 5-HSA was 0.1 ng ml-1. This procedure is suitable for pharmacological and clinical studies of 5-ASA.

Simultaneous determination of furprofen and rufloxacin in human plasma by high-performance liquid chromatography.

A simple and reproducible method for the simultaneous determination of the nonsteroidal anti-inflammatory agent, furprofen, and the quinolone antimicrobial agent, rufloxacin, in human plasma is described. It involves a two-step liquid-liquid extraction and a separation using an LC-SAX column with ultraviolet detection at 280 nm. Fenbufen is used as the internal standard. Within-day and between-day coefficients of variation are less than 6%. The lower limits of detection are 0.05 and 0.03 micrograms/mL for furprofen and rufloxacin, respectively. The method is suitable for pharmacological, toxicological, and pharmacokinetic studies of furprofen and rufloxacin.

Simultaneous determination of rufloxacin and furprofen in plasma by derivative UV-spectrophotometry.

A procedure for the simultaneous determination of rufloxacin and furprofen in rat plasma by second-derivative UV-spectrophotometry is described. The proposed method, which gives useful data for pharmacokinetic studies, is simple and rapid, and allows precise and accurate results.

Determination of 2,6-dimethyl-4-(2'-nitrosophenyl)-3,5-pyridinedicarboxylic acid dimethylester in nifedipine by derivative UV-spectrophotometry in bulk material and pharmaceutical forms.

A method for the determination of 2,6-dimethyl-4-(2'-nitrosophenyl)-3,5-pyridinedicarboxylic acid dimethylester in nifedipine (bulk material and pharmaceutical formulations) by second-derivative ultraviolet spectrophotometry is described. The procedure is simple and rapid and gives accurate and precise results.

[Acute idiopathic interstitial nephritis: report of a case]. / Nefrite interstiziale acuta idiopatica: descrizione di un caso.

The Authors report the case of a 9 years old girl with acute intestitial nephritis. The clinical picture was characterized by the association of nonspecific systemic symptoms, poliuria, acute renal failure with signs of tubular disfunctions. There was no evident inciting agent of the disease. The patient experienced rapid improvement of both symptoms and laboratory parameters with normalization of the renal function.