LC-HRMS and GC-MS Profiling of Urine Free Cortisol, Cortisone, 6Β-, and 18-Hydroxycortisol for the Evaluation of Glucocorticoid and Mineralocorticoid Disorders.

INTRODUCTION: Urine free cortisol measurements are routinely performed to evaluate hypercortisolism. Despite their analytical inaccuracy, immunoassay-based methods are frequently used. Advances in liquid chromatography-high-resolution mass spectrometry (LC-HRMS) facilitate the incorporation of powerful diagnostic tools into clinical laboratories. In addition to its high analytical specificity and simultaneous analysis of different metabolites, accurate mass measurement allows for untargeted compound identification, which may help to identify clinically relevant metabolites or drugs. METHODS: The present study aimed to validate a simple routine LC-HRMS method to quantify cortisol, cortisone, 6ß-hydroxycortisol, and 18-hydroxycortisol simultaneously in human urine. Additionally, the study also validated a GC-MS method for the same steroids, evaluated their cross-reactivity with commercial cortisol immunoassays, and quantified the 24 h urine excretion in patients under clinical suspicion or follow-up for hypercortisolism. RESULTS: The LC-HRMS method involved liquid-liquid extraction using dichloromethane, micro-LC for chromatographic separation and detection using the accurate masses of the steroids, and simultaneous high-resolution full scan acquisition. The method presented acceptable linearity, precision, and accuracy. Significant interference from 6ß-hydroxycortisol and cortisone was demonstrated in the cortisol immunoassays, which impacted their reliability in the follow-up of patients with hypercortisolism and significant changes in these cortisol metabolites (i.e., due to drug-induced changes in CYP3A4 activity). CONCLUSION: A rapid and accurate routine LC-HRMS method was validated, which is useful for the evaluation of hypercortisolism and other disorders of glucocorticoid and mineralocorticoid metabolism.

Pancreatic Cancer Insights: Optimization of the Diagnostic Capacity of Tumor Biomarkers.

OBJECTIVE: Pancreatic cancer (PC) is one of the deadliest malignancies. The aim of this study was to determine the usefulness of the carbohydrate antigen 19.9 (CA19.9)/ carcinoembryonic antigen (CEA) ratio as a diagnostic tool. METHODS: This was a retrospective observational study (2015-2019), including laboratory requests with increased CA19.9 and CEA but no previous neoplasia. Receiver operating characteristic (ROC) curve analyses were performed for the CA19.9/CEA ratio and for CA19.9 and CEA alone for the detection of PC, and cutoff values for all strategies were selected separately and in combination. RESULTS: A total of 373 individuals were included. The area under the curve (AUC) for CA19.9/CEA was 0.872, whereas the AUC for CA19.9 was 0.847 and for CEA was 0.554. Cutoff values with the greatest diagnostic power were CA19.9/CEA >40, CA19.9 >1130 U/mL, and CEA > 14.5 U/mL. The combination of CA19.9/CEA > 40 with CA19.9 > 550 U/mL maximized the diagnostic accuracy for PC. CONCLUSION: Our results highlight the relevance of the measurement of serum CA19.9 and CEA in the detection of PC.

Disciplina Inglés en la formación cultural de los estudiantes de universidades médicas cubanas / English discipline within the cultural education of Cuban medical university students

La disciplina Inglés favorece la formación cultural de los estudiantes de las universidades médicas cubanas. En este trabajo se propone sobrepasar el aprendizaje lingüístico para lograr un mayor entendimiento entre culturas, desde la enseñanza del inglés como lengua extranjera. Lo anterior posibilita que los futuros profesionales respondan cada vez más a las demandas del contexto y del ejercicio de sus carreras dentro y fuera del país (AU)

English discipline favors the cultural education of Cuban medical university students. This paper proposes to go beyond the linguistic learning and gain a wider understanding among cultures, from the teaching of English as a foreign language. The latter increases future professionals response to context and career demands inside the country and abroad (AU)

Disciplina Inglés en la formación cultural de los estudiantes de universidades médicas cubanas / English discipline within the cultural education of Cuban medical university students

La disciplina Inglés favorece la formación cultural de los estudiantes de las universidades médicas cubanas. En este trabajo se propone sobrepasar el aprendizaje lingüístico para lograr un mayor entendimiento entre culturas, desde la enseñanza del inglés como lengua extranjera. Lo anterior posibilita que los futuros profesionales respondan cada vez más a las demandas del contexto y del ejercicio de sus carreras dentro y fuera del país.

English discipline favors the cultural education of Cuban medical university students. This paper proposes to go beyond the linguistic learning and gain a wider understanding among cultures, from the teaching of English as a foreign language. The latter increases future professionals' response to context and career demands inside the country and abroad.