Impact of pretreatment quality of life on tolerance and survival outcome in head and neck cancer patients undergoing definitive CCRT.

BACKGROUND: Health-related quality of life (HRQoL) is a predictor of treatment outcomes in cancer patients. This study aimed to evaluate the effect of pretreatment HRQoL on treatment tolerance and survival outcomes in patients with HNC planned for concurrent chemoradiotherapy (CCRT) in Taiwan. METHODS: This study included 461 patients with HNC planned for definitive CCRT at three medical centers in Taiwan between August 2017 and December 2018. HRQoL was assessed using the QLQ-HN35 one week before the initiation of CCRT. Patients were grouped based on the sum scores of QLQ-HN35 (

Hexabromocyclododecane in sediments from riverine, port, and coastal areas of Kaohsiung, Taiwan: levels, spatial distribution, and potential ecological risk.

The widespread use of hexabromocyclododecane (HBCD), a brominated flame retardant, is a major public health concern because of the toxic, persistent, and bioaccumulative nature of HBCD. However, there is limited information available regarding the distribution and transportation of HBCD in sediments across various environmental settings, spanning from riverine to marine environments in the Kaohsiung area of Taiwan. In this study, we comprehensively investigated the level and distribution of and potential ecological risk posed by HBCD in surface sediments in the Kaohsiung area of Taiwan. In sediment samples from stations on the Love River and Kaohsiung Port area, the concentrations of HBCD ranged from 10.6 to 320.1 µg/kg dry weight (dw) and nondetectable (n.d.) to 58.4 µg/kg dw, respectively. The concentrations of HBCD in sediment collected from the M1, M2, and M3 sites, located in the Cijin coastal area, were 896.2 µg/kg dw, 3.2 µg/kg dw ( 1. The M1 site had the highest risk level (RQ = 5.27). These data suggest that domestic sewage and industrial wastewater discharge pose a potential risk to marine environments. Consequently, timely measures to control HBCD-related risks are required. Our study offers insight into the environmental effects of HBCD contamination of sediment and provides valuable information that can be used to guide environmental policy and safety measures.

Three-Dimensional Simulation Training for Oncology Nurses to Address Pitfalls in Current Irrigation Strategy for Intravenous Ports: Repeated Measurements Study.

OBJECTIVE: We designed an interactive visual training course and three-dimensional (3-D) simulator for participants and used verified questionnaires as tool to evaluate the efficacy of the education course. DATA SOURCES: From August 2020 to December 2021, 159 nursing staff who received the interactive visual training course and completed validated questionnaires before and after the course were included. The efficacy of the course was evaluated by comparing the pre- and post-course questionnaires. CONCLUSION: The interactive visual training course, including maintenance lectures and practice with a 3-D simulator, improved consensus among the nursing staff and increased the willingness of oncology nurses to perform the proposed port irrigation procedure. IMPLICATIONS FOR NURSING PRACTICE: An implanted intravenous port cannot be directly seen by nursing staff and can only be identified through manual palpation. This lack of visibility may result in individual variations in port identification during daily practice, potentially leading to malpractice. To minimize these individual variations, we have designed an interactive visual training course. We used validated questionnaires before and after the course to analyze its efficacy in practical education.

Comprehensive assessment of metals and organic pollutants in pelagic fishing port sediments.

Fishing ports are among the environments that accumulate pollutants along the coast but often lack environmental data and scientific research. This study investigated 8 metals, 16 polycyclic aromatic hydrocarbons (PAHs), 10 phthalate esters (APs), and 2 alkylphenols (APs) in the surface sediments of Qianzhen Fishing Port, the largest pelagic fishing port in Taiwan. Indicator compounds, pollution hotspots, potential ecological risk levels, and pollution sources were evaluated. Results showed that copper, zinc, and bis(2-ethylhexyl) phthalate (DEHP) in surface sediments were pollution indicators posing potential toxicological risks. Metals and PAHs in sediments were mainly from ship-related sources, while PAEs and APs were related to dockland activities. Combining metal and organic pollutants, the sediments had a moderate potential ecological risk, with metals higher than organic pollutants. Cluster analysis and color geographic map of risks indicate sediment pollution hotspots and areas requiring immediate intervention. In the future, sustainable operation and management can be carried out by using metal-free antifouling paint, improving sewage treatment rate, and regular environmental dredging of fishing port.

Sex differences in medication-naïve adults with attention-deficit/hyperactivity disorder: A counting Stroop functional MRI study.

Emerging evidence supports deficits in executive functions in the fronto-striato-parietal network in individuals with attention-deficit/hyperactivity disorder (ADHD). However, most functional studies recruited men with ADHD only, leaving it unclear whether executive deficits are also demonstrated in women with ADHD. Thus, we used functional magnetic resonance imaging to examine the sex differences in a counting Stroop task that explored interference control. The sample consisted of 55 medication-naïve adults with ADHD (28 men, 27 women) and 52 healthy controls (HC, 26 men, 26 women). The Conners' Continuous Performance Test further evaluated the performance of focused attention (standard deviation of the reaction time, RTSD) and vigilance (the reaction time change across different inter-stimulus intervals, RTISI). First, for the main effect of diagnosis, compared to the HC group, the ADHD group showed less activation in the caudate nucleus and inferior frontal gyrus (IFG). Second, for the main effect of sex, no significant effects were found. Third, a diagnosis-by-sex interaction indicated that the magnitude of ADHD-HC difference was greater for women than men in the right IFG and precuneus, reflecting greater difficulties for ADHD women to resolve interference. Conversely, no significant brain activation showed greater ADHD-HC difference in men than women. Also, reduced right IFG and precuneus activation was negatively associated with the scores assessing focused attention and vigilance in ADHD women, indicating that the attentional abilities are disrupted in ADHD women. Abnormalities in the frontoparietal areas may represent the main difference between ADHD women and ADHD men.

The impact of pandemic-related stress on attentional bias and anxiety in alexithymia during the COVID-19 pandemic.

The COVID-19 pandemic had negative consequences for mental health, yet it is unknown how and to what extent the psychological outcomes of this stressful event are moderated by individual traits. Alexithymia is a risk factor for psychopathology, and thus likely predicted individual differences in resilience or vulnerability to stressful events during the pandemic. This study explored the moderating role of alexithymia in the relationships of pandemic-related stress with anxiety levels and attentional bias. The participants were 103 Taiwanese individuals who completed a survey during the outbreak of the Omicron wave. Additionally, an emotional Stroop task including pandemic-related or neutral stimuli was used to measure attentional bias. Our results demonstrate that pandemic-related stress had a lesser impact on anxiety in individuals with a higher level of alexithymia. Moreover, we found that in individuals with higher exposure to pandemic-related stressors, a higher level of alexithymia indicated less attentional bias toward COVID-19-related information. Thus, it is plausible that individuals with alexithymia tended to avoid pandemic-related information, which could temporarily relieve stressors during the pandemic.

Effectiveness of a Protocol Intervention for Aspiration Pneumonia Prevention in Patients With Esophageal Cancer During Concurrent Chemoradiotherapy: A Randomized Control Trial.

BACKGROUND: Dysphagia is a leading cause of aspiration pneumonia and negatively affects tolerance of chemoradiotherapy in patients with esophageal cancer. OBJECTIVE: This study aimed to assess a protocol for preventing the occurrence of aspiration pneumonia for adult patients with esophageal cancer experiencing swallowing dysfunction. METHODS: This study tested a dysphagia intervention that included high-risk patients confirmed by the Eating Assessment Tool questionnaire and Water Swallowing Test. A protocol guide (Interventions for Esophageal Dysphagia [IED]) to prevent aspiration pneumonia during chemoradiotherapy was also implemented. Thirty participants were randomly assigned to an intervention or control group. The study period was 50 days; participants were visited every 7 days for a total of 7 times. Instruments for data collection included The Eating Assessment Tool, Water Swallowing Test, and personal information. The IED was administered only to the experimental group. All data were managed using IBM SPSS statistics version 21.0. RESULTS: The IED significantly reduced the occurrence of aspiration pneumonia (P = .012), delayed the onset of aspiration pneumonia (P = .005), and extended the survival time (P = .007) in the experimental group. CONCLUSION: For patients with esophageal cancer undergoing chemoradiotherapy, this protocol improved swallowing dysfunction and reduced aspiration pneumonia. IMPLICATION FOR PRACTICE: The IED protocol should be included in continuous educational training for clinical nurses to help them become familiar with these interventions and to provide these strategies to patients.

Attentional Processing of Unpleasant Stimuli in Alexithymia.

Alexithymia is a multi-faceted personality trait defined by difficulties in identifying and describing emotions and is considered a risk factor for multiple psychiatric disorders. Current alexithymia research debates the type of attention bias involved in the processing of negative emotional information, especially in anxiety-evoking situations that are frequently associated with stress states. Relatedly, this study aims to examine the role of emotional influence on the attentional processing of Taiwanese alexithymic individuals. Using the Chinese version of the Toronto Alexithymia Scale-20 (TAS-20), individuals with high alexithymia (HA: TAS > 60, n = 26; Mage = 23.36) and individuals with low alexithymia (LA: TAS < 39, n = 26; Mage = 25.76) were recruited. Participants performed an emotional counting Stroop task preceded by anxiety-evoking (threatening and aversive pictures) or neutral pictures. Reaction times (RTs) of the emotional Stroop task were compared between HA and LA groups. Our results demonstrate that compared to individuals with LA, individuals with HA show early avoidance tendency (i.e., allocate less attentional resources to anxiety-evoking stimuli), and that negative affect therefore does not interfere with subsequent attention processing during the Stroop task, resulting in faster RT for unpleasant stimuli (Mthreatening = 683.87, Maversive = 685.87) than neutral stimuli (Mneutral = 695.64) (ps < .05). In addition, the attentional bias toward specific types of negative emotion was not differentiated in individuals with HA (p < .05), suggesting that alexithymic individuals' emotion schemas may be underdeveloped in terms of ability to specify exact emotions. This study provides evidence regarding early sensitization to negative stimuli during information processing, consistent with the notion that alexithymia is related to avoidant emotion regulation processes.

External validation of a risk model for survival prediction in older patients with cancer undergoing elective abdominal surgery: a prospective cohort study.

We previously developed a Chang Gung Memorial Hospital (CGMH) model to predict the 1-year postoperative mortality risk in patients with solid cancer undergoing cancer surgery. This study aimed to externally validate the CGMH score for survival outcome and surgical complication prediction in a prospective patient cohort. A total of 345 consecutive patients aged ≥65 years who underwent elective abdominal surgery for cancer treatment were prospectively enrolled. Patients were categorized into the low, intermediate, high, and very high-risk groups according to the CGMH score for comparison. The postoperative 1-year mortality rate was 12.5% in the entire cohort. The postoperative 1-year mortality rates were 0%, 2.2%, 14.0%, and 31.6% among patients in the low, intermediate, high, and very-high risk groups, respectively. The c-statistic of the CGMH model was 0.82 (95% confidence interval [CI], 0.76-0.88) for predicting the 1-year mortality risk. Hazard ratios for overall survival were 3.73 (95% CI, 2.11-6.57; P<0.001) and 10.1 (95% CI, 5.84-17.6; P<0.001) when comparing the high and very-high risk groups with the low/intermediate risk groups, respectively. Patients in the higher CGMH risk groups had higher risks of adverse surgical outcomes in terms of longer length of hospital stay, major surgical complications, postoperative intensive care unit stay, and in-hospital death. The CGMH model accurately predicted thesurvival probabilityand risk of adverse surgical outcomes in older patients with cancer undergoing elective abdominal surgery. Our study justifies the prospective use of the CGMH model for survival outcome and safety profile predictionfor cancer surgery in older patients.

Distribution patterns and transportation behavior of alkylphenol polyethoxylate degradation metabolites among river, port area, and coastal water bodies of Kaohsiung City, Taiwan.

In this study, we conducted a comprehensive study of the distribution, transportation behavior and potential ecological risk of alkylphenol polyethoxylates (APnEOs) in the aquatic environments of Kaohsiung City, Taiwan because little information is available regarding the fate of APnEOs in the water bodies of a total environment. At Love River, APnEOs concentrations were much higher at upstream of interception stations L15 (27.33 ± 1.22 µg/L) and L16 (6.31 ± 0.14 µg/L) than at downstream of interception stations L1-L14 (0.69-2.54 µg/L). Additionally, the average ethoxy (EO) chain lengths of APnEOs at L15 and L16 were longer than at L1-L14. These observations were attributed to the sluice between L14 and L15 that intercepts and accumulates untreated sewage from upstream areas and to the infrastructure of the sewage system that prevents domestic sewage from flowing downstream in the river and to the Kaohsiung Port Area. At Kaohsiung Port Area, APnEO concentrations ranging from 0.63 to 6.50 µg/L were measured. The concentration range and average EO chain length of these APnEOs were similar to those of the downstream stretch of the river, which was attributed to the mixing efficiency of the Kaohsiung Port Area and Love River through tidal exchange. At Cijin Coastal Area, APnEO concentrations ranged from 0.14 to 18.77 µg/L. Notably, the APnEO concentration of surface waters was much higher than that of bottom waters. This observation was attributed to the sewage discharged from the ocean outfall buoying up to the surface instead of mixing with surrounding bottom waters. In potential ecological risk, 19 of 39 sampling points exceeded toxic equivalency of 1 µg/L, and approximately 48.7% of the sampling points would exceed the threshold. The result provides insight into the environmental implications of APnEOs contamination in aquatic environments and useful information for environmental policy and ecological risk assessments.

Utility of Palliative Prognostic Index in Predicting Survival Outcomes in Patients With Hematological Malignancies in the Acute Ward Setting.

BACKGROUND: The palliative prognostic index (PPI) predicts the life expectancy of patients with terminally ill cancer in hospice settings. This study aimed to evaluate PPI as a prognostic tool for predicting the life expectancy of patients with hematological malignancies admitted to the acute ward. METHODS: A total of 308 patients with hematological malignancies admitted to the hematological ward at a medical center between January 2016 and December 2017 were consecutively enrolled. PPI was scored within 24 h of admission. All patients were categorized into 3 groups by PPI for comparing survival and in-hospital mortality rates. RESULTS: The median survival times were 38.4, 3.6, and 1.1 months for patients with good, intermediate, and poor prognostic group, respectively. The hazard ratio was 2.31 (95% CI 1.59-3.35, p < 0.001) when comparing the intermediate and good prognosis groups, and 3.90 (95% CI 2.52-6.03, p < 0.001) when comparing the poor and good prognosis groups. Forty-five (14.6%) patients died at discharge; in-hospital mortality rates among the good, intermediate, and poor prognostic groups were 9.0%, 23.4%, and 46.4%, respectively. The adjusted odds ratio for in-hospital mortality was 1.96 (95% CI, 0.80-4.82, p = 0.14) and 5.25 (95% CI, 2.01-13.7, p < 0.001) for patients in the intermediate and poor prognostic groups compared to those in the good prognostic group. CONCLUSION: PPI is an accurate prognostic tool for predicting survival times and in-hospital mortality rates in patients with hematological malignancies in an acute ward setting. PPI could assist clinicians in discussing end-of-life issues and in referring patients with hematological malignancies to palliative care.

Association of frailty and chemotherapy-related adverse outcomes in geriatric patients with cancer: a pilot observational study in Taiwan.

BACKGROUND: With the rapid growth of the elderly population and the increasing incidence of cancer, an increasing number of geriatric patients are receiving cancer treatment, making the selection of appropriate treatment an important issue. Increasing studies have confirmed that frailty can predict adverse outcomes in geriatric patients with cancer after treatment, but local data from Taiwan are lacking. Therefore, this study aimed to investigate the correlation between frailty and chemotherapy-related adverse outcomes in geriatric patients with cancer. MATERIAL AND METHODS: A total of 234 geriatric patients aged ≥65 years with cancer receiving chemotherapy were enrolled during the study period of September 2016 to November 2018. The collected data included: patients' basic demographics and Comprehensive Geriatric Assessment (CGA) before treatment, chemotherapy-related adverse outcomes, unexpected hospitalizations, and emergency department visits within 3 months of treatment. We investigated the association between frailty and chemotherapy-related adverse outcomes in geriatric patients with cancer using the chi-square test and logistic regression analysis. RESULTS: The prevalence of frailty in geriatric patients with cancer was 58.1%. Age, marital status, main caregiver, cancer type, and Eastern Cooperative Oncology Group performance status, and physical fitness were factors associated with frailty. Frail geriatric patients with cancer were at higher risk of chemotherapy-related adverse outcomes, such as grades 3-4 thrombocytopenia (odds ratio [OR] = 11.13, p = 0.021) and grades 3-4 hyponatremia (OR = 12.03, p = 0.017), than non-frail patients, and they were at increased risk of unexpected hospitalizations (OR = 2.15, p = 0.025) and emergency department visits (OR = 1.99, p = 0.039). CONCLUSIONS: Frailty is a common problem in geriatric patients with cancer and significantly impacts chemotherapy-related adverse outcomes. Our findings suggest that geriatric patients with cancer should undergo frail assessment prior to chemotherapy as a reference to guide future treatment decisions.

[Exploration of Distress Symptoms and Medical Interventions in Patients With Terminal Cancer in Hospice Shared Care].

BACKGROUND: Hospice shared care is a model of care widely used in patients with terminal cancer. Appropriate interventions to improve related symptoms should be provided during disease progression through the end of life. PURPOSE: The purpose of this study was to explore the related symptoms and to compare symptom severity before and after the implementation of hospice shared care and medical care interventions. METHODS: Fifty patients with terminal cancer were enrolled in this longitudinal, quasi-experimental research. Inclusion criteria included having an expected life span of < 6 months and agreeing to enter hospice shared care. RESULTS: The three most-frequently noted physical symptoms were, in rank order: "pain", "weakness", and "dyspnea". In terms of severity, "pain" was the most severe, followed by "weakness" and "disturbance of sleep". The three most-frequently noted psychological symptoms were, in rank order: "depression", "worry about the disease", and "afraid of dragging others down". In terms of severity, "depression" was the most severe, followed by "anxiety" and "worry about the disease". The frequency and severity of the top-3 social and spiritual distress symptoms were, in rank order: "unfinished wish", "economic difficulties", and "painlessness". During the study period, the severity of physical symptoms improved gradually, while the severity of psychological symptoms improved significantly. The top-3 items in the original medical team`s hospice-care interventions were, in rank order: "tube care", "laboratory test", and "wound care" in the non-pharmacological category; "symptom control medication", "antibiotic injection", and "intravenous fluid infusion" in the pharmacological category; and "cognitive clarification of the prognosis condition", "do not conduct resuscitation discussions and signing", and "emotional stress consoling" in the problem-coordination and interview categories. The interventions implemented by the hospice specialist team included "emotional stress interview", "team communication", and "cognitive clarification of prognosis condition" in the problem coordination and interview categories, and "massage", "consultation", and "nursing advice" in the non-pharmacological category. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The symptoms identified in this study provide clinical staff with a reference for the rapid assessment of patients with terminal-stage cancer. Manpower from various professional fields are committed to providing diversified services in the care teams, which positively affect the control of related symptoms. The experience presented in this article may be used as a reference to promote the hospice shared care model.

Supportive Care and Unmet Needs in Upper Gastrointestinal Cancer Patients: Screening and Related Factors.

Upper gastrointestinal (UGI) cancer treatment can cause physical and psychological distress and may result in unmet needs. The purposes of this study were to (1) examine the levels of gastrointestinal (GI) symptom distress, social support, and supportive care needs; (2) screen the priorities of unmet supportive care needs; and (3) identify the factors associated with supportive care needs among UGI cancer patients receiving chemotherapy. This cross-sectional study examined UGI cancer patients who received treatment from the outpatient chemotherapy department of a single cancer center in northern Taiwan. Questionnaires were used to collect data regarding GI symptom distress, social support, unmet needs, and supportive care needs. The top three unmet needs were "fears about the cancer spreading", "uncertainty about the future", and "being informed about things you can do to help yourself to get well". Descriptive statistics examined the levels of GI symptom distress, social support, supportive care needs, and priorities of unmet supportive care needs. Stepwise regression was conducted to determine significant factors related to supportive care needs. Greater supportive care needs were found to be associated with higher levels of disease-related worries, increased treatment-related symptoms, and a lower level of physical performance. These factors explained 48.0% of the variance in supportive care needs. Disease-related worries and treatment-related symptoms strongly influence overall supportive care needs and each domain of supportive care needs. Symptom management and psychological support for patients receiving outpatient chemotherapy may help patients meet needs.

Effectiveness of Applying Evidence-based Guidelines for Nurses Training on Nasogastric Tube Care.

BACKGROUND: This study formulated clinical guidelines for assessing nasogastric tube placement and for health education guidance according to evidence-based recommendations. METHOD: This study used a single group, pre- and postintervention design. Purposive sampling was used to recruit participants from nursing institutions in Taiwan. RESULTS: Sixty-two individuals in charge of nursing institutions were recruited to participate in the in-service training program. Statistically significant differences were observed in the four major items in the self-directed learning readiness scale (t = 3.85, p < .00; t = 3.99, p < .00; t = 2.94, p < .01; t = 4.13, p < .00). With regard to program satisfaction, the mean score was 4.88 to 4.9 points. The mean score for teaching satisfaction was 4.94 to 4.9 points. Furthermore, the participants scored more than 80 points in the online course test and the nasogastric tube placement skill. CONCLUSION: The individuals in-charge are expected to be willing to apply and promote methods of literature collation and recommendation in their respective institutions. [J Contin Educ Nurs. 2021;52(7):326-334.].

Detecting phthalate esters in sludge particulates from wastewater treatment plants.

This study proposed a method for analysis of 10 phthalate esters compounds from wastewater treatment plant sludges. The analytical efficiency of GC-MS for of target compounds was verified by a standard mixture of phthalate esters. The response factors related to the respective internal standards from a five-point calibration curve quantified the phthalate esters in individual compounds. Based on the literature compiled by environmental agencies, new generation phthalate compounds have been developed, such as di-iso-nonyl phthalate (DiNP), di-iso-decyl phthalate (DiDP), as alternative to conventional phthalates. The analytical results showed that the total PAEs concentration was in the range from 7.4 to 138.6 mg kg-1 dw in these seven analyzed sludge samples. More, di-iso-nonyl phthalate (DiNP), di-iso-decyl phthalate (DiDP) and bis(2-ethylhexyl) phthalate (DEHP) contributed to over 99% of PAEs in the sludge. The correlation between total PAEs concentration in household and sewage flow treated at seven WWTPs and concentrations of DEHP, DiNP and DiDP was significant.

Clinical Significance of Vulnerability Assessment in Patients with Primary Head and Neck Cancer Undergoing Definitive Concurrent Chemoradiation Therapy.

PURPOSE: This study aimed to identify vulnerable patients with head and neck cancer undergoing concurrent chemoradiation therapy (CCRT) who are susceptible to higher treatment-related adverse effects and have poorer treatment tolerance. This study also aimed to determine whether comprehensive geriatric assessment, developed in the geriatric population, can predict vulnerability to treatment-related adverse events and survival even in nongeriatric patients with head and neck cancer, as well as the prevalence of vulnerability and its effect on toxicities and survival among these patients. METHODS AND MATERIALS: This prospective cohort study examined 461 patients with primary head and neck cancer who underwent definitive CCRT during 2016 to 2017 at 3 medical centers across Taiwan. Vulnerability is defined as susceptibility to cancer- and treatment-related adverse events that result in poor treatment tolerance and unexpected emergent medical needs, such as hospitalization and emergency room visits. Vulnerability was assessed as impairment with ≥2 dimensions on comprehensive geriatric assessment, 7 days before CCRT. The association of vulnerability with treatment-related adverse events and survival was analyzed. RESULTS: The prevalence of vulnerability was 22.2%, 27.3%, 30.2%, and 27.9% among patients aged 20 to 34, 35 to 49, 50 to 64, and >65 years, respectively. Survival was poorer in vulnerable patients than in nonvulnerable patients (hazard ratio, 1.97; 95% confidence interval, 1.26-3.07; P = .003). Vulnerable patients showed a higher tendency toward CCRT incompletion (19.5% vs 6.1%, P < .001), hospitalization (34.6% vs 23.5%, P = .020), need for tubal feeding (29.3% vs 11.8%, P < .001), and longer length of hospital stay (8.1 days vs 4.0 days, P = .004) than nonvulnerable patients. Hematologic and nonhematologic toxicities were more severe in vulnerable patients than in nonvulnerable patients. CONCLUSIONS: Vulnerability, which is an urgent concern when it presents among patients with head and neck cancer, was independently associated with poorer survival and severe treatment-related complications. Vulnerability assessment should be routinely evaluated in all patients with primary head and neck cancer who are undergoing definitive CCRT, not only in such patients who are geriatric.

An environmentally friendly strategy for determining organic ultraviolet filters in seawater using liquid-phase microextraction with liquid chromatography-tandem mass spectrometry.

Benzophenone-3, benzophenone-8, and 4-methylbenzylidene camphor are used in sunscreens because they can protect the skin from UV radiation. The widespread use of organic UV filters may mean that they directly or indirectly enter seawater during recreational activities or through sewage discharge. In this study, a simple and efficient method using 1-octanol:isooctane (2:8, v/v) as an extraction solvent and liquid chromatography-electrospray tandem mass spectrometry was developed to measure trace levels of organic UV filters in seawater samples. This proposed method proved to be a highly sensitive, low-cost, and green analytical tool that requires minimal sample preparation. The method was validated and it exhibited favorable performance as well as acceptable accuracy (67 to 115%), precision (2.1 to 7.3%), coefficients of determination (0.9952 < R2 < 0.9987), sensitivity (limits of quantification [3.3 to 5.7 ng L-1]), and an acceptable matrix effect (87 to 99%). This methodology was successfully applied to analyze seawater taken from Kenting National Park located in the Hengchun Peninsula of southern Taiwan. Benzophenone-3 was detected at all sampling sites and at a higher concentration than the other organic UV filters. The highest concentration of benzophenone-3 was 514.6 ng L-1 in a sample collected from Baisha Beach.

Association of time interval between cancer diagnosis and initiation of palliative chemotherapy with overall survival in patients with unresectable pancreatic cancer.

INTRODUCTION: Palliative chemotherapy is the standard treatment for patients with unresectable pancreatic cancer. Whether the early initiation of palliative chemotherapy is associated with a favorable survival outcome for these patients is not known. This study aimed to analyze the association of the time interval between cancer diagnosis and initiation of palliative chemotherapy with survival outcome in patients with pancreatic cancer. METHOD: A total of 838 patients with unresectable pancreatic cancer who underwent palliative chemotherapy from 2010 to 2016 at 4 institutions in Taiwan were retrospectively enrolled. All patients were categorized according to time interval between cancer diagnosis and initiation of palliative chemotherapy for comparison of the survival outcome. RESULT: The median time interval was 14 days (range, 0 to 163 days) in our patient cohort. Accordingly, 22%, 29%, and 49% of the patients underwent palliative chemotherapy within 1, 1 to 2, and >2 weeks after cancer diagnosis, respectively. The survival outcome had no statistical difference among these 3 patient groups. Subgroup analyses revealed that patients with the time interval ≤2 weeks exhibited poorer survival outcome than those with the time interval >2 weeks if they initially presented with jaundice (6.1 months vs 8.4 months, P = 0.029). In contrast, patients with the time interval ≤2 weeks revealed a better survival outcome than those with the time interval >2 weeks if they initially presented with pain (8.0 vs 6.3 months, P = 0.014). CONCLUSION: In our study, time interval between cancer diagnosis and the initiation of palliative chemotherapy >2 weeks was not associated with a poorer survival outcome for patients with unresectable pancreatic cancer. Our result might help clinicians to clarify that early initiation of palliative chemotherapy might provide survival benefit for patients who present with tumor pain, but not for those who present with jaundice.

Determination of sulfamonomethoxine in tilapia (Oreochromis niloticus × Oreochromis mossambicus) by liquid chromatography-tandem mass spectrometry and its application pharmacokinetics study.

A precise and reliable analytical method to measure trace levels of sulfamonomethoxine (SMM) and N4-acetyl metabolite in tilapia samples using liquid chromatography-tandem mass spectrometry was developed. Optimized chromatographic separation was performed on C18 reversed-phase columns using gradient elution with methanol and 5 mmol/L of an ammonium acetate aqueous solution (adjusted to pH 3.5 using formic acid). This study investigated the pharmacokinetic properties and tissue distribution of SMM and its major metabolite N4-acetyl sulfamonomethoxine (AC-SMM) in tilapia after a single dose of 100 mg kg-1 body weight of orally administered SMM. Blood and tissues were collected between 0.5 and 192 h with 14 total sampling time points. SMM was rapidly absorbed, and extensively distributed in the bile and liver through systemic circulation. Enterohepatic circulation of SMM was observed in the tilapia body. Acetylation percentages were 45% (blood), 90% (liver), 62% (kidney), 98% (bile), and 52% (muscle). High concentrations of AC-SMM accumulated in the tilapia bile. At 192 h, AC-SMM concentration in the bile remained at 4710 µg kg-1. The ke value of AC-SMM (0.015 h-1) in the blood was lower than that of SMM (0.032 h-1). This study demonstrated effective residue monitoring and determined the pharmacokinetic properties of SMM and AC-SMM in tilapia.