Prognostic value of CT integrated with clinical and laboratory data during the first peak of the COVID-19 pandemic in Northern Italy: A nomogram to predict unfavorable outcome.

PURPOSE: To evaluate the prognostic role of chest computed tomography (CT), alone or in combination with clinical and laboratory parameters, in COVID-19 patients during the first peak of the pandemic. METHODS: A retrospective single-center study of 301 COVID-19 patients referred to our Emergency Department (ED) from February 25 to March 29, 2020. At presentation, patients underwent chest CT and clinical and laboratory examinations. Outcomes included discharge from the ED after improvement/recovery (positive outcome), or admission to the intensive care unit or death (poor prognosis). A visual quantitative analysis was formed using two scores: the Pulmonary Involvement (PI) score based on the extension of lung involvement, and the Pulmonary Consolidation (PC) score based on lung consolidation. The prognostic value of CT alone or integrated with other parameters was studied by logistic regression and ROC analysis. RESULTS: The impact of the CT PI score [≥15 vs. ≤ 6] on predicting poor prognosis (OR 5.71 95 % CI 1.93-16.92, P = 0.002) was demonstrated; no significant association was found for the PC score. Chest CT had a prognostic role considering the PI score alone (AUC 0.722) and when evaluated with demographic characteristics, comorbidities, and laboratory data (AUC 0.841). We, therefore, developed a nomogram as an easy tool for immediate clinical application. CONCLUSIONS: Visual analysis of CT gives useful information to physicians for prognostic evaluations, even in conditions of COVID-19 emergency. The predictive value is increased by evaluating CT in combination with clinical and laboratory data.

Analysis of antithyroid drugs in surface water by using liquid chromatography-tandem mass spectrometry.

This paper describes development and validation of a new method for the simultaneous determination of six antithyroid drugs (ATDs) in surface waters by using liquid chromatography-triple quadrupole mass spectrometry (LC-MS/MS). Target compounds include two ATD classes: thiouracil derivatives (thiouracil (TU), methyl-thiouracil (MTU), propyl-thiouracil (PTU), phenyl-thiouracil (PhTU)) and imidazole derivatives (tapazole (TAP), and mercaptobenzimidazole (MBI)). Sensitivity and selectivity of the LC-multiple reaction monitoring (MRM) analysis allowed applying a simple pre-concentration procedure and "shooting" the concentrated sample into the LC-MS/MS system without any other treatment. Recoveries were higher than 75% for all analytes. Intra-day precision and inter-day precision, calculated as relative standard deviation (RSD), were below 19 and 22%, respectively. Limits of detection (LODs) ranged from 0.05 to 0.25 µg/L; limits of quantitation (LOQs) varied between 0.15 and 0.75 µg/L. The validated method was successfully applied to the analysis of ATD residues in surface water samples collected from the Tiber River basin and three lakes of Lazio (central Italy). The analytes were quantified based on matrix-matched calibration curves with mercaptobenzimidazole-d4 (MBI-d4) as the internal standard (IS). The most widespread compound was TAP, one of the most common ATDs used in human medicine, but also TU and MBI were often detected in the analysed samples.

Simultaneous determination of water-soluble vitamins in selected food matrices by liquid chromatography/electrospray ionization tandem mass spectrometry.

A rapid, simple and sensitive method based on liquid chromatography/tandem mass spectrometry (LC/MS/MS) with an electrospray ionization (ESI) source for the simultaneous analysis of fourteen water-soluble vitamins (B1, B2, two B3 vitamers, B5, five B6 vitamers, B8, B9, B12 and C) in various food matrices, i.e. maize flour, green and golden kiwi and tomato pulp, is presented here. Analytes were separated by ion-suppression reversed-phase liquid chromatography in less than 10 min and detected in positive ion mode. Sensitivity and specificity of this method allowed two important results to be achieved: (i) limits of detection of the analytes at ng g(-1) levels (except for vitamin C); (ii) development of a rapid sample treatment that minimizes analyte exposition to light, air and heat, eliminating any step of extract concentration. Analyte recovery depended on the type of matrix. In particular, recovery of the analytes in maize flour was > or =70%, with the exception of vitamin C, pyridoxal-5'-phosphate and vitamin B9 (ca 40%); with tomato pulp, recovery was > or =64%, except for vitamin C (41%); with kiwi, recovery was > or =73%, except for nicotinamide (ca. 30%).

High- and low-resolution mass spectrometry coupled to liquid chromatography as confirmatory methods of anabolic residues in crude meat and infant foods.

Within the European Union the use of anabolic steroids for promoting growth and improving meat-to-fat ratio in food-producing animals has been banned since 1988. For the unequivocal identification of hormone residues in a complex matrix such as meat we have developed a rapid, specific and sensitive liquid chromatography/tandem mass spectrometry (LC/MS/MS) method, in combination with a simple extraction procedure based on the matrix solid-phase dispersion (MSPD). The performances of a triple quadrupole (QqQ) and a quadrupole/time-of-flight (QqTOF) were compared: the QqQ mass spectrometer was found to be more sensitive for almost all studied analytes, but the selectivity was superior using the QqTOF system; the full-scan spectra (acquired without losing sensitivity), mass accuracy and resolution of the hybrid instrument enabled a more probatory analyte identification than that obtained selecting two multiple-reaction monitoring (MRM) transitions with a QqQ. Average recoveries ranged from 80 to 100%, and the detection capabilities (CCbetas) were less than 1.06 ppb with the QqQ instrument and less than 5.20 ppb with the QqTOF instrument for the bovine meat, which proved to be the most complex matrix.

Determination of free fatty acids in chocolate by liquid chromatography with tandem mass spectrometry.

This paper describes a rapid extraction method, based on a matrix solid-phase dispersion technique using diatomaceous earth as solid support and 50:50 (v/v) chloroform/methanol as extracting solvent, that can determine 11 free fatty acids in chocolate. The extraction procedure is followed by reversed-phase liquid chromatography/tandem mass spectrometry (LC/MS/MS) using a normal-bore (4.6 mm i.d.) C-18 column and an electrospray interface operating in the negative ion mode. The tandem mass spectra of selected compounds show that charge-remote fragmentation (CRF) mechanisms are occurring; the intensities of the CRF reactions increase with the carbon number and degree of unsaturation of the fatty acids. Average recoveries, evaluated by the standard addition method, vary between 79-103%, and the estimated quantification limits are less than 153 ng/g. The proposed method has been used to analyse nine chocolate samples from various price ranges, bought from supermarkets.

Accelerated solvent extraction and confirmatory analysis of sulfonamide residues in raw meat and infant foods by liquid chromatography electrospray tandem mass spectrometry.

This paper describes a new method for the rapid extraction and unequivocal confirmation of 13 sulfonamides (SAs) in raw meat and infant foods. The highly automated extraction procedure is based on accelerated solvent extraction followed by liquid chromatography-tandem mass spectrometry (LC-MS/MS) as a confirmatory analysis. After 1 g of food matrix was blended with 2 g of C18 as a solid support material, the mixture was packed into the extraction cell and the SAs were extracted with 10 mL of hot water at 160 degrees C and 100 atm; 100 microL of the extract was directly injected into the LC-MS system. The analytes were ionized in an electrospray interface operating in the positive ion mode and were identified by selecting two multireaction monitoring transitions, which guaranteed method specificity. Typical recoveries from crude meat and baby food samples ranged from 70 to 101% at a fortification level of 100 ppb, corresponding to the maximum residue limits established by the European Union and the U.S. Food and Drug Administration. The interday method precision was less than 8.5%, and the limits of detection were below 2.6 ppb. This study has taken matrix-induced suppression of ionization into account, by comparing standard and matrix-matched calibration curves. Four of the 13 monitored SAs have been detected in some baby foods and raw meat samples, bought from Roman supermarkets and butchers' shops, using the described methodology.

Simultaneous determination of the urinary metabolites of benzene, toluene, xylene and styrene using high-performance liquid chromatography/hybrid quadrupole time-of-flight mass spectrometry.

A simple and rapid method using reversed-phase liquid chromatography/tandem mass spectrometry (LC/MS/MS) for the simultaneous determination of the urinary metabolites of benzene, toluene, xylene and styrene in human urine specimens and standard solutions is described. A hybrid quadrupole/time-of-flight (QqTOF) mass spectrometer was compared for the determination of metabolite of aromatic solvents in urine samples. The metabolites selected were: trans,trans-muconic acid, hippuric acid, o-, m- and p-methylhippuric acid and phenylglyoxylic acid. The compounds were well separated from each other on narrow-bore 1-mm i.d. reversed-phase LC C-18 columns. Average recoveries for loading 100 microL of urine samples varied from 88-110% and the quantification limits were less than 30 ng/mL for each analyte (3 ng/mL for trans,trans-muconic acid). The qualitative information obtained (mass accuracy, resolution and full-scan spectra) with the QqTOF mass spectrometer allows a secure identification of analytes in biological matrices.

Quadrupole time-of-flight versus triple-quadrupole mass spectrometry for the determination of non-steroidal antiinflammatory drugs in surface water by liquid chromatography/tandem mass spectrometry.

A triple-quadrupole instrument and a hybrid quadrupole/time-of-flight (TOF) mass spectrometer were compared for the determination of pharmaceutical compounds in water samples. The drugs investigated were the analgesics Ibuprofen, Fenoprofen, Ketoprofen, Naproxen, and Diclofenac. The recently introduced Q2-pulsing function, which enhances the transmission of fragment ions of a selected m/z window from the collision cell into the TOF analyzer, improved the sensitivity of product ion scans on the quadrupole/TOF instrument. The selectivity is much better on quadrupole/TOF systems than on triple quadrupoles because the high resolving power of the reflectron-TOF mass analyzer permits high-accuracy fragment ion selection. This minimizes interferences from environmental matrices and allows acquisition of full spectra for selected analytes with better signal-to-noise characteristics than comparable spectra obtained with a scanned quadrupole. The qualitative information obtained (mass accuracy, resolution and full-scan spectra) by hybrid quadrupole/TOF mass spectrometry allows a more certain identification of analytes in environmental matrices at trace levels. Sample enrichment of water samples was achieved by a solid-phase extraction procedure. Average recoveries for loading 1 L of samples varied from 88 to 110%, and the quantification limits were less than 1.2 ng/L for the triple-quadrupole instrument (in MRM mode) and less than 3 ng/L for the quadrupole/TOF instrument.

Validation of a method for the determination of multiclass pesticide residues in fruit juices by liquid chromatography/tandem mass spectrometry after extraction by matrix solid-phase dispersion.

A multiresidue method was developed and validated for the determination of pesticide residues (omethoate, dimethoate, carbendazim, propoxur, thiabendazole, carbaryl, pirimicarb, azinphos-methyl, methidathion, and iprodione) in fruit juices. The samples were extracted by matrix solid-phase dispersion with diatomaceous earth and analyzed by liquid chromatography/tandem mass spectrometry. The method detection limits were <0.2 ppb for all pesticides; the relative standard deviations for analyses of samples fortified over the range of 2-50 ng/g were <9%, and the recoveries for each pesticide were all between 77 and 102%. The proposed method was used to analyze 21 commercial fruit juices; pesticide residues were found in 71% of the samples.

Determination of phenoxyacid herbicides and their phenolic metabolites in surface and drinking water.

An evaluation was made of the feasibility of using reversed-phase liquid chromatography/tandem mass spectrometry with an electrospray interface (LC/ESI-MS/MS) to measure traces of phenoxyacid herbicides and their metabolites in surface and drinking water samples. The procedure involved passing 0.5 L of river and drinking water samples through a 0.5 g graphitized carbon black (GCB) extraction cartridge. Recovery was higher than 85% irrespective of the aqueous matrix in which the analytes were dissolved. A conventional 4.6-mm i.d. reversed-phase LC C-18 column operating with a mobile phase flow rate of 1 mL/min was used to chromatograph the analytes. A flow of 200 microL/min of the column effluent was diverted to the ESI source. The limits of detection (signal-to-noise ratio = 3) of the method for the pesticides considered in drinking and surface water samples are less than 0.1 ng/L for phenoxyacid herbicides, and about 5-10 ng/L for their metabolites (2,4-dichlorophenol and 4-chloro-2-methylphenol).