A novel strategy by combining foam fractionation with high-speed countercurrent chromatography for the rapid and efficient isolation of antioxidants and cytostatics from Camellia oleifera cake.

Camellia oleifera cake is a by-product, which is rich in functional chemical components. However, it is typically used as animal feed with no commercial value. The purpose of this study was to isolate and identify compounds from Camellia oleifera cake using a combination of foam fractionation and high-speed countercurrent chromatography (HSCCC) and to investigate their biological activities. Foam fractionation with enhanced drainage through a hollow regular decahedron (HRD) was first established for simultaneously enriching flavonoid glycosides and saponins for further separation of target compounds. Under suitable operating conditions, the introduction of HRD resulted in a threefold increase in enrichment ratio with no negative effect on recovery. A novel elution-extrusion countercurrent chromatography (EECCC) coupled with the consecutive injection mode was established for the successful simultaneous isolation of flavonoid glycosides and saponins. As a result, 38.7 mg of kaemferol-3-O-[2-O-D-glucopyranosyl-6-O-α-L-rhamnopyranosyl]-ß-D-glucopyranoside (purity of 98.17%, FI), 70.8 mg of kaemferol-3-O-[2-O-ß-D-xylopyranosyl-6-O-α-L-rhamnopyranosyl]-ß-D-glucopyranoside (purity of 97.52%, FII), and 560 mg of an oleanane-type saponin (purity of 92.32%, FIII) were separated from the sample (900 mg). The present study clearly showed that FI and II were natural antioxidants (IC50 < 35 µg/mL) without hemolytic effect. FIII displayed the effect of inhibiting Hela cell proliferation (IC50 < 30 µg/mL). Further erythrocyte experiments showed that this correlated with the extremely strong hemolytic effect of FIII. Overall, this study offers a potential strategy for efficient and green isolation of natural products, and is beneficial to further expanding the application of by-products (Camellia oleifera cake) in food, cosmetics, and pharmacy.

Multi-target analysis of cytostatics in hospital effluents over a 9-month period.

The consumption of cytostatics, pharmaceuticals prescribed in chemotherapy, is increasing every year and worldwide, along with the incidence of cancer. The presence and the temporal evolution of cytostatics in wastewaters from a Portuguese hospital center was evaluated through a 9-month sampling campaign, comprising a total of one hundred and twenty-nine samples, collected from May 2019 to February 2020. Eleven cytostatics out of thirteen pharmaceuticals were studied, including flutamide, mycophenolate mofetil and mycophenolic acid, which have never been monitored before. Target analytes were extracted and quantified by solid-phase extraction coupled to liquid-chromatography-tandem mass spectrometry analysis; the method was fully validated. All pharmaceuticals were detected in at least one sample, bicalutamide being the one found with higher frequency (detected in all samples), followed by mycophenolic acid, which was also the compound detected at higher concentrations (up to 5340 ± 211 ng/L). Etoposide, classified as carcinogenic to humans, was detected in 60% of the samples at concentrations up to 142 ± 15 ng/L. The risk from exposure to cytostatics was estimated for aquatic organisms living in receiving bodies. Cyclophosphamide, doxorubicin, etoposide, flutamide, megestrol and mycophenolic acid are suspected to induce risk. Long-term and synergic effects should not be neglected, even for the cytostatics for which no risk was estimated.

LC-MS-MS Determination of Cytostatic Drugs on Surfaces and in Urine to Assess Occupational Exposure.

The ever-increased usage of cytostatic drugs leads to high risk of exposure among healthcare workers. Moreover, workers are exposed to multiple compounds throughout their lives, leading to cumulative and chronic exposure. Therefore, multianalyte methods are the most suitable for exposure assessment, which minimizes the risks from handling cytostatic drugs and ensures adequate contamination containment. This study describes the development and full validation of two liquid chromatography-tandem mass spectrometry methods for the detection of gemcitabine, dacarbazine, methotrexate, irinotecan, cyclophosphamide, doxorubicinol, doxorubicin, epirubicin, etoposide, vinorelbine, docetaxel and paclitaxel in working surfaces and urine samples. The urine method is the first to measure vinorelbine and doxorubicinol. For surfaces, limits of detection (LOD) and limits of quantification (LOQ) were 5-100 pg/cm2, and linearity was achieved up to 500 pg/cm2. Inaccuracy was between -11.0 and 8.4%. Intra-day, inter-day and total imprecision were <20%, except for etoposide and irinotecan (<22.1%). In urine, LOD and LOQ were 5-250 pg/mL, with a linear range up to 1,000-5,000 pg/mL. Inaccuracy was between -3.8 and 14.9%. Imprecision was <12.4%. Matrix effect was from -58.3 to 1,268.9% and from -66.7 to 1,636% in surface and urine samples, respectively, and extraction efficiency from 10.8 to 75% and 47.1 to 130.4%, respectively. All the analytes showed autosampler (6°C/72 h), freezer (-22°C/2 months) and freeze/thaw (three cycles) stability. The feasibility of the methods was demonstrated by analyzing real working surfaces and patients' urine samples. Contamination with gemcitabine, irinotecan, cyclophosphamide, epirubicin and paclitaxel (5-4,641.9 pg/cm2) was found on biological safety cabinets and outpatients' bathrooms. Analysis of urine from patients under chemotherapy identified the infused drugs at concentrations higher than the upper LOQ. These validated methods will allow a comprehensive evaluation of both environmental and biological contamination in hospital settings and healthcare workers.

Are cytostatic drugs in surface waters a potential threat?

Cytostatic drugs are pharmaceuticals administered to cancer patients under chemotherapy. Their occurrence in surface waters has been reported worldwide, increasing environmental and human health concerns. This work addresses a question of worldwide interest: are these hazardous pharmaceuticals in surface waters a potential threat? For the first time, this study brings information on the presence of cytostatic drugs in Portuguese rivers. Furthermore, cutting-edge data on the occurrence of two cytostatic drugs is provided; up to the authors' best knowledge, flutamide and mycophenolate mofetil have never been monitored in worldwide surface waters. Nine out of thirteen cytostatic drugs were detected in Portuguese rivers. Despite bicalutamide being the cytostatic most frequently detected, the highest concentration was recorded for cyproterone (19 ± 3 ng/L). Three different scenarios were considered to estimate the risks from the exposure of humans to cytostatic drugs via surface waters. Two scenarios are associated with bathing practices in rivers, particularly in the spring and summer seasons (river beaches): (i) the exposure to cytostatic drugs by dermal contact with contaminated water and (ii) the exposure by accidental ingestion of contaminated water, which is less likely but also occurs. The third exposure scenario is related to (iii) the long-life consumption of drinking water produced from river water capture, under worst-case conditions, i.e. negligible degradation of cytostatic drugs at drinking water treatment plants. It was concluded that the third exposure context to cytostatics could represent a risk to children, if the highest concentration ever reported in the literature for cyclophosphamide in surface waters is considered. Still, attending to the carcinogenicity of some of these compounds (e.g., cyclophosphamide, chlorambucil, etoposide and tamoxifen), health risks might always be expected, regardless of the contamination level. Furthermore, health risks associated with synergic effects and/or long-term exposures cannot be ruled out, even for the remaining cytostatics/exposure contexts.

Evaluation of uptake of the cytostatic methotrexate in Elliptio complanata mussels by LC-MS/MS.

Aquatic organisms are continuously exposed to emerging contaminants coming from urban effluents of wastewater treatment plants. The contamination of surface water by those effluents poses a number of environmental risks, and pharmaceuticals are part of this class of effluent contaminants. Various classes of pharmaceuticals are not treated by wastewater treatment plants and anticancer drugs are part of them. The chemotherapy drug methotrexate (MTX) is an emerging contaminant and its growing use with the increase in cancer cases worldwide raises potential risk to aquatic organisms exposed to effluent discharges. However, chemical analyses in exposed freshwater aquatic organisms for ecotoxicological studies are rarely available and no studies have been done yet to accompany ecotoxicological data of exposed filter-feeding organisms. The purpose of this study was to develop a specific and sensitive analytical LC-MS/MS method for the quantification of methotrexate uptake in mussels exposed at different concentrations of the drug. A solid/liquid extraction followed by solid phase extraction (SPE) using an MCX phase purification scheme was optimized. The optimal recovery of 65% and matrix effect of 38% allowed to achieve a limit of quantification of 0.25 ng g-1, with an accuracy of 99-106%, a precision of no more than 3% RSD, and linearity ranging from 0.25 to 25 ng g-1. This methodology was tested with mussels exposed for 96 h at different concentrations (4 to 100 µg L-1) of MTX. The data revealed tissue uptake at concentrations ranging from 0 to 2.53 ng g-1. This suggests that this drug has low uptake potential and this methodology could be used to examine tissue levels of this drug in organisms continuously exposed to urban pollution.

Ozonation of cytostatic drugs in aqueous phase.

As the number of cancer patients increases, so does the consumption of cytostatic drugs, which are commonly used in chemotherapy. These compounds are already ubiquitous in wastewater treatment plant (WWTP) effluents and natural water streams, revealing the urgent need for efficient technologies for their removal from the aqueous phase. This work presents the elimination of five cytostatics of concern, found in Portuguese WWTP effluents: bicalutamide (BICA), capecitabine (CAP), cyclophosphamide (CYC), ifosfamide (IFO) and mycophenolic acid (MPA), using non-catalytic ozonation. Experiments were performed starting from trace-level concentrations (1 µM) for all cytostatics at neutral pH (pH: 7.3 ± 0.1) and room temperature (23 ± 1 °C), employing different ozone dosages. Under the studied conditions, CAP and MPA were quickly eliminated by direct ozonation, whereas BICA, CYC and IFO were more slowly degraded, as they undergo a breakdown via hydroxyl radicals generation (HO) exclusively. Increasing the O3 dosage from 1 to 3 mgO3/mgDOC, CAP, MPA and IFO were completely removed, and BICA and CYC were converted more than 90% after 180 min. The presence of both inorganic ions and organic matter in real water matrices (river water, WWTP secondary effluent) did not affect the removal of CAP and MPA. Nonetheless, there was an inefficient and very fast O3 consumption that resulted in only around 30% elimination of BICA, CYC and IFO, even if the reaction time is extended.

Control of retention mechanisms on an octadecyl-bonded silica column using ionic liquid-based mobile phase in analysis of cytostatic drugs by liquid chromatography.

This study assesses the potential of using ionic liquids (ILs) as mobile phase additives to control the retention mechanism of four cytostatic drugs: doxorubicin hydrochloride (DOX), epirubicin hydrochloride (EPI), daunorubicin hydrochloride (DAU) and idarubicin hydrochloride (IDA). Chromatographic separations were performed on a C18 analytical column (Discovery C18 150 × 4.6 mm, 5 µm) using six IL anions and four methyl-substituted IL cations with different alkyl chain lengths (alone or with the additional methyl group on the aromatic ring), or with an allyl group added as a cationic substituent. Thus, a total of 17 different ILs were assessed. The aqueous formic acid solution and phosphate buffer were used to compare how mobile phase composition affected the behavior of the analyzed cytostatic agents in the presence of ILs. In addition, the impacts of IL concentration, phosphate buffer concentration, and phosphate buffer pH on the final results were also considered. The ability to change analyte retention without negatively impacting peak shape or analytical efficiency was also controlled via the tailing factor and number of theoretical plates. Based on the results, the tested ILs were classified as either effective or ineffective mobile phase additives for separation of anthracyclines and identification by LC-FL technique.

Quality control of cytostatic drug preparations-comparison of workflow and performance of Raman/UV and high-performance liquid chromatography coupled with diode array detection (HPLC-DAD).

The drugs used for treatment during chemotherapy are manufactured individually for each patient in specialised pharmacies. Thorough quality control to confirm the identity of the delivered active pharmaceutical ingredient and the final concentration of the prepared application solution is not standardized yet except for optical or gravimetric testing. However, solution stability problems, counterfeit drugs, and erroneous or deliberate underdosage may occur and negatively influence the quality of the product and could cause severe health risks for the patient. To take a step towards analytical quality control, an on-site analytical instrument using Raman and UV absorption spectroscopy was employed and the results were compared to high-performance liquid chromatography coupled to diode array detection. Within the scope of the technology evaluation, the uncertainty of measurement was determined for the analysis of the five frequently used cytostatic drugs 5-fluorouracil, cyclophosphamide, gemcitabine, irinotecan and paclitaxel. The Raman/UV technique (2.0-3.2% uncertainty of measurement; level of confidence: 95%) achieves a combined uncertainty of measurement comparable to HPLC-DAD (1.7-3.2% uncertainty of measurement; level of confidence: 95%) for the substances 5-fluorouracil, cyclophosphamide and gemcitabine. However, the uncertainty of measurement for the substances irinotecan and paclitaxel is three times higher when the Raman/UV technique is used. This is due to the fact that the Raman/UV technique analyses the undiluted sample; therefore, the sample has a higher viscosity and tendency to foam. Out of 136 patient-specific preparations analysed within this study, 96% had a deviation of less than 10% from the target content.

Liquid-liquid extraction as a simple tool to quickly quantify fourteen cytostatics in urban wastewaters and access their impact in aquatic biota.

Cytostatics are highly toxic pharmaceuticals used in the treatment of cancer. These substances are partially excreted by the human body after administration. The inefficient removal of some cytostatics in urban wastewater treatment plants (WWTPs) allows them to reach surface waters and consequently the aquatic biota. However, information about their occurrence in urban wastewaters is available only for certain active ingredients. A liquid-liquid extraction method coupled to liquid-chromatography-tandem mass spectrometry analysis was developed, allowing the identification and quantification of 14 cytostatics in wastewater samples, avoiding the use of expensive sorbents. Moreover, satisfactory cytostatics' recoveries were achieved when the new method was applied to wastewaters from a Portuguese WWTP: average of (74 ± 21)% for the influents, (83 ± 22)% for secondary effluents, and (94 ± 24)% for tertiary effluents collected after UV treatment, except for imatinib. Doxorubicin, etoposide, megestrol and prednisone were completely eliminated in the first stage of the WWTP treatment (i.e. detected in the influents, but not in the effluents). Bicalutamide, capecitabine, cyclophosphamide, ifosfamide and mycophenolic acid were recalcitrant to UV radiation (i.e. detected in tertiary effluents), ifosfamide being the cytostatic most difficult to be removed (its concentration did not decrease from the entrance to the outlet of the WWTP). The risk at which aquatic organisms might be subjected, due to their exposure to cytostatics' concentrations 10-times lower than those found in the tertiary effluents, was estimated and it was verified that mycophenolic acid may represent a high risk. Although no risk was estimated for the other cytostatics, the risks associated to long-term and synergic exposure should not be ruled out.

Cytostatic compounds in sludge and sediment: extraction and determination by a combination of microwave-assisted extraction and UHPLC-MS/MS.

Cytostatic compounds are an important group of micro-pollutants since they are used to kill cells or stop cell division. For this reason, they are also considered mutagenic. Several cytostatic compounds have been detected in hospital effluents, in the influents and effluents of wastewater treatment plants and even in river water. However, their detection in solid matrices is very scarce. In this work, we have developed a new procedure based on microwave-assisted extraction (MAE) for the extraction of cytostatic compounds from sludge and sediment before determination by ultra-high-performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS). To develop this procedure, we have chosen a group of eight widely used cytostatic compounds and carried out a systematic experimental design to optimize the extraction conditions. Under these optimal conditions, the studied cytostatic compounds are extracted with good sensitivity, with recoveries ranging from 65 to 122% in sludge and recoveries varying between 49 and 109% in sediment, with the exception of etoposide, which has a lower recovery from these types of samples. The limits of detection were from 0.42 to 79.8 ng g-1 in sludge and from 0.10 to 87.5 ng g-1 in sediment. Intraday and interday relative standard deviations (RSDs) were below 15% and 18%, respectively, in both matrices at the tested concentrations. The total procedure was applied to samples of sludge taken from the main wastewater treatment plant (WWTP) of the island of Gran Canaria (Spain) and for sediment samples obtained close to the marine outfalls of different wastewater treatment plants for the same island. Graphical abstract.

Cytostatic pharmaceuticals as water contaminants.

Due to the growing problem of cancer diseases, cytostatic drugs have become a great environmental threat. Their main sources are hospital effluents, household discharge and drug manufacturers. As these compounds are not removed during wastewater treatment with sufficient efficiency, they are found in the surface, ground and drinking water in quantities up to 2.12 × 10-4 mg/l. The current knowledge about their harmful influence on humans does not indicate a significant risk to the health of water consumers, although it points to certain groups of risk (children and lactating women) in particular. In aquatic organisms, anticancer drugs in detected concentrations can cause chronic toxicity and have a detrimental impact on their genetic material. The acute toxicity effect is less likely. The HC5 value calculated by us (the concentration at which 5% of the species is potentially affected) equalling 2.1 × 10-4 mg/l shows that anticancer drugs are real hazardous contaminants for the environment. It indicates that effective elimination of cytostatics from water still requires intensive research.

New insights on cytostatic drug risk assessment in aquatic environments based on measured concentrations in surface waters.

Cytostatic drugs are compounds used to treat cancer, one of the deadliest diseases worldwide with a rising yearly incidence. However, the occurrence and concentrations of a large number of cytostatics in waters and wastewaters are unknown. Thus, this study sought to analyze the concentrations of these compounds in different aquatic environments worldwide to assess the risk that these compounds pose to aquatic organisms. The top five most monitored cytostatics in aquatic environments are fluorouracil, methotrexate, tamoxifen, ifosfamide, and cyclophosphamide. Risk quotients (RQs) based on maximum reported measured concentrations revealed that mycophenolic acid and tamoxifen pose a high risk to aquatic organisms (RQmax ≥ 1) at concentrations observed in surface waters. Moreover, methotrexate and tegafur were categorized as moderate risk compounds, and bicalutamide was found to pose a low risk. Importantly, the available analytical methodologies for the quantification of some cytostatics (e.g., cisplatin, fluorouracil, daunorubicin, imatinib, and mycophenolic acid) in water could not rule out potential risk to aquatic biota, since estimated risks for these compounds using the lowest method detection limits reported in the literature (RQ MDL) were all ≥0.01 (i.e., low risk or higher). Moreover, risks based on predicted concentrations (RQ PEC) were consistently lower than those based on measured concentrations, highlighting the importance of risk assessment based on measured values. Thus, accurate and sensitive analytical methods are crucial to identify and quantify cytostatic exposure in aquatic ecosystems in order to preserve biodiversity and ensure a safer environment.

Simultaneous and systematic analysis of cytostatic drugs in wastewater samples by ultra-high performance liquid chromatography tandem mass spectrometry.

Cytostatic drugs are compounds used to fight cancer, which may be excreted after administration to patients, and eventually reach wastewater. Given the high incidence of cancer and the properties of drugs, the drug concentrations in water systems should be evaluated. We present the optimization, development and application of a solid phase extraction (SPE) method for the determination of eight cytostatic compounds of different classes in wastewater and seawater samples. We compared four SPE cartridges prior to their determination by Ultra-High Performance Liquid Chromatography tandem Mass Spectrometry. For wastewater samples, the Oasis HLB cartridge gave the best recoveries, which were higher than 65% in most cases, achieving limit of detections (LODs) of 1.68-103.95 ng·L-1. In seawater samples, the Bond Elut cartridge afforded the best recoveries >70%, with LODs of 0.95-5.14 ng·L-1. The optimal procedure was applied in four hospital wastewater effluent samples taken during one year, and in different influents and effluents from wastewater treatment plants and seawater from marine outfalls taken in eight campaigns during two years, in Gran Canaria island (Spain). Results showed that etoposide was present in influents of wastewater treatment plants in several months and different wastewater treatment plants and hospital effluents in the range 375.8-5141 ng·L-1, while cyclophosphamide was present in some months in effluents from only one wastewater treatment plant and hospital effluents in the range 55.94-1212 ng·L-1. Vinblastine and vincristine were detected in one sample of hospital at concentrations of 1836 ng·L-1 and 1851 ng·L-1, respectively.

Development of an analytical methodology for the analysis of priority cytostatics in water.

The consumption of cytostatics has remarkably increased over the last years due to the high cancer incidence worldwide. In previous studies, seven cytostatics were already recognized to potentially induce chronic effects in aquatic organisms, taking into account their estimated concentrations in surface waters: cyclophosphamide (CYC), capecitabine (CAP), mycophenolic acid (MPA), imatinib (IMA), bicalutamide (BICA), prednisone (PRED) and 5-fluorouracil (5FU). The objective of the present study was to simultaneously analyse these 7 prioritized compounds, which have the highest chances to be found in surface and wastewaters. The analytical challenge relies in the determination of these very polar compounds, which have different chemical and structural properties. Solid-phase extraction with an Ultra Performance Liquid Chromatograph-Mass Spectrometer in electrospray ionization mixed mode (5-fluorouracil and bicalutamide in negative mode and the others in positive one) was developed to determine seven cytostatics in wastewater and surface water. Among eight tested cartridges with different sorbents and conditions, the best extraction performance was attained with Oasis WAX at pH 10, with recoveries ranging from 31 ±â€¯4 (5FU) and 103 ±â€¯17% (MPA). Regarding the chromatographic analysis, the best results were achieved with an XBridge amide column. The final analytical methodology was successfully applied for the analysis of real water samples, confirming the presence of risky cytostatics in surface and wastewaters.

[Hygiene and legal aspects of occupational exposure assessment to cytostatics]. / Aspekty higieniczne i prawne oceny narazenia zawodowego na cytostatyki.

The employers responsibilities for the assessment of occupational exposure to cytostatics in the workplace were analyzed in the light of existing legal regulations. Cytostatics may pose a threat to health and life of workers taking care of patients treated oncologically, i.e., pharmacists, physicians, nurses and other personnel. The significant scale of occupational exposure to cytostatics in Poland is confirmed by the data collected in the Central Register of Data on Exposure to Carcinogenic or Mutagenic Substances, Mixtures, Agents or Technological Processes, maintained by the Nofer Institute of Occupational Medicine, Lódz, Poland. The issue of occupational risk assessment of exposure to cytostatics gives raise to numerous concerns. Polish regulations concerning health protection of employees occupationally exposed to cytostatics are not unequivocal, as they are derived from different areas of the law, especially those applying to hazard classification, labeling and preparation of safety data sheets for cytostatics. There are neither binding occupational exposure limits legally set for active compounds of antineoplastic drugs nor methods for monitoring of these substances concentrations in a worker's breathing zone and biological material. This prevents the employer to carry out the correct assessment of occupational exposure, the results of which are the basis for preparing the proper preventive strategy. In this article the consequences of amendments to the European chemical legislation for employers responsible for adequate protection of health and life of employees exposed to cytostatics, were discussed, as well as some legal changes aimed at a better health and life protection of workers exposed to cytostatics in a workplace were proposed. Med Pr 2018;69(1):77-92.

A case study to identify priority cytostatic contaminants in hospital effluents.

This study analyses the presence of 17 cytostatic agents from seven different groups, based on their different mechanisms of action, in the effluent from a medium-sized hospital located in eastern Spain. Analysis of the compounds found in the effluents studied involved solidphase extraction (SPE) coupled on-line to a high performance liquid chromatograph tandem mass spectrometer (HPLC-MS/MS). The environmental risk of the compounds studied was then assessed by calculating the hazard quotient (HQ), combining the measured environmental concentrations (MECs) with dose-response data based on the predicted no effect concentrations (PNECs). In addition, the environmental hazard associated was evaluated in accordance with their intrinsic characteristics by calculating the PBT (Persistence Bioaccumulation Toxicity) index. The results of this study showed the presence of seven of the 17 compounds analysed in a range of between 25 and 4761 ng/L. The highest concentrations corresponded to ifosfamide (58-4761 ng/L), methotrexate (394-4756 ng/L) and cyclophosphamide (46-3000 ng/L). Assessment of the environmental hazard showed that the three hormonal agents (tamoxifen and its metabolites endoxifen and hydroxytamoxifen) exhibited a maximum PBT value of 9 due to their inherent harm to the environment resulting from their characteristics of persistence, bioaccumulation and toxicity. A combined evaluation of the risk and environmental hazard showed that three of the 17 compounds studied, namely, ifosfamide, imatinib and irinotecan, all of which exhibited HQ values higher than 10 and PBT indices of 6, indicative of a particularly high potential to harm the environment, deserve special attention.

Optimization and application of fabric phase sorptive extraction coupled to ultra-high performance liquid chromatography tandem mass spectrometry for the determination of cytostatic drug residues in environmental waters.

Every year, hundreds of tons of organic pollutants reach the environment through effluents released from wastewater treatment plants worldwide, and many of these compounds have harmful effects on the aquatic ecosystem. A new class of emerging pollutants of high concern is cytostatic drugs, which are designed to treat different types of cancers by attacking cells. Environmental concentrations of cytostatic drugs are known to be in the range of ngL-1, and for this reason, it is imperative to develop analytical methods of extraction and preconcentration to allow for subsequent instrumental analysis of these drugs. In this work, a rapid, simple and green method for the analysis of seven cytostatic drug compounds that are commonly used in anti-cancer therapies was developed using a novel extraction process based on a powerful miniaturized technique, fabric phase sorptive extraction (FPSE) coupled to ultra-high performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS). The major parameters that affect the extraction process were optimized. The new method shows good linearity, with a relative standard deviation (RSD) of less than 12%. Relative recoveries higher than 40% were obtained for the studied compounds, and the detection limit of the method was within the values at which these compounds are usually found in environmental water (0.20ngL-1 to 80ngL-1). The Limit of Quantification ranged from 0.68 to 267ngL-1. Significant suppression of the signal due to the matrix effect, a common shortcoming attributed to interference from the extraction process as well as the use of ionization mode, was not observed. Subsequently, the method was applied to real wastewater samples from an effluent obtained from a hospital area and three wastewater treatment plants located in Gran Canaria Island, Spain.

Determination of cytostatic drugs in Besòs River (NE Spain) and comparison with predicted environmental concentrations.

The number of cytostatic drugs used in cancer treatments is wide and increases every year; therefore, tools have been developed to predict their concentration in the environment to prioritize those for monitoring studies. In the present study, the predicted environmental concentrations (PECs) were calculated according to consumption data in Catalonia (NE Spain) for 2014. According to PECs and to the most widely reported compounds, 19 cytostatics were monitored in two sampling campaigns performed along the Besòs River. A total of seven drugs were detected at levels between 0.5 and 656 ng L-1. PEC and measured environmental concentrations (MECs) were compared in order to validate PECs. The PEC/MEC ratio presented a good agreement between predicted and measured concentrations confirming the PEC estimations. Mycophenolic acid, prioritized as the compound with the highest PEC, was detected at the highest concentrations (8.5-656 ng L-1) but showed no risk for aquatic organisms (risk quotient <1) considering acute toxicity tests performed in Daphnia magna.

Direct and indirect photodegradation pathways of cytostatic drugs under UV germicidal irradiation: Process kinetics and influences of water matrix species and oxidant dosing.

The ever-increasing consumption of various cytostatic drugs (CSDs) has attracted growing public concern in recent years. The photodegradation of 8 CSDs was investigated using a low-pressure UV-254Hg lamp, resulting in fluence-based first-order kinetic rate constants in the range of (0.20-6.97)×10-4cm2mJ-1. The influence of water matrix components, including natural dissolved organic matter (DOM), bicarbonate (HCO3-), nitrate (NO3-), chloride (Cl-), and sulfate (SO42-), was investigated. The degradation rates of CSDs decrease in the presence of DOM due to the competition for the UV light, but increase with addition of NO3- due to an indirect production of HO. Further investigation was carried out to evaluate the viability of UV treatment performances using two real water samples, namely treated water from a water treatment plant and secondary effluent from a wastewater treatment plant. The primary photodegradation byproducts of CSDs were identified using LC/MS/MS to investigate the mechanism of direct UV photolysis and indirect NO3--induced and DOM-induced photolysis. The degradation rates of CSDs increase significantly with the addition of H2O2 or S2O82- under UV irradiation, due to the generation of non-selective HO or selective SO4-. As an electrophilic radical, SO4- mainly reacts via electron transfer and selectively attacks certain electron-donating functional groups of CSDs.

Análisis modal de fallos y efectos aplicado a la elaboración de citostáticos intravenosos / Failure mode effect analysis applied to preparation of intravenous cytostatics

Objetivo. Identificar los riesgos en la elaboración de citostáticos intravenosos de forma proactiva, priorizarlos y establecer medidas de mejora en la seguridad de los procedimientos utilizados. Material y métodos. Se utilizó la metodología «análisis modal de fallos y efectos». Un equipo multidisciplinar identificó los modos de fallo del proceso a través de tormenta de ideas. Se evaluó el impacto asociado a cada modo de fallo con el número de prioridad de riesgo (NPR), en el que intervienen 3 variables: ocurrencia, gravedad y detectabilidad. Se establecieron medidas de mejora para todos los modos de fallo identificados; se consideraron críticos aquellos con un NPR > 100. Se calculó también el NPR final (teórico) que se obtendría con las medidas propuestas y se rediseñó el proceso. Resultados. Se identificaron un total de 34 modos de fallo. El NPR inicial acumulado fue de 3022 (rango: 3-252), y tras las acciones recomendadas el NPR final fue de 1292 (rango: 3-189). Se obtuvieron puntuaciones de NPR > 100 en 13 modos de fallo; solo el subproceso de dispensación estuvo exento de puntos críticos (NPR > 100). Se consiguió una reducción del NPR final >50% en 9 modos de fallo. Conclusiones. Esta metodología de análisis de riesgo prospectiva nos permite priorizar los puntos débiles del sistema para optimizar el empleo de recursos y conseguir una mejora sustancial en la seguridad de la elaboración de citostáticos mediante la introducción del doble chequeo y el etiquetado de productos intermedios (AU)

Objective. To proactively identify risks in the preparation of intravenous cytostatic drugs, and to prioritise and establish measures to improve safety procedures. Material and methods. Failure Mode Effect Analysis methodology was used. A multidisciplinary team identified potential failure modes of the procedure through a brainstorming session. The impact associated with each failure mode was assessed with the Risk Priority Number (RPN), which involves three variables: occurrence, severity, and detectability. Improvement measures were established for all identified failure modes, with those with RPN > 100 considered critical. The final RPN (theoretical) that would result from the proposed measures was also calculated and the process was redesigned. Results. A total of 34 failure modes were identified. The initial accumulated RPN was 3022 (range: 3-252), and after recommended actions the final RPN was 1292 (range: 3-189). RPN scores > 100 were obtained in 13 failure modes; only the dispensing sub-process was free of critical points (RPN > 100). A final reduction of RPN > 50% was achieved in 9 failure modes. Conclusions. This prospective risk analysis methodology allows the weaknesses of the procedure to be prioritised, optimize use of resources, and a substantial improvement in the safety of the preparation of cytostatic drugs through the introduction of double checking and intermediate product labelling (AU)