Watson Clinic

Objective: To establish a robust ultra-high performance liquid chromatography coupled to mass spectrometry (UHPLC-MS/MS) method for the simultaneous determination of imidazole compounds and their enantiomers in blood, urine, and hair. Materials and Methods: Blood and urine samples were subjected to protein precipitation with acetonitrile, whereas hair samples were pulverized after washing and extracted with methanol, followed by ultrasonication and centrifugation. The supernatant was filtered through a 0.22 μm membrane for analysis. Enantiomeric separation was achieved on a Phenomenex Lux ® Cellulose-3 chiral column using an isocratic mobile phase of 5 mmol/L ammonium acetate with 0.1% formic acid (60%) and acetonitrile (40%) at a flow rate of 0.5 mL/min. Detection was performed in positive electrospray ionization mode with multiple reaction monitoring. The method was validated according to international forensic toxicology standards and applied to authentic case samples. Results: The method demonstrated excellent selectivity and linearity ( R ²>0.996). Calibration ranges were 5–3000 ng/mL for blood and urine and 0.05–30 ng/mg for hair. Limits of detection were 1 ng/mL for blood and urine and 0.02 ng/mg for hair, with corresponding limits of quantification (LLOQ) of 5 ng/mL and 0.05 ng/mg. Accuracy ranged from 86.00% to 114.58%, recoveries exceeded 86.75%, and matrix effects were within 0.01%–14.82%, all meeting forensic validation criteria. Application to 22 authentic hair samples revealed widespread exposure to etomidate, with the R-isomers of metomidate, propoxate, and isopropoxate detected more frequently and at higher concentrations than their S-counterparts. Conclusion: The established UHPLC-MS/MS method provides high sensitivity, selectivity, and reproducibility, with a wide linear range and straightforward sample preparation. Its successful application to multiple biological matrices underscores its potential as a powerful tool for the screening, quantification, and source tracing of imidazole compounds and their enantiomers in forensic toxicology and drug abuse monitoring.

Examinamos neste artigo a arrojada tese defendida por Abib no ensaio “O que é Comportamentalismo?”, qual seja, a de que a história do Comportamentalismo começa com Skinner, e não com Watson. Para explicitar seus argumentos, apresentamos, inicialmente, a forma de trabalho intertextual de Abib, pautada em uma interpelação filosófica e cultu­ral do texto psicológico. Com base nesse método, Abib delineia uma história filosófica do Comportamentalismo, descortinando os compromissos epistemológicos e metafísicos das teorias do comportamento de J. B. Watson, E. C. Tolman e B. F. Skinner. O resultado dessa investigação conceitual mostra que apenas a teoria de Skinner é capaz de realizar o sentido originário da proposta de psicologia comportamentalista, que é explicar os fenômenos psi­cológicos no comportamento. Destacamos algumas vantagens da história filosófica de Abib sobre outras versões da história do Comportamentalismo, e concluímos que sua análise ar­queológica fornece ferramentas heurísticas profícuas para nos ajudar no debate sobre pro­postas comportamentais contemporâneas.

Abstract INTRODUCTION: Routine resection of cavity shave margins has been shown in single center studies to result in a significant reduction in positive margin and re-excision rates. In this prospective multicenter randomized controlled trial, we sought to validate these findings across practice settings. METHODS: Nine centers across the United States, varying in practice setting and patient population, participated in this clinical trial of 398 stage 0-III breast cancer patients undergoing partial mastectomy (with or without resection of selective cavity margins). Participants were stratified by clinical stage and randomized 1:1 to either have routine cavity shave margins resected (“shave”) or not (“no shave”). Randomization group was revealed to the surgeon intraoperatively, after they had completed their standard partial mastectomy and were ready to close. Positive margins were defined as “tumor at ink” for invasive cancer or within 2 mm for ductal carcinoma in situ (DCIS). Adverse events were defined as seromas requiring percutaneous drainage, and/or hematomas or abscesses requiring operative intervention. RESULTS: Median patient age was 65 (range; 29-94). 116 patients had invasive disease, 74 had DCIS, 179 had both, and 29 had no residual cancer at the time of partial mastectomy. The median invasive cancer size was 1.2 cm (range; 0.05-8.00 cm); the median extent of DCIS was 0.9 cm (range; 0.05-6.40 cm). The “shave” and “no shave” groups were well matched at baseline for clinicopathologic and demographic factors. FactorShave (n=197)No Shave (n=201)p-valueAge (years); median (range)67 (36-94)64 (29-89)0.585Race 0.062-- White173 (87.8%)164 (81.6%) -- Black20 (10.2%)33 (16.4%) -- Asian2 (1.0%)2 (1.0%) -- Native American0 (0%)2 (1.0%) -- Unknown/Declined2 (1.0%)0 (0%) Hispanic ethnicity28 (14.2%)32 (15.9%)0.806Invasive tumor size (cm); median (range)1.30 (0.09-8.00)1.20 (0.05-7.50)0.282DCIS extent (cm); median (range)0.80 (0.10-6.40)1.00 (0.05-5.50)0.906Invasive histology 0.556-- Ductal177 (89.8%)186 (92.5%) -- Lobular16 (8.1%)13 (6.5%) -- Mucinous3 (1.5%)2 (1.0%) -- Other1 (0.5%)0 (0%) Neoadjuvant therapy15 (7.6%)19 (9.5%)0.592Palpable tumor57 (28.9%)56 (27.9%)0.825Node positive*24 (16.3%)16 (10.6%)0.175*Of the 298 patients who had lymph nodes evaluated Prior to randomization, positive margin rates were similar in the “shave” and “no shave” groups (38.1% vs. 37.3%, respectively, p=0.918). After randomization, however, those in the “shave” group were significantly less likely than those in the “no shave” group to have positive margins (8.6% vs. 37.3%, respectively, p<0.001). They were also less likely to require re-excision or mastectomy for margin clearance (8.6% vs. 23.9%, p<0.001). There were no significant differences between the two groups in terms of adverse events (p=0.280). Rates of seroma (1.5% vs. 0.5%, p=0.368), hematoma (0.5% vs. 0.5%, p=1.000) and abscess (0.3% vs. 0%, p=0.495) were similar between the “shave” and “no shave” groups, respectively. CONCLUSION: Resection of cavity shave margins significantly reduces positive margin and re-excision rates in patients with stage 0-III breast cancer undergoing partial mastectomy. Citation Format: Chagpar AB, Tsangaris T, Garcia-Cantu C, Howard-McNatt M, Chiba A, Berger AC, Levine E, Gass JS, Gallagher K, Lum SS, Martinez RD, Willis AI, Pandya SV, Brown EA, Fenton A, Mendiola A, Murray M, Haddad V, Solomon NL, Senthil M, Bansil H, Ollila D, Snyder SK, Edmonson D, Lazar M, Namm JP, Li F, Butler M, McGowan NE, Herrera ME, Avitan YP, Yoder B, Dupont E. Does resection of cavity shave margins result in lower positive margin and re-excision rates in patients with stage 0-III breast cancer? Results from a prospective multicenter randomized controlled trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD8-07.

Hospice care is medical care provided to terminally ill patients with a life expectancy of 6 months or less. Hospice services include symptom control, pain management, palliative care, and other supportive services such as providing for home equipment or oxygen; however, it does not provide for life-prolonging therapies such as chemotherapy. Although oncologic benchmarks suggest patients should be enrolled in hospice 3 months prior to death, studies show that most hospice referrals are being made too late. These shorter stays in hospice result in increased cost of care especially at the end of life with most patients dying on aggressive treatments in the hospital. Thus, identifying barriers to hospice placement is critical in improving the referral process and enhancing the quality of end-of-life care. This retrospective study collected data on 418 oncologic patients who passed in 2015 and categorized patients based on hospice status at the time of death. Our study found that the demographics between hospice and nonhospice patients were not significantly different. Hospice patients spent a median of 10 days in hospice and 71% (n = 161) of patients were in hospice 30 days or less. Additionally, 56% of patients were in hospice 10 days or less. Increased education for patients and health-care providers along with better utilization of palliative care services and incorporating a nurse navigator to help with transitioning patients to hospice would improve earlier referral to hospice care and enhance patients' quality of life.

To the Editors: oniliformis moniliformis (thorny headed worm) is 1 of the 5 Acanthocephalan species widely distributed throughout the world. This helminth resides in the intestines of rodents, dogs, and cats, which serve as its definitive hosts. Infection with M. moniliformis is spread via intermediary hosts, primarily cockroaches, and beetles. Human infection with this organism is rare. The last reported case of human infection with M. moniliformis in the United States was in a boy from Pensacola, FL in 1989.1 We report 2 cases of M. moniliformis infection in central Florida. The first patient was a 23-month-old otherwise healthy girl with worms in her stool for 2 months. She was otherwise asymptomatic. She was treated for a presumed tapeworm infection with mebendazole, however, the worms persisted. The patient's stool sample contained a visible cream-colored worm which was approximately 20-cm long. The worm was segmented, with a beaded appearance, and did not have the typical flattened appearance of a tapeworm. Oval-shaped eggs measuring 60 × 83 μm were seen on microscopic examination. Based upon the morphology and measurement of the parasite and the ova, the worm was identified as M. moniliformis. Animal exposures included a dog and cat. She frequently put items, including insects, found on floor into her mouth. She was treated with three 11-mg/kg doses of pyrantel pamoate separated by 2-week intervals. No worms were seen after the third dose. She remains asymptomatic. The second patient was a 15-month-old girl from central Florida who also experienced asymptomatic passage of worms in the stool, identified as M. moniliformis (Figure). Animal exposures included a pet chinchilla as well as chickens, cows, dogs, cats, and young squirrels at her grandparent's farm. Her parents and grandparents had witnessed her putting cockroaches in her mouth on several occasions. The child was also was treated with mebendazole, followed by pyrantel pamoate after identification of the organism was made. No more worms were seen in the stool after treatment. The patient has continued to do well with no symptoms.FIGURE 1.: A, Macroscopic view of M. moniliformis from stool sample of patient 2. B, Microscopic view of M. moniliformis eggs from stool sample of patient 2.Human infection with any of the Acanthocephalan worms is rare, but is most commonly caused by infection with M. moniliformis and Macracanthorhyncus hirudinaeceus.2 Acanthocephalan worms possess unique physical characteristics helpful in identification. They lack a digestive tract, a coelom, and a circulatory system. They are also distinguished by their spinous retractile proboscis (“thorny head”), which enables attachment to the intestinal wall, and by their spindle shaped, pseudo-segmented body. Adult female worms measure 100 to 270 mm and males measure 40 to 130 mm. Their thick-walled, oval shaped eggs measure 85 to 118 × 40 to 52 μm.3 A wide range symptoms have been described, including diarrhea, weight loss, irritability, edema, weakness,4,5,6 and asymptomatic passage of worms.1,3,7 In many cases, there is a history of ingestion of a beetle, or a cockroach. Many cases are described in toddlers, who may be at particular risk because of their propensity to put nonfood objects into their mouths. ACKNOWLEDGMENT The authors thank Karen Kelly, MLS (ASCP) for specimen processing and images. Allison F. Messina, MD Division of Infectious Diseases Department of Pediatrics All Children's Hospital Frederick J. Wehle, Jr, MD Department of Pediatrics The Watson Clinic LLP Lakeland, FL Si Intravichit, MT, ASCP Kenneth Washington, MD Department of Pathology and Laboratory Medicine All Children's Hospital Saint Petersburg, FL