[Expectations of private nurses in the care management of oncology and haematology patients]. / Attentes des infirmiers libéraux dans la prise en soins des patients en oncologie et en hématologie.

Toxicities from chemotherapy administered in an outpatient department occur mostly when patients return home. Support treatment prescriptions are given to them in order to prevent or limit these toxicities. The cancer plans also specify the need for collaboration between the city and the hospital. In this sense, it is interesting to take stock of the knowledge of private nurses caring for these patients and to identify their expectations.

Vascular Acrosyndromes Associated With Prolonged Tumor Response in Advanced Lung Cancer Patients During Treatment With Antimetabolites: A Report of Two Cases.

BACKGROUND: Pemetrexed and gemcitabine are both antimetabolites drugs approved in advanced non-small cell lung cancer (NSCLC). Their toxicity profile is well known. However, rare vascular side effects can occur such as vascular acrosyndromes and especially digital ischemia. The cause of this disfiguring and painful event is still controversial. Amputation is frequently required and has been described as a predictor of poor survival outcomes. CASE PRESENTATION: This report presents two cases of vascular acrosyndrome in NSCLC patients during treatment with antimetabolites (pemetrexed and gemcitabine). Patients presented severe digital ischemia having required prostacyclin analog and chemotherapy discontinuation. In one case, symptoms improved while in the other case symptoms persisted. Both patients experienced prolonged tumor response. These findings suggest a multifactorial mechanism behind digital necrosis including an autoimmune process, which could lead to prolonged tumor control as described with immune checkpoint inhibitors. CONCLUSION: Severe vascular acrosyndrome such as digital ischemia can occur in lung cancer patients treated with antimetabolites. Awareness needs to be raised when using these drugs in patients with predisposing factors. Whether occurrence of chemotherapy-induced immune vascular side effects might explain prolonged tumor response deserves further investigations.

Comprehensive two-dimensional gas chromatography coupled with time of flight mass spectrometry featuring tandem ionization: Challenges and opportunities for accurate fingerprinting studies.

The capture of volatile patterns from food is a fingerprinting that opens access to a high level of information related to functional variables (origin, processing, shelf-life etc.) and their impact on sample composition and quality. When the focus is on food volatilome, comprehensive two-dimensional gas chromatography combined with time-of-flight mass spectrometry (GC×GC-TOF MS) is undoubtedly the most effective technique to obtain a highly representative fingerprinting. A recently patented ion source, featuring variable-energy EI, when operated at low energies (10 eV, 12 eV, 14 eV), claims enhanced intensity of structure-indicating ions while minimizing the inherent loss of sensitivity due to low EI energies. The spectral acquisition is done by multiplexing between two ionization energies and generates tandem data streams in a single run. This study explores the potentials of combined untargeted/targeted (UT) fingerprinting with tandem signals to study the complex volatile metabolome of high quality cocoa. The quality of the spectra at 70 eV is confirmed by similarity match factors above a fixed threshold (950) while spectral differences between hard (70 eV) and soft (12 eV, 14 eV) ionization are computed in terms of spectral similarity and signal-to-noise ratio (SNR). Tandem signals are then processed independently and after fusion in a single stream (summed signal) by the UT fingerprinting work-flow; signal characteristics (SNR, detectable 2D peaks, spectral peak intensities) are then computed and adopted to define the best strategy to discriminate and classify samples. Classification performance, on processed cocoa from four different origins, is validated by cross-comparing results between single ionization channels and fused data streams and considering both targeted and untargeted features. Classification results indicate the potential for superior performances of UT fingerprinting with fused data streams (summed signals), while signal characteristics at low ionization energies not only offer additional elements to better discriminate and/or identify isomeric analytes but also to achieve wider dynamic range of exploration.

Odorants quantitation in high-quality cocoa by multiple headspace solid phase micro-extraction: Adoption of FID-predicted response factors to extend method capabilities and information potential.

This paper focuses on several methodological aspects in the quantitation of volatiles in solid samples by headspace solid phase micro-extraction (HS-SPME) combined with gas chromatography and parallel detection by flame ionization detector and mass spectrometry (GC-FID/MS). Informative volatiles, including key odorants and process markers, from single-origin cocoa samples (Colombia, Ecuador, Mexico, Sao Tomè, and Venezuela) were captured at two processing stages along the chocolate production chain (nibs and cocoa mass). Accurate quantitation was achieved by multiple headspace extraction (MHE) in headspace linearity conditions and by external calibration. Quantitative results on selected analytes (3-hydroxy-2-butanone, 2-heptanol, 2,3,5-trimethylpyrazine, 2-ethyl-3,6-dimethylpyrazine, ethyl octanoate, benzaldehyde, 2-methylpropionic acid, 3-methylbutyric acid, ethyl phenylacetate, 2-phenylethyl acetate, guaiacol, 2-phenylethanol, and (E)-2-phenyl-2-butenal) provided reliable information about the key sensory notes of cocoa intermediates (odor activity values) and their origin specificities. Additional information about analytes release by the solid environment (cocoa nibs, mass, and powders) was achieved by modeling decay curves. Parallel detection by MS and FID enabled quantitative cross-validation, and FID-predicted relative response factors (RRFs) extended method quantitation capabilities to additional compounds that were not subjected to an external calibration procedure: 3-methylbutyl acetate (isoamyl acetate), 2-heptanone, heptanal, 2-nonanone, γ-butyrolactone, octanoic acid, 2-ethyl-5(6)-methylpyrazine, phenylacetic acid, phenol, 2-acetyl pyrrole, and 2,3-dihydro-3,5-dihydroxy-6-methyl(4H)-pyran-4-one. This procedure extends method capabilities and information potential with great consistency.

Prediction of response factors for gas chromatography with flame ionization detection: Algorithm improvement, extension to silylated compounds, and application to the quantification of metabolites.

We previously showed that the relative response factors of volatile compounds were predictable from either combustion enthalpies or their molecular formulae only . We now extend this prediction to silylated derivatives by adding an increment in the ab initio calculation of combustion enthalpies. The accuracy of the experimental relative response factors database was also improved and its population increased to 490 values. In particular, more brominated compounds were measured, and their prediction accuracy was improved by adding a correction factor in the algorithm. The correlation coefficient between predicted and measured values increased from 0.936 to 0.972, leading to a mean prediction accuracy of ± 6%. Thus, 93% of the relative response factors values were predicted with an accuracy of better than ± 10%. The capabilities of the extended algorithm are exemplified by (i) the quick and accurate quantification of hydroxylated metabolites resulting from a biodegradation test after silylation and prediction of their relative response factors, without having the reference substances available; and (ii) the rapid purity determinations of volatile compounds. This study confirms that Gas chromatography with a flame ionization detector and using predicted relative response factors is one of the few techniques that enables quantification of volatile compounds without calibrating the instrument with the pure reference substance.

Differentiation of lemon essential oil based on volatile and non-volatile fractions with various analytical techniques: a metabolomic approach.

Due to the importance of citrus lemon oil for the industry, fast and reliable analytical methods that allow the authentication and/or classification of such oil, using the origin of production or extraction process, are necessary. To evaluate the potential of volatile and non-volatile fractions for classification purposes, volatile compounds of cold-pressed lemon oils were analyzed, using GC-FID/MS and FT-MIR, while the non-volatile residues were studied, using FT-MIR, (1)H-NMR and UHPLC-TOF-MS. 64 Lemon oil samples from Argentina, Spain and Italy were considered. Unsupervised and supervised multivariate analyses were sequentially performed on various data blocks obtained by the above techniques. Successful data treatments led to statistically significant models that discriminated and classified cold-pressed lemon oils according to their geographic origin, as well as their production processes. Studying the loadings allowed highlighting of important classes of discriminant variables that corresponded to putative or identified chemical functions and compounds.

Comprehensive profiling and marker identification in non-volatile citrus oil residues by mass spectrometry and nuclear magnetic resonance.

The detailed characterization of cold-pressed lemon oils (CPLOs) is of great importance for the flavor and fragrance (F&F) industry. Since a control of authenticity by standard analytical techniques can be bypassed using elaborated adulterated oils to pretend a higher quality, a combination of advanced orthogonal methods has been developed. The present study describes a combined metabolomic approach based on UHPLC-TOF-MS profiling and (1)H NMR fingerprinting to highlight metabolite differences on a set of representative samples used in the F&F industry. A new protocol was set up and adapted to the use of CPLO residues. Multivariate analysis based on both fingerprinting methods showed significant chemical variations between Argentinian and Italian samples. Discriminating markers identified in mixtures belong to furocoumarins, flavonoids, terpenoids and fatty acids. Quantitative NMR revealed low citropten and high bergamottin content in Italian samples. The developed metabolomic approach applied to CPLO residues gives some new perspectives for authenticity assessment.