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Various plants native to arid and semiarid habitats throughout the southwestern United States, Baja California, and northern Mexico were bioassayed for phototoxic natural products. Approximately 115 species representing 57 genera and eight plant families were assayed for phototoxic activity by standard antimicrobial techniques usingEscherichia coli andSaccharomyces cerevisiae. Phototoxic constituents were extracted from numerous members in the Asteraceae (Compositae) and occurred with highest frequency among species of the subtribe Pectidinae (tribe Heliantheae). Extracts ofPectis, the largest genus in the Pectidinae, had substantial light-activated biocidal action despite the paucity of acetylenic thiophenes, the phototoxins characteristic of most other genera in the subtribe. Leaf resin from the creosote bush [Larrea tridentata (Sesse & Mol. ex DC.) Coville; Zygophyllaceae], a dominant desert shrub, possessed potent antimicrobial activity in the absence of light; however, the toxicity of this extract was slightly enhanced in the presence of UVA irradiation. Phototoxic antimicrobials were not detected in extracts of selected species from the Asclepiadaceae, Chenopodiaceae, Hydrophyllaceae, Lamiaceae, Polygonaceae, or Solanaceae.

Clinical guidelines suggest neoadjuvant cisplatin-based chemotherapy prior to cystectomy in the setting of muscle-invasive bladder cancer (MIBC). A creatinine clearance (CrCl) >60 mL/min is frequently used to characterize cisplatin-eligible patients, and use of the CKD-EPI equation to estimate CrCl has been advocated. From a prospectively maintained institutional database, patients with MIBC who received cystectomy were identified and clinicopathologic information was ascertained. CrCl prior to surgery was computed using three equations: (1) Cockcroft-Gault (CG), (2) CKD-EPI, and (3) MDRD. The primary objective was to determine if the CG and CKD-EPI equations identified a different proportion of patients who were cisplatin-eligible, based on an estimated CrCl of >60 mL/min. Cisplatin-eligibility was also assessed in subsets based on age, CCI score and race. Actuarial rates of neoadjuvant cisplatin-based chemotherapy use were also reported. Of 126 patients, 70% and 71% of patients were found to be cisplatin-eligible by the CKD-EPI and CG equations, respectively (P = 0.9). The MDRD did not result in significantly different characterization of cisplatin-eligibility as compared to the CKD-EPI and CG equations. In the subset of patients age >80, the CKD-EPI equation identified a much smaller proportion of cisplatin-eligible patients (25%) as compared to the CG equation (50%) or the MDRD equation (63%). Only 34 patients (27%) received neoadjuvant cisplatin-based chemotherapy. Of the 92 patients who did not receive neoadjuvant chemotherapy, 64% had a CrCl >60 mL/min by CG. In contrast to previous reports, the CKD-EPI equation does not appear to characterize a broader span of patients as cisplatin-eligible. Older patients (age >80) may less frequently be characterized as cisplatin-eligible by CKD-EPI. The discordance between actual rates of neoadjuvant chemotherapy use and rates of cisplatin eligibility suggest that other factors (e.g., patient and physician preference) may guide clinical decision-making.

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