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More than 50% of pharmaceuticals in current use are chiral compounds. Enantiomers of the same pharmaceutical have identical physicochemical properties, but may exhibit differences in pharmacokinetics, pharmacodynamics and toxicity. The advancement in separation and detection methods has made it possible to analyze trace amounts of chiral compounds in environmental media. As a result, interest on chiral analysis and evaluation of stereoselectivity in environmental occurrence, phase distribution and degradation of chiral pharmaceuticals has grown substantially in recent years. Here we review recent studies on the analysis, occurrence, and fate of chiral pharmaceuticals in engineered and natural environments. Monitoring studies have shown ubiquitous presence of chiral pharmaceuticals in wastewater, surface waters, sediments, and sludge, particularly β-receptor antagonists, analgesics, antifungals, and antidepressants. Selective sorption and microbial degradation have been demonstrated to result in enrichment of one enantiomer over the other. The changes in enantiomer composition may also be caused by biologically catalyzed chiral inversion. However, accurate evaluation of chiral pharmaceuticals as trace environmental pollutants is often hampered by the lack of identification of the stereoconfiguration of enantiomers. Furthermore, a systematic approach including occurrence, fate and transport in various environmental matrices is needed to minimize uncertainties in risk assessment of chiral pharmaceuticals as emerging environmental contaminants.

PURPOSE Effective interventions to improve prognosis in metastatic esophagogastric cancer (EGC) are urgently needed. We assessed the effect of the early integration of interdisciplinary supportive care for patients with metastatic EGC on overall survival (OS). PATIENTS AND METHODS An open-label, phase III, randomized, controlled trial was conducted at Peking University Cancer Hospital & Institute. Patients with previously untreated metastatic EGC were enrolled. Patients were randomly assigned (2:1) to either early interdisciplinary supportive care (ESC) integrated into standard oncologic care or standard care (SC). ESC was provided by a team of GI medical oncologists, oncology nurse specialists, dietitians, and psychologists; patients in the SC group received standard oncologic care alone. The primary end point was OS in the intention-to-treat population. RESULTS Between April 16, 2015, and December 29, 2017, 328 patients were enrolled: 214 in the ESC group and 114 in the SC group. At the data cutoff date of January 26, 2019, 15 (5%) patients were lost to follow-up. The median number of cycles of first-line chemotherapy was five (interquartile range [IQR], 4-7) in the ESC group and four (IQR, 2-6) in the SC group. The median OS was 14.8 months (95% CI, 13.3 to 16.3) in the ESC group and 11.9 months (95% CI, 9.6 to 13.6) in the SC group (hazard ratio, 0.68; 95% CI, 0.51 to 0.9; P = .021). CONCLUSION The early integration of interdisciplinary supportive care is an effective intervention with survival benefits for patients with metastatic EGC. Further optimization and standardization are warranted.

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Tono-Pen and TonoVet have been used in rabbits to measure intraocular pressure (IOP) and investigate the effect of IOP lowering therapies. Therefore, their reliability and accuracy are very important and deserve careful evaluation. Our results showed that the with-subject deviation (Sw) and intraclass correlation coefficient (ICC) of the TonoVet and Tono-Pen were 0.61 mmHg/0.83 mmHg and 0.97/0.94, respectively for intrasession repeatability. For intersession reproducibility, the Sw and ICC of TonoVet and Tono-Pen were 1.42 mmHg/1.66 mmHg and 0.73/0.67, respectively. For interoperator reproducibility, the Sw and ICC of the TonoVet and Tono-Pen were 0.72 mmHg/1.11 mmHg and 0.91/0.82 respectively. Both TonoVet and Tono-Pen underestimated the IOP measured by manometry. The regression function was: y = 0.8249x + 0.1011 and y =0.6881x + 2.2290 for TonoVet and Tono-Pen, respectively. Our study suggests that both TonoVet and Tono-Pen had excellent intrasession repeatability and inter-operator reproducibility, but good intersession reproducibility. Both TonoVet and Tono-Pen correlated well with manometry, but underestimated the manometric IOP with presence of fixed and proportional biases. These factors should be considered when measuring IOP with Tono-Pen or TonoVet in rabbit eyes.