Developing Benchmarking Metrics for Appropriate Ordering of Vitamin D, Thyroid Testing, and Iron Workups.

Background: Laboratory stewardship programs are increasingly adopted to enhance test utilization and improve patient care. Despite their potential, implementation within complex healthcare systems remains challenging. Benchmarking metrics helps institutions compare their performance against peers or best practices.

Cannabis positivity rates in 17 emergency departments across the United States with varying degrees of marijuana legalization.

Background: Many states in the United States have progressed towards legalization of marijuana including decriminalization, medicinal and/or recreational use. We studied the impact of legalization on cannabis-related emergency department visits in states with varying degrees of legalization.

Methods: Seventeen healthcare institutions in fifteen states (California, Colorado, Connecticut, Florida, Iowa, Kentucky, Maryland, Massachusetts, Missouri, New Hampshire, Oregon, South Carolina, Tennessee, Texas, Washington) participated.

How the VALID Act could affect patient access to laboratory developed testing for therapeutic drug monitoring.

•LDTs are important to lab medicine as they allow flexibility for laboratories to provide testing that patients need.•Many TDMs are LCMS-based and are considered LDTs.•Some TDMs currently have little to no options for obtaining FDA cleared testing.

A 24-Hour Extended Calibration Strategy for Quantitating Tacrolimus Concentrations by Liquid Chromatography-Tandem Mass Spectrometry.

Background: Tacrolimus has a low therapeutic index requiring strict control of whole blood concentrations. Although random access immunoassay platforms exist that rapidly provide quantitative values for tacrolimus, LC-MS/MS may provide more accurate quantitation. However, batch testing in many LC-MS/MS assays is not efficient, particularly when testing patients suspected of having tacrolimus toxicity.

Dilution of Urine Followed by Adulteration in an Attempt to Deceive the Laboratory.

Adulteration of samples submitted for toxicological analyses can present unique challenges to non-forensic clinical laboratories. With the number of overdose-related deaths expected to surpass 60,000 in 2018, it is incumbent on all members of the healthcare team to be active participants in curbing opioid dependence and identifying prescription drug misuse and diversion. Recently published guidelines have sought to provide guidance to laboratories overseeing prescription drug-monitoring programs.

A Young Woman With Recurrent Gestational Hypercalcemia and Acute Pancreatitis Caused by CYP24A1 Deficiency.

The CYP24A1 gene encodes a mitochondrial 24-hydroxylase that inactivates 1,25(OH) D. Loss-of-function mutations in CYP24A1 cause hypercalcemia, nephrolithiasis and nephrocalcinosis. We describe a woman with CYP24A1 deficiency and recurrent gestational hypercalcemia.

Evaluation of the Waters MassTrak LC-MS/MS Assay for Tacrolimus and a Comparison to the Abbott Architect Immunoassay.

Background: Tacrolimus (Prograf, Advagraf, and FK-506) is the most commonly prescribed calcineurin inhibitor after kidney and liver transplantation. The use of tacrolimus (in conjunction with other drugs) has successfully contributed to the maintenance of solid organ allografts; however, it also exhibits toxic side effects. Therapeutic drug monitoring of tacrolimus is used as an aid to achieve drug concentrations within a narrow therapeutic window.

Comparative analysis of hospital and forensic laboratory ethanol concentrations: A 15 month investigation of antemortem specimens.

Quantitative serum alcohol concentrations from regional hospitals (from specimens collected at time of hospital admission) were compared to results from whole blood (from specimens collected at the time of hospital admission) concentrations measured at the San Diego County Medical Examiner's Office (SDCMEO). Over a 15 month period (January 2012 to March 2013), the postmortem forensic toxicology laboratory analyzed a total of 2,321 cases. Of these, 280 were hospital cases (antemortem) representing 12% of the overall Medical Examiner toxicology casework.

Evaluation and comparison of postmortem hydrocodone concentrations in peripheral blood, central blood and liver specimens: a minimal potential for redistribution.

Postmortem changes can alter the concentration of drugs in the vascular compartment as compared with concentrations originally present at the time of death. Numerous drugs have been reported to increase due to postmortem redistribution (PMR). The potential for PMR of hydrocodone, a therapeutic opioid analgesic used to manage pain, is of particular interest due to its wide use.

False-positive interferences of common urine drug screen immunoassays: a review.

Urine drug screen (UDS) immunoassays are a quick and inexpensive method for determining the presence of drugs of abuse. Many cross-reactivities exist with other analytes, potentially causing a false-positive result in an initial drug screen. Knowledge of these potential interferents is important in determining a course of action for patient care.

Synthesis of a highly functionalized core of verrillin.

An efficient stereoselective synthesis of furanoverrillin (5), a highly functionalized core of verrillin (1), is reported. The synthetic strategy is based on constructing bicyclic lactone 17 prior to the 10-membered ring macrocyclization. The effect of the C4 methyl group on the furan reactivity is also discussed.

A strategy toward the synthesis of C-oxidized cembrenolides.

An efficient strategy for the construction of C-oxidized cembrenolides is reported. Central to this strategy is the installation of the C hydroxyl group prior to cembrane macrocyclization (via formation of the C-C bond), allowing access to both C alcohol epimers. The orientation of the C alcohol was found to influence the cyclization mode of the cembranolide scaffold upon furan oxidation, leading to motifs reminiscent to bipinnatolide F, bielschowskysin, and verrillin.

Total synthesis of norcembrenolide B and scabrolide D.

An efficient stereoselective synthesis of norcembrenolide B (8) and scabrolide D (9) is reported. The strategy is inspired by biogenetic relationships of related cembrenoids. Central to this approach is the construction of norbipinnatin J which upon selective C2 deoxygenation and C8 oxygenation produces norrubifolide and norcoralloidolide A.