Development of a specific fragment pattern-based quadrupole-Orbitrap mass spectrometry method to screen adulterated products of phosphodiesterase-5 inhibitors and their analogues

Recently, adulterated supplements with phosphodiesterase-5 inhibitors (PDE-5i) have frequently observed. New synthetic analogues obtained from the chemical modification of parent compounds are frequently found in illicit products despite continuous efforts to inspect for these adulterants. A rapid and accurate method based on quadrupole-Orbitrap mass spectrometry was developed for simultaneously confirming and quantifying 85 PDE-5i and derived analogues present in illicit products for erectile dysfunction (ED). Common ions of PDE-5i according to their similar structures were proposed based on MS/MS fragmentations. These common ions could be an important diagnosis of their presence targets or new emerging analogues in supplements. Several validation parameters were employed, resulting in a limit of detection and quantification of 0.09–8.55 ng/mL and 0.24–17.10 ng/mL, respectively. The linear correlation coefficient (r²) was higher than 0.995, and mean recoveries of target compounds were in the range of 82–118%. A total of 187 illicit products, obtained from on/offline markets over a period of 3 years (2015–2017), were screened by the established method. Approximately 53% of them were adulterated with PDE-5i or derived analogues at concentrations of 0.1–726.0 mg/g in the illicit products. In the interests of public health, this study describes a rapid and accurate method to determine PDE-5i and new emerging analogues in adulterated products.     

Confucian bioethics and cross-cultural considerations in health care decision-making

This article discusses the similarities and differences between Beauchamp and Childress's principlism and Confucian bioethics in terms of autonomy, beneficence, nonmaleficence, and justice. The author presents sensitive approaches for culturally diverse groups in health care areas and cautions against dichotomy in cross-cultural studies, which ignores the dynamic nature and intravariations of cultures. As a way of health care providers to become engaged in cultural diversity in nursing practice and research, the author suggests that they do not only have a general knowledge about the theoretical differences among groups through "normative analysis" but also learn to appreciate each individual's particular beliefs and values through narratives of morality. Health care providers as well as legal professionals need to cultivate "cultural humility," which is the willingness to explore the similarities and differences between their own and each client's priorities and values and to develop courses of action with patients.