Legacy and novel perfluoroalkyl substances in raw and cooked squids: Perspective from health risks and nutrient benefits

Perfluoroalkyl substance (PFAS) existed ubiquitously in the environment and could be ingested unconsciously with food which posed a disease risk to human health. Swordtip squid (Uroteuthis edulis) is one of the most popular and highly consumed seafood worldwide, with wide distribution and abundant biomass. Therefore, it is of great importance to the health of the public by reducing the health risks of squid consumption while preserving the benefits of squid to humans. In this study, the PFAS and fatty acids in squids were tested from the southeast coastal regions of China, a major habitat for squids. Relative higher concentrations of PFAS in squid were found in the subtropical zone of southern China (mean: 15.90 ng/g·dw) compared to those of the temperate zone of northern China (mean: 11.77 ng/g·dw). The digestive system had high tissue/muscle ratio (TMR) values, and the pattern of TMR among the same carbon-chain PFAS was similar. Cooking methods have a significant contribution to eliminating PFAS (in squids). PFAS were transferred from squids to other mediums after cooking, so juice and oil should be poured out to minimize PFAS exposure into body. The result showed that squids can be regarded as a healthy food by health benefits associated with fatty acids. Estimated daily intake (EDI) had the highest level in Korea via consuming squids through cooking processes compared with other countries. Based on the assessment of the hazard ratios (HRs), there was a high exposure risk of perfluoropentanoic acid (PFPeA) via taking squids for human health. This research provided the theoretical guidance of aquatic product processing in improving nutrition and reducing harmful substances.

Androgens in endometrial carcinoma: the killer or helper?

PURPOSE

The aim of this review is to discuss the role of androgens in the progression of endometrial carcinoma (EC) with particular focus on the different kinds of androgenic hormones, androgen receptor (AR) and intracrine androgen metabolism.

METHODS

A comprehensive literature search within PubMed was performed. Selected publications related to androgens and EC were reviewed.

RESULTS

There are different kinds of androgenic hormones, and different kinds of androgens may have different effects. Elevated androgens (especially testosterone) have been associated with an increased EC risk in postmenopausal women. 5α-reductases (5α-Reds) and 17β-hydroxysteroid dehydrogenase type 2 (17βHSD2) pathway may inhibit the progression of EC mediated by dihydrotestosterone (DHT), but aromatases stimulate further progression of EC. The most of studies accessing the prognostic value of AR have found that AR expression may be a favorable prognostic indicator.

CONCLUSION

Androgens may have both oncogenic and tumor suppressive roles. Androgen-specific biases in metabolism and the expression of AR may contribute to the different prognosis of patients with EC.

Patient preferences for features of HER2-targeted treatment of advanced or metastatic breast cancer: a discrete-choice experiment study

BACKGROUND

We aimed to quantify patients' benefit-risk preferences for attributes associated with human epidermal growth factor receptor 2 (HER2)-targeted breast cancer treatments and estimate minimum acceptable benefits (MABs), denominated in additional months of progression-free survival (PFS), for given treatment-related adverse events (AEs).

METHODS

We conducted an online discrete-choice experiment (DCE) among patients with self-reported advanced/metastatic breast cancer in the United States, United Kingdom, and Japan (N = 302). In a series of nine DCE questions, respondents chose between two hypothetical treatment profiles created by an experimental design. Profiles were defined by six attributes with varying levels: PFS, nausea/vomiting, diarrhea, liver function problems, risk of heart failure, and risk of serious lung damage and infections. Data were analyzed using an error component random-parameters logit model.

RESULTS

Among the attributes, patients placed the most importance on a change in PFS from 5 to 26 months; change from no diarrhea to severe diarrhea was the least important. Avoiding a 15% risk of heart failure had the largest MAB (5.8 additional months of PFS), followed by avoiding a 15% risk of serious lung damage and infections (4.6 months), possible severe liver function problems (4.2 months), severe nausea/vomiting (3.7 months), and severe diarrhea (2.3 months) compared with having none of the AEs. The relative importance of 21 additional months of PFS (increasing from 5 to 26 months) increased for women with HER2-negative disease and those with children.

CONCLUSIONS

Patients valued PFS gain higher than the potential risk of AEs when deciding between hypothetical breast cancer treatments.

Use of composite outcomes to assess risk-benefit in clinical trials

Before a novel treatment can be deemed a clinical success, an assessment of its risk-benefit profile must be made. One of the inherent challenges for this assessment comes from the multiplicity that arises from comparing treatment groups across multiple outcomes. Composite outcomes that summarize a patient's clinical status, or severity, across a prioritized list of safety and efficacy outcomes have become increasing popular. In this article, we review these approaches and illustrate through examples some of the challenges and complexities of a composite derived from prioritized outcomes, such as the win ratio. These challenges include the difficult tension between the analytical validity that comes from choosing a pre-specified outcome and an evaluation that is responsive to unexpected safety events that arise during the course of a trial. Other challenges include a sensitivity of the resulting test statistic to the underlying censoring distribution and other nuisance parameters. Approaches that resolve some of the difficulties of the analytical challenges associated with prioritized outcomes are then discussed. Ultimately, a composite outcome of net clinical benefit is another decision tool, but one to be used alongside more traditional analyses of efficacy and safety, and with the broader perspective that investigators, the data safety monitoring board, and regulators bring to an evaluation of risk-benefit.

Risk of cancer death by comorbidity severity and use of adjuvant chemotherapy among women with locoregional breast cancer

OBJECTIVES

To examine the associations of comorbidity and chemotherapy with breast cancer- and non-breast cancer-related death.

MATERIALS AND METHODS

Included were women with invasive locoregional breast cancer diagnosed in 2004 from seven population-based cancer registries. Data were abstracted from medical records and verified with treating physicians when there were inconsistencies and missing information on cancer treatment. Comorbidity severity was quantified using the Adult Comorbidity Evaluation 27. Treatment guideline concordance was determined by comparing treatment received with the National Comprehensive Cancer Network guidelines. Kaplan-Meier method and multivariable Cox proportional hazards regressions were employed for statistical analyses.

RESULTS

Of 5852 patients, 76% were under 70years old and 69% received guideline concordant adjuvant chemotherapy. Comorbidity was more prevalent in women age 70 and older (79% vs. 51%; p<0.001). After adjusting for tumor characteristics and treatment, severe comorbidity burden was associated with significantly higher cancer-related mortality in older patients (Hazard Ratio [HR]=2.38, 95% CI 1.08-5.24), but not in younger patients (HR=1.78, 95% CI 0.87-3.64). Among patients receiving guideline adjuvant chemotherapy, cancer-related mortality was significantly higher in older patients (HR=2.35, 95% CI 1.52-3.62), and those with severe comorbidity (HR=3.79, 95% CI 1.72-8.33).

CONCLUSIONS

Findings suggest that, compared to women with no comorbidity, patients with breast cancer age 70 and older with severe comorbidity are at increased risk of dying from breast cancer, even after adjustment for adjuvant chemotherapy and other tumor and treatment differences. This information adds to risk-benefit discussions and emphasizes the need for further study of the role for adjuvant chemotherapy in these patient groups.

The importance of the patient voice in vaccination and vaccine safety-are we listening?

Much has been written about the patient-physician relationship over the years. This relationship is essential in maintaining trust in the complex arena of modern diagnostic techniques, treatment and prevention, including vaccines and vaccine safety. However, a great deal of this material was written from the viewpoint of clinicians and academics. The patient voice may be positive or negative, fragmented or complex. Information sources are weighed and treated differently, according to the value system and risk perceptions of the individual. In post-trust societies, when people have less confidence in health authorities, communication needs to be more than a paternalistic top-down process. Notions of empowerment and individual patient choice are becoming crucial in medical care. The 'voice of the patient', which includes healthy individuals receiving vaccines, needs to be heard, considered and addressed. With respect to childhood immunizations, this will be the voice of the parent or caregiver. The key to addressing any concerns could be to listen more and to develop a communication style that is trust-based and science-informed. Regulatory agencies are encouraging clinical and patient-reported outcomes research under the umbrella of personalized medicine, and this is an important step forward. This paper attempts to reflect the paradigm shift towards increasing attention to the patient voice in vaccination and vaccine safety.

Effect of eutrophication on mercury, selenium, and essential fatty acids in bighead carp (Hypophthalmichthys nobilis) from reservoirs of eastern China

Analyses of the risks and benefits of consuming fish assess the content of beneficial fatty acids found in fish relative to harmful pollutants such as methylmercury (MeHg). Quantifying the effect of eutrophication on mercury (Hg), selenium (Se) and essential fatty acids (EFAs) in fish is necessary to determine how measures of risk vary with productivity. Total Hg and MeHg, Se and fatty acids, including the EFA eicosapentaenoic acid (EPA, 20:5n-3) and docosahexaenoic acid (DHA, 22:6n-3), were analyzed in Bighead Carp (Hypophthalmichthys nobilis) dorsal muscle tissue from seven subtropical reservoirs of eastern China. Individual elements and fatty acids, as well as derived measures of risk (Se:Hg and hazard quotient, HQ(EFA)) were regressed against indicators of eutrophication, including total phosphorous (TP), chlorophyll-a (chl-a) and phytoplankton species composition. We found low MeHg concentrations (range=0.018-0.13 μg/g ww) and Se concentrations (range=0.12-0.28 μg/g ww), and Se:Hg molar ratios that were well above 1.0, indicating a low risk of Hg toxicity. Bighead Carp had a high content of total polyunsaturated fatty acids (∑PUFAs=44.2-53.6%), which included both EPA (6.9-12.5%) and DHA (16.1-23.2%). However, fish had significantly lower Se:Hg molar ratios in reservoirs with high TP, and lower EPA content with increasing plankton density (i.e. higher chl-a). Phytoplankton species composition predicted Se concentrations, but not Hg concentrations or EFA content. Overall, Hg concentrations in Bighead Carp were very low relative to consumption guidelines, and Se concentrations were adequate to confer protective benefits against MeHg toxicity. Our findings suggest that changes to plankton species composition and density with eutrophication may result in fish of lower nutritional value and thus increase risks to fish consumers by changing the availability of Se and EPA relative to MeHg.