Recovery and utilization of collagen protein powder extracted from chromium leather scrap waste

Abstract

In this work, we investigate collagen protein powder (CPP) extracted from chromium leather scrap waste (CLSW). The composition and molecular weight distribution of CPP were determined by elemental analysis and sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), respectively. The microstructure and size distribution of CPP were then characterized by scanning electron microscopy (SEM) and nanometer analyzer instrument. Finally, CPP was treated with corn starch (CS), and the swelling behavior of the resulting CPP-CS blend was investigated in order to determine its range of applications. The experimental data showed that CPP contains 13 different amino-acids. CPP also displayed low mineral salt levels and a nitrogen content of 43.84%, indicating its potential use as an organic fertilizer. The molecular weight range of CPP is 6.5 to ~ 26.6 kDa. After the obtained CPP was blended with CS, the CPP-CS blend is endowed with optimal swelling properties and is able to overcome the solubility drawbacks of CPP alone. In addition, when the CPP was used as a natural fertilizer, the germination rate and height of kidney beans obviously increased.

http://bit.ly/2Tc4hAT

Arsenic, selenium, and metals in a commercial and vulnerable fish from southwestern Atlantic estuaries: distribution in water and tissues and public health risk assessment

Abstract

The anadromous catfish Genidens barbus is a vulnerable and economically important species from the Southwestern Atlantic Ocean. Concentrations of As, Co, Fe, Se, and Zn were determined in water and muscle, gill, and liver of catfish from two southwestern Atlantic estuaries (Brazil and Argentina) and health risk via fish consumption was evaluated. High spatial variability was observed in the metals, As, and Se distribution for both estuaries. Considering all tissues, element concentrations (mg/kg, wet weight) were As = 0.41–23.50, Co = 0.01–2.9, Fe = 2.08–773, Se = 0.15–10.7, and Zn = 3.97–2808). Most of the trace elements tended to be higher in Brazil than in Argentina, except for Co, Fe, Se, and Zn in liver and Fe and Co in muscle and gill, respectively. Arsenic accumulation order was muscle > liver ≥ gill. Only As (muscle) was above the maximum recommended by international guidelines at both estuaries. The target hazard quotient ranged from 0.10 to 1.58, suggesting that people may experience significant health risks through catfish consumption. Supposing that the inorganic/toxic As ranged between 1 and 20% of the total, the recommended maximum intakes per capita bases were 6.1–95 and 8.4–138 kg/year (wet weight) for Brazil and Argentina, respectively. Carcinogenic risk for As intake was within the acceptable range but close to the recommended limit (> 10⁻⁴). These results highlights the importance of quantifying the As species in catfish muscle in order to generate more reliable risk estimates.

http://bit.ly/2AX54P5

Vertical flow wetlands and hybrid systems for the treatment of landfill leachate

Abstract

Landfill leachates contain a variety of toxic compounds, which makes them one of the most difficult types of wastewater to be treated. An alternative "green" technology for leachate treatment is the use of constructed wetlands (CWs). The aims of this study were to select macrophytes and substrates to be used in vertical flow wetlands (VFWs) and to evaluate the performance of hybrid systems composed by a VFW and a horizontal subsurface flow (HSSW) or a free water surface flow (FWSW) wetlands for the treatment of a high ammonium concentration landfill leachate. In microcosms scale experiments, Typha domingensis, Scirpus californicus, and Iris pseudacorus were studied to assess their tolerance to raw and diluted leachate. Substrate selection for VFWs was evaluated using different layers of light expanded clay aggregate (LECA), coarse sand, fine sand, and gravel. Contaminant removals were higher in planted than in unplanted wetlands. Plants did not tolerate the raw effluent but showed a positive effect on plant growth when exposed to the diluted leachate. T. domingensis and I. pseudacorus showed higher contaminant removal ability and tolerance to landfill leachate than S. californicus. VFW with LECA + coarse sand showed the best performance in removal efficiencies. Hybrid system composed by VFW-FWSW planted with T. domingensis presented the best performance for the treatment of landfill leachate with high concentrations of ammonium.

http://bit.ly/2WoQGIy

Acute ecotoxicological effects of salicylic acid on the Polychaeta species Hediste diversicolor : evidences of low to moderate pro-oxidative effects

Abstract

Contamination of the aquatic environment by pharmaceutical drugs is an emerging issue in ecotoxicology. Aquatic organisms, in the presence of xenobiotics, tend to activate defensive mechanisms against toxic effects in order to mitigate and/or compensate for the toxic damages that frequently result from these interactions. Salicylic acid (SA) is a common drug, widely used in human medicine due to its analgesic, anti-inflammatory, and antipyretic properties, as well as its activity in terms of preventing platelet aggregation, among other clinical and cosmetic uses. It is commonly found in levels of the nanograms per liter to the micrograms per liter range in receiving waters, and its presence has been related to toxic effects in aquatic organisms, including oxidative stress. However, the number of studies that characterize the ecotoxicological profile of salicylates is still scarce and no studies have been published about the putative toxic effects of SA, especially in marine polychaetes. In order to determine the potential ecotoxicological effects caused by SA, individuals of the marine Polychaeta species Hediste diversicolor were exposed for 96 h to ecologically relevant concentrations of this compound, and several biochemical endpoints were evaluated, namely the activity of the antioxidant enzymes glutathione peroxidase (GPx) and catalase (CAT), the phase II biotransformation isoenzymes glutathione S-transferases (GSTs), the cholinergic enzyme acetylcholinesterase (AChE), and the determination of lipoperoxidative damage (thiobarbituric acid-reactive substances (TBARS) assay). The obtained results demonstrated that despite the pro-oxidative effects elicited by SA, exposure to realistic levels of this compound was not able to generate a state of oxidative stress, and the adaptive protective responses elicited by exposed individuals were effective enough to minimize and/or inhibit the damage potentially caused by overproduced reactive oxygen species.

http://bit.ly/2R9LzIk

Carcinoma of Unknown Primary with EML4‐ALK Fusion Response to ALK Inhibitors

AbstractWith the advent of next‐generation sequencing (NGS) and precision medicine, investigators have determined that tumors from different tissue sources that have the same types of genetic mutations will have a positive response to the same targeted therapy. This finding has prompted us to seek potential therapeutic targets for patients with carcinoma of unknown primary (CUP) using NGS technology. Here, we reported a case of a woman with CUP resistance to chemotherapy. We detected 450 cancer‐related gene alterations using three metastatic tumor specimens and found the presence of EML4 exon13 and ALK exon20 fusion. The tumor did respond to crizotinib, a first‐generation ALK inhibitor. When her tumor progressed, circulating tumor DNA detection revealed ALK L1196 M and G1269A mutation resistance to crizotinib, but she had a response to brigatinib. This case revealed that NGS technology used to detect the genetic alterations in patients with CUP might be a reliable method to find potential therapeutic targets, although the primary lesion could not always be confirmed.Key Points.This case exemplifies responsiveness to ALK inhibitor in carcinoma of unknown primary (CUP) with EML4‐ALK fusion.Next‐generation sequencing is an important diagnostic tool to find potential therapeutic targets in CUP.Liquid biopsy may be useful to provide critical information about resistance mechanisms in CUP to guide sequential treatment decision with targeted therapy.

http://bit.ly/2RdwYLN

Everolimus plus Exemestane for Hormone Receptor‐Positive Advanced Breast Cancer: A PAM50 Intrinsic Subtype Analysis of BOLERO‐2

AbstractBackground.The prognostic and predictive value of the two nonluminal (human epidermal growth factor receptor 2 [HER2]‐enriched and basal‐like) subtypes within advanced hormone receptor‐positive (HR+) breast cancer is currently unknown.Materials and Methods.This study retrospectively analyzed 261 tumors (80.7% primary; 19.3% metastatic) from the BOLERO‐2 study; BOLERO‐2 randomized 724 patients with advanced HR+/HER2‐negative breast cancer to everolimus plus exemestane or placebo plus exemestane. Tumors were classified using a PAM50 subtype predictor. Multivariable Cox regression analyses tested the independent prognostic significance of PAM50, and associations between PAM50 subtypes and treatment upon progression‐free survival (PFS) were evaluated.Results.Subtype distribution was 46.7% luminal A (n = 122), 21.5% HER2‐enriched (n = 56), 15.7% luminal B (n = 41), 14.2% normal‐like (n = 37), and 1.9% basal‐like (n = 5); HER2‐enriched subtypes were more common in metastatic versus primary tumors (32.0% vs. 18.7%; p = .038). Median PFS differences between luminal and nonluminal (6.7 vs. 5.2 months; adjusted hazard ratio, 0.66; 95% confidence interval [CI], 0.47–0.94; p = .020) and HER2‐enriched and non‐HER2‐enriched subtypes (5.2 vs. 6.2 months; adjusted hazard ratio, 1.53; 95% CI, 1.07–2.19; p = .019) were significant. Everolimus plus exemestane significantly improved median PFS versus placebo plus exemestane among patients with HER2‐enriched tumors (5.8 vs. 4.1 months; adjusted hazard ratio, 0.49; 95% CI, 0.26–0.90; p = .034); however, the association between HER2‐enriched tumors and everolimus benefit was nonsignificant (p = .433).Conclusion.The HER2‐enriched subtype was identified in a substantial proportion of advanced HR+/HER2‐negative breast tumors, and was a consistent biomarker of poor prognosis. Tailored therapies are therefore needed for HER2‐enriched tumors in the advanced HR+/HER2‐negative breast cancer setting.Implications for Practice.Using 261 tumor samples from the BOLERO‐2 phase III clinical trial, this study shows that a substantial proportion (20%–30%) of hormone receptor‐positive (HR+)/human epidermal growth factor receptor 2 (HER2)‐negative advanced breast cancers do not have a luminal A or B gene expression profile. This group of patients with nonluminal disease has a poor survival outcome regardless of the addition of everolimus to exemestane. This is the second study that confirms the prognostic value of this biomarker. Overall, these findings indicate a necessity to design novel clinical trials targeting nonluminal disease within HR+/HER2‐negative breast cancer.

http://bit.ly/2WiK7a7

Aromatase Inhibitors and Newly Developed Nonalcoholic Fatty Liver Disease in Postmenopausal Patients with Early Breast Cancer: A Propensity Score‐Matched Cohort Study

AbstractBackground.Unlike tamoxifen, the relationship between aromatase inhibitor use in postmenopausal patients with breast cancer and nonalcoholic fatty liver disease (NAFLD) has not been delineated.Materials and Methods.A retrospective analysis of 253 patients with early breast cancer without baseline NAFLD and treated with nonsteroidal aromatase inhibitors was performed. Among them, 220 patients were matched for sex, age, and menstruation status with healthy patients, and the prevalence of NAFLD was compared. NAFLD was determined by hepatic steatosis index in the absence of other known liver diseases. The presence of significant liver fibrosis in patients with NAFLD was determined noninvasively by AST‐platelet ratio index, FIB‐4 score, and NAFLD fibrosis score (NFS).Results.Postmenopausal patients with breast cancer undergoing treatment with aromatase inhibitors had higher prevalence of NAFLD independent of body mass index (BMI) and underlying diabetes mellitus (DM). Although the aromatase inhibitor group showed higher fibrotic burden by NFS, independent of BMI and DM, the proportion of advanced fibrosis did not show statistically significant differences between AI‐treated patients and the healthy patients. Those with abnormal baseline fasting glucose levels are suggested to have increased risk of NAFLD development after aromatase inhibitor treatment. In addition, patients with NAFLD developed after aromatase inhibitor use had significantly lower disease‐free survival than those without NAFLD, although there was no significant difference in overall survival.Conclusion.Results of this study suggest that inhibition of estrogen synthesis in postmenopausal women undergoing treatment with aromatase inhibitors could increase the risk of NAFLD, which might have some influence on the prognosis of patients with breast cancer.Implications for Practice.Unlike tamoxifen, the role of aromatase inhibitor treatment use in postmenopausal patients with breast cancer in development of fatty liver is not well known. In this propensity‐matched cohort study, postmenopausal patients with breast cancer treated with aromatase inhibitors had increased risk of nonalcoholic fatty liver disease compared with healthy women after menopause, independent of obesity and diabetes mellitus. The results show possible adverse influence of the newly developed fatty liver on breast cancer disease‐free survival and suggest a necessity for further validation. Fatty liver may need to be considered as an adverse event for aromatase inhibitor treatment.

http://bit.ly/2Rd8m5W

Phase II Study of the Triple Combination Chemotherapy of SOXIRI (S‐1/Oxaliplatin/Irinotecan) in Patients with Unresectable Pancreatic Ductal Adenocarcinoma

AbstractLessons Learned. The triple combination chemotherapy of SOXIRI (S‐1/oxaliplatin/irinotecan) in patients with unresectable pancreatic ductal adenocarcinoma was an effective treatment that appeared to be better tolerated than the widely used FOLFIRINOX regimen.SOXIRI regimen may provide an alternative approach for advanced pancreatic cancer.Background.In our previous phase I study, we determined the recommended dose of a biweekly S‐1, oxaliplatin, and irinotecan (SOXIRI) regimen in patients with unresectable pancreatic ductal adenocarcinoma (PDAC). This phase II study was conducted to assess the safety and clinical efficacy in patients with unresectable PDAC.Methods.Patients with previously untreated metastatic and locally advanced PDAC were enrolled. The primary endpoint was response rate (RR). Secondary endpoints were adverse events (AEs), progression‐free survival (PFS), and overall survival (OS). Patients received 80 mg/m2 of S‐1 twice a day for 2 weeks in alternate‐day administration, 150 mg/m2 of irinotecan on day 1, and 85 mg/m2 of oxaliplatin on day 1 of a 2‐week cycle.Results.Thirty‐five enrolled patients received a median of six (range: 2–15) treatment cycles. The RR was 22.8% (95% confidence interval [CI]: 10.4–40.1); median OS, 17.7 months (95% CI: 9.8–22.0); and median PFS, 7.4 months (95% CI: 4.2–8.4). Furthermore, the median OS in patients with distant metastasis was 10.1 months, whereas that in patients with locally advanced PDAC was 22.6 months. Major grade 3 or 4 toxicity included neutropenia (54%), anemia (17%), febrile neutropenia (11%), anorexia (9%), diarrhea (9%), and nausea (9%). There were no treatment‐related deaths.Conclusion.SOXIRI is considered a promising and well‐tolerated regimen in patients with unresectable PDAC.

http://bit.ly/2WdPB68

A Phase II Randomized Trial of Panitumumab, Erlotinib, and Gemcitabine Versus Erlotinib and Gemcitabine in Patients with Untreated, Metastatic Pancreatic Adenocarcinoma: North Central Cancer Treatment Group Trial N064B (Alliance)

AbstractLessons Learned. Dual epidermal growth factor receptor (EGFR)‐directed therapy with erlotinib and panitumumab in combination with gemcitabine was superior to gemcitabine and erlotinib, but the clinical relevance is uncertain given the limited role of gemcitabine monotherapy.A significantly longer overall survival was observed in patients receiving the dual EGFR‐directed therapy.The dual EGFR‐directed therapy resulted in increased toxicity.Background.Gemcitabine is active in patients with advanced pancreatic adenocarcinoma. The combination of erlotinib, an oral epidermal growth factor receptor (EGFR) inhibitor, and gemcitabine was shown to modestly prolong overall survival when compared with gemcitabine alone. The North Central Cancer Treatment Group (now part of Alliance for Clinical Trials in Oncology) trial N064B compared gemcitabine plus erlotinib versus gemcitabine plus combined EGFR inhibition with erlotinib and panitumumab.Methods.Eligible patients with metastatic adenocarcinoma of the pancreas were randomized to either gemcitabine 1,000 mg/m2 on days 1, 8, and 15 of a 28‐day cycle with erlotinib 100 mg p.o. daily (Arm A) or the same combination with the addition of panitumumab 4 mg/kg on days 1 and 15 of a 28‐day cycle (Arm B). The primary endpoint of the trial was overall survival. Secondary endpoints included progression‐free survival, the confirmed response rate, and toxicity. Comparison between arms for the primary endpoint was done with a one‐sided log‐rank test, and a p value less than .20 was considered statistically significant. Response rate comparison was done with Fisher's exact test. All other reported p values are two‐sided.Results.A total of 92 patients were randomized, 46 to each arm. The median overall survival was 4.2 months in Arm A and 8.3 months in Arm B (hazard ratio, 0.817; 95% confidence interval [CI], 0.530–1.260; p = .1792). The progression‐free survival was 2.0 months in Arm A and 3.6 months in Arm B (hazard ratio, 0.843; 95% CI, 0.555–1.280; p = .4190). A partial confirmed response was seen in 8.7% of patients on Arm A and 6.5% on Arm B (p = .9999). No patients had a complete response. Grade 3 and higher nonhematologic toxicities were more common in patients on Arm B compared with those on Arm A (82.6% vs. 52.2%; p = .0018).Conclusion.Dual EGFR‐directed therapy resulted in a significant prolongation of overall survival in patients with advanced adenocarcinoma of the pancreas but was associated with substantially increased toxicities. Dual EGFR‐directed therapy in combination with gemcitabine alone cannot be recommended for further study, as single‐agent gemcitabine is no longer considered an appropriate therapy for otherwise fit patients with metastatic pancreatic cancer.

http://bit.ly/2RdwOUH

Cutaneous involvement as the first manifestation of T‐lymphoblastic lymphoma and review of the literature.

Lymphoblastic lymphomas (LBL) are uncommon malignant neoplasms derived from immature T‐ or B‐ lymphoid progenitor cells. Although cutaneous involvement may reach 33% in B‐LBL, only twelve cutaneous cases of T‐ LBL have been published. We report the case of a 49‐year‐old woman with 2‐month history of erythematous‐violaceous plaques in the sternal region and breasts. Histopathologic examination showed a dense monomorphus infiltrate in dermis and positive immunostainings for CD3, CD99 and terminal deoxynucleotidyl transferase, thus indicating T‐LBL. Staging work‐up only revealed a mediastinal mass at diagnosis. After a 51‐month follow‐up and different treatment regimens, the patient remains alive although she has presented four relapses, all of them extramedullary.

This article is protected by copyright. All rights reserved.

http://bit.ly/2B5fZWT

Biomonitoring chronic lead exposure among battery manufacturing workers in Tunisia

Abstract

The aim of the study was the biomonitoring of the chronic exposure to Pb by measuring its levels in blood, urine, and hair of battery workers. Blood lead (BPb), urinary lead (UPb), hair lead (HPb), and urinary δ-aminolevulinic acid (UALA) levels were determined for 52 workers in a battery plant and compared to those of 20 non-occupational exposed subjects (controls). BPb and UPb levels were determined by graphite furnace atomic absorption spectrometry (GFAAS). HPb levels were measured by triple quadrupole ICP-MS and UALA levels were determined using cation exchanger column. The measured levels were significantly higher compared to the controls exceeding the OSHA cutoff values (p < 0.01). The GM mean levels of BPb, UPb, UALA, and HPb of workers were 715 μg L⁻¹, 331 μg L⁻¹, 16.3 mg g⁻¹, and 234 μg g⁻¹, respectively. The GM mean levels of BPb, UPb, UALA, and HPb of controls were 93.6 μg L⁻¹, 36.3 μg L⁻¹, 1.9 mg g⁻¹, and 1.8 μg g⁻¹, respectively. Significant correlations were observed between BPb and UALA (r = 0.630, p = 0.000), UPb and UALA (r = 0.566, p = 0.000), and between BPb and HPb (r = 0.466, p = 0.004). The significant correlation between BPb and HPb suggests the usefulness of hair for assessing occupational exposure particularly when the study area presents medium to high levels of Pb pollution. The association between Pb biomarkers and potential confounding factors revealed significant influence of the occupational factor over smoking and alcohol consumption. The results of this study urge for the reinforcement of the implemented engineering controls and safety measures in order to reduce exposure and to address the health issues related to Pb poisoning.

http://bit.ly/2sKCkV6

Bio-removal of cadmium from aqueous solutions by filamentous fungi: Trichoderma spp. and Piriformospora indica

Abstract

Six strains of Trichoderma spp. and Piriformospora indica have been studied for cadmium tolerance and bioaccumulation capacities by the poisoned food technique. A quantitative assay for Trichoderma spp. and P. indica was conducted in broth cultures supplemented with different cadmium concentrations (0–500 mg/l). In addition, the growth pattern of P. indica was determined by growing the fungus in a solid medium amended with eight concentrations of cadmium (0–200 mg/l). Generally, an increasing cadmium gradient in the culture medium suppressed the ability of fungi for cadmium accumulation. However, a negative relation was observed between the biomass production of fungi and cadmium uptake (q: mg/g biomass). Results showed that Trichoderma spp., especially T. simmonsii [UTFC 10063], are tolerant to cadmium toxicity and have a high ability to cadmium bioaccumulation. The biomass production of T. simmonsii [UTFC 10063] was significantly stimulated and increased by 46.1% when cadmium concentration increased from 0 to 125 mg/l. Moreover, 91.7 and 31.2% of cadmium removal was observed at 10 and 500 mg/l of the cadmium concentration, respectively. P. indica, however, showed a lower tolerance and removal efficiency for cadmium as compared with Trichoderma spp. Therefore, Trichoderma spp., especially T. simmonsii [UTFC 10063], can be exploited as potent bio-removal agents in cadmium-polluted aqueous solutions.

Graphical abstract

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http://bit.ly/2SbLEQs

Arginase Inhibition Improves Endothelial Function in an Age-Dependent Manner in Healthy Elderly Humans

Rejuvenation Research, Ahead of Print.


http://bit.ly/2RMjT1i

The Relationship Between Sleep Duration, Falls, and Muscle Mass: A Cohort Study in an Elderly Chinese Population

Rejuvenation Research, Ahead of Print.


http://bit.ly/2CKfaTy

Sono-advanced Fenton-like degradation of aromatic amines in textile dyeing sludge: efficiency and mechanisms

Abstract

In this paper, a novel strategy integrating ultrasound (US) with a Fenton-like (zero-valent iron/EDTA/air, ZEA) process was proposed for the removal of the refractory and carcinogenic aromatic amines (AAs) in textile dyeing sludge for the first time. The operating condition was optimized as 1.08 W/cm³ ultrasonic density, 15 g/L ZVI, and 1.0 mM EDTA, which could reach degradation efficiencies of 51.79% in US, 72.88% in ZEA, and 92.40% in US/ZEA system after 90-min reaction. Quenching experiments showed that electron transfer reactions generated by the iron ligands in ZEA brought about various reactive oxidative species (ROS), in which Fe (IV), O₂˙⁻, and ˙OH dominated the degradation. US induced sludge disintegration by ultrasonic shear, proven by particle size decrease and supernatant organic matter upsurge, which helps ROS contact with those pollutants in the sludge cavities. Besides, US facilitated the iron redox cycle for oxygen activation by promoting the corrosion of ZVI and stripping considerable ferric ions from sludge iron oxides which were verified by SEM, XRF, and XPS.

Graphical abstract

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http://bit.ly/2S0M3oH

Evaluation of osseous changes in dental panoramic radiography of thalassemia patients using mandibular indexes and fractal size analysis

Abstract

Objective

This study aimed to evaluate the radiomorphometric indexes and fractal dimension (FD) on dental panoramic radiography (DPR) of Thalassemia Major (TM) patients.

Methods

In 59 TM patients and in 59 healthy control subjects, mandibular cortical index (MCI), mandibular cortical width (MCW), panoramic mandibular index (PMI), and FD of four different regions (FD1-4) were evaluated and compared using DPRs.

Results

The distribution of MCI in TM patients was similar to control subjects (p > 0.05). The mean MCW was significantly lower in TM patients (p = 0.001). There was no significant difference in PMI between TM patients and control subjects. The mean of FD measured in the supracortical area above the angle of mandible (FD2), in the anterior to the mental foramen (FD4) and mean FD of four different regions was significantly lower in TM patients (p = 0.003, p = 0.001, and p = 0.014, respectively).

Conclusions

The radiomorphometric indices and fractal dimensions evaluated in the panoramic radiograph are capable of identifying thalassemia patients' jaw bone, and the results of DPR scanning can be used to refer these patients to appropriate medical investigation.

http://bit.ly/2HwbSbZ

Short-term exposure to tricyclic antidepressants delays righting time in marine and freshwater snails with evidence for low-dose stimulation of righting speed by imipramine

Abstract

Active pharmaceutical ingredients such as tricyclic antidepressants (TCAs) are contaminants of emerging concern which are commonly detected in wastewater effluent and which can disrupt the behavior of non-target organisms. In aquatic snails, the righting response is a critical behavior that has been shown to be inhibited by exposure to SSRI-type antidepressants. We exposed marine and freshwater snails to three tricyclic antidepressants (clomipramine, amitriptyline, and imipramine) for 1 h and measured righting response time. In the marine mud snail (Ilyanassa obsoleta), all three TCAs significantly increased righting time at concentrations as low as 156 μg/L. Similarly, in the freshwater snail Leptoxis carinata, all three TCAs increased righting time at concentrations as low as 263 μg/L. However, exposure to imipramine from 15.8 to 316 μg/L resulted in significantly faster righting time. Such low-dose stimulation and high-dose inhibition are characteristics of a hormetic response. We discuss the possible physiological mechanism of action of TCAs and other antidepressants on snail behavior, and the occurrence of non-monotonic, hormetic dose responses to human pharmaceuticals in the aquatic environment.

http://bit.ly/2CHlQ4U

Methodology Flaws and Implications of A Complementary Medicine Study

To the Editor In a retrospective case-control study using records from the US National Cancer Database with 1:4 matching of 258 vs 1032 patients with cancer, Johnson et al reported: (1) reduced survival among the 258 patients who used at least 1 conventional treatment together with complementary medicine (CM) compared with the 1032 patients who used only conventional treatment and (2) an association between the use of CM and refusal of standard treatment. The authors concluded that such refusal may explain the reduced survival. Herein, we briefly argue why we are not convinced that the authors' results support their conclusion.

http://bit.ly/2RKp3uA

Stripping the Fear of a Fatal Disease

This article describes the coping mechanism used by a patient with cancer.

http://bit.ly/2CGRFux

Rapidly Evolving Extensive Fluorodeoxyglucose-Positive Soft-Tissue Activity During Nivolumab Therapy

A 41-year-old woman with stage IIa melanoma of the upper thigh presented with diffuse erythematous induration of the upper thigh expanding to the lower left abdominal area and palpable subcutaneous nodules on the ipsilateral gluteal region and leg during nivolumab therapy. What is your diagnosis?

http://bit.ly/2RK1rX0