Increased risk of bladder cancer in critical areas at high pressure of pollution of the Campania region in Italy: A systematic review

Levels of PCDD/Fs, PCBs, metals and rare earth elements in eggs and vegetables from areas with different environmental contamination impacts in the Campania region (Southern Italy)

Studying the links between environmental pollution and the levels of contamination in food is an important challenge to ensure human health. Matched samples of eggs from free-range hens and vegetables were analysed to investigate the bioaccumulation of PCDD/Fs, PCBs, metals and rare earth elements. Only two egg samples resulted above the limit fixed for PCDD/Fs and the action level set for DL-PCBs. The highest concentrations were found in the eggs from an area situated in a big city affected by strong urbanisation. Although eggs and vegetables were subjected to the same environmental pollution, the PCDD/F and PCB bioaccumulation that occurred in the eggs was much higher than those in vegetables (p < 0.01). In vegetables, the highest PCDD/F and PCB concentrations were found in lettuce and potatoes grown on contaminated soil. Higher bioaccumulation of Fe and Zn occurred in eggs compared to vegetables; La, Pr, Nd, Sm and Eu were found only in lettuce samples. The results of this study may provide important data useful in the risk assessment of human exposure through diet in accidents involving dangerous chemicals. Furthermore, the estimated weekly intakes calculated for PCDD/Fs and PCBs highlighted that, although vegetables accumulate very low concentrations of these contaminants, they contribute more than eggs to human exposure.

Exposure to environmental pollutants selects for xenobiotic-degrading functions in the human gut microbiome

Environmental pollutants from different chemical families may reach the gut microbiome, where they can be metabolized and transformed. However, how our gut symbionts respond to the exposure to environmental pollution is still underexplored. In this observational, cohort study, we aim to investigate the influence of environmental pollution on the gut microbiome composition and potential activity by shotgun metagenomics. We select as a case study a population living in a highly polluted area in Campania region (Southern Italy), proposed as an ideal field for exposomic studies and we compare the fecal microbiome of 359 subjects living in areas with high, medium and low environmental pollution. We highlight changes in gut microbiome composition and functionality that were driven by pollution exposure. Subjects from highly polluted areas show higher blood concentrations of dioxin and heavy metals, as well as an increase in microbial genes related to degradation and/or resistance to these molecules. Here we demonstrate the dramatic effect that environmental xenobiotics have on gut microbial communities, shaping their composition and boosting the selection of strains with degrading capacity. The gut microbiome can be considered as a pivotal player in the environment-health interaction that may contribute to detoxifying toxic compounds and should be taken into account when developing risk assessment models. The study was registered at ClinicalTrials.gov with the identifier NCT05976126.

Biomonitoring of Airborne Microplastic Deposition in Semi-Natural and Rural Sites Using the Moss Hypnum cupressiforme

We show that the native moss Hypnum cupressiforme can be used as a biomonitor of atmospheric microplastics (MPs). The moss was collected in seven semi-natural and rural sites in Campania (southern Italy) and was analyzed for the presence of MPs, according to standard protocols. Moss samples from all sites accumulated MPs, with fibers representing the largest fraction of plastic debris. Higher numbers of MPs and longer fibers were recorded in moss samples from sites closer to urbanized areas, likely as the results of a continuous flux from sources. The MP size class distribution showed that small size classes characterized sites having a lower level of MP deposition and a high altitude above sea level.

The spatial association between environmental pollution and long-term cancer mortality in Italy

Tumours are nowadays the second world‑leading cause of death after cardiovascular diseases. During the last decades of cancer research, lifestyle and random/genetic factors have been blamed for cancer mortality, with obesity, sedentary habits, alcoholism, and smoking contributing as supposed major causes. However, there is an emerging consensus that environmental pollution should be considered one of the main triggers. Unfortunately, all this preliminary scientific evidence has not always been followed by governments and institutions, which still fail to pursue research on cancer's environmental connections. In this unprecedented national-scale detailed study, we analyzed the links between cancer mortality, socio-economic factors, and sources of environmental pollution in Italy, both at wider regional and finer provincial scales, with an artificial intelligence approach. Overall, we found that cancer mortality does not have a random or spatial distribution and exceeds the national average mainly when environmental pollution is also higher, despite healthier lifestyle habits. Our machine learning analysis of 35 environmental sources of pollution showed that air quality ranks first for importance concerning the average cancer mortality rate, followed by sites to be reclaimed, urban areas, and motor vehicle density. Moreover, other environmental sources of pollution proved to be relevant for the mortality of some specific cancer types. Given these alarming results, we call for a rearrangement of the priority of cancer research and care that sees the reduction and prevention of environmental contamination as a priority action to put in place in the tough struggle against cancer.

Polychlorinated dibenzo-p-dioxins (PCDDs) and dibenzofurans (PCDFs) soil contamination in Lausanne, Switzerland: Combining pollution mapping and human exposure assessment for targeted risk management

In December 2020, high soil concentrations of polychlorinated dibenzo-p-dioxins (PCDDs) and dibenzofurans (PCDFs) were discovered across large parts of Lausanne, Switzerland. Concentrations reached up to 640 ng TEQ_WHO-2005/kg dry weight. The most likely source was a former municipal waste incinerator. A three-step, multidisciplinary approach to human health risk assessment was conducted to determine the potential population exposure to PCDD/Fs and identify appropriate preventive measures. First, exposure scenarios were developed based on contaminated land uses. Second, the toxicological risks of different scenarios were evaluated using a toxicokinetic model estimating increases in blood serum PCDD/F concentrations over background concentrations from the general population's food consumption. Third, a detailed geostatistical mapping of PCDD/F soil contamination was performed. Stochastic simulations with an external drift and an anisotropic model of the variogram were generated to incorporate the effects of distance from emission source, topography, and main wind directions on the spatial distribution of PCDD/Fs in topsoil. Three main scenarios were assessed: i) direct ingestion of soil by children in playgrounds; ii) consumption of vegetables from private gardens by children and adults; and iii) consumption of food from livestock and poultry raised on contaminated soil. The worst exposure scenario involved the consumption of eggs from private hen houses, resulting in PCDD/F concentrations in serum an order of magnitude higher than might normally be expected. No relevant increases in serum concentrations were calculated for direct soil ingestion and vegetable consumption, except for cucurbitaceous vegetables. Combining mapping and exposure scenario assessment resulted in targeted protective measures for land users, especially concerning food consumption. The results also raised concerns about the potential unsafe consumption of products derived from animals raised on land with PCDD/F concentrations only moderately over environmental background levels.

The potential osteoporosis due to exposure to particulate matter in ambient air: Mechanisms and preventive methods

Air pollution and health consequences associated with exposure to air pollutants, such as particulate matter, are of serious concerns in societies. Over the recent years, numerous studies have investigated the relation of many diseases with air pollutants. This review used a search strategy to provide the comprehensive information on the relationship between particle matters and osteoporosis. To this end, three search databases were used to find the articles focused on particle matters and osteoporosis. After the screening process, 13 articles related to the purpose of the study were selected and the relevant data were extracted. The results indicated that osteoporosis is significantly associated with PM₁₀. However, this association with PM_2.5 remains unclear. In addition, particle materials indirectly lead to the osteoporosis and bone fractures as a consequence of reduced UV-B, reduced adsorption of vitamin D. Furthermore, they can lead to other diseases by use of drugs with adverse effects on bone health, and creating conditions that may increase the risk of falling in the elderly. This review shows that although more accurate research is needed to determine the mechanism and risk of exposure to particulate matter in the air on bone health, the negative effects of this pollutant on bone mineral density (BMD) are evident.Implications: PM is usually classified by its size or aerodynamic diameter; PM10 denotes particles < 10 µm in diameter; PM2.5 particles are <2.5 µm in diameter. Many epidemiological studies have shown that short-term exposure to PM might reduce lung function. However, short-term effects might be reversible, and the main concern is attributed to long-term exposure. A major public health concern that may be affected by numerous metabolic and even environmental risk factors is osteoporosis. The purpose of this systematic review was to investigate the role of PM in the occurrence or exacerbation of osteoporosis in citizens.

Campania and cancer mortality: An inseparable pair? The role of environmental quality and socio-economic deprivation

The region of Campania in Southern Italy features high levels of socio-economic deprivation and low levels of environmental quality. A vast strand of the scientific literature has tried to verify whether poor environmental quality and widespread socio-economic deprivation might explain the high cancer mortality rates (CMRs) observed, especially in the municipalities - infamously labelled as the 'Land of Fires' - that were hit most severely by the crisis. While some studies managed to identify links between these two confounding factors and cancer mortality, the evidence is overall mixed. Interesting information may be drawn from the observation of municipal data: in spite of previous claims, some municipalities featuring high environmental quality and low socio-economic deprivation also display high CMRs, while other Campanian municipalities facing disastrous environmental and socio-economic conditions are characterised by low CMRs. These figures, in contrast to common sentiment and previous studies, need to be investigated thoroughly in order to assess the exact role of the confounding factors. In this work, we aim to identify the municipalities where confounding factors act as driving forces in the determination of high CMRs through an original multi-step analysis based on frequentist and Bayesian analysis. Pinpointing these municipalities could allow policymakers to design targeted and effective policy measures aimed at reducing cancer mortality.

A risk-group classification model in patients with bladder cancer under neoadjuvant cisplatin-based combination chemotherapy

The objective of the current research was to explore the potential prognostic value of readily available clinical and pathologic variables in bladder cancer. The novel association found between cholesterol levels and prognosis may provide the rationale for exploring novel treatments. Patients included had histologically confirmed urothelial bladder cancer and were treated with at least 3 cycles of cisplatin-based neoadjuvant chemotherapy before radical cystectomy with lymphadenectomy. A total of 245 patients at low, intermediate and high risk, presenting with 0-1, 2 or 3-4 risk factors, including positive lymph nodes, Hb <12.8, NLR ≥2.7 and cholesterol levels ≥199, were included. Five-year cancer-specific survival rate was 0.67, 0.78 and 0.94 at high, intermediate and low risk, respectively. Total cholesterol levels at the time of cystectomy may represent a commonly assessable prognostic factor and may be incorporated in a clinically meaningful risk-group classification model.

Why We Will Continue to Lose Our Battle with Cancers If We Do Not Stop Their Triggers from Environmental Pollution

Besides our current health concerns due to COVID-19, cancer is a longer-lasting and even more dramatic pandemic that affects almost a third of the human population worldwide. Most of the emphasis on its causes has been posed on genetic predisposition, chance, and wrong lifestyles (mainly, obesity and smoking). Moreover, our medical weapons against cancers have not improved too much during the last century, although research is in progress. Once diagnosed with a malignant tumour, we still rely on surgery, radiotherapy, and chemotherapy. The main problem is that we have focused on fighting a difficult battle instead of preventing it by controlling its triggers. Quite the opposite, our knowledge of the links between environmental pollution and cancer has surged from the 1980s. Carcinogens in water, air, and soil have continued to accumulate disproportionally and grow in number and dose, bringing us to today's carnage. Here, a synthesis and critical review of the state of the knowledge of the links between cancer and environmental pollution in the three environmental compartments is provided, research gaps are briefly discussed, and some future directions are indicated. New evidence suggests that it is relevant to take into account not only the dose but also the time when we are exposed to carcinogens. The review ends by stressing that more dedication should be put into studying the environmental causes of cancers to prevent and avoid curing them, that the precautionary approach towards environmental pollutants must be much more reactionary, and that there is an urgent need to leave behind the outdated petrochemical-based industry and goods production.

Three vs. Four Cycles of Neoadjuvant Chemotherapy for Localized Muscle Invasive Bladder Cancer Undergoing Radical Cystectomy: A Retrospective Multi-Institutional Analysis

BACKGROUND

Three or four cycles of cisplatin-based chemotherapy is the standard neoadjuvant treatment prior to cystectomy in patients with muscle-invasive bladder cancer. Although NCCN guidelines recommend 4 cycles of cisplatin-gemcitabine, three cycles are also commonly administered in clinical practice. In this multicenter retrospective study, we assessed a large and homogenous cohort of patients with urothelial bladder cancer (UBC) treated with three or four cycles of neoadjuvant cisplatin-gemcitabine followed by radical cystectomy, in order to explore whether three vs. four cycles were associated with different outcomes.

METHODS

Patients with histologically confirmed muscle-invasive UBC included in this retrospective study had to be treated with either 3 (cohort A) or 4 (cohort B) cycles of cisplatin-gemcitabine as neoadjuvant therapy before undergoing radical cystectomy with lymphadenectomy. Outcomes including pathologic downstaging to non-muscle invasive disease, pathologic complete response (defined as absence of disease -ypT0), overall- and cancer-specific- survival as well as time to recurrence were compared between cohorts A vs. B.

RESULTS

A total of 219 patients treated at 14 different high-volume Institutions were included in this retrospective study. Patients who received 3 (cohort A) vs. 4 (cohort B) cycles of neoadjuvant cisplatin-gemcitabine were 160 (73,1%) vs. 59 (26,9%).At univariate analysis, the number of neoadjuvant cycles was not associated with either pathologic complete response, pathologic downstaging, time to recurrence, cancer specific, and overall survival. Of note, patients in cohort B vs. A showed a worse non-cancer specific overall survival at univariate analysis (HR= 2.53; 95 CI= 1.05 - 6.10; p=0.046), although this finding was not confirmed at multivariate analysis.

CONCLUSIONS

Our findings suggest that 3 cycles of cisplatin-gemcitabine may be equally effective, with less long-term toxicity, compared to 4 cycles in the neoadjuvant setting.

Reduction of Management Costs and Avoidance of Air Release of Carcinogens Through a Waste Segregation Program in a Brazilian Medical Institution

Hospital waste management is a current sustainability challenge. Although not always performed, the most applied approach in current protocols is the proper segregation of waste. The incineration of hospital waste is an significant source of emission of specific toxic particles and gases. We highlighted dioxins, whose representatives have been considered carcinogenic agents since 1994. Several experimental and epidemiologic studies have shown greater cancer morbidity and mortality associated with dioxin exposure. In the present study, we presented the impact of a hospital waste management program implemented in an oncology institution based on proper segregation and consequent reduction of incinerated mass. Data were collected for 8 years and the waste was separated into five categories: infectious (A4), chemical (B), recyclable (DR), non-recyclable (DNR), and sharps (E). The classes addressed to incineration were A4, B, and E. A team education starting from the admission process and with a continued education program was essential for a successfully implemented program. We achieved a 66% saving of waste from incineration, equivalent to 76 tons, of which 71.9 tons corresponded to recyclable waste. If the waste separation protocol was not implemented, the biohazardous and chemical material would contaminate the rest of the residues, making incineration as a final destination mandatory for all the waste. This scenario would result in significantly more dioxins release and a 64% higher cost of waste management. This low-cost implementation measure was effective in the cost reduction of waste management and minimization of air release of human carcinogens.

Spatiotemporal heterogeneity of PM2.5 and its relationship with urbanization in North China from 2000 to 2017

Fine particulate matter (PM_2.5) pollution is becoming an increasing global concern due to rapid urbanization and socioeconomic development, especially in North China. Although North China experiences poor air quality and high PM_2.5 concentrations, their spatial heterogeneity and relationship with the relative spatial risks of air pollution have not been explored. Therefore, in this study, the temporal variation trends (slope values) of the PM_2.5 concentrations in North China from 2000 to 2017 were first quantified using the unitary linear regression model, and the Bayesian space-time hierarchy model was introduced to characterize their spatiotemporal heterogeneity. The spatial lag model was then used to examine the determinant power of urbanization and other socioeconomic factors. Additionally, the correlation between the spatial relative risks (probability of a region becoming more/less polluted relative to the average PM_2.5 concentrations of the study area), and the temporal variation trends of the PM_2.5 concentrations were quantified using the bivariate local indicators of spatial association model. The results showed that the PM_2.5 concentrations increased during 2000-2017, and peaked in 2007 and 2013. Spatially, the cities at high risk of PM_2.5 pollution were mainly clustered in southeastern Hebei, northern Henan, and western Shandong where the slope values were low, as demonstrated by the value of Moran's I (-0.56). Moreover, urbanization and road density were both positively correlated with PM_2.5 pollution, while the proportion of tertiary industry was negatively correlated. Furthermore, a notable increasing trend was observed in some cities, such as Tianjin, Zaozhuang, Qingdao, and Xinyang. These findings can contribute to the development of effective policies from the perspective of rapid urbanization to relieve and reduce PM_2.5 pollution.

Type 2 diabetes mellitus predicts worse outcomes in patients with high-grade T1 bladder cancer receiving bacillus Calmette-Guérin after transurethral resection of the bladder tumor

OBJECTIVES

The aim of this multicenter study was to investigate the prognostic role of type 2 diabetes mellitus (T2DM) comorbidity in a large multi-institutional cohort of patients with primary T1HG/G3 non-muscle-invasive bladder cancer (NMIBC) treated with transurethral resection of the bladder (TURB).

MATERIALS AND METHODS

A total of 1,172 patients with primary T1 HG/G3 who had NMIBC on re-TURB and who received adjuvant intravesical bacillus Calmette-Guérin therapy with maintenance were included. Endpoints were recurrence-free survival and progression-free survival.

RESULTS

A total of 231 (19.7%) of patients had T2DM prior to TURB. Five-year recurrence-free survival estimates were 12.5% in patients with T2DM compared to 36% in patients without T2DM, P < 0.0001. Five-year PFS estimates were 60.5% in patients with T2DM compared to 70.2% in patients without T2DM, P = 0.003. T2DM was independently associated with disease recurrence (hazard ratio = 1.41; 95% confidence interval = 1.20-1.66, P < 0.001) and progression (hazard ratio = 1.27; 95% confidence interval = 0.99-1.63, P < 0.001), after adjusting for other known predictive factors such as tumor size, multifocality, T1G3 on re-TURB, body mass index, lymphovascular invasion, and neutrophil-to-lymphocytes ratio.

CONCLUSIONS

Given the potential implications for management, prospective validation of this finding along with translational studies designed to investigate the underlying biology of such an association are warranted.

Absolute basophil count is associated with time to recurrence in patients with high-grade T1 bladder cancer receiving bacillus Calmette-Guérin after transurethral resection of the bladder tumor

BACKGROUND

Basophils, eosinophils and monocytes may be involved in BCG-induced immune responses and be associated with outcomes of bladder cancer patients receiving intravesical BCG. Our objective was to explore the association of baseline counts of basophils, eosinophils and monocytes with outcomes of patients with high-grade T1 bladder cancer receiving a standard course of intravesical BCG.

METHODS

We retrospectively reviewed medical records of patients with primary T1 HG/G3 bladder cancer. After re-TURBT, patients were treated with a 6-week course of intravesical BCG induction followed by intravesical BCG every week for 3 weeks given at 3, 6, 12, 18, 24, 30 and 36 months from initiation of therapy The analysis of potential risk factors for recurrence, muscle invasion and cancer-specific and overall survival was performed using univariable Cox regression models. Those factors that presented, at univariate analysis, an association with the event at a liberal p < 0.1, have been selected for the development of a multivariable model.

RESULTS

A total of 1045 patients with primary T1 HG/G3 were included. A total of 678 (64.9%) recurrences, 303 (29.0%) progressions and 150 (14.3%) deaths were observed during follow-up. Multivariate analysis showed that logarithmic transformation of basophils count was associated with a 30% increment in the hazard of recurrence per unit increase of logarithmic basophils count (HR 1.30; 95% confidence interval 1.09-1.54; p = 0.0026). Basophil count modeled by quartiles was also significantly associated with time to recurrence [second vs. lower quartile HR 1.42 (1.12-1.79); p = 0.003, third vs. lower quartile HR 1.26 (1.01-1.57); p = 0.041; upper vs. lower quartile HR 1.36 (1.1-1.68); p = 0.005]. The limitations of a retrospective study are applicable.

CONCLUSION

Baseline basophil count may predict recurrence in BCG-treated HG/G3 T1 bladder cancer patients. External validation is warranted.

Association of air particulate pollution with bone loss over time and bone fracture risk: analysis of data from two independent studies

BACKGROUND

Air particulate matter (PM) is a ubiquitous environmental exposure associated with oxidation, inflammation, and age-related chronic disease. Whether PM is associated with loss of bone mineral density (BMD) and risk of bone fractures is undetermined.

METHODS

We conducted two complementary studies of: (i) long-term PM <2.5 μm (PM_2.5) levels and osteoporosis-related fracture hospital admissions among 9.2 million Medicare enrollees of the Northeast/Mid-Atlantic United States between 2003-2010; (ii) long-term black carbon [BC] and PM_2.5 levels, serum calcium homeostasis biomarkers (parathyroid hormone, calcium, and 25-hydroxyvitamin D), and annualized BMD reduction over a 8-year follow-up of 692 middle-aged (46.7±12.3 yrs), low-income BACH/Bone cohort participants.

FINDINGS

In the Medicare analysis, risk of bone fracture admissions at osteoporosis-related sites was greater in areas with higher PM_2.5 levels (Risk ratio [RR] 1.041, 95% Confidence Interval [CI], 1.030, 1.051). This risk was particularly high among low-income communities (RR 1.076; 95% CI, 1.052, 1.100). In the longitudinal BACH/Bone study, baseline BC and PM_2.5 levels were associated with lower serum PTH (Estimate for baseline one interquartile increase in 1-year average BC= -1.16, 95% CI -1.93, -0.38; Estimate for baseline one interquartile increase in 1-year average PM_2.5= -7.39; 95%CI -14.17, -0.61). BC level was associated with higher BMD loss over time at multiple anatomical sites, including femoral neck (-0.08%/year per one interquartile increase; 95% CI -0.14, -0.02%/year) and ultradistal radius (-0.06%/year per one interquartile increase; 95% CI -0.12, -0.01%/year).

INTERPRETATION

Our results suggest that poor air quality is a modifiable risk factor for bone fractures and osteoporosis, especially in low-income communities.

Chlorinated biphenyls effect on estrogen-related receptor expression, steroid secretion, mitochondria ultrastructure but not on mitochondrial membrane potential in Leydig cells

To characterize polychlorinated biphenyls (PCBs) action on Leydig cells, PCBs congeners, low-chlorinated (delor 103; d103) and high-chlorinated ones (delor 106; d106) were selected. The cells were treated according to PCBs dose (d103 or d106 0.2 ng/ml in low doses:, or 2 ng/ml in high doses) and type (d103 + d106 in low doses or 103 + 106 in high doses). After 24 h treatment with PCBs, a distinct increase in estrogen-related receptors (ERRs type α, β and γ) expression was revealed. However, the dose- and type-dependent PCBs effect was mostly exerted on ERRα expression. A similar increase in ERRs expression was demonstrated by estradiol but not testosterone, which was without an effect on ERRs. PCBs caused no decrease in the membrane potential status of Leydig cells (either in dose or type schedule) but had severe effects on the mitochondria number and structure. Moreover, PCBs markedly increased calcium (Ca2+) concentration and sex steroid secretion (both androgens and estrogens were elevated). These findings suggest a similar estrogenic action of PCBs congeners (d103 and d106) on Leydig cell function. We report dose- and type-specific effects of PCBs only on Leydig cell ERRs expression. Both delors showed common effects on the mitochondria ultrastructural and functional status. Based on our results, ERRα seems to be the most sensitive to hormonal modulation. The increases in Ca2+ and sex steroid secretion may be due to the activation of ERRs by PCBs binding and/or direct effect of PCBs on ERRs mRNA/protein expression. Nevertheless, to confirm the existence of possible relationships between ERRs signaling (including PCBs as ligands) and mitochondria function in Leydig cells, further intensive studies are needed.

Environment and bladder cancer: molecular analysis by interaction networks

Bladder cancer (BC) is the 9th most common cancer worldwide, and the 6th most common cancer in men. Its development is linked to chronic inflammation, genetic susceptibility, smoking, occupational exposures and environmental pollutants. Aim of this work was to identify a sub-network of genes/proteins modulated by environmental or arsenic exposure in BC by computational network approaches. Our studies evidenced the presence of HUB nodes both in "BC and environment" and "BC and arsenicals" networks. These HUB nodes resulted to be correlated to circadian genes and targeted by some miRNAs already reported as involved in BC, thus suggesting how they play an important role in BC development due to environmental or arsenic exposure. Through data-mining analysis related to putative effect of the identified HUB nodes on survival we identified genes/proteins and their mutations on which it will be useful to focus further experimental studies related to the evaluation of their expression in biological matrices and to their utility as biomarkers of BC development.

Assessment of human health hazards associated with the dietary exposure to organic and inorganic contaminants through the consumption of fishery products in Spain

In this work we have evaluated the potential carcinogenic and acutely toxic risks associated to the exposure to highly prevalent organic and inorganic contaminants through the consumption of fishery products by the Spanish population. The concentrations of 8 organochlorine pesticides (OCPs), 18 polychlorinated biphenils (PCBs), 7 polycyclic aromatic hydrocarbons (expressed as benzo[a]pyrene toxic equivalents (B[a]Peq)), and three inorganic toxic elements [arsenic (As), cadmium (Cd), and mercury (Hg)] were determined in 93 samples of the most consumed species of white fish, blue fish, cephalopods and seafood species, which were acquired directly in markets and supermarkets in the Canary Islands, Spain. The chemical concentration data were combined with the pattern of consumption of these foodstuffs in order to calculate the daily intake of these contaminants, and on this basis the risk quotients for carcinogenicity and acute toxicity were determined for Spanish adults and children. Our results showed that the daily intake of OCPs, PCBs and B[a]Peq, which is associated to blue fish consumption was the highest within the fish group. The estimated intake of pollutants can be considered low or very low for the individual contaminants, when compared to reference values, except in the case of HCB and As. All the estimated intakes were below the reported Tolerable Daily Intakes. Considering the additive effects of multiple contaminants, the risk of acute toxic effects can also be considered as low or very low. However, our results reflect that the current consumption of white fish in adults and children, and also the blue fish in the case of adults, poses a moderate carcinogenic risk to Spanish consumers, mainly related to their concentrations of As. The conclusions of this research may be useful for the design of appropriate risk communication campaigns.

The evidence of toxic wastes dumping in Campania, Italy

The region of Campania (particularly Naples and Caserta) were subjected to extensive illegal dumping operations of toxic and radioactive wastes since the 1980s. The highly toxic wastes (HTW) dumping operations that have taken place both along the coast and the hinterland, have extremely adverse effects on health, livelihoods and the future prospect of sustainable development of the local population. The toxic wastes dumping in Campania is real and it has compromised (irreversibly) the human health, natural environment, food security and the long-term development prospects of the affected population. To reverse this tragic trend, it is necessery the identification, isolation and reclamation of the polluted sites and full assessment of the nature and the scale of the polluting chemicals and other hazardous wastes. The purpose of this review is to contribute significantly to the available evidence of the long-running toxic waste dumping in Campania and its negative impact on the health of population.

Complete Response and Fatigue Improvement With the Combined Use of Cyclophosphamide and Quercetin in a Patient With Metastatic Bladder Cancer: A Case Report

Bladder cancer is a major cause of cancer-related mortality, with an estimated 74,000 new cases and 16,000 deaths in the United States in 2015. In patients with metastatic disease, vinflunine and taxanes are the most widely used chemotherapy agents in the second-line setting after failure of platinum-based treatment. Cyclophosphamide has been used in combination with paclitaxel in urothelial carcinoma of the bladder, but there are no data about the effectiveness of cyclophosphamide administered as a single agent.We here describe the first case of an advanced bladder cancer patient suffering from grade 2 fatigue.He benefited from administration of third-line single-agent metronomic oral cyclophosphamide plus oral doses of quercetin. A complete, prolonged radiologic response according to the RECIST criteria 1.1 was achieved with minimal toxicity and an improvement in fatigue.Further studies are required to assess the potential benefits associated with the combined use of cyclophosphamide plus quercetin in advanced bladder cancer patients.