Perceptions and intentions toward medical assistance in dying among Canadian medical students.

BACKGROUND: Medical assistance in dying (MAID) was legalized in Canada in 2016. As of July 2017, approximately 2149 patients have accessed MAID. There remains no national-level data on the perspectives of future physicians about MAID or its changing legal status. We provide evidence from a national survey of Canadian medical students about their opinions, intentions, and concerns about MAID. METHODS: From October 2016 to July 2017, we distributed an anonymous online survey to all students at 15 of Canada's 17 medical schools. The survey collected data on respondent socio-demographic characteristics, features of their medical education, intentions for medical practice, and perspectives on MAID. We analyzed responses using univariate descriptive and stepwise multivariate logistic regression. RESULTS: In 1210 completed surveys, 71% of respondents reported being willing to provide MAID under a legal framework that permits it. Non-religious respondents reported greater willingness to participate in MAID than respondents of any religious affiliation (p < 0.001). Frequency of religious attendance was inversely associated with willingness to provide MAID (p < 0.001). Medical students born in Québec were more willing to provide MAID than respondents from other provinces (OR 2.21; p < 0.001). Age, sex, socioeconomic status, year of medical study, previous academic major, and rural/urban city of birth were not associated with willingness to provide MAID. CONCLUSION: As the current class of medical students becomes the first cohort of new physicians to enter Canada's changing medical and legal landscape around MAID, our findings inform the public debate by examining attributes associated with support or opposition to the practice.

Ochratoxin A is not detectable in renal and testicular tumours.

INTRODUCTION: Ochratoxin-A (OTA) is one of the most abundant food-contaminating mycotoxins, known for its nephrotoxicity, neurotoxicity, gonadotoxicity, teratogenicity, immunosuppression and carcinogenesis. OTA has been linked to several genitourinary pathologies, including Balkan nephropathy and genitourinary malignancies. We examine OTA levels in serum samples and tumour specimens collected from patients with renal and testicular tumours. METHODS: Frozen samples were obtained from the Ontario Tumour Bank. Serum specimens, along with renal and testicular tumour biopsies, were included in this study. Normal tissue from the negative surgical margins of each tumour served as a control. OTA levels in serum was measured using the enzyme-linked immunosorbent assay (ELISA), while OTA detection in tissue specimens was determined using immunohistochemistry (IHC). RESULTS: We included specimens collected from 56 patients (36 men and 20 women). Histopathology of the 52 renal tumours included 31 (60%) conventional type renal cell carcinomas (RCC), 5 (10%) chromophobe RCC, 5 (10%) papillary RCC, 1 (2%) oncocytoma and 10 (19%) upper tract urothelial carcinoma (UC). The 4 testicular tumours included 1 seminomatous (25%) germ cell tumour and 3 (75%) non-seminomatous germ cell tumours. OTA was detected in the serum of renal tumour patients, with a range from 0.004 to 0.25 ng/mL (mean: 0.07 and median 0.06 ng/mL). There was no OTA signal detected by IHC staining in all tested renal and testicular tumours. CONCLUSIONS: The OTA levels detected in the serum of patients were highly variable and relatively low. No OTA was detected in the tissue samples.

Endogenous biotin expression in renal and testicular tumours and literature review.

INTRODUCTION: The aim of this study was to examine endogenous biotin levels in tumour specimens collected from patients with renal and testicular tumours and compare them to the surrounding non-neoplastic surgical margin. METHODS: Frozen samples were obtained from the Ontario Tumour Bank. Renal and testicular tumour tissue were included in this study. Normal tissue from the negative surgical margins of each tumour served as a control. Biotin detection in tissue specimens was determined using immunohistochemistry (IHC). RESULTS: Specimens collected from 56 patients (36 men and 20 women) were included in this study. Histopathology of the 52 renal tumours included 31 (60%) conventional type RCC, 5 (10%) chromophobe RCC, 5 (10%) papillary RCC, 1 (2%) oncocytoma and 10 (19%) upper tract urothelial carcinoma (UC). The 4 testicular tumours included 1 seminomatous (25%) germ cell tumour and 3 (75%) non seminomatous germ cell tumours. CONCLUSION: No biotin signal was perceived in all tested tumour samples. Endogenous biotin expression was detected in the matching non-neoplastic surgical margin of tested renal tissues. This lack of staining may prove to be a valuable tool in future studies.