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Background The American Joint Committee on Cancer (AJCC) staging system has limited accuracy in predicting survival of gastric cancer patients with inadequate counts of evaluated lymph nodes (LNs). We therefore aimed to develop a prognostic nomogram suitable for clinical applications in such cases. Methods A total of 1511 noncardia gastric cancer patients treated between 1990 and 2010 in the academic surgical center were reviewed to compare the 7 th and 8 th editions of the AJCC staging system. A nomogram was developed for the prediction of 5-year survival in patients with less than 16 LNs evaluated ( n  = 546). External validation was performed using datasets derived from the Polish Gastric Cancer Study Group ( n  = 668) and the SEER database ( n  = 11,225). Results The 8th edition of AJCC staging showed better overall discriminatory power compared to the previous version, but no improvement was found for patients with < 16 evaluated LNs. The developed nomogram had better concordance index (0.695) than the former (0.682) or latest (0.680) staging editions, including patients subject to neoadjuvant treatment, and calibration curves showed excellent agreement between the nomogram-predicted and actual survival. High discriminatory power was also demonstrated for both validation cohorts. Subsequently, the nomogram showed the best accuracy for the prediction of 5-year survival through the time-dependent ROC curve analysis in the training and validation cohorts. Conclusions A clinically relevant nomogram was built for the prediction of 5-year survival in patients with inadequate numbers of LNs evaluated in surgical specimens. The predictive accuracy of the nomogram was validated in two Western populations.

BackgroundTo estimate the impact of oophorectomy and other treatments on the survival of breast cancer patients with a CHEK2 mutation.MethodsWomen with Stage I–III breast cancer who were treated at 17 hospitals in Poland were tested for four founder mutations in the CHEK2 gene. 974 women (10%) were positive for a CHEK2 mutation. Control patients without a CHEK2 mutation were selected from a database of patients treated over the same time period. Information on treatments received and distant recurrences were retrieved from medical records. Treatments included chemotherapy, hormonal therapy (tamoxifen) and radiation therapy. Oophorectomies were performed for the treatment of breast cancer or for benign conditions. Dates of death were obtained from the Polish Vital Statistics Registry. Causes of death were determined by medical record review. Predictors of survival were determined using the Cox proportional hazards model.ResultsIn all, 839 patients with a CHEK2 mutation were matched to 839 patients without a mutation. The mean follow-up was 12.0 years. The 15-year survival for CHEK2 carriers was 76.6% and the 15-year survival for non-carrier control patients was 78.8% (adjusted HR = 1.06; 95% CI: 0.84–1.34; P = 0.61). Among CHEK2 carriers, the 15-year survival for women who had an oophorectomy was 86.3% and for women who did not have an oophorectomy was 72.1% (adjusted HR = 0.59; 95% CI: 0.38–0.90; P = 0.02). Among controls, the 15-year survival for patients who had an oophorectomy was 84.5% and for women who did not have an oophorectomy was 77.6% (adjusted HR = 1.03; 95% CI: 0.66–1.61; P = 0.90).ConclusionAmong women with breast cancer and a CHEK2 mutation, oophorectomy is associated with a reduced risk of death from breast cancer.

Objective: The aim of this study was to evaluate the efficacy of adjuvant chemotherapy with etoposide, Adriamycin and cisplatin (EAP) after potentially curative resections for gastric cancer. Methods: After surgery, patients were randomly assigned to the EAP or control arm. Chemotherapy included 3 courses, administered every 28 days. Each cycle consisted of doxorubicin (20 mg/m 2 ) on days 1 and 7, cisplatin (40 mg/m 2 ) on days 2 and 8, and etoposide (120 mg/m 2 ) on days 4, 5, and 6. Results: Of 309 eligible patients, 141 were allocated to chemotherapy and 154 to the supportive care group. Four (2.8%) treatment-related deaths were recorded, including 3 due to septic complications of myelosuppression and 1 due to cardiocirculatory failure. Grade 3 or 4 toxicities were found in 17 (22%) patients. According to the intention-to-treat analysis, the median survival was 41.3 months (95% confidence interval, 24.5–58.2) and 35.9 months (95% confidence interval, 25.5–46.3) in the chemotherapy and control group, respectively (p = 0.398). Subgroup analysis revealed survival benefit from chemotherapy in patients with tumors infiltrating the serosa and in those with 7–15 metastatic lymph nodes. Conclusion: Three cycles of EAP regimen postoperatively offer no survival advantage in gastric cancer patients.

We assess Holocene environmental change at alpine Lake Njulla (68 degree 22'N, 18 degree 42'E, 999 m a.s.l.) in northernmost Sweden using sedimentary remains of chironomid head capsules and diatoms. We apply regional calibration sets to quantitatively reconstruct mean July air temperature (using chironomids and diatoms) and lake-water pH (using diatoms). Both chironomids and diatoms infer highest temperatures (1.7-2.3 degree C above present-day estimates, including a correction for glacio-isostatic land up-lift by 0.6 degree C) during the early Holocene (c. 9,500-8,500 cal. yrs BP). Diatoms suggest a decreasing lake-water pH trend (c. 0.6 pH units) since the early Holocene. Using detrended canonical correspondence analysis (DCCA), we compare the Holocene development of diatom communities in Lake Njulla with four other nearby lakes (Lake 850, Lake Tibetanus, Vuoskkujavri, Vuolep Njakajaure) located along an altitudinal gradient. All five lakes show similar initial DCCA scores after deglaciation, suggesting that similar environmental processes such as high erosion rates and low light availability associated with high summer temperature appear to have regulated the diatom community, favouring high abundances of Fragilaria species. Subsequently, the diatom assemblages develop in a directional manner, but timing and scale of development differ substantially between lakes. This is attributed primarily to differences in the local geology, which is controlling the lake-water pH. Imposed on the basic geological setting, site-specific processes such as vegetation development, climate, hydrological setting and in-lake processes appear to control lake development in northern Sweden.

Analysis of the clinical course of patients with postirradiation rectovaginal fistula after fecal diversion. The studied group included 17 women with postirradiation rectovaginal fistula who underwent fecal diversion as a sole mode of treatment, between January 1987 and December 2002, in our department. All patients were subjected to radiotherapy due to cancer of the uterine cervix, administered 5–107 months before the fistula appearance (mean, 22.9 months). In 3 of 17 patients (18%), spontaneous closure of fistula was observed after 5, 6, and 9 months, respectively, from fecal diversion. Closure was confirmed by endoscopy. Length of follow-up after fecal diversion ranged from 0.5 to 122 months. The actuarial probability of spontaneous closure of postradiotherapy rectovaginal fistula was 0.24 at 9 months of follow-up and then remained stable thereafter. In conclusion, colostomy alone gives hardly a chance for closure of the postradiotherapy rectovaginal fistula. Additional surgical measures are necessary.

There are very few reports concerning the presence of malignant cystosarcoma phyllodes (CSP) in breasts of pregnant women. In the hereby described case, a 28-year-old woman presented in our department with huge (18 × 11 × 8 cm) tumor of left breast, 2 weeks after labor. The patient discovered a tumor in 34th week of pregnancy, 6 weeks before labor. Histopatholgic examination of excised tumor revealed the presence of malignant CSP tumor. Simple mastectomy was proposed to patient as a best treatment modality. However, the patient refused. She underwent excision of tumor bed (2-cm tumor-free margin was achieved). Despite insufficient treatment, she remains free of disease 20 months after the wide excision of breast malignancy. It is not known how pregnancy influences prognosis of patients with malignant CSP. Lack of such information prompted us to describe the clinical course of our patient.

Calcium (Ca) is a major component of the crustacean zooplankton carapace. As crustacean zooplankton obtain most of their Ca from lake water, taxa with high Ca demands may be negatively affected if environmental Ca concentrations fall below thresholds necessary for adequate Ca uptake rates. Currently, Ca concentrations are falling in many soft-water lakes with a history of acid deposition, both within Canada and globally. Hence, there is a need to identify species with high Ca demands. We analyzed Ca concentrations of eight crustacean zooplankton taxa from nine lakes spanning a 0.4–35 mg·L –1 Ca gradient. Our objectives were to determine (i) if both species identity and lake Ca concentrations are determinants of zooplankton Ca concentration and (ii) if zooplankton Ca concentration varies seasonally. Large differences in Ca concentrations were observed among taxa. Levels in Daphnia sp. ranged from 2% to 8% of dry body weight, whereas levels in copepods and non-daphniid cladocera were much lower at 0.2%–0.4%. Seasonal variation in zooplankton Ca concentration was negligible, but positive correlations with lake Ca concentration were detected, with up to twofold differences in Ca concentration between lakes in three of the eight species. Species identity was the most important determinant of crustacean zooplankton Ca concentration.

The American Joint Committee on Cancer (AJCC) staging system has limited accuracy in predicting survival of gastric cancer patients with inadequate counts of evaluated lymph nodes (LNs). We therefore aimed to develop a prognostic nomogram suitable for clinical applications in such cases. A total of 1511 noncardia gastric cancer patients treated between 1990 and 2010 in the academic surgical center were reviewed to compare the 7 and 8 editions of the AJCC staging system. A nomogram was developed for the prediction of 5-year survival in patients with less than 16 LNs evaluated (n = 546). External validation was performed using datasets derived from the Polish Gastric Cancer Study Group (n = 668) and the SEER database (n = 11,225). The 8th edition of AJCC staging showed better overall discriminatory power compared to the previous version, but no improvement was found for patients with < 16 evaluated LNs. The developed nomogram had better concordance index (0.695) than the former (0.682) or latest (0.680) staging editions, including patients subject to neoadjuvant treatment, and calibration curves showed excellent agreement between the nomogram-predicted and actual survival. High discriminatory power was also demonstrated for both validation cohorts. Subsequently, the nomogram showed the best accuracy for the prediction of 5-year survival through the time-dependent ROC curve analysis in the training and validation cohorts. A clinically relevant nomogram was built for the prediction of 5-year survival in patients with inadequate numbers of LNs evaluated in surgical specimens. The predictive accuracy of the nomogram was validated in two Western populations.

In response to biotic and abiotic cues, the cladoceran genus Bosmina can undergo changes in body size and appendage length and shape over successive generations. To improve our understanding of the environmental controls on Bosmina size structure, we used paleolimnological techniques to examine Bosmina size responses to the extreme acidification and metal contamination, and then subsequent chemical recovery, of lakes in the vicinity of mining and smelting operations near Sudbury, Canada. During the acidification period, Bosmina antennule and carapace length significantly increased in three of the five study lakes, while mucro length significantly decreased in four of the five lakes. However, despite the recent return to pre-impact pH levels, the size structure of the present-day Bosmina community still differs from the pre-impact size distributions. We suggest that the continued dominance of the food webs by small invertebrate predators (e.g., cyclopoid copepods) is responsible for the persistent changes to Bosmina size structure.

The “Ring of Fire” in the Far North of Ontario (50–57° N, 79–94° W) is a region of growing economic and environmental interest due to recent mineral discoveries and the potential for resource development. Due to the remote location of the region, little baseline ecological information is available to distinguish any environmental impacts of mine development from ongoing regional warming. Here, we compare modern and pre-industrial sedimentary cladoceran assemblages from 60 lakes centered on McFaulds Lake in the “Ring of Fire” to identify directional changes through time and compare the assemblages with prior paleolimnological cladoceran studies of Ontario lakes closer to the Hudson Bay coast, and further south in the Muskoka-Haliburton region. The cladoceran assemblages from the “Ring of Fire” contain diverse littoral assemblages relative to the other two regions; however, despite the shallow depth of these lakes, there have been significant increases in the relative abundances of pelagic taxa (e.g. Bosmina spp. and Daphnia spp.) since pre-industrial times; taxonomic shifts consistent with warming-induced changes in lake properties including a longer ice-free period and increased algal plankton production. This evidence of widespread changes within the cladoceran assemblages in the “Ring of Fire” prior to the onset of resource extraction provides lake managers and stewards with information to better monitor and evaluate future development projects.