Ecosystem regimes and responses in a coupled ancient lake system from MIS 5b to present: the diatom record of lakes Ohrid and Prespa

We reconstruct the aquatic ecosystem interactions since the last interglacial period in the oldest, most diverse, hydrologically connected European lake system, by using palaeolimnological diatom and selected geochemistry data from Lake Ohrid “DEEP site” core and equivalent data from Lake Prespa core, Co1215. Driven by climate forcing, the lakes experienced two adaptive cycles during the last 92 ka: "interglacial and interstadial" and "glacial" cycle. The short-term ecosystems reorganizations, e.g. regime shifts within these cycles substantially differ between the lakes, as evident from the inferred amplitudes of variation. The deeper Lake Ohrid shifted between ultra oligo- and oligotrophic regimes in contrast to the much shallower Lake Prespa, which shifted from a deeper, (oligo-) mesotrophic to a shallower, eutrophic lake and vice versa. Due to the high level of ecosystem stability (e.g. trophic state, lake level), Lake Ohrid appears relatively resistant to external forcing, such as climate and environmental change. Recovering in a relatively short time from major climate change, Lake Prespa is a resilient ecosystem. At the DEEP site, the decoupling between the lakes' response to climate change is marked in the prolonged and gradual changes during the MIS 5/4 and 2/1 transitions. These response differences and the lakes' different physical and chemical properties may limit the influence of Lake Prespa on Lake Ohrid. Regime shifts of Lake Ohrid due to potential hydrological change in Lake Prespa are not evident in the data presented here. Moreover, a complete collapse of the ecosystems functionality and loss of their diatom communities did not happen in either lake for the period presented in the study.

Recommendations for Genetic Testing to Reduce the Incidence of Anthracycline-induced Cardiotoxicity

AIM Anthracycline-induced cardiotoxicity (ACT) occurs in 57% of treated patients and remains an important limitation of anthracycline-based chemotherapy. In various genetic association studies, potential genetic risk markers for ACT have been identified. Therefore, we developed evidence-based clinical practice recommendations for pharmacogenomic testing to further individualize therapy based on ACT risk. METHODS We followed a standard guideline development process; including a systematic literature search, evidence synthesis and critical appraisal, and the development of clinical practice recommendations with an international expert group. RESULTS RARG rs2229774, SLC28A3 rs7853758 and UGT1A6 rs17863783 variants currently have the strongest and the most consistent evidence for association with ACT. Genetic variants in ABCC1, ABCC2, ABCC5, ABCB1, ABCB4, CBR3, RAC2, NCF4, CYBA, GSTP1, CAT, SULT2B1, POR, HAS3, SLC22A7, SCL22A17, HFE and NOS3 have also been associated with ACT, but require additional validation. We recommend pharmacogenomic testing for the RARG rs2229774 (S427L), SLC28A3 rs7853758 (L461L) and UGT1A6*4 rs17863783 (V209V) variants in childhood cancer patients with an indication for doxorubicin or daunorubicin therapy (Level B - moderate). Based on an overall risk stratification, taking into account genetic and clinical risk factors, we recommend a number of management options including increased frequency of echocardiogram monitoring, follow-up, as well as therapeutic options within the current standard of clinical practice. CONCLUSIONS Existing evidence demonstrates that genetic factors have the potential to improve the discrimination between individuals at higher and lower risk of ACT. Genetic testing may therefore support both patient care decisions and evidence development for an improved prevention of ACT.