Adjuvant chemotherapy followed by goserelin compared with either modality alone: the impact on amenorrhea, hot flashes, and quality of life in premenopausal patients--the International Breast Cancer Study Group Trial VIII

The purpose of this article is to compare quality of life (QOL) and menopausal symptoms among premenopausal patients with lymph node-negative breast cancer receiving chemotherapy, goserelin, or their sequential combination, and to investigate differential effects by age.

HIV treatment response and prognosis in Europe and North America in the first decade of highly active antiretroviral therapy: a collaborative analysis

BACKGROUND: Highly active antiretroviral therapy (HAART) for the treatment of HIV infection was introduced a decade ago. We aimed to examine trends in the characteristics of patients starting HAART in Europe and North America, and their treatment response and short-term prognosis. METHODS: We analysed data from 22,217 treatment-naive HIV-1-infected adults who had started HAART and were followed up in one of 12 cohort studies. The probability of reaching 500 or less HIV-1 RNA copies per mL by 6 months, and the change in CD4 cell counts, were analysed for patients starting HAART in 1995-96, 1997, 1998, 1999, 2000, 2001, and 2002-03. The primary endpoints were the hazard ratios for AIDS and for death from all causes in the first year of HAART, which were estimated using Cox regression. RESULTS: The proportion of heterosexually infected patients increased from 20% in 1995-96 to 47% in 2002-03, and the proportion of women from 16% to 32%. The median CD4 cell count when starting HAART increased from 170 cells per muL in 1995-96 to 269 cells per muL in 1998 but then decreased to around 200 cells per muL. In 1995-96, 58% achieved HIV-1 RNA of 500 copies per mL or less by 6 months compared with 83% in 2002-03. Compared with 1998, adjusted hazard ratios for AIDS were 1.07 (95% CI 0.84-1.36) in 1995-96 and 1.35 (1.06-1.71) in 2002-03. Corresponding figures for death were 0.87 (0.56-1.36) and 0.96 (0.61-1.51). INTERPRETATION: Virological response after starting HAART improved over calendar years, but such improvement has not translated into a decrease in mortality.

Tree-ring-reconstructed summer temperatures from northwestern North America during the last nine centuries

Northwestern North America has one of the highest rates of recent temperature increase in the world, but the putative “divergence problem” in dendroclimatology potentially limits the ability of tree-ring proxy data at high latitudes to provide long-term context for current anthropogenic change. Here, summer temperatures are reconstructed from a Picea glauca maximum latewood density (MXD) chronology that shows a stable relationship to regional temperatures and spans most of the last millennium at the Firth River in northeastern Alaska. The warmest epoch in the last nine centuries is estimated to have occurred during the late twentieth century, with average temperatures over the last 30 yr of the reconstruction developed for this study [1973–2002 in the Common Era (CE)] approximately 1.3° ± 0.4°C warmer than the long-term preindustrial mean (1100–1850 CE), a change associated with rapid increases in greenhouse gases. Prior to the late twentieth century, multidecadal temperature fluctuations covary broadly with changes in natural radiative forcing. The findings presented here emphasize that tree-ring proxies can provide reliable indicators of temperature variability even in a rapidly warming climate.

Pb pollution from leaded gasoline in South America in the context of a 2000-year metallurgical history

Exploitation of the extensive polymetallic deposits of the Andean Altiplano in South America since precolonial times has caused substantial emissions of neurotoxic lead (Pb) into the atmosphere; however, its historical significance compared to recent Pb pollution from leaded gasoline is not yet resolved. We present a comprehensive Pb emission history for the last two millennia for South America, based on a continuous, high-resolution, ice core record from Illimani glacier. Illimani is the highest mountain of the eastern Bolivian Andes and is located at the northeastern margin of the Andean Altiplano. The ice core Pb deposition history revealed enhanced Pb enrichment factors (EFs) due to metallurgical processing for silver production during periods of the Tiwanaku/Wari culture (AD 450–950), the Inca empires (AD 1450–1532), colonial times (AD 1532–1900), and tin production at the beginning of the 20th century. After the 1960s, Pb EFs increased by a factor of 3 compared to the emission level from metal production, which we attribute to gasoline-related Pb emissions. Our results show that anthropogenic Pb pollution levels from road traffic in South America exceed those of any historical metallurgy in the last two millennia, even in regions with exceptional high local metallurgical activity.