Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2)

BACKGROUND: Worldwide data for cancer survival are scarce. We aimed to initiate worldwide surveillance of cancer survival by central analysis of population-based registry data, as a metric of the effectiveness of health systems, and to inform global policy on cancer control. METHODS: Individual tumour records were submitted by 279 population-based cancer registries in 67 countries for 25·7 million adults (age 15-99 years) and 75,000 children (age 0-14 years) diagnosed with cancer during 1995-2009 and followed up to Dec 31, 2009, or later. We looked at cancers of the stomach, colon, rectum, liver, lung, breast (women), cervix, ovary, and prostate in adults, and adult and childhood leukaemia. Standardised quality control procedures were applied; errors were corrected by the registry concerned. We estimated 5-year net survival, adjusted for background mortality in every country or region by age (single year), sex, and calendar year, and by race or ethnic origin in some countries. Estimates were age-standardised with the International Cancer Survival Standard weights. FINDINGS: 5-year survival from colon, rectal, and breast cancers has increased steadily in most developed countries. For patients diagnosed during 2005-09, survival for colon and rectal cancer reached 60% or more in 22 countries around the world; for breast cancer, 5-year survival rose to 85% or higher in 17 countries worldwide. Liver and lung cancer remain lethal in all nations: for both cancers, 5-year survival is below 20% everywhere in Europe, in the range 15-19% in North America, and as low as 7-9% in Mongolia and Thailand. Striking rises in 5-year survival from prostate cancer have occurred in many countries: survival rose by 10-20% between 1995-99 and 2005-09 in 22 countries in South America, Asia, and Europe, but survival still varies widely around the world, from less than 60% in Bulgaria and Thailand to 95% or more in Brazil, Puerto Rico, and the USA. For cervical cancer, national estimates of 5-year survival range from less than 50% to more than 70%; regional variations are much wider, and improvements between 1995-99 and 2005-09 have generally been slight. For women diagnosed with ovarian cancer in 2005-09, 5-year survival was 40% or higher only in Ecuador, the USA, and 17 countries in Asia and Europe. 5-year survival for stomach cancer in 2005-09 was high (54-58%) in Japan and South Korea, compared with less than 40% in other countries. By contrast, 5-year survival from adult leukaemia in Japan and South Korea (18-23%) is lower than in most other countries. 5-year survival from childhood acute lymphoblastic leukaemia is less than 60% in several countries, but as high as 90% in Canada and four European countries, which suggests major deficiencies in the management of a largely curable disease. INTERPRETATION: International comparison of survival trends reveals very wide differences that are likely to be attributable to differences in access to early diagnosis and optimum treatment. Continuous worldwide surveillance of cancer survival should become an indispensable source of information for cancer patients and researchers and a stimulus for politicians to improve health policy and health-care systems

True substrates: The exceptional resolution and unexceptional preservation of deep time snapshots on bedding surfaces

Abstract: Rock outcrops of the sedimentary–stratigraphic record often reveal bedding planes that can be considered to be true substrates: preserved surfaces that demonstrably existed at the sediment–water or sediment–air interface at the time of deposition. These surfaces have high value as repositories of palaeoenvironmental information, revealing fossilized snapshots of microscale topography from deep time. Some true substrates are notable for their sedimentary, palaeontological and ichnological signatures that provide windows into key intervals of Earth history, but countless others occur routinely throughout the sedimentary–stratigraphic record. They frequently reveal patterns that are strikingly familiar from modern sedimentary environments, such as ripple marks, animal trackways, raindrop impressions or mudcracks: all phenomena that are apparently ephemeral in modern settings, and which form on recognizably human timescales. This paper sets out to explain why these short‐term, transient, small‐scale features are counter‐intuitively abundant within a 3.8 billion year‐long sedimentary–stratigraphic record that is known to be inherently time‐incomplete. True substrates are fundamentally related to a state of stasis in ancient sedimentation systems, and distinguishable from other types of bedding surfaces that formed from a dominance of states of deposition or erosion. Stasis is shown to play a key role in both their formation and preservation, rendering them faithful and valuable archives of palaeoenvironmental and temporal information. Further, the intersection between the time–length scale of their formative processes and outcrop expressions can be used to explain why they are so frequently encountered in outcrop investigations. Explaining true substrates as inevitable and unexceptional by‐products of the accrual of the sedimentary–stratigraphic record should shift perspectives on what can be understood about Earth history from field studies of the sedimentary–stratigraphic record. They should be recognized as providing high‐definition information about the mundane day to day operation of ancient environments, and critically assuage the argument that the incomplete sedimentary–stratigraphic record is unrepresentative of the geological past

Circular polarization in scattered light as a possible biomarker

Original article can be found at : http://www.sciencedirect.com/ Copyright ElsevierBiological molecules exhibit homochirality and are optically active. Therefore, it is possible that the scattering of light by biological molecules might result in a macroscopic signature in the form of circular polarization. If this is the case, then circular polarization spectroscopy, which may be utilized in remote sensing, can offer a powerful indicator of the presence of a universal biosignature, namely homochirality. Here, we describe laboratory experiments designed to investigate this idea. We focus on photosynthetic microorganisms, and also show results from macroscopic vegetation and control minerals. In the microorganisms, we find unambiguous circular polarization associated with electronic absorption bands of the photosynthetic apparatus. Macroscopic vegetation yields a stronger and more complex signature while the control minerals produce low-levels of circular polarization unrelated to their spectra. We propose a heuristic explanation of our results, which is that the polarization is produced by circular dichroism in the material after the light has undergone its last scattering event. The results are encouraging for the use of circular polarization spectroscopy in remote sensing of a generic biomarker from space or the ground.Peer reviewe

Intracerebral Haemorrhages and Oral Anticoagulation in the North of Scotland

The aim of this study has been twofold: 1 - to examine the impact of oral anticoagulant (OAC) use on a possible recent rise in the admission rate of intracerebral haemorrhages to Aberdeen Royal Infirmary (ARI), and 2 - to estimate the absolute risk of intracranial haemorrhage for outpatients followed up in the OAC Clinic at AR1. The number of patients admitted to ARI with intracerebral bleedings increased by 60% between 1993 and 1998. A corresponding increase in the proportion of patients with concurrent OAC use (4.7% vs 15.7%, p=0.055) cannot sufficiently explain the increase in the total number of intracerebral haemorrhages. The average annual incidence of intracranial haemorrhages for the OAC Clinic at ARI is found to be acceptably low at 0.33% per year. Further audit of the large number of patients receiving warfarin outwith the supervision of the clinic is urgently required. </jats:p

N-terminal pro-brain natriuretic peptide - A new gold standard in predicting mortality in patients with advanced heart failure

Aims The selection of patients for cardiac transplantation (CTx) is notoriously difficult and traditionally involves clinical assessment and an assimilation of markers of the severity of CHF such as the left ventricular ejection fraction (LVEF), maximum oxygen uptake (peak VO2) and more recently, composite scoring systems e.g. the heart failure survival score (HFSS). Brain natriuretic peptide (BNP) is well established as an independent predictor of prognosis in mild to moderate chronic heart failure (CHF). However, the prognostic ability of NT-proBNP in advanced heart failure is unknown and no studies have compared NT-proBNP to standard clinical markers used in the selection of patients for transplantation. The purpose of this study was to examine the prognostic ability of NT-proBNP in advanced heart failure and compare it to that of the LVEF, peak VO2and the HFSS. Methods and results We prospectively studied 142 consecutive patients with advanced CHF referred for consideration of CTx. Plasma for NT-proBNP analysis was sampled and patients followed up for a median of 374 days. The primary endpoint of all-cause mortality was reached in 20 (14.1%) patients and the combined secondary endpoint of all-cause mortality or urgent CTx was reached in 24 (16.9%) patients. An NT-proBNP concentration above the median was the only independent predictor of all cause mortality (χ2=6.03, P=0.01) and the combined endpoint of all cause mortality or urgent CTx (χ2=12.68, P=0.0004). LVEF, VO2and HFSS were not independently predictive of mortality or need for urgent cardiac transplantation in this study. Conclusion A single measurement of NT-proBNP in patients with advanced CHF, can help to identify patients at highest risk of death, and is a better prognostic marker than the LVEF, VO2or HFSS