ALBERT

Description: Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related death worldwide, with an increased incidence in South Asia. In order to describe the effect of surveillance for HCC with biannual ultrasound and alpha-fetoprotein (AFP) on diagnosis and survival in an Indian population a retrospective cohort-control study was performed at two liver clinics in India. The medical records of 3,258 patients with cirrhosis who received surveillance for HCC were reviewed, and 100 patients who developed HCC identified. Sixty-four cirrhotic patients diagnosed with HCC during the same time period without a history of surveillance were included and survival, BCLC stage at diagnosis, and treatment were compared.Patients who underwent surveillance were more likely to be diagnosed with potentially curable or treatable BCLC Stage 0/A disease and Stage B/C disease respectively, than late Stage D disease (chi2 = 0.0007). Patients diagnosed at an earlier stage of HCC lived significantly longer after diagnosis than patients diagnosed at a later stage (Stage 0/A: 15.6 +/- 14.2 months vs. Stage B/C: 9.43 +/- 19.7 months vs. Stage D: 5.59 +/- 11.9 months; p = 0.0006). While treatment for HCC improved overall survival, only 28% of eligible patients received treatment, explaining the lack of survival benefit noted in the surveillance group. Surveillance for HCC led to detection of HCC at earlier stages. The impact of surveillance on improved mortality could not be evaluated given the limited number of patients who received treatment. HCC surveillance has the potential to improve survival in South Asian patients with cirrhosis only if improvements in access to appropriate treatment are made.

Description: Fundamentally, El Niño Southern Oscillation (ENSO) is a climatic and oceanographic phenomenon, but it has profound effects on terrestrial ecosystems. Although the ecological effects of ENSO are becoming increasingly known from a wide range of terrestrial ecosystems (Holmgren et al., 2001), their impacts have been more intensively studied in arid and semiarid systems. In this brief communication, we summarize the main conclusions of a recent symposium on the effects of ENSO in these ecosystems, which was convened as part of the First Alexander von Humboldt International Conference on the El Niño Phenomenon and its Global Impact, in Guayaquil, Ecuador, from 16–20 May 2005. Participants in the symposium shared results and perspectives from research conducted in North and South America and Australia, regions where the ecological effects of ENSO have been studied in depth. Although the reports covered a wide array of organisms and ecological systems (Fig. 1), a recurring theme was the strong increase in rainfall associated with ENSO events in dry ecosystems (during the El Niño phase of the oscillation in the Americas and the La Niña phase in Australia). Because inter-annual variability in precipitation is such a strong determinant of productivity in arid and semiarid ecosystems, increased ENSO rainfall is crucial for plant recruitment, productivity and diversity in these ecosystems. Several long-term studies show that this pulse in primary productivity causes a subsequent increase in herbivores, followed by an increase in carnivores, with consequences for changes in ecosystem structure and functioning that can be quite complex.