| 1. |
- Province, M. A., et al.
(författare)
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CYP2D6 Genotype and Adjuvant Tamoxifen : Meta-Analysis of Heterogeneous Study Populations
- 2014
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Ingår i: Clinical Pharmacology and Therapeutics. - New York, USA : Nature Publishing Group. - 0009-9236 .- 1532-6535. ; 95:2, s. 216-227
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Tidskriftsartikel (refereegranskat)abstract
- The International Tamoxifen Pharmacogenomics Consortium was established to address the controversy regarding cytochrome P450 2D6 (CYP2D6) status and clinical outcomes in tamoxifen therapy. We performed a meta-analysis on data from 4,973 tamoxifen-treated patients (12 globally distributed sites). Using strict eligibility requirements (postmenopausal women with estrogen receptor-positive breast cancer, receiving 20 mg/day tamoxifen for 5 years, criterion 1), CYP2D6 poor metabolizer status was associated with poorer invasive disease-free survival (IDFS: hazard ratio = 1.25; 95% confidence interval = 1.06, 1.47; P = 0.009). However, CYP2D6 status was not statistically significant when tamoxifen duration, menopausal status, and annual follow-up were not specified (criterion 2, n = 2,443; P = 0.25) or when no exclusions were applied (criterion 3, n = 4,935; P = 0.38). Although CYP2D6 is a strong predictor of IDFS using strict inclusion criteria, because the results are not robust to inclusion criteria (these were not defined a priori), prospective studies are necessary to fully establish the value of CYP2D6 genotyping in tamoxifen therapy.
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| 2. |
- North, R. L., et al.
(författare)
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The state of Lake Simcoe (Ontario, Canada) : the effects of multiple stressors on phosphorus and oxygen dynamics
- 2013
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Ingår i: Inland Waters. - 2044-2041 .- 2044-205X. ; 3:1, s. 51-74
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Tidskriftsartikel (refereegranskat)abstract
- Lake Simcoe, the largest lake in southern Ontario outside of the Laurentian Great Lakes, is affected by numerous stressors including eutrophication resulting from total phosphorus (TP) loading, climate change, and invasions of exotic species. We synthesized the long-term responses of Lake Simcoe to these stressors by assessing trends in water quality and biological composition over multiple trophic levels. Evidence for climate change included increasing thermal stability of the lake and changes in subfossil diatom communities over time. Although the deep water dissolved oxygen (O-2) minimum has increased significantly since TP load reductions, it is still below estimated historical values and the Lake Simcoe Protection Plan end-of-summer target level of 7 mg O-2 L-1. Low deep water O-2 concentrations corresponded with a decline in coldwater fish abundance. Since 1980, some nutrient concentrations have decreased (spring TP) while others have increased (silica), but many show no obvious changes (ice-free TP, nitrate, ammonium). Increases in water clarity, combined with declines in chlorophyll a and phytoplankton biovolumes in Cook's Bay, were temporally consistent with declines in TP loading and the lake-wide establishment of dreissenid mussels as a major component of the Lake Simcoe ecosystem. Using an investigative tool, we identified 2 periods when abrupt shifts potentially occurred in multiple parameters: 1986 and 1995-1997. Additional ecosystem level changes such as declines in zooplankton, declines in offshore benthic invertebrate abundance, and increased nearshore invertebrate abundance likely reflect the effects of invasive species. The interaction of these multiple stressors have significantly altered the Lake Simcoe ecosystem.
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