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SummaryBackgroundNeoadjuvant chemotherapy (NACT) for early breast cancer can make breast-conserving surgery more feasible and might be more likely to eradicate micrometastatic disease than might the same chemotherapy given after surgery. We investigated the long-term benefits and risks of NACT and the influence of tumour characteristics on outcome with a collaborative meta-analysis of individual patient data from relevant randomised trials.MethodsWe obtained information about prerandomisation tumour characteristics, clinical tumour response, surgery, recurrence, and mortality for 4756 women in ten randomised trials in early breast cancer that began before 2005 and compared NACT with the same chemotherapy given postoperatively. Primary outcomes were tumour response, extent of local therapy, local and distant recurrence, breast cancer death, and overall mortality. Analyses by intention-to-treat used standard regression (for response and frequency of breast-conserving therapy) and log-rank methods (for recurrence and mortality).FindingsPatients entered the trials from 1983 to 2002 and median follow-up was 9 years (IQR 5–14), with the last follow-up in 2013. Most chemotherapy was anthracycline based (3838 [81%] of 4756 women). More than two thirds (1349 [69%] of 1947) of women allocated NACT had a complete or partial clinical response. Patients allocated NACT had an increased frequency of breast-conserving therapy (1504 [65%] of 2320 treated with NACT vs 1135 [49%] of 2318 treated with adjuvant chemotherapy). NACT was associated with more frequent local recurrence than was adjuvant chemotherapy: the 15 year local recurrence was 21·4% for NACT versus 15·9% for adjuvant chemotherapy (5·5% increase [95% CI 2·4–8·6]; rate ratio 1·37 [95% CI 1·17–1·61]; p=0·0001). No significant difference between NACT and adjuvant chemotherapy was noted for distant recurrence (15 year risk 38·2% for NACT vs 38·0% for adjuvant chemotherapy; rate ratio 1·02 [95% CI 0·92–1·14]; p=0·66), breast cancer mortality (34·4% vs 33·7%; 1·06 [0·95–1·18]; p=0·31), or death from any cause (40·9% vs 41·2%; 1·04 [0·94–1·15]; p=0·45).InterpretationTumours downsized by NACT might have higher local recurrence after breast-conserving therapy than might tumours of the same dimensions in women who have not received NACT. Strategies to mitigate the increased local recurrence after breast-conserving therapy in tumours downsized by NACT should be considered—eg, careful tumour localisation, detailed pathological assessment, and appropriate radiotherapy.FundingCancer Research UK, British Heart Foundation, UK Medical Research Council, and UK Department of Health.

[1] This paper documents a global Bayesian variational inversion of CO 2 surface fluxes during the period . Weekly fluxes are estimated on a 3.75°× 2.5°(longitudelatitude) grid throughout the 21 years. The assimilated observations include 128 station records from three large data sets of surface CO 2 mixing ratio measurements. A Monte Carlo approach rigorously quantifies the theoretical uncertainty of the inverted fluxes at various space and time scales, which is particularly important for proper interpretation of the inverted fluxes. Fluxes are evaluated indirectly against two independent CO 2 vertical profile data sets constructed from aircraft measurements in the boundary layer and in the free troposphere. The skill of the inversion is evaluated by the improvement brought over a simple benchmark flux estimation based on the observed atmospheric growth rate. Our error analysis indicates that the carbon budget from the inversion should be more accurate than the a priori carbon budget by 20% to 60% for terrestrial fluxes aggregated at the scale of subcontinental regions in the Northern Hemisphere and over a year, but the inversion cannot clearly distinguish between the regional carbon budgets within a continent. On the basis of the independent observations, the inversion is seen to improve the fluxes compared to the benchmark: the atmospheric simulation of CO 2 with the Bayesian inversion method is better by about 1 ppm than the benchmark in the free troposphere, despite possible systematic transport errors. The inversion achieves this improvement by changing the regional fluxes over land at the seasonal and at the interannual time scales. Citation: Chevallier, F., et al. (2010), CO 2 surface fluxes at grid point scale estimated from a global 21 year reanalysis of atmospheric measurements,

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Sulfur and lead isotope ratios in the atmosphere were measured at several selected sites (Harbin, Changchun, Dalian, Waliguan, Shanghai, Nanjing, Guiyang) in China and Tsukuba (Japan), to reveal regional sources characteristics over Eastern Asia. Average S isotope ratios for SO2 and sulfate in the atmosphere in China were close to those of the coals used in each region, indicating a considerable contribution of coal combustion to the sulfur compounds in the atmosphere. Most northern cities had around 5% sulfur isotope ratio, while Guiyang, a southwestern city in China, showed a considerably lower sulfur isotope ratio (about -3%) because of the unusually light sulfur isotope ratio of coals in this region. These were considerably different from the value (-1.4%) for Tsukuba (Japan). Lead isotope ratios also suggested that coal combustion considerably contributed to atmospheric lead in some cases in China. At the same time, influences by the emission of Chinese lead ores were also observed in northern cities. Seasonal variations of both sulfur and lead isotope ratios indicated the existence of a certain amount of industrial sources other than coal combustion. In addition, fractionation effect between SO2 and sulfate showed a seasonal tendency (high in winter (0-6%) and low in summer (-1-3%)), suggesting the oxidation pathway of SO2 changed seasonally.

[1] Bromoform (CHBr 3 ), dibromochloromethane (CHBr 2 Cl), and dibromomethane (CH 2 Br 2 ) in the atmosphere were measured at various sites, including tropical islands, the Arctic, and the open Pacific Ocean. Up to 40 ppt of bromoform was observed along the coasts of tropical islands under a sea breeze. Polybromomethane concentrations were highly correlated among the coastal samples, and the ratios CH 2 Br 2 /CHBr 3 and CHBr 2 Cl/ CHBr 3 showed a clear tendency to decrease with increasing CHBr 3 concentration. These findings are consistent with the observations that polybromomethanes are emitted mostly from macroalgae whose growth is highly localized to coastal areas and that CHBr 3 has the shortest lifetime among these three compounds. The relationship between the concentration ratios CHBr 3 /CH 2 Br 2 and CHBr 2 Cl/CH 2 Br 2 suggested a large mixing/ dilution effect on bromomethane ratios in coastal regions and yielded a rough estimate of 9 for the molar emission ratio of CHBr 3 /CH 2 Br 2 and of 0.7 for that of CHBr 2 Cl/CH 2 Br 2 . Using these ratios and an global emission estimate for CH 2 Br 2 (61 Gg/yr (Br)) calculated from its background concentration, the global emission rates of CHBr 3 and CHBr 2 Cl were calculated to be approximately 820(±310) Gg/yr (Br) and 43(±16) Gg/yr (Br), respectively, assuming that the bromomethanes ratios measured in this study are global representative. The estimated CHBr 3 emission is consistent with that estimated in a very recent study by integrating the sea-to-air flux database. Thus the contribution of CHBr 3 and CHBr 2 Cl to inorganic Br in the atmosphere is likely to be more important than previously thought. Citation: Yokouchi, Y., et al. (2005), Correlations and emission ratios among bromoform, dibromochloromethane, and dibromomethane in the atmosphere,

Airborne particulate matter was collected at urban sites in six Asian countries (Japan, Korea, China, Thailand, Sri Lanka, and Indonesia), and the stable lead isotope ratios were measured. Some source-related materials, such as coal and leaded gasoline, were also analyzed and compared to the ratios observed in airborne lead. Airborne lead isotope ratios differed considerably from each other, and these differences corresponded to differences in the regional source of lead. Leaded gasoline was still the primary source of lead in some cities in Asia, and the lead isotope ratios were strongly influenced by those of leaded gasoline. In Chinese and Korean cities, however, the considerable effect from coal combustion and industrial activity was also observed in their isotope ratios, despite leaded gasoline use. On the other hand, only refuse incineration was a possible single source of lead in J apanese air from the view of lead isotope ratios.