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Water SA
versión On-line ISSN 1816-7950
versión impresa ISSN 0378-4738
Water SA vol.35 no.5 Pretoria oct. 2009
Morphological abnormalities of diatom silica walls in relation to heavy metal contamination and artificial growth conditions
Elisa FalascoI,III,*; Francesca BonaI; Marco GineproII; Daa HlúbikováIII; Lucien HoffmannIII; Luc EctorIII
IDBAU, University of Turin, Via Accademia Albertina 13, I-10123 Turin, Italy
II Analytical Chemistry Department, University of Turin, Via P. Giuria 5, I-10125 Turin, Italy
III Department of Environment and Agro-biotechnologies (EVA), Public Research Center Gabriel Lippmann, Rue du Brill 41, L-4422 Belvaux, Luxembourg
Teratological forms of diatoms are non-adaptive phenotypic abnormalities caused by various environmental stresses. Heavy metal contamination and artificial growth conditions are the best known causes. In fact, the recording of abnormal cells in a diatom population or community can give both a temporal and quantitative indication of heavy metal contamination of water bodies. Moreover, long-term cultures generally present a high percentage of abnormal cells due to the scarcity of nutrients, presence of waste products and osmotic pressure. The aim of this paper is to classify and provide photographic documentation and descriptions of all known teratologies occurring in the most widespread freshwater diatom genera.
Keywords: aquatic ecosystem health, diatoms, teratological forms
Morphological variation in diatoms can be both adaptive and non-adaptive in response to environmental conditions. Teratological forms are non-adaptive phenotypic abnormalities usually involving the outline of valves or their striation pattern. Some alterations, such as those involving valve outlines, are mechanically conveyed during reproduction, giving rise to a population with a different morphology from that of the parental line (Hustedt, 1956). Others, such as structure and distribution of striations, seem to be limited to a few generations. For this reason, an abnormal valve outline is more frequent than other teratologies (Granetti, 1968a). Other kinds of aberrancy have been noted, but they are rarer. Many environmental stresses seem to be responsible for teratological cell development and the recording of abnormal cells in a diatom population or community can give both a temporal and quantitative indication of the stress. Indeed, several papers report a significant positive correlation between the abundance of teratological cells and environmental stresses such as low current velocity and flow, drought conditions, light intensity, increase in temperature (Antoine and Benson-Evans, 1986), decrease in water quality (Gómez and Licursi, 2003) or herbicide contamination (Debenest et al., 2008).
Heavy metal contamination and artificial growth conditions are the best known causes of teratological forms. In particular, Cu, Cd and Zn seem to be the most effective trace metals in the production of abnormal cells. Copper led to deformed valve outlines in Fragilaria rumpens, F. tenera, Eunotia exigua and Eunotia sp. (Barber and Carter, 1981; Ruggiu et al., 1998), twinned valves in Nitzschia delicatissima (Thomas et al., 1980), 90° rotation in Asterionella formosa frustules (Cattaneo et al., 2004) and large deformities in A. japonica (Fisher and Frood, 1980; Fisher et al., 1981). In general, no atypical ornamentation pattern was recorded. Cadmium (100 µg Cd·ℓ-1) led to the development of abnormal valve outlines in Achnanthidium spp., Amphora pediculus, Eolimna minima, Gomphonema parvulum, Mayamaea spp. (including M. agrestis) and Nitzschia palea (Morin et al., 2008b). Interruption of the raphe was noticed in Encyonema minutum, Eolimna minima and Sellaphora seminulum, and abnormal pore shape and pattern in E. minima and G. parvulum. Cadmium contamination also caused unusual colony formation of Tabellaria flocculosa (Adshead-Simonsen et al., 1981). Although no studies have been carried out on Zn as a single pollutant, great importance has been given to combined Cd and Zn contamination; these two heavy metals have been responsible for an abnormal valve profile and striation pattern, doubled central area and distorted raphe canal in several species (McFarland et al., 1997; Nunes et al., 2003; Morin et al., 2008a). In particular, these two heavy metals together induced abnormal valve outlines (wiggly or asymmetric frustules) in Fragilaria gracilis, Cocconeis pediculus and C. placentula. An abnormal striation pattern and displaced longitudinal area were characteristic of Ulnaria ulna, while, in the same conditions, Planothidium frequentissimum showed a doubled central area and Nitzschia fonticola presented an atypical raphe canal.
'Teratological growths' in cultures were observed in the 19th century by Miquel (1890-1892), who proved that changes in the chemical composition of the culture medium induced the development of abnormal cells. Later, Locker (1950) recorded teratological cells of Fragilaria capucina (abnormal valve outline), while Cholnoky-Pfannkuche (1971) described abnormal cells of Nitzschia palea. Indeed, old culture media enriched by metabolic waste matter could be responsible for the production of teratological forms. Abnormal cells stimulated by intense artificial light also easily undergo vegetative reproduction, thus transmitting alterations through the generations (Granetti, 1968a). Between 1960 and 1978, Granetti (1968a; b; 1975a; b; 1978) fully described teratological cells of Diadesmis gallica, Eolimna minima, Fistulifera pelliculosa and Sellaphora seminulum maintained in artificial growth conditions for several years. These Naviculaceae species showed abnormalities involving the valve outline, orientation centre for the striae, raphe system, central and axial areas, central nodule, pores and spines. Nitzschia denticula was a good example to support the hypothesis that the more complex the valve ornamentation, the more teratologies can be developed (Granetti, 1975a). Besides the above-mentioned abnormal features, Nitzschia can present abnormal dislocation of the raphe canal, anomalous development of the pores and atypical internal septum (disorientated or branched).
In long-term cultures, not only nutrients and waste but also salinity can stimulate the production of teratological forms. Increased osmotic pressure acts as microtubule poison and was observed to cause aberrancy in cells of Anomoeoneis sphaerophora f. costata (Schmid, 1980). Furthermore, Håkansson and Chepurnov (1999) found that, at high salinity concentrations, some specimens of Cyclotella meneghiniana showed multiple striae orientation centres and abnormal striation patterns. Teratologies were also observed in long-term cultures of Achnanthes brevipes, Nitzschia palea and Ulnaria ulna (Estes and Dute, 1994), generally involving the valve outline, raphe system, sternum (branched or dislocated), fibulae arrangements and ornamentation pattern.
The main problem underlying the confusion in the literature is the lack of a morphological classification of teratological forms. In view of the fact that abnormal cells could be used in environmental assessments, the 1st step is to create a classification system to provide a common technical basis (thus far unavailable). The aim of this paper is to fill this gap by providing photographs and specific descriptions encompassing a wide range of teratologies found in a heavy metal-contaminated river and long-term cultures.
Materials and methods
Samples from the Bormida River (Italy) and long-term artificial cultures were examined under light microscopy. Bormida River is an Apennine river flowing on sedimentary rocks (sandstone, marlstone and sand) of the Tertiary Piedmontese Basin. It has been contaminated by heavy metals and other toxic compounds for more than 100 years, from outflow of the chemical plant of the Associated National Chemical Companies (ACNA) of Cengio (Savona, SV). Five sampling stations located between Cengio and Cortemilia (Cuneo, CN) were chosen (B1-B5). B1 (Cengio) was located 0.2 km downstream of the old outfalls of the ACNA factory. B2 (Gabutti di Camerana, CN), B3 (Monesiglio, CN) and B4 (Monesiglio, CN) were located downstream of the ACNA outfalls at a distance of respectively 7 km, 12.5 km and 22.5 km. The last station (B5) was located in Cortemilia (CN), ca. 35 km from Cengio. To record the maximum number of teratological forms of diatoms, seasonal samplings were carried out between 2003 and 2004 following standard sampling methods (Kelly et al., 1998; AFNOR, 2000). No trace of heavy metals was found in the water column, and for this reason we only refer to heavy metal concentrations in river sediments analysed in 2003 by the local environmental protection agency (ARPA, unpublished data). Due to its highly compromised ecological status, it was not possible to identify control sites on the Bormida River. Therefore, we selected 3 control sites (considered as replicates in the following sections) on the Erro River, a tributary of the Bormida with similar physical characteristics but not polluted by nutrients or heavy metals. Geologically, the Erro Valley is located in the Erro-Tobbio complex, a slice of subcontinental mantel characterised by peridotitic rocks (spinel and plagioclase lherzolites, spinel dunites). Heavy metal concentrations in Erro River sediments were analysed by the Chemistry Department of the University of Turin. To investigate the relationships among heavy metals in sediments, we calculated the toxicity coefficient (ToxC) for each metal, taking into consideration the legislative limits given by Bona et al. (1997). ToxC was calculated as ToxCj= ([HMejs]/ [HMejl]), where [HMejs] was the concentration of the heavy metal j in the sediments; [HMejl] was the limit concentration level proposed as ineffective. For the teratological forms, we calculated the deformation factor of species (DF_sp.) as DF_sp. = (% SB)/(% SE), where (% SB) was the number of species presenting teratological forms in the Bormida River; (% SE) was the number of species presenting teratological forms in the Erro River. Moreover, we calculated the deformation factor of the percentage of individuals (DF_in.) as (DF_in.) = (% NtjB)/(% NtjE), where (% NtjB) was the percentage of deformed cells of species j in the Bormida River, and (% NtjE) the percentage of deformed cells of species j in the Erro River. We also calculated the percentage of teratological frustules for each diatom species, taking into consideration the most frequent species in the whole sample (present in at least 2 sampling seasons), showing at least 2% of abnormal forms in the samples.
Sixteen monospecific cultures belonging to 12 genera and coming from different European rivers were set up in the Public Research Centre Gabriel Lippmann, Luxembourg. A list of the cultured species is given in Table 4. From each original sample, 2 mℓ of diatom suspension were put in a sterile flask and 10 mℓ of standard culture medium (WC Medium; Guillard and Lorenzen, 1972) were added. After 1 to 4 d of incubation, we isolated individual cells by means of a micropipette and repeatedly washed them in fresh medium. Cultures were maintained in a growth chamber at 15°C constant temperature, with cool white fluorescent lamps providing 400 to 700 nm light. The measured intensity in the growth chamber was 33.1 ± 3.4 µmol·s-1·cm-2 with a 16h:08h light:dark cycle (Rimet et al., 2004).
Both natural samples and monospecific cultures were treated with hot hydrogen peroxide (110 vols.) and HCl (1 N) to obtain a suspension of clean frustules, which were mounted as permanent slides in Naphrax®. Light microscope observations were performed using a Leica DMRX light microscope and a Leitz Wetzlar Ortholux with 100x oil immersion objective. Light microscope photographs were taken with a Leica DC500 camera.
Teratological types
Based on a review of published reports on the relationships between environmental stresses and abnormal diatom cells (Falasco et al., 2009), 7 types of teratological forms could be defined (Table 1).
Type 1: deformed valve outline (loss of symmetry relative to both axes; pentagonal or trilobate shapes; abnormal outline: bent, jagged, incised, kidney-shaped, swollen, twinned, wiggly, showing bulbous protrusions, or 'boomerang'-shaped).
Type 2: changes in striation pattern, costae and septae (multiple orientation centres for the striation; branched striae; loss of transverse costae; arrangement and shape of areolae; loss of the areolae or striae).
In addition to these 2 frequent teratologies, there are 5 types of rarer morphological alterations:
Type 3: changes in the shape and size of the longitudinal and central area (e.g. displaced, doubled, abnormally enlarged, absent).
Type 4: modifications of the raphe (split, sinuate or fragmented, sometimes turned down, double or triple, angular, bifurcate, orientated toward the centre of the valve, completely absent, with portions associated with and occasionally connected to the areolae).
Type 5: modifications of the raphe canal system (distorted, curved and occasionally doubled back or displaced, disordered and stretched out fibulae).
Type 6: unusual arrangement of the cells forming colonies.
Type 7: mixed type in which one valve shows more than one kind of teratology, each independent of the others.
Teratological forms in natural conditions
Cadmium, copper, lead and zinc concentrations in Bormida River sediments are shown in Table 2. Due to the lack of common agreed limits in Italian legislation for heavy metal concentrations in uncontaminated sediments, we refer to Bona et al. (1997).
All heavy metal ToxCs were significantly correlated with each other. In particular, Pb was correlated with Cd (0.638**), with Cu (0.690**) and with Zn (0.947***); Zn was correlated with Cd (0.717***) and with Cu (0.462*). The percentage of species presenting at least one teratological cell in the community diminished from Sites B1 to B5. In general, the species with the highest number of teratological forms belonged to the genera Navicula and Nitzschia. To investigate the relationships among diatom teratological forms and heavy metals in the sediments, we carried out a Spearman correlation analysis of ToxCs and deformation factors (DF_sp. and DF_in.). We found a significant positive correlation between Cd ToxC and DF_sp. (0.593**). Moreover, DF_in. of Mayamaea permitis, Navicula gregaria and Nitzschia dissipata was significantly correlated with Cd ToCs, while DF_in. of Encyonema minutum was correlated with ZnToxCs.
A list of the most frequent diatom taxa and the respective teratological types recorded in the samples from the Bormida River is shown in Table 3. Photographs of the most frequent teratologies recorded in the field are shown in Figs. 1 to 96.
The most frequent type of teratology was deformed valve outline (Type 1). Navicula and Nitzschia had the highest number of cells and species affected by Type 1. This alteration affected only one valve or the whole frustule, involving different portions of the outline. In general, Type 1 cells showed frustule constrictions on the distal (Figs. 2; 7; 21; 23; 26; 29; 44; 49 to 50; 66) and/or central portions (Figs. 8; 22; 25; 30; 39; 41 to 42), involving one side of the cell (Figs. 7; 20; 22 to 23; 25-31; 42; 48-49; 59; 64 to 66) or two sides of the cell (Figs. 2; 39-41; 47; 50; 57-58; 60-62). Sometimes this affected one pole (Figs. 17 to 19; 24; 37; 63; 68), rarely both of them at the same time (Fig. 6). We usually observed a decreased cell surface (due to the valve outline deformation), while an increase was rarely detected (swollen specimens). These unusual valve outlines led to loss of the typical cell symmetry of the affected species. Stringy species, such as Fragilaria rumpens, assumed bent or wiggly shapes. Sometimes the valve surface maintained its shape, while the alterations occurred on the girdle bands (for example Staurosira venter [Figs. 14 to 16] and Aulacoseira italica). This alteration was mainly visible in girdle view, especially in colonies.
Type 2 involved the ornamentation pattern. In some cases, there was loss of the areolae (Figs. 75; 80; 82). As a consequence, we recorded cells with interrupted ornamentation or atypical and alternated striae lengths (e.g. Caloneis bacillum). At times the striation pattern was abnormal and confused (Figs. 78 to 79), and sometimes it seemed that 2 or more centres of orientation had been created. An unusual costae arrangement was typical of the genus Diatoma (Figs. 71 to 73).
Only Cocconeis pseudolineata (Fig. 83), Planothidium frequentissimum, Synedra vaucheriae and Fragilaria capucina var. capitellata showed the Type 3 teratology. In the first species, the pseudoraphe was dislocated and bent. In P. frequentissimum, the teratology usually affected the horseshoe thickening on the rapheless valve. In F. capucina var. capitellata, we observed an unusual central area: while in normal cells the central area was asymmetric and located in one part of the hemivalve, in the teratological specimen the central area was symmetric, cutting off the pseudoraphe.
Type 4 teratology was characteristic of species of the genera Cymbella and Encyonema. The alterations of the raphe could be observed in C. excisa (interrupted raphe slit) and E. minutum (dislocation of raphe, Fig. 84). Modifications of the raphe canal were also typical of the genus Nitzschia. Surirella species were only affected by Type 1 teratology, maintaining the usual raphe canal and fibulae arrangement. In Nitzschia dissipata, N. fonticola and N. inconspicua, the raphe canal sometimes showed abnormal fibulae, both in the shape and pattern. Moreover, it was often displaced or bent. Note that this kind of alteration could be a consequence of an abnormal valve outline, although in this case it was not recorded.
No abnormal arrangement of the cells forming colonies was observed in the samples. As mentioned previously, some unusual colonies were recognised as the consequence of abnormalities in the girdle bands (Figs. 14 to 16).
The mixed type (Type 7) was quite rare and always involved an abnormal valve outline, sometimes linked to an unusual ornamentation pattern (Figs. 88 to 91; 94 to 95), sometimes to displacement of the central area (Planothidium frequentissimum) or to the raphe canal position (Nitzschia dissipata) or fibulae arrangement (Figs. 92 to 93). Some Araphideae showed an abnormal valve outline, atypical striation pattern and dislocated central area at the same time (Figs. 85 to 86). Loss of the raphe together with an abnormal striation pattern was also observed in Navicula tripunctata (Fig. 96).
Teratological forms in long-term cultures
The teratological types recorded in long-term cultures are summarised in Table 4. Photographs of the most frequent diatom teratologies recorded are provided in Figs. 97 to 234.
Some culture samples did not show any teratologies at all (Achnanthidium minutissimum) or merely a low percentage (Cyclotella meneghiniana, Diatoma mesodon, Gomphonema coronatum and Reimeria sinuata). Cultures with Cyclotella meneghiniana contained only 10% of teratological cells (Figs. 97 to 102) and the most frequently recorded abnormalities were abnormal valve outline and atypical orientation of the ornamentations (not directed toward the centre). The only abnormality in Diatoma mesodon cultures was an atypical costae pattern, affecting 10% of the population (Figs. 110 to 115). Less than 10% of Gomphonema coronatum cells (Figs. 233 to 234) showed loss of the areolae, sometimes of the whole stria, and abnormal raphe (doubled, wavy or fragmented); only a few cases of abnormal valve outline were recorded. Teratological cells of Reimeria sinuata (Figs. 224 to 232) usually showed abnormal valve outline, sometimes dislocated central area and abnormal pattern of striation; however, the percentage of abnormal cells was relatively low (12%).
High percentages of teratologies were recorded in some culture samples (Cocconeis sp., Cymbella tumida, Encyonema silesiacum, E. lange-bertalotii, Fragilaria rumpens, Gomphonema micropus, G. parvulum, G. rosenstockianum, Mayamaea permitis, Nitzschia linearis, N. palea and Ulnaria ulna). Cocconeis sp. (Figs. 141 to 150) showed an abnormal valve outline, atypical pattern of striation and abnormal pseudoraphe (branched or bent). The loss of longitudinal area, often reduced to one point, led to an abnormal striation pattern. Cymbella tumida cultures (Figs. 170 to 176) showed a huge percentage of teratological forms (over 98%), with a wide range of types. Type 1 abnormalities included loss of transverse or longitudinal symmetry, and the cells were stretched and distorted; Type 2 was represented by loss of the areolae and a confused striation pattern. We also noticed the dislocation or complete loss of the central area, and interruption of the raphe, which sometimes was curved. The mixed type was also observed in Encyonema species: loss of areolae was often coupled with interruption of the raphe, with abnormal valve outline and/or dislocated central area. Abnormal valve outline was recorded together with atypical striation pattern. A very high percentage of teratological forms was observed in Encyonema silesiacum (Figs. 177 to 193) and Encyonema cf. lange-bertalotii (Figs. 194 to 208) cultures (96% and 99% respectively). Even though most of the Encyonema cells were small and round, few cells with Type 1 teratology were recorded. The most frequent teratologies presented by the genus Encyonema were Types 2 and 4: the pattern of striation was abnormal, usually induced by an atypical raphe (absent, curved, wiggly or branched). Fragilaria rumpens presented small rounded cells, losing the typical linear shape (Figs. 103 to 109). The atypical valve outline was swollen, incised or bent. The pattern of striation was disordered (Fig. 105) and with loss of areolae (Fig. 109). The central area was sometimes dislocated, especially in small cells. Mixed types consisted of an abnormal valve outline together with an atypical striation pattern (Fig. 105) and sometimes with a dislocated central area as well.
Gomphonema micropus showed a high percentage of teratological cells (50%) (Figs. 151 to 160). The most frequent abnormalities were abnormal valve outline, often swollen (Figs. 151; 155; 157 to 158), and loss of areolae (Figs. 154 to 158; 160). An abnormal pattern of striation was often linked to loss of areolae. Less frequent but present were interruption of the raphe slit and loss of one raphe branch; consequently, the striae orientation was directed toward one pole instead of the central nodule.
Gomphonema parvulum (Figs. 161 to 169) and G. rosenstockianum (Figs. 125 to 137) cells were very small and rounded, losing the characteristic heteropolarity. G. rosenstockianum had a higher abnormal cell percentage (83.33%) than G. parvulum (58.18%), although both species presented the same types of teratologies. While Type 1 was rare, the most frequent abnormalities regarded the pattern of striation (directed toward one pole) and the raphe slit. In the latter case, we observed bent (Figs. 134; 161; 164 to 165), wiggly and branched raphes (Figs. 131 to 132; 136 to 137; 162; 166 to 169) with effects on the striation patterns. Cells presenting a branched raphe showed a divided valvar surface with independent ornamentation. The teratologies observed in Mayamaea permitis (Figs. 116 to 124) were Type 1 and dislocated or branched raphes (Figs. 117; 120 to 121; 123 to 124). All the Nitzschia linearis cells (100%) had incised valves, either on one side (Figs. 209 to 212; 214) or on two sides (Figs. 213; 215). Less frequent were an abnormal striation pattern or dislocated raphe canal. 28% of cultured Nitzschia palea cells (Figs. 216 to 223) presented an abnormal valve outline in the middle part of the valves. We never observed raphe canal dislocation in this species. Finally, almost all the Ulnaria ulna samples presented teratological cells (99%), with wiggly, arched or undulate valve outline (Figs. 138 to 140), abnormal striation pattern (Figs. 139 to 140), or both together (mixed type) (Figs. 139 to 140), and sometimes a dislocated longitudinal area.
Discussion and conclusion
The most important factor causing the development of teratological forms in the Bormida River was Cd contamination. Indeed, we found a significant correlation between the number of species affected by teratologies and the Cd toxicity coefficient. However, the statistical analysis showed that only a few species were potential indicators of heavy metal contamination. The percentage of deformed cells of Mayamaea permitis, Navicula gregaria and Nitzschia dissipata was significantly correlated with Cd ToxCs, while the percentage of Encyonema minutum abnormalities was correlated with ZnToxCs. Comparison of our results with those of other authors (Morin et al., 2008b; c) confirmed that some species (such as Cocconeis pediculus, C. placentula, Eolimna minima, Gomphonema parvulum, Nitzschia fonticola, Planothidium frequentissimum, Ulnaria ulna) can develop abnormal forms in relation to Cd pollution, although in our study they were not significantly correlated with the Cd contamination. However, we cannot exclude an additive or synergic effect of heavy metals or the interaction of other environmental factors in the development of teratologies.
The different percentages of teratologies recorded in monospecific cultures depend on the adaptive capacity of each species to grow in artificial conditions. It was recently demonstrated that the natural fluctuation of light intensity and daily variation of temperature are the main factors responsible for higher growth rates of diatoms in natural vs. artificial environments (Morin et al., 2008a). Although artificial growth systems could mimic field conditions, the low flow, oxygenation, nutrient supply and artificial light represent a stress for diatom populations. For these reasons, we hypothesise that competitive, large-late coloniser species (such as Nitzschia linearis or Ulnaria ulna) have a lower tolerance to artificial growth conditions, and the stress they perceive is expressed as teratological forms. Indeed, in our study the competitive taxa showed higher percentages of teratological forms than stress-tolerant or ruderal ones (such as Achnanthidium minutissimum).
The comparison of species growth in natural contaminated and artificial non-contaminated conditions reveals both similarities and differences. Achnanthidium minutissimum is a small adnate species able to survive and reproduce in poorly illuminated habitats (Johnson et al., 1997; Peterson, 1996) and able to colonise a wide range of environments, even those characterised by physical disturbance or mesotrophic conditions. We found that cells of A. minutissimum grown in artificial conditions did not present any deformations, while there were abnormal valve outlines in natural contaminated samples from the Bormida River. Therefore, A. minutissimum can be considered a useful species for indoor ecotoxicological tests, since it produces teratologies only as a response to specific chemical contaminants.
Fragilaria rumpens from the Bormida River never presented an abnormal striation pattern or longitudinal area, only deformed valve outlines. In contrast, F. rumpens grown in artificial conditions also showed Type 2 and Type 3 teratologies. The same occurred for Gomphonema parvulum, affected by Type 2 and Type 4 teratologies (in addition to Type 1) in long-term cultures. It seems that artificial growth conditions offer greater possibilities for the development of a wider range of teratologies than natural conditions. We could hypothesise that teratologies involving frustule ornamentation should be considered secondary effects with respect to those involving valve outline, and they probably need more time to develop. Moreover, it is possible that abnormalities of the raphe and raphe canal systems prevent correct adhesion of the cells to rock surfaces, disadvantaging specimens affected by these abnormalities. Indeed, these teratologies are rarely recorded in natural environments. On the other hand, cells in artificial conditions are less influenced by flow and can better survive and reproduce even with abnormal anchorage structure. However, we cannot exclude that the teratological type depends on the type of stress affecting the species. For this reason, abnormal valve outlines in Fragilaria rumpens could be associated with heavy metal contamination, while physical stress (produced in artificial cultures) leads to an abnormal striation pattern or dislocation of the central area in the same species. Despite this, we noticed a constancy of teratological types in other species: Diatoma mesodon and Encyonema silesiacum usually showed the same teratologies in both natural and artificial conditions.
Although it is not yet possible to establish a direct correlation between a certain environmental stress and a defined morphological alteration, teratological forms of diatoms should be considered a valid tool to provide a first indication of past water contamination (Medley and Clements, 1998; Morin et al., 2007). This paper provides an illustrated classification of the main deviations of frustule morphology in some common diatom freshwater genera, with the aim of stimulating the interest of researchers in this potential stress indicator. However, it is still necessary to investigate the effects of single and multiple contaminants and their additional and synergic effects on diatom communities and monospecific strains in order to consider teratological forms a reliable tool in the assessment of water body contamination.
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KELLY MG, CAZAUBON A, CORING E, DELL'UOMO A, ECTOR L, GOLDSMITH B, GUASCH H, HÜRLIMANN J, JARLMAN A, KAWECKA B, KWANDRANS J, LAUGASTE R, LINDSTRØM EA, LEITAO M, MARVAN P, PADISÁK J, PIPP E, PRYGIEL J, ROTT E, SABATER S, VAN DAM H and VIZINET J (1998) Recommendations for the routine sampling of diatoms for water quality assessments in Europe. J. Appl. Phycol. 10 (2) 215224. [ Links ]
LOCKER F (1950) Beiträge zur Kenntnis des Formwechsels der Diatomeen an Hand von Kulturversuchen. Österr. Bot. Z. 97 (3-5) 322-332. [ Links ]
McFARLAND BH, HILL BH and WILLINGHAM WT (1997) Abnormal Fragilaria spp. (Bacillariophyceae) in streams impacted by mine drainage. J. Freshwater Ecol. 12 (1) 141-149. [ Links ]
MEDLEY CN and CLEMENTS WH (1998) Responses of diatom communities to heavy metals in streams: the influence of longitudinal variation. Ecol. Appl. 8 (3) 631-644. [ Links ]
MIQUEL P. (1890-1892) De la culture artificielle des diatomées. Le Diatomiste 1 73-75, 93-99, 121-128, 149-156, 165-172. [ Links ]
MORIN S, VIVAS-NOGUES M, DUONG TT, BOUDOU A, COSTE M and DELMAS F (2007) Dynamics of benthic diatom colonization in a cadmium/zinc-polluted river (Riou-Mort, France). Fundam. Appl. Limnol. (Arch. Hydrobiol.) 168 (2) 179-187. [ Links ]
MORIN S, COSTE M and DELMAS F (2008a) A comparison of specific growth rates of periphytic diatoms of varying cell size under laboratory and field conditions. Hydrobiol. 614 (1) 285-297. [ Links ]
MORIN S, COSTE M and HAMILTON PB (2008b) Scanning electron microscopy observations of deformities in small pennate diatoms exposed to high cadmium concentrations. J. Phycol. 44 (6) 1512-1518. [ Links ]
MORIN S, DUONG TT, DABRIN A, COYNEL A, HERLORY O, BAUDRIMONT M, DELMAS F, DURRIEU G, SCHÄFER J, WINTERTON P, BLANC G and COSTE M (2008c) Long-term survey of heavy-metal pollution, biofilm contamination and diatom community structure in the Riou Mort watershed, South-West France. Environ. Pollut. 151 (3) 532-542. [ Links ]
NUNES ML, FERREIRA DA SILVA E and ALMEIDA SFP (2003) Assessment of water quality in the Caima and Mau river basins (Portugal) using geochemical and biological indices. Water, Air, Soil Pollut. 149 (1-4) 227-250. [ Links ]
PETERSON CG (1996) Mechanisms of lotic microalgal colonization following space-cleaning disturbances acting at different spatial scales. Oikos 77 (3) 417-435. [ Links ]
RIMET F, ECTOR L, DOHET A and CAUCHIE HM (2004) Impacts of fluoranthene on diatom assemblages and frustule morphology in indoor microcosms. Vie Milieu 54 (2-3) 145-156. [ Links ]
RUGGIU D, LUGLIÉ A, CATTANEO A and PANZANI P (1998) Paleoecological evidence for diatom response to metal pollution in Lake Orta (N. Italy). J. Paleolimnol. 20 (4) 333-345. [ Links ]
SCHMID AMM (1980) Valve morphogenesis in diatoms: A pattern-related filamentous system in pennates and the effect of APM, colchicine and osmotic pressure. Nova Hedwigia 33 811-847. [ Links ]
THOMAS WH, HOLLIBAUGH JT and SEIBERT DLR (1980) Effects of heavy metals on the morphology of some marine phytoplankton. Phycologia 19 (3) 202-209. [ Links ]
Received 24 June 2009; accepted in revised form 28 August 2009.
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ADAM MINTER: China censors offer to help bloggers by outing them
The other day China presented a new deal to its 538 million Internet users: Disclose your identities to your service providers, and we'll protect your privacy from everyone else.
Acceptance is not voluntary -- rather, it's law. But that isn't stopping China's editorialists, bloggers and microbloggers from openly contemplating a serious question: Can China's raucous, muckraking Internet culture survive if the anonymous microbloggers who enervate it are forced to disclose their identities to the often state-owned entities that allow them to surf in the first place?
For the Communist Party-run news outlets that make it their business to propagandize in favor of government policy, the answer is an enthusiastic yes. In the weeks and days before the law was revealed to the public, People's Daily, the self- declared mouthpiece of the Party ran several editorials that -- in retrospect -- were designed to lay the groundwork for restrictive Internet legislation. Of these, perhaps the most notable was published on Christmas Eve, under a pseudonymous byline. It argued:
"Without wings, the bird of freedom cannot fly high. Without rule of law, a free internet cannot go far .. . Cleaning up the online world demands the self-discipline of web users, but even more it demands the interventionist discipline of rule of law. Only by putting the "binds" of rule of law on the internet . . . can we possibly restrain irresponsible rumors, restrain the leakage of personal information, and make the internet clean again."
The binds that China's lawgivers have in mind are several, including provisions restricting and penalizing spammers, fraudsters and online marketers. But the provision at the heart of the new law targets the average Internet user most directly. Under it, internet service providers will be required to verify the identities of new subscribers (subscribers will be allowed to maintain online pseudonyms) before service can be activated.
For most users, this won't be much of an inconvenience or change (540 million people are already online in China). But the cumulative effect of this provision, and an earlier March 2012 rule that China's rollicking microblogs verify the actual identities of their millions of oft-anonymous users have left many of China's netizens nervous. (Even though that earlier rule has been barely and badly enforced.)
Anonymity, after all, is one of the reasons that China's microblogs have become the nation's de facto town square, providing an unprecedented platform for discussions about politics and public affairs. At the same time, they've provided cover for a wave of amateur muckrakers to uncover, tweet about and re-tweet alleged corruption and other misdeeds among Chinese officialdom (often with the approval of Party-run media and some government officials). Lift the veil of anonymity so that Internet service providers and their regulators know who is doing the anti-corruption tweeting, and the anti-corruption tweeters will go silent, the argument goes.
"After the internet real-name registration comes into effect, online anti-corruption efforts will be a thing of the past," tweeted Duan Wanjin, a lawyer in Xian, via the Sina Weibo microblog on Saturday night. "In the future, if citizens want to report wrongdoers online, they'll have to handle themselves like suicide bombers, dying but succeeding for a righteous cause."
Neither People's Daily or other Party-run newspapers deny a state interest in the "real name" data collected by the service providers. Rather they shift the terms of the argument and offer the Orwellian argument that by disclosing their identities, China's netizens are actually enhancing their privacy. For example, the nationalist, English-language edition of the Global Times ran a Saturday editorial in support of the law, noting:
"It regulates for the first time that the State should protect online information that bears someone's personal identity and relates to privacy, along with punitive measures for violations."
In other words, the government can't be expected to protect your privacy if it doesn't know who you are. So tell us who you are.
For now, online Chinese reaction to the requirement has been decidedly muted, especially compared with the panicked reaction that real-name registration for microblogs produced in March 2012. It's possible that many netizens, having seen the lax enforcement of the microblogging requirements, are assuming that this latest step will wither as well. Or, just as likely, the fact that the new law only applies to new accounts means that most current Chinese microbloggers won't be affected by it, anyway. And then there's the holidays: China may not be a Christian nation, but it celebrates Christmas and New Year's Eve with a gusto that renders privacy concerns a low priority right now.
Whatever the explanation, the discussion hasn't topped any trending topic lists. Still, the issue isn't censored -- searching for "real name registration" brings up thousands of results on Chinese microblogs, the vast majority of which directly oppose the new law. Humor, especially in service of exposing government hypocrisy, is typically the first-line defense, with many microbloggers pointing out that People's Daily, a paper that regularly runs pseudonymous editorials, is the chief propagandist in promoting the end to their anonymity.
"Real-name registration has been put into practice on the Internet," tweeted a microblogger in Shenyang, using the Sina Weibo service. "So why isn't it being used in People's Daily?"
Adam Minter is Shanghai correspondent for Bloomberg's World View blog.


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Another powerful interview by Celente, one that I hadn't heard before until Denninger just posted it, but was recorded on September 25th. Celente calls a crook a crook. I agree that the stock market has degenerated into nothing but a casino and a way to siphon off America's money. Retirement based on self-directed 401K's? Riiiight…
Mp3 LINK: King World News – Gerald Celente Interview
Schedule for Week of December 6, 2020
2 hours ago


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chintz chĭnts [key] [probably Hindustani,=variegated], originally a painted or stained calico from India. Esteemed for its bright colors and designs, it was used in Europe for bedcovers and draperies. Reproductions of Indian designs and also original patterns were soon produced. Especially noted was toile de Jouy, manufactured from 1700 to 1843 at Jouy, near Paris. Both flower motifs and characteristic pictorial scenes are prized by collectors and imitated in modern prints. Modern chintz is usually made up of bright prints on a light background.
The Columbia Electronic Encyclopedia, 6th ed. Copyright © 2012, Columbia University Press. All rights reserved.
See more Encyclopedia articles on: Textiles and Weaving


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Scottsdale Musical Theater Company Presents MAN OF LA MANCHA, Now thru 12/30
Continuing its tradition of bringing Broadway's favorites back to life, SMTC has announced its next production, the classic musical Man of La Mancha, for a special engagement. Performances will take place at the intimate 300-seat Dorrance Auditorium on the beautiful campus at Phoenix Country Day School (3901 E. Stanford Drive, Paradise Valley, AZ 85253). This full production of will feature an incredible cast and a full live orchestra, a rarity in town.Show dates are:
• TONIGHT, December 27th @ 7:30PM
• Friday, December 28th @ 8:00PM
• Saturday, December 29th @ 8:00PM
• Sunday, December 30th @ 2PM
AaRon Jacobson, who portrayed Tevye with such depth and passion in SMTC's Fiddler on the Roof, will return to bring the iconic role of Don Quixote back to life in splendid fashion. Plus, 2012 AriZoni Award nominee Hector Coris, who brilliantly starred as Pseudolus in SMTC's production of A Funny Thing Happened on the Way to the Forum, will play his comical sidekick, Sancho and Alexus Poulette will be making her SMTC debut as the fiery Aldonza. Four-time AriZoni Award winner Matt Newhard will portray the Padre and national tour stage veteran Ron Jennings will portray the Governor/Innkeeper. Patrick Salazar is cast as Dr. Carrasco, Nicole Bond is Antonia, Cantor Melissa Berman is The Housekeeper and Jonathan Brown is the Barber.
The 1965 Tony Award-winning musical, written by Dale Wasserman with music by Mitch Leigh and lyrics by Joe Darion, and contains the classic songs "The Impossible Dream", "Dulcinea" and "Little Bird" will be directed and choreographed by SMTC executive producer and theatre veteran, David Hock. The 18-piece orchestra will be conducted by Tim Verville.
Reserved seating tickets are now on sale for $24.50 with senior and student discounted tickets available for $19.50. Special ticket pricing for groups of 15 or more. Tickets can be purchased on-line at the company's website, www.scottsdalemusicaltheater.com or by calling (602) 909-4215.Pictured: Hector Coris as Sancho, AaRon Jacobson as Don Quixote and Alexus Poulette as Aldonza. Photo credit: Scottsdale Musical Theater Company.


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Mamma Mia!
January 18, 2019 @ 5:30 pm$33 - $62
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MAMMA MIA! Set on a Greek island, this romantic musical comedy follows a young woman's search for her father. What could go wrong when she invites the three men to her wedding? Rated PG-13. 5:30 p.m. Tickets: $33-$62. Roger Rocka's Dinner Theatre, 1226 N. Wishon Avenue, Fresno. 266-9494


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IntroductionFrom a distance, Atakpame is somewhat reminiscent of Jerusalem. The Germans had planned for it to serve as the capital when they colonized the country, and there are still some interesting old colonial buildings to be found among the town's rolling hills. If you're lucky, you may see the tchebe ("stilt dance"), one of Togo's most renowned dances. (Check beforehand in Lome to see when performances are scheduled.) 90 mi/145 km north of Lome.
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Avoiding chemicals in this world isn't easy. But a great place to start is in the home. And when we teach our children to follow our lead by saying "no" to chemicals, we can all enjoy a better quality of life with overall reduction of chemicals in our homes, one family at a time.
Help kids understand the importance of reducing chemicals in the home using Norwex Kids Cloths. Sized to comfortably fit small hands, our Kids microfiber products are brightly colored and fun to use. Plus, they're the same great quality as our adult-sized versions—and every bit as effective against dirt and grime!
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GENERIC NAME(S): Ivermectin
OTHER NAME(S): Stromectol Tablet
This medication is used to treat certain parasitic roundworm infections. Curing parasitic infections helps to improve your quality of life. In people with weakened defense (immune) systems, curing roundworm infections can reduce the risk of developing a severe or life-threatening infection. Ivermectin belongs to a class of drugs known as antihelmintics. It works by paralyzing and killing parasites.
How to use Stromectol
Take this medication by mouth with a full glass of water (8 ounces or 240 milliliters) on an empty stomach at least 1 hour before a meal. Ivermectin is usually taken as a single dose or series of doses, or as directed by your doctor.
Dosage is based on your weight, medical condition, and response to treatment.
Tell your doctor if your condition persists or worsens.
Side Effects
Headache, dizziness, muscle pain, nausea, or diarrhea may occur. If you are being treated for "river blindness" (onchocerciasis), you may experience reactions to the dying parasites during the first 4 days of treatment, including joint pain, tender/swollen lymph nodes, eye swelling/redness/pain, weakness, vision changes, itching, rash, and fever. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.
To reduce dizziness upon standing, get up slowly when rising from a sitting or lying position.
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
Tell your doctor right away if any of these rare but very serious side effects occur: neck/back pain, swelling face/arms/hands/feet, chest pain, fast heartbeat, confusion, seizures, loss of consciousness.
A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
In the US -
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.
In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
Before taking ivermectin, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.
Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver problems.
If you have traveled or lived in West or Central Africa, you may be infected with certain parasites (such as Loa loa, African trypanosomiasis) that could cause problems with ivermectin treatment. These effects could rarely result in serious (possibly fatal) effects on the brain (such as encephalopathy). Consult your doctor for more information.
This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).
Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).
If you have a weakened immune system (such as due to HIV infection), you may need repeat treatments with this medicine. Talk to your doctor for more details.
During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.
Ivermectin passes into breast milk. Though there have been no reports of harm to nursing infants, consult your doctor before breast-feeding.
The effects of some drugs can change if you take other drugs or herbal products at the same time. This can increase your risk for serious side effects or may cause your medications not to work correctly. These drug interactions are possible, but do not always occur. Your doctor or pharmacist can often prevent or manage interactions by changing how you use your medications or by close monitoring.
To help your doctor or pharmacist give you the best care, be sure to tell your doctor or pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products) before starting treatment with this product. While using this product, do not start, stop, or change the dosage of any other medicines you are using without your doctor's approval.
Some of the products that may interact with this drug include: barbiturates (such as phenobarbital, butalbital), benzodiazepines (such as clonazepam, lorazepam), sodium oxybate (GHB), valproic acid.
This document does not contain all possible interactions. Keep a list of all the products you use. Share this list with your doctor and pharmacist to lessen your risk for serious medication problems.
If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: numbness, tingling, trouble breathing, loss of coordination, seizures.
Do not share this medication with others.
Laboratory and/or medical tests (such as stool exams for intestinal parasites) should be performed periodically to monitor your progress or check for side effects. If you are being treated for "river blindness," you may need more medical examinations and repeated treatment because ivermectin does not kill adult Onchocerca worms. Consult your doctor for more details.
Missed Dose
If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.
Store at room temperature below 86 degrees F (30 degrees C) away from light and moisture. Do not store in the bathroom. Keep all medicines away from children and pets.
Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.Information last revised October 2018. Copyright(c) 2018 First Databank, Inc.
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What is palliative care? It's a simple question, yet often it elicits the wrong answer, even among clinicians. It's common to believe that palliative care is for patients nearing the end of life when all other treatment options are exhausted. In truth, its aim is to alleviate suffering in all its forms – physical, emotional, psychological and spiritual – and it can begin as early as diagnosis.
Palliative care allows us to treat the whole patient, to address things that matter beyond the disease. In practice, palliative care involves a team of doctors, nurses, social workers and sometimes nutritionists, physical therapists, pharmacists and chaplains. It can be administered for a range of serious illnesses, including congestive heart failure, emphysema, diabetes, kidney disease and, of course, cancer.
When we give palliative care along with curative care, not only do patients feel better, but their quality of life improves and their anxiety and depression ease.
In fact, a landmark study published in the New England Journal of Medicine in 2010 found that patients given palliative care shortly after diagnosis live longer than those who do not receive such care, and require less aggressive end-of-life care.
The study, "Early Palliative Care for Patients with Metastatic Non-Small-Cell Lung Cancer," involved 151 patients. Besides having significantly higher quality-of-life measures, patients receiving palliative care lived on average two months longer than patients who received standard care.
Patient story: Home away from hospital »
The reasons for these improved outcomes are still unclear, but the results may be due to better treatment of symptoms or to addressing the patient's anxiety, depression or stress.
Referrals still too low
Despite this evidence, and the fact that more than 80 percent of health systems provide palliative care services, use of these services by physicians and patients remains low, according to a study published in Annals of Oncology.
Physicians tend to view palliative care as a last-ditch therapy when curative treatments have failed, and many fear that a referral earlier in the process may alarm patients, the study found.
Our challenge is to better integrate palliative care into our patients' treatment plans.
Providence Home Health Palliative Care works with patients and families on treatment wishes, coordinates care throughout the illness, and helps educate patients and their loved ones on the disease and available resources.
Although these patients suffer a chronic, often terminal disease, palliative care can help them live richer and fuller lives. It's not just good medicine, it's our mission as healers.


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SAMJ: South African Medical Journal
versión On-line ISSN 2078-5135
versión impresa ISSN 0256-9574
SAMJ, S. Afr. med. j. vol.101 no.5 Pretoria may. 2011
Adenocarcinoma the most common cell type in patients presenting with primary lung cancer in the Western Cape
Coenraad F N KoegelenbergI; Kushroo AubeelackII; Aldoph B NanguzgamboIII; Elvis M Irusen; Abdurasiet MowlanaIV; Florian von Groote-BidlingmaierV; Chris T BolligerVI
IMB ChB, MMed (Int), FCP (SA), MRCP (UK), Cert Pulm (SA). Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Tygerberg, W Cape
IIMB ChB, MSc Epid, MRCP (UK). Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Tygerberg, W Cape
IIIMB ChB, FCP (SA), PhD. Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Tygerberg, W Cape
IVMB ChB, FCP (SA), MMed (Int). Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Tygerberg, W Cape
VMD. Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Tygerberg, W Cape
VIMD, PhD. Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, Tygerberg, W Cape
To the Editor: Lung cancer is the most common cause of cancer-related mortality worldwide for men and women, causing approximately 1.2 million deaths per year.1 The absolute and relative frequencies of lung cancer have risen dramatically1 and in South Africa account for 17% of all cancer deaths.2 We found that adenocarcinoma is now the most common histological subtype of primary lung cancer diagnosed in the Western Cape and that almost 90% of all patients with non-small cell lung cancer have advanced local or metastatic disease at the time of diagnosis.
'Lung cancer' denotes cancer arising in the airways and pulmonary parenchyma. Its histopathological designation is based on the World Health Organization classification system, with 4 cell types responsible for most deaths: adenocarcinoma (including bronchoalveolar carcinoma), squamous cell carcinoma, large cell (undifferentiated) carcinoma and small cell carcinoma.3 Carcinoid tumours and other rare cell types complete the list of cell types. An interesting phenomenon in the developed world over the last two decades has been the relative increase in the diagnosis of adenocarcinoma which has replaced squamous cell carcinoma as the most frequent histological subtype.4 Many explanations for this well-documented phenomenon have been suggested.
There are few current South African data regarding the relative incidence of the various cell types. The latest National Cancer Registry (NCR) report is from 2001, and contains no data on the relative incidence of the lung cancer cell types.5 Moreover, published and unpublished data from the 1980s suggested that more than 50 - 60% of all lung cancers were squamous cell carcinomas.6 As we found no published study over the last two decades that addresses this issue, we report the relative figures for a two-year period observed in a tertiary referral centre in Cape Town. We postulate that adenocarcinoma could be the most frequently observed variant, and provide an overview of the staging of all the cases of non-small cell and small cell lung cancer patients included.
We used our local lung cancer registry that is updated weekly during a combined multidisciplinary oncology meeting at Tygerberg Academic Hospital to identify all cases of primary lung cancer presented from January 2008 - December 2009 for potential curative or palliative treatment. We retrospectively collected data on all patients who had a tissue diagnosis of primary lung cancer and who underwent at least a staging computed tomography (CT) scan as per hospital protocol. Lung cancer was staged according to the 2002 Union Internationale Contre le Cancer staging system at the time of the study. The Health Research Ethics Committee of Stellenbosch University approved the study (project number N10/03/096) and the Chief Medical Superintendent of Tygerberg Academic Hospital gave permission for the anonymous collection of data.
We identified 507 cases (patient ages 59.7 ±10.4 years, 323 male) of primary lung cancer that fulfilled the inclusion criteria; 430 (84.8%) had non-small cell lung cancer, and the relative contributions were: adenocarcinoma 215 (42.4%), squamous cell carcinoma 113 (22.3%), large cell carcinoma 98 (19.3%) and bronchoalveolar carcinoma 4 (0.8%). Additionally, 63 (12.4%) had small cell lung cancer, and 14 (2.8%) were diagnosed with other forms of lung cancer.
Only 28 patients had early stage non-small cell lung cancer (stages I (N=13) and II (N=15)); 19 were staged as IIIA and 81 as IIIB, respectively. Most patients (302, 69.9%) with non-small cell lung cancer had metastatic disease (stage IV) at the outset. Among the patients with small cell lung cancer, 12 had limited disease while 51 had extensive disease.
We believe that this is the first study providing evidence from South Africa that adenocarcinoma has overtaken squamous cell carcinoma as the most frequently diagnosed subtype of primary lung cancer. We also found that 89.1% of patients with non-small cell lung cancer had advanced disease at presentation (stage IIIB or stage IV disease).
Although South Africa has lagged in the shift from squamous cell carcinoma to adenocarcinoma, the explanation for the shift is probably the same as that suggested for Europe and the United States. Implicated factors include technical aspects (e.g. the routine use of immunohistochemistry or immunocytochemistry in practically all cases) and smoking-related explanations (e.g. decrease in nicotine and tar delivery of cigarettes with compensatory deeper inhalation, composition of cigarette tobacco blends, and use of filter tips).7-9
There are limitations in our study. Apart from its retrospective nature, our institution provides a tertiary service to a population of approximately 1.5 million, comprising coloureds (52.3%), blacks (27.9%), and whites (18.2%), that may not be representative of South Africa as a whole, and it is unclear whether our findings can be extrapolated to rural southern Africa. Similar studies from other areas as well as an updated national registry are urgently needed.
1. Jemal, A, Siegel, R, Ward, E, et al. Cancer statistics, 2009. CA Cancer J Clin 2009;59:225. [ Links ]
2. Bradshaw D, Groenewald P, Laubscher R, et al. Initial burden of disease estimates for South Africa, 2000. S Afr Med J 2003;93(8):682-688. [ Links ]
3. Brambilla E, Travis WD, Colby TV, Corrin B, Shimosato Y. The new World Health Organization classification of lung tumours. Eur Respir J 2001;18:1059-1068. [ Links ]
4. Santos-Martínez MJ, Curull V, Blanco ML, et al. Lung cancer at a university hospital: epidemiological and histological characteristics of a recent and a historical series. Arch Bronconeumol 2005;41:307-312. [ Links ]
5. The Cancer Association of South Africa. National Cancer Registry. http://www.cansa.org.za (accessed 15 September 2010). [ Links ]
6. McGlashan ND, Harington JS. Lung cancer 1978-1981 in the black peoples of South Africa. Br J Cancer 1985;52:339-346. [ Links ]
7. Thun MJ, Lally CA, Flannery JT, et al. Cigarette smoking and changes in the histopathology of lung cancer. J Natl Cancer Inst 1997;89:1580-1586. [ Links ]
8. Wynder EL, Muscat JE. The changing epidemiology of smoking and lung cancer histology. Environ Health Perspect 1995;103(Suppl): S143-S148. [ Links ]
9. Nanguzgambo AB, Aubeelack K, von Groote-Bidlingmaier F, et al. Radiologic features, staging, and operability of primary lung cancer in the Western Cape, South Africa: a 1-year retrospective study. J Thorac Oncol 2011;6(2):343-350. [ Links ]
Accepted 11 November 2010.
Corresponding author: C Koegelenberg (email@example.com)


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Article content
PHILADELPHIA — Evander Kane is no stranger to attracting interest from other teams, but the talk of his possible departure is definitely picking up steam.
On Thursday in Philadelphia, as Winnipeg Jets general manager Kevin Cheveldayoff met with the media in advance of Friday's 2014 NHL Draft, Kane's name and potential availability came up again.
That wasn't a surprise.
Since the last time Cheveldayoff addressed the local media, there have been an abundance of rumours about whether the speedy power forward might be available for the right price.
But when Cheveldayoff was asked if Kane had requested a trade — a topic Kane himself refused to address late in the season — the Jets' GM sounded rather annoyed when a simple denial would have probably put out the fire.
"These kind of questions are really unfair," Cheveldayoff told reporters at a downtown hotel. "There's lots of conversations that go on and I'm sure that there were different levels of frustration at different points and times for different players. From our standpoint, Evander is a Winnipeg Jet. I know there are obviously lots of different rumours and that out there.
"At this point and time, that's how we're going to proceed. As far as any (trade) demands, we're working as normal."
Kane only ramped up the speculation when he took to Twitter from his verified personal account (@EKane9JETS) on Thursday and favourited a Tweet from Dan Schmidt (@DanS_SotS) that said "Yes @RonHextall, bring us Evander Kane."
Whether Kane favourited the Tweet accidentally (these things happen) or by design to rile up "the haters" and suggest he'd actually welcome a deal to the Philadelphia Flyers is unclear.
Either way, Kane removed the favourite later in the day.
This is not to say the Jets have reached the breaking point with Kane but he's tested their patience on more than one occasion and they seem more open to moving him than they were in the past, provided the return is substantial.
After missing the playoffs for three consecutive seasons after arriving from Atlanta, there seems to be a greater chance Cheveldayoff might be willing to part with one of his core pieces.
However, he can't afford to make a deal that sets the franchise back either. That's why Cheveldayoff is keeping his options open, just in case he receives an offer he can't refuse for Kane or someone else.
"I've been pretty open from an organization standpoint that we're going to be open to listen to everybody. If there is a guy that a team has an interest in, my phone is open for a phone call," said Cheveldayoff. "But that shouldn't be categorized that anything is imminent or that a deal is on the table or not.
"As far as individual players, I'm really not going to get into those type of discussions because I think it's really unfair to the individual players. There's enough of it out there at different points and time. Some of it is probably true, some of it is probably false. At the end of the day, it is a business where you need to discuss making moves that help each others' franchises, but there are people that are involved as well."
As for the draft itself, the Jets currently hold the ninth overall pick — the same spot they held in 2012 when stud defenceman Jacob Trouba fell into their lap.
Is there another impact player waiting at No. 9 or might the Jets be trying to move up closer to the top, where they could call the name of Aaron Ekblad, Sam Reinhart or maybe even Leon Draisaitl?
"You make the calls and try to see if there is opportunity (to move up)," said Cheveldayoff. "You never know what might fall to you. Certainly, there are different wants that other teams maybe have, different needs. Scouting is more of an art, than it is a science,when it comes down to how some of the other scouts value some things. We're going to get a good player at No. 9. At what position and where that person fits into the building of our franchise remains to be seen."
Some answers could start coming into focus on Friday night in Philadelphia.
tap here to see other videos from our team.


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Let's face it: productivity suites like Microsoft Office or the cloud-based Google Docs aren't exactly exciting, but they are among the most vital applications for the businessmen in us. Whether this remains true when 2.8-4.3-inch displays are concerned is debatable, but if you ask DataViz, the company that developed the free Documents To Go app, the answer is a resounding "yes."
The company has just released a brand new version 3.0 of its uber-popular app, which includes numerous improvements, namely:
- a "totally redesigned" UI (not so sure that's for the better, though; all I'm seeing right now is a bunch of ugly blue menus)
- an enhanced file browser
- Google Docs support (the one thing that had always been missing for me)
- an improved PDF viewer that now includes various zooming options (pinch-to-zoom and double-tap-to-zoom), keypad shortcuts, hyperlinks, the ability to rotate a page, render multiple pages, and more
- an "optimized" version of Slideshow To Go
- support for password-protected Office 2003 & 2007 docs as well as support for Microsoft Office 2010 files
The free version of the app doesn't allow you to edit or create files but can be used for reading them. It is also missing Google Docs, PDF support, and a few other things, but you can unlock these premium features by purchasing an optional $14.99 upgrade.
You can download the app for free by clicking the barcode below (if you're on your phone) or scanning it with an app like Barcode Scanner or Google Goggles:
The premium version is available here:
Source: DataViz


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It took an arm-breaking effort, but Tim Lincecum is the latest pitcher to no-hit an opponent as the Giants hurler shut down the Padres in San Diego tonight thanks to 13 strikeouts (and four walks).
The 148 pitches is the second-most known to have been thrown in a no-hitter, after the 149 it took Edwin Jackson to keep the Rays hitless. Here's how it sounded on KNBR radio:
Lincecum, Matt Cain, and Jonathan Sánchez have combined for three Giants no-hitters since 2009, the most of any MLB team in that span.
The Padres are the only MLB franchise without a no-hitter to their credit, but they've been no-hit eight times.
The Giants were previously the last MLB team to be no-hit, with Reds pitcher Homer Bailey throwing his second no-hitter against San Francisco on July 2.


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The Living Foods Institute in Atlanta, Georgia is a Healing and Educational Center devoted to helping people heal from any disease, no matter how serious. We have Programs to help slow and reverse aging, restore and optimize great health with positive mental thinking, emotional healing, stress management, cleansing and detoxification and the optimum Organic, Vegan, Raw and Living Foods Nutrition for specific needs. This is not a one size fits all which is why we work with each and every person to develop and individualized a Program that will help them the most.
We believe in holistic healing of the body, mind and spirit and in using the best nutrition available including an Organic, Vegan Diet of enzyme-rich Raw and Living Foods. We teach how and why Organic, Vegan, Raw and Living Foods help a person achieve optimum health and slow aging. We provide hands-on recipe instruction in our Living Foods Kitchen, where participants learn how to prepare a multitude of delicious and nutritious Raw and Living Food recipes with ease.
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Reds prospect Winker has swing that sings
Outfielder developing into more than a pure hitter with guidance in Dayton
CINCINNATI -- Last month, the Class A Dayton Dragons were locked in a tie game with the Wisconsin Timber Rattlers heading into the bottom of the ninth. The inning started with a groundout and a flyout, leaving it up to left fielder Jesse Winker to avoid extra innings.
Winker's day began with a strikeout in the first, and he later flew out twice to left field. But with the game on the line and the first eight innings behind him, Winker stepped to the plate and, after watching two pitches miss the strike zone, drilled a no-doubt home run to right field for the walk-off win.
Since the Reds selected Winker with the 49th pick of the 2012 First-Year Player Draft, his swing has been praised by most everyone who's had the pleasure of seeing it in action. It's specific moments like the one Winker delivered on that mid-July night in Dayton, though, that makes Dragons manager Jose Nieves believe the young Reds prospect has a bright future.
"You'll see it in clutch situations," Nieves said. "I think that is the thermometer that separates one kid that hits a lot with nobody on when there is no pressure from someone who is capable of doing good things when there is a key situation, clutch situations, situations with pressure. That's where he's been at his best."
Winker, who is ranked fifth among Reds prospects by MLB.com, doesn't turn 20 years old until later this month, but he's already busy making a name for himself in Dayton. Following his 100th game of the year on Sunday, Winker was batting .283 with a team-leading 14 home runs and 70 RBIs in his first season at the Class A level. In June, he was selected to play in the Midwest League All-Star Game and participate in the Home Run Derby, which he helped the East team win with 10 dingers -- five more than anyone else.
Playing baseball for a living has been a dream in the works since Winker was 3 years old. His mom and dad, who now run a baseball warehouse started by former Major League All-Star Dante Bichette in Orlando, Fla., spent Winker's younger years driving him across the country for tournaments. When they weren't traveling, Winker would take batting practice from his dad in the family's backyard cage.
That's where the foundation of Winker's effortless swing was laid, and that work has paid off everywhere he's been. At Olympia High School in Orlando, he batted .488 with 19 extra-base hits during his senior season and fell just short of leading the team to a state title. Not long after, Winker was drafted by the Reds and sent to play for the club's Rookie League team in Billings. There, he hit five home runs and drove in 35 RBIs in 62 games, to go with his .338/.443/.500 slash line.
"It's always something I've taken a lot of pride in, is hitting," Winker said. "I just work really hard at it. I don't think anyone has the perfect swing; everyone has something to work on in all aspects of their game. I just try to put a good swing on the ball, and I'm glad people like it."
With Dayton this season, Winker said he's adjusted to the speed of the game after signing immediately out of high school, and that has led to his increase in power. He also said he's been focusing on improving his approach, which didn't need as much work as most players in their first full year of pro ball.
"It takes a lot of time and focus for a young hitter to learn not only the strike zone, but his own strike zone -- what he can do damage with and which pitches he's better off taking," Reds director of player development Jeff Graupe said. "For such a young guy, [Winker] has had an advanced approach that's been impressive to see."
Like any 19-year-old, Winker is still maturing -- not just as baseball player, but as a person. Nieves said his most important job when working with Winker and other young players is to keep them in a positive mental state. Sometimes, a tough night at the plate or in the field can get Winker down, and Nieves has to emphasize that even the greats fail most of the time and that perfection is not the end goal.
"It's natural," Nieves said. "You're going to have ups and downs. He's been having some times when we need to be on him, but this game is pretty much 80 percent mental and the rest physical. When those times of failure come, the most important thing is how you react after those bad days and how you come back."
To deal with struggles and anything else he might need to discuss, Winker often goes to his older brother, Joe, who was drafted out of Mercer University by the Dodgers in 2011. Although Joe retired from baseball earlier this summer, his experiences and advice have made life easier on his younger brother.
One thing Winker hasn't been afraid to do is seek guidance from those who have been there before. When Reds pitcher Johnny Cueto and outfielders Chris Heisey and Ryan Ludwick were on rehab assignments with Dayton this season, Winker took the opportunity to pick their brains about how to attack pitches and play in the field. In Spring Training, he talked to Jay Bruce, whom Winker has been compared to often because of their swings and fresh-face appearances at 19 years old.
"Sometimes I would just sit there and watch and learn," Winker said. "It was really cool to hear their perspective on hitting, and hopefully one day I can be up there with them."
Winker still has some time left before reaching the Majors. To make up for his lack of natural top-end speed, he's had to learn how to use angles and pick up the ball as quickly as possible off the bat, and Nieves said he continues to improve in that regard. Winker also has had to figure out the best way to get through 140 games without burning out after playing 30-game seasons in high school.
But Winker loves every single second. Having never pictured himself doing anything other than playing baseball, he's embraced everything that comes along with it -- all the way down to the travel accommodations.
"I love it," Winker said. "I love hopping on the bus and traveling with the team. It's a blast. I don't think about it anymore as, 'Man, a seven-hour bus ride.' You kind of appreciate it, take the downtime when you can and just get your mind right.
"Really, just every day when you wake up, you realize this is awesome. I get to come here and play baseball. It's a dream come true. I'm very thankful for the opportunity, and it's just been an honor, really."


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The End Times Prophesies of the Bible
A prewrath view with synchronous seals and trumpets and nested Bowls. A prewrath view.
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Box 3.1 Protecting the rights of the vulnerable
Gender. Collaboration across the UN system on gender has grown in the context of system-wide preparations for the Beijing Conference and its aftermath. The focus has been on the advancement of women and on implementing the Convention on the Elimination of Discrimination Against Women. (See also Box 2.12, Inter-agency collaboration on gender equality and empowerment of women.)