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3% and 22.3%, respectively. However, the effects of drought on ecosystem WUE varied in different seasons with more severe consequence in the karst ecosystem. During the early stage of autumn-spring drought in 2009/2010, ecosystem WUE was apparently larger than the baseline condition with the difference turning to be negative anomalies during the peak period, whereas the effect of summer drought in 2011 led to negative anomalies nearly throughout the duration. Further analysis revealed that the anomalies in evapotranspiration acted a prominent role in altering WUE at the onset of both droughts, while ecosystem WUE was mainly determined by the sensitivity of gross primary production during the later stage. All analyses are beneficial for expecting the coupling relationship between global carbon and water cycles to future climate change, particularly as droughts are projected to increase in terms of frequency and severity.

The classical treatment of osteosarcoma used to be ablative surgery. read more After the appearance of adjuvant chemotherapy, survival in these patients increased, and with it, the number of affected school age children with high growth potential. Hence, reconstructive surgeries are currently proposed instead of conventional bone resections due to greater limb preservation and better functional status than those achieved with conventional amputations.

We describe a case of osteosarcoma in a 9-year-old boy with a history of retinoblastoma. The tumour involved the entire length of the left femur. He also had a lung metastasis. Given the incomplete response to neoadjuvant chemotherapy, we chose bone resection, rotation and fitting of the left lower limb and thoracoscopy to treat the lung injury. A bypass ortoprosthesis was placed for the first 6 weeks, until there was healing, bone consolidation and absence of complications, followed by a definitive orthoprosthesis for the next 4 months. At one year, the patient was able to walk independently with the use of the ortoprosthesis, swimming with a fin adapted to the stump and was had restarted cycling. At the last clinical review, at the age of 13 years, he is disease free and continues to have periodic follow-up visits in our office for adaptations to the prosthesis according to his growth.

This case highlights the various reconstructive options available and the difficulties encountered in the management of these aggressive malignant processes. Rotationplasty is a viable therapeutic option in young patients with osteosarcoma, which allows the child to participate again in premorbid daily and recreational activities.

This case highlights the various reconstructive options available and the difficulties encountered in the management of these aggressive malignant processes. Rotationplasty is a viable therapeutic option in young patients with osteosarcoma, which allows the child to participate again in premorbid daily and recreational activities.It has been 35 years since Professor Thoenes and his colleagues discovered chromophobe renal cell carcinoma (RCC). Since then, our knowledge about this tumour entity has changed and novel tumour entities have been discovered. The aim of this review is to discuss recent molecular findings and open questions in diagnosing chromophobe-like/oncocytic neoplasms. The broader differential diagnosis of chromophobe-like and oncocytoma-like neoplasms includes SDH-deficient renal cell carcinoma, fumarate hydratase (FH) deficient RCC, epitheloid angiomyolipoma ('oncocytoma like'), MiT family translocation RCC and the emerging entity of eosinophilic solid and cystic renal cell carcinoma. After separation of these tumours from chromophobe RCC, it becomes evident that chromophobe RCC are low malignant tumours with a 5-6% risk of metastasis. Recent next generation sequencing (NGS) and DNA methylation profiling studies have confirmed Thoenes' theory of a distal tubule derived origin of chromophobe RCC and renal oncocytomas. Comprehensive genomic analyses of chromophobe RCC have demonstrated a low somatic mutation rate and identified TP53 and PTEN as the most frequently mutated genes, whereas 'unclassified' RCC with oncocytic or chromophobe-like features can show somatic inactivating mutations of TSC2 or activating mutations of MTOR as the primary molecular alterations. For the future, it would be desirable to create a category of 'oncocytic/chromophobe RCC, NOS' with the potential of further molecular studies for identification of TSC1/2 mutations in these rare tumours.Full blood counts (FBC) are routinely performed on blood donors donating by apheresis. Australian Red Cross Lifeblood (Lifeblood) historically set FBC reference intervals (RIs) in alignment with standards of the Royal College of Pathologists of Australasia (RCPA). Recommendations now advise that RIs be developed locally to represent the population. This study analysed new blood donors' FBC results to inform a review of the current Lifeblood RIs. Retrospective analysis of routine laboratory data for first-time direct to plasmapheresis donations from 1 July 2018 to 30 June 2019 was conducted (n=15,710). FBC were performed using DxH 800 Haematology analysers. The 2.5% and 97.5% percentiles were compared with the current RIs and clinically significant variation informed adjustment. White blood cell and platelet parameters remained in alignment with RCPA reference intervals. The haemoglobin (Hb) RI for female donors reduced from 115-165 g/L to 113-147 g/L. For male donors, the upper limit for Hb required reduction from 185 g/L to 165 g/L. Red blood cell (RBC) counts and haematocrit (HCT) levels were lowered in this derivation from blood donors. Appropriate RIs allow for both the early detection of disease and avoid unnecessary investigation of otherwise healthy people. FBC analysis from current blood donors indicated changes were required to the RIs. The adjusted lower RBC and HCT values reduces the proportion of donors considered to have abnormal findings. The lower Hb limits will remain at 115 g/L in females and 125 g/L in males to align with regulatory requirements for blood donation.

There has been increasing uptake of minimally invasive pancreatoduodenectomy during the past decade, but it remains a highly specialized procedure as benefits over open pancreatoduodenectomy remain contentious. This study aimed to evaluate current evidence on minimally invasive pancreatoduodenectomy versus open pancreatoduodenectomy in terms of impact of center volume on outcomes.

A systematic review of articles on comparative cohort and registry studies on minimally invasive pancreatoduodenectomy versus open pancreatoduodenectomy published until 31st December 2019 were identified, and meta-analyses were performed. Primary endpoints were International Study Group on Pancreatic Fistula grade B/C postoperative pancreatic fistula and 30-day mortality.

After screening 7,390 studies, 43 comparative cohort studies (8,755 patients) with moderate methodological quality and 3 original registry studies (43,735 patients) were included. For the cohort studies, the median annual hospital minimally invasive pancreatoduodenectomy volume was 10.