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We experienced six cases with eosinophilic esophagitis (EoE). They complained of dysphagia, heartburn, or retrosternal discomfort. Endoscopy revealed typical findings of EoE and biopsy examination showed significant eosinophil infiltration in the esophageal epithelium. They received sublingual immunotherapy (SLIT) for allergic rhinitis. Discontinuation or spit method during SLIT resulted in improvement of symptoms, and endoscopic and histological remission. Previously six cases with SLIT-induced EoE has been reported. Our case series suggest that SLIT is clearly associated with the development of EoE by entering of aeroallergens from the luminal side of the esophagus and spit method during SLIT might be one of the therapeutic options for SLIT-induced EoE.

Background A balloon occlusion technique is suggested for use in cryobiopsy for interstitial lung diseases because of the bleeding risk. However, it may interfere with selection of the involved bronchus for peripheral pulmonary lesions (PPLs). A two-scope technique, in which two scopes are prepared and hemostasis is started using the second scope immediately after cryobiopsy, has also been reported. This study aimed to evaluate the safety and diagnostic utility of transbronchial cryobiopsy using the two-scope technique for PPLs. Methods Data of patients who underwent conventional biopsy followed by cryobiopsy using the two-scope technique for PPLs from November 2019 to March 2021 were collected. The incidence of complications and risk factors for clinically significant bleeding (moderate to life-threatening) were investigated. Diagnostic yields were also compared among conventional biopsy, cryobiopsy, and the combination of them. Results A total of 139 patients were analyzed. Moderate bleeding occurred in 25 (18.0%) patients without severe/life-threatening bleeding. Although five cases required transbronchial instillation of thrombin, all bleeding was completely controlled using the two-scope technique. Other complications included two pneumothoraces and one asthmatic attack. On multivariable analysis, only ground-glass features (P P = 0.28). The total diagnostic yield was 89.9%, significantly higher than conventional biopsy alone (P Conclusions The two-scope technique provides useful hemostasis for safe cryobiopsy for PPLs, with a careful decision needed for ground-glass lesions.

The prognosis of scirrhous gastric carcinoma (SGC), which is characterized by rapid infiltration and proliferation of cancer cells accompanied by extensive stromal fibrosis, is extremely poor. In this study, we report the establishment of a unique SGC cell line from a gastric cancer patient in whom an autopsy was performed. A new SGC cell line, OCUM-14, was established from malignant ascites of a male patient with SGC. A postmortem autopsy was performed on the patient. Characterization of OCUM-14 cells was analyzed by microscopic examination, reverse transcription polymerase chain reaction, fluorescence in situ hybridization analysis, immunohistochemical examination, CCK-8 assay, and in vivo assay. OCUM-14 cells grew singly or in clusters, and were floating and round-shaped. Most OCUM-14 cells had many microvilli on their surfaces. The doubling time was 43.1 h, and the subcutaneous inoculation of 1.0 × 107 OCUM-14 cells into mice resulted in 50% tumor formation. mRNA expressions of fibroblast growth factor receptor 2 (FGFR2) and human epidermal growth factor receptor 2 (HER2) were observed in OCUM-14 cells. FGFR2, but not HER2, overexpression was found in OCUM-14 cells. The heterogeneous overexpression of FGFR2 was also found in both the primary tumor and metastatic lesions of the peritoneum, lymph node, bone marrow, and lung of the patient. The FGFR2 inhibitors AZD4547 and BGJ398 significantly decreased the growth of OCUM-14 cells, while paclitaxel and 5-fluorouracil significantly decreased the proliferation of OCUM-14 cells, but cisplatin did not. A new gastric cancer cell line, OCUM-14, was established from SGC and showed FGFR2 overexpression. OCUM-14 might be useful for elucidating the characteristic mechanisms of SGC and clarifying the effect of FGFR2 inhibitors on SGC.

The latest World Health Organization 2017 Classification of Head and Neck Tumours includes a new chapter on tumors and tumor-like lesions of the neck and lymph nodes. Tumor-like lesions include a variety of cystic lesions of the parotid gland. Cystic lesions of the parotid gland can be divided into three groups: non-neoplastic cysts, benign tumors with macrocystic change, and malignant tumors with macrocystic change. It is important to distinguish these lesions from one another because treatment and patient management differ among the three groups. The purpose of this review is to describe the magnetic resonance imaging and scintigraphy findings and the histopathologic characteristics of each parotid gland lesion based on the latest World Health Organization 2017 Classification of Head and Neck Tumours and to summarize the key points of differential diagnosis for cystic lesions of the parotid gland.

Background Alveolar soft part sarcoma (ASPS) is an extremely rare neoplasm that tends to occur in the lower limbs of children and adolescents. Metastatic breast tumors constitute 0.5–2.0% of all malignant mammary neoplasms, and cases of ASPS with mammary metastases are very rare. Case presentation Three years ago, an 11-year-old girl presented to the hospital with pain in the right jaw after becoming aware of a mass in the right cheek. After detailed examination, the patient was diagnosed with ASPS with the primary tumor in the right cheek and multiple lung metastases, and chemotherapeutic treatment was initiated. One year later, accumulation of fluorodeoxyglucose (FDG) was observed in the right front of the skull (standardized uptake value (SUV)-max 2.8) and left breast (SUV-max 2.4) using FDG-positron emission tomography (PET) / computed tomography (CT). Ultrasonography revealed the mammary tumor as a hypoechoic, internally heterogeneous mass measuring 22.4 × 16.2 × 21.1 mm with a rich blood supply. Using pathological findings of core-needle biopsy, we diagnosed it as ASPS. Based on the above information, we made a diagnosis of ASPS with left mammary and cranial metastases. Due to chemoresistance, surgical excision was selected as the mode of treatment; resection of the metastatic cranial bone was performed first, and partial mastectomy of the left breast was performed in two stages. Postoperative conditions were good, and we are currently performing regular follow-ups (visual palpation every 3 months and semi-annual mammary gland ultrasonography). Conclusions We have reported an extremely rare case of ASPS with mammary metastasis with some reference-based discussion. In our case, disease control was obtained by a combination of drug therapy and surgical treatment.

Background “Avoiding immune destruction” has recently been established as one of the hallmarks of cancer. The programmed cell death (PD)-1/programmed cell death-ligand (PD-L) 1 pathway is an important immunosuppression mechanism that allows cancer cells to escape host immunity. The present study investigated how the expressions of these immune checkpoint proteins affected responses to neo-adjuvant chemotherapy (NAC) in breast cancer. Methods A total of 177 patients with resectable early-stage breast cancer were treated with NAC. Estrogen receptor, progesteron receptor, human epidermal growth factor receptor 2, Ki67, PD-L1, PDL-2 and PD-1 status were assessed by immunohistochemistry. Results There were 37 (20.9%) patients with high PD-1 expression, 42 (23.7%) patients had high PD-L1 expression, and 52 (29.4%) patients had high PD-L2 expression. The patients with high PD-1 and PD-L1 expressions had a significantly higher rate of triple-negative breast cancer (TNBC) (p = 0.041) (p

Background The trastuzumab, pertuzumab, and docetaxel (TPD) regimen is strongly recommended as a treatment option for first-line therapy for advanced human epidermal growth factor receptor (HER) 2-positive breast cancer. Monitoring the host microenvironments in cancer plays a significant role in predicting prognoses and curative effects. It is important to clarify the role of immune related gene expression in tumor-infiltrating lymphocytes in the tumor microenvironment. In this study, we evaluated the impact of chemotherapy with a TPD regimen, on immune micro environments in HER2-positive breast cancer using immune related proteins as indicators. Methods The subjects consisted of 30 patients who received the TPD regimen. The expression levels of estrogen receptor, progesterone receptor, Ki67, CD8, forkhead box protein (FOXP) 3, programmed death (PD) 1, programmed death ligand (PD-L) 1, CD163, phosphatase and tensin homolog and lymphocyte activation gene 3 were evaluated in biopsy specimens, by immunostaining. Results CD8+, CD8/FOXP3 ratio (CFR)high and PD-L1− group had significantly longer PFS than the CD8−, CFRlow and PDL1+ group (p = 0.045, log-rank) (p = 0.007, log-rank) (p = 0.040, log-rank), respectively. The CFRhigh group had significantly better OS than the CFRlow group (p = 0.034, log-rank). In the univariate analysis, CD8+, CFRhigh groups extended PFS significantly (p = 0.027, hazard ratio [HR] = 0.162) (p = 0.008, HR = 0.195), respectively. The receiver operating characteristic (ROC) analyses showed that the results for CFR [area under the curve (AUC): 0.708] were better than those for other factors (AUC: CD8 = 0.681, FOXP3 = 0.639, PD1 = 0.528, PD-L1 = 0.681). Conclusions This study shows with the TPD regimen, a high CFR leads to a high ORR and long PFS in HER2-positive breast cancer. CFR, therefore, may be one of the important prognostic factors for this disease. Electronic supplementary material The online version of this article (10.1186/s12967-018-1460-4) contains supplementary material, which is available to authorized users.

Background Recently, the concepts of progression due to pre-existing lesions (PPL) and progression due to new metastasis (PNM) have been proposed to differentiate the progression types of treatment-resistant cancers. Previously, the differences between these two progression types did not affect the determination of treatment strategies since both PPL and PNM are classified as progressive disease based on the response evaluation criteria in solid tumors (RECIST) diagnostic criteria. On the other hand, tumor infiltrating lymphocytes (TILs) are effective when used as indicators for monitoring the immune tumor microenvironment (iTME) in the cancer host, and TILs play an important role as biomarkers in predicting prognosis and therapeutic effects. This study focused on the progression types of cancer in patients undergoing eribulin chemotherapy. In addition, the iTME in individuals with PPL and PNM was evaluated using TILs as a marker. Methods Of the 52 patients with locally advanced or metastatic breast cancer who underwent chemotherapy with eribulin, 40 remained in the study, and 12 patients were dropout cases. The antitumor effect was evaluated based on the RECIST criteria using version 1.1. TILs were defined as the infiltrating lymphocytes within tumor stroma and were expressed in proportion to the field investigated. In PPL cases, the high-TIL group was considered as type I and the low-TIL group was classified as type II. In PNM cases, the high-TIL group was considered as type III and the low-TIL group was classified as type IV. Results In 19 cases, individuals with type I progression had significantly longer progression free survival and overall survival (OS) compared to those with type III progression (p = 0.040, p

Background The neutrophil/lymphocyte ratio (NLR) has been reportedly associated with prognosis in cancer patients by influencing both cancer progression and chemosensitivity. However, the correlation between NLR and the outcome of neoadjuvant chemotherapy (NAC) in breast cancer patients remains unclear. Methods NLR was evaluated in 177 patients with breast cancer treated with NAC with 5-fluorouracil, epirubicin, and cyclophosphamide, followed by weekly paclitaxel and subsequent curative surgery. The correlation between NLR and prognosis, including the efficacy of NAC, was evaluated retrospectively. Results NLR ranged from 0.5 to 10.6. Fifty-eight patients with low NLR (

Background The tumor immune environment not only modulates the effects of immunotherapy, but also the effects of other anticancer drugs and treatment outcomes. These immune responses can be evaluated with tumor-infiltrating lymphocytes (TILs), which has frequently been verified clinically. On the other hand, residual cancer burden (RCB) evaluation has been shown to be a useful predictor of survival after neoadjuvant chemotherapy (NAC). In this study, RCB and TILs evaluations were combined to produce an indicator that we have termed “RCB-TILs”, and its clinical application to NAC for breast cancer was verified by subtype-stratified analysis. Methods A total of 177 patients with breast cancer were treated with NAC. The correlation between RCB and TILs evaluated according to the standard method, and prognosis, including the efficacy of NAC, was investigated retrospectively. The RCB and TILs evaluations were combined to create the “RCB-TILs”. Patients who were RCB-positive and had high TILs were considered RCB-TILs-positive, and all other combinations were RCB-TILs-negative. Results On multivariable analysis, being RCB-TILs-positive was an independent factor for recurrence after NAC in all patients (p < 0.001, hazard ratio = 0.048), triple-negative breast cancer (TNBC) patients (p = 0.018, hazard ratio = 0.041), HER2-positive breast cancer (HER2BC) patients (p = 0.036, hazard ratio = 0.134), and hormone receptor-positive breast cancer (HRBC) patients (p = 0.002, hazard ratio = 0.081). Conclusions The results of the present study suggest that RCB-TILs is a significant predictor for breast cancer recurrence after NAC and may be a more sensitive indicator than TILs alone. Electronic supplementary material The online version of this article (doi: 10.1186/s12885-017-3927-8) contains supplementary material, which is available to authorized users.

Background Circulating tumor cells (CTCs) are linked to metastatic relapse and are regarded as a prognostic marker for human cancer. High expression of plakoglobin, a cell adhesion protein, within the primary tumor is positively associated with CTC clusters in breast cancer. In this study, we investigated the correlation between plakoglobin expression and survival of breast cancer. Methods We evaluated 121 breast cancer patients treated with neoadjuvant chemotherapy. Expression of plakoglobin was identified by immunohistochemical staining in the cell membrane. We also examined the relation between the expression of plakoglobin and E-cadherin, an epithelial–mesenchymal transition (EMT) marker. Results Patients with high plakoglobin expression had significantly worse distant-metastasis-free survival (DMFS) (P = 0.016, log rank). Plakoglobin expression had no correlation with pathological complete response rate (P = 0.627). On univariate analysis with respect to distant metastasis, high plakoglobin expression showed worse prognosis than low plakoglobin expression [P = 0.036, hazard ratio (HR) = 3.719]. Multivariate analysis found the same result (P = 0.013, HR = 5.052). In addition, there was a significant relationship between the expression of plakoglobin and E-cadherin (P = 0.023). Conclusions Plakoglobin expression is an independent prognostic factor in patients with breast cancer, particularly for DMFS, and this is related to EMT.

Background Focal nodular hyperplasia (FNH) is the second most common benign hepatic tumor and is very rarely complicated by hemorrhage or rupture. Although thought to be extremely rare, there have been several reports of hemorrhage caused by ruptured FNH. Herein, we report the case of a patient with ruptured FNH, who subsequently developed hemorrhage during follow-up. Case presentation A 32-year-old man was admitted to our department for an asymptomatic hepatic tumor in segments 4 and 5 (S4/5), which measured 8 cm in diameter and observed to project from the liver. Imaging and pathologic examination of a biopsy specimen confirmed the diagnosis of FNH. Three years after the diagnosis, the patient was readmitted to our hospital because of sudden onset of upper abdominal pain. Dynamic abdominal computed tomography revealed ascites around the tumor with high-density areas that were considered to represent hematoma caused by ruptured FNH. Transcatheter arterial embolization (TAE) was performed to stop the hemorrhage. One month after TAE, S4/5 of the liver was resected; macroscopic findings revealed that a large part of the tumor was composed of necrotic tissue and hematoma. Pathological examination using hematoxylin–eosin staining and immunohistochemical examination indicated a final diagnosis of FNH rupture and hemorrhage. Conclusion Although a well-established diagnosis of FNH usually requires no treatment or surveillance, careful examination remains necessary when the FNH is large and projects from the liver because of the possibility of rupture and hemorrhage.

Background Tonsillar metastasis is very rare and accounts for only 0.8% of tonsillar tumors. And phyllodes tumor of the breast with tonsillar metastasis is very rare. Case presentation A 57-year-old Japanese woman received surgery (partial mastectomy) of malignant phyllodes tumor. Seven months after initial surgery, pharyngeal pain, swelling, and a feeling of dyspnea developed, and tumor was found in the left palatine tonsil. Computed tomography for further evaluation showed a tonsillar lesion with contrast enhancement, and tonsillar metastasis was suspected. The metastatic lung tumors had not progressed. Laryngoscopic biopsy showed a tonsillar metastasis from the malignant phyllodes tumor. Despite the diagnosis of malignant phyllodes tumor with tonsillar and pulmonary metastases, the patient refused further treatment and died about 1 month later. Conclusions A patient with a malignant phyllodes tumor of the breast and tonsillar metastasis was reported, along with a discussion of the relevant literature of this very rare pattern of metastasis.

Little is known about the difference in enhancement patterns of hepatocellular carcinoma (HCC) during multistep hepatocarcinogenesis between the post-vascular phase of Sonazoid-enhanced ultrasonography (SEUS) and hepatobiliary phase of gadolinium ethoxybenzyl diethylenetriamine (Gd-EOB-DTPA)-enhanced MRI, as well as uptakes of Sonazoid and Gd-EOB-DTPA by HCC.Seventy patients with 73 histologically proven HCCs (33 hypovascular well-differentiated HCCs and 40 progressed HCCs) and 9 dysplastic nodules (DNs) were enrolled. Enhancement patterns of the lesions on the post-vascular phase of SEUS and hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI were evaluated. Uptakes of Sonazoid and Gd-EOB-DTPA were assessed by Sonazoid enhancement index and EOB enhancement ratio in relation to immunohistochemistry of CD68 and organic anion transporting polypeptide 8 (OATP8), respectively.On the post-vascular phase of SEUS, none of the 9 DNs and 3 of 33 hypovascular well-differentiated HCCs (9 %) were hypoechoic, whereas 3 of 9 DNs (33 %) and 31 of 33 hypovascular well-differentiated HCCs (94 %) showed hypointensity on the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI. Of 31 progressed HCCs, 95 and 93 % were hypoechoic and hypointense on the post-vascular phase of SEUS and hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI, respectively. Sonazoid enhancement indexes decreased in progressed HCCs, correlating with lower Kupffer cell numbers (P0.001). EOB enhancement ratios decreased in hypovascular well-differentiated and progressed HCCs, as OATP8 expression declined (P0.001).In stepwise hepatocarcinogenesis, uptake of Sonazoid starts decreasing later than that of Gd-EOB-DTPA. Although signal reductions on the post-vascular phase of SEUS or hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI suggest HCC, hypoechoic appearance on the post-vascular phase of SEUS might be HCC-specific, particularly progressed HCC.

Intracranial dermoid cysts are rare congenital lesions with typical imaging findings of well-defined fat-containing masses located along the midline and infratentorial regions. We report two rare cases of petrous apex dermoid cyst, one in the petrous apex and the other in the interdural space, with unusual imaging appearances mimicking epidermoid cysts because of the presence of little or no fat. Dermoid cysts with little or no lipid contents, as in these cases, may be radiologically misdiagnosed as epidermoid cysts. Careful evaluation of preoperative computed tomography and magnetic resonance images is necessary because the surgical approaches used for this region vary depending on the accurate location and histopathology.

Chronic impairment of cardiac function can be an important health risk and impair the quality of life, and may even be life-threatening for long-term survivors of allogeneic hematopoietic cell transplantation (HCT). However, risk factors for and/or the underlying mechanism of cardiac dysfunction in the chronic phase of HCT are still not fully understood. We retrospectively investigated factors affecting cardiac function and left-ventricular hypertrophy (LVH) in the chronic phase of HCT. Sixty-three recipients who survived for >1 year after receiving HCT were evaluated using echocardiography. Based on simple linear regression models, high-dose TBI-based conditioning was significantly associated with a decrease in left-ventricular ejection fraction and the early peak flow velocity/atrial peak flow velocity ratio, following HCT (coefficient=-5.550, P=0.02 and coefficient=-0.268, P=0.02, respectively). These associations remained significant with the use of multiple linear regression models. Additionally, the serum ferritin (s-ferritin) level before HCT was found to be a significant risk factor for LVH on multivariable logistic analysis (P=0.03). In conclusion, our study demonstrated that a myeloablative regimen, especially one that involved high-dose TBI, impaired cardiac function, and that a high s-ferritin level might be associated with the development of LVH in the chronic phase of HCT.

Background Acute adrenal hemorrhage is an uncommon entity. Although trauma is the most common cause of adrenal hemorrhage, non-traumatic etiologies have also been reported. We report an unusual case of a spontaneously ruptured adrenocortical carcinoma that initially presented as a critical massive retroperitoneal hemorrhage. The case was treated successfully using a combination of emergency interventional radiology and elective surgery. Case presentation A 47-year-old woman was transported to our hospital because of the sudden onset of severe pain in her left lower back. The shadow of a tumor-like soft mass accompanied by bleeding was observed in the upper pole of the left kidney, together with vascular leakage from the middle suprarenal artery on computed tomography. Transcatheter embolization of the left middle adrenal artery was administered based on a diagnosis of acute adrenal hemorrhage. Further observation indicated that the bleeding was caused by rupture of an adrenocortical carcinoma. Left adrenalectomy was subsequently carried out via laparotomy. Conclusions We experienced an unusual case of acute massive adrenal hemorrhage caused by the rupture of a non-functional adrenocortical carcinoma, which was treated successfully by ambulatory transcatheter embolization therapy and elective surgery.

Altitudinal forest and climate changes from warm, dry valley bottom (1250 m a.s.l.) to cool, humid ridge top (3550 m a.s.l.) along the typical dry valley slopes of the Bhutan Himalaya were studied. Annual mean temperature decreased upslope with a lapse rate of 0.62 °C·100 m−1 from 18.2 °C at the valley bottom to 4.3 °C at the ridge top. On the contrary volumetric soil moisture content increased from 14.7 to 75.0%. This inverse relationship is the major determinant factor for the distribution of different forest types along the altitudinal gradient. Based on the quantitative vegetation data from 15 plots arranged ca. 200 m in altitude interval (1520–3370 m a.s.l.), a total of 83 tree species belonging to 35 families were recorded. Three major formation types of lower and upper coniferous forests, and a mid-altitude evergreen and deciduous broad-leaved forest were contrasted. Including two transitional types, five forest zones were categorized based on cluster analysis, and each zone can be characterized by the dominants and their phytogeographical traits, viz. (1) west Himalayan warm, dry pine (1520–1760 m a.s.l.), (2) wide ranging east-west Himalayan mixed broad-leaved (1860–2540 m a.s.l.), (3) humid east Himalayan evergreen broad-leaved (2640–2820 m a.s.l.), (4) cool, humid east Himalayan conifer (2950–3210 m a.s.l.), and (5) wide ranging cold, humid conifer (3305–3370 m a.s.l.). Structurally, total basal area (biomass) increased from 15.2 m2 ha−1 in the pine forest (1520 m) to 101.7 m2 ha−1, in the conifer forest (3370 m a.s.l.). Similarly, soil organic carbon increased from 2.7 to 11.3% and nitrogen from 0.2 to 1.9% indicating dry, poor nutrient fragile ecosystem at the dry valley bottom. We concluded that low soil moisture content (

The floristic characteristics, age structure and survival modes of Tertiary-relic deciduous forests were analyzed at 1600 m on Mt. Emei (3099 m), Sichuan, China. Three plots were selected to represent typical topographies: Plot 1 at 1620 m on a scree slope, Plot 2 at 1640 m on a slope with moderately rocky soils, and Plot 3 at 1616 m on a gentle slope with less rocky soils. At Plot 1, on the scree slope, the forest was rich in species and dominated by Tertiary remnants and other deciduous trees (Davidia involucrata, Styrax hemsleyana, Cercidiphyllum japonicum var.sinense, Pterocarya hupehensis, Prunus brachypoda, Prunus padus, Tetracentron sinense andStaphylea holocarpa). The relic deciduous tree taxaDavidia, Cercidiphyllum, Tetracentron andEuptelea occupied the unstable concave slopes, where evergreen broad-leaved trees (Castanopsis platycantha andMachilus pingii) were rarely able to survive. On the relatively stable convex slopes of this plot, evergreen trees with small diameter mainly appeared in the subcanopy and shrub layers.Davidia involucrata was the dominant species in this forest. On the slope with moderately rocky soils (Plot 2), the forest was co-dominated by relicDavidia and other deciduous (Styrax andPterocarya), and evergreen trees (Castanopsis andMachilus). On the gentle slope with less rocky soils (Plot 3),Davidia trees were found only in the subcanopy and shrub layers, and the forest was dominated byMachilus, Castanopsis, Styrax andPrunus trees. Regeneration ofDavidia occurs mainly on the scree slope where landslides are most common. The age structure of theDavidia stands indicates that this species is able to survive on the unstable scree habitat due to its strong sprouting ability. The Tertiary-relic deciduous forest on the scree slope is seen to be a topographic climax forest.

Structure and regeneration of a mid-montane (2200 m a.s.l.)mixed forest codominated by evergreen (Lithocarpuscleistocarpus), deciduous (Acer flabellatum)andconiferous (Tsuga chinensis, Abies fabri, andTaxus chinensis) trees were analyzed in a 40m× 60 m plot on Mt. Emei, Sichuan, China. Plant communitystructure and composition varied depending on topographic micro-habitat withinthe plot. Four topographic communities (topo-communities) were distinguishedwith dominant species corresponding to topography: (1)Abies – valley bank, (2) Acer– lower steep slope, (3) Lithocarpus – uppergentle slope, and (4) Tsuga – ridge. The coexistencemechanisms of the evergreen, deciduous, and coniferous trees were determined byidentifying the regeneration process characteristic of each dominant species,asrepresented by their seedling dispersion patterns and seedling establishmentalong the topographic gradients. The saplings and seedlings of the dominantswere distributed differently according to the topography:Lithocarpus under the canopy of parent trees and in gapsofthe upper gentle slope and ridge, Acer mainly in bothwell-lit and shady sites on the lower steep slope and on fallen logs,Abies on the valley bank but only in well-lit sites,Tsuga on the ridge, Taxus mostly onrock and well-lit sites on the slopes. Distribution of surviving saplings andseedlings was also related to the species of nearby canopy trees. We suggestthat Lithocarpus, Tsuga and Acer tendto be self-replacing in their own topographic habitats, andAbies survives as a fugitive by occupying occasionalsuitable gaps. The variation in soil conditions, particularly nutrients, withtopography affected seedling establishment and the growth of trees. Thesuccessional change of quantitative species composition, as predicted by theMarkovian model, shows the mixed forest to be in a sustained climax stage.

Introduction Reactive lymphoid hyperplasia is a benign nodular lesion characterized by marked proliferation of non-neoplastic, polyclonal lymphocytes forming follicles. The lesion is found in various organs such as skin, orbit, lung, gastrointestinal tract, and liver. However, reactive lymphoid hyperplasia in the thyroid gland is extremely rare. Here, we present an interesting case of reactive lymphoid hyperplasia in the thyroid, which suggests the nature of the disease. Case presentation A 74-year-old Japanese man was referred to our institute because of a growing well-demarcated irregular-shaped mass in the right lobe of the thyroid. Malignant lymphoma was suspected by cytology, and right lobectomy was conducted. A final diagnosis of reactive lymphoid hyperplasia was made by the intimate investigation of the surgical specimen, with evidence of polyclonal and non-neoplastic lymphatic proliferations forming follicles with an active germinal center. After an initial uneventful postoperative course, our patient developed severe symptoms of systemic rheumatic arthritis, and alterations in autoimmune reaction, including clinically overt chronic thyroiditis, were identified. Conclusions Our case demonstrated important clinical information on reactive lymphoid hyperplasia of the thyroid, and suggested the importance of differential diagnosis, and possible close correlation between systemic autoimmune disorder and the disease.

Background Neoadjuvant chemotherapy (NAC) is one of the standard care regimens for patients with resectable early-stage breast cancer. It would be advantageous to determine the chemosensitivity of tumors before initiating NAC. One of the parameters potentially compromising such chemosensitivity would be a hypoxic microenvironment of cancer cells. The aim of this study was thus to clarify the correlation between expression of the hypoxic marker carbonic anhydrase-9 (CA9) and chemosensitivity to NAC as well as prognosis of breast cancer patients. Methods A total of 102 patients with resectable early-stage breast cancer was treated with NAC consisting of FEC (5-fluorouracil, epirubicin, and cyclophosphamide) followed by weekly paclitaxel before surgery. Core needle biopsy (CNB) specimens and resected tumors were obtained from all patients before and after NAC, respectively. Chemosensitivity to NAC and the prognostic potential of CA9 expression were evaluated by immunohistochemistry. Results CA9 positivity was detected in the CNB specimens from 47 (46%) of 102 patients. The CA9 expression in CNB specimens was significantly correlated with pathological response, lymph node metastasis, and lymph-vascular invasion. Multivariate analysis revealed that the CA9 expression in CNB specimens was an independent predictive factor for pathological response. The Kaplan-Meier survival curve revealed a significant negative correlation (p = 0.013) between the disease-free survival (DFS) and the CA 9 expression in resected tissues after NAC. Multivariate regression analyses indicated that the CA9 expression in resected tissues was an independent prognostic factor for DFS. Conclusions CA9 expression in CNB specimens is a useful marker for predicting chemosensitivity, and CA9 expression in resected tissue is prognostic of DFS in patients with resectable early-stage breast cancer treated by sequential FEC and weekly paclitaxel prior to resection.

Altitudinal distribution of evergreen broad-leaved trees and changes in their leaf sizes were studied on a humid subtropical mountain, Mt. Emei (3099 m a.s.l., 29°34.5′ N, 103°21.5′ E), Sichuan, China. Among the total woody flora of ca. 540 species, evergreen broad-leaved trees account for 88 species in 39 genera and 23 families, corresponding to the northern limit of subtropical evergreen broad-leaved trees. The number of evergreen broad-leaved tree species greatly decreased from the low-altitudinal, evergreen broad-leaved forest zone (600–1500 m) to the mid-altitudinal, mixed forest zone (1500–2500 m), and to the high-altitudinal, coniferous forest zone (2500–3099 m). The overall trend of reduced leaf size toward upper zones was analyzed and documented in detail. The 88 species were assigned to three leaf-size classes: notophylls (48%), microphylls (36%), and mesophylls (16%). The leaf size was relatively small and the specific leaf weight (SLW, mg cm−2) was much larger in high altitude as compared to low altitude. No overall correlation was found between leaf size and SLW, but leaf size decreased as SLW increased toward high altitude for certain species having relatively wide altitudinal ranges. Moreover, leaf size varied with forest stratification: canopy trees were predominantly notophyllous species, while subcanopy and understorey trees were mainly microphyllous species. The tendency is compatible with the trend found in other mountains of East Asia.

Emergence and establishment of Tsuga sieboldii seedlings were monitored for six years in an old-growth mixed forest in Japan, to clarify the reason why adult T. sieboldii trees are distributed only on convex slopes. T. sieboldii seedlings germinated on exposed soils without broad-leaved litter cover on both convex and concave slopes, but they died out from concave slope during the first two years after germination. Along a gradient from convex to concave slope, litter cover became higher and surface soil erosion became severer, and T. sieboldii seedlings died at the plots with severe surface soil erosion. Other environmental variables, such as relative illuminance, vegetation cover of seedling layer and soil water potential were not significantly different between convex and concave slopes. We concluded that the restricted seedling establishment of T. sieboldii to convex slope is determined by stability of surface soils and broad-leaved litter cover.

Hodgkin's disease primarily originating from the chest wall is very rare. A 48-year-old man was admitted to our hospital because of an abnormal shadow on a chest X-ray. Radiographic examinations suggested a neurogenic tumor located in the right second-intercostal space, and it was thus extirpated thoracoscopically. The tumor was thought to have arisen from the subpleural space, probably from a lymph node of the chest wall. The resected specimen measured 5.5 x 2.0 cm in size, and the pathological diagnosis was Hodgkin's disease of the diffuse lymphocyte predominant type. A clinical examination showed no other lesions in any other part of the body, including the bone marrow. Following surgery, adjuvant chemotherapy (COPP-ABVD) was given because of the possible scattering of malignant cells during surgery. To the best of our knowledge, this is the first report of Hodgkin's disease originating in the chest wall.

Dynamic features of shoot phenology including leaf emergence and leaf fall, and leaf life span for eleven evergreen broad-leaved tree species were investigated in a warm-temperate rain forest in Mount Kiyosumi, central Japan. All species had periodic leaf emergence or flushing pattern, and were classified into two types; single and multiple flush and only one species, Eurya japonica, represented the latter type and the rest had single flush in spring. The single flush type can further be subdivided into two groups according to their duration of shoot growth; short and long flush. Seasonal patterns of leaf fall were categorized into four; unimodal, bimodal, broad unimodal, and multimodal type though they were not fixed pattern. The leaf emergence and leaf fall patterns were correlated for the eleven species, and five phenological types were categorized. Four of them were the single flush types, i.e., short flush of leaf emergence with unimodal leaffall (SSU) type of Castanopsis sieboldii and Quercus salicina, short flush with bimodal leaf fall (SSB) type of Quercus acuta, Machilus thunbergii, Neolitsea sericea, and Cinnamomum japonicum, long flush with bimodal leaffall (SLB) type of Myrsine seguinii, and long flush with broad unimodal leaffall (SLR) type of Symplocos prunifolia, Cleyera japonica, and Illicium anisatum. The multiple flush type is only one species, Eurya japonica, and it had multimodal leaffall pattern (MM type). The phenological pattern varied in relation to leaf life span, leaf size, and tree habit. Leaf life span ranged from 1.1 to 5.8 yr. The short flush species or SSU and SSB types were all canopy or subcanopy trees, and the former had short and the latter had long leaf life spans. The long flush species were all microphyllous small trees, and SLB type had a relatively long leaf life span in understory, SLR type had a long leaf life span in understory or in open habitat and/or forest gap as a pioneer tree. MM type had a long leaf life span and colonizing species in open habitat but they can survive in understory as well. The phenological attributes of evergreen trees were well corresponded to the ecological guild of the tree in both forest structure and successional stage, and were also constrained by phylogenetic groups.

Altitudinal zonation of evergreen, deciduous and coniferous forests on Mt. Emei (3099 m asl, 29°34.5' N, 103°21.5' E), Sichuan, China was studied to understand the transition of vegetation zonation from tropical to temperate mountains in humid Asia. On the basis of quantitative data on floristic composition and community structure sampled at ten plots selected in different altitudes on the eastern slope of the mountain, forest zonation and the inter-relationships among different life-forms of trees in each zonal forest community were studied quantitatively. Three forest zones were identified physiognomically along the altitudinal gradient, viz. (i) the evergreen broad-leaved forest zone (660–1500 m asl), (ii) the mixed forest zone (1500–2500 m asl), and (iii) the coniferous forest zone (2500–3099 m asl). Great compositional changes were observed along elevation, and the zonal forest communities were characterized by their dominants and floristic composition. Maximum tree height decreased from 33 m at lower middle altitude (965 m asl) to 13 m near the summit (2945 m asl). There was no apparent deciduous forest zone along the altitudinal gradient, but true mixed forests of three life-forms (evergreen, deciduous, and coniferous) were formed around 2000–2500 m asl. Patches of deciduous forest were found in a lower part of the mixed forest zone, particularly on scree slopes, between 1450 m and 1900 m asl. These patches were dominated by the Tertiary relic deciduous trees, such as Davidia involucrata, Tetracentron sinense, and Cercidiphyllum japonicum var. sinense. High species diversity in the mixed forest zone resulted from the overlapping of different life-forms at middle altitudes, which is partly due to wider variety of temperature-altitude correlations. A comparison of the altitudinal zonation with the other east Asian mountain vegetation clarified that Mt. Emei is located exactly at the ecotone between tropical and temperate zonation types in eastern Asia.

Objective Mucinous breast carcinoma (MBC) is classified into mixed mucinous breast carcinoma (MMBC) and pure mucinous breast carcinoma (PMBC) based on whether the tumor is with or without a component of invasive ductal carcinoma, respectively. PMBC is subtyped into hypocellular PMBC (PMBC-A) and hypercellular PMBC (PMBC-B). Methods Of 1,760 primary breast carcinomas, 71 were diagnosed as MBC, and were subtyped for comparison purposes. Results Seventy-one of all breast cancers (4.0%) were MBC, and consisted of 23 MMBC, 32 PMBC-A and 16 PMBC-B. The MBC tumors were more often hormone receptor-positive and HER2-negative than non-MBC tumors. Patients with MMBC, PMBC-B or PMBC-A, in this order, had significantly higher recurrence rates than non-MBC cases (p=0.006, log-rank). Conclusions In the NCCN guidelines, MBC is also regarded as “a histological type with a favorable prognosis” in a uniform manner, and “treatment for a histological type with a favorable prognosis” is recommended. However, the results of this study suggest that sub-classification-based, individualized therapeutic strategies should be considered.

Objective Recently, therapies targeting the biological characteristics of individual cancers according to markers indicating underlying molecular biological mechanisms have become available. Core needle biopsy (CNB) is widely used, not only to diagnose, but also to determine therapeutic strategies, in patients with breast cancer. Although the diagnostic accuracy of CNB is acceptably high, false-negative results have occasionally been encountered. Methods The results of adjunctive imprint cytology (AIC) coinciding with CNB in 2,820 patients suspected to have breast cancer were retrospectively reviewed. The feasibility and clinical usefulness of AIC-assisted diagnosis were analyzed. Results Fourteen-hundred and sixty-four cases were diagnosed as not malignant using CNB alone. Forty-seven of 1464 cases were suspected to be malignant on a cytological review of AIC, and 42 were confirmed to be breast cancer on additional biopsies. The combination of CNB and AIC achieved a sensitivity of 100% (1398/1398) and a specificity of 99.6% (1417/1422). Small lesions and large noninvasive- or scirrhous-type carcinomas were the common features of the CNB-negative/AIC-positive cases. Conclusions Adjunctive imprint cytodiagnosis is a simple and easy procedure that assists the pathological diagnosis of breast cancer using CNB and therefore serves as a possible novel standard application.

Structural changes in altitudinal vegetation zones along a 30° N parallel were studied based on vegetation data from 20 mountains in East Asia, from 85° E to 130° E longitude. The altitude of comparable vegetation zones showed a sharp increase of 1400–1900 m from east to west. Forest limit reached an altitude of 4400–4600 m in the eastern Tibetan Plateau, being the highest forest limit in the world. The limidng factor for the upper limit of a vegetation zone was different in the east and west. Low temperature in winter controlled the upward distribution of the evergreen broadleaf forest in the east, whereas the limiting factor was growing season warmth in the west. A close correlation was found between the climatic indices and annual range of monthly mean temperature (ART) at the upper limit of a vegetation zone. Component genera of each vegetation zone along the 30° N parallel were analyzed, and it was found that the alternation of component genera from east to west was much more apparent in cool-temperate forests, reflecting their response to macrotopography and air masses. The distribution of Fagus extended into winter-cold regions, whilst Tsuga occurred principally in oceanic and warm climates. The northern limit of Tsuga corresponded well to an ART isotherm of 23 °C and its southern limit coincided with that of Fagus. According to the distribution of Fagus and Tsuga, the cool-temperate forests in East Asia along the 30° N belt were divided into three types: deciduous broadleaf forest (represented by Fagus), mixed forest (dominated by Fagus, Tsuga and others), and mixed evergreen forest (consisting mainly of Tsuga and sclerophyll oaks).

We investigated growth characteristics ofEuptelea polyandra Sieb. et Zucc. (Eupteleaceae), a Japanese endemic deciduous tree species growing on unstable ground such as that of very steep slopes with thin soil.Euptelea polyandra began to sprout at the juvenile stage and had a multiple-stemmed tree form. There was a positive correlation between diameter of the maximumsized stem within a stool (DMS) and the number of stems within the stool. Many stools had suffered from disturbances as shown by the fact that uprooting scars were found on 31.4% and 42.4%, respectively, of the stools of the two populations studied. Sprouting played a significance role in repairing damaged stems and stools, and at least 15.5% and 18.2% of the stools of the two populations, respectively, had apparently avoided death by sprouting. Sprouted stems gradually inclined with the increase in their relative sizes within each stool, and this seemed to facilitate the establishment of younger sprouted stems. The small younger sprouted stems had their own roots. There were dormant buds on stems which originated from axillary buds, and secondary dormant buds occurred by branching. The total number of dormant buds in a stool increased with DMS. It is concluded thatE. polyandra accumulates dormant buds for sprouting in order to respond to disturbances quickly.

We evaluated the status of the microbial biomass N pool in grassland, and in deciduous and evergreen forest soils in Chiba, central Japan. Microbial biomass N, a labile fraction of total N in the soil, ranged from 6.96 g N m-2 (15 cm depth) in the grassland to 24.8 g in the deciduous and 20.7 g in the evergreen soils, on a landscape basis. Thus the pattern in the grassland and in the forest soils differed. The N flush measured by a fumigation-incubation method indicated that in the grassland soil microbial biomass N was underestimated by a factor of 2.6 compared with the results from a fumigation-extraction method, because of heavy N immobilization in the microbial biomass. This was in contrast to results from the forest soils, which did not immobilize N. Thus, the forest soils were in a steady-state condition compared with the grassland which formed a seral phase in the ecological succession. Simple correlation coefficients indicated a significant positive relationship between biomass N and organic C in the soil and the N concentration in the litter, the main component of organic matter in the soils of the three ecosystems.

The establishment and maintenance mechanisms of pioneer communities were investigated in ruderal habitats under two disturbance regimes, frequent and infrequent cutting sites. In the infrequent cutting sites, large perennials dominated through the year and inhibited the invasion of annuals, and the perennial community succeeded to forest stage if the cutting was stopped. In the frequent cutting sites, therophytic communities of winter and summer annuals alternated by season. Fresh seeds of both winter and summer annuals are dormant, but they have different germination times and thus can share the same sites in different seasons. Wind-dispersed biennials and large perennials have nondormant seeds and easily invade the sites; however, they are unable to mature to reproductive phase due to recurrent cuttings. The therophytic species, which can complete their life-cycle in a period between cuttings, accumulate seeds in the soils and are maintained by these buried seeds (seed bank annuals) during recurrent disturbances. The seed bank is compensation for the dispersal inefficiency of seed bank annuals. After abandonment of the frequent cutting sites, the buried seeds of seed bank annuals germinate and become the first-year pioneers. Thus, seed bank annuals are not invasive colonizers but are the remnants of the ruderal weed communities before abandonment.

Background There has been insufficient examination of the factors affecting long-term survival of more than 5 years in patients with leukemia that is not in remission at transplantation. Method We retrospectively analyzed leukemia not in remission at allogeneic hematopoietic cell transplantation (allo-HCT) performed at our institution between January 1999 and July 2009. Forty-two patients with a median age of 39 years received intensified conditioning (n = 9), standard (n = 12) or reduced-intensity conditioning (n = 21) for allo-HCT. Fourteen patients received individual chemotherapy for cytoreduction during the three weeks prior to reduced-intensity conditioning. Diagnoses comprised acute leukemia (n = 29), chronic myeloid leukemia-accelerated phase (n = 2), myelodysplastic syndrome/acute myeloid leukemia (MDS/AML) (n = 10) and plasma cell leukemia (n = 1). In those with acute leukemia, cytogenetic abnormalities were intermediate (44%) or poor (56%). The median number of blast cells in bone marrow (BM) was 26.0% (range; 0.2-100) before the start of chemotherapy for allo-HCT. Six patients had leukemic involvement of the central nervous system. Stem cell sources were related BM (7%), related peripheral blood (31%), unrelated BM (48%) and unrelated cord blood (CB) (14%). Results Engraftment was achieved in 33 (79%) of 42 patients. Median time to engraftment was 17 days (range: 9-32). At five years, the cumulative probabilities of acute graft-versus-host disease (GVHD) and chronic GVHD were 63% and 37%, respectively. With a median follow-up of 85 months for surviving patients, the five-year Kaplan-Meier estimates of leukemia-free survival rate and overall survival (OS) were 17% and 19%, respectively. At five years, the cumulative probability of non-relapse mortality was 38%. In the univariable analyses of the influence of pre-transplant variables on OS, poor-risk cytogenetics, number of BM blasts (>26%), MDS overt AML and CB as stem cell source were significantly associated with worse prognosis (p = .03, p = .01, p = .02 and p < .001, respectively). In addition, based on a landmark analysis at 6 months post-transplant, the five-year Kaplan-Meier estimates of OS in patients with and without prior history of chronic GVHD were 64% and 17% (p = .022), respectively. Conclusion Graft-versus-leukemia effects possibly mediated by chronic GVHD may have played a crucial role in long-term survival in, or cure of active leukemia.

Background Recently, maintaining higher relative dose intensity (RDI) of chemotherapeutic drugs has become a widespread practice in an attempt to achieve better outcomes in the treatment of aggressive lymphoma. The addition of rituximab to chemotherapy regimens has significantly improved outcome in diffuse large B-cell lymphoma (DLBL). However, it is unknown if higher RDI in chemotherapy when combined with rituximab leads to a better outcome in aggressive B-cell lymphoma. Methods We retrospectively evaluated the impact of the RDI of initial chemotherapy (consisting of cyclophosphamide, doxorubicin, vincristine and prednisolone with rituximab (R-CHOP) on outcome in 100 newly diagnosed DLBL patients. Results A multivariate Cox regression model showed that RDI trended towards a significant association with mortality [hazard ratio per 0.1 of RDI = 0.8; 95% confidence interval 0.6–1.0; P = 0.08]. Additionally, on multivariate logistic analysis, advanced age was a significant factor for reduced RDI. Conclusion Our data suggest that in DLBL patients, mortality was affected by RDI of R-CHOP as the initial treatment, and the retention of a high RDI could therefore be crucial.

Geographical patterns of altitudinal zonation, floristic composition, and structural features of tropical montane rain forests were examined along latitudinal gradients in south and east Asia. On equatorial mountains, the tropical montane rain forests occur above 1000 m. Toward middle latitudes, they come farther down and reach sea level at c. 35° N. Thus, the forests are equivalent to the subtropical rain forests of the latitudinal, horizontal zonation series. They exhibit gradual changes in floristic composition and structure along both altitudinal and latitudinal gradients. On equatorial mountains, they are divided into three types, i.e. tropical lower montane, upper montane, and subalpine forests. The three tree regeneration types, having emergent, sporadic and inverse-J type stem-diameter class frequency distributions, coexist in the lower montane forests, but the upper and subalpine forests display only the inverse-J type species with a few species of the sporadic type. Toward the northern latitudinal limit, the distinction between the three tropical montane forest zones in equatorial mountains becomes less clear. This can be explained by temperature conditions: on equatorial mountains, a temperature sum of 85° C months which controls the upper limit of the lower montane forests, and a coldest month mean temperature of-1° C which controls the evergreen broad-leaved trees, appear at c. 2500 and c. 4000 m respectively. The altitudinal range between 2500 m and 3800 m, which is the upper forest limit, is covered by upper montane and subalpine forests. On the other hand, at the latitudinal northern limit, the tropical upper montane and subalpine forests cannot exist because the above mentioned two temperature conditions occur at nearly the same point. Thus, at the northern latitudinal limit of the tropical montane forests, the three zones of equatorial mountains amalgamate into a single subtropical lowland forest community. This is due to the seasonal temperature climate in middle latitudes in, e.g., central Japan and central China.

The Colchis is one of the species-rich refugia and a centre of biological diversity in western Eurasia. We analysed patterns of richness, endemism and invasions in relation to taxonomy (family membership), life form, certain habitats in the Colchis, and compared them to patterns found for Japan. We found that in the Colchis perennials are significantly over-represented in endemic species, and that they typically occur on limestone soils and in alpine tall herbaceous vegetation. The Asteraceae produce significantly large number of both endemic and alien species, whereas the Poaceae are over-represented in alien species but under-represented in endemics. Likewise, the Apiaceae are over-represented in endemics, whereas the Euphorbiaceae are over-represented in alien species. Similar patterns have been found in Yakushima, Japan. The Morisita-Horn index of similarity between these two sites was 0.83 (based on family size). Although the flora of Adjara comprised of fewer families than the flora of Yakushima, the largest families are richer in species in the flora of Adjara than in the flora of Yakushima. Floristic analysis of refugia of western Eurasia and their comparison with geographically distant areas can provide useful data for plant ecological and evolutionary studies. Potentially, such studies can produce testable hypotheses on plant migrations and on their historical geography. For example, the data presented in this study indicate that more severe conditions in the Pleistocene and geographical isolation of the Colchis may be responsible for the higher relative importance of adaptive radiation in the shaping of its modern flora.

The floristic and structural differentiation of vegetation along the altitudinal gradient in four subalpine forests of different developmental stages on Mt. Fuji has been studied. Near the forest limit a micropattern of vegetation corresponding to the altitudinal zonation has been observed which elucidated the mechanisms of development of the vegetation zonation. As to early stages of vegetation development only two types can be distinguished: the volcanic desert above 1500 m and the pioneer forests below. As to later stages a differentiation of subzones includes from higher to lower altitudes: the Alnus maximowiczii, Betula ermanii, Abies veitchii and Tsuga diversifolia forests. Larix leptolepis and Sorbus americana ssp. japonica, appear as co-dominants in ecotonal communities between the principal subzones and are also important pioneers in early stages. Similarity analyses reveal that the upper subalpine Alnus-Betula forests can be regarded as early successional phases of the climax Abies-Tsuga forests of the lower subalpine zone. The regular arrangement of A. maximowiczii-B. ermanii-A. veitchii is studied along the gradient from the margin to the interior of the forest growing near the forest limit where locally favourable conditions prevail. Growth form, height growth, photosynthetic activity, seed supply, and seedling distribution of the three principal species have been compared, as well as biomass and production relations in contiguous forests of these species. The marginal Alnus type community is productive and disturbance-tolerant, and has a wide ecological and sociological amplitude along the gradient, while the central Abies community is accumulative and disturbance-intolerant, and has a narrower tolerance range, but is superior in competition under stable habitat conditions. A vegetation organization, ‘temporal multi-storeyed structure’, is suggested which means that a zonal pattern of vegetation within a climax region develops by successive replacement of successional species along an environmental gradient.