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Abstract Mountain social‐ecological systems (MtSES) are vital to humanity, providing ecosystem services to over half the planet's human population. Despite their importance, there has been no global assessment of threats to MtSES, even as they face unprecedented challenges to their sustainability. With survey data from 57 MtSES sites worldwide, we test a conceptual model of the types and scales of stressors and ecosystem services in MtSES and explore their distinct configurations according to their primary economic orientation and land use. We find that MtSES worldwide are experiencing both gradual and abrupt climatic, economic, and governance changes, with policies made by outsiders as the most ubiquitous challenge. Mountains that support primarily subsistence‐oriented livelihoods, especially agropastoral systems, deliver abundant services but are also most at risk. Moreover, transitions from subsistence‐ to market‐oriented economies are often accompanied by increased physical connectedness, reduced diversity of cross‐scale ecosystem services, lowered importance of local knowledge, and shifting vulnerabilities to threats. Addressing the complex challenges facing MtSES and catalyzing transformations to MtSES sustainability will require cross‐scale partnerships among researchers, stakeholders, and decision makers to jointly identify desired futures and adaptation pathways, assess trade‐offs in prioritizing ecosystem services, and share best practices for sustainability. These transdisciplinary approaches will allow local stakeholders, researchers, and practitioners to jointly address MtSES knowledge gaps while simultaneously focusing on critical issues of poverty and food security.

A 35 year old woman with biopsy proved breast cancer was submitted for sentinel node (SN) biopsy. Preoperative lymphoscintigraphy displayed both axillary and internal mammary (IM) uptake foci consistent with SNs. Full axillary dissection was completed because of a greater-than 2 cm primary lesion. Two axillary SNs were excised. An IM SN was also excised through the second intercostal space, with the aid of the gamma probe. Fourteen axillary nodes, including SNs, were negative, whereas the IM SN harbored several metastatic implants. Implications for staging, prognosis and further therapy of such IM-only positive sentinel nodes are discussed.

Background: As sentinel lymph node biopsy (SNB) becomes a new surgical standard in the treatment of patients with breast carcinoma, there is an emergent need for a fast and accurate method with which to assess the SN intraoperatively, so a decision can be made regarding whether to perform axillary lymph node dissection during primary surgery. In the current study, the authors performed a prospective investigation of the relative merits of imprint cytology for that purpose., Methods: Seventy-six patients with T1-T2 breast carcinoma were included after undergoing successful SNB. SNs were freshly sectioned at 2-mm intervals and imprint smears were obtained from all cut surfaces. The smears were examined using a rapid May-Grünwald-Giemsa stain variation, and the SNs were judged to be positive or negative for metastases. SNs later were submitted for paraffin embedding and serial sectioning. Both hematoxylin and eosin stained and cytokeratin (CK) immunostained sections were examined. The postoperative evaluation of the SNs was taken as the gold standard., Results: Intraoperative cytology showed a sensitivity of 67.7%, a specificity of 100%, an accuracy of 86.8%, and a negative predictive value of 81.8%. The majority of false-negative cases (8 of 10 cases) were due to micrometastasis in the SNs that were discovered only after exhaustive examination with serial sectioning and CK immunostaining., Conclusions: The results of the current study demonstrate that the accuracy of imprint cytology is high enough to warrant its use for intraoperative SN assessment. If the findings are negative, axillary lymph node dissection can be omitted. Only a few patients with SN micrometastasis may require reoperation., (Copyright 2002 American Cancer Society.)