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A comprehensive analysis of heavy metal pollution was conducted in the representative limnetic ecosystems of eastern China, which are subject to rapid economic development and population growth. The results demonstrated that the average contents with standard deviations of Cd, Cr, Cu, Ni, Pb and Zn in the surface sediments were 0.925 ± 0.936, 142 ± 46.8, 54.7 ± 29.1, 60.5 ± 21.6, 61.9 ± 36.0 and 192 ± 120 mg/kg dry wt., respectively, and that higher values were mainly observed in the southern portion of the study area, especially in the basins of Southeast Coastal Rivers (SCRB) and the Zhu River (ZRB). The six heavy metals in the surface sediments all had anthropogenic origins. In addition, the limnetic ecosystems, especially in the southern portion of the study area were found to be polluted by heavy metals, especially Cd. Overall, two hotspots of heavy metal pollution in the limnetic ecosystems of eastern China were found, one that consisted of the heavy pollution regions, SCRB and ZRB, and another composed of Cd pollution. These results indicate that heavy metal contamination, especially Cd, should be taken into account during development of management strategies to protect the aquatic environment in the limnetic ecosystems of eastern China, especially in the two aforementioned basins.

BACKGROUND Ovarian cancer (OC) is associated with a >75% risk of recurrence after completion of primary therapy. Several clinical trials have explored the role of continued therapy after complete response to primary adjuvant therapy to reduce the risk of recurrence; however, these trials have largely been underpowered, leading to inconclusive results. METHODS A systematic search strategy was initiated to identify all clinical trials involving consolidation or maintenance therapy regimens for OC in first complete remission. A meta-analysis was conducted to evaluate toxicity and progression-free (PFS) and overall survival (OS). RESULTS There were 37 publications meeting all eligibility criteria, representing 20 consolidation and 9 maintenance therapy trials. Consolidation and maintenance therapies were associated with improved PFS (hazard ratio [HR], 0.79 [P = .003] and HR, 0.82 [P = .02], respectively) and OS (HR, 0.68 [P = .0008] and HR, 0.68 [P = .007], respectively). This relationship remained statistically significant when the analysis was limited to randomized trials and across other sensitivity analyses. CONCLUSIONS Although individual studies have not yet convincingly shown a survival advantage with maintenance chemotherapy in OC, this metaanalysis demonstrates that continued chemotherapy after completion of primary therapy for OC improves PFS and OS. Benefits are greatest in patients with advanced stage OC who reach complete clinical or pathologic response after primary therapy.

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