Surgery for Intraductal Papillary Mucinous Neoplasms of the Pancreas: Preoperative Factors Tipping the Scale of Decision-Making

Background: Decision-making in intraductal papillary mucinous neoplasms (IPMNs) of the pancreas depends on scaling the risk of malignancy with the surgical burden of a pancreatectomy. This study aimed to develop a preoperative, disease-specific tool to predict surgical morbidity for IPMNs. Methods: Based on preoperative variables of resected IPMNs at two high-volume institutions, classification tree analysis was applied to derive a predictive model identifying the risk factors for major morbidity (Clavien-Dindo ≥3) and postoperative pancreatic insufficiency. Results: Among 524 patients, 289 (55.2%) underwent pancreaticoduodenectomy (PD), 144 (27.5%) underwent distal pancreatectomy (DP), and 91 (17.4%) underwent total pancreatectomy (TP) for main-duct (18.7%), branch-duct (12.6%), or mixed-type (68.7%) IPMN. For 98 (18.7%) of the patients, major morbidity developed. The classification tree distinguished different probabilities of major complications based on the type of surgery (area under the surve [AUC] 0.70; 95% confidence interval [CI], 0.63-0.77). Among the DP patients, the presence of preoperative diabetes identified two risk classes with respective probabilities of 5% and 25% for the development of major morbidity, whereas among the PD/TP patients, three different classes with respective probabilities of 15%, 20%, and 36% were identified according to age and body mass index (BMI). Overall, history of diabetes, age, and cyst size segregated three different risk classes for new-onset/worsening diabetes. Conclusions: In presumed IPMNs, the disease-specific risk of major morbidity and pancreatic insufficiency can be determined in the preoperative setting and used to personalize the possible surgical indication. Age and overweight status in case of PD/TP and diabetes in case of DP tip the scale toward less aggressive clinical management in the absence of features suggestive for malignancy

Cultivation of biomass sorghum for second generation ethanol production

Sorghum (Sorghum bicolor L.) is a very interesting biofuel feedstock crop. With C4 photosynthesis and drought tolerance, it is suitable for cultivation in water limited environments and could be a key crop in a warmer and unpredictable global climate. Furthermore, sorghum can be used for ethanol production from both 1st and 2nd generation technologies (using sweet/grain genotypes or biomass genotypes, respectively). The potential use of commercial sorghum genotypes for the production of 2nd generation ethanol was investigated in a two year project in Northern Italy. Fields trials were carried out for two years in two locations on a selection of genotypes to optimize agronomical technique, identifying in particular the effect of plant density, irrigation, fertilization, time of harvesting on crop yield. Biomass compositions were analysed for all genotypes while ethanol yield was estimated on three genotypes at harvest and after conservation. Pretreatment, hydrolysis and fermentation were carried out with the innovative technology developed by Chemtex. Biomass yield was on average 22.6 Mg ha-1, with large differences among genotypes, environments and cultivation techniques so that extreme yield of 10.6 and 38.4 Mg ha-1 were measured. Percentage of fermentable sugars on dry matter in the genotypes under trial varied from 47% to 60%, and glucans were on average 63% of the fermentable sugars in both years. Average Klason lignin and acetyl content were, respectively, 12.8% and 1.7%. Biomass composition varied significantly among genotypes. The test carried out on biomass preserved by on field drying or silage showed that the latter method results in high ethanol yield reduction and is therefore not a suitable option for sorghum conservation. In general biomass sorghum can be considered an interesting crop for 2nd generation ethanol production. Keywords: Sorghum bicolor, 2nd generation ethanol, cultivation, processing, conservation

Surveillance for Presumed BD-IPMN of the Pancreas: Stability, Size, and Age Identify Targets for Discontinuation.

Background and aimsCurrently, most patients with branch duct intraductal papillary mucinous neoplasms (BD-IPMN) are offered indefinite surveillance, resulting in health care costs with questionable benefits regarding cancer prevention. This study sought to identify patients where the risk of cancer is equivalent to an age-matched population, thereby justifying discontinuation of surveillance.MethodsInternational multicenter study involving presumed BD-IPMN without worrisome features (WF) or high-risk stigmata (HRS) at diagnosis who underwent surveillance. Clusters of individuals at risk for cancer development were defined according to cyst size and stability for at least 5 years, and age-matched controls were used for comparison using standardized incidence ratios (SIRs) for pancreatic cancer.ResultsOf 3844 patients with presumed BD-IPMN, 775 (20.2%) developed WF and 68 (1.8%) HRS after a median surveillance of 53 (IQR 53) months. Some 164 patients (4.3%) underwent surgery. Of the overall cohort, 1617 patients (42%) remained stable without developing WF or HRS for at least 5 years. In patients 75 years or older, the SIR was 1.12 (95%CI 0.23-3.39), and in patients 65 years or older with stable lesions below 15mm in diameter after 5 years, the SIR was 0.95 (95%CI 0.11-3.42). The all-cause mortality for patients who did not develop WF or HRS for at least 5 years was 4.9% (n= 79), while the disease-specific mortality was 0.3% (n=5).ConclusionsThe risk of developing pancreatic malignancy in presumed BD-IPMN without WF or HRS after 5 years of surveillance is comparable to that of the general population depending on cyst size and patient age. Surveillance discontinuation could be justified after 5 years of stability in patients older than 75 years with cysts < 30 mm, and in patients 65 years or older who have cysts ≤ 15 mm

RET-MAP: An International Multicenter Study on Clinicobiologic Features and Treatment Response in Patients With Lung Cancer Harboring a RET Fusion

Nearly 1% to 2% of NSCLCs harbor RET fusions. Characterization of this rare population is still incomplete