The recommended treatment for resectable pancreatic cancer (PC) is resection followed by adjuvant FOLFIRINOX. We assessed the proportion of patients that managed to complete the 12 courses of ...adjuvant FOLFIRINOX and compared their outcome with that of patients with borderline resectable pancreatic cancer (BRPC) who underwent resection after neoadjuvant FOLFIRINOX.
A retrospective analysis was performed on a prospectively maintained database of all PC patients who underwent resection with (2/2015-12/2021) or without (1/2018-12/2021) neoadjuvant therapy.
A total of 100 patients underwent upfront resection, and 51 patients with BRPC received neoadjuvant treatment. Only 46 resection patients started adjuvant FOLFIRINOX, and only 23 completed 12 courses. The main reasons for not starting/completing adjuvant therapy were poor tolerance and rapid recurrence. Significantly more patients in the neoadjuvant group received at least six FOLFIRINOX courses (80.4% vs. 31%,
< 0.001). Patients who completed at least 6 courses, either pre- or postoperatively, had better overall survival (
= 0.025) than those who did not. In spite of having more advanced disease, the neoadjuvant group had comparable overall survival (
= 0.062) regardless of the number of treatment courses.
Only a minority of patients (23%) undergoing upfront pancreatic resection completed the planned 12 courses of FOLFIRINOX. Patients who received neoadjuvant treatment were significantly more likely to receive at least six treatment courses. Patients receiving at least six courses had better overall survival than those who received fewer than six courses, regardless of the timing of treatment relative to surgery. Potential ways to increase chemotherapy adherence, such as administering treatment before surgery, should be considered.
•Pancreatic neuroendocrine tumors (PNETs) are rare, but their incidence has risen significantly in recent years.•Diabetes mellitus (DM) is clearly recognized in association with chronic pancreatitis ...and pancreatic cancer, but it has not been well-characterized in relation to non-functioning (NF)- PNETs.•We found a high rate of impaired glucose metabolism, either DM or Pre-DM, in a large cohort of subjects with NF-PNETs.•The high prevalence of diabetes/pre-diabetes was not related to obesity or tumor size.•The study highlights and reinforces the increased rate and association of DM and pre-DM with NF-PNETS. In addition, it adds a novel piece of information by evaluating the effect of tumor size, grade and tumor location on this association.
Pancreatic neuroendocrine tumors (PNETs) are rare, but their incidence has risen significantly in recent years. Whereas diabetes mellitus (DM) is recognized in association with chronic pancreatitis and pancreatic cancer, it has not been well-characterized concerning non-functioning (NF)-PNETs.
Study aim:to determine whether NF-PNETs are associated with DM/ Pre-DM and characterize the features of this putative association.
Retrospective study to evaluate rate of Pre-DM /DM in subjects with NF-PNETs.
Study cohort of 129 patients with histologically confirmed NF-PNETs, ∼60% were men (M/F: 77/52). Abnormal glucose metabolism that preceded any treatment was seen in 70% of this cohort: overt DM in 34% and Pre-DM in 36% of the subjects. However, during follow-up, the overall prevalence rose to 80.6%, owing exclusively to newly diagnosed DM in subjects who received treatment.
Patients with DM/Pre-DM were older (65 ± 11; 54 ± 14; p < 0.0001), the tumor was more commonly localized in the pancreatic body and tail (76.5% vs. 23.5% p = 0.03), while BMI (27 ± 6 vs. 28 ± 5 kg/m2), and tumor size (2.4 ± 2 vs. 2.9 ± 3.2 cm) were similar. The relative prevalence of DM in our cohort of NF-PNETs was 1.6 higher than that in the age and gender-adjusted general Israeli population (95 %CI: 1.197–2.212p = 0.03).
We found a high rate of impaired glucose metabolism, either DM or Pre-DM, in a large cohort of NF-PNETs. The high prevalence of diabetes/pre-diabetes was unrelated to obesity or tumor size. This observation should increase awareness of the presence of DM on presentation or during treatment of “NF”-PNETs.
The objective of this study was to determine the prognostic value of lymph node (LN) involvement and the LN ratio (LNR) and their effect on recurrence rates and survival in patients with pancreatic ...neuroendocrine tumors (PNETs) undergoing surgery. This single-center retrospective study reviewed the medical records of 95 consecutive patients diagnosed with PNETs who underwent surgery at our medical center between 1997 and 2017. The retrieved information included patient demographics, pathology reports, treatments, and oncological outcomes. Results: 95 consecutive potentially suitable patients were identified. The 78 patients with PNETs who underwent surgery and for whom there was adequate data were included in the analysis. Their mean ± standard deviation age at diagnosis was 57.4 ± 13.4 years (range 20-82), and there were 50 males (64%) and 28 females (36%). 23 patients (30%) had LN metastases (N1). The 2.5- and 5-year disease-free survival (DFS) rates for the entire cohort were 79.5% and 71.8%, respectively, and their 2- and 5-year overall survival (OS) rates were 85.9% and 82.1%, respectively. The optimal value of the LNR was 0.1603, which correlated with the outcome (2-year OS
= 0.002 HR = 13.4 and 5-year DFS
= 0.016 HR = 7.2, respectively, and 5-year OS and 5-year DFS
= 0.004 HR = 9 and
= 0.001 HR = 10.6, respectively). However, the multivariate analysis failed to show that the LNR was an independent prognostic factor in PNETs. Patients with PNETs grade and stage are known key prognostic factors influencing OS and DFS. According to our results, LNR failed to be an independent prognostic factor.
Memorization of training data is an active research area, yet our understanding of the inner workings of neural networks is still in its infancy. Recently, Haim et al. (2022) proposed a scheme to ...reconstruct training samples from multilayer perceptron binary classifiers, effectively demonstrating that a large portion of training samples are encoded in the parameters of such networks. In this work, we extend their findings in several directions, including reconstruction from multiclass and convolutional neural networks. We derive a more general reconstruction scheme which is applicable to a wider range of loss functions such as regression losses. Moreover, we study the various factors that contribute to networks' susceptibility to such reconstruction schemes. Intriguingly, we observe that using weight decay during training increases reconstructability both in terms of quantity and quality. Additionally, we examine the influence of the number of neurons relative to the number of training samples on the reconstructability. Code: https://github.com/gonbuzaglo/decoreco
Drought can cause tree mortality through hydraulic failure and carbon starvation. To prevent excess water loss, plants typically close their stomata before massive embolism formation occurs. However, ...unregulated water loss through leaf cuticles and bark continues after stomatal closure. Here, we studied the diurnal and seasonal dynamics of bark transpiration and how it is affected by tree water availability. We measured continuously for six months water loss and CO
efflux from branch segments and needle-bearing shoots in
growing in a control and an irrigation plot in a semi-arid forest in Israel. Our aim was to find out how much passive bark transpiration is affected by tree water status in comparison with shoot transpiration and bark CO
emission that involve active plant processes, and what is the role of bark transpiration in total tree water use during dry summer conditions. Maximum daily water loss rate per bark area was 0.03-0.14 mmol m
s
, which was typically ~76% of the shoot transpiration rate (on leaf area basis) but could even surpass the shoot transpiration rate during the highest evaporative demand in the control plot. Irrigation did not affect bark transpiration rate. Bark transpiration was estimated to account for 64-78% of total water loss in drought-stressed trees, but only for 6-11% of the irrigated trees, due to differences in stomatal control between the treatments. Water uptake through bark was observed during most nights, but it was not high enough to replenish the lost water during the day. Unlike bark transpiration, branch CO
efflux decreased during drought due to decreased metabolic activity. Our results demonstrate that although bark transpiration represents a small fraction of the total water loss through transpiration from foliage in non-stressed trees, it may have a large impact during drought.
Global warming and drying trends, as well as the increase in frequency and intensity of droughts, may have unprecedented impacts on various forest ecosystems. We assessed the role of internal water ...storage (WS) in drought resistance of mature pine trees in the semi-arid Yatir Forest. Transpiration (T), soil moisture and sap flow (SF) were measured continuously, accompanied by periodical measurements of leaf and branch water potential (Ψleaf) and water content (WC). The data were used to parameterize a tree hydraulics model to examine the impact of WS capacitance on the tree water relations. The results of the continuous measurements showed a 5-h time lag between T and SF in the dry season, which peaked in the early morning and early afternoon, respectively. A good fit between model results and observations was only obtained when the empirically estimated WS capacitance was included in the model. Without WS during the dry season, Ψleaf would drop below a threshold known to cause hydraulic failure and cessation of gas exchange in the studied tree species. Our results indicate that tree WS capacitance is a key drought resistance trait that could enhance tree survival in a drying climate, contributing up to 45% of the total daily transpiration during the dry season.
•Improvements in AFIS provide identifications on vast friction ridge skin areas.•Identification based upon lateral palm print by using AFIS search is presented.•Non-distal phalanges search and ...comparison by using AFIS derive identifications.•It is recommended to include comparison of lateral palms and non-distal phalanges in proficiency tests.
The ongoing upgrade of AFIS worldwide resulted in new achievements in the domain of fingerprint identification. Two cases are presented which depict the importance of collecting and employing a broader search in AFIS to include lateral palm prints and non-distal phalanges prints.
Summary
The drier climates predicted for many regions will result in reduced evaporative cooling, leading to leaf heat stress and enhanced mortality. The extent to which nonevaporative cooling can ...contribute to plant resilience under these increasingly stressful conditions is not well known at present.
Using a novel, high accuracy infrared system for the continuous measurement of leaf temperature in mature trees under field conditions, we assessed leaf‐to‐air temperature differences (ΔTleaf–air) of pine needles during drought.
On mid‐summer days, ΔTleaf–air remained < 3°C, both in trees exposed to summer drought and in those provided with supplemental irrigation, which had a more than 10‐fold higher transpiration rate. The nonevaporative cooling in the drought‐exposed trees must be facilitated by low resistance to heat transfer, generating a large sensible heat flux, H. ΔTleaf–air was weakly related to variations in the radiation load and mean wind speed in the lower part of the canopy, but was dependent on canopy structure and within‐canopy turbulence that enhanced the H.
Nonevaporative cooling is demonstrated as an effective cooling mechanism in needle‐leaf trees which can be a critical factor in forest resistance to drying climates. The generation of a large H at the leaf scale provides a basis for the development of the previously identified canopy‐scale ‘convector effect’.
The modulation of the leaf energy budget components to maintain optimal leaf temperature are fundamental aspects of plant functioning and survival. Better understanding these aspects becomes ...increasingly important under a drying and warming climate when cooling through evapotranspiration (E) is suppressed. Combining novel measurements and theoretical estimates, we obtained unusually comprehensive twig‐scale leaf energy budgets under extreme field conditions in droughted (suppressed E) and non‐droughted (enhanced E) plots of a semi‐arid pine forest. Under the same high mid‐summer radiative load, leaf cooling shifted from relying on nearly equal contributions of sensible (H) and latent (LE) energy fluxes in non‐droughted trees to relying almost exclusively on H in droughted ones, with no change in leaf temperature. Relying on our detailed leaf energy budget, we could demonstrate that this is due to a 2× reduction in leaf aerodynamic resistance. This capability for LE‐to‐H shift in leaves of mature Aleppo pine trees under droughted field conditions without increasing leaf temperature is likely a critical factor in the resilience and relatively high productivity of this important Mediterranean tree species under drying conditions.
Summary statement
Relying on detailed leaf energy budgets in mature pines, we demonstrate that leaves greatly enhance their sensible heat flux to prevent overheating under drought, which must rely on changes in leaf aerodynamic resistance. This may be a critical factor in the resilience of trees to drying conditions.
Abstract
Climate change is often associated with increasing vapour pressure deficit (VPD) and changes in soil moisture (SM). While atmospheric and soil drying often co‐occur, their differential ...effects on plant functioning and productivity remain uncertain. We investigated the divergent effects and underlying mechanisms of soil and atmospheric drought based on continuous, in situ measurements of branch gas exchange with automated chambers in a mature semiarid Aleppo pine forest. We investigated the response of control trees exposed to combined soil‒atmospheric drought (low SM, high VPD) during the rainless Mediterranean summer and that of trees experimentally unconstrained by soil dryness (high SM; using supplementary dry season water supply) but subjected to atmospheric drought (high VPD). During the seasonal dry period, branch conductance (
g
br
), transpiration rate (
E
) and net photosynthesis (
A
net
) decreased in low‐SM trees but greatly increased in high‐SM trees. The response of
E
and
g
br
to the massive rise in VPD (to 7 kPa) was negative in low‐SM trees and positive in high‐SM trees. These observations were consistent with predictions based on a simple plant hydraulic model showing the importance of plant water potential in the
g
br
and
E
response to VPD. These results demonstrate that avoiding drought on the supply side (SM) and relying on plant hydraulic regulation constrains the effects of atmospheric drought (VPD) as a stressor on canopy gas exchange in mature pine trees under field conditions.
Summary statement
Under high evaporative demand conditions, mature Aleppo pine trees demonstrated increased transpiration and photosynthesis in response to supplementary irrigation. Stomatal conductance exhibited hypo‐sensitivity to increasing water demand (high vapour pressure deficit) but was sensitive to a decrease in water supply, expressed as soil water content or plant water potential. Our findings highlight that water supply, rather than water demand, is the primary limiting factor for transpiration in Aleppo pine trees.
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