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The concept of the bioeconomy and the growing demand for biomass have raised concerns about the sustainability of an increased biomass use. To address this issue, various certification systems and labels have been developed to verify compliance with sustainability requirements in bioenergy and bio-based value chains. However, various market requirements and political frameworks make certification complex and difficult to understand. An IEA Bioenergy Task 45 project has analyzed existing certification schemes to better understand methodological differences and compliance factors. This article summarises the main project outcomes regarding relevant compliance and verification parameters such as risk assessments, transparency, auditor competencies and others. Sustainability certification supports sustainable biomass production, but it alone cannot guarantee sustainability. Certification should be part of a broader sustainability governance framework, including national policies and legislation. The complexity and competition of markets and political frameworks can lead to a race to the bottom that jeopardizes trust and reputation. Policy makers and industry need to streamline certification as a driver of change within a functional governance framework.

We present the paleomagnetic dating of the upper Miocene red alluvial to palustrine sequences of the area north of Teruel. The magnetostratigraphy of the Masada del Valle and Masada Ruea sections indicates a minimum age of about 11 Ma to the lowermost sediments post-dating the unconformity over the Mesozoic basement. The overall Miocene sequence represents a retrogradation of the alluvial system, grading upwards into palustrinellacustrine sedimentation. The onset of palustrine deposition is dated in Masada Ruea at about 9.7 Ma. The late Vallesian faunas of Masía del Barbo, of which leve1 2B is the reference locality of biochronozone MNlO, are dated to 9.3 Ma. The anisotropy of magnetic susceptibility (AMS) in the tenigenous sediments suggests that the orientation of the magnetic ellipsoids represents the paleocurrent direction. Paleocurrent interpretations based on AMS data can be used for a better comprehension of the facies arrangement in the Neogene sediments of the Teruel basin., Se ha realizado un estudio magnetostratigráfico de las sucesiones aluviales que afloran al norte de Teruel (sector de Masada del Valle- Masada Ruea) con objeto de precisar la edad de los sedimentos y de los yacimientos de vertebrados fósiles. La correlación de las sucesiones con la escala de tiempo de polaridad geomagnética indica una edad de 11 Ma para los sedimentos mas antiguos estudiados y que yacen en discordancia sobre el substrato Mesozoico. La iniciación de la expansión de la sedimentación palustre/lacustre ha sido datada en Masada Ruea en cerca de 9.7 Ma. La edad de las faunas de Masía del Barbo 2B, localidad de referencia para la biocronozona MN10, es de 9.3 Ma. La anisotropia de la susceptibilidad magnética (AMS) en las facies siliciclásticas indica que la orientación de la fábrica magnética esta controlada por la dirección de paleocorrientes. Los datos de AMS pueden ser útiles para determinar la evolución de las paleocorrientes y contribuir al estudio de la distribución de facies y la evolución del relleno sedimentario de la cuenca, Comisión Interministerial de Ciencia y Tecnología, Diputación General de Aragón, Comissionat per Universitats i Recerca de la Generalitat de Catalunya, Depto. de Mineralogía y Petrología, Fac. de Ciencias Geológicas, TRUE, pub

BACKGROUND: Surgical resection followed by adjuvant mFOLFIRINOX (5-fluorouracil with leucovorin, irinotecan, and oxaliplatin) is currently the standard of care for patients with resectable pancreatic cancer. The main concern regarding adjuvant chemotherapy is that only half of patients actually receive adjuvant treatment. Neoadjuvant chemotherapy, on the other hand, guarantees early systemic treatment and may increase chemotherapy use and thereby improve overall survival. Furthermore, it may prevent futile surgery in patients with rapidly progressive disease. However, some argue that neoadjuvant therapy delays surgery, which could lead to progression towards unresectable disease and thus offset the potential benefits. Comparison of perioperative (i.e., neoadjuvant and adjuvant) with (only) adjuvant administration of mFOLFIRINOX in a randomized controlled trial (RCT) is needed to determine the optimal approach. METHODS: This multicenter, phase 3, RCT will include 378 patients with resectable pancreatic ductal adenocarcinoma with a WHO performance status of 0 or 1. Patients are recruited from 20 Dutch centers and three centers in Norway and Sweden. Resectable pancreatic cancer is defined as no arterial contact and ≤ 90 degrees venous contact. Patients in the intervention arm are scheduled for 8 cycles of neoadjuvant mFOLFIRINOX followed by surgery and 4 cycles of adjuvant mFOLFIRINOX (2-week cycle of oxaliplatin 85 mg/m2, leucovorin 400 mg/m2, irinotecan 150 mg/m2 at day 1, followed by 46 h continuous infusion of 5-fluorouracil 2400 g/m2). Patients in the comparator arm start with surgery followed by 12 cycles of adjuvant mFOLFIRINOX. The primary outcome is overall survival by intention-to-treat. Secondary outcomes include progression-free survival, resection rate, quality of life, adverse events, and surgical complications. To detect a hazard ratio of 0.70 with 80% power, 252 events are needed. The number of events is expected to be reached after the inclusion of

Background: Hepaticojejunostomy anastomotic stricture (HJAS) is an adverse event after pancreatoduodenectomy (PD) which can result in jaundice and/or cholangitis. With endoscopy, HJAS can be managed. However, few studies report the specific success and adverse event rates of endoscopic therapy after PD. Methods: Patients with symptomatic HJAS, who underwent an endoscopic retrograde cholangiopancreatography at the Erasmus MC between 2004-2020, were retrospectively included. Primary outcomes were short-term clinical success defined as no need for re-intervention <3 months and long-term <12 months. Secondary outcome measures were cannulation success and adverse events. Recurrence was defined as symptoms with radiological/endoscopic confirmation. Results: A total of 62 patients were included. The hepaticojejunostomy was reached in 49/62 (79%) of the patients, subsequently cannulated in 42/49 (86%) and in 35/42 patients (83%) an intervention was performed. Recurrence of symptomatic HJAS after technically successful intervention occurred in 20 (57%) patients after median time to recurrence of 7.5 months [95%CI, 7.2–NA]. Adverse events were reported in 4% of the procedures (8% of patients), mostly concerning cholangitis. Discussion: Endoscopic treatment for symptomatic HJAS after PD has a moderate technical success rate and a high recurrence rate. Future studies should optimize endoscopic treatment protocols and compare percutaneous versus endoscopic treatment.

Background: In general, migrant women have a lower breast cancer (BC) incidence rate and higher BC mortality than autochthonous women. Further, migrant women show lower participation in the national BC screening program. To further investigate those aspects, we aimed to determine differences in incidence and tumor characteristics between autochthonous and migrant BC patients in Rotterdam, the Netherlands. Methods: We selected women diagnosed with BC in Rotterdam during 2012–2015 from the Netherlands Cancer Registry. Incidence rates were calculated by migrant status (i.e., women with or without migration background). Multivariable analyses revealed adjusted odds ratios (OR) and 95% confidence intervals (CI) on the association between migration status and patient and tumor characteristics, additionally stratified by screening attendance (yes/no). Results: In total 1372 autochthonous and 450 migrant BC patients were included for analysis. BC incidence was lower among migrants than among autochthonous women. Overall, migrant women were younger at BC diagnosis (53 vs. 64 years, p < 0.001), and had higher risks of positive lymph nodes (OR 1.76, 95% CI 1.33–2.33) and high grade tumors (OR 1.35, 95% CI 1.04–1.75). Especially non-screened migrant women had higher risk of positive nodes (OR 2.73, 95% CI 1.43–5.21). Among the subgroup of screened women, we observed no significant differences between migrant and autochthonous patients. Conclusion: Migrant women have lower BC incidence than autochthonous women, but diagnosis was more often at younger age and with unfavorable tumor characteristics. Attending the screening program strongly reduces the latter. Therefore, promotion of participation in the screening program is recommended.

BackgroundNeoadjuvant therapy has several potential advantages over upfront surgery in patients with localized pancreatic cancer; more patients receive systemic treatment, fewer patients undergo futile surgery, and R0 resection rates are higher, thereby possibly improving overall survival (OS). Two recent randomized trials have suggested benefit of neoadjuvant chemoradiotherapy over upfront surgery, both including single-agent chemotherapy regimens. Potentially, the multi-agent FOLFIRINOX regimen (5-fluorouracil with leucovorin, irinotecan, and oxaliplatin) may further improve outcomes in the neoadjuvant setting for localized pancreatic cancer, but randomized studies are needed. The PREOPANC-2 trial investigates whether neoadjuvant FOLFIRINOX improves OS compared with neoadjuvant gemcitabine-based chemoradiotherapy and adjuvant gemcitabine in resectable and borderline resectable pancreatic cancer patients.MethodsThis nationwide multicenter phase III randomized controlled trial includes patients with pathologically confirmed resectable and borderline resectable pancreatic cancer with a WHO performance score of 0 or 1. Resectable pancreatic cancer is defined as no arterial and <= 90 degrees venous involvement; borderline resectable pancreatic cancer is defined as <= 90 degrees arterial and <= 270 degrees venous involvement without occlusion. Patients receive 8cycles of neoadjuvant FOLFIRINOX chemotherapy followed by surgery without adjuvant treatment (arm A), or 3cycles of neoadjuvant gemcitabine with hypofractionated radiotherapy (36Gy in 15 fractions) during the second cycle, followed by surgery and 4cycles of adjuvant gemcitabine (arm B). The primary endpoint is OS by intention-to-treat. Secondary endpoints include progression-free survival, quality of life, resection rate, and R0 resection rate. To detect a hazard ratio of 0.70 with 80% power, 252 events are needed. The number of events is expected to be reached after inclusion of 368 eligible patients as

PURPOSE: The American Joint Committee on Cancer (AJCC) eighth edition schema for pancreatic ductal adenocarcinoma treats T and N stage as independent factors and uses positive lymph nodes (PLNs) to define N stage, despite data favoring lymph node ratio (LNR). We used artificial intelligence-based techniques to compare PLN with LNR and investigate interactions between tumor size and nodal status. METHODS: Patients who underwent pancreatic ductal adenocarcinoma resection between 2000 and 2017 at six institutions were identified. LNR and PLN were compared through shapley additive explanations (SHAP) analysis, with the best predictor used to define nodal status. We trained optimal classification trees (OCTs) to predict 1-year and 3-year risk of death, incorporating only tumor size and nodal status as variables. The OCTs were compared with the AJCC schema and similarly trained XGBoost models. Variable interactions were explored via SHAP. RESULTS: Two thousand eight hundred seventy-four patients comprised the derivation and 1,231 the validation cohort. SHAP identified LNR as a superior predictor. The OCTs outperformed the AJCC schema in the derivation and validation cohorts (1-year area under the curve: 0.681 v 0.603; 0.638 v 0.586, 3-year area under the curve: 0.682 v 0.639; 0.675 v 0.647, respectively) and performed comparably with the XGBoost models. We identified interactions between LNR and tumor size, suggesting that a negative prognostic factor partially overrides the effect of a concurrent favorable factor. CONCLUSION: Our findings highlight the superiority of LNR and the importance of interactions between tumor size and nodal status. These results and the potential of the OCT methodology to combine them into a powerful, visually interpretable model can help inform future staging systems.