Within Commission Implementing Regulation 2019/2072, potential entry pathways for D. undecimpunctata howardi, such as Asteraceae, Poaceae and Solanaceae plants for planting with foliage and soil/growing medium, and soil/growing media by themselves can be considered as closed. However, plants for planting of the families Chenopodiaceae, Cucurbitaceae, Fabaceae and Polygonaceae are not specifically regulated. Should D. undecimpunctata howardi arrive in the EU, climatic conditions and availability of susceptible hosts provide conditions suitable for establishment and further spread. Economic impact is anticipated in maize and outdoor cucurbit production. D. undecimpunctata howardi satisfies the criteria that are within the remit of EFSA to assess for this species to be regarded as a potential Union quarantine pest. This species does not meet the criteria of being present in the EU, nor plants for planting being the main pathway for spread, for it to be regarded as a potential regulated non-quarantine pest.The food enzyme dextranase (6-α-d-glucan 6-glucanohydrolase, EC 3.2.1.11) is produced with the non-genetically modified Collariella gracilis strain ATCC-16153 by Mitsubishi-Kagaku Foods Corporation. The food enzyme is free from viable cells of the production organism. The food enzyme is intended to be used in sugar production and processing.  https://www.selleckchem.com/products/wnt-c59-c59.html  As residual amounts of total organic solids (TOS) are removed during the production of refined sugars, dietary exposure was calculated only for unrefined sugar products. Based on the maximum use levels, dietary exposure to the food enzyme TOS was estimated to be up to 15 μg TOS/kg body weight (bw) per day in European populations. Genotoxicity tests did not raise a safety concern. The systemic toxicity was assessed by means of a repeated dose 90-day oral toxicity study in rats. The Panel identified a no observed adverse effect level (NOAEL) of 110 mg TOS/kg bw per day, the highest dose tested, which, when compared with the estimated dietary exposure, results in a sufficiently high margin of exposure (MoE) of at least 7,300. Similarity of the amino acid sequence of the food enzyme to those of known allergens was searched and no match was found. The Panel considered that, under the intended conditions of use, the risk of allergic sensitisation and elicitation reactions by dietary exposure cannot be excluded, but the likelihood is considered to be low. Based on the data provided, the Panel concluded that this food enzyme does not give rise to safety concerns under the intended conditions of use.Ectopic adrenocorticotropic hormone (ACTH) syndrome is rare and identification of its source is often challenging. We report the case of an ectopic Cushing syndrome in a young adult male secondary to an occult ACTH producing atypical carcinoid tumor. Extensive biochemical and imaging workup was unrevealing. The diagnosis was aided by Ga-DOTA PET scan demonstrating a suspicious left upper lobe lung nodule. The patient underwent video-assisted thoracoscopic exploration with wedge resection and mediastinal lymphadenectomy of a T2aN2M0 atypical carcinoid, resulting in the normalization of ACTH levels and complete resolution of symptoms. The role of a Ga-DOTA PET scan in diagnosing pulmonary carcinoid tumors and their management are discussed.
  This study aimed to describe the frequency and distribution of biopsy procedures for patients diagnosed and treated for primary lung cancer.
 
  Retrospective cohort study within an administrative database.
 
  This observational study used data from the IBM MarketScan
  Databases between 2013 and 2015.
 
  The total number of lung biopsies performed among eligible subjects was 32,814; an average of 1.7 biopsies per patient. Bronchoscopy and percutaneous approaches accounted for 95% of all procedures. Complication rates by procedure are remarkably similar irrespective of biopsy frequency.
 
  Nearly half (46%) of patients in this population experienced multiple biopsies prior to diagnosis. Further, biopsy choice or sequence in patients receiving multiple procedures was unpredictable.
 Nearly half (46%) of patients in this population experienced multiple biopsies prior to diagnosis. Further, biopsy choice or sequence in patients receiving multiple procedures was unpredictable.Palliative care (PC) is the care of patients and their families with serious illness and is rapidly becoming an important part of the care of cancer patients. Patients with advanced lung cancer are a highly symptomatic population of patients and clearly experience benefits in quality of life and potentially benefits in overall survival when PC is incorporated early on after diagnosis. However, referrals to PC are still reliant on clinical judgment of patient prognosis and symptom burden. Moving forward, improving the integration of PC and lung cancer care will require more efficient real-time screening of patient symptoms, which may be accomplished through the use of patient-reported outcomes.
  To compare the efficacy and safety of tyrosine kinase inhibitors (TKIs) as first-line treatment in patients with locally advanced or metastatic non-small-cell lung cancer (NSCLC) with positive 
  mutation.
 
  Following a systematic literature review until December 2019, we conducted a random-effects pairwise and network meta-analyses (NMA). We ranked treatments for efficacy and safety based on the surface under the cumulative ranking curve (SUCRA).
 
  Tyrosine kinase inhibitors of the epidermal growth factor receptor (EGFR-TKI) improved survival outcomes with fewer grade 3 or higher adverse events compared to chemotherapy. Overall survival results suggest that osimertinib has the highest probability of being the most efficacious (SUCRA, 79.9%), followed by dacomitinib (SUCRA, 75.8%). Adverse events results suggest that osimertinib (SUCRA, 84.3%) and gefitinib (SUCRA, 78.9%) has the highest probability of being the safest.
 
  In this NMA, we found that osimertinib is the most efficacious and safest EGFR-TKI. These results may guide clinicians in choosing the most appropriate treatment option among EGFR-TKIs for their patient's individual clinical characteristics.
 In this NMA, we found that osimertinib is the most efficacious and safest EGFR-TKI. These results may guide clinicians in choosing the most appropriate treatment option among EGFR-TKIs for their patient's individual clinical characteristics.