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Mountain pastures are essential for maintainig biodiversity and local economies. Despite the great value and fragility of these ecosystems, an up-to-date overview of extent and type of alpine pastures is lacking in many areas of the Alps. In this study, the interpretation of ancillary information combined with expeditious field campaigns, and the harmonization of classification methodologies allowed us to: (1) define the spatial extent of mountain pastures; (2) identify the non-grazeable percentage in these areas; (3) Characterize and map pasture types within the Gran Paradiso National Park (Italy), where 4596 ha of grazeable areas were mapped. Among the 13 categories identified, the three most represented in the park are Bare thermophile grasslands (38%), Nardus swards (20%), and Alpine intermediate grasslands (18%). The maps obtained in this study are useful for animal management during the grazing season, and have the capability of geographically assessing potential forage avaibility through modeling and remote sensing data.

According to American Thyroid Association (ATA) guideline, papillary thyroid cancer (PTC) with minimal extrathyroidal extension (mETE) is classified at “intermediate risk” of persistent/recurrent disease. However, the impact of mETE per se on patients’ outcome is not fully understood. The aim of our study was to evaluate the prognostic significance of mETE in patients with PTC not submitted to therapeutic or prophylactic lymph node dissection, according to tumor size and other prognostic factors. We retrospectively evaluated a total of 514 PTC patients: 127 (24.7%) had mETE (pT3Nx) and 387 (75.3%) had negative margins (pT1-2Nx). At a median follow-up of 9.1 years, patients were divided in two groups: patients with “good outcome” (no evidence of disease) and patients with “poor outcome” (persistent structural disease or recurrent disease or tumor-related death). The rate of patients with “poor outcome” was significantly higher in patients with mETE compared with patients with negative margins (11.8 versus 5.1%; OR 2.4576, 95% CI 1.2178–4.9594, p = 0.01). However, mETE was significantly associated with poor outcome only in patients with tumors larger than 1.5 cm. mETE is an unfavorable prognostic factor in tumors larger than 1.5 cm, suggesting that, in the absence of other unfavorable characteristics, smaller tumors with mETE should be classified and managed as “low risk” tumors.

Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up F. Pacini, M. G. Castagna, L. Brilli & G. Pentheroudakis On behalf of the ESMO Guidelines Working Group* Section of Endocrinology and Metabolism, Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry, Section of Endocrinology and Metabolism, University of Siena, Siena, Italy; Department of Medical Oncology, Ioannina University Hospital, Ioannina, Greece