Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the digestive tract, with an incidence of 1.1 cases/100,000 inhabitants/year. A group of experts from the Spanish ...Society of Pathology and the Spanish Society of Oncology met to discuss a brief update on GISTs and agree on aspects relating to the pathological and molecular diagnosis of these tumors. GISTs are generally solitary, well-circumscribed lesions of variable size (<10 mm–35 cm) that may present with intra- or extra-luminal parietal growth or a mixed-type (hourglass) growth pattern. Histologically, they are unencapsulated neoplasms displaying expansive growth and spindle-shaped (70%), epithelioid (20%), or mixed cellularity (10%). Mitotic activity is generally moderate or low and should be evaluated only in areas with high cellularity or higher mitotic frequency. The great majority of GISTs harbour mutually exclusive activating mutations in genes coding for the type III receptor tyrosine kinases KIT and PDGFRA; less commonly, GISTs have also been reported to display mutations elsewhere, including
BRAF
and
NF1
and SDH-complex genes. The method most widely used to detect
KIT
and
PDGFRA
mutations is amplification of the exons involved by polymerase chain reaction followed by direct sequencing (Sanger method) of these amplification products. Molecular analyses should always specify the type of analysis performed, the region or mutations evaluated, and the sensitivity of the detection method employed.
Summary
We report the largest study on the prevalence and distribution of HCV genotypes in Spain (2000‐2015), and we relate them with clinical, epidemiological and virological factors. Patients from ...29 hospitals in 10 autonomous communities (Andalusia, Aragon, Castilla‐Leon, Catalonia, Galicia, Canary Islands, Madrid Community, Valencian Community, Murcia Region and Basque Country) have been studied. Annual distribution of HCV genotypes and subtypes, as well as gender, age, transmission route, HIV and/or HBV coinfection, and treatment details were recorded. We included 48595 chronically HCV‐infected patients with the following characteristics: median age 51 years (IQR, 44‐58), 67.9% male, 19.1% HIV‐coinfected, 23.5% HBV‐coinfected. Parenteral transmission route was the most frequent (58.7%). Genotype distribution was 66.9% GT1 (24.9% subtype 1a and 37.9% subtype 1b), 2.8% GT2, 17.3% GT3, 11.4% GT4 and 0.1% GT5 and 0.02% GT6. LiPA was the most widely HCV genotyping test used (52.4%). HCV subtype 1a and genotypes 3 and 4 were closely associated with male gender, parenteral route of infection and HIV and HBV coinfection; in contrast, subtype 1b and genotype 2 were associated with female gender, nonparenteral route and mono‐infection. Age was related to genotype distribution, and different patterns of distribution and biodiversity index were observed between different geographical areas. Finally, we describe how treatment and changes in transmission routes may have affected HCV genotype prevalence and distribution patterns. We present the most recent data on molecular epidemiology of hepatitis C virus in Spain. This study confirms that genotype distributions vary with age, sex, HIV and HBV coinfection and within geographical areas and epidemiological groups.
Aims.
We analyze the white dwarf population in miniJPAS, the first square degree observed with 56 medium-band, 145 Å in width optical filters by the Javalambre Physics of the accelerating Universe ...Astrophysical Survey (J-PAS), to provide a data-based forecast for the white dwarf science with low-resolution (
R
∼ 50) photo-spectra.
Methods.
We define the sample of the bluest point-like sources in miniJPAS with
r
< 21.5 mag, a point-like probability larger than 0.5, (
u
−
r
)< 0.80 mag, and (
g
−
i
)< 0.25 mag. This sample comprises 33 sources with spectroscopic information: 11 white dwarfs and 22 quasi-stellar objects (QSOs). We estimate the effective temperature (
T
eff
), the surface gravity, and the composition of the white dwarf population by a Bayesian fitting to the observed photo-spectra.
Results.
The miniJPAS data are sensitive to the Balmer series and the presence of polluting metals. Our results, combined with those from the Javalambre Photometric Local Universe Survey (J-PLUS) which has a lower spectral resolution but has already observed thousands of white dwarfs, suggest that J-PAS photometry would permit – down to
r
∼ 21.5 mag and at least for sources with 7000 <
T
eff
< 22 000 K – both the classification of the observed white dwarfs into H-dominated and He-dominated with 99% confidence and the detection of calcium absorption for equivalent widths larger than 15 Å. The effective temperature is estimated with a 2% uncertainty, which is close to the 1% from spectroscopy. A precise estimation of the surface gravity depends on the available parallax information. In addition, the white dwarf population at
T
eff
> 7000 K can be segregated from the bluest extragalactic QSOs, providing a clean sample based on optical photometry alone.
Conclusions.
The J-PAS low-resolution photo-spectra would produce precise effective temperatures and atmospheric compositions for white dwarfs, complementing the data from
Gaia
. J-PAS will also detect and characterize new white dwarfs beyond the
Gaia
magnitude limit, providing faint candidates for spectroscopic follow-up.
The impact of oseltamivir on mortality in critically ill patients with 2009 pandemic influenza A (2009 H1N1) is not clear. The main objective of this study was to investigate the relationship between ...the timing of antiviral administration and intensive care unit (ICU) outcomes.
Prospective, observational study of a cohort of ICU patients with confirmed 2009 H1N1 infection. Clinical data, treatment and outcome were compared between patients receiving early treatment (ET) with oseltamivir, initiated within 2 days, and patients administered late treatment (LT), initiated after this timepoint. Multivariate analysis and propensity score were used to determine the effect of oseltamivir on ICU mortality.
Six hundred and fifty-seven patients were enrolled. Four hundred and four (61.5%) patients required mechanical ventilation (MV; mortality 32.6%). Among them, 385 received effective antiviral therapy and were included in the study group. All patients received oseltamivir for a median duration of 10 days (interquartile range 8-14 days). Seventy-nine (20.5%) ET patients were compared with 306 LT patients. The two groups were comparable in terms of main clinical variables. ICU length of stay (22.7 ± 16.7 versus 18.4 ± 14.2 days; P = 0.03), hospital length of stay (34.0 ± 20.3 versus 27.2 ± 18.2 days; P = 0.001) and MV days (17.4 ± 15.2 versus 14.0 ± 12.4; P = 0.04) were higher in the LT group. ICU mortality was also higher in LT (34.3%) than in ET (21.5%; OR = 1.9; 95% CI 1.06-3.41). A multivariate model identified ET (OR = 0.44; 95% CI 0.21-0.87) as an independent variable associated with reduced ICU mortality. These results were confirmed by propensity score analysis (OR = 0.44; 95% CI 0.22-0.90; P < 0.001).
Our findings suggest that early oseltamivir administration was associated with favourable outcomes among critically ill ventilated patients with 2009 H1N1 virus infection.
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