Unusual appearance of a pendulated gastric tumor : always think of GIST

Objective. To investigate the clinicopathological characteristics of gastrointestinal stromal tumor (GIST) with significant cystic changes and to assess the molecular genetic characteristics. Methods. In a 68-year-old man, a large abdominal tumoral mass was discovered incidentally. Computed tomography (CT) and magnetic resonance imaging (MRI) confirmed the presence of a large cystic lesion with multiple contrast-enhancing septae and papillary projections. No clear connection with any of the surrounding organs was identified. Malignancy could not be excluded, and surgery was indicated. During surgery, the large mass was found to be attached by a narrow stalk to the large curvature of the stomach. Results. The histological features and immunohistiochemical profile of the tumor cells (positivity for CD117 and CD34) were consistent with a gastrointestinal stromal tumor with a high risk of progressive disease according to the Fletcher classification. Diagnosis was confirmed by mutational analysis; this demonstrated mutation in exon 14 of PDGFRA. During the followup of 97 months, the patient had a cancer-free survival. Conclusions. This case demonstrates that gastrointestinal stromal tumors (GISTs) with extensive cystic degeneration should be considered in the differential diagnosis of a cystic abdominal mass

Intramontane lacustrine basins in the Siberian Altai: recorders of Cenozoic intracontinental tectonic and climatic events

The Altai Mountains are part of the vast intracontinental Central Asian orogenic system that formed during the Cenozoic as a distal effect of continued indentation of the Indian plate into the Eurasian continent. In the Siberian part of the Altai Mountains there is ample evidence to suggest that the pre-Cenozoic structural fabric of its basement is a controlling factor in the Cenozoic deformation and development of this intracontinental orogen. We give evidence that important Paleozoic fault zones were reactivated during the Cenozoic, particularly the Late Cenozoic and play a key role in the formation, evolution and current morphology of the Siberian Altai Mountains. Some of these faults are still active and recent and historic movements along them have triggered large seismic events. Late Cenozoic reactivation was expressed as pure thrust, oblique thrust to pure strike-slip faulting, resulting in an overall transpressive tectonic regime. In some cases, as for the graben basin of Lake Teletskoye, local, pure extensional stresses are responsible for its formation as we show in this contribution. Various other intramontane, tectonic basins developed. Some of these are very recent structures (the Teletskoye Basin) and are Pleistocene in age or younger, others have a prolonged history and contain a relatively complete Cenozoic sedimentary section, with evidence of Late Mesozoic precursor basins (Chuya Basin, Dzhulukul Basin). Some of these exhibit indications of marine incursions, but the basins are predominantly continental. The development of these basins is clearly associated with the location and Cenozoic reactivation of aforementioned long-lived fault zones in the Altai tectonic assemblage. Many of these basins accommodated fresh water lakes during their evolution and some are still the site of contemporary mountain lakes. Their stratigraphy, as well as the sedimentary architecture and basin morphology is manifestly influenced by and progresses with the stages of (Late) Cenozoic intracontinental mountain building and erosive denudation of the growing mountain ranges. Together with the clastic sedimentary input and the provenance characteristics, the intramontane Altai basin deposits are affected by evolving climatic conditions. These conditions dictate the main mode of erosion and transport, influence the sedimentary facies and supply rate and create the framework for a specific biocoenosis signature found in the fossil record. Our contribution reviews the data obtained over the last years from a selection of intramontane lacustrine basins in the Siberian Altai Mountains. We direct our attention in particular to the Teletskoye basin, the Chuya-Kurai Basin and the Dzhulukul Basin. We combine sedimentologic-stratigraphic data with basin architecture and morphology, and with basement geochronologic-thermochronologic constraints (apatite fission-track, U/Pb and Ar-dating) in order to show the potential of these basins as recorders of Cenozoic tectonic and climatic events in relation with basement features. While for example the data obtained from the Chuya Basin yields a continuous Cenozoic picture of deformation and climatic evolution of the Altai area, data from the Teletskoye Basin zooms in with higher resolution on the Pleistocene to Recent history. In general, all data point towards intensifying tectonic reactivation and mountain building of the Siberian Altai Mountains since the Middle Cenozoic, with clear peak activity in the Pliocene to Recent. This is demonstrated by the molassetype deposits in these basins, and by thermochronologic constraints. This activity is ongoing and structural, (paleo)seismic, geomorphologic and sedimentologic data corroborates this. The lacustrine Altai basins provide a record for a more or less continuous progressive cooling and aridification of the Altai area during the Cenozoic as manifested in the pollen fossil assemblages found in the Altai sediments

A family of Nikishin systems with periodic recurrence coefficients

Suppose we have a Nikishin system of $p$ measures with the $k$th generating measure of the Nikishin system supported on an interval \Delta_k\subset\er with $\Delta_k\cap\Delta_{k+1}=\emptyset$ for all $k$. It is well known that the corresponding staircase sequence of multiple orthogonal polynomials satisfies a $(p+2)$-term recurrence relation whose recurrence coefficients, under appropriate assumptions on the generating measures, have periodic limits of period $p$. (The limit values depend only on the positions of the intervals $\Delta_k$.) Taking these periodic limit values as the coefficients of a new $(p+2)$-term recurrence relation, we construct a canonical sequence of monic polynomials $\{P_{n}\}_{n=0}^{\infty}$, the so-called \emph{Chebyshev-Nikishin polynomials}. We show that the polynomials $P_{n}$ themselves form a sequence of multiple orthogonal polynomials with respect to some Nikishin system of measures, with the $k$th generating measure being absolutely continuous on $\Delta_{k}$. In this way we generalize a result of the third author and Rocha \cite{LopRoc} for the case $p=2$. The proof uses the connection with block Toeplitz matrices, and with a certain Riemann surface of genus zero. We also obtain strong asymptotics and an exact Widom-type formula for the second kind functions of the Nikishin system for $\{P_{n}\}_{n=0}^{\infty}$.Comment: 30 pages, minor change

The optical identifcation of events with poorly defined locations: The case of the Fermi GBM GRB140801A

We report the early discovery of the optical afterglow of gamma-ray burst (GRB) 140801A in the 137 deg$^2$ 3-$\sigma$ error-box of the Fermi Gamma-ray Burst Monitor (GBM). MASTER is the only observatory that automatically react to all Fermi alerts. GRB 140801A is one of the few GRBs whose optical counterpart was discovered solely from its GBM localization. The optical afterglow of GRB 140801A was found by MASTER Global Robotic Net 53 sec after receiving the alert, making it the fastest optical detection of a GRB from a GBM error-box. Spectroscopy obtained with the 10.4-m Gran Telescopio Canarias and the 6-m BTA of SAO RAS reveals a redshift of $z=1.32$. We performed optical and near-infrared photometry of GRB 140801A using different telescopes with apertures ranging from 0.4-m to 10.4-m. GRB 140801A is a typical burst in many ways. The rest-frame bolometric isotropic energy release and peak energy of the burst is $E_\mathrm{iso} = 5.54_{-0.24}^{+0.26} \times 10^{52}$ erg and $E_\mathrm{p, rest}\simeq280$ keV, respectively, which is consistent with the Amati relation. The absence of a jet break in the optical light curve provides a lower limit on the half-opening angle of the jet $\theta=6.1$ deg. The observed $E_\mathrm{peak}$ is consistent with the limit derived from the Ghirlanda relation. The joint Fermi GBM and Konus-Wind analysis shows that GRB 140801A could belong to the class of intermediate duration. The rapid detection of the optical counterpart of GRB 140801A is especially important regarding the upcoming experiments with large coordinate error-box areas.Comment: in press MNRAS, 201

Super-solar metallicity at the position of the ultra-long GRB130925A

Over the last decade there has been immense progress in the follow-up of short and long GRBs, resulting in a significant rise in the detection rate of X-ray and optical afterglows, in the determination of GRB redshifts, and of the identification of the underlying host galaxies. Nevertheless, our theoretical understanding on the progenitors and central engines powering these vast explosions is lagging behind, and a newly identified class of `ultra-long' GRBs has fuelled speculation on the existence of a new channel of GRB formation. In this paper we present high signal-to-noise X-shooter observations of the host galaxy of GRB130925A, which is the fourth unambiguously identified ultra-long GRB, with prompt gamma-ray emission detected for ~20ks. The GRB line of sight was close to the host galaxy nucleus, and our spectroscopic observations cover both this region along the bulge/disk of the galaxy, in addition to a bright star-forming region within the outskirts of the galaxy. From our broad wavelength coverage we obtain accurate metallicity and dust-extinction measurements at both the galaxy nucleus, and an outer star-forming region, and measure a super-solar metallicity at both locations, placing this galaxy within the 10-20% most metal-rich GRB host galaxies. Such a high metal enrichment has implications on the progenitor models of both long and ultra-long GRBs, although the edge-on orientation of the host galaxy does not allow us to rule out a large metallicity variation along our line of sight. The spatially resolved spectroscopic data presented in this paper offer important insight into variations in the metal and dust abundance within GRB host galaxies. They also illustrate the need for IFU observations on a larger sample of GRB host galaxies at varies metallicities to provide a more quantitative view on the relation between the GRB circumburst and the galaxy-whole properties.Comment: 9 pages, 3 figures, A&A in press, matches published versio

Why Give Birth in Health Facility? Users' and Providers' Accounts of Poor Quality of Birth Care in Tanzania.

In Tanzania, half of all pregnant women access a health facility for delivery. The proportion receiving skilled care at birth is even lower. In order to reduce maternal mortality and morbidity, the government has set out to increase health facility deliveries by skilled care. The aim of this study was to describe the weaknesses in the provision of acceptable and adequate quality care through the accounts of women who have suffered obstetric fistula, nurse-midwives at both BEmOC and CEmOC health facilities and local community members. Semi-structured interviews involving 16 women affected by obstetric fistula and five nurse-midwives at maternity wards at both BEmOC and CEmOC health facilities, and Focus Group Discussions with husbands and community members were conducted between October 2008 and February 2010 at Comprehensive Community Based Rehabilitation in Tanzania and Temeke hospitals in Dar es Salaam, and Mpwapwa district in Dodoma region. Health care users and health providers experienced poor quality caring and working environments in the health facilities. Women in labour lacked support, experienced neglect, as well as physical and verbal abuse. Nurse-midwives lacked supportive supervision, supplies and also seemed to lack motivation. There was a consensus among women who have suffered serious birth injuries and nurse midwives staffing both BEmOC and CEmOC maternity wards that the quality of care offered to women in birth was inadequate. While the birth accounts of women pointed to failure of care, the nurses described a situation of disempowerment. The bad birth care experiences of women undermine the reputation of the health care system, lower community expectations of facility birth, and sustain high rates of home deliveries. The only way to increase the rate of skilled attendance at birth in the current Tanzanian context is to make facility birth a safer alternative than home birth. The findings from this study indicate that there is a long way to go

Effects of a 105 hours psychological training program on attitudes, communication skills and occupational stress in oncology: a randomised study

There is today a wide consensus regarding the need to improve communication skills (CS) of health-care professionals (HCPs) dealing with cancer patients. Psychological training programs (PTPs) may be useful to acquire the needed CS. Testing the efficacy of PTP will allow to define their optimal content. The present study was designed to assess the impact of a PTP on HCP stress, attitudes and CS, and on HCP and patients' satisfaction with HCP communication skills in a randomised study. A total of 115 oncology nurses were randomly assigned to a 105-h PTP or to a waiting list. Stress was assessed with the Nursing Stress Scale, attitudes with a Semantic Differential Questionnaire, CS used during one simulated and one actual patient interview with the Cancer Research Campaign Workshop Evaluation Manual, and satisfaction with the nurses' CS with a questionnaire completed by the patients and the nurses. Trained (TG) and control (CG) groups were compared at baseline, after 3 months (just following training for TG) and after 6 months (3 months after the end of training for TG). Compared to controls, trained nurses reported positive changes on their stress levels (P</=0.05) and on their attitudes (P</=0.05). Positive training effects were found on CS used during the simulated interview: a significant increase in facilitative behaviours (open questions: P</=0.001; evaluative functions: P</=0.05) and a significant decrease in inhibitory behaviours (inappropriate information: P</=0.01; false reassurance: P</=0.05). Less positive training effects were found regarding interviews with a cancer patient: a significant increase in educated guesses (P</=0.001) was noticed. No training effect was observed on nurses' satisfaction levels, but a positive training effect was found on patients' satisfaction levels (P</=0.01). Although results outline PTP efficacy, they indicate the need to design PTP, amplifying the transfer of learned CS to clinical practice.info:eu-repo/semantics/publishe