Severe paraneoplastic hypoglycemia in a patient with a gastrointestinal stromal tumor with an exon 9 mutation: a case report

BACKGROUND: Non-islet cell tumor induced hypoglycemia (NICTH) is a very rare phenomenon, but even more so in gastrointestinal stromal tumors. It tends to present in large or metastatic tumors, and can appear at any time in the progression of the disease. We present herein a case of NICTH in a GIST tumor and report an exon 9 mutation associated to it. CASE PRESENTATION: A thirty nine year-old man with a recurrent, metastatic gastrointestinal stromal tumor presented to the hospital with nausea, dizziness, loss of consciousness, and profound hypoglycemia (20 mg/dL). There was no evidence of factitious hypoglycemia. He was stabilized with a continuous glucose infusion and following selective vascular embolization, the patient underwent debulking of a multicentric 40 cm × 25 cm × 10 cm gastrointestinal stromal tumor. After resection, the patient became euglycemic and returned to his normal activities. Tumor analysis confirmed excessive production of insulin-like growth factor II m-RNA and the precursor protein, "big" insulin-like growth factor II. Mutational analysis also identified a rare, 6 bp tandem repeat insert (gcctat) at position 1530 in exon 9 of KIT. CONCLUSION: Optimal management of gastrointestinal stromal tumor-induced hypoglycemia requires a multidisciplinary approach, and surgical debulking is the treatment of choice to obtain immediate symptom relief. Imatinib or combinations of glucocorticoids and growth hormone are alternative palliative strategies for symptomatic hypoglycemia. In addition, mutations in exon 9 of the tyrosine kinase receptor KIT occur in 11–20% of GIST and are often associated with poor patient outcomes. The association of this KIT mutation with non-islet cell tumor induced hypoglycemia has yet to be established

Diagnostic value of copper parameters to predict growth of suckling calves grazing native range in Argentina

A study was conducted to evaluate the predictive diagnostic value of different copper (Cu) parameters as indicators of average daily gain (ADG) in growing calves. The effects in calves of cow Cu supplementation in the last one-third gestation period were also evaluated. Five supplementation trials, with a total of 300 calves, were carried out. Two groups of 30 calves were randomly assigned to each trial, one group was parenterally supplemented (SG) and the other was not supplemented (NSG). Trials began when calves were three-month-old and ended at weaning time. At each sampling calves were weighed and blood was taken to determine Cu concentrations in plasma, Whole Blood (WB), Red Cells (RC) and Packed Cell Volume (PCV). Liver samples from six animals of each group were taken both at the beginning and at the end of the trial. In two trials the mothers of the SG received Cu supplementation at the last one- third gestation period. Four of the five trials exhibited low ADG in the NSGs. In these groups, plasma Cu concentration decreased rapidly before low ADG was detected, which occurred with values remaining below 25µg/dl. The decrease of RC Cu concentration was considerably slow. WB showed an intermediate position. PCV in the SGs was higher than in the NSGs in all trials. Cow supplementation was insufficient to generate a liver storage able to last after calves reached the 3 months of age. These data could be useful to predict the risk of low ADG in grazing calves

Renal cortex copper concentration in acute copper poisoning in calves

The aim of this study was to estimate the diagnostic value of renal cortex copper (Cu) concentration in clinical cases of acute copper poisoning (ACP). A total of 97 calves that died due to subcutaneous copper administration were compiled in eleven farms. At least, one necropsy was conducted on each farm and samples for complementary analysis were taken. The degree of autolysis in each necropsy was evaluated. The cases appeared on extensive grazing calf breeding and intensive feedlot farms, in calves of 60 to 200 kg body weight. Mortality varied from 0.86 to 6.96 %, on the farms studied. The first succumbed calf was found on the farms between 6 and 72 hours after the susbcutaneous Cu administration. As discrepancies regarding the reference value arose, the local value (19.9 parts per million) was used, confirming the diagnosis of acute copper poisoning in 93% of the analyzed kidney samples. These results confirm the value of analysis of the cortical kidney Cu concentration for the diagnosis of acute copper poisoning

Measurement of ψ\psi(2SS) production cross-sections in proton-proton collisions at s\sqrt{s} = 7 and 13 TeV

International audienceThe cross-sections of $\psi(2S)$ meson production in proton-proton collisions at $\sqrt{s}=13~\mathrm{TeV}$ are measured with a data sample collected by the LHCb detector corresponding to an integrated luminosity of $275~p\mathrm{b}^{-1}$. The production cross-sections for prompt $\psi(2S)$ mesons and those for $\psi(2S)$ mesons from $b$-hadron decays ($\psi{(2S)}\mathrm{-from-}b$) are determined as functions of the transverse momentum, $p_{\mathrm{T}}$, and the rapidity, $y$, of the $\psi(2S)$ meson in the kinematic range $2<p_{\mathrm{T}}<20~\mathrm{GeV}/c$ and $2.0<y<4.5$. The production cross-sections integrated over this kinematic region are \begin{equation*} \begin{split} \sigma(\mbox{prompt }\psi(2S),13~\mathrm{TeV}) &= {1.430 \pm 0.005(\mathrm{stat}) \pm 0.099 (\mathrm{syst})\mu\mathrm{b}},\\ \sigma(\psi(2S)\mathrm{-from-}b,13~\mathrm{TeV})&={0.426 \pm 0.002(\mathrm{stat}) \pm0.030 (\mathrm{syst})\mu\mathrm{b}}. \end{split} \end{equation*} A new measurement of $\psi(2S)$ production cross-sections in $pp$ collisions at $\sqrt{s}=7~\mathrm{TeV}$ is also performed using data collected in 2011, corresponding to an integrated luminosity of $614~{p\mathrm{b}^{-1}}$.The integrated production cross-sections in the kinematic range $3.5<p_{\mathrm{T}}<14~\mathrm{GeV}/c$ and $2.0<y<4.5$ are \begin{equation*} \begin{split} \sigma(\mbox{prompt }\psi(2S),7~\mathrm{TeV}) &={0.471 \pm0.001 (\mathrm{stat}) \pm 0.025 (\mathrm{syst})\mu\mathrm{b}},\\ \sigma(\psi(2S)\mathrm{-from-}b,7~\mathrm{TeV}) &={0.126\pm0.001 (\mathrm{stat}) \pm0.008 (\mathrm{syst})\mu\mathrm{b}}. \end{split} \end{equation*} All results show reasonable agreement with theoretical calculations

Observation of Several Sources of CPCP Violation in B+→π+π+π−B^+ \to \pi^+ \pi^+ \pi^- Decays

International audienceObservations are reported of different sources of CP violation from an amplitude analysis of B+→π+π+π- decays, based on a data sample corresponding to an integrated luminosity of 3  fb-1 of pp collisions recorded with the LHCb detector. A large CP asymmetry is observed in the decay amplitude involving the tensor f2(1270) resonance, and in addition significant CP violation is found in the π+π-S wave at low invariant mass. The presence of CP violation related to interference between the π+π-S wave and the P wave B+→ρ(770)0π+ amplitude is also established; this causes large local asymmetries but cancels when integrated over the phase space of the decay. The results provide both qualitative and quantitative new insights into CP -violation effects in hadronic B decays