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Background: Studies have demonstrated comparable outcomes between laparoscopic and open resection of gastrointestinal stromal tumor (GIST). We sought to compare outcomes among robotic, laparoscopic, and open resection of gastric GIST in the era of expanding minimally invasive surgery. Methods: A retrospective analysis was performed of adult patients with gastric GIST undergoing definitive surgery using the National Cancer Database from 2010 to 2020, excluding cases converted to open. Patients were stratified into minimally invasive surgery (MIS), (combined robotic (R) and laparoscopic (L)), and open (O). Hospital length of stay (LOS), 30-day mortality, 90-day mortality, and margin status were assessed. Subgroup analysis was performed to evaluate outcomes between R and L cohorts. Entropy balancing was used to adjust for intergroup differences. Kaplan–Meier survival estimates were used to compare unadjusted 5-year survival. Results: Of the 15,022 patients (R = 10.4%, L = 44.3%, O = 45.3%), 63.2% were stage I and 70.6% underwent partial gastrectomy. MIS approach was associated with shorter hospital LOS (β: − 2.58; 95% CI: − 2.82 to − 2.33) and lower odds of 30-day (OR 0.45; 95% CI: 0.30–0.68) and 90-day mortality (OR 0.54; 95% CI: 0.39–0.74) compared to O. Likelihood of R0 resection similar between groups (OR 1.00; 95% CI: 0.88–1.14). Hospital LOS (β: + 0.25; 95% CI: − 0.14–0.64), odds of 30-day (OR 0.99; 95% CI: 0.40–2.46) and 90-day mortality (OR 0.89; 95% CI: 0.47–1.70), and rate of R0 resection (OR 1.02; 95% CI: 0.82–1.27) were comparable between R and L cohorts. Compared to O, MIS approach was associated with improved 5-year OS (log rank p < 0.001). Overall survival was not significantly different between R and L (log rank p = 0.44). Conclusion: These findings suggest that MIS approach may be considered for resection of gastric GIST in select patients. Among patients receiving an MIS approach, the robotic technique can be considered an oncologically safe alternative to laparoscopic surgery. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, it was important for people to be able to comprehend information about mRNA vaccination. Moderna and Pfizer were two of the largest distributors of mRNA vaccinations, and their websites provided information about how mRNA vaccinations work. Applying the tenets of Fuzzy-trace Theory (FTT), we calculated Gist Inference Scores (GIS) to assess the extent to which texts taken from Moderna and Pfizer websites facilitate gist comprehension. We then rewrote the Moderna and Pfizer texts to increase GIS and tested their ability to facilitate a reader's understanding of how mRNA vaccinations work. We conducted two experiments in which participants read original Moderna and Pfizer texts, a High GIS-version presenting the same content, or control texts on unrelated topics. Findings indicate that the High GIS-version increased comprehension. We conclude that this theory-driven approach can help subject-matter experts better communicate important information, allowing readers to "get the gist" of it. [ABSTRACT FROM AUTHOR]

Cancers of the gastrointestinal tract are a major cause of morbidity and mortality globally and, not surprisingly, there has been intense interest in identifying prognostic and predictive markers for new targeted therapies. The cancers of the gastrointestinal tract are unique in so completely exemplifying many of the key features of biomarker profiling across all solid cancers. Firstly, they involve the assessment of many individual biomarkers of many types, with both genomic and proteomic markers requiring assessment for complete profiling. Secondly, the interpretation of one biomarker is often critically dependent on the presence or absence of other biomarkers. And finally, this vast array of testing must be delivered often on very small samples. Here, we review the clinically-validated molecular targets in carcinomas of the esophagus, stomach, colorectum and anal canal, and in gastrointestinal stromal tumors, and discuss a handful of markers which are likely to be of use in the future. [ABSTRACT FROM AUTHOR]

As they become more common, automated systems are also becoming increasingly opaque, challenging their users' abilities to explain and interpret their outputs. In this study, we test the predictions of fuzzy-trace theory—a leading theory of how people interpret quantitative information—on user decision making after interacting with an online decision aid. We recruited a sample of 205 online crowdworkers and asked them to use a system that was designed to detect URLs that were part of coordinated misinformation campaigns. We examined how user endorsements of system interpretability covaried with performance on this coordinated misinformation detection task and found that subjects who endorsed system interpretability displayed enhanced discernment. This interpretability was, in turn, associated with both objective mathematical ability and mathematical self-confidence. Beyond these individual differences, we evaluated the impact of a theoretically motivated intervention that was designed to promote sensemaking of system output. Participants provided with a "gist" version of system output, expressing the bottom-line meaning of that output, were better able to identify URLs that might have been part of a coordinated misinformation campaign, compared to users given the same information presented as verbatim quantitative metrics. This work highlights the importance of enabling users to grasp the essential, gist meaning of the information they receive from automated systems, which benefits users regardless of individual differences. [ABSTRACT FROM AUTHOR]

A patient with gastrointestinal stroma tumor (GIST) and KIT p.V559D and BRAF p.G469A alterations was referred to our institutional molecular tumor board (MTB) to discuss therapeutic implications. The patient had been diagnosed with B-cell chronic lymphocytic leukemia (CLL) years prior to the MTB presentation. GIST had been diagnosed 1 month earlier. After structured clinical annotation of the molecular alterations and interdisciplinary discussion, we considered BRAF/KIT co-mutation unlikely in a treatment-naïve GIST. Discordant variant allele frequencies furthermore suggested a second malignancy. NGS of a CLL sample revealed the identical class 2 BRAF alteration, thus supporting admixture of CLL cells in the paragastric mass, leading to the detection of 2 alterations. Following the MTB recommendation, the patient received imatinib and had a radiographic response. Structured annotation and interdisciplinary discussion in specialized tumor boards facilitate the clinical management of complex molecular findings. Coexisting malignancies and clonal hematopoiesis warrant consideration in case of complex and uncommon molecular findings. [ABSTRACT FROM AUTHOR]

Gastrointestinal stromal tumors (GISTs) are the most frequent mesenchymal tumors of the gastrointestinal tract, usually arising in the stomach or in the small bowel. Most GISTs are diagnosed early due to the presence of symptoms (e.g., abdominal discomfort/pain, anemia, etc.); at times, diagnosis could be incidental (e.g., ultrasound or endoscopic examinations performed for other reasons, surgical intervention for a different disease, etc.). Diagnosis occurs when the tumor is already metastatic in 10-20% of cases. The most common metastatic sites are liver, peritoneum, and loco-regional lymph nodes. Here, we present the case of a male patient with an atypical presentation of disease: as a matter of fact, during his oncological history, he developed metastases in unlikely sites, such as penis, scrotum, myocardium, and soft tissues. [ABSTRACT FROM AUTHOR]

Simple Summary: A gastric gastrointestinal stromal tumor (GIST) is a rare type of tumor that originates in the stomach's connective tissue. GISTs develop from specialized cells called interstitial cells of Cajal, which regulate digestive tract movements. These tumors can vary in size and may not always cause symptoms. Common symptoms include abdominal pain, gastrointestinal bleeding, or a feeling of fullness. Gastric GISTs are typically diagnosed through imaging tests like CT scans and are confirmed with a biopsy. Treatment options for GISTs depend on factors such as tumor size, location, and aggressiveness. Surgical removal is often the primary treatment, with medication (tyrosine kinase inhibitors) used before or after surgery to shrink the tumor or prevent recurrence. Regular monitoring is crucial because GISTs can grow slowly or aggressively. Overall, a multidisciplinary team is essential for managing localized gastric GISTs effectively. Gastric gastrointestinal stromal tumors (GIST) are rare, neuroectodermal tumors primarily residing in the stomach with characteristic genetic mutations. They are often identified using ultrasound and cross-sectional imaging, or they are noted during endoscopy. Localized gastric GISTs are commonly treated with surgical resection, with the possible use of neoadjuvant or adjuvant medical therapies as they are considered to have malignant potential. The use of tyrosine kinase inhibitors (TKI) such as imatinib has been shown to successfully reduce pre-operative tumor burden, recurrence, and disease progression. Surgical resection considerations vary depending on tumor size, location, and malignant potential. Neoadjuvant and adjuvant TKI therapy dosing varies in response to the type of GIST mutation present and greatly influences prognosis. Novel cooperative minimally invasive surgical techniques and targeted therapies are currently in development to address challenges in GIST treatment for tumors in challenging locations or with significant potential for progression. The management of localized gastric GISTs continues to rapidly evolve; each case should be managed individually, where care is taken in considering details, including tumor location, tumor size, and the molecular genetic profile, before embarking on a course of treatment. [ABSTRACT FROM AUTHOR]

Simple Summary: Soft tissue sarcomas (STSs) are rare cancers, making up less than 1% of all adult malignancies. Traditionally, the primary treatment for STS has been surgical resection. However, non-surgical approaches are becoming increasingly important in specific clinical situations. In this review, we explore the role of non-surgical treatments in managing STS, including their use as a bridge to surgery, as alternatives to surgery, for improving surgical outcomes, and for managing cases where surgery is not an option. Our findings highlight the effectiveness of these strategies in enhancing patient care and outcomes, providing a more personalized and less invasive approach to STS treatment. This review aims to advance the understanding and application of non-surgical methods in the treatment of soft tissue sarcomas. Mesenchymal tumors originate from mesenchymal cells and can be either benign or malignant, such as bone, soft tissue, and visceral sarcomas. Surgery is a cornerstone treatment in the management of mesenchymal tumors, often requiring complex procedures performed in high-volume referral centers. However, the COVID-19 pandemic has highlighted this need for alternative non-surgical approaches due to limited access to surgical resources. This review explores the role of non-surgical treatments in different clinical scenarios: for improving surgical outcomes, as a bridge to surgery, as better alternatives to surgery, and for non-curative treatment when surgery is not feasible. We discuss the effectiveness of active surveillance, cryoablation, high-intensity focused ultrasound, and other ablative techniques in managing these tumors. Additionally, we examine the use of tyrosine kinase inhibitors in gastrointestinal stromal tumors and hypofractionated radiotherapy in soft tissue sarcomas. The Sarculator tool is highlighted for its role in stratifying high-risk sarcoma patients and personalizing treatment plans. While surgery remains the mainstay of treatment, integrating advanced non-surgical strategies can enhance therapeutic possibilities and patient care, especially in specific clinical settings with limitations. A multidisciplinary approach in referral centers is vital to determine the optimal treatment course for each patient. [ABSTRACT FROM AUTHOR]

Xiaodong Wang, Chunhui Shou, Kankai Zhu, Weili Yang, Jiren Yu Gastroenterology Department, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of ChinaCorrespondence: Jiren Yu, Gastroenterology Department, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China, Email yujr0909@zju.edu.cnAbstract: A new lump in patients with a history of gastrointestinal stromal tumor (GIST) may indicate resistance to medication and recurrence. It is important to monitor for recurrence or metastasis after surgery for GIST, especially in cases of high-risk GIST, as it determines the subsequent treatment. However, it is difficult to differentiate between GIST and DF by imaging. Tissue biopsy and final diagnosis through pathological analysis are usually required. Here, we report 2 cases of primary diagnosis with high-risk GIST and suspected tumor recurrence during Imatinib treatment. The mass was not located where the previous GIST lesion had been. After the complete excision of the mass through laparoscopic surgery, the pathological findings revealed that it was not a recurrence of GIST, but a desmoid-type fibromatosis.Keywords: lumpectomy, pathological diagnosis, GIST, imatinib

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract, frequently characterized by mutations in the KIT or PDGFRA genes. This case report details the complex clinical course of a 71-year-old female with a history of HIV and metastatic GIST presenting with acute abdominal symptoms indicative of perforated viscus. Initial imaging revealed a massive pneumoperitoneum and a large abdominal mass, necessitating immediate surgical intervention. The patient underwent multiple surgeries, including bowel resections and colostomy creation, to address the extensive tumor burden and complications. Postoperatively, she required intensive care management, including mechanical ventilation, vasopressor support, and hemodialysis for acute kidney injury. Pathological examination confirmed metastatic GIST with extensive mesenteric and omental involvement. Immunohistochemical staining was positive for CD117 (c-KIT) and DOG-1. Despite aggressive surgical and supportive measures, the patient's condition highlighted the significant challenges in managing advanced GIST with perforation. This case highlights the importance of a multidisciplinary approach, integrating surgical, medical, and intensive care to optimize outcomes. The prognosis of GIST varies widely, with localized tumors having favorable outcomes following resection, while metastatic cases often face a poorer prognosis despite advances in targeted therapies. This case exemplifies the critical need for personalized treatment plans and ongoing research to improve the management and prognosis of GIST patients.

Introduction. Interstitial Cells of Cajal (ICCs) play a critical role in the regulation of gastrointestinal motility and have been implicated in various functional gastrointestinal disorders. Recent research indicates a possible association between ICCs and the tumor risk of Gastrointestinal Stromal Tumors (GISTs). This research aims to examine the clinical, histopathological, and biomolecular characteristics of ICCs and their relevance in assessing GIST risk. Materials and Methods. This study examined fourteen GIST patients who underwent surgical intervention at the Surgery Department of Carol Davila Nephrology Hospital in Bucharest. Parameters including age, gender, tumor location/ dimensions were scrutinized. Immunohistochemistry employing markers CD117, DOG-1, and CD34 was employed to ascertain the presence of ICCs and GISTs. Results. The GIST risk stratification revealed distribution with 35.71% very low-risk, 21.42% low-risk, 14.28% intermediate-risk, and 28.57% high-risk categories. Predominantly, 57.14% of cases fell within the very low-risk and low-risk categories. Positive immunoreactivity for CD117 and DOG-1 was noted in 92.86% of patients, while CD34 exhibited positivity in 85.71% of cases. Gastric GISTs manifested heightened marker expression. Notably, immunohistochemistry unveiled robust positivity for CD117, DOG-1, and CD34, illustrating a positive correlation between elevated ICC levels and high-risk GISTs. Conclusions. The findings propose an association between ICC levels and high-risk GISTs, accentuating the diagnostic utility of CD117, DOG-1, and CD34 markers in GIST assessment.

Abstract As they become more common, automated systems are also becoming increasingly opaque, challenging their users’ abilities to explain and interpret their outputs. In this study, we test the predictions of fuzzy-trace theory—a leading theory of how people interpret quantitative information—on user decision making after interacting with an online decision aid. We recruited a sample of 205 online crowdworkers and asked them to use a system that was designed to detect URLs that were part of coordinated misinformation campaigns. We examined how user endorsements of system interpretability covaried with performance on this coordinated misinformation detection task and found that subjects who endorsed system interpretability displayed enhanced discernment. This interpretability was, in turn, associated with both objective mathematical ability and mathematical self-confidence. Beyond these individual differences, we evaluated the impact of a theoretically motivated intervention that was designed to promote sensemaking of system output. Participants provided with a “gist” version of system output, expressing the bottom-line meaning of that output, were better able to identify URLs that might have been part of a coordinated misinformation campaign, compared to users given the same information presented as verbatim quantitative metrics. This work highlights the importance of enabling users to grasp the essential, gist meaning of the information they receive from automated systems, which benefits users regardless of individual differences.

Objective: Gastrointestinal stromal tumors (GISTs) are difficult to identify the risk level accurately without surgical pathological confirmation. The purpose of our study was to propose a noninvasive prediction method for predicting the malignant potential of GISTs preoperatively by using contrast-enhanced ultrasound (CEUS) with gastric distention. Methods: We reviewed 47 GISTs who underwent CEUS from April 2017 to August 2023 retrospectively, all the lesions were certificated by pathology after surgery. The age of the patient, size of the lesion, shape, necrosis, calcification in the lesion, perfusion parameters including arrival time (AT), peak intensity (PI), time to peak (TTP), and area under the curve (AUC) of the lesion and surrounding normal tissue were analyzed. Logistic regression analyses were performed. Of the 47 GISTs, 26 were high-risk and 21 low-risk tumors respectively. Results: Compared with low-risk GISTs, high-risk GIST had faster AT (7.7s vs. 11.5s, p < 0.05), higher PI (15.2dB vs. 12.5dB, p < 0.05), and larger size (4.4 cm vs. 2.2 cm, p < 0.001). In multivariate logistic regression, AT, PI, and size were significant features. The corresponding regression equation In (p/(1-p)=-5.9 + 4.5 size + 4.6 PI + 4.0 AT). Conclusion: The size, AT, and PI of the GISTs on CEUS can be used as parameters for a noninvasive risk level prediction model of GISTs. This model may help identify the different risk levels of GISTs before surgery. [ABSTRACT FROM AUTHOR]

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasm of the gastrointestinal (GI) tract (1% to 2% of GI malignant tumors). They are most commonly located in the stomach (50 to 60%) and rarely in the small intestine (20-25% of all cases). The hallmark of most GISTs is their positivity for KIT (CD117) and DOG-1. Intussusception occurs rarely in adults with an incidence of approximately 2-3 per 1L per year. It represents 5% of all intussusceptions and is the cause of 1% of all intestinal obstructions. Ileocolic intussusception in adults is a unique variant in which most cases have a malignant lead point. In our case, we report an elderly patient presenting with intestinal obstruction, and imaging showed ileocecal intussusception with a solid nodular growth arising from the ileum. On exploration, the tumor was intraluminal arising from the ileum with ileocecal intussusception. Adhering to oncological principles, a right hemicolectomy was performed. The final pathologic diagnosis indicated the GIST of the ileum. Immunohistochemistry (IHC) showed CD117 negative and DOG-1 positive. Bowel obstruction due to intussusception in adults is rare. GIST in the ileum causing intussusception is unusual with a poorer prognosis than other GISTs. Intussusception in adults obstructing with small intestinal GIST which is CD117 negative makes it interesting and even rare. The diagnosis of intussusception and GISTs causing obstruction in adults is delicate, and timely surgical treatment can be vital. Given a high risk of malignancy, primary surgical resection using oncologic principles presents the best option in this scenario.

A 44-year-old woman was referred to our hospital for the examination and treatment of a presumed gallbladder tumor. Both ultrasound and computed tomography showed an intracystic tumor but failed to point out the discontinuity between the cystic lesion and the gallbladder. Magnetic resonance imaging, however, could clearly depict the presumed intracystic tumor and the discontinuity between the gallbladder and the target lesion. Both contents of the gallbladder and the cystic lesion showed hypo and hyper intense patterns, though both with slightly different intensities, on T1- and T2-weighted images, respectively. Under the preoperative diagnosis of early gallbladder cancer despite these image findings, laparoscopic cholecystectomy was attempted to the patient. Laparoscopic observation, however, revealed that the target lesion was not continuous with the gallbladder and was located in the round ligament of the liver. Intraoperative findings led us to do cholecystectomy and resection of the adjacent cystic tumor. The intracystic tumor was 3 cm in size and had minute solid component inside the cyst wall. Pathological study of the presumed gallbladder cancer showed epithelioid cells and spindle cells growing in sheet like and storiform fashions, respectively. Cystic walls mainly consisted of hypo cellular fibrous components. Immunohistochemical staining of the tumor was positive for CD117 and negative both for desmin and S100, leading to the diagnosis of gastrointestinal stromal tumor. MIB-1 labelling index of the gastrointestinal stromal tumor was 8%. The patient recovered uneventfully and has been well without any recurrences for 3 months.

Gastric gastrointestinal stromal tumors (GIST) are rare, neuroectodermal tumors primarily residing in the stomach with characteristic genetic mutations. They are often identified using ultrasound and cross-sectional imaging, or they are noted during endoscopy. Localized gastric GISTs are commonly treated with surgical resection, with the possible use of neoadjuvant or adjuvant medical therapies as they are considered to have malignant potential. The use of tyrosine kinase inhibitors (TKI) such as imatinib has been shown to successfully reduce pre-operative tumor burden, recurrence, and disease progression. Surgical resection considerations vary depending on tumor size, location, and malignant potential. Neoadjuvant and adjuvant TKI therapy dosing varies in response to the type of GIST mutation present and greatly influences prognosis. Novel cooperative minimally invasive surgical techniques and targeted therapies are currently in development to address challenges in GIST treatment for tumors in challenging locations or with significant potential for progression. The management of localized gastric GISTs continues to rapidly evolve; each case should be managed individually, where care is taken in considering details, including tumor location, tumor size, and the molecular genetic profile, before embarking on a course of treatment.

The gene protection of telomere 1 (POT1) is involved in telomere maintenance and stability and plays a crucial role in the preservation of genomic stability. POT1 is considered a high-penetrance melanoma susceptibility gene; however, the number of cancer types associated with the pathogenic germline variants of POT1 is gradually increasing, including chronic lymphocytic leukemia (CLL), angiosarcomas, and gliomas, even though many associations are still elusive. Here, we reported a case of a 60-year-old man who showed early-onset multiple neoplasms, including multiple melanomas, gastrointestinal stromal tumor (GIST), and lung adenocarcinoma. Next-generation sequencing (NGS) analyses revealed a germline heterozygous pathogenic variant in the POT1 gene. Notably, GIST and lung adenocarcinoma were not previously reported in association with the POT1 germline variant. Lung cancer susceptibility syndrome is very rare and the actual knowledge is limited to a few genes althoughmajor genetic factors are unidentified. Recently, genome-wide association studies (GWAS) have pointed out an association between POT1 variants and lung cancer. This case report highlights the clinical relevance of POT1 alterations, particularly their potential involvement in lung cancer. It also suggests that POT1 testing may be warranted in patients with familial cancer syndrome, particularly those with a history of melanoma and other solid tumors. [ABSTRACT FROM AUTHOR]

Desmoid tumors (DTs) are rare and locally aggressive with a high rate of local recurrence even with optimal surgical resection. Systemic treatments are often utilized for desmoid cases with high risk of surgical morbidity or for local and symptomatic control of recurrent disease. However, the systemic treatment options for DTs are limited with limited responses. Avapritinib is a tyrosine kinase inhibitor (TKI) approved in 2020 for adults with unresectable or metastatic gastrointestinal (GI) stromal tumors (GISTs) harboring a platelet‐derived growth factor receptor alpha (PDGFRA) Exon 18 mutation, including D842V mutations. In this case report, we describe a 55‐year‐old man with a history of D842V‐mutant gastric GIST who presented several years after complete resection of the GIST with an enlarging soft tissue mass in the small intestine. After a nondiagnostic biopsy, the patient was started on avapritinib due to concerns for recurrent D842V‐mutant GIST. The tumor had a partial response to treatment by RECIST 1.1 criteria, and the patient underwent surgical resection. The final pathology report revealed a sporadic DT. To our knowledge, this is the first known description of the activity of avapritinib in the treatment of a sporadic mesenteric DT, which is relevant given the limited treatment options for patients with this diagnosis. This clinical finding may be worth exploring in a dedicated clinical trial. [ABSTRACT FROM AUTHOR]

In today's digital world, Android phones play a vital part in a variety of facets of both professionals and individuals' personal and professional lives. Android phones are great for getting things done faster and more organized. The proportionate increase in the number of malicious applications has also been seen to be expanding. Since the play store offers millions of apps, detection of malware apps is challenging task. In this paper, a methodology is introduced for detecting malware in Android applications through the utilization of global image shape transform (GIST) features extracted from grayscale images of the applications. The dataset comprises samples of both malware and benign apps collected from the virus share website. After converting the apps into grayscale images, GIST features are extracted to capture their global spatial layout. Various machine learning (ML) algorithms, such as logistic regression (LR), k-nearest neighbour (KNN), AdaBoost, decision tree (DT), Naïve Bayes (NB), random forest (RF), support vector machine (SVM), extra tree classifier (ETC), and gradient boosting (GB), are employed to classify the applications according to their GIST features. Furthermore, a feed forward neural network (FFNN) is utilized as a deep learning (DL) technique to further improve the accuracy of classification. The performance of each algorithm is evaluated using metrics such as accuracy, precision and recall. The results demonstrated that the FFNN achieves superior accuracy compared to traditional ML classifiers, indicating its effectiveness in detecting malware in Android apps. [ABSTRACT FROM AUTHOR]

Gastrointestinal stromal tumours (GISTs) are mesenchymal tumours that originate from the interstitial cells of Cajal. GISTs are mainly driven by gain-of-function mutations in receptor tyrosine kinase or platelet-derived growth factor receptor alpha. Surgical resection is the only curative treatment for localized tumours and all currently approved medical GIST treatments are based on orally available tyrosine kinase inhibitors. Recent discoveries in the molecular and clinical features of GISTs have greatly impacted GIST management. Due to the provincially rather than nationally administered Canadian healthcare system, there have been inconsistencies in the treatment of GISTs across the country. Therefore, guidance on the latest knowledge, clinical management and treatment of GIST is needed to standardize the approach to GIST management nationwide. To establish pan-Canadian guidance, provide up-to-date data and harmonize the clinical practice of GIST management in high- and low-throughput centres across Canada; a panel of 20 physicians with extensive clinical experience in GIST management reviewed relevant literature. This included radiologists, pathologists, interventional radiologists, surgeons and medical oncologists across Canada. The structured literature focused on seven key domains: molecular profiling, radiological techniques/reporting, targeted localized therapy, intricacies of systemic treatments, emerging tests, multidisciplinary care and patient advocacy. This literature review, along with clinical expertise and opinion, was used to develop this concise and clinically relevant consensus paper to harmonize the knowledge and clinical practice on GIST management across Canada. The content presented here will help guide healthcare providers, especially in Canada, in terms of approaching and managing GIST. [ABSTRACT FROM AUTHOR]

Background: Gastric gastrointestinal stromal tumors (GISTs) represent a subset of gastrointestinal tumors predominantly found in the stomach. Despite their rarity, these tumors carry significant implications for patient health and management. GISTs are potentially malignant tumors with unpredictable progression. They originate from the interstitial cells of Cajal, which are positioned between the intramural neurons and the smooth muscle cells of the digestive tract. These tumors are characterized primarily by mutations in the c-Kit gene, as well as other mutations such as those in the platelet-derived growth factor receptor alpha (PDGFRA) gene. Methods: Our comprehensive search across five databases initially yielded 2976 articles. After eliminating 197 duplicates, we screened the titles and abstracts of 2779 articles, excluding 2692 for not meeting the inclusion criteria. During the full-text screening, 16 more articles were excluded. Ultimately, 71 papers met the inclusion criteria and were included in our analysis. Results: Due to differences in study designs, inclusion criteria for patients, and reported outcomes, a meta-analysis was not conducted. The accurate diagnosis of GIST is established through histopathological examination and immunohistochemistry. Histopathologically, GISTs are classified into three main types: spindle cell, epithelioid, and mixed. The therapeutic management of GIST involves surgery, endoscopic treatment, and chemotherapy. Conclusions: The prognosis for GIST patients depends on various factors, including risk category, disease stage, applied treatments, and recurrence post-treatment. A significant recent advancement comes from artificial intelligence, which can be increasingly involved in both the diagnosis and treatment of this tumor. [ABSTRACT FROM AUTHOR]

Introduction. Interstitial Cells of Cajal (ICCs) play a critical role in the regulation of gastrointestinal motility and have been implicated in various functional gastrointestinal disorders. Recent research indicates a possible association between ICCs and the tumor risk of Gastrointestinal Stromal Tumors (GISTs). This research aims to examine the clinical, histopathological, and biomolecular characteristics of ICCs and their relevance in assessing GIST risk. Materials and Methods. This study examined fourteen GIST patients who underwent surgical intervention at the Surgery Department of Carol Davila Nephrology Hospital in Bucharest. Parameters including age, gender, tumor location/ dimensions were scrutinized. Immunohistochemistry employing markers CD117, DOG-1, and CD34 was employed to ascertain the presence of ICCs and GISTs. Results. The GIST risk stratification revealed distribution with 35.71% very low-risk, 21.42% low-risk, 14.28% intermediate-risk, and 28.57% high-risk categories. Predominantly, 57.14% of cases fell within the very low-risk and low-risk categories. Positive immunoreactivity for CD117 and DOG-1 was noted in 92.86% of patients, while CD34 exhibited positivity in 85.71% of cases. Gastric GISTs manifested heightened marker expression. Notably, immunohistochemistry unveiled robust positivity for CD117, DOG-1, and CD34, illustrating a positive correlation between elevated ICC levels and high-risk GISTs. Conclusions. The findings propose an association between ICC levels and high-risk GISTs, accentuating the diagnostic utility of CD117, DOG-1, and CD34 markers in GIST assessment. [ABSTRACT FROM AUTHOR]

Simple Summary: This systematic review of the medical literature concerning the overlap between adnexal and gastrointestinal stromal tumors (GISTs) was designed to provide the overall number of previous observed cases and to calculate outcome prognosis, specifically the disease-free survival and overall survival. The impact of immunostaining and new chemotherapeutic medication such as Imatinib are also discussed. Background: Gastrointestinal stromal tumors (GISTs) are a rare neoplasm, sometimes mimicking primary ovarian tumors (OTs) and/or metastasizing to the ovaries (M-OT). We performed a systematic literature review (SLR) of OTs and M-OTs, investigating differences in recurrence-free and overall survival. Methods: Our SLR was performed according to PRISMA guidelines, searching in Pubmed, Scopus, and Web of Science databases from inception until 21 April 2024. Results: Overall, 59 OTs (Group 1) and 21 M-OTs (Group 2) were retrieved. The absence of residual disease after surgery was achieved significantly in a higher percentage of patients with Group 1 GISTs (91.5%) compared with Group 2 GISTs (57.1%). Chemotherapy was more frequently administered to Group 2 patients (33% vs. 0%). Recurrence and deaths for disease were significantly more frequent in Group 2 than Group 1 cases (54.5% vs. 6.8%, and 37.5% vs. 9.8%, respectively). Conclusions: GISTs can rarely mimic primary ovarian cancers or even more rarely metastasize to the ovaries. Group 1 GISTs occurred in younger women, were not associated with elevated tumor markers, and had a better prognosis. In contrast, Group 2 GISTs occurred in older women, may exhibit elevated tumor markers, and presented a worse prognosis. However, no significant statistical difference for survival between the two studied groups was detected. Computed tomography scans can define the size of GISTs, which correlate to stage and prognostic risk classes. The gold standard treatment is complete surgical resection, which was achieved in almost all cases of Group 1 GISTs and in half of Group 2. Histopathology and immunohistochemistry are essential for the final diagnosis and guide chemotherapy treatment. [ABSTRACT FROM AUTHOR]

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasm of the gastrointestinal (GI) tract (1% to 2% of GI malignant tumors). They are most commonly located in the stomach (50 to 60%) and rarely in the small intestine (20-25% of all cases). The hallmark of most GISTs is their positivity for KIT (CD117) and DOG-1. Intussusception occurs rarely in adults with an incidence of approximately 2-3 per 1L per year. It represents 5% of all intussusceptions and is the cause of 1% of all intestinal obstructions. Ileocolic intussusception in adults is a unique variant in which most cases have a malignant lead point. In our case, we report an elderly patient presenting with intestinal obstruction, and imaging showed ileocecal intussusception with a solid nodular growth arising from the ileum. On exploration, the tumor was intraluminal arising from the ileum with ileocecal intussusception. Adhering to oncological principles, a right hemicolectomy was performed. The final pathologic diagnosis indicated the GIST of the ileum. Immunohistochemistry (IHC) showed CD117 negative and DOG-1 positive. Bowel obstruction due to intussusception in adults is rare. GIST in the ileum causing intussusception is unusual with a poorer prognosis than other GISTs. Intussusception in adults obstructing with small intestinal GIST which is CD117 negative makes it interesting and even rare. The diagnosis of intussusception and GISTs causing obstruction in adults is delicate, and timely surgical treatment can be vital. Given a high risk of malignancy, primary surgical resection using oncologic principles presents the best option in this scenario. [ABSTRACT FROM AUTHOR]

Background: The role of robotic surgery for gastrointestinal stromal tumor (GIST) resection remains unclear. This systematic review and meta-analysis aimed to investigate the outcomes of robotic versus laparoscopic surgery in patients requiring surgery for gastric GISTs. Methods: MEDLINE, EMBASE, and the Cochrane databases were searched from inception to September 4, 2023. Two independent reviewers conducted a systematic review of the literature to select all types of analytic studies comparing robotic versus laparoscopic surgery for GISTs and reporting intraoperative, postoperative, and/or pathological outcomes. Results: Overall, 4 retrospective studies were selected, including a total of 264 patients, specifically 111 (42%) in the robotic and 153 (58%) in the laparoscopic group. Robotic surgery was associated with longer operating time (+42.46 min; 95% confidence interval [CI]: 9.34, 75.58; P=0.01; I2: 85%) and reduced use of mechanical staplers (odds ratio [OR]: 0.05; 95%CI: 0.02, 0.11; P<0.00001; I2: 92%;) compared with laparoscopy. Although nonsignificant, conversion to open surgery was less frequently reported for robotic surgery (2.7%) than laparoscopy (5.2%) (OR: 0.59; 95%CI: 0.17, 2.03; P=0.4; I2: 0%). No difference was found for postoperative and oncological outcomes. Conclusions: Robotic surgery for gastric GISTs provides similar intraoperative, postoperative, and pathological outcomes to laparoscopy, despite longer operative time. [ABSTRACT FROM AUTHOR]

Background: Esophageal gastrointestinal stromal tumors (E-GISTs) are highly uncommon and have not been thoroughly examined. Objectives: The objective of this multi-center study was to assess the viability of endoscopic resection (ER) in the treatment of E-GISTs and to explore its clinical implications. Design: This was a multi-center retrospective study. Consecutive patients referred to the four participating centers. Methods: E-GISTs among the consecutive subepithelial tumors (SETs) treated by ER methods were enrolled from April 2019 to August 2022. Clinicopathological, endoscopic, and follow-up data were collected and analyzed. Results: A total of 23 patients with E-GISTs were included for analysis, accounting for 1.9% of all the esophageal SETs (1243 patients). The average size of the tumor lesions was 2.3 cm (range 1.0–4.0 cm). We observed that tumors larger than 2.0 cm were more likely to grow deeper, with a statistically significant difference (p < 0.001). End bloc resection was achieved in all 23 patients. The mean operation time was 53.6 min (range 25–111 min). One patient experienced significant intraoperative bleeding, which was promptly managed endoscopically without necessitating surgery. The average hospital stay was 4.5 days (range 3–8 days). The overall median follow-up period was 31 months (range 13–47 months). No tumor recurrence, residual tumor, distal metastasis, or death was observed during the follow-up period. Conclusion: Based on our limited data, our study indicates that ER may be a feasible and effective option for treating esophageal GISTs measuring 4 cm or less. We suggest submucosal tunnel endoscopic resection as the preferred approach, as all E-GISTs in our study were situated in the muscularis propria layer. Additionally, tumors larger than 2 cm were more prone to deeper growth or extraluminal extension. [ABSTRACT FROM AUTHOR]

How rapidly can we encode the specifics versus the gist of episodic memories? Competing theories have opposing answers, but empirical tests are based primarily on tasks of item memory. Few studies have addressed this question with tasks measuring the binding of event components (e.g., a person and a location), which forms the core of episodic memory. None of these prior studies included older adults, whose episodic memories are less specific in nature. We addressed this critical gap by presenting face–scene pairs (e.g., an old man with a park) at various encoding presentation rates to 80 young (M = 21.83 years) and 86 older (M = 68.62 years) adults. Participants completed associative recognition tests featuring old/intact (e.g., the old man with the same park), similar (e.g., the old man with a different park), and unrelated (e.g., the old man with a kitchen) pairs. Multinomial-processing-tree model analyses revealed that young and older adults encoded each pair's gist representation more rapidly than its specific representation, supporting fuzzy-trace theory. No age-related differences in gist representations were obtained at any presentation rate, but older adults required more time to encode specific representations commensurate with those of younger adults. However, older adults' abilities to retrieve these representations were cue-dependent, as they were more susceptible than younger adults to experiencing vivid false memories of similar lures. These phantom recollections were remediated with further increases in encoding time. Thus, slower speed of encoding partially underlies age-related declines in episodic memory specificity, but retrieval mechanisms also play a role. Public Significance Statement: The present study provides novel insights into the speed with which specific (detailed) and gist (meaning-based) representations of episodic memories can be encoded among young and older adults. These insights constrain leading theories of information processing and have implications for understanding why older adults are less likely to remember the specific details of past episodes. Providing older adults with more time to learn new information may be one solution for fostering stronger and longer-lasting memories that are rich in specific details. [ABSTRACT FROM AUTHOR]

Purpose: GISTs arising from organs outside GI tract are defined as extragastrointestinal GISTs (EGIST). The majority of EGISTs arise from small intestinal mesentry, mesocolon, omentum, retroperitoneum, abdominal wall, liver and pancreas with pancreas comprising less than 5% of it. Due to limited data, it is unknown if the results of GIST can be generalised for EGISTs. We thereby present the largest single-centre case series of primary pancreatic GIST so far with review of existing literature. Methods: A total of 9 patients of primary pancreatic GIST were treated at our institute from September 2016 to February 2023. After literature search for all studies published before February 2023, 51 articles including 57 patients were identified. Their clinicopathological data and survival analysis were assessed. Results: The median age of patients treated at our centre was 53 years with a female predominance. The most common epicentre was pancreatic head with abdominal pain as the most common presenting symptom. All 57 patients documented in literature belonged to a similar age group with similar gender predilection. The factors impacting DFS were histologic type, mitotic index, NIH risk category and adjuvant therapy. The median DFS was 74 months with a 5-year DFS being 71.9%, while the 5-year OS was 90.4%. Conclusion: Pancreatic GIST is a rare entity. Due to limited evidence and evolving literature, results cannot be generalised to a larger population. Larger case series with longer follow-up data are required to further understand the disease biology and long-term outcomes of pancreatic GIST. [ABSTRACT FROM AUTHOR]

The new viral strains of severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) are continuously rising, becoming more virulent, and transmissible. Therefore, the development of new antiviral drugs is essential. Due to its significant role in the viral life cycle of SARS‐CoV‐2, the main protease (Mpro) enzyme is a leading target for antiviral drug design. The Mpro monomer consists of domain DI, DII, and DI‐DII interface. Twenty‐one conserved water molecules (W4–W24) are occupied at these domains according to multiple crystal structure analyses. The crystal and MD structures reveal the presence of eight conserved water sites in domain DI, DII and remaining in the DI‐DII interface. Grid‐based inhomogeneous fluid solvation theory (GIST) was employed on MD structures of Mpro native to predict structural and thermodynamic properties of each conserved water site for focusing to identify the specific conserved water molecules that can easily be displaced by proposed ligands. Finally, MD water W13 is emerged as a promising candidate for water mimic drug design due to its low mean interaction energy, loose binding character with the protein, and its involvement in a water‐mediated H‐bond with catalytic His41 via the interaction Thr25(OG)‐‐‐W13‐‐‐W‐‐‐His41(NE2). In this context, water occupancy, relative interaction energy, entropy, and topologies of W13 are thermodynamically acceptable for the water displacement method. Therefore, the strategic use of W13's geometrical position in the DI domain may be implemented for drug discovery against COVID disease by designing new ligands with appropriately oriented chemical groups to mimic its structural, electronic, and thermodynamic properties. [ABSTRACT FROM AUTHOR]

As bariatric surgeries (BS) increase, more incidental findings are liable to be discovered. Incidental gastric gastrointestinal stromal tumors (GISTs) during BS can be found in around 0.7% of the cases. In this article, we have performed a systematic review of the literature and added our data to those of the review to review a conceptual treatment strategy to both improve patient outcomes and decrease the risk of overall cancer. With the rise of new bariatric techniques, we have proposed a new classification to BS to enhance our description of the treatment strategy. [ABSTRACT FROM AUTHOR]

Gastrointestinal stromal tumors (GISTs) are neoplasms of neural cells in the gastrointestinal tract; they typically develop in older adults, with less than 10% of cases presenting among patients under the age of 40. This report describes the clinical course and management of a 28-year-old woman with a history of irritable bowel syndrome (IBS) who presented with acute upper abdominal pain. Surgical pathology confirmed a diagnosis of metastatic GIST. The patient underwent imatinib therapy and subsequent surgical tumor debulking. Postoperatively, she presented with acute appendicitis, for which she eventually required appendectomy, and she became pregnant approximately 1 year after the initial diagnosis. This case highlights several treatment challenges that may be encountered in young patients presenting with GIST.

Background: Atrial Fibrillation (AF) is the most common sustained arrhythmia in the general population. Patients with atrial fibrillations commonly go to Emergency Departments (ED) with complications or aggravation of symptoms. They eventually receive rate or rhythm control intervention for rapid ventricular response and other interventions to prevent further worsening. Case report: -We present a case of atrial fibrillation with rapid ventricular rate later found to have an undiagnosed gastrointestinal stromal tumor (GIST) along the lesser curvature, resulting in abrupt exsanguination. Initial symptoms were non-specific until manifesting acutely as new-onset atrial fibrillation with rapid ventricular response. Despite recovering sinus rhythm, unremitting evidence of concealed hemorrhagic shock directed attention toward occult bleeding. Emergent operative treatment controlled bleeding and prevented fatality. Why should an emergency physician be aware of this?: An emergency physician should know this because atrial fibrillation does not always require acute rate/rhythm control. Newly diagnosed atrial fibrillation with rapid ventricular response in critically ill patients could be compensatory. Investigating underlying atrial fibrillation triggers can unveil precipitating factors. Occult shock demands urgent evaluation, as medications might precipitate overt shock and rapid deterioration. Even in cardiac patients, new-onset atrial fibrillation could be secondary.

Background: Gastrointestinal stromal tumour (GIST) is a rare entity. The diagnosis, treatment and follow-up pose a challenge in our environment. We describe the presentation, diagnosis, treatment, and long-term follow-up of a patient with a localized, large exogastric GIST. Method: The case notes of a 51-year-old woman who presented with a one-year history of upper abdominal swelling with no associated symptom was reviewed. Result: On examination, an oval intraperitoneal mass at the epigastrium measuring 16 x 14cm which was freely mobile, smooth, firm, non-tender with dull percussion notes was found. She subsequently had resection of a large exogastric mass with a histologic diagnosis of GIST. Following tumour resection with a wide margin of gastric wall, she has done well so far for ten (10) years. Conclusion: Wide margin gastric resection may suffice in the treatment of a large localized gastric GIST when it is exogastric.

Gastrointestinal stromal tumors (GISTs) are the most frequent mesenchymal tumors of the gastrointestinal tract, usually arising in the stomach or in the small bowel. Most GISTs are diagnosed early due to the presence of symptoms (e.g., abdominal discomfort/pain, anemia, etc.); at times, diagnosis could be incidental (e.g., ultrasound or endoscopic examinations performed for other reasons, surgical intervention for a different disease, etc.). Diagnosis occurs when the tumor is already metastatic in 10-20% of cases. The most common metastatic sites are liver, peritoneum, and loco-regional lymph nodes. Here, we present the case of a male patient with an atypical presentation of disease: as a matter of fact, during his oncological history, he developed metastases in unlikely sites, such as penis, scrotum, myocardium, and soft tissues.

. BACKGROUND: A limited number of studies have been conducted in Russian and world literature on the differential diagnosis of gastrointestinal stromal tumors with other intra-abdominal tumors. The treatment of gastric non-epithelial tumors is dependent on the histologic type. The standard treatment for localized forms of gastrointestinal stromal tumors is surgery. For subepithelial masses up to 2 cm in size, in the absence of endoscopic signs of high risk, a strategy of active surveillance with mandatory endoscopic ultrasound examination and compliance with short-term intervals may be considered. Leiomyomas, benign masses, do not typically necessitate surgical intervention in the absence of clinical symptoms. Therefore, preoperative determination of the tumor type may help to avoid unwarranted surgical intervention. However, the ability of computed tomography to differentiate these tumor types is limited due to the similar radiological picture. Therefore, new scientific and clinical methods are needed. One of the possible techniques is texture analysis (radiomics). AIM: The study aims to investigate the potential of texture analysis (radiomics) in the diagnosis and differential diagnosis of gastrointestinal stromal tumors and gastric leiomyomas by analyzing the available world scientific literature. MATERIALS AND METHODS: A search was conducted in PubMed, Scopus, and Web of Science databases for published articles using the following keywords gastrointestinal stromal tumors, leiomyomas, and radiomics. The review included 4 meta-analyses and 16 original articles. RESULTS: Texture analysis represents a promising tool for quantifying the heterogeneity of masses on radiologic images, thereby enabling the extraction of additional data that cannot be assessed by imaging analysis. The potential applications of texture analysis for differential diagnosis of gastrointestinal stromal tumors with other gastrointestinal neoplasms, risk stratification, and prediction of outcome after surgical treatment, as well as assessment of the mutational status of tumors, were explored. A differential diagnosis of gastrointestinal stromal tumors should be made with other mesenchymal tumors of the stomach (schwannoma, leiomyoma), as well as with malignant tumors (adenocarcinoma, lymphoma), although the number of such publications is limited. Some published studies on texture analysis of gastrointestinal stromal tumors have demonstrated excellent reproducibility of the obtained models. CONCLUSIONS: The lack of standardization and differences in study methodology present significant challenges to the clinical application of radiomics. Texture analysis may offer a valuable tool for the initial evaluation of gastric tumors, reducing the time required for diagnosis and determining patient management before biopsy. This approach could help to prevent inappropriate treatment.

Background: A majority of previous studies appear to support a view that human observers can only perceive coarse information from a natural scene image when it is presented rapidly ( Methods: We used a novel free-report paradigm to examine what people can freely report following a rapidly presented natural scene image (67/133/267ms, masked). N = 670 online participants typed up to five words to report what they saw in the image together with confidence of the respective responses. We developed a novel index, Intersubjective Agreement (IA). IA quantifies how specifically the response words were used to describe the target image, with a high value meaning the word is not often reported for other images. Importantly, IA eliminates the need for experimenters to preselect response options. Results: The words with high IA values are often something detailed (e.g., a small object) in a particular image. With IA, unlike commonly believed, we demonstrated that participants reported highly specific and detailed aspects of the briefly (even at 67ms, masked) shown image. Further, IA is positively correlated with confidence, indicating metacognitive conscious access to the reported aspects of the image. Conclusion: These new findings challenge the dominant view that the content of rapid scene experience is limited to global and coarse gist. Our novel paradigm opens a door to investigate various contents of consciousness with a free-report paradigm.

Background: In this study, we discussed the incidental detection of Gastro Intestinal Stromal Tumor (GIST) in patients who underwent Laparoscopic Sleeve Gastrectomy (LSG) operation in our hospital. Materials and Methods: We retrospectively analyzed the data of 743 patients operated on by a single surgeon in our clinic between January 2015 and November 2023. The pathology reports of these patients were examined. Results: When the pathology reports of 743 patients were examined, GIST was detected incidentally in 4 patients (0.54%). These patients had lesions that were noticed during surgery and were suspicious for GIST. Conclusions: GIST is very rare in the normal population. With the widespread use of LSG operation, it has been observed that the rate of GIST is much higher in the morbidly obese patient population than in the normal population. The rate determined in our study was found to be compatible with the general literature (0.3-1.2%). [ABSTRACT FROM AUTHOR]

Background: We previously treated small gastric submucosal tumors originating from the muscularis propria layer by precutting endoscopic band ligation but lacked precise pathological results. Then, precutting endoscopic band ligation was modified by additional snare resection after ligation to obtain tumor specimens, termed precutting endoscopic band ligation-assisted resection. Aims: In this study, we aimed to explore the safety, feasibility, and efficacy of precutting endoscopic band ligation-assisted resection. Methods: From 2021 to 2022, a total of 16 consecutive patients underwent precutting endoscopic band ligation-assisted resection to treat small gastric submucosal tumors originating from the muscularis propria. The clinical demography, perioperative data, and follow-up outcomes were retrospectively collected. Results: With a mean operative time of 21.3 min, all lesions were successfully and completely resected, and no severe adverse events or local recurrences occurred postoperatively. More importantly, en bloc and R0 resection were achieved in all 16 patients. Conclusion: Precutting endoscopic band ligation-assisted resection is a safe, effective, and time-saving endoscopic technique for managing gastric small gastric submucosal tumors originating from the muscularis propria for both diagnosis and eradication. [ABSTRACT FROM AUTHOR]

Simple Summary: Most gastrointestinal stromal tumors (GISTs) are driven by activating mutations in KIT and PDGFRA or alterations in the succinate dehydrogenase (SDH) complex. A small fraction of GISTs lack alterations in KIT, PDGFRA, and the SDH complex, so-called "triple-negative" GISTs. We assessed clinical genomic sequencing, treatment, and survival outcomes in a cohort of 20 triple-negative GISTs. Genomic alterations were most commonly seen in the RAS/RAF/MAPK pathway and the DNA damage response pathway. Compared to KIT/PDGFRA mutant GIST, limited benefit was observed with imatinib in triple-negative GIST. In-depth molecular profiling can be helpful in identifying driver mutations and guiding therapy. Objective: The vast majority of gastrointestinal stromal tumors (GISTs) are driven by activating mutations in KIT, PDGFRA, or components of the succinate dehydrogenase (SDH) complex (SDHA, SDHB, SDHC, and SDHD genes). A small fraction of GISTs lack alterations in KIT, PDGFRA, and SDH. We aimed to further characterize the clinical and genomic characteristics of these so-called "triple-negative" GISTs. Methods: We extracted clinical and genomic data from patients seen at MD Anderson Cancer Center with a diagnosis of GIST and available clinical next generation sequencing data to identify "triple-negative" patients. Results: Of the 20 patients identified, 11 (55.0%) had gastric, 8 (40.0%) had small intestinal, and 1 (5.0%) had rectal primary sites. In total, 18 patients (90.0%) eventually developed recurrent or metastatic disease, and 8 of these presented with de novo metastatic disease. For the 13 patients with evaluable response to imatinib (e.g., neoadjuvant treatment or for recurrent/metastatic disease), the median PFS with imatinib was 4.4 months (range 0.5–191.8 months). Outcomes varied widely, as some patients rapidly developed progressive disease while others had more indolent disease. Regarding potential genomic drivers, four patients were found to have alterations in the RAS/RAF/MAPK pathway: two with a BRAF V600E mutation and two with NF1 loss-of-function (LOF) mutations (one deletion and one splice site mutation). In addition, we identified two with TP53 LOF mutations, one with NTRK3 fusion (ETV6-NTRK3), one with PTEN deletion, one with FGFR1 gain-of-function (GOF) mutation (K654E), one with CHEK2 LOF mutation (T367fs*), one with Aurora kinase A fusion (AURKA-CSTF1), and one with FANCA deletion. Patients had better responses with molecularly targeted therapies than with imatinib. Conclusions: Triple-negative GISTs comprise a diverse cohort with different driver mutations. Compared to KIT/PDGFRA-mutant GIST, limited benefit was observed with imatinib in triple-negative GIST. In depth molecular profiling can be helpful in identifying driver mutations and guiding therapy. [ABSTRACT FROM AUTHOR]

Novel treatments in gastrointestinal stromal tumors (GISTs) are essential due to imatinib resistance and the modest results obtained with multi-target tyrosine kinase inhibitors. We investigated the possibility that the hydroalcoholic extract from the leaves of Arbutus unedo L. (AUN) could harbor novel chemotherapeutics. The bio-guided fractionation of AUN led to a subfraction, FR2-A, that affected the viability of both imatinib-sensitive and -resistant GIST cells. Cells treated with FR2-A were positive for Annexin V staining, a marker of apoptosis. A rapid PARP-1 downregulation was observed, although without the traditional caspase-dependent cleavage. The fractionation of FR2-A produced nine further active subfractions (FRs), indicating that different molecules contributed to the effect promoted by FR2-A. NMR analysis revealed that pyrogallol-bearing compounds, such as gallic acid, gallic acid hexoside, gallocatechin, myricetin hexoside, and trigalloyl-glucose, are the main components of active FRs. Notably, FRs similarly impaired the viability of GIST cells and peripheral blood mononuclear cells (PBMCs), suggesting a non-specific mechanism of action. Nevertheless, despite the lack of specificity, the established FRs showed promising chemotherapeutic properties to broadly affect the viability of GIST cells, including those that are imatinib-resistant, encouraging further studies to investigate whether pyrogallol-bearing compounds could represent an alternative avenue in GISTs. [ABSTRACT FROM AUTHOR]

The grid inhomogeneous solvation theory (GIST) method requires the often time-consuming calculation of water-water and water-solute energy on a grid. Previous efforts to speed up this calculation include using OpenMP, GPUs, and particle mesh Ewald. This article details how the speed of this calculation can be increased by parallelizing it with MPI, where trajectory frames are divided among multiple processors. This requires very little communication between individual processes during trajectory processing, meaning the calculation scales well to large processor counts. This article also details how the entropy calculation, which must happen after trajectory processing since it requires information from all trajectory frames, is parallelized via MPI. This parallelized GIST method has been implemented in the freely-available CPPTRAJ analysis software. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Duodenal GISTs are rare and challenging tumors. Acute life‐threatening upper GI bleeding is a possible presentation of duodenal GISTs. Surgery is the standard treatment for localized duodenal GISTs. Imatinib is an effective adjuvant therapy for duodenal GISTs. GIST is the most common mesenchymal neoplasm of the gastrointestinal tract, accounting for 1%–2% of gastrointestinal tumors. They originate from the interstitial cells of Cajal and are rare in patients younger than 30 years. The stomach is the most common site, followed by the small intestine and colon. GISTs are caused by a gain‐of‐function mutation in the proto‐oncogene receptor tyrosine kinase, with activating mutations in KIT being the most common. Most GISTs are asymptomatic. Even if gastrointestinal bleeding is the most common complication life‐threatening hemorrhage is extremely uncommon. We present a case of a 31‐year‐old male patient presented with massive active hematemesis and melena with hemorrhagic shock. The patient presented with massive hematemesis and melena of 1 h duration. Endoscopy showed pulsating active bleeding from the third part of the duodenum which was difficult to manage via endoscopy. Histopathologic evaluation showed spindle cell type GIST. Intraoperatively, there was a nodular mass with active bleeding on the third part of the duodenum. Duodenectomy with end‐to‐end anastomosis was done. Discharged with no postoperative complication and was put on imatinib. There are considerable challenges that arise in the diagnosis and treatment of duodenal gastrointestinal stromal tumors (GISTs) when they present with life‐threatening upper gastrointestinal hemorrhage. In order to achieve the best possible outcomes for patients, it is crucial to have a comprehensive understanding of the clinical presentation, diagnostic methods, and treatment approaches. [ABSTRACT FROM AUTHOR]