Differences in hypertension and prehypertension among people living with and without HIV in China: role of HIV infection and antiretroviral therapy

OBJECTIVES

Hypertension is a growing health concern in people living with HIV (PLWH). However, association between HIV infection and hypertension is equivocal.

METHODS

In all, 1472 PLWH and 2944 HIV-negative individuals frequency-matched by age and sex were derived from the baseline survey of Comparative HIV and Aging Research in Taizhou (CHART), China. Prehypertension was defined as systolic blood pressure (BP) of 120-139 mmHg and/or diastolic blood pressure of 80-89 mmHg.

RESULTS

Despite the fact that prevalence of hypertension was overall lower among PLWH than among HIV-negative people (21.1% vs. 29.1%, P < 0.001), it was similar at ages 18-29 (7.6% vs. 8.5%) and 30-44 years (17.1% vs. 18.5%) but significantly lower in PLWH at ages 45-59 (26.1% vs. 40.7%) and 60-75 years (37.1% vs. 57.3%). Prehypertension prevalence was consistently higher in PLWH across all age groups. In the model adjusting for traditional risk factors, HIV infection was associated with hypertension (adjusted odds ratio [aOR] = 1.27, 95% confidence interval: 1.04-1.55) and prehypertension (aOR = 1.77, 95% CI: 1.51-2.08), and attenuated after additional adjustment for abdominal obesity. Age-stratified analysis showed that these associations of HIV with hypertension were observed at ages 18-29 and 30-44 years and associations with prehypertension were observed at ages 18-29, 30-44 and 45-59 years only. Years since HIV diagnosis and stavudine use were the HIV-specific factors independently associated with hypertension or/and prehypertension.

CONCLUSIONS

HIV infection is independently associated with prehypertension and hypertension especially at younger ages, and this risk may increase as treatment becomes prolonged. Our findings reinforce the urgent necessity for active BP screening and control strategies be adopted for PLWH in China.

Parkin interacting substrate zinc finger protein 746 is a pathological mediator in Parkinson's disease

α-Synuclein misfolding and aggregation plays a major role in the pathogenesis of Parkinson's disease. Although loss of function mutations in the ubiquitin ligase, parkin, cause autosomal recessive Parkinson's disease, there is evidence that parkin is inactivated in sporadic Parkinson's disease. Whether parkin inactivation is a driver of neurodegeneration in sporadic Parkinson's disease or a mere spectator is unknown. Here we show that parkin in inactivated through c-Abelson kinase phosphorylation of parkin in three α-synuclein-induced models of neurodegeneration. This results in the accumulation of parkin interacting substrate protein (zinc finger protein 746) and aminoacyl tRNA synthetase complex interacting multifunctional protein 2 with increased parkin interacting substrate protein levels playing a critical role in α-synuclein-induced neurodegeneration, since knockout of parkin interacting substrate protein attenuates the degenerative process. Thus, accumulation of parkin interacting substrate protein links parkin inactivation and α-synuclein in a common pathogenic neurodegenerative pathway relevant to both sporadic and familial forms Parkinson's disease. Thus, suppression of parkin interacting substrate protein could be a potential therapeutic strategy to halt the progression of Parkinson's disease and related α-synucleinopathies.

[Study on maternal-fetal status of Pb, Cd, As, Hg, Mn and Se elements and transplacental transfer efficiency]

Objective: To understand the levels of Pb, Cd, As, Hg, Mn, and Se in maternal and umbilical cord blood, and to explore the transplacental transfer efficiency (TTE). Methods: From September 2010 to December 2013, a total of 773 pregnant women and their newborns (Laizhou Bay Birth Cohort) were recruited from a second grade hospital in the south bank of Laizhou Bay, Bohai, Shandong Province. According to different detection methods, the six measured elements are classified into three groups including the Hg measurement group (595 mother-newborn pairs), the Pb measurement group (534 mother-newborn pairs), and the Cd, As, Mn and Se measurement group (244 mother-newborn pairs). The demographic characteristics of pregnant women and their newborns were obtained by the questionnaire. The concentrations of elements in maternal and umbilical cord blood were detected and the TTE of each element (elemental concentration in cord blood/elemental concentration in maternal blood) was calculated. The correlation of elements between maternal and cord blood was analyzed using Spearman's rank correlation coefficient. Results: The mean±SD of maternal age, gestational week and newborn birth weight of 773 mother-infant pairs were (28.34±4.50) years, (39.47±1.39) weeks and (3 419.47±497.39) g respectively. The median concentrations of Pb, Cd, As, Hg, Mn and As in maternal and cord blood were 31.12 and 30.02, 1.19 and 0.47, 8.05 and 6.03, 0.69 and 1.26, 100.70 and 105.55, 127.25 and 115.00 μg/L, respectively. The TTE of Pb, Cd, As, Hg, Mn, and Se was 0.98, 0.41, 0.73, 1.73, 0.96 and 0.91, respectively. Pb, Cd, Hg, Mn, and Se showed a significant positive correlation between maternal blood and cord blood, with Spearman correlation coefficients of 0.397, 0.298, 0.698, 0.555, and 0.285 (all P values<0.001). Conclusion: Each element was commonly detected in maternal blood and cord blood. The TTE of Hg was the highest.

HIV infection and electrocardiogram abnormalities: baseline assessment from the CHART cohort

OBJECTIVES

To investigate the prevalence of various electrocardiogram (ECG) abnormalities among HIV-positive and HIV-negative individuals.

METHODS

This cross-sectional evaluation included 1412 HIV-positive and 2824 HIV-negative participants aged 18 to 75 years and frequency matched by age and sex, derived from the baseline survey of Comparative HIV and Aging Research in Taizhou (CHART), China, between February and December 2017.

RESULTS

HIV-positive individuals had higher prevalence of sinus tachycardia (5.6% (79/1412) vs. 1.3% (36/2824), p < 0.001) and ST/T wave abnormalities (14.9% (211/1412) vs. 9.4% (264/1412), p < 0.001) but lower prevalence of sinus bradycardia (4.8% (68/1412) vs. 7.5% (211/2824), p 0.001); such associations remained statistically significant after adjusting for traditional risk factors (respectively, adjusted odds ratio (aOR) 4.68, 95% confidence interval (CI) 3.06-7.17; aOR 1.89, 95% CI 1.54-2.34; aOR 0.60, 95% CI 0.44-0.80). In adjusted models, being in higher carotid intima-media thickness categories was significantly associated with ST/T abnormalities in HIV-positive individuals only (0.78-1.00 mm: aOR 1.46, 95% CI 1.01-2.12; >1.00 mm: aOR 2.18, 95% CI 1.39-3.42), whereas being in higher blood pressure categories was significantly associated with both sinus tachycardia (prehypertension: aOR 5.61, 95% CI 1.76-17.91; hypertension: aOR 12.62, 95% CI 3.60-44.27) and ST/T abnormalities (hypertension: aOR 2.04, 95% CI 1.41-2.95) in HIV-negative individuals only. Longer duration of known HIV infection was the only HIV-specific factor of ST/T abnormalities (aOR 1.61, 95% CI 1.17-2.22), with none for sinus tachycardia.

CONCLUSIONS

HIV infection is independently associated with sinus tachycardia and ST/T abnormalities. Further research is needed to investigate specific mechanisms by which HIV infection leads to ECG abnormalities and to evaluate whether inclusion of ECG parameters improves cardiovascular disease prediction. Integrating ECG screening into routine HIV care is recommended in China.

[Effect of the number of previous spontaneous abortions on the first in vitro fertilization cycle]

Objective: To investigate the effect of the number of previous spontaneous abortions on the first in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) cycle. Methods: A retrospective case-control study was conducted to analyze the clinical data of 1 279 patients who received IVF/ICSI treatment for the first time from July 2014 to July 2018 in Tianjin Central Hospital of Gynecology Obstetrics;they were divided into 0 time group (group A, n=924), 1 time group (group B, n=267) and 2 times group (group C, n=88) for comparison, according to the previous frequency of spontaneous abortions. Results: There were no statistically significant differences in age, basal testosterone, estradiol, progesterone, prolactin and embryo quality in group A, B and C (all P>0.05). The biochemical pregnancy rate of group C (9.1%) was higher than those of the other two groups (4.1% and 4.1%; all P>0.05). The clinical pregnancy rate of group A (42.5%) [>group B (40.4%) and >group C (35.2%)] was not statistically significant(P>0.05).Early abortion rate in group A (8.9%) was<group B (15.7%), also <group C (38.7%), there were significant differences (all P<0.05).The live birth rate of group C (21.6%) was significantly lower than that of group A (35.5%; P<0.05), but the difference between group C and group B (30.7%) was not statistically significant (P>0.05). Conclusions: Women with a history of one- or two-time spontaneous abortion have no obvious effect on embryo quality, and have a negative impact of clinical pregnancy rate, early abortion rate, live birth rate in the first IVF/ICSI cycle; especially for patients with a history of two times spontaneous abortion, early abortion rate has a significant increase, live birth rate decreases significantly, suggesting that patients with a history of two times of spontaneous abortion should find the causes of miscarriage according to the process of recurrent spontaneous miscarriage and receive treatment if necessary before subsequent pregnancy.

P978Core to block: a new ablation strategy for treating persistent atrial fibrillation

Background

Ablation strategy targeting the core of atrial fibrillation (AF) rotors alone can lead to both stabilisation and destabilisation of rotational activity. Non-contact dipole density mapping system is designed to rapidly identify dynamic regional atrial activation patterns of interest (API) during AF.

Purpose

To assess the feasibility of an ablation strategy consisted of pulmonary vein isolation + targeting the core of APIs followed by linear ablation to the nearest non-conducting boundary to treat persistent AF.

Methods

The ablation strategy includes: 1. Antral pulmonary vein electrical isolation (APVI); 2. APIs (focal, localised rotational and localised irregular activation; Figure1) detection by dipole density mapping; 3. API core ablation followed by linear ablation to the nearest non-conduction barrier (APVI/mitral valve); 4. repeat step 2 and 3 in LA (RA, if necessary) until sinus rhythm is achieved.

Results

Consecutive 40 persistent AF patients (mean 62±12 years, 29 males, AF duration 10±4 months, LA diameter 42±9 mm) were included from 2 centres. An average of 2.0±0.7 APIs per patient were targeted post-APVI. Acute AF termination by ablation was achieved in 27/40 (68%) patients. The mean ablation time of APVI and “Core to block” was 33±12 mins and 31±22 mins, respectively. No major complication occurred. During a mean follow-up of 12±5 months, 32/40 patients (80%) maintained sinus rhythm.

Conclusion

APVI + “Core to block” guided by the dipole density mapping is feasible for treating persistent AF. A larger randomised study is needed to test the effectiveness of this ablation strategy.

Acknowledgement/Funding

None

P3756Diverse activation patterns during persistent atrial fibrillation characterised by dipole density non-contact mapping

Background

Global simultaneous recording of activation during atrial fibrillation (AF) can elucidate underlying mechanisms contributing to AF maintenance. A better understanding of these mechanisms may allow for a personalised ablation strategy to treat persistent AF.

Purpose

To characterise left atrial endocardial activation patterns during AF using a novel non-contact dipole density mapping.

Methods

Activation patterns were characterised into three sub-types: (i) focal with centrifugal activation (FCA); (ii) localised rotational activation (LRA); (iii) localised irregular activation (LIA). Continuous activation patterns were quantified and distributed in the left atrium.

Results

A total of 144 persistent AF segments with 1068 activation patterns from 25 patients were analysed. The most common pattern was LIA (63%), which consist of four disparate features: slow conduction (45%), pivoting (30%), collision (16%) and acceleration (7%). LRA was the second commonest pattern (20%). FCA (17%) arose frequently from the PVs/ostia. Continuous AF activations comprise multiple combinations of FCA, LRA and LIA, transitioning from one to the next without a discernible order. Preferential conduction areas were typically seen in mid-anterior (48%) and lower-posterior (40%) walls where dominant activations were made up of LRA and LIA.

Conclusion

AF is characterised by heterogenous activation patterns that vary between individuals. Clinical implications of individualised ablation strategies guided by dipole density mapping will have to be determined.

Acknowledgement/Funding

None

Clinical evaluation of total and high-avidity anti-dsDNA antibody assays for the diagnosis of systemic lupus erythematosus

Background

This study evaluated the diagnostic performances of total and high-avidity (HA) anti-dsDNA enzyme immunoassays (EIA) in Chinese systemic lupus erythematosus (SLE) patients.

Methods

A total of 410 serum samples from 217 SLE patients, 54 patients with other systemic autoimmune diseases, and 139 healthy subjects were tested on total and HA anti-dsDNA EIA, as well as three commercial in vitro diagnostic kits: BioPlex 2200 ANA Screen, Kallestad anti-dsDNA EIA, and Crithidia Lucilae IFA. The disease activities of SLE patients were assessed using the modified SLE Disease Activity Index. The diagnostic performances of each assay were analyzed using Analyse-it software.

Results

The diagnostic performances of the total and HA anti-dsDNA EIA kits were comparable to other commercially available in vitro diagnostic assays. Receiver operating characteristic curve analysis demonstrated an area under the curve ranging from 0.85 to 0.89, with the total anti-dsDNA kit demonstrating the highest sensitivity and the HA kit showing higher specificity. An overall agreement of >90% was observed between the total and HA anti-dsDNA EIA kits and commercially available quantitative anti-dsDNA kits. The ratio of HA to total anti-dsDNA antibody was significantly higher among SLE patients with active disease status and/or kidney damage. All assays exhibited a significant correlation with disease activity and multiple clinical manifestations.

Conclusions

While the clinical performances of various anti-dsDNA assays showed adequate agreements, the BioPlex 2200 anti-dsDNA assay demonstrated the highest positive likelihood ratio and odds ratio. The HA anti-dsDNA EIA kit in association with the total anti-dsDNA kit provided superior performance in SLE diagnosis and monitoring disease activity.

Plasma C-type lectin-like receptor 2 as a predictor of death and vascular events in patients with acute ischemic stroke

BACKGROUND AND PURPOSE

C-type lectin-like receptor 2 (CLEC-2) has prominent involvement in platelet activation, which is increased in coronary heart disease and acute ischaemic stroke (AIS) and is associated with stroke progression and stroke prognosis. Here, the aim was to examine the prognostic value of CLEC-2 in death and vascular event recurrence in AIS patients.

METHODS

In all, 352 patients with AIS were studied prospectively. All patients were followed up for 1 year. Death for all vascular events and a combination of death and vascular diseases (recurrent stroke, myocardial infarction, hospitalized and treated angina, hospitalized and treated peripheral arterial disease) were recorded.

RESULTS

During 1 year of follow-up, 46 patients (14.2%) experienced death or combined end-points (23 death and 46 combined end-points). Plasma CLEC-2 (pCLEC-2) was significantly associated with an increased risk of death and combined events of death and vascular diseases after adjusting for age, sex, history of hypertension, diabetes mellitus and coronary artery disease, and National Institutes of Health Stroke Scale scores. Each 1 SD higher log-transformed pCLEC-2 was associated with a 4.27-fold (hazard ratio 4.27, 95% confidence interval 1.71-10.65) increased risk for death and a 2.42-fold increased risk for combined end-points (hazard ratio 2.42, 95% confidence interval 1.52-3.86). The optimal cut-off point of pCLEC-2 for predicting death was 184.38 pg/ml.

CONCLUSIONS

Higher pCLEC-2 levels at admission were associated with increased risk of death and combined events of death and vascular diseases in patients with AIS, which indicated that pCLEC-2 is an important prognostic factor for AIS.

Enhanced broadband spin Hall effects by core-shell nanoparticles

Spin-orbit interaction of light is ubiquitous in any optical system. However, the relevant spin Hall effects are usually weak for the light scattering from nanoparticles, making it challengeable to detect directly in experiment. In this paper, we demonstrate enhanced broadband spin Hall effects by using core-shell nanoparticles. The electric and magnetic dipoles can be tuned by the core-shell nanostructure with great freedom, and are excited simultaneously in a broadband spectrum, resulting in robust enhanced spin Hall shifts. Moreover, the coupling of the electric dipole and electric quadrupole gives rise to enhanced spin Hall shifts at both forward and backward directions. Numerical results from far-field and near-field verify the strong spin-orbit interaction of light. Our work offers a new way to exploit spin Hall effects in superresolution imaging and spin-dependent displacement sensing.

Genetic analysis of skinfold thickness and its association with body condition score and milk production traits in Chinese Holstein population

The skin has many important roles in dairy cattle, and skinfold thickness could be used as an indicator of body fat deposition. The objectives of this study were to estimate genetic parameters of skinfold thickness and to explore its association with body condition score (BCS) and milk production traits in a Chinese Holstein population. Skinfold thicknesses over the neck (STN) and the last rib (STR), BCS, and test-day records of milk production traits were available for 6,416 lactating Holstein cows in the summers of 2015 and 2016 in Beijing, China. Multi-trait animal models were used to estimate variance and covariance components using the DMU software. The average STN was 7.15 ± 1.28 mm, and the average STR was 11.76 ± 1.95 mm (mean ± standard deviation). Estimated heritability was 0.13 ± 0.03 for STN and 0.26 ± 0.04 for STR. We detected a high genetic correlation (0.79 ± 0.08; heritability ± standard error) between STN and STR. Genetic correlations between skinfold thickness and BCS were low to moderate: 0.18 between STR and BCS, and 0.33 between STN and BCS. Genetic correlations between skinfold thickness and milk yield, milk fat percentage, and milk protein percentage were negligible, ranging from -0.02 to 0.15. Collectively, skinfold thickness is characterized as a trait with moderate heritability. Skinfold thickness is sensitive to changes in body condition or fat deposition across parities and lactation stages in milking cows, and we confirmed the complementary nature of skinfold thickness and BCS genetically as well as phenotypically by comparing their changing trends throughout lactation and across lactations. The use of skinfold thickness, together with BCS, can assist in the monitoring of changes in body fat deposition to achieve higher management precision.

[The effects of prenatal exposure to brominated diphenyl ethers-209 to the influence of male offspring rats hippocampus BDNF potein expression and its mechanism of action]

Objective: The effects of prenatal exposure to brominated diphenyl ethers-209 to the Influence of male offspring rats hippocampus BDNF potein expression and its mechanism of action. Methods: Pregnant Sprague-Dawley (SD) rats were randomly treated with BDE-209 (100, 300, and 900 mg/kg body weight) or corn oil by gavage on gestational days 6-20. Blood was obtained through heart puncture for thyroid hormone analysis in male rats offspring on PND 60. The hippocampus tissues were excised. The expression levels of BDNF protein were measured by Western blot. Results: 1) In hippocampal tissue, BDNF protein expression concentration ratio relative to the control group (control group concentration of 1) were 0.87 (300 mg/kg dose group) and 0.67 (900 mg/kg) (P<0.01) . 2) Compared to controls, total T4 levels and free T4 levels were significantly decreased in the BDE-209 treated-group (900 mg/kg, 300 mg/kg) (P<0.05) . Total T3 levels in 300 mg/kg group were also significantly decreased compared to the control (P<0.05) . However, no significant difference was observed in 100 mg/kg group (P>0.05) . Conclusion: During 300 and 900 mg/kg dose group of BDE-209 exposure to male offspring BDNF protein expression in rat hippocampus decreased, may be related to its interference with thyroid hormone.

The embryonic and evolutionary boundaries between notochord and cartilage: a new look at nucleus pulposus-specific markers

The adult nucleus pulposus (NP) and articular cartilage are similar in terms of their histocytological components and biomechanical functionalities, requiring a deep understanding of NP-specific markers to better evaluate stem-cell-based NP regeneration. Here, we seek to distinguish NP cells from articular chondrocytes (ACs), focusing on differences in their embryonic formation and evolutionary origin. Embryonically, NP cells are conservatively derived from the axial notochord, whereas ACs originate in a diversified manner from paraxial mesoderm and neural crest cells. Evolutionarily, although the origins of vertebrate NP and AC cells can be traced to similar structures within protostomia-like bilaterian ancestors, the distant phylogenetic relationship between the two groups of animals and the differences in the bodily origins of the tissues suggest that the tissues may in fact have undergone parallel evolution within the protostomia and deuterostomia. The numbers of supposedly NP-specific markers are increasing gradually as microarray studies proceed, but no final consensus has been attained on the specificity and physiology of "exclusive" NP markers because of innate variations among species; intrinsic expression of genes that destabilize the circadian clock; and cooperation by, and crosstalk among, different genes in terms of physiology-related phenotypes. We highlight the embryonic and evolutionary boundaries between NP and AC cells, to aid in recognition of the challenges associated with evaluation of the role played by nucleopulpogenic differentiation during stem-cell-based intervertebral disc regeneration.

Effect of peer support on diabetes distress: a cluster randomized controlled trial

AIM

To investigate whether peer support would reduce diabetes distress and improve glycaemic control when added to usual diabetes education among adults with Type 2 diabetes in China.

METHODS

We conducted a cluster randomized trial involving 400 adults with Type 2 diabetes from eight communities in Nanjing. All participants received usual education for an average of 2 h each month from physicians, certified diabetes educators, dieticians, psychologists and podiatric nurses. Peer support was led by trained peer leaders and included diabetes knowledge- and skills-sharing at least once a month, as well as peer-to-peer communication. The primary outcome was diabetes distress measured using the Diabetes Distress Scale at 12 months. Secondary outcomes included fasting plasma glucose, 2-h postprandial glucose and HbA_1c concentration. Outcome data were collected from all participants at baseline, 6 months and 12 months.

RESULTS

From 2012 to 2013, there were 200 participants in each study arm at baseline. Compared with the usual education arm, the peer support with usual education arm had greater reductions in regimen-related distress (1.4 ± 0.6 vs 1.2 ± 0.4; P=0.004) and total distress (1.3 ± 0.4 vs 1.2 ± 0.3; P=0.038) at 6 months. At 12 months, the scores for emotional burden (1.2 ± 0.3 vs 1.4 ± 0.6; P=0.002), physician-related distress (1.1 ± 0.3 vs 1.3 ± 0.4; P=0.001) and total scores (1.2 ± 0.3 vs 1.3 ± 0.4; P=0.002) were significantly lower in the peer support with usual education arm than in the usual education arm. Fasting plasma glucose levels were lower in the peer support with usual education arm than in the usual education arm at 6 months (7.5 ± 1.95 vs 8.0 ± 2.2; P=0.044) and 12 months (7.0 ± 2.3 vs 7.6 ± 1.5; P=0.008).

CONCLUSIONS

Beyond the benefits of usual education, peer support was effective in reducing diabetes distress for Type 2 diabetes mellitus. (Clinical Trials Registry no: NCT02119572).

Interferon-gamma response to the treatment of active pulmonary and extra-pulmonary tuberculosis

BACKGROUND

Interferon-gamma (IFN-γ) release assays (IGRAs) are used to diagnose tuberculosis (TB) but not to measure treatment response.

OBJECTIVE

To measure IFN-γ response to active anti-tuberculosis treatment.

DESIGN

Patients from the Henan Provincial Chest Hospital, Henan, China, with TB symptoms and/or signs were enrolled into this prospective, observational cohort study and followed for 6 months of treatment, with blood and sputum samples collected at 0, 2, 4, 6, 8, 16 and 24 weeks. The QuantiFERON® TB-Gold assay was run on collected blood samples. Participants received a follow-up telephone call at 24 months to determine relapse status.

RESULTS

Of the 152 TB patients enrolled, 135 were eligible for this analysis: 118 pulmonary (PTB) and 17 extra-pulmonary TB (EPTB) patients. IFN-γ levels declined significantly over time among all patients (P = 0.002), with this decline driven by PTB patients (P = 0.001), largely during the initial 8 weeks of treatment (P = 0.019). IFN-γ levels did not change among EPTB patients over time or against baseline culture or drug resistance status.

CONCLUSION

After 6 months of effective anti-tuberculosis treatment, IFN-γ levels decreased significantly in PTB patients, largely over the initial 8 weeks of treatment. IFN-γ concentrations may offer some value for monitoring anti-tuberculosis treatment response among PTB patients.

Diagnostic conundrum of a perineal tumour: a rectal gastrointestinal stromal tumour mimic

Gastrointestinal stromal tumour (GIST) is a common mesenchymal tumour arising in the gastrointestinal tract, but not frequently encountered in the rectum. Herein, we describe a case of a rectal GIST which mimicked histomorphological features of a schwannoma; thus, making intraoperative frozen section evaluation challenging. Although subsequent immunohistochemistry and molecular findings readily confirmed the diagnosis of a GIST, we wish to draw attention to three clues that will help the pathologist steer clear of this potential diagnostic pitfall. One, GISTs are relatively more common than schwannomas in the rectum. Two, schwannomas usually have very little mitoses. Three, rectal GISTs commonly exhibit nuclear palisades. We also discuss the diagnostic, prognostic and therapeutic functions of immunohistochemical and molecular investigations. As the surgical intent for rectal GISTs is for en-bloc excision with wide margins, we surmise that the intraoperative consult should include GIST as a possible differential diagnosis for rectal mesenchymal tumours. In view of the potential for neoadjuvant treatment with imatinib before surgical excision to preserve sphincter function, a multidisciplinary approach is recommended for establishing most effective treatment strategy in these rare complex cases.