This national database reveals relevant information regarding epidemiology, current clinical practices and prognosis of NETs in Spain, providing valuable insights that may contribute to understand regional disparities in the incidence, patterns of care and survival of this heterogeneous disease across different continents and countries.

BackgroundThe aim of this study was to create a new meta-analysis method for cost-effectiveness studies using comparative efficiency research (COMER).MethodsWe built a new score named total incremental net benefit (TINB), with inverse variance weighting of incremental net benefits (INB). This permits determination of whether an alternative is cost-effective, given a specific threshold (TINB > 0 test). Before validation of the model, the structure of dependence between costs and quality-adjusted life years (QoL) was analysed using copula distributions. The goodness-of-fit of a Spanish prospective observational study (n = 498) was analysed using the Independent, Gaussian, T, Gumbel, Clayton, Frank and Placket copulas. Validation was carried out by simulating a copula distribution with log-normal distribution for costs and gamma distribution for disutilities. Hypothetical cohorts were created by varying the sample size (n: 15–500) and assuming three scenarios (1-cost-effective; 2-non-cost-effective; 3-dominant). The COMER result was compared to the theoretical result according to the incremental cost-effectiveness ratio (ICER) and the INB, assuming a margin of error of 2,000 and 500 monetary units, respectively.ResultsThe Frank copula with positive dependence (−0.4279) showed a goodness-of-fit sufficient to represent costs and QoL (p-values 0.524 and 0.808). The theoretical INB was within the 95% confidence interval of the TINB, based on 15 individuals with a probability > 80% for scenarios 1 and 2, and > 90% for scenario 3. The TINB > 0 test with 15 individuals showed p-values of 0.0105 (SD: 0.0411) for scenario 1, 0.613 (SD: 0.265) for scenario 2 and < 0.0001 for scenario 3.ConclusionsCOMER is a valid tool for combining cost-effectiveness studies and may be of use to health decision makers.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2288-14-139) contains supplementary material, which is available to authorized users.

Introduction: Pancreatic neuroendocrine neoplasms (PNENs) are uncommon neoplasms with a wide spectrum of clinical behavior. The objective of this study was to assess in a large cohort of patients the relative impact of prognostic factors on survival. Methods: From June 2001 through October 2010, 1,271 patients were prospectively registered online (www.getne.org) at the Spanish National Cancer Registry for Gastroenteropancreatic Neuroendocrine Tumors (RGETNE) by participating centers. Clinical and histopathological features were assessed as potential prognostic factors by uni- and multivariate analyses. Results: Of 483 PNENs, 171 (35%) were functional (F) and 312 (65%) non-functional (NF). NF-PNENs were associated with a higher incidence of histological features denoting more aggressive disease, such as poor tumor differentiation, Ki-67 >20%, or vascular invasion (NF- vs. F-PNENs, respectively, p < 0.05). Nevertheless, functionality was not a significant predictor of survival (p = 0.19). Stage at diagnosis, Ki-67 index, tumor differentiation and surgical resection of the primary tumor were all significant prognostic factors in univariate analysis. However, Ki-67 (>20 vs. ≤2%) (hazard ratio (HR) 2.21, p = 0.01) and surgical resection (yes vs. no) (HR 0.92, p = 0.001) were the only independent predictors of survival in multivariate analysis. Among patients who underwent surgery, high Ki-67 index (HR 10.37, p = 0.02) and poor differentiation (HR 8.16, p = 0.03) were the only independent predictors of clinical outcome. Conclusion: Ki-67 index and tumor differentiation are key prognostic factors influencing survival of patients with PNENs and, in contrast to what it is observed for other solid malignancies, they seem to have a greater impact on survival than the extent of disease. This should be borne in mind by physicians in order to appropriately tailor therapeutic strategies and surveillance of these patients.

The faunistic results regarding intestinal parasitism by protozoa and helminths in 21 primate species (three Cebidae, thirteen Cercopithecidae, one Hylobatidae, one Lemuridae, three Pongidae) are reported. The primate species were housed in four separate galleries. Six faecal samples of each host species were subjected to coprological analysis. Fifteen parasite species were detected: 11 protozoa (Entamoeba coli, E. chattoni, E. hartmanni, Iodamoeba bütschlii, Endolimax nana, Giardia intestinalis, Chilomastix mesnilii, Enteromonas hominis, Trichomonas intestinalis, Balantidium coli, and Blastocystis hominis) and 4 helminths (Ancylostoma sp., Strongyloides fuelleborni, Strongyloides sp., and Trichuris trichiura). The results reveal certain parasitic similarities between host species housed in the same gallery; however, these primate species do not always carry identical parasite species.

Diphasic sedimentation technique complemented by a statistical approach as a useful tool to the quantification and the determination of dynamics of eggs produced by adult monogenean parasitizing groupers, Epinephelus marginatus (Lowe, 1834), in captivity Abstract Monogenean parasites create problems in confined fish, such as at aquaculture and aquariums facilities. Strategic timing of antihelminthic treatments should be based on the dynamics of monogenean egg production which requires egg quantification, but there is no standardized analytical method. The WHO diphasic sedimentation method for helminth quantification of eggs was applied in samples with tetrahedral and fusiform monogenean eggs from six specimens of confined groupers (Epinephelus marginatus) (31 m 3 sea water tank; water temperature 21.1-14.4°C; photoperiod 9:53-15 h light; November 2011 to June 2012). Helminth eggs remain in the pellet, while most organic matter was removed forming a cap. In contrast, monogenean eggs are distributed within both the pellet and cap. The diphasic sedimentation method is suitable to quantify tetrahedral and total egg number by counting those eggs in the pellet and incorporing water temperature data to obtain a statistically significant model expression (R 2 = 0.943; R 2 = 0.809), while this approach only weakly predicted fusiform egg numbers (R 2 = 0.297). Fusiform egg numbers declined along November-December, and increased in FebruaryMarch, until June. Tetrahedral eggs decreased in November-December, but did not increase until March. The trend of egg populations and best time for antihelminthic treatment application can be set by WHO technique with the statistical approach proposed.