Neoadjuvant immunotherapy in microsatellite instability-high (MSI-H) duodenal adenocarcinoma leads to pathological complete response and paves the way for new strategies.

Duodenal adenocarcinoma is a rare digestive cancer, often diagnosed at a late stage and harbours a poor prognosis. The arrival of immunotherapy has changed the prognosis of many neoplasia, including digestive adenocarcinomas with MSI-H status. Hereby, we describe three cases of MSI-H locally advanced duodenal adenocarcinoma who received neoadjuvant treatment with a PD1 inhibitor, pembrolizumab. A partial metabolic and endoscopic response was observed in all patients after 2 cycles. Duodenopancreatectomy was performed at the end of treatment (4-6 cycles), and anatomopathological analysis demonstrated pathological complete response in all patients. Our case series paves the way for prospectively exploring neoadjuvant immunotherapy in duodenal MSI-H adenocarcinoma and raises the question of organ sparing surgery in case of complete clinical response as observed in gastric and colo-rectal adenocarcinomas.

Medical anticancer treatment of lung cancer associated with comorbidities: a review.

Comorbidities are frequent in patients with lung cancer, who are often treated with systemic anticancer therapy. The purpose of the present review is to report the adaptations recommended for the various drugs used in lung cancer treatment, in the context of a specific comorbidity. The literature was reviewed for neurologic, endocrine, hepatic, renal, digestive, cardiovascular, pulmonary, blood and systemic diseases. The comorbidities impact on the systemic anticancer treatment is poorly assessed. There are no good data with a high level of evidence and literature is often limited to experts' opinion and to case reports. We need to improve our knowledge about those patients by adequate multicentric and prospective studies and registries in order to offer them better care in term of evidence-based medicine.

Integrating gender into a basic medical curriculum.

INTRODUCTION: In 1998, gaps were found to exist in the basic medical curriculum of the Radboud University Nijmegen Medical Centre regarding health-related gender differences in terms of biological, psychological and social factors. After screening the curriculum for language, content and context, adjustments aimed at incorporating gender issues were proposed. The aim of this study was to evaluate those adjustments, as well as to investigate whether gender had been successfully incorporated into the basic medical curriculum, and to identify the factors that played a role in this. METHODS: The education material of 9 curricular blocks was re-evaluated and interviews were held with block co-ordinators. RESULTS: Since the beginning of the project, gender has increasingly been brought to the attention of the students. Various factors have played a role: concrete and directly executable content-oriented proposals for adjustment; adequate translation of gender differences into actual patient care; motivated block co-ordinators; the presence of a 'trigger person' in the faculty; incorporation into the existing education programme; the involvement of block co-ordinators in decision making, and the provision of practical support. DISCUSSION: Integrating gender into the basic medical curriculum has been largely successful. Block co-ordinators' personal recognition of the importance of gender in patient care greatly facilitated implementation. The evaluation stimulated the forming of new ideas. It is recommended that these factors and those mentioned above should be taken into consideration when integrating gender into other faculties.

Mirrow reactions of Down's syndrome infants and toddlers: cognitive underpinnings of self-recognition.

To examine the developmental significance of mirrow self-recognition in early childhood, a cross-sectional study with 55 Down's syndrome children was conducted. When their image is altered by rouge on the nose, normal infants by 22 months indicate self-recognition by touching their noses while looking in the mirror. Only a small percentage of Down's syndrome children touched their noses by this age, confirming the expected lag in this development. However, those young Down's syndrome infants with near-normal development quotient did manifest the reaction. In general, when developmental age was equated, the Down's syndrome children showed parallel development to normal children.

Alternating measurement of ambient and cabin ozone concentrations in commercial jet aircraft.

Ambient and cabin-air ozone concentrations were determined with an adapted commercial ozone analyzer installed in a KLM DC-10 from Amsterdam to Toronto and back. Cabin levels were detected directly and almost continuously; ambient levels were measured using a sampling system in which the ambient samples were converted to the cabin pressure at intervals of 13 min. A correlation is demonstrated between the ambient level, the cabin level, and the tropopause height. It was found that 70% of the ambient ozone concentration enters the cabin through the ventilation system, and about 50% of this concentration was measured 1.20 m above the cabin floor. For about 50% of the total flying time, the ozone level exceeded 200 parts per billion, by volume (ppb) in the cabin, with peak concentrations of about 600 ppb (TLV levels of 80--100 ppb apply in most IATA countries). Finally, medical and technical recommendations are made for future measurements.