Case report and presentation of a new classification system for hip acetabular and periacetabular ossifications and calcifications.

This report describes a rare case in which double calcifications of the acetabular labrum and rectus femoris occurred concomitantly in a middle-aged female patient who was treated successfully with surgical intervention via hip arthroscopy. Contribution: This case highlights the existence of various types of calcifications around the acetabulum, with a proposed new classification system for acetabular and periacetabular rim ossifications.

Photostrictive Actuators Based on Freestanding Ferroelectric Membranes.

Complex oxides offer a wide range of functional properties, and recent advances in the fabrication of freestanding membranes of these oxides are adding new mechanical degrees of freedom to this already rich functional ecosystem. Here, photoactuation is demonstrated in freestanding thin film resonators of ferroelectric Barium Titanate (BaTiO3) and paraelectric Strontium Titanate (SrTiO3). The free-standing films, transferred onto perforated supports, act as nano-drums, oscillating at their natural resonance frequency when illuminated by a frequency-modulated laser. The light-induced deflections in the ferroelectric BaTiO3 membranes are two orders of magnitude larger than in the paraelectric SrTiO3 ones. Time-resolved X-ray micro-diffraction under illumination and temperature-dependent holographic interferometry provide combined evidence for the photostrictive strain in BaTiO3 originating from a partial screening of ferroelectric polarization by photo-excited carriers, which decreases the tetragonality of the unit cell. These findings showcase the potential of photostrictive freestanding ferroelectric films as wireless actuators operated by light.

Resonant Transducers Consisting of Graphene Ribbons with Attached Proof Masses for NEMS Sensors.

The unique mechanical and electrical properties of graphene make it an exciting material for nanoelectromechanical systems (NEMS). NEMS resonators with graphene springs facilitate studies of graphene's fundamental material characteristics and thus enable innovative device concepts for applications such as sensors. Here, we demonstrate resonant transducers with ribbon-springs made of double-layer graphene and proof masses made of silicon and study their nonlinear mechanics at resonance both in air and in vacuum by laser Doppler vibrometry. Surprisingly, we observe spring-stiffening and spring-softening at resonance, depending on the graphene spring designs. The measured quality factors of the resonators in a vacuum are between 150 and 350. These results pave the way for a class of ultraminiaturized nanomechanical sensors such as accelerometers by contributing to the understanding of the dynamics of transducers based on graphene ribbons with an attached proof mass.

AURKA Gene Variants rs1047972, and rs8173 Are Associated With Breast Cancer.

PURPOSE: Association between variants rs1047972 and rs8173 of the AURKA gene in healthy women and breast cancer (BC) in a Mexican population. METHODS: Genomic DNA samples from 409 healthy women and 572 patients with BC were analyzed for variants rs1047972 and rs8173 of the AURKA gene by polymerase chain reaction-restriction fragment length polymorphism. RESULTS: TT genotype (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.22-5.11; p = 0.0015) and the T allele (OR, 1.16; 95% CI, 1.23-2.12; p = 0.0007) of the rs1047972 variant were associated as risk susceptibility for BC relative to the control group. Contrarily, the GG genotype (OR, 0.64; 95% CI, 0.43-0.94; p = 0.029) was associated as a protective factor of susceptibility of BC of the variant rs8173 of the AURKA gene. Differences were observed in the patients with BC who were carriers of the CT genotype of the rs1047972 variant with overweight, obesity, estrogen receptor-positive plus obesity, Ki-67 (≥ 20%) plus history familial positive of cancer; and for variant rs8173 the BC patients who were CG carriers and presented chemotherapy gastric toxicity, hormonal receptor positive plus chemotherapy gastric toxicity, and menopause status plus chemotherapy gastric toxicity (p < 0.05). Two common haplotypes were identified in the study groups: CG and TC genotypes, were associated as a protective and risk factor, respectively (p < 0.05). CONCLUSION: Variants rs1047972 and rs8173 of the AURKA gene and the TC haplotype were associated as risk susceptibility factors for BC in this population.

Central generators of migraine and autonomic cephalalgias as targets for personalized pain management: Translational links.

BACKGROUND AND OBJECTIVE: Migraine oscillates between different states in association with internal homeostatic functions and biological rhythms that become more easily dysregulated in genetically susceptible individuals. Clinical and pre-clinical data on migraine pathophysiology support a primary role of the central nervous system (CNS) through 'dysexcitability' of certain brain networks, and a critical contribution of the peripheral sensory and autonomic signalling from the intracranial meningeal innervation. This review focuses on the most relevant back and forward translational studies devoted to the assessment of CNS dysfunctions involved in primary headaches and discusses the role they play in rendering the brain susceptible to headache states. METHODS AND RESULTS: We collected a body of scientific literature from human and animal investigations that provide a compelling perspective on the anatomical and functional underpinnings of the CNS in migraine and trigeminal autonomic cephalalgias. We focus on medullary, hypothalamic and corticofugal modulation mechanisms that represent strategic neural substrates for elucidating the links between trigeminovascular maladaptive states, migraine triggering and the temporal phenotype of the disease. CONCLUSION: It is argued that a better understanding of homeostatic dysfunctional states appears fundamental and may benefit the development of personalized therapeutic approaches for improving clinical outcomes in primary headache disorders. SIGNIFICANCE: This review focuses on the most relevant back and forward translational studies showing the crucial role of top-down brain modulation in triggering and maintaining primary headache states and how these central dysfunctions may interact with personalized pain management strategies.

Broadband Mechanically Tunable Metasurface Reflectivity Modulator in the Visible Spectrum.

Reflectivity modulation is a critical feature for applications in telecommunications, 3D imaging and printing, advanced laser machining, or portable displays. Tunable metasurfaces have recently emerged as a promising implementation for miniaturized and high-performance tunable optical components. Commonly, metasurface response tuning is achieved by electro-optical effects. In this work, we demonstrate reflectivity modulation based on a nanostructured, mechanically tunable, metasurface, consisting of an amorphous silicon nanopillar array and a suspended amorphous silicon membrane with integrated electrostatic actuators. With a membrane displacement of only 150 nm, we demonstrate reflectivity modulation by Mie resonance enhanced absorption in the pillar array, leading to a reflectivity contrast ratio of 1:3 over the spectral range from 400-530 nm. With fast, low-power electrostatic actuation and a broadband response in the visible spectrum, this mechanically tunable metasurface reflectivity modulator could enable high frame rate dynamic reflective displays.

Association between the Polymorphisms rs2070744, 4b/a and rs1799983 of the NOS3 Gene with Chronic Kidney Disease of Uncertain or Non-Traditional Etiology in Mexican Patients.

Background and Objectives: Chronic Kidney Disease of uncertain or non-traditional etiology (CKDnT) is a form of chronic kidney disease of undetermined etiology (CKDu) and is not associated with traditional risk factors. The aim of this study was to investigate the association of polymorphisms rs2070744, 4b/a and rs1799983 of the NOS3 gene with CKDnT in Mexican patients. Materials and Methods: We included 105 patients with CKDnT and 90 controls. Genotyping was performed by PCR-RFLP's, genotypic and allelic frequencies were determined and compared between the two groups using χ2 analysis, and differences were expressed as odd ratios with 95% confidence intervals (CI). Values of p < 0.05 were considered statistically significant. Results: Overall, 80% of patients were male. The rs1799983 polymorphism in NOS3 was found to be associated with CKDnT in the Mexican population (p = 0.006) (OR = 0.397; 95% CI, 0.192-0.817) under a dominant model. The genotype frequency was significantly different between the CKDnT and control groups (χ2 = 8.298, p = 0.016). Conclusions: The results of this study indicate that there is an association between the rs2070744 polymorphism and CKDnT in the Mexican population. This polymorphism can play an important role in the pathophysiology of CKDnT whenever there is previous endothelial dysfunction.

Micro 3D printing of a functional MEMS accelerometer.

Microelectromechanical system (MEMS) devices, such as accelerometers, are widely used across industries, including the automotive, consumer electronics, and medical industries. MEMS are efficiently produced at very high volumes using large-scale semiconductor manufacturing techniques. However, these techniques are not viable for the cost-efficient manufacturing of specialized MEMS devices at low- and medium-scale volumes. Thus, applications that require custom-designed MEMS devices for markets with low- and medium-scale volumes of below 5000-10,000 components per year are extremely difficult to address efficiently. The 3D printing of MEMS devices could enable the efficient realization and production of MEMS devices at these low- and medium-scale volumes. However, current micro-3D printing technologies have limited capabilities for printing functional MEMS. Herein, we demonstrate a functional 3D-printed MEMS accelerometer using 3D printing by two-photon polymerization in combination with the deposition of a strain gauge transducer by metal evaporation. We characterized the responsivity, resonance frequency, and stability over time of the MEMS accelerometer. Our results demonstrate that the 3D printing of functional MEMS is a viable approach that could enable the efficient realization of a variety of custom-designed MEMS devices, addressing new application areas that are difficult or impossible to address using conventional MEMS manufacturing.

Altered cortical trigeminal fields excitability by spreading depolarization revealed with in vivo functional ultrasound imaging combined with electrophysiology.

Spreading depolarization (SD), usually termed cortical spreading depression has been proposed as the pathophysiological substrate of migraine aura and as an endogenous trigger of headache pain. The links between neurovascular coupling and cortical craniofacial nociceptive activities modulated by SD were assessed by combining in vivo local field potential (LFPs) recordings in the primary somatosensory cortex (S1) with functional ultrasound (fUS) imaging of S1 and caudal insular (INS) cortices of anesthetized male rats. A single SD wave triggered in the primary visual cortex elicited an ipsilateral, quadriphasic hemodynamic and electrophysiological response in S1 with an early phase consisting of concomitant increases of relative cerebral blood volume (rCBV) and LFPs. A transient hypoperfusion was then correlated with the beginning of the neuronal silence, followed by a strong increase of rCBV while synaptic activities remained inhibited.LFPs and rCBV recovery period was followed by a progressive increase in S1 and INS baseline activities and facilitation of cortical responses evoked by periorbital cutaneous receptive fields stimulation. Sensitization of cortical ophthalmic fields by SD was bilateral, occurred with precise spatiotemporal profiles and was significantly reduced by pre-treatment with a NMDA antagonist. Combined high-resolution assessing of neurovascular coupling and electrophysiological activities has revealed a useful preclinical tool for deciphering central sensitization mechanisms involved in migraine attacks.SIGNIFICANCE STATEMENTA crucial unsolved issue is whether visual aura and migraine headache are parallel or sequential processes. Here we show that a single spreading depolarization (SD) wave triggered from the primary visual cortex is powerful enough to elicit progressive, sustained increases of hemodynamic and sensory responses to percutaneous periorbital noxious stimuli recorded in S1 and Insular ophthalmic fields. Sensitization of cortical ophthalmic fields by SD was bilateral, occurred with precise spatiotemporal profiles and was significantly reduced by pre-treatment with a NMDA antagonist. Combined high-resolution assessing of neurovascular coupling and electrophysiological activities has revealed a useful preclinical tool for deciphering central sensitization mechanisms involved in migraine attacks.

A Resonant Graphene NEMS Vibrometer.

Measuring vibrations is essential to ensuring building structural safety and machine stability. Predictive maintenance is a central internet of things (IoT) application within the new industrial revolution, where sustainability and performance increase over time are going to be paramount. To reduce the footprint and cost of vibration sensors while improving their performance, new sensor concepts are needed. Here, double-layer graphene membranes are utilized with a suspended silicon proof demonstrating their operation as resonant vibration sensors that show outstanding performance for a given footprint and proof mass. The unveiled sensing effect is based on resonant transduction and has important implications for experimental studies involving thin nano and micro mechanical resonators that are excited by an external shaker.

Sexual Dimorphism of the Neuroimmunoendocrine Response in the Spleen during a Helminth Infection: A New Role for an Old Player?

The interaction of the nervous, immune, and endocrine systems is crucial in maintaining homeostasis in vertebrates, and vital in mammals. The spleen is a key organ that regulates the neuroimmunoendocrine system. The Taenia crassiceps mouse system is an excellent experimental model to study the complex host-parasite relationship, particularly sex-associated susceptibility to infection. The present study aimed to determine the changes in neurotransmitters, cytokines, sex steroids, and sex-steroid receptors in the spleen of cysticercus-infected male and female mice and whole parasite counts. We found that parasite load was higher in females in comparison to male mice. The levels of the neurotransmitter epinephrine were significantly decreased in infected male animals. The expression of IL-2 and IL-4 in the spleen was markedly increased in infected mice; however, the expression of Interleukin (IL)-10 and interferon (IFN)-γ decreased. We also observed sex-associated differences between non-infected and infected mice. Interestingly, the data show that estradiol levels increased in infected males but decreased in females. Our studies provide evidence that infection leads to changes in neuroimmunoendocrine molecules in the spleen, and these changes are dimorphic and impact the establishment, growth, and reproduction of T. crassiceps. Our findings support the critical role of the neuroimmunoendocrine network in determining sex-associated susceptibility to the helminth parasite.

Creencias tradicionales mexicanas y su relación con la aceptación de la autotoma vaginal para la detección del VPH / Traditional Mexican beliefs and their relationship with the acceptance of vaginal self-sampling for HPV detection

Resumen OBJETIVO: Conocer el grado de aceptación de la autotoma vaginal y su relación con variables psicosocioculturales que prevalecen en México. MATERIALES Y MÉTODOS: Estudio observacional, prospectivo, transversal y descriptivo, efectuado entre 2017 y 2018 en mujeres del estado de Guanajuato. Se aplicaron cuestionarios y entrevistas antes y después de la toma de la muestra mediante la autotoma. El análisis estadístico incluyó medidas de tendencia central, medidas de dispersión, frecuencias y proporciones. Las diferencias entre grupos se analizaron con las pruebas de Wilcoxon y t de Student. RESULTADOS: Se estudiaron 85 mujeres con edad promedio de 37.82 años (± 9.82). Si bien 75 participantes declararon no conocer el procedimiento, 80 accedieron a practicarlo. Se encontró que la mayoría de las mujeres prefiere la autotoma a la inspección ginecológica tradicional. Se observaron dos perfiles sociopsicológicos opuestos entre las mujeres que prefieren la autotoma por "pena" y las que optan por ella por su "facilidad". CONCLUSIONES: La autotoma fue un método de muestreo completamente viable en el contexto en el que se llevó a cabo esta investigación. Si bien se observaron barreras psicosocioculturales, la autotoma se prefirió entre las mujeres que informaron acudir menos al ginecólogo, por lo que puede constituir una estrategia para las mujeres con baja vigilancia médica.

Abstract OBJECTIVE: To know the degree of acceptance of vaginal autotomy and its relationship with psychosocial-cultural variables prevailing in Mexico. MATERIALS AND METHODS: Observational, prospective, cross-sectional and descriptive study, carried out between 2017 and 2018 in women in the state of Guanajuato. Questionnaires and interviews were applied before and after sampling by autotoma. Statistical analysis included measures of central tendency, measures of dispersion, frequencies and proportions. Differences between groups were analyzed with Wilcoxon and Student's t-tests. RESULTS: Eighty-five women with a mean age of 37.82 years (± 9.82) were studied. Although 75 participants stated that they were unaware of the procedure, 80 agreed to undergo it. It was found that the majority of women preferred autotoma to traditional gynecological inspection. Two opposite socio-psychological profiles were observed between women who prefer autotomy for "embarrassment" and those who opt for it because of its "ease". CONCLUSIONS: Autotomography was a completely feasible sampling method in the context in which this research was conducted. Although psychosocio-cultural barriers were observed, autotoma was preferred among women who reported less frequent visits to the gynecologist, so it may be a strategy for women with low medical vigilance.

Avoiding transduction-induced heating in suspended microchannel resonators using piezoelectricity.

Calorimetry of single biological entities remains elusive. Suspended microchannel resonators (SMRs) offer excellent performance for real-time detection of various analytes and could hold the key to unlocking pico-calorimetry experiments. However, the typical readout techniques for SMRs are optical-based, and significant heat is dissipated in the sensor, altering the measurement and worsening the frequency noise. In this manuscript, we demonstrate for the first time full on-chip piezoelectric transduction of SMRs on which we focus a laser Doppler vibrometer to analyze its effect. We demonstrate that suddenly applying the laser to a water-filled SMR causes a resonance frequency shift, which we attribute to a local increase in temperature. When the procedure is repeated at increasing flow rates, the resonance frequency shift diminishes, indicating that convection plays an important role in cooling down the device and dissipating the heat induced by the laser. We also show that the frequency stability of the device is degraded by the laser source. In comparison to an optical readout scheme, a low-dissipative transduction method such as piezoelectricity shows greater potential to capture the thermal properties of single entities.

Design and fabrication of a vigorous "cavitation-on-a-chip" device with a multiple microchannel configuration.

Hydrodynamic cavitation is one of the major phase change phenomena and occurs with a sudden decrease in the local static pressure within a fluid. With the emergence of microelectromechanical systems (MEMS), high-speed microfluidic devices have attracted considerable attention and been implemented in many fields, including cavitation applications. In this study, a new generation of 'cavitation-on-a-chip' devices with eight parallel structured microchannels is proposed. This new device is designed with the motivation of decreasing the upstream pressure (input energy) required for facile hydrodynamic cavitation inception. Water and a poly(vinyl alcohol) (PVA) microbubble (MB) suspension are used as the working fluids. The results show that the cavitation inception upstream pressure can be reduced with the proposed device in comparison with previous studies with a single flow restrictive element. Furthermore, using PVA MBs further results in a reduction in the upstream pressure required for cavitation inception. In this new device, different cavitating flow patterns with various intensities can be observed at a constant cavitation number and fixed upstream pressure within the same device. Moreover, cavitating flows intensify faster in the proposed device for both water and the water-PVA MB suspension in comparison to previous studies. Due to these features, this next-generation 'cavitation-on-a-chip' device has a high potential for implementation in applications involving microfluidic/organ-on-a-chip devices, such as integrated drug release and tissue engineering.

Cysticidal effect of a pure naphthoquinone on Taenia crassiceps cysticerci.

Cysticercosis is a disease caused by the metacestode of the parasite Taenia solium (T. solium). In humans, the most severe complication of the disease is neurocysticercosis. The drug of choice to treat this disease is albendazole; however, the bioavailability and efficacy of the drug are variable. Therefore, new molecules with therapeutic effects against this and other parasitic infections caused by helminths must be developed. Naphthoquinones are naphthalene-derived compounds that possess antibacterial, antifungal, antitumoral, and antiparasitic properties. The aim of this work was to evaluate the in vitro anti-helminthic effect of 2-[(3-chlorophenylamino)phenylmethyl]-3-hydroxy-1,4-naphthoquinone, isolated from a natural source and then synthesized (naphthoquinone 4a), using an experimental model of murine cysticercosis caused by Taenia crassiceps (T. crassiceps). This compound causes paralysis in the cysticerci membrane from day 3 of the in vitro treatment. Additionally, it induces changes in the shape, size, and appearance of the cysticerci and a decrease in the reproduction rate. In conclusion, naphthoquinone 4a has in vitro cysticidal activity on T. crassiceps cysticerci depending on the duration of the treatment and the concentration of the compound. Therefore, it is a promising drug candidate to be used in T. crassiceps and possibly T. solium infections.

Total neoadjuvant chemotherapy with FLOT scheme in resectable adenocarcinoma of the gastro-oesophageal junction or gastric adenocarcinoma: impact on pathological complete response and safety.

BACKGROUND: Gastric cancer is the fifth cause of cancer incidence worldwide. Multidisciplinary approaches that improve the survival are needed. Perioperative chemotherapies show improvement in pathological complete remission (pCR) and overall survival (OS), but less than 50% of the patients completed the chemotherapeutic regimen. The recent 5-fluorouracil, leucovorin, oxaliplatin, docetaxel-4 (FLOT4) study shows OS 50 months and pCR 16.6%, but only 46% of the patients completed pre- and postoperative treatment. This case series report evaluated pCR and safety in patients that received complete preoperative chemotherapeutic with FLOT. METHODS: Patients received eight cycles FLOT regimen before surgery. Each cycle comprised 50 mg/m2 docetaxel intravenous (iv) on day 1, 85 mg/m2 oxaliplatin iv on day 1, 200 mg/m2 leucovorin iv on day 1 and 2,600 mg/m2 5-fluorouracil iv in a 24-hour infusion on day 1, every 2 weeks. RESULTS: Fifty-nine patients were evaluated, 58 patients received preoperative cycles. Thirty-one patients received all eight cycles of preoperative therapy. 65.5% patients presented any major adverse event. Thirty-nine patients underwent surgery. Thirty-three biopsy reports were obtained. Six patients (18.2%) presented pCR, 13 patients (39.4%) had no lymph node involvement. OS was 21.32 months. Patients with histology of signet ring carcinoma cells had a shorter survival than other histologies. CONCLUSION: Total neoadjuvant with FLOT chemotherapy presents an adequate safety profile, a similar pathologic regression rate, and a slightly higher rate of completing treatment to report in perioperative FLOT regimen studies. A prospective clinical study with suitable diagnostic, staging tools and an adequate follow-up may prove total neoadjuvant chemotherapy's efficacy.

Directed Self-Assembly of Block Copolymers for the Fabrication of Functional Devices.

Directed self-assembly of block copolymers is a bottom-up approach to nanofabrication that has attracted high interest in recent years due to its inherent simplicity, high throughput, low cost and potential for sub-10 nm resolution. In this paper, we review the main principles of directed self-assembly of block copolymers and give a brief overview of some of the most extended applications. We present a novel fabrication route based on the introduction of directed self-assembly of block copolymers as a patterning option for the fabrication of nanoelectromechanical systems. As a proof of concept, we demonstrate the fabrication of suspended silicon membranes clamped by dense arrays of single-crystal silicon nanowires of sub-10 nm diameter. Resulting devices can be further developed for building up high-sensitive mass sensors based on nanomechanical resonators.

Efficacy and Safety of Pembrolizumab or Pembrolizumab Plus Chemotherapy vs Chemotherapy Alone for Patients With First-line, Advanced Gastric Cancer: The KEYNOTE-062 Phase 3 Randomized Clinical Trial.

Importance: Safe and effective therapies for untreated, advanced gastric/gastroesophageal junction (G/GEJ) cancer remain an unmet need. Objective: To evaluate the antitumor activity of pembrolizumab, pembrolizumab plus chemotherapy, or chemotherapy alone in patients with untreated, advanced G/GEJ cancer with programmed cell death ligand 1 (PD-L1) combined positive score (CPS) of 1 or greater. Design, Setting, and Participants: The phase 3 KEYNOTE-062 randomized, controlled, partially blinded interventional trial enrolled 763 patients with untreated, locally advanced/unresectable or metastatic G/GEJ cancer with PD-L1 CPS of 1 or greater from 200 centers in 29 countries between September 18, 2015, and May 26, 2017. Interventions: Patients were randomized 1:1:1 to pembrolizumab 200 mg, pembrolizumab plus chemotherapy (cisplatin 80 mg/m2/d on day 1 plus fluorouracil 800 mg/m2/d on days 1 to 5 or capecitabine 1000 mg/m2 twice daily), or chemotherapy plus placebo, every 3 weeks. Main Outcomes and Measures: Primary end points were overall survival (OS) and progression-free survival (PFS) in patients with PD-L1 CPS of 1 or greater or 10 or greater. Results: A total of 763 patients were randomized to pembrolizumab (n = 256), pembrolizumab plus chemotherapy (n = 257), or chemotherapy (n = 250). The median (range) age of all patients in the study cohort was 62 (20-87) years; 554 of 763 (72.6%) were men. At final analysis, after a median (range) follow-up of 29.4 (22.0-41.3) months, pembrolizumab was noninferior to chemotherapy for OS in patients with CPS of 1 or greater (median, 10.6 vs 11.1 months; hazard ratio [HR], 0.91; 99.2% CI, 0.69-1.18). Pembrolizumab monotherapy was not superior to chemotherapy in patients with CPS of 1 or greater. Pembrolizumab prolonged OS vs chemotherapy in patients with CPS of 10 or greater (median, 17.4 vs 10.8 months; HR, 0.69; 95% CI, 0.49-0.97), but this difference was not statistically tested. Pembrolizumab plus chemotherapy was not superior to chemotherapy for OS in patients with CPS of 1 or greater (12.5 vs 11.1 months; HR, 0.85; 95% CI, 0.70-1.03; P = .05) or CPS of 10 or greater (12.3 vs 10.8 months; HR, 0.85; 95% CI, 0.62-1.17; P = .16) or for PFS in patients with CPS of 1 or greater (6.9 vs 6.4 months; HR, 0.84; 95% CI, 0.70-1.02; P = .04). Grade 3 to 5 treatment-related adverse event rates for pembrolizumab, pembrolizumab plus chemotherapy, and chemotherapy were 17%, 73%, and 69%, respectively. Conclusions and Relevance: This phase 3 randomized clinical trial found that among patients with untreated, advanced G/GEJ cancer, pembrolizumab was noninferior to chemotherapy, with fewer adverse events observed. Pembrolizumab or pembrolizumab plus chemotherapy was not superior to chemotherapy for the OS and PFS end points tested. Trial Registration: ClinicalTrials.gov Identifier: NCT02494583.

Management of cancer patients during COVID-19 pandemic at developing countries.

Cancer patient care requires a multi-disciplinary approach and multiple medical and ethical considerations. Clinical care during a pandemic health crisis requires prioritising the use of resources for patients with a greater chance of survival, especially in developing countries. The coronavirus disease 2019 crisis has generated new challenges given that cancer patients are normally not prioritised for admission in critical care units. Nevertheless, the development of new cancer drugs and novel adjuvant/neoadjuvant protocols has dramatically improved the prognosis of cancer patients, resulting in a more complex decision-making when prioritising intensive care in pandemic times. In this context, it is essential to establish an effective and transparent communication between the oncology team, critical care, and emergency units to make the best decisions, considering the principles of justice and charity. Concurrently, cancer treatment protocols must be adapted to prioritise according to oncologic response and prognosis. Communication technologies are powerful tools to optimise cancer care during pandemics, and we must adapt quickly to this new scenario of clinical care and teaching. In this new challenging pandemic scenario, multi-disciplinary work and effective communication between clinics, technology, science, and ethics is the key to optimising clinical care of cancer patients.

Mucinous cystic neoplasms of the pancreas associated with pregnancy: Two case reports.

RATIONALE: Although rare, pancreatic neoplasms can occur during pregnancy, both in benign and malignant forms. Mucinous cystic neoplasms (MCNs) of the pancreas, a type of these neoplasms, are precursor lesions to invasive pancreatic cancer. The presence of the ovarian-type stroma is a defining feature. PATIENT CONCERNS: The first case was a 38-year-old woman in her 18th week of pregnancy with abdominal pain that worsens a few weeks later. The second case was a 30-year-old woman in her 17th week of pregnancy with abdominal pain in the left hypochondrium. DIAGNOSIS: The patients were under clinical examination and laboratory test including carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA). Both patients had magnetic resonance imaging (MRI). The diagnosis of a MCNs of the pancreas was done preoperatively in the 2 cases. INTERVENTIONS: Both patients underwent distal pancreatectomy during pregnancy. One of them was an emergency laparotomy because of a ruptured MCN. OUTCOMES: Both patients were completely recovered from distal pancreatectomy and continued to full term, delivering a healthy baby by Caesarean section. After 6 years of follow-up, the first patient underwent a total gastrectomy, because of a gastric cancer with carcinomatosis. Currently the 2 patients are still alive after 8 years and 5 years of follow-up, respectively. LESSONS: Surgical resection of MCNs during pregnancy should be considered during the second trimester given common distal pancreas location, rapid growth, risk of spontaneous rupture, and malignant potential.