Immune checkpoint inhibitors (ICIs) have resulted in improved outcomes in non-small cell lung cancer (NSCLC) patients. However, data demonstrating the efficacy of ICIs in NSCLC brain metastases (NSCLCBM) is limited. We analyzed overall survival (OS) in patients with NSCLCBM treated with ICIs within 90 days of NSCLCBM diagnosis (ICI-90) and compared them to patients who never received ICIs (no-ICI). We reviewed 800 patients with LCBM who were diagnosed between 2010 and 2019 at a major tertiary care institution, 97% of whom received stereotactic radiosurgery (SRS) for local treatment of BM. OS from BM was compared between the ICI-90 and no-ICI groups using the Log-Rank test and Cox proportional-hazards model. Additionally, the impact of KRAS mutational status on the efficacy of ICI was investigated. After accounting for known prognostic factors, ICI-90 in addition to SRS led to significantly improved OS compared to no-ICI (12.5 months vs 9.1, p < 0.001). In the 109 patients who had both a known PD-L1 expression and KRAS status, 80.4% of patients with KRAS mutation had PD-L1 expression vs 61.9% in wild-type KRAS patients (p = 0.04). In patients without a KRAS mutation, there was no difference in OS between the ICI-90 vs no-ICI cohort with a one-year survival of 60.2% vs 54.8% (p = 0.84). However, in patients with a KRAS mutation, ICI-90 led to a one-year survival of 60.4% vs 34.1% (p = 0.004). Patients with NSCLCBM who received ICI-90 had improved OS compared to no-ICI patients. Additionally, this benefit appears to be observed primarily in patients with KRAS mutations that may drive the overall benefit, which should be taken into account in the development of future trials.

Takotsubo cardiomyopathy (TC) is a non-ischemic cardiomyopathy that is accompanied by sudden left ventricular myocardial stunning, dilation and dysfunction. It often results from severe emotional or physical stress. We present the case of a 41-year-old female patient who had general anesthesia induced uneventfully for an elective bladder sling procedure. After an intravaginal injection of local anesthesia (lidocaine 2%; epinephrine 1:100,000) just prior to the surgical incision, the patient had cardiovascular collapse for which cardiopulmonary resuscitation (CPR) was performed. The patient was eventually stabilized but transesophageal echocardiography showed impairment in cardiac motion and remarkably reduced ejection fraction. Troponin levels were elevated but coronary angiography was unremarkable. The ejection fraction returned to normal the next day. Local anesthetic with epinephrine administration can lead to TC, and with optimal management, long-term cardiac sequela can be avoided.

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In high-rise buildings, shear walls are an important structures feature for sustaining lateral forces. The production of prefabricated steel frames buildings will effectively overcome iron and steel spare capacity, allowing the building sector to recover the industrial revolution. As an advanced kind of flexural rigidity steel plate shear walls (SPSWs) can withstand majority of the load in the frame structure, boost the preliminary lateral toughness and lateral bearing strength, and serve as a first protective barrier until the main frame is demolished, reducing the main frame's failure level and improving the structure's failure resistance. When structures are subjected to external loads such as earthquakes, wind, and other natural disasters, shear walls can be used to increase the structure's strength and safety. The main focus of this research is to use SAP2000 to compare and analyze two different types of shear walls in two different 7-story buildings. Two structural members, one having a honeycombed steel sheet sandwiched between two thin steel plates shear wall and the other having RCC shear wall are compared based on lateral loading parameters (base shear, displacement story-drift etc.). Using SAP2000, the effects of three main parameters were investigated by Pushover analysis and Time history analysis. From the complete analysis, shear wall with honey combed thin plates is proved to be better against seismic and wind loading as compared to RCC wall as well as honeycombed sheet sandwiched between steel plates is economical and gives more area to the story by occupying less space.

INTRO/OBJECTIVE Glioblastoma (GBM) and MGMT have been reported to have sexual dimorphism. In multiple studies, including our own population-based cohort analysis, females had higher rates of MGMT methylation and improved methylation-associated progression-free and overall survival outcomes compared to males. MGMT methylation is assessed as a mean of five cysteine-phosphate-guanine (CpG1-5) islands (CpG methylation is highly inversely correlated with MGMT RNA expression). The primary objective of this study was to investigate differences in mean and individual CpG methylation by sex. METHODS 155 patients who underwent first surgical intervention for newly diagnosed GBM at a single tertiary care institution between 2016 and 2018 were reviewed. Of these, 135 patients had available CpG methylation data determined by a clinically validated test using bisulfate conversion followed by PCR and pyrosequencing. MGMT was defined as methylated if the mean of CpG1-5 ≥ 12. The mean of CpG1-5 and each CpG parameter were compared by sex using the Wilcoxon signed-rank test. RESULTS Overall (mean age 62, 34% female, 42% MGMT methylated), the median (IQR) of mean degree of methylation was 4.0% (2–33) and median CpG1-5 ranged from 3.0 to 4.5%. More females (53.3%) were MGMT methylated than males (37.1%). Females had significantly higher rates of mean methylation compared to males (14.0 vs 3.0%, p=0.046). Females also had higher rates of methylation at each CpG island compared to males CpG1(7.0 vs 3.0%, p=0.15), CpG2(8.0 vs 4.0%, p=0.10), CpG3(9.0 vs 4.0%, p=0.23), CpG4(7.0 vs 3.0%, p=0.047), and CpG5(6.0 vs 4.0%, p=0.097). CONCLUSION Females had higher rates of mean methylation and methylation of each CpG island compared to males, although only mean and CpG4 methylation values were statistically significant given the limited sample size. Further investigation with a larger cohort is ongoing to elucidate this dimorphism and establish whether sex-specific methylation cut-offs need to be implemented into clinical practice.

The only significant predictor for non-dHGP was detectable CTCs (odds ratio: 2.39 95%CI 1.07;5.63, p=0.037). Conclusion: A significantly higher rate of circulating tumour cells were detected in patients with non-dHGP and detectable circulating tumor cells was the only significant predictor for the presence of non-dHGP.

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Introduction: Surgery remains the only treatment in pancreatic cancer with a chance for cure, but it is only possible in 10 to 20%. The purpose of this study is to research the early clinical and biological criteria which will predict the profile of patients with resectable tumor. Methods: 1001 patients were included by 15 centers in BACAP between May 2014 and July 2017. Three groups were defined: Resectable (Res), Locally advanced (LA) and Metastatic (Met). 71 variables were analyzed in univariable and 21 in multivariable tests in each group. Results: Of the 1001 patients included in BACAP, 703 were analyzed. The Res group included 164 patients, the LA group 266 patients and the Met group 273 patients. The median ages were 69, 71 and 69 respectively. The patients were correctly classified by the initial assessment in 72% of the Res, 85% of the LA, and 87% of the Met. The median survival rate of the Res, LA and Met were 21, 15 and 9 months, respectively. We found 6 criteria which reduced the probability of resectable tumor: a cruoric thrombosis, an OMS 2, pain, characteristic symptoms (jaundice, weight loss and acute pancreatitis), the body topography and the size of the tumor. Two biological criteria increased the probability of having a resectable lesion: elevated bilirubin and an ACE rate < 10 ng/ml. Conclusion: This study carried out on a large national cohort allowing us to define the predictive clinical and biological profile of tumor resectability at the time of diagnosis.