Management of Aortoesophageal Fistula in a Palliative Patient with Non-Small-Cell Lung Cancer: A Case Report.

INTRODUCTION: Aortoesophageal fistulas are a rare but life-threatening complication in patients with thoracic malignancies. CASE PRESENTATION: We describe a case of a 55-year-old female patient with metastatic non-small-cell lung cancer. Due to esophageal tumor compression, a fully covered self-expanding metal stent (fcSEMS) had been deployed in the esophagus several months before. The patient was subsequently admitted to the emergency department with massive hematemesis. Endoscopy suggested a fistula between the aorta and the esophagus proximal of the fcSEMS, which was confirmed by computed tomography and led to hemodynamical relevant upper gastrointestinal bleeding. A thoracic endovascular aortic repair was performed to stop the hemorrhage. After the successful intervention, the patient needed long-term antibiotic treatment, and the fcSEMS remained in place. Afterward, the patient continued palliative tumor therapy using pembrolizumab for further 5 months. The patient died 8 months after the initial admission to the emergency department. CONCLUSION: This is to the best of our knowledge the first case of a technically successful interventional therapy of an aortoesophageal fistula which did not only achieve hemostasis but also enabled the patient to continue tumor therapy to regain quality of life.

Brain metastases in gastroesophageal cancers-an underestimated complication.

BACKGROUND: Brain metastases represent a severe complication in many gastrointestinal malignancies especially those arising from the upper gastrointestinal tract, including cancer of the esophagus, gastroesophageal junction, and stomach (GEC). However, there is little knowledge about the onset or potential risk factors for brain metastases (BRMs) in upper gastrointestinal cancers resulting in a lack of screening guidelines for BRMs. METHODS: We analyzed 827 patients from our cancer registry suffering from gastroesophageal cancer (GEC) and treated at the University Medical Center Göttingen between January 2013 and December 2019 for the presence of BRMs. RESULTS: From 827 patients with GEC we found 54 patients with BRMs, resulting in an incidence of 6.5%. BRMs are more frequent in male patients (90.74% vs 9.26%, p = 0.0051) and in adenocarcinomas (90.74% vs 9.26%, p = 0.0117). Mean duration for the onset of BRMs from initial cancer diagnoses was 20.9 months in limited disease (curative approach) and 9.3 months in advanced disease (palliative approach) (p = 0.0026). However, early detection of BRMs is a prognostic factor since patients with successful resection of BRMs have a better prognosis compared to those with unresectable BRMs (5.93 vs 2.07 months, p = 0.0091). CONCLUSION: In this single-center retrospective study, brain metastases (BRMs) occur with a high frequency (6.5%) in gastroesophageal cancer (GEC), significantly more often in male patients and adenocarcinomas. Since survival of these patients considerably correlates with successful BRMs resection, our observations propose further prospective trails to validate our hypothesis and ultimately the implementation of routine screening procedures to detect asymptomatic brain metastases.

Protect ya Grandma! The Effects of Students' Epistemic Beliefs and Prosocial Values on COVID-19 Vaccination Intentions.

The present study investigates epistemic beliefs (beliefs about the nature of knowledge and knowing) and prosocial values as predictors of COVID-19 vaccination intentions. As a first hypothesis, we posit that beliefs in justification by authority will positively relate to vaccination intentions. Second, we expect a positive relationship between prosocial values and vaccination intentions. Third, we hypothesize that beliefs in justification by authority moderate the relationship between prosocial values and vaccination intentions, so that the positive correlation between prosocial values and vaccination intentions becomes stronger with increasing beliefs in justification by authority. Hypotheses were tested in a sample of N = 314 German university students, a group with rather high mobility, who, when vaccinated, will increase the chance of attaining herd immunity. Hypotheses were tested using correlational and multiple regression analyses. Results revealed a highly significant positive relationship between justification by authority and vaccination intentions, whereas both hypotheses that included prosocial values did not yield significant results. Additional exploratory analyses revealed that the relationship between justification by authority and vaccination intentions was mediated by beliefs in the safety and effectiveness of the vaccines. Furthermore, significant negative relationships were found between personal justification and vaccination intentions as well as between justification by multiple sources and vaccination intentions. These results highlight the crucial role of science and public health communication in fostering vaccination intentions regarding COVID-19.