Breast cancer has a strange way of being both familiar and frightening. Almost everyone knows someone who has battled it, and yet the details of treatment often sound like an alien language. According to the World Health Organisation, breast cancer is the most common cancer among women worldwide, with 2.3 million new cases in 2022 alone. Among these, about 15 to 20 per cent are HER2-positive, the type that is fast-moving, aggressive, and hard to ignore.

Increasingly, the doctors are turning to a strategy that feels a bit like hitting “pause” before the main act—neoadjuvant therapy.

What Makes HER2-Positive Breast Cancer Tricky

HER2 (human epidermal growth factor receptor 2) is a protein that helps cells grow. In HER2-positive breast cancer, the cells get an overdose of this protein. As a result, the cancer multiplies faster than usual and is often linked to poorer outcomes.

“HER2-positive breast cancer is an aggressive type,” explains Dr Mandeep Singh Malhotra, co-founder, Art Of Healing Cancer. “It is very important to give the right information to patients and their families for better outcomes. With the right treatment sequence, it is possible to offer better treatment to patients.”

What Is Neoadjuvant Therapy?

Neoadjuvant therapy (NT) is like a warm-up session but for cancer treatment. Instead of rushing into surgery to remove the tumour, doctors first administer chemotherapy and targeted drugs. The idea is to shrink the tumour, make surgery easier, and gather valuable intel on how the cancer responds.

“Nowadays, when we talk about HER2-positive breast cancer, we talk about targeted therapy and dual targeted therapy involving both trastuzumab and pertuzumab,” says Dr Malhotra. Both are monoclonal antibodies, meaning they are lab-made molecules designed to stick to specific parts of cancer cells. Together with chemotherapy, they not only shrink tumours but also improve surgical outcomes.

Why Doctors Like It

One of the superpowers of neoadjuvant therapy is its ability to act as a kind of crystal ball. By giving treatment before surgery, doctors can tell which patients are “responders” and which are not.

“As Dr Malhotra puts it, “Even at early stages, if we give NT and then operate, we are able to prognosticate. Responders have a better prognosis. Non-responders have poorer prognosis and a higher chance of the cancer coming back.”

This ability to sort patients into risk categories allows doctors to tailor follow-up care more precisely. For example, non-responders may be put on more aggressive treatments, offered newer diagnostic tests like liquid biopsy, or monitored more closely.

The Big Advantage Over Surgery-First

Surgery-first and neoadjuvant-first have similar survival data, but the latter provides an extra layer of information.

“If we do upfront surgery in these patients, we lose the chance of prognostication,” says Dr Malhotra. “Secondly, even if we do the upfront surgery, we will still have to give chemo with targeted therapy after surgery. So the treatment does not change; the sequence changes. And with neoadjuvant therapy, we get the added benefit of knowing who is high risk and who is low risk.”

In other words, neoadjuvant therapy is not just about shrinking tumours; it is about outsmarting them.

What Patients Need to Keep in Mind

For patients, all of this can feel overwhelming. Surgery often seems like the most direct way to “get rid” of cancer, so the idea of delaying it can cause anxiety. But Dr Malhotra reassures patients that this approach is carefully designed.

“Even in very early-stage breast cancer, with a less than 1 cm tumour, I will not go for surgery first,” he says. “I will first give targeted chemotherapy. The reason is I see a lot of patients who have already had surgery and then are given the option of dual therapy. They are confused and afraid that the cancer will come back if they cannot afford either trastuzumab or pertuzumab.”

Interestingly, cost can also play a role. If patients achieve a complete response, meaning no invasive cancer remains after neoadjuvant therapy, sometimes treatment can be stopped earlier, sparing both physical and financial strain. “We lose this opportunity if surgery is opted for first,” Dr Malhotra adds.

The Future of HER2-Positive Breast Cancer Treatment

The shift towards neoadjuvant therapy represents a significant change in how doctors approach HER2-positive breast cancer. Instead of rushing in with surgery, the modern strategy is more like a chess game, carefully setting up each move to give patients the best possible outcome.

By combining chemotherapy with targeted drugs like trastuzumab and pertuzumab before surgery, doctors can shrink tumours, assess risk, personalise treatment, and often improve long-term survival.

Breast cancer treatment has always been a mix of science, strategy, and courage. Neoadjuvant therapy, especially in HER2-positive cases, is proving to be more than just a pre-surgery step. It is a game-changer, giving both patients and doctors a crucial edge in the fight.

As Dr Malhotra puts it, “Neoadjuvant therapy is not an inferior modality. With current data, we feel it is a superior one.”

We have all been there. You polish off a hearty meal, lean back with satisfaction and then comes that all-too-familiar burn in your stomach. For most people, the quick fix is to blame the food and pop an antacid. But what if that nagging pain is not just about what you ate?

According to Dr Akash Chaudhary, Clinical Director and Sr Consultant Medical Gastroenterology at Care Hospitals, Hyderabad, “That familiar burn after a meal might seem harmless at first. But when it starts showing up regularly, especially during long gaps between meals or waking you up at night, it could be your body signalling something more serious, like a peptic ulcer.”

What Is a Peptic Ulcer?

A peptic ulcer is basically a sore that develops on the inner lining of your stomach or the upper part of your small intestine. These sores form when the protective lining of the stomach wears down. “This kind of damage is often due to an H. pylori infection or the regular use of pain-relief medication like NSAIDs,” Dr Chaudhary explains. Without that protective cushion, the very acid that digests your food ends up irritating and damaging your stomach instead.

Unique Symptoms of Peptic Ulcer You Might Miss

Ulcers do not always announce themselves with big warning signs. Dr Pavan Reddy Thondapu, HOD of Medical Gastroenterology at Arete Hospitals, says that what often begins as “minor digestive discomfort, a burning sensation, early satiety, or bloating after meals can sometimes signal something more serious if ignored.”

Other tell-tale but easily overlooked signs include:

• Upper abdominal pain that keeps coming back, often worse after meals
• Unexpected nausea or changes in appetite
• Feeling unusually full too quickly (early satiety)
• Black, tarry stools or vomiting blood in advanced cases
• Unexplained tiredness, weight loss, or loss of appetite

Most people dismiss these symptoms as routine acidity or indigestion. But as Dr Chaudhary warns, “When the real cause goes unnoticed, ulcers can quietly progress, sometimes leading to bleeding or even a tear in the stomach lining.”

Why Antacids Do Not Always Cut It

Reaching for an antacid may calm the discomfort for a few hours, but it does not solve the underlying issue. “It is not uncommon for patients to self-medicate and ignore early symptoms, but that often delays recovery and increases risk,” Dr Thondapu points out. Antacids mask the pain, but the ulcer continues its work quietly in the background, setting the stage for bigger problems.

When to See a Doctor

The golden rule, if the burning pain keeps returning, especially after meals or early in the morning, is to not wait it out. According to Dr Chaudhary, “If someone experiences persistent burning pain after meals, they shouldn’t delay medical attention. What feels like a routine gastric issue may be a more serious condition silently progressing in the background.”

Red flag symptoms that warrant immediate medical evaluation include:

• Vomiting blood or black stools
• Difficulty swallowing
• Severe, persistent upper abdominal pain
• Unexplained weight loss or fatigue

How Doctors Get to the Bottom of It

Thankfully, diagnosing a peptic ulcer is not as scary as it sounds. “We usually diagnose peptic ulcers through simple procedures like an upper GI endoscopy or a breath test for H. pylori,” says Dr Thondapu. An endoscopy gives a direct look at the stomach lining, while non-invasive tests can quickly confirm an infection.

The Road to Healing

Ulcers are highly treatable once detected. Treatment usually involves:

• Acid-suppressing medications to give the stomach lining a chance to heal
• Antibiotics if H. pylori is detected
• Stopping or adjusting long-term NSAID use
• Simple but powerful lifestyle shifts

Dr Chaudhary emphasises that “with the right medicines and a few mindful shifts in daily eating habits, most people begin to feel better within weeks.”

Important Lifestyle Tweaks

Treatment is not just about pills; how you live day to day plays a big role in preventing recurrence. Dr Thondapu recommends:

• Eating meals on time instead of long gaps or binge-eating sessions
• Cutting back on alcohol and tobacco
• Avoiding overly spicy, oily, or processed foods
• Managing stress through exercise, yoga, or mindfulness

These shifts help protect the stomach lining and keep acid levels in check, making ulcers less likely to return. In a nutshell, stomach pain after meals does not always mean you overdid it on the food. Sometimes it is your body’s way of flagging a deeper issue. As both experts stress, ignoring persistent burning pain or bloating is not worth the risk. Early diagnosis makes ulcers easy to treat, while delay can lead to serious complications.

For the first time in history, scientists have captured on film the moment a human embryo implants itself—an elusive biological milestone that has long been considered a “black box” in early human development. The breakthrough, published in Science Advances, not only offers a rare window into the earliest stages of life but also carries profound implications for fertility science and reproductive medicine.

Before any of us became who we are, we were once a fragile cluster of cells adrift, searching for a home inside the uterus. That critical moment—when the embryo anchors itself into the uterine lining, is known as implantation. It is a make-or-break step for pregnancy.

Yet until now, scientists had little more than snapshots of the process. Ultrasounds only detect pregnancies weeks later, and the act of implantation itself occurs deep within the womb, hidden from view. Roughly 60 percent of pregnancy losses occur during or shortly after implantation, making it a critical bottleneck to life.

Dr. Samuel Ojosnegros, senior author and bioengineer at the Barcelona Institute of Science and Technology (BIST), explains the importance, “For the first time, we’ve been able to watch human embryo implantation unfold dynamically. We’ve opened a window into a stage of development that was previously hidden.”

How Scientists Filmed the "Hidden" Process?

Since it would be too risky to disrupt implantation inside a living uterus, researchers had to recreate the process in the lab. Using embryos donated by couples undergoing IVF, Ojosnegros and his team built a model of the uterine environment.

The embryos were placed into a collagen-based gel designed to mimic the structure and nutrients of uterine tissue. With advanced microscopy and fluorescence imaging, researchers recorded time-lapse videos showing the embryos penetrating the gel.

What they saw was surprisingly forceful. Unlike mouse embryos, which invaded only superficially, human embryos drilled deep, burrowing aggressively and reshaping the surrounding environment.

The footage revealed the embryo not as a passive passenger but as an active architect, exerting mechanical force, releasing enzymes to break down tissues, and remodeling its new home.

Watching The Surprising Force of Early Life

Implantation is not a delicate nudge. It’s invasive. The embryo pulls surrounding collagen fibers toward itself, digs deep into the tissue, and begins to prepare the foundation for the placenta.

“The embryo opens a path through this structure and begins to form specialized tissues that connect to the mother’s blood vessels,” Ojosnegros explains. “It is a surprisingly invasive process.”

In fact, this burrowing behavior underscores how different human embryos are from animal models. For decades, most implantation studies have relied on mice. But what happens in mice only loosely reflects the human experience. This research shows that human embryos go much further, both physically and biologically.

Why The “Goldilocks zone” Of Uterus Plays A Critical Role?

The study also raises new questions about the uterus itself. The maternal environment is far more than a passive host. The human uterus contracts one to two times per minute on average, and the frequency of these contractions changes throughout the menstrual cycle.

Some research suggests that too many or too few contractions on the day of embryo transfer in IVF can reduce the chances of success. The right rhythm, what some scientists call the “Goldilocks zone” of contractions may improve implantation rates.

Amélie Luise Godeau, lead author of the study, says the embryo appears to interact with these external forces as it burrows in, “We hypothesize that contractions occurring in vivo may influence embryo implantation.” Understanding this delicate rhythm between embryo and uterus could prove pivotal for advancing fertility treatments.

What Are The Implications for Fertility Science?

Implantation failure is one of the main reasons IVF doesn’t work. Despite technological advances, many embryos fail to attach, leaving patients and clinicians frustrated. By uncovering the mechanics of implantation, this research may open new paths to improve success rates.

Through their spin-off company Serabiotics, Ojosnegros and his colleagues are already working with pharmaceutical partner Grifols on protein supplements that could enhance implantation in clinics.

The model developed in the lab also offers flexibility. Since the matrix of collagen can be manipulated, researchers can experiment and see how embryos react under various conditions, nutrients, or drugs. That is, researchers can observe not just why implantation fails but also how to make it succeed.

What Are The Ethical and Biological Limits?

It's also worth noting that the model employed in this study is not a complete imitation of the uterus. It doesn't have human uterine cells, so the interaction is only half the story. Nevertheless, this restriction is also a chance—it enables scientists to manipulate the environment in ways that are impossible within the human body.

Ethically, the study stayed within the strict rules, employing donated embryos with informed consent. None of the embryos were brought to a point beyond reproductive law and ethical boundaries.

Since decades ago, the process of implantation has been told as one of biology's biggest mysteries. Now, thanks to this live footage, scientists are reauthoring the book on how life gets started.

It's not merely intellectual curiosity. For the millions of individuals around the globe who are infertile, the results might mean more targeted fertility treatments and better IVF success rates. For researchers, it provides a new method to explore the very beginnings of human existence.

Ojosnegros and his colleagues hope to refine their model further, study how embryos engage with the maternal environment, and look for signs that might some day prevent early pregnancy loss.

What this research establishes is that implantation is not a passive handoff between embryo and uterus. It's an active, forceful, highly coordinated process in which both partners—the embryo and maternal tissue are both key players.

By now, most of us know the liver as the tireless detox unit of the body. It takes in the grease, sugar, alcohol, and all the questionable late-night binge decisions and keeps life moving smoothly. But when the liver is badly scarred by cirrhosis, the consequences are not just digestive. According to Dr Joseph Salhab, a gastroenterologist, it can creep up and affect your brain in a condition known as overt hepatic encephalopathy (OHE). And trust us, the symptoms can be stranger than ever.

Can your liver change your personality?

Yes, and it is not even funny. "OHE is a complication of cirrhosis and occurs when the liver sustains damage and loses its ability to remove toxins from the bloodstream effectively, causing toxins to accumulate and lead to impaired brain function," explains Dr Salhab.

The results in symptoms that do not immediately lead to liver problems. People may develop personality changes, tremors, disorientation, or even a complete shift in their sleep-wake cycles. Imagine feeling jetlagged without ever stepping on a plane.

Also Read: Why Your Anxiety Might Be In Your DNA: Study

Spotting the red flags

Dr Salhab stresses that OHE often goes undetected because its symptoms can look like other issues—stress, ageing, or even just a bad week. Confusion, forgetfulness, mood swings, and sudden changes in behaviour are all warning signs that should not be ignored. Families sometimes notice it first, especially when a usually calm person turns irritable or when handwriting suddenly looks shaky and uneven.

Tremors and clumsiness are another giveaway. These motor symptoms are particularly telling because they show the brain is being affected in very real ways.

It is this toxin overload that leads to the neurological and psychological effects we see in OHE. This makes OHE not just a medical problem but a quality-of-life bombshell.

Why it matters more than you think

Left unchecked, OHE episodes can become severe, even leading to hospitalisation. Patients might not recognise loved ones, forget basic routines, or lose the ability to care for themselves. The impact is not just medical but social and emotional. It affects families, careers, and independence.

In fact, many carers share stories of how they mistook early OHE signs for dementia or burnout. It is only after medical consultation that the link between liver and brain became clear.

Also Read: How Neoadjuvant Therapy Changes The Game In Breast Cancer Treatment

Can OHE be managed?

The good news is yes, but it requires vigilance. The first step is awareness. Knowing that cirrhosis can lead to OHE empowers patients and families to act early. Regular check-ups, honest conversations with doctors, and close monitoring of symptoms are essential in staying ahead of episodes.

Lifestyle choices also make a difference. Following medical advice on diet, avoiding alcohol, and keeping other health issues like diabetes under control can all reduce the strain on the liver.

Talking to your doctor without holding back

One of the biggest obstacles is silence. People usually do not report symptoms like confusion or mood swings because they do not connect them to their liver condition. But being open about every change, no matter how small, helps doctors spot OHE early.

Even something as simple as poor sleep or hand tremors can be clues your doctor needs. Despite sounding like a rare complication, OHE is more common than most realise. Cirrhosis itself is a growing health issue, linked not only to alcohol but also to obesity and viral hepatitis. As cirrhosis rates rise, awareness about OHE has to grow too.

If you or someone you love has cirrhosis, those little signs like irritability, shaking hands, or sudden confusion might not just be signs. They could be OHE waving its red flag. And the earlier it is caught, the better the chances of managing it.