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Objectives: The aim of this study is to evaluate device size selection in patients within the borderline annulus size range undergoing transcatheter aortic valve replacement (TAVR) and to assess if pre-procedural patient-specific computer simulation will lead to the selection of a different device size than standard of care. Background: In TAVR, appropriate device sizing is imperative. In borderline annulus size cases no standardised technique for tailored device size selection is currently available. Pre-procedural patient-specific computer simulation can be used, predicting the risk for paravalvular leakage (PVL) and need for permanent pacemaker implantation (PPI). Methods: In this multicentre retrospective study, 140 patients in the borderline annulus size range were included. Hereafter, device size selection was left to the discretion of the operator. After TAVR, in 24 of the 140 patients, patient-specific computer simulation calculated the most appropriate device size expected to give the lowest risk for PVL and need for PPI. In these 24 patients, device size selection based on patient-specific computer simulation was compared with standard-of-care device size selection relying on a standardised matrix (Medtronic). Results: In a significant proportion of the 140 patients (26.4%) a different device size than recommended by the matrix was implanted. In 10 of the 24 patients (41.7%) in whom a computer simulation was performed, a different device size was recommended than by means of the matrix. Conclusions: Device size selection in patients within the borderline annulus size range is still ambiguous. In these patients, patient-specific computer simulation is feasible and can contribute to a more tailored device size selection. [ABSTRACT FROM AUTHOR]

Objectives: The present study aims to evaluate the efficacy and safety of the MANTA vascular closure device (VCD) (Teleflex, Morrisville, NC, USA) in transfemoral transcatheter aortic valve replacement (TF-TAVR). Background: To close the femoral artery in TF-TAVR a VCD is the treatment of choice. Data involving suture-based VCDs have been extensive. Although scarce, results on the MANTA device are promising. There is no consensus yet as to whether the MANTA device is associated with fewer access-site-related vascular/bleeding complications when compared to suture-based VCDs. Methods: In this prospective single-arm study, performed at a single centre, a total of 73 patients eligible for TF-TAVR were included and consecutively treated with the MANTA device. Results: Access-site-related vascular complications were seen in 13.7% of patients treated with the MANTA device. In this group of patients only minor vascular complications were observed. Access-site-related bleeding complications were rare (6.8%), and device failure was seen in 13.7% of the patients. Conclusions: This single-centre study confirms that use of the MANTA device in TF-TAVR is feasible with an acceptable rate of access-site-related complications and no major vascular complications. [ABSTRACT FROM AUTHOR]

Background: It has been argued that salpingectomy would reduce the risk of epithelial ovarian cancer (EOC), based on the theory of the tube being the site of origin.Objectives: To conduct a systematic review of 'salpingectomy' associated with ovarian cancer risk and 'salpingectomy with concomitant hysterectomy' on outcomes of complications including endocrine function.Search Strategy: A comprehensive search was conducted in PubMed, Embase, and the Cochrane library.Selection Criteria: Original studies and systematic reviews were eligible.Data Collection and Analysis: Each article was quality assessed. Data were extracted and, when possible, pooled in meta-analyses. The certainty of evidence across studies was evaluated using GRADE.Main Results: Of 844 articles found, 11 were included. No study evaluated risk reduction for EOC after salpingectomy in conjunction with hysterectomy. Two retrospective studies reported a reduced ovarian cancer risk after indicated salpingectomy, compared with no surgery: adjusted hazard ratio 0.65 (95% confidence interval, 95% CI 0.52-0.81) and adjusted odds ratio 0.58 (95% CI 0.36-0.95). Complications did not differ between groups with or without salpingectomy, but were non-systematically reported. Ovarian endocrine function, measured with surrogate outcomes, did not differ at short-term follow-up in randomised or observational studies. The certainty of evidence was very low or low for all outcomes.Conclusions: There is currently insufficient evidence to state that opportunistic salpingectomy reduces the risk of EOC. The impact on long-term endocrine function is unknown. The heterogeneity in results and identified knowledge gaps stress the need for a prospective trial.Tweetable Abstract: Insufficient evidence for prophylactic removal of the fallopian tubes for risk reduction of ovarian cancer. [ABSTRACT FROM AUTHOR]

The author reflects on the importance of proper selection in administering a safe and effective cancer treatment. Topics discussed include efforts made towards the optimisation of comprehensive geriatric assessments in multidisciplinary cancer care, studies that look into a range of research questions from various angles including the introduction of guidelines on geriatric assessments in oncology and the integration of geriatric oncology as another paradigm of multidisciplinary cancer care.

Head and neck ( H& N) cancer is mainly a cancer of the elderly; however, the implementation of comprehensive geriatric assessment ( CGA) to quantify functional age in these patients has not yet been studied. We evaluated the diagnostic performance of screening tools [ Vulnerable Elders Survey-13 ( VES-13), G8 and the Combined Screening Tool ' VES-13 + (17- G8)' or CST], the feasibility of serial CGA, and correlations with health-related quality of life evolution [ HRQOL; European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires ( EORTC QLQ)- C30 and - HN35] during therapy in hundred patients, aged ≥65 years, with primary H& N cancer undergoing curative radio(chemo)therapy. Respectively 36.8%, 69.0%, 62.1% and 71.3% were defined vulnerable according to VES-13, G8, CST and CGA at week 0, mostly due to presence of severe grade co-morbidities, difficulties in community functioning and nutritional problems. At week 4, significantly more patients were identified vulnerable due to nutritional, functional and emotional deterioration. The CST did not achieve the predefined proportion necessary for validation. Vulnerable patients reported lower function and higher symptom HRQOL scores as compared with fit patients. A comparable deterioration in HRQOL was observed in both groups through therapy. In conclusion, G8 remains the screening tool of choice. Serial CGA identifies the evolution of multidimensional health problems and HRQOL conditions during therapy with potential to guide individualised supportive care. [ABSTRACT FROM AUTHOR]

The impact of the Western diet on chronic diseases, such as cancer, has been well recognized. Dietary saturated and trans fatty acids have been found to play a negative role in obesity, heart disease, diabetes and cancer, while the beneficial health effects of n-3 polyunsaturated fatty acids ( n-3 PUFAs) have become widely accepted. Despite the current knowledge, n-3 PUFA intake is still under recommended daily intake levels in Europe. As wild fish, currently still the major source of n-3 PUFA, are facing a decline, alternative sources such as marine and plant (both natural and transgenic) sources are being explored. In this review we aim to provide an overview of the current biological sources of n-3 PUFAs, their part in normal physiology, as well as their emerging application in supportive cancer care, and more specifically in cancer cachexia, therapy-related neurocognitive dysfunction and distress. In addition, we provide a brief summary of currently ongoing clinical trials examining potential beneficial effects of n-3 PUFAs in reducing cancer(therapy)-related side effects, and describe future research directions. [ABSTRACT FROM AUTHOR]

We evaluated the ability of mice made genetically deficient for B cells to resolve a primary infection and to develop protective immunity against vaginal challenge with a human isolate of Chlamydia trachomatis bacteria. The B-cell-deficient μMT mice cleared a primary ascending infection with similar or faster kinetics compared with wild-type mice. The presence of chlamydial inclusion bodies and the degree of inflammation in the upper genital tract was comparable and showed similar kinetics in μMT as in wild-type mice. Following resolution of the primary infection the mice were challenged by 100 ID50 of live bacteria and the level of protection and the extent of local inflammation was assessed. Strikingly, all μMT mice, as well as most of the wild-type mice, demonstrated complete immune protection with no bacterial shedding. While high titres of chlamydia-specific antibodies were stimulated locally and systemically in wild-type mice, no antibodies were detected in μMT mice. However, in both strains, immunohistochemical analysis of the upper genital tract demonstrated the presence of large numbers of CD4+ T cells and increased levels of interferon-γ (IFN-γ)-producing cells. The results unequivocally demonstrate that antibodies are not required for full protection to develop against ascending infection with a high dose of C. trachomatis in the female genital tract. Our study confirms the notion that cell-mediated immunity, in particular that owing to CD4+ T helper 1 (Th1)-type cells, is critical for host resistance against C. trachoinatis in mice. [ABSTRACT FROM AUTHOR]