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There was statistically positive relationship between the number of alveoli invaded with STAS and locoregional recurrence of metastases (
 = 0.0001). The presence of STAS is not a factor affecting the 5-year overall survival rate (
 = 0.6651).
 We identified STAS as a frequent finding in resected CRC lung metastases and found insignificant association with outcome.
 We identified STAS as a frequent finding in resected CRC lung metastases and found insignificant association with outcome.
 The aim of this study was to investigate the need for postoperative permanent pacemaker implantation (PPI) following sutureless and rapid-deployment aortic valve replacement (SuRD-AVR) in the context of a progress report from a large multicenter international registry (SURD-IR).
 We retrospectively analyzed 4,166 patients who underwent SuRD-AVR between 2008 and 2019. The primary outcome was the need for PPI before discharge. The study population was analyzed separately according to the implanted prostheses (Su cohort and RD cohort). Each cohort was divided into two groups based on the operation date an early group ("EG" = 2008-2016) and a late group ("LG" = 2017-2019).
 The rate of PPI decreased significantly in the Su cohort over time (EG = 10.8% vs LG = 6.3%,
 < 0.001). In the Su cohort, a decrease in age, risk profile, and incidence of bicuspid aortic valve, increased use of anterior right thoracotomy, reduction of cardiopulmonary bypass time and of associated procedures, and more frequent use of smaller prostheses were observed over time. In the RD cohort, the rate of PPI was stable over time (EG = 8.8% vs LG = 9.3%,
 = 0.8). In this cohort, a younger age, lower risk profile, and higher incidence of concomitant septal myectomy were observed over time.
 Our analysis showed a significant decrease in the PPI rate in patients who underwent Su-AVR over time. Patient selection as well as surgical improvements and a more accurate sizing could be correlated with this phenomenon. The RD cohort revealed no significant differences either in patient's characteristics or in PPI rate between the two time periods.
 Our analysis showed a significant decrease in the PPI rate in patients who underwent Su-AVR over time. Patient selection as well as surgical improvements and a more accurate sizing could be correlated with this phenomenon. The RD cohort revealed no significant differences either in patient's characteristics or in PPI rate between the two time periods.
Omental flap (OF) is a traditional surgical option to counteract severe postcardiotomy mediastinal infection and to cover extensive sternal defects. We reviewed our experience with omental flap transfer (OFT) in various clinical circumstances, in which omentoplasty may be considered by cardiac surgeons.
Twenty-one patients, who underwent OFT from January 2012 to December 2021, were studied. The main indication was treatment of infected foreign material implants including vascular grafts and ventricular assist devices or prevention of its infection (16 patients). In five patients, an OFT was used to cure mediastinitis following deep sternal wound infection after median sternotomy.
All patients had a high surgical risk with 3 ± 1.9 previous sternotomies and a mean Euro Score II of 55.0 ± 20.1. OF was successful in its prophylactic or therapeutic purpose in all patients, no complications related to the operative procedure were noted, that is, no early or late flap failure and no herniation of abdominal organs occurred. In-hospital mortality was six patients as three patients each died from multiple organ dysfunction syndrome and cerebral hemorrhage. All fifteen patients discharged demonstrated rapid recovery, complete wound healing without fistula, and no late gastrointestinal complications. The mean follow-up of 18 months was uneventful.
OFT seems to be an excellent solution for extensive mediastinal and deep sternal wound infections.
OFT seems to be an excellent solution for extensive mediastinal and deep sternal wound infections.
 Invasive coronary angiography (ICA) is essential to detect significant coronary artery disease (CAD) but is generally not recommended in patients with infective aortic valve endocarditis. This study aimed to evaluate the risks and benefits of preoperative ICA in patients before aortic valve replacement.
 Between March 2008 and September 2020, 232 patients were surgically treated for infectious endocarditis of the aortic valve. Sixty-seven (29%) of them underwent preoperative diagnostic ICA and were compared with the patients without preoperative ICA. We collected their baseline characteristics, including the neurological status, previous cardiac surgical procedures, and reviewed the preoperative echocardiograms and the ICA data. The intraoperative data and clinical outcomes after ICA and after surgery were evaluated.
 ICA revealed a CAD in the majority of our patients (
 = 36; 54%) One-vessel disease
 = 19 (28%), two-vessel disease
 = 6 (9%), and three-vessel disease
 = 11 (16%). We observed no adverse events following preoperative diagnostic ICA, particularly no thromboembolic complications, including stroke, visceral, or lower body ischemia were detected. During surgical aortic valve replacement, concomitant coronary artery bypass grafting was performed in 20 patients (30%). In patients with preoperative ICA, postoperative in-hospital mortality was significantly lower (
 = 8 [12%] vs.
 = 30 [18%];
 < 0.001), while the incidence of postoperative bleeding was higher (
 = 18 [27%] vs.
 = 22 [13%];
 = 0.022). The new-onset stroke incidence was 5% in each group.
 Taking a multidisciplinary team approach, ICA is safe in selected patients with aortic valve infectious endocarditis with no adverse clinical outcomes, but significant clinical implications.
 Taking a multidisciplinary team approach, ICA is safe in selected patients with aortic valve infectious endocarditis with no adverse clinical outcomes, but significant clinical implications.
Asymmetry in diameter between pre-communicating (A1) segments of the anterior cerebral arteries is related to anterior communicating artery aneurysm formation. Diameter asymmetry definitions vary and have not been related to blood flow measurements using the same imaging modality. We aimed to evaluate the relationship between A1-diameter asymmetry and blood flow asymmetry and to define a hemodynamically significant cut-off value for A1-diameter asymmetry. We assessed sex differences between different groups of A1-asymmetry.
3-Tesla time-of-flight MRA and 4D-phase-contrast MRI were performed in 122 healthy participants. Diameter and blood flow measurements were performed halfway in both A1-segments. Participants were subdivided based on A1-diameter asymmetry ≤10% (symmetric); 11-20%; 21-30%; 31-40%; and >40% (increasing asymmetry) groups. We studied the relationship between A1-diameter asymmetry and corresponding flow asymmetry (scatterplot and correlation). A hemodynamic-based cutoff value for A1-asymmetry was determined by comparing dominant A1 blood flow in the asymmetry groups to the mean blood flow of the symmetric A1-group (linear mixed-effects model). SW033291 Sex-related differences in A1-diameter, blood flow and asymmetry were assessed with t-tests.
A1-diameter asymmetry was linearly related to blood flow asymmetry between dominant and non-dominant sides. A1-diameter asymmetry >30% yielded statistically significant increased blood flow in the dominant A1 compared to symmetric A1s. Men had statistically significant larger A1-diameters, higher blood flow and a similar degree of A1-diameter asymmetry compared to women.
A1-diameter asymmetry is linearly related to blood flow asymmetry. A >30% A1-asymmetry can be used as hemodynamically significant cut-off value. There were no sex-related differences in A1-diameter asymmetry.
30% A1-asymmetry can be used as hemodynamically significant cut-off value. There were no sex-related differences in A1-diameter asymmetry.Pancreatic cancer (PC) is a highly devastating neoplasm due to its irrepressible characteristics and propensity to override the available treatment strategies. Rapid prevalence and enormous severity of this cancer urgently demand the exploration of novel approaches for the development of effective therapeutic measures. Metabolic derangement is one of the hallmarks of cancers which restructures mitochondrial activities and biological pathways. Apart from their bioenergetic and biosynthetic functions, mitochondria are also implicated in a myriad of cellular functions including proliferation, differentiation, apoptosis, senescence, homeostasis, and other cell regulatory mechanisms. It has been noted that PC, like other types of cancers, exploits these activities in favor of tumor growth and survival by inducing mitochondrial dysfunctions such as mitochondrial-DNA mutation, metabolic enzyme modification, ROS generation, mitophagy, evasion of apoptosis, and mitochondrial biogenesis. During pancreatic carcinogenesis, a large number of onco-factors including Bcl-2 family proteins, NF-κB, HIFs, NRF2, NOX, MFNs, DRP1, DUSP6, Cyp-D, PARKIN, and others are dysregulated, resulting into reprogramming of metabolic pathways and cellular kinetics. Hence, targeted interventions in these metabolic derangements may present some effective anticancer approaches. The current review gives an insight into various mitochondrial disorders and their targetable molecules in PC which may provide certain novel opportunities in the pursuit of therapeutic development. Furthermore, we have also discussed certain treatment perspectives in PC based on specific mitochondrial activities.Cancer-related cognitive impairment (CRCI) has increasingly been identified over the last two decades in non-CNS system cancer patients. Across Europe, researchers have contributed to this effort by developing preclinical models, exploring underlying mechanisms and assessing cognitive and quality of life changes. The ultimate goal is to develop interventions to treat patients experiencing CRCI. To do so, new challenges need to be addressed requiring the implementation of multidisciplinary research groups. In this consensus paper, we summarize the state of the art in the field of CRCI combined with the future challenges and action plans in Europe. These challenges include data sharing/pooling, standardization of assessments as well as assessing additional biomarkers and neuroimaging investigations, notably through translational studies. We conclude this position paper with specific actions for Europe based on shared scientific expert opinion and stakeholders involved in the Innovative Partnership for Action Against Cancer, with a particular focus on cognitive intervention programs.Renal cell carcinoma (RCC) is the seventh most frequently diagnosed tumor in adults in Europe and represents approximately 2.5 % of cancer deaths. In metastatic setting, clinical strategies including angiogenesis inhibition with tyrosine kinase inhibitors, as well as immunotherapy against immune checkpoint proteins, such as PD-1/PDL-1 and CTLA-4, have revolutionized the treatment landscape. Unfortunately, most patients progress to anti angiogenic and immunotherapy treatment. Epigenetic aberrations are commonly found in RCC, showing that changes in epigenetic modifications, like promoter methylation or abnormal microRNA expression, are key in the development of RCC due to gene expression alterations without changes in the genome sequence. Nowadays, new drugs in the field of epigenetics are able to modify gene expression to induce antitumoral effect in the tumor cell. In kidney cancer, drugs targeting epigenetics are in early development, but could be promising in the near future. In this review, we summarize the main epigenetic alterations found in RCC and their involvement in pathological signaling pathways, being a new potential target that could potentially be added to the treatment flow of patients with advanced RCC.