Background Nipple fluid aspiration (NFA) is a technique to acquire nipple aspirate fluid (NAF), which is considered a rich source of breast-specific biomarkers. Originating directly from the mammary ...ducts, this liquid biopsy can offer insight into the process of carcinogenesis at its earliest stage and therefore could be of added value to the current imaging-based breast cancer screening tools. With that in mind, it is necessary to know how well NFA is tolerated. Aim To evaluate the participants' tolerability of NFA compared to breast imaging screening methods and blood draws. Materials and methods Three cohorts of women underwent NFA: healthy women (n = 190), women diagnosed with breast cancer (n = 137) and women at high risk of developing breast cancer (n = 48). A 0-10 discomfort score of NFA, mammography, breast MRI and blood draws, was filled in at the study visits, which took place once or annually. Results The median discomfort rate of NFA was 1, which was significantly lower than the median discomfort of mammography and breast MRI (5 and 3, respectively, p < 0.001), but significantly higher than median discomfort for blood draws (0, p < 0.001). The great majority of women would undergo the procedure again (98%) and recommend it to others (97%). Conclusion This study shows that NFA was well tolerated by healthy women, women diagnosed with breast cancer and high-risk women. This makes NFA a feasible method to pursue as a potential future breast cancer early detection tool, based on resident biomarkers. Trial registration NL41845.041.12, NL57343.041.16 and NL11690.041.06 in trialregister.nl. Keywords: Nipple aspirate fluid, Nipple fluid aspiration, Blood, Screening, Breast cancer, Liquid biopsies, Tolerability, Discomfort
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Purpose
We assessed the recent trends in the administration of adjuvant chemotherapy thereby evaluating the role of the 70-gene signature (70-GS) testing in decision-making in the systemic treatment ...of patients with lymph node negative (N0) and lymph node positive (N+) breast cancer.
Methods
Patients with a national guideline directed indication for 70-GS use treated between 2013 and 2016 were selected from the Netherlands Cancer Registry. Time trends in the administration of adjuvant chemotherapy were evaluated within guideline- and age-delineated subgroups. The influence of the 70-GS on chemotherapy use was assessed with logistic regression.
Results
During the study period, the overall administration of adjuvant chemotherapy decreased from 49 to 23% and 70-GS use increased from 24 to 51%. The 70-GS was not associated with a decreased likelihood for N0 patients to receive chemotherapy (odds ratio OR 1.0; 95% confidence interval CI 0.86–1.17), as the proportion of N0 patients who received chemotherapy in the absence of 70-GS use decreased during the study period. In patients with N1a disease, 70-GS testing was associated with a decreased likelihood to receive chemotherapy (OR 0.21; 95% CI 0.15–0.29). In patients < 50 years and 50–59 years of age, 70-GS use was associated with a consistent lower proportion of patients receiving chemotherapy throughout the study period (OR 0.17; 95% CI 0.13–0.23 and OR 0.53; 95% CI 0.43–0.65, respectively).
Conclusions
In this population-based study, the administration of adjuvant chemotherapy in ER+ breast cancer strongly declined. For node-positive and younger patients, 70-GS use was associated with a decreased probability for patients to receive adjuvant chemotherapy.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
We evaluate nationwide perioperative outcomes of complex EVAR and assess the volume-outcome association of complex EVAR.
Endovascular treatment with fenestrated (FEVAR) or branched (BEVAR) endografts ...is progressively used for excluding complex aortic aneurysms (complex AAs). It is unclear if a volume-outcome association exists in endovascular treatment of complex AAs (complex EVAR).
All patients prospectively registered in the Dutch Surgical Aneurysm Audit who underwent complex EVAR (FEVAR or BEVAR) between January 2016 and January 2020 were included. The effect of annual hospital volume on perioperative mortality was examined using multivariable logistic regression analyses. Patients were stratified into quartiles based on annual hospital volume to determine hospital volume categories.
We included 694 patients (539 FEVAR patients, 155 BEVAR patients). Perioperative mortality following FEVAR was 4.5% and 5.2% following BEVAR. Postoperative complication rates were 30.1% and 48.7%, respectively. The first quartile hospitals performed <9 procedures/yr; second, third, and fourth quartile hospitals performed 9-12, 13-22, and ≥23 procedures/yr. The highest volume hospitals treated the significantly more complex patients. Perioperative mortality of complex EVAR was 9.1% in hospitals with a volume of < 9, and 2.5% in hospitals with a volume of ≥13 (P = 0.008). After adjustment for confounders, an annual volume of ≥13 was associated with less perioperative mortality compared to hospitals with a volume of < 9.
Data from this nationwide mandatory quality registry shows a significant effect of hospital volume on perioperative mortality following complex EVAR, with high volume complex EVAR centers demonstrating lower mortality rates.
The momentum and helicity density distributions of the strange quark sea in the nucleon are obtained in leading order from charged-kaon production in deep-inelastic scattering on the deuteron. The ...distributions are extracted from spin-averaged K± multiplicities, and from K± and inclusive double-spin asymmetries for scattering of polarized positrons by a polarized deuterium target. The shape of the momentum distribution is softer than that of the average of the u¯ and d¯ quarks. In the region of measurement 0.02<x<0.6 and Q2>1.0 GeV2, the helicity distribution is zero within experimental uncertainties.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Abstract Background In vitro cadaveric studies showed that elastomer femoroplasty prevents displacement of fracture parts after proximal hip fracture allowing for conservative treatment. In the event ...that secondary displacement does occur, the purpose of this present study was to determine the feasibility of performing osteosynthesis of a fractured hip after preventive treatment with elastomer femoroplasty. Methods Ten pairs of human cadaveric femurs were fractured in a simulated fall configuration. From each pair, one femur was randomly selected for elastomer femoroplasty prior to fracture generation and the contralateral femur was used as control. Following hip fracture generation, osteosynthesis was performed in all femurs. The operative time per case, technical difficulties during the procedure, and postoperative energy-to-failure load were recorded. Results The mean (SD) time to perform osteosynthesis was 20 (6) minutes in the control-group and 19 (5) minutes in the elastomer femoroplasty-group ( P = 0.69). During osteosynthesis of the fractured hip in the elastomer femoroplasty-group, no difficulties including the need for additional instruments to remove elastomer from the proximal femur were recorded. Postoperative energy-to-failure load was similar in the control-group and the elastomer femoroplasty-group. Conclusion Fixation with routine osteosynthesis of displaced cadaveric hip fractures is not hindered by the presence of previously injected elastomer.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
BACKGROUND:Surgical skills and decision making are influenced by alertness, reaction time, eye-hand coordination, and concentration. Night shift might impair these functions but it is unclear to what ...extent. The aim of this study was to investigate whether a night shift routinely impairs the surgeonʼs fitness to perform and whether this reaches a critical limit as compared to relevant frames of reference.
METHODS:Consultants (n = 59) and residents (n = 103) conducted fitness to perform measurements at precall, postcall, and noncall moments. This validated self-test consists of an adaptive tracker that is able to objectively measure alertness, reaction time, concentration, and eye-hand coordination, and multiple visual analog scales to subjectively score alertness. Results are compared to sociolegal (ethanol) and professional (operative skills) frames of reference that refer to a decrease under the influence of 0.06% ethanol.
RESULTS:Residents spent 1.7 call hours asleep on average as compared to 5.4 for consultants. Subjective alertness decreased in residents after night shifts (−13, P < 0.001) but not in consultants (−1.2, P = NS). The overnight difference in tracker score was −1.17 (P < 0.001) for residents and 0.46 (P = NS) for surgeons. Postcall subjective alertness only correlated to objective alertness in consultants. For residents, hours slept on-call correlated to objective alertness. For consultants, subsequent night calls significantly correlated to objective alertness, with the third subsequent call related to performance below the reference.
CONCLUSIONS:Consultants remain fit to perform after night call, but subsequent calls may compromise clinical activities. This study provides insight and awareness of individual performance with clear frames of reference.
The minimum gas speed for a heat exchanger (HE) at which particulate fouling is avoided is investigated. Fouling experiments have been done with particles of different sizes and different materials ...running under different gas speeds. It is found that the smallest particles in the flow deposit first on the tubes of the HE at areas of minimum flow velocities. Then the large particles deposit and the fouling layer starts to build up. The fouling layer thickness and growth over the HE tube is influenced by the flow speed. As the flow speed in the HE increases, the thickness and the surface area of the fouling layer deposited over the heat exchanger tube are reduced. There is a limiting flow speed above which fouling is avoided. This limiting speed is related to the critical flow velocity required to roll a particle resting on a flat surface. To prevent fouling, the gas speed of a HE should be larger than the critical flow velocity that corresponds to the particle size most likely to stick on the heat exchanger tube.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Longitudinal double-spin asymmetries of charged hadrons with high transverse momentum
p
T
have been measured in electroproduction using the H
ermes
detector at H
era
. Processes involving gluons in ...the nucleon have been enhanced relative to others by selecting hadrons with
p
T
typically above 1 GeV. In this kinematic domain the gluon polarization has been extracted in leading order making use of the model embedded in the Monte Carlo Generator P
ythia
6.2. The gluon polarization obtained from single inclusive hadrons in the
p
T
range 1 GeV <
p
T
< 2.5 GeV using a deuterium target is
at a scale
and
. For different final states and kinematic domains, consistent values of
have been found within statistical uncertainties using hydrogen and deuterium targets.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Abstract Objectives Customized Aortic Repair (CAR) is a new concept for endovascular aortic aneurysm repair in which a non-polymerised elastomer is injected to fill the aneurysm sac around a balloon ...catheter. Amongst other variables, the thrombogenicity of the elastomer should be tested, before further clinical experiments can take place. The aim of this human ex vivo study was to measure the thrombogenicity of the elastomer and to compare it to expanded polytetrafluoroethylene (ePTFE). Design and materials In a validated ex vivo model, non-anticoagulated blood was drawn from the antecubital veins of 10 healthy donors with a 19-gauge needle. It was drawn through elastomer tubes and through ePTFE Gore-Tex vascular grafts, both 60 cm long and with an inner diameter of 3 mm. Methods Fibrinopeptide A (FPA) and P-selectin expression was measured in blood samples, collected at the end of the grafts. After the experiments, the deposition of platelets and fibrin onto the grafts was visualised by scanning electron microscopy. Results For these graft types, a progressive increase in FPA production was observed in time. No significant difference was observed between the elastomer and ePTFE grafts ( p > 0.05). No increase in P-selectin expression, and thereby no platelet activation, was observed in the perfusate of either grafts ( p > 0.05). By scanning electron microscopy, numerous platelet aggregates were observed on the ePTFE grafts, whereas just a few adhered platelets and no aggregates were observed in the elastomer grafts. Conclusions The elastomer in its current formulation has a low thrombogenicity, comparable to ePTFE, making it an ideal substance for endovascular aneurysm sac filling. Further research should clarify the feasibility of CAR in vivo.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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