Background: Age-related macular degeneration (AMD) is one of the principal causes of irreversible visual impairment in the older adult population. Recent evidence indicates that there are signs of undertreatment and overtreatment, underdiagnosis and insufficient information provision in AMD care. Shared decision-making (SDM) can aid information sharing between patients and health professionals and enhances highquality care. This research aimed to gain insight into patients' and professionals' views on SDM in AMD care.

Unprecedented immunization campaigns have been rolled out worldwide in an attempt to contain the ongoing COVID-19 pandemic. Multiple vaccines were brought to the market, among two utilizing novel messenger ribonucleic acid technology. Despite their undisputed success in decreasing COVID-19-associated hospitalizations and mortality, various adverse events have been reported. The emergence of malignant lymphoma is one of such rare adverse events that has raised concern, although an understanding of the mechanisms potentially involved remains lacking. Herein, we present the first case of B-cell lymphoblastic lymphoma following intravenous high-dose mRNA COVID-19 vaccination (BNT162b2) in a BALB/c mouse. Two days following booster vaccination (i.e., 16 days after prime), at only 14 weeks of age, our animal suffered spontaneous death with marked organomegaly and diffuse malignant infiltration of multiple extranodal organs (heart, lung, liver, kidney, spleen) by lymphoid neoplasm. Immunohistochemical examination revealed organ sections positive for CD19, terminal deoxynucleotidyl transferase, and c-MYC, compatible with a B-cell lymphoblastic lymphoma immunophenotype. Our murine case adds to previous clinical reports on malignant lymphoma development following novel mRNA COVID-19 vaccination, although a demonstration of direct causality remains difficult. Extra vigilance is required, with conscientious reporting of similar cases and a further investigation of the mechanisms of action explaining the aforementioned association.

Objective We present the long term results of a trileaflet (Triflo) vs. bileaflet (On-X) mechanical valve in both aortic and pulmonary position in a sheep model. Methods The Triflo valve was implanted in 21 female sheep in aortic (n = 8) and pulmonary position (n = 13). The On-X valve was implanted in 7 female sheep in aortic (n = 1) and pulmonary (n = 6) position. No antithrombotic medication of any kind was given postoperatively. In the aortic group, survival cohorts were 3 and 5 months. In the pulmonary group, survival cohorts were 10 and 20 weeks. Valve performance was assessed using hematology, echocardiography and acoustic measurements combined with postmortem pathology analysis of the downstream organs. Results Mean gradients were lower for the Triflo valve in both pulmonary (4,30 mmHg (3.70-5.73) vs. 6.80 mmHg (4.63-7.96), p = 0.012) and aortic (5.1 mmHg (4.2-7.7) vs. 10.7 mmHg (8.7-12.9), p = 0.007) position. Peak gradients were lower for the Triflo-valve in both pulmonary (8.05 mmHg (6.75-10.23) vs. 13.15 mmHg (9.20-14.76), p = 0.005) and aortic (8.7 mmHg (7.5-12.5) vs. 16.5 mmHg (14.2-19.6), p = 0.009) position. In both positions, leaflets and housing surface were free from any deposits macro- and microscopically and comparable to nonimplanted control valves. Peripheral organs showed no signs of thrombo-embolic damage. Biochemical and hematological were comparable to preoperative. The closing click sound pressure level (SPL) of the Triflo was significantly lower in both aortic (108.4 SPL (102.0-115.7) vs. 111.7 SPL (105.5-117.0), p < 0.001) and pulmonary (103.6 SPL (99.1-108.9) vs. 118.5 SPL (116.7-120.2), p < 0.001) position. Conclusions Preliminary in vivo results of the Triflo valve are promising in both aortic and pulmonary position in an ovine model. Excellent hemodynamics, stable long term function, low valve noise and no thromboembolic events in the absence of antithrombotic medication lay the foundation to a future clinical first-in-man trial.

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