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BackgroundLaparoscopic skill acquisition involves a steep learning curve and laparoscopic suturing is an exceptionally challenging task. By improving the way feedback is given, trainees can learn these skills more effectively. This study aims to establish the most effective form of structured feedback on laparoscopic suturing skill acquisition in novices, by comparing the effects of expert verbal feedback, video review with expert feedback (video feedback), and video review with self-assessment.MethodsA prospective randomized blinded trial comparing verbal feedback, video feedback, and self-assessment. Novices in laparoscopic surgery were tasked with performing laparoscopic suturing with intracorporeal knot tying. Time was given for practice, and pre- and post-feedback assessments were undertaken. Suturing performance was measured using a task-specific checklist and global ratings. A post-study questionnaire was used to measure participant-perceived confidence, knowledge, and experience levels.ResultsFifty-one participants were randomized and allocated equally into the three groups. Performance in all three groups improved significantly from baseline. Video feedback had the largest improvement margin with checklist and global score improvements of 17.1% (± 9.9%) and 14.7% (± 9.3%), respectively. Performance improvements between groups were statistically significant in the global components (p = 0.004) but not the checklist components (p = 0.186). Global score improvement was significantly better in the video feedback group but was statistically insignificant between the self-assessment and verbal feedback groups. Questionnaire responses demonstrated positive results in confidence, knowledge, and experience levels, across all three study groups, with no differences between the groups (p > 0.05).ConclusionStructured video feedback facilitates reflection and self-directed learning, which improves the ability to develop proficiency in surgical skills. Combining both self-assessment and video feedback may be beneficial over verbal feedback alone due to the advantages of video review. These techniques should therefore be considered for implementation into surgical education curricula.

Background/aimPost-operative uveitis is the most common complication after cataract surgery in the UK. The study aims to evaluate the risk of post-operative uveitis in cataract surgery patients of different ethnicity in the presence and absence of co-morbidities as well as operative complications using multivariate analysis.MethodsA retrospective case-control study of patients undergoing phacoemulsification cataract surgery between January 2018 to December 2019 at two hospital sites. Differences in demographic and clinical characteristics were compared between two groups defined by the development of post-operative uveitis. Statistically significant factors in univariate analysis were further analysed using multivariate analysis to account for confounders.ResultsOne thousand and five hundred eighty seven eyes had undergone phacoemulsification cataract operations with 104 (6.6%) developing post-operative uveitis. Compared to eyes of White/Mixed/Other ethnicity, Asian and Afro-Caribbean eyes were associated with a twofold (OR 2.02, 95% CI 1.16–3.52, P = 0.013) and fivefold (OR 5.15, 95% CI 2.85–9.29, P < 0.001) risk of post-operative uveitis, respectively. Complicated surgery involving eyes with small pupil/iris hooks/Malyugin ring (OR 2.70, 95% CI 1.16–6.30, P = 0.022) and posterior capsular rupture (OR 6.00, 95% CI 2.55–14.12, P < 0.001) were associated with an increased risk of post-operative uveitis.ConclusionsThe factors significantly associated with a post-operative uveitis outcome were patients of Asian and Afro-Caribbean ethnicity, small intra-operative pupil size, use of iris hooks or Malyugin ring and PCR. The post-operative management plan should be tailored in these group of patients with a view of early assessment and prompt management of symptoms.

Calcific aortic stenosis is commonly treated using surgical or transcatheter aortic valve replacement; however, many patients are not considered suitable candidates for these interventions due to severe comorbidities and limited life expectancy. As such, non-invasive therapies might offer alternative therapeutic possibilities in these patients. This study aimed to assess the safety of non-invasive ultrasound therapy and its ability to improve valvular function by softening calcified valve tissue. This prospective, multicentre, single-arm series enrolled 40 adult patients with severe symptomatic aortic valve stenosis at three hospitals in France, the Netherlands, and Serbia between March 13, 2019, and May 8, 2022. Patients were treated with transthoracically delivered non-invasive ultrasound therapy. Follow-ups were scheduled at 1, 3, 6, 12, and 24 months. The primary endpoints were procedure-related deaths within 30 days and improved valve function. We report the 6-month data. This study is registered at ClinicalTrials.gov, NCT03779620 and NCT04665596. 40 high-risk patients with a mean Society of Thoracic Surgeons score of 5·6% (SD 4·4) and multiple severe comorbidities were included. The primary endpoint, procedure-related mortality, did not occur; furthermore, no life-threatening or cerebrovascular events were reported. Improved valve function was confirmed up to 6 months, reflected by a 10% increase in mean aortic valve area from 0·58 cm2 (SD 0·19) at baseline to 0·64 cm2 (0·21) at follow-up (p=0·0088), and a 7% decrease in mean pressure gradient from 41·9 mm Hg (20·1) to 38·8 mm Hg (17·8; p=0·024). At 6 months, the New York Heart Association score had improved or stabilised in 24 (96%) of 25 patients, and the mean Kansas City Cardiomyopathy Questionnaire score had improved by 33%, from 48·5 (SD 22·6) to 64·5 (21·0). One serious procedure-related adverse event occurred in a patient who presented with a transient decrease in peripheral oxygen saturation. Non-serious adverse events included pain, discomfort during treatment, and transient arrhythmias. This novel, non-invasive ultrasound therapy for calcified aortic stenosis proved to be safe and feasible. Cardiawave.

Renewable energy is energy that will not run out along with its use and the energy can be directly used or stored in an energy storage system. If the pressure from footsteps can be converted into electrical energy, this energy can be obtained every day. To ensure safe and monitored energy harvesting from piezoelectric tiles, a Battery Management System (BMS) and monitoring application have been developed. The use of piezoelectric sensors will convert any form of pressure or vibration into electricity. The Battery Management System (BMS) will collect data on the voltage of each battery cell, the current flowing in and out, and the battery temperature. Based on sensor data, the BMS will implement the following safety measures and functions, i.e. Over Voltage Input Safety (OVIS), Over Current Input Safety (OCIS), Over Current Output Safety (OCOS), Battery Under Voltage Protection (BUVP), Battery Over Voltage Protection (BOVP), and Cell Balancing (CB). The BMS is also designed to control the limit of each cell′s voltage and current. A monitoring system was developed to make sure they are working properly. The system developed was in the shape of web and mobile applications which show and update data of the BMS in real-time. From these applications users can control the usage of the battery as a power source by turning the switch on the applications on and off. Switch on each application will update based on the latest data. Based on the research in this manuscript, 1 tile with 64 piezoelectric sensors can generate a voltage of 18.75 V from 189 footsteps. The BMS system function test, and data control test were successfully executed. Based on the conducted experiments, the maximum deviation in voltage readings was 0.046 volts, while the deviation in temperature readings was ±1 degree Celsius. However, current readings remain inaccurate.

ObjectivesThe balloon-expandable Sapien-3 valve demonstrated superior results in terms of residual aortic regurgitation when compared with self-expandable devices. We aimed to compare for the first-time early outcomes of Sapien-3 transcatheter heart valve (THV) with the balloon-expandable Myval device.MethodsConsecutive real-world patients from nine European institutions with symptomatic severe aortic stenosis treated either with Sapien-3 or Myval THV devices after June 2018 were compared. Early clinical outcomes were prospectively gathered and blinded analysis of 30-day echocardiography was conducted. Matching for the following variables was performed: age, body surface area, Society of Thoracic Surgeons risk score, left ventricular function, mean gradient, transfemoral approach, aortic valvular calcium, aortic annulus mean diameter, area and eccentricity index.ResultsA total of 416 patients treated either with the Sapien-3 (n=286, 68.7%) or with Myval THV (n=130, 31.3%) were included and 103 pairs compared after matching. Baseline characteristics were similar. Procedural success rate (Sapien-3: 94.2%; Myval: 93.2%, p=0.219), 30-day mortality (Sapien-3: 2.9%; Myval: 0.97%, p=0.625), clinical efficacy (12.6 vs 4.9%, p=0.057) and early safety (12.6 vs 4.9%, p=0.096) were comparable. There was a lower need for new permanent pacemaker (15.5 vs 5.8% p=0.020) with Myval. No significant differences were found in terms of ≥moderate aortic regurgitation (1% for Sapien-3, 0% for Myval, p=0.314), but mean gradients were higher following Sapien-3 than after Myval (p<0.001).ConclusionsThe new Myval balloon-expandable THV was favourable in terms of safety, with low rate of permanent pacemaker and with favourable residual gradients and paravalvular leak rate according to blinded echocardiographic analysis.

ObjectiveEndoscopic suturectomy for craniosynostosis with helmet therapy (ESCH) has emerged as a successful treatment for craniosynostosis initially in North America. We present early outcomes from the first cohort of ESCH patients treated in the United Kingdom.MethodsRetrospective cohort study with review of electronic records.Results18 consecutive patients from the first procedure in the UK (May 2017) until January 2020 were identified. Our cohort consisted of 12 male and 6 female infants with craniosynostosis, with mean age of 4.6 months (range: 2.5–7.8 months) and weight of 6.8 kg (range 4.8–9.8 kg). The most commonly operated diagnosis was metopic synostosis (n=8) followed by unicoronal (n=7), sagittal (n=2) and multi-sutural (n=1) synostoses. Median length of skin incision was 3 cm (range 2–10 cm), with 15 patients having a single skin incision. 16/18 received no blood products with 2 requiring transfusion (1 donor exposure).Mean operative time (including anaesthesia) was 96 mins (range 40–127 mins). The median length of hospital stay was 1 night with no patients staying more than 2 nights (n=3). Only 1 surgical complication was noted (a suture abscess requiring oral antibiotics). All patients are currently undergoing helmet orthosis with 100% compliance so far. No patients have required revisional surgery.ConclusionEarly peri-operative experience from the first UK cohort of ESCH patients suggests this is a safe and well tolerated technique with low morbidity, need for transfusion and short hospital stay. We hope the success of these results leads to developing discussions to facilitate funding of the helmet orthotic therapy as part of NHS highly specialised commissioning services at Great Ormond Street.

The optimal treatment strategy for coronary bifurcation lesions by percutaneous coronary intervention (PCI) is complex and remains a subject of debate. Current guidelines advise a stepwise provisional approach with optional two-stent strategy. However, a two-stent strategy, both upfront and stepwise provisional, is technically demanding. Therefore, there is increasing interest in the use of drug-eluting balloons (DEB) in bifurcation lesions, mainly after a provisional approach with unsatisfactory result of the side branch. Some small pilot studies already showed that the use of DEB in bifurcation lesions is safe and feasible. However, a randomized comparison of this hybrid DEB strategy with a two-stent strategy is currently lacking. The Hybrid DEB study is a prospective, multicenter, randomized controlled trial investigating noninferiority of a hybrid DEB approach, using a combination of a drug-eluting stent (DES) in the main vessel and DEB in the side branch, compared to stepwise provisional two-stent strategy in patients with true bifurcation lesions. A total of 500 patients with de novo true coronary bifurcation lesions, treated with a stepwise provisional approach and an unsatisfactory result of the side branch after main vessel stenting (≥ 70% stenosis and/or < thrombolysis in myocardial infarction III flow), will be randomized in a 1:1 ratio to receive either treatment with a DEB or with a DES in the side branch. The primary endpoint is a composite endpoint of the occurrence of all-cause death, periprocedural or spontaneous myocardial infarction and/or target vessel revascularization at the anticipated median 2-year follow-up. The Hybrid DEB study will compare in a multicenter, randomized fashion a hybrid DEB approach with a stepwise provisional two-stent strategy in patients with true bifurcation lesions. ClinicalTrials.gov no. NCT05731687.

The increasing prevalence of electronic cigarette (e-cigarette) use among Malaysian youths highlights the inadequacy of current health education initiatives in addressing cessation challenges. This study aims to evaluate the content and face validity of educational infographics to support e-cigarette cessation among youth e-cigarette users in Malaysia. This study employed a cross-sectional study design and involved experts and youth e-cigarette users. Upon the development, 17 experts specialising in smoking or e-cigarette cessation, with a mean age of 39.10 years and a mean years of experience of 12.24 years, were recruited for content validation. Meanwhile, for the face validation, 10 Malaysian youth e-cigarette users, with a mean age of 24.00, were purposively selected to assess the clarity of the infographics and provide feedback. Content validity indices (CVI) and face validity indices (FVI) were calculated for each topic, with thresholds of > 0.74 and 0.83 indicating acceptable content. The infographics demonstrated strong content and face validity, with average CVI of 0.98 (range: 0.94, 1.00; 95% CI: 0.95, 1.00) and average FVI of 0.96 (range: 0.70, 1.00; 95% CI: 0.87, 1.00), respectively. The infographics can be utilised to promote e-cigarette cessation after the trial and implementation phase, to assess their real-world effectiveness.

Background: The Myval balloon-expandable (BE) valve has shown encouraging early clinical data in terms of safety and efficacy. Comparative data with other well-established contemporary valves are nonetheless still scarce. This study aims to compare the performance of the Myval BE valve with the Evolut self-expanding (SE) valve. Methods: In this retrospective single-center study, 223 patients with symptomatic severe aortic stenosis (AS) were included and treated with the Myval BE valve (n = 120) or with the Evolut SE valve (n = 103). Then, 91 pairs were compared after matching. Clinical outcomes were evaluated at 30 days and 1 year. Echocardiographic follow-up was performed at 30 days. Results: Procedural complications were rare in both groups. At the 30-day follow-up, no significant difference in cardiac death (Myval: 1% vs. Evolut: 2%, p = 0.56), stroke (2% vs. 4%, p = 0.41) and myocardial infarction (1% vs. 3%, p = 0.31) was observed. A permanent pacemaker implantation (PPI) was significantly less needed in the Myval group (4% vs. 15%, p = 0.01). At 1 year, cardiac death (2% vs. 4%, p = 0.41) and the stroke rate (7% vs. 5%, p = 0.76) were similar. Moderate–severe paravalvular leakage (PVL) was also comparable in both groups (1% vs. 4%, p = 0.17). Conclusion: Safety and efficacy outcomes were comparable between the two valves, except for a higher PPI rate for the Evolut SE valve. Up to 1-year follow-up, clinical outcomes showed acceptable rates of stroke and cardiac death with both valves. Valve hemodynamics were excellent with a low rate of moderate–severe PVL in both groups.

Abstract Background Embolization of a Watchman device in patients undergoing percutaneous left atrial appendage (LAA) closure is a rare complication. Retrieval of the device can be achieved percutaneously with a snaring technique or a bioptome. Case summary We present an illustrative case of Watchman closure device embolization during an LAA closure attempt in a 77-year-old man. The complication was caused by anatomical restraints of the LAA, in particular limited depth resulting in poor stability of the closure device after implantation. By the use of a double snaring technique, however, we managed to retrieve the device percutaneously. By applying such strategy, a more invasive surgical approach can be prevented. Discussion Prompt response is needed when embolization of a Watchman device occurs. A snaring technique can be used in most cases to attempt device retrieval. A double snaring technique is in this case associated with higher retrieval success than a single snaring technique.