Abstract Background With an increase in the use of endovascular interventions as an alternative to open surgery and the unique technical skills required, current methods for assessing the competence of vascular surgery trainees may not be optimal, suggesting a need for a shift in assessment modalities. We conducted this systematic review to explore current assessment methods used in vascular surgery training to assess competence specific to endovascular procedures. Methods A comprehensive literature search was performed with a structured search strategy using terms focusing on endovascular procedures and assessment. Inclusion and exclusion criteria were used in order to screen for suitable articles. Results We identified 54 articles that satisfied the inclusion criteria. These included a single randomized controlled trial, a single systematic review, a single narrative review and a single literature review, with the vast majority having level 2 evidence. Global rating scales, proficiency assessments and written/oral examinations were described as standard current assessment tools. These modalities lack reproducibility and objectivity, neglecting the needs of assessment of endovascular procedures requiring specialized decision making and finger dexterity. Novel methods such as high fidelity simulation and virtual reality promote reproducible and objective assessment methods in the context of endovascular surgery, and have a promising future. Conclusion While current assessment methods in vascular surgery are widely supported the changing skills required of a vascular surgery trainee warrants a shift in assessment modalities to better align to these requirements. High fidelity simulations show promise, although they require more extensive research to understand their relative merits.
A highly sensitive, non-probe-based, real-time quantitative reverse transcriptase PCR was developed for viral load measurements in both serum and liver samples from patients with hepatitis C virus (HCV) infection. With synthetic RNA, the linearity of the approach was conserved over a wide range of HCV copy numbers. There was a strong correlation between hepatic and serum viral load measurements (r = 0.689, P = 0.004, n = 15), indicating that the level of viremia reflected the amount of virus present in the liver.
Objective: Compare long-term mortality, secondary intervention and secondary rupture following elective endovascular aneurysm repair (EVAR) and open surgical repair (OSR). Background: EVAR has surpassed OSR as the most common procedure used to repair abdominal aortic aneurysm (AAA), but evidence regarding long-term outcomes is inconclusive. Methods: We included patients in linked clinical registry and administrative data undergoing EVAR or OSR for intact AAA between January 2010 and June 2019. We used an inverse probability of treatment-weighted survival analysis to compare all-cause mortality, cause-specific mortality, secondary interventions and secondary rupture, and evaluate the impact of secondary interventions and secondary rupture on all-cause mortality. Results: The study included 3460 EVAR and 427 OSR patients. Compared to OSR, the EVAR all-cause mortality rate was lower in the first 30 days [adjusted hazard ratio (HR) = 0.22, 95% confidence interval (CI) 0.140.33], but higher between 1 and 4 years (HR = 1.29, 95% CI 1.12–1.48) and after 4years (HR = 1.41, 95% CI 1.23–1.63). Secondary intervention rates were higher over the first 30 days (HR = 2.26, 95% CI 1.11–4.59), but lower between 1 and 4years (HR = 0.59, 95% CI 0.48–0.74). Secondary aortic intervention rates were higher across the entire follow-up period (HR = 2.52, 95% CI 2.06–3.07). Secondary rupture rates did not differ significantly (HR = 1.06, 95% CI 0.73–1.55). All-cause mortality beyond 1 year remained significantly higher for EVAR after adjusting for any secondary interventions, or secendary rupture Conclusions: EVAR has an early survival benefit compared to OSR. However, elevated long-term mortality and higher rates of secondary aortic interventions and subsequent aneurysm repair suggest that EVAR may be a less durable method of aortic aneurysm exclusion.
The factors influencing lymphocyte trafficking to the liver lobule during chronic hepaititis C virus (HCV) infection are currently not well defined. Interferon-gamma-inducible protein 10 (IP-10), a chemokine that recruits activated T lymphocytes, has recently been shown by in situ hybridization to be expressed in the liver during chronic HCV infection. This study sought to define the cellular source of IP-10 in the liver by immunohistochemistry, to examine the expression of its receptor, CXCR3, on T lymphocytes isolated from blood and liver tissue, and to correlate IP-10 expression with the histological markers of inflammation and fibrosis. IP-10 was expressed by hepatocytes but not by other cell types within the liver, and the most intense immunoreactivity was evident in the areas of lobular inflammation. The IP-10 receptor was expressed on a significantly higher proportion of T lymphocytes in the liver compared with blood. CD8 T lymphocytes, which predominate in the liver lobule, were almost uniformly CXCR3-positive. The expression of IP-10 mRNA correlated with lobular necroinflammatory activity but not with inflammation or fibrosis in the portal tracts. These findings suggest that IP-10 may be induced by HCV within hepatocytes and may be important in the pathogenesis of chronic HCV infection, as recruitment of inflammatory cells into the lobule is an important predictor of disease progression.
With increased need for vascular surgery trainees to gain endovascular surgery proficiency, current models of case-numbers and subjective visual assessment are inadequate in capturing the skills required in endovascular surgery. We explored the use of high-fidelity simulators in (1) assessing endovascular surgical competence; (2) clinical decision making; and (3) the reliability of an artificial intelligence (AI) assessor.Registrars, fellows and consultants from vascular surgery, interventional radiology and general surgery performed identical procedures on a high-fidelity simulator. Performance was independently assessed using a modified Reznick scale. Scores were compared to raw metric data extracted from the simulator, objective scores extracted from the recordings and analysed by AI.22 participants were enrolled from vascular surgery (n = 6, 27.3%), interventional radiology (n = 10, 45.5%) and general surgery (n = 6, 27.3%). There were 12 trainees, 2 fellows and 8 consultants. Significant correlations between raw metric data and all categories of the modified Reznick scale except 'respect for tissue' were found. An AI demonstrated positive reliability in all categories, with some predictions being moderately correlated.The use of high-fidelity simulators to assess endovascular surgical competence has comparable correlations to the traditional assessment methods with global rating scales, which can be used in formative assessment. AI demonstrates an ability to support assessment but requires further research.
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