Comparing the Efficacy of Endovascular Simulation Training in Different Training Formats: A Randomized Controlled Trial.

BACKGROUND: High-fidelity endovascular simulators have demonstrated significant potential in enhancing interventionalists' performance metrics, including procedure time (PT), fluoroscopy time (FT), and contrast volume (CV) usage. However, it is less clear whether trainee performance, when assessed using both multidimensional global and procedure-specific rating scales (PSRS), improves in a manner consistent with these metric parameters. This study aimed to determine whether the structure of the training-conducted in block sessions or weekly intervals-impacts the effectiveness of the training. METHODS: Twenty students were enrolled in this prospective, randomized, controlled, single-center trial. They were randomly divided into block and weekly training groups, each undergoing 6 hrs of supervised endovascular training on a Mentice simulator over a span of 3 weeks. At the outset and conclusion of their training, students performed a predefined peripheral endovascular intervention, which was assessed by an experienced interventionalist. Furthermore, participants were prompted to complete a survey at both the beginning and the end of the study. RESULTS: Both groups exhibited significant improvements in PT, FT, CV usage, global rating scale (GRS) scores, and performance-specific rating scale scores. However, no significant difference was observed between the 2 groups. The simulator training notably boosted the trainee's self-confidence. CONCLUSIONS: Simulator training not only enhances metric performance parameters but also improves performance as assessed by both GRS and PSRS. Whether the training is conducted in block sessions or weekly intervals did not affect its efficacy. As such, the training format can be tailored to best fit the specific circumstances and setting.

Could Phosphorous MR Spectroscopy Help Predict the Severity of Vasospasm? A Pilot Study.

One of the main causes of the dismal prognosis in patients who survive the initial bleeding after aneurysmal subarachnoidal hemorrhage is the delayed cerebral ischaemia caused by vasospasm. Studies suggest that cerebral magnesium and pH may potentially play a role in the pathophysiology of this adverse event. Using phosphorous magnetic resonance spectrocopy (31P-MRS), we calculated the cerebral magnesium (Mg) and pH levels in 13 patients who suffered from aSAH. The values between the group that developed clinically significant vasospasm (n = 7) and the group that did not (n = 6) were compared. The results of this study show significantly lower cerebral Mg levels (p = 0.019) and higher pH levels (p < 0.001) in the cumulative group (all brain voxels together) in patients who developed clinically significant vasospasm. Further clinical studies on a larger group of carefully selected patients are needed in order to predict clinically significant vasospasm.

Strut Onlay Allograft in Revision Arthroplasty: Osseous Union and Clinical Outcome.

AIM: To evaluate the clinical outcome and the osseous union of strut onlay allografts (SOAs) used as adjunct in revision total joint arthroplasty (TJA). PATIENTS AND METHODS: Patients that had previously undergone SOA augmentation were considered for inclusion. Patients were invited to provide information for the following: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EuroQol five dimension score (EQ-5D) and Parker mobility score. Osseous union rates between SOA and the host bone were determined by radiograph with the Emerson classification system. Bone mineral density was measured via quantitative computed tomography. RESULTS: Seventeen patients were identified, at a mean follow-up of 2.8 years. The median total WOMAC score was 22 [interquartile range (IQR)=21]. The median EQ-5D score was 0.887 (IQR=0.350) (time trade-off). The Parker Mobility Score was 8.0 (IQR=3.5). Emerson stages of radiographic graft to host union were 'rounding off' in one case, 'partial bridging' in three and 'complete bridging' in 13. Quantitative computed tomography showed an average bone mineral density of approximately 1,300 mg/cm3. CONCLUSION: From our findings, it is concluded that SOAs used in revision total joint arthroplasty provide promising results and are recommended for broader clinical use. A complete osseous union between host and graft bone was observed in the majority of cases.