Meeting tomorrow's needs: a single-centre study in geriatric neurosurgery.

BackgroundChinese population has a high prevalence of chronic hepatitis B virus (HBV) infection, the impact of which on pregnancy outcome remains controversial. A single-center retrospective cohort study was performed in Kunming, a multi-ethnic city in south-western China to examine this issue.MethodsThe singleton pregnancies delivering at ≥28 weeks gestation under our care in 2005–2017 constituted the study cohort. Maternal characteristics and pregnancy outcome were compared between mothers with and without seropositivity for hepatitis B surface antigen (HBsAg) determined at routine antenatal screening.ResultsAmong the 49,479 gravidae in the cohort, the 1624 (3.3%) HBsAg seropositive gravidae had a lower incidence of nulliparity (RR 0.963, 95% CI 0.935–0.992) and having received tertiary education (RR 0.829, 95% CI 0.784–0.827). There was no significant difference in the medical history, pregnancy complications, or labor or perinatal outcome, except that HBV carriers had significantly lower incidence of labor induction (RR 0.827, 95% CI 0.714–0.958) and of small-for-gestational age (SGA) infants (RR 0.854, 95% CI 0.734–0.994). On regression analysis, maternal HBV carriage was independently associated with spontaneous labor (aRR 1.231, 95% CI 1.044–1.451) and reduced SGA infants (aRR 0.842, 95% CI 0.712–0.997).ConclusionsOur 3.3% prevalence of maternal HBV infection was around the lower range determined in the Chinese population. The association with spontaneous labor and reduced SGA infants could have helped to promote the perpetuation of the infection through enhanced survival of the offspring infected at birth, thus explaining the high prevalence in the Chinese population.

Clinical-Pathological Features of Non-Transfusion Dependent Thalassemia in Adults — a Single Center Study in Hong Kong

When Is "Never Enough" (Data) … Enough?

Purpose To quantify the rate of detection of aneurysms at follow-up digital subtraction angiography (DSA) after initial DSA with results negative for aneurysms in subjects with perimesencephalic (PM) nonaneurysmal subarachnoid hemorrhage. Materials and Methods This single-center retrospective study and meta-analysis was approved by the institutional review board. At a single institution from 2000 to 2013, 252 consecutive patients with subarachnoid hemorrhage at computed tomography (CT) and two DSA examinations negative for aneurysm within 10 days were evaluated for inclusion in the study, and 131 met CT criteria for PM nonaneurysmal subarachnoid hemorrhage (53 women; mean age, 53 years [range, 33-88 years]). DS angiographic reports were reviewed for causative abnormalities. Three reviewers searched MEDLINE and electronic databases for studies that reported detection of aneurysm in subjects with PM hemorrhage who had undergone multiple DSA examinations. Main inclusion criteria were PM hemorrhage at CT per van Gijn classification, head CT performed within 72 hours of symptom onset, initial DS angiographic results negative for aneurysm, and two DSA examinations within 10 days. Studies with fewer than 25 subjects were excluded. Methodology was assessed by using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The summary rate of aneurysm detection for subsequent DSA was calculated by using a fixed-effects model. Results Six studies with 298 subjects and a single-institution study with 131 subjects were included. No aneurysms were seen at follow-up DSA in the single-center study (0.0%). Three aneurysms were detected at follow-up DSA in three of six studies from the literature (one of 29 [3.4%], one of 65 [1.5%], and one of 34 [2.9%] patients). Two occurred in cases that likely preceded the use of the current DSA technique. The summary aneurysm detection rate at subsequent DSA was 1.6% (95% confidence interval: 0.7%, 3.8%; range of individual study detection rate: 0.0%-3.4%). Conclusion In patients with PM nonaneurysmal subarachnoid hemorrhage and initial DSA negative for aneurysms, the yield of follow-up DSA for detection of causative aneurysms is very low. © RSNA, 2016 Online supplemental material is available for this article.

Background: Coronavirus disease-2019 (COVID-19) pandemic continues to storm internationally. Various essential services in the health systems have failed to meet the standardized health needs for those non-COVID-19 patients. In this single academic center study, we describe the epidemiological profiles and clinical outcomes on non-COVID-19 patients during COVID-19 pandemic to guide decision-makers in maintaining essential health services and building a structured recovery plan by the end of this pandemic. Materials and Methods: This retrospective cross-sectional single academic center study included 718 non-COVID-19 patients in King Saud University Medical City between March and June 2020. Demographic, clinical, laboratory, treatment, and disposition data were extracted from the Hospital Electronic Records, Electronic System for Integrated Health Information database. Results: The highest age group was 26–35 years, representing 28.6% (n = 205), and 56% (n = 402) were females. The most common comorbidity was hypertension by 25.5% (n = 183), and the main route of admission was through Emergency Medicine Department, 76.7% (n = 551), and 87% (n = 624) of the admissions were to wards, 13% (n = 92) were to Intensive Care Unit, and 7% (n = 51) were deceased. Based on International Classification of Diseases, Revision 10 classifications, 33.6% (n = 241) had diseases of the respiratory system, 14.5% (n = 104) were obstetrics, and 10.4% (n = 75) were cardiac cases. Conclusion: In this single-center study, maintaining essential health-care services is critical during COVID-19 pandemics. Attention should be addressed to extreme ages and to those with pulmonary, obstetric, and cardiac diseases. Mapping decisions taken to curb COVID-19 is critical to structure a solid recovery plan.

Bowel obstruction due to internal hernia (IH) is a well-known late complication of a laparoscopic roux-en-y gastric bypass (LRYGBP). The objective of this study is to evaluate if closure of the mesenteric defect and Petersen's space will decrease the rate of internal hernias compared to only closure of the mesenteric defect. A single-center retrospective descriptive study was performed. All patients with LRYGBP from 2011 till April 2017 were included. An antecolic technique was used with closure of the mesenteric defect with a non-absorbable running suture between 2011 and October 2013 (group A), and from November 2013, we added closure of the Petersen defect (group B). From a total of 3124 patients, 116 patients (3.71%) had an exploratory laparoscopy due to suspicion of bowel obstruction, but in only 67 (2.14%) patients, an IH was found. Preoperative CT predicted the diagnosis in only 73%. In group A, including 1586 patients, 53 (3.34%) were diagnosed with an internal hernia: 39 at Petersen's space and 14 at the mesenteric defect. The mean time interval was 24.2months and the mean BMI 25.7kg/m2. After routine closure of the Petersen defect in 1538 patients in group B, an internal hernia during laparoscopy was found in 14 (0.91%) patients after a mean period of 13.5months: 11 at Petersen's space and 3 at the mesenteric defect. In two subgroups (C and D) with an equal follow-up time (24-42m), the incidence of 1.15% (8/699) was halved in the closure group of both defects compared to the incidence of 2.58% (23/893) in the group with only closure of the mesenteric defect. After descriptive analysis, these results can provide strong recommendation of closure of the mesenteric defect and Petersen's space, as we notice a tendency to lower incidence of internal hernias.

Transorbital sonography (TOS) provides a noninvasive tool to detect intracranial pressure by assessing optic nerve sheath diameter (ONSD) and optic disc elevation (ODE). The utility of TOS in the diagnosis of idiopathic intracranial hypertension (IIH) has been increasingly recognized. A single-center case-control study sought to compare TOS-acquired ONSD and ODE among IIH-cases versus patients with other neurological diseases (controls). Furthermore, a systematic review and meta-analysis was conducted to present pooled mean differences and diagnostic measures of ONSD and ODE between IIH-cases and controls. In the single-center study, consisting of 31 IIH-cases and 34 sex- and age-matched controls, ONSD values were higher among IIH-cases than controls (p<.001), while ODE was more prevalent in cases (65%vs. 15%; p<.001). The receiver-operating characteristic (ROC)-curve analysis revealed that the optimal cutoff value of ONSD for predicting IIH was 5.15mm, with an area under the curve (AUC) of 0.914 (95% confidence interval [CI]: 0.861-0.967) and sensitivity and specificity values of 85% and 90%, respectively. In a meta-analysis of 14 included studies with 415 IIH-cases, ONSD and ODE values were higher in IIH-cases than controls (mean difference in ONSD 1.20mm; 95% CI: 0.96-1.44mm and in ODE 0.3mm; 95% CI: 0.33-0.67mm). With regard to ONSD, pooled sensitivity, specificity, and diagnostic odds ratio were calculated at 85.5% (95% CI: 77.9-90.8%), 90.7% (95% CI: 84.6-94.5%), and 57.394 (95% CI: 24.597-133.924), respectively. The AUC in summary ROC-curve analysis was 0.878 (95% CI: 0.858-0.899) with an optimal cutoff point of 5.0mm. TOS has a high diagnostic utility for the noninvasive diagnosis of IIH and may deserve wider implementation in everyday clinical practice.

Inpatient Subspecialty Consultations: A New Target for High-Value Pediatric Hospital Care?

&lt;p dir="ltr"&gt;&lt;b&gt;Background&lt;/b&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;Minimally invasive cardiac surgery (MICS) has emerged as an alternative to conventional sternotomy, offering potential benefits due to reduced surgical trauma. This thesis evaluates the clinical outcomes, safety, and efficacy of MIMVS and the use of percutaneous femoral access and plug-based VCD in MIMVS and transcatheter aortic valve replacement (TAVR).&lt;/p&gt;&lt;p dir="ltr"&gt;&lt;b&gt;Methods and Results&lt;/b&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;&lt;i&gt;Study I&lt;/i&gt;: This single-center study analyzed patients who underwent mitral valve surgery at Karolinska University Hospital between January 2012 and May 2019, treated either via sternotomy or MIMVS. A total of 605 patients (294 sternotomy, 311 minimally invasive) were included. Propensity score matching was performed, resulting in 251 matched pairs. In the matched analysis, minimally invasive procedures had a shorter aortic occlusion duration (97+36 vs. 105+40 min; p=0.03) but a longer extracorporeal circulation duration (149+52 vs. 133+57 min; p=0.001). Minimally invasive procedures were associated with a lower incidence of reoperation for bleeding (2.4% vs. 7.2%; p=0.012), reduced need for transfusion (19.1% vs. 30.7%; p=0.003), and a shorter in-hospital stay (5.0+2.7 vs. 7.2+4.6 days; p&lt;0.001).&lt;/p&gt;&lt;p dir="ltr"&gt;&lt;i&gt;Study II&lt;/i&gt;: This single-center prospective study compared patients undergoing MIMVS with femoral cannulation, performed either via surgical cut-down or percutaneously with access site closure using a plug-based VCD (MANTA, Teleflex/Essential Medical Inc., Malvern, Pennsylvania, USA) between 2016 and 2018. A total of 268 patients (147 surgical cut-down, 121 percutaneous) were included, with 109 matched pairs after propensity score matching. The primary outcome was vascular complications according to Valve Academic Research Consortium (VARC)-2 criteria. The VCD group had a significantly higher rate of major vascular complications (4.6% vs. 0%; p=0.024). No bleeding occurred in either group. In the full series, patients in the surgical cut-down group had a significantly higher incidence of seroma (10.9% vs. 0%, p&lt;0.001). Infection and seroma were not observed in the VCD group.&lt;/p&gt;&lt;p dir="ltr"&gt;&lt;i&gt;Study III&lt;/i&gt;: A single-center observational study evaluated 1000 consecutive patients undergoing transfemoral TAVR between May 2017 and September 2020. Patients received a MANTA VCD for arterial access management, and outcomes were assessed using VARC-2 criteria. The primary endpoint was VCD- related major vascular complications. Major vascular complications occurred in 4.2% of patients. Complications included the need for a covered stent (1.7%), surgical repair (1.7%), and vascular surgery post-discharge (0.3%). A significant risk factor for vascular complications was a larger sheath outer diameter relative to the femoral artery's inner diameter (p=0.028).&lt;/p&gt;&lt;p dir="ltr"&gt;&lt;i&gt;Study IV&lt;/i&gt;: This single-center study included 650 patients undergoing MICS between August 2017 and September 2022. The early group (207 patients) did not undergo intraoperative ultrasound assessment after VCD placement, while the late group (443 patients) did. The primary outcome was vascular complications according to VARC-2 criteria. Six patients (2.9%) in the early group experienced vascular complications, while no complications were reported in the ultrasound-assessed group (p&lt;0.001). A total of 15 patients (2.3%) required surgical cut-down due to incomplete hemostasis or femoral artery stenosis/occlusion, all caused by intravascular deployment of the closure device.&lt;/p&gt;&lt;p dir="ltr"&gt;&lt;b&gt;Conclusions&lt;/b&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;[I] MIMVS was associated with comparable short-term outcomes to sternotomy mitral valve surgery. MIMVS had lower rates of bleeding, blood transfusions, and shorter hospital stays. The initiation of an MIMVS program, when managed appropriately, proved safe and effective. [II] The use of the MANTA VCD in MIMVS eliminated wound complications seen with surgical cut-down, such as seromas and infections, but was associated with a higher risk of major vascular complications. [IV] By introducing intraoperative ultrasound to assess proper positioning of the VCD, vascular complications were reduced, particularly femoral artery stenosis. [III] Also, the MANTA VCD was effective for large-bore arterial access management during transfemoral TAVR with a low rate of complications. A larger sheath-to-femoral artery diameter ratio increased the risk of complications. The studies confirm the safety and efficacy of the MANTA device in a broad patient population, although vascular risks must be carefully managed.&lt;/p&gt;&lt;h3&gt;List of scientific papers&lt;/h3&gt;&lt;p dir="ltr"&gt;I. &lt;b&gt;Kastengren M,&lt;/b&gt; Svenarud P, Källner G, Franco-Cereceda A, Liska J, Gran I, Dalén M. Minimally invasive versus sternotomy mitral valve surgery when initiating a minimally invasive programme. Eur J Cardiothorac Surg. 2020;58:1168-1174. &lt;a href="https://doi.org/10.1093/ejcts/ezaa232" rel="noreferrer" target="_blank"&gt;https://doi.org/10.1093/ejcts/ezaa232&lt;/a&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;II. &lt;b&gt;Kastengren M,&lt;/b&gt; Svenarud P, Källner G, Settergren M, Franco- Cereceda A, Dalén M. Percutaneous Vascular Closure Device in Minimally Invasive Mitral Valve Surgery. Ann Thorac Surg. 2020;110:85-91. &lt;a href="https://doi.org/10.1016/j.athoracsur.2019.10.038" rel="noreferrer" target="_blank"&gt;https://doi.org/10.1016/j.athoracsur.2019.10.038&lt;/a&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;III. &lt;b&gt;Kastengren M,&lt;/b&gt; Settergren M, Rück A, Feldt K, Saleh N, Linder R, Verouhis D, Meduri CU, Bager J, Dalén M. Percutaneous plug-based vascular closure device in 1000 consecutive transfemoral transcatheter aortic valve implantations. Int J Cardiol. 2022;359:7-13. &lt;a href="https://doi.org/10.1016/j.ijcard.2022.04.033" rel="noreferrer" target="_blank"&gt;https://doi.org/10.1016/j.ijcard.2022.04.033&lt;/a&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;IV. Ma K, &lt;b&gt;Kastengren M,&lt;/b&gt; Svenarud P, Green R, Dalen M. Routine use of percutaneous femoral cannulation in minimally invasive cardiac surgery. Eur J Cardiothorac Surg. 2023;63:ezad020. &lt;a href="https://doi.org/10.1093/ejcts/ezad020" rel="noreferrer" target="_blank"&gt;https://doi.org/10.1093/ejcts/ezad020&lt;/a&gt;&lt;/p&gt;

SUMMARYPregnancy can alter the natural course of epilepsy and affect pharmacokinetic profile of antiepileptic drugs (AEDs) making therapeutic management more demanding. Since there is no relevant population-based study in Croatia to date, we conducted this research with the aim to observe antiepileptic treatment policy in pregnancy and to determine if the number of AEDs affects pregnancy outcomes. The study included all women with epilepsy with singleton pregnancy exposed to one or more AEDs divided into two groups (group 1: one AED and group 2: more than one AED used). Data were collected retrospectively at the Department of Obstetrics and Gynecology, Zagreb University Hospital Centre, Zagreb, Croatia, and included 153 women from January 2010 to December 2018. Primary outcomes included rates of preterm delivery, major fetal malformations, gestational hypertension, cesarean section rate, and appearance of seizures during pregnancy. We found higher rates of all pregnancy complications examined than in the general population, while comparison of the two study groups yielded significant differences. Preterm labor was detected in 30% of deliveries in polytherapy group compared to 16.6% in monotherapy group (p=0.03). Gestational hypertension was recorded in 20% of women in polytherapy group vs. 4.90% in monotherapy group (p=0.009). There was also a high rate of cesarean deliveries in polytherapy group (27.5%). Seizures during pregnancy occurred in 48.4% of patients in polytherapy group, which was significantly higher than the rate recorded in monotherapy group (p=0.015). In this single-center retrospective study, women with epilepsy using AEDs during pregnancy had a higher rate of gestational hypertension and preterm delivery than the general population of pregnant women. To the best of our knowledge, this is the first study in Croatia observing antiepileptic treatment policy in pregnancy with regards to AED regimen and perinatal outcome.

Posterior instrumentation is an established treatment for a range of spinal disorders. Material failure is not uncommon, and the indications for a revision are very heterogeneous. This study aimed to evaluate the indications and timing for early revision spinal surgery due to material failure.In this retrospective, single-center cohort study, patients underwent spinal posterior instrumentation between January 2017 and July 2019. They were followed up at 3, 12, and 18 months postoperatively. The time of onset of material failure which led to revision surgery was analyzed. In addition, the relationship between the indications for revision surgery and independent variables was examined using a multivariate logistic regression model.A total of one hundred thirty-five patients were enrolled. Radiolucent zones were found in 30 patients (20%) after 3 months, whereas 48 patients (31%) had radiolucent zones after 12 months. Revision surgery was performed in 13 patients (8.5%). The peak time for revision due to instability was within the first four months of the primary surgery. Multivariate analysis revealed that location, pathology, ASA score, and smoking had no significant impact on the indication for revision surgery, and neither did BMI (P = .042). Non-fusion (P = .007) and radiolucent zones (P = .004), in combination with increased pain (P = .006), were predictors for revision.Our data show that the peak time for early revision of material failure after posterior instrumentation was within the first 4 months of primary surgery. The abnormalities (e.g., radiolucent zones) surrounding the screws without fusion, including persistence of pain, were predictors for revision surgery.

Probable antibody-mediated rejection in kidney transplantation is a rare and challenging phenotype to define: Findings from a single-center study

&lt;p dir="ltr"&gt;&lt;b&gt;Background&lt;/b&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;Minimally invasive cardiac surgery (MICS) has emerged as an alternative to conventional sternotomy, offering potential benefits due to reduced surgical trauma. This thesis evaluates the clinical outcomes, safety, and efficacy of MIMVS and the use of percutaneous femoral access and plug-based VCD in MIMVS and transcatheter aortic valve replacement (TAVR).&lt;/p&gt;&lt;p dir="ltr"&gt;&lt;b&gt;Methods and Results&lt;/b&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;&lt;i&gt;Study I&lt;/i&gt;: This single-center study analyzed patients who underwent mitral valve surgery at Karolinska University Hospital between January 2012 and May 2019, treated either via sternotomy or MIMVS. A total of 605 patients (294 sternotomy, 311 minimally invasive) were included. Propensity score matching was performed, resulting in 251 matched pairs. In the matched analysis, minimally invasive procedures had a shorter aortic occlusion duration (97+36 vs. 105+40 min; p=0.03) but a longer extracorporeal circulation duration (149+52 vs. 133+57 min; p=0.001). Minimally invasive procedures were associated with a lower incidence of reoperation for bleeding (2.4% vs. 7.2%; p=0.012), reduced need for transfusion (19.1% vs. 30.7%; p=0.003), and a shorter in-hospital stay (5.0+2.7 vs. 7.2+4.6 days; p&lt;0.001).&lt;/p&gt;&lt;p dir="ltr"&gt;&lt;i&gt;Study II&lt;/i&gt;: This single-center prospective study compared patients undergoing MIMVS with femoral cannulation, performed either via surgical cut-down or percutaneously with access site closure using a plug-based VCD (MANTA, Teleflex/Essential Medical Inc., Malvern, Pennsylvania, USA) between 2016 and 2018. A total of 268 patients (147 surgical cut-down, 121 percutaneous) were included, with 109 matched pairs after propensity score matching. The primary outcome was vascular complications according to Valve Academic Research Consortium (VARC)-2 criteria. The VCD group had a significantly higher rate of major vascular complications (4.6% vs. 0%; p=0.024). No bleeding occurred in either group. In the full series, patients in the surgical cut-down group had a significantly higher incidence of seroma (10.9% vs. 0%, p&lt;0.001). Infection and seroma were not observed in the VCD group.&lt;/p&gt;&lt;p dir="ltr"&gt;&lt;i&gt;Study III&lt;/i&gt;: A single-center observational study evaluated 1000 consecutive patients undergoing transfemoral TAVR between May 2017 and September 2020. Patients received a MANTA VCD for arterial access management, and outcomes were assessed using VARC-2 criteria. The primary endpoint was VCD- related major vascular complications. Major vascular complications occurred in 4.2% of patients. Complications included the need for a covered stent (1.7%), surgical repair (1.7%), and vascular surgery post-discharge (0.3%). A significant risk factor for vascular complications was a larger sheath outer diameter relative to the femoral artery's inner diameter (p=0.028).&lt;/p&gt;&lt;p dir="ltr"&gt;&lt;i&gt;Study IV&lt;/i&gt;: This single-center study included 650 patients undergoing MICS between August 2017 and September 2022. The early group (207 patients) did not undergo intraoperative ultrasound assessment after VCD placement, while the late group (443 patients) did. The primary outcome was vascular complications according to VARC-2 criteria. Six patients (2.9%) in the early group experienced vascular complications, while no complications were reported in the ultrasound-assessed group (p&lt;0.001). A total of 15 patients (2.3%) required surgical cut-down due to incomplete hemostasis or femoral artery stenosis/occlusion, all caused by intravascular deployment of the closure device.&lt;/p&gt;&lt;p dir="ltr"&gt;&lt;b&gt;Conclusions&lt;/b&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;[I] MIMVS was associated with comparable short-term outcomes to sternotomy mitral valve surgery. MIMVS had lower rates of bleeding, blood transfusions, and shorter hospital stays. The initiation of an MIMVS program, when managed appropriately, proved safe and effective. [II] The use of the MANTA VCD in MIMVS eliminated wound complications seen with surgical cut-down, such as seromas and infections, but was associated with a higher risk of major vascular complications. [IV] By introducing intraoperative ultrasound to assess proper positioning of the VCD, vascular complications were reduced, particularly femoral artery stenosis. [III] Also, the MANTA VCD was effective for large-bore arterial access management during transfemoral TAVR with a low rate of complications. A larger sheath-to-femoral artery diameter ratio increased the risk of complications. The studies confirm the safety and efficacy of the MANTA device in a broad patient population, although vascular risks must be carefully managed.&lt;/p&gt;&lt;h3&gt;List of scientific papers&lt;/h3&gt;&lt;p dir="ltr"&gt;I. &lt;b&gt;Kastengren M,&lt;/b&gt; Svenarud P, Källner G, Franco-Cereceda A, Liska J, Gran I, Dalén M. Minimally invasive versus sternotomy mitral valve surgery when initiating a minimally invasive programme. Eur J Cardiothorac Surg. 2020;58:1168-1174. &lt;a href="https://doi.org/10.1093/ejcts/ezaa232" rel="noreferrer" target="_blank"&gt;https://doi.org/10.1093/ejcts/ezaa232&lt;/a&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;II. &lt;b&gt;Kastengren M,&lt;/b&gt; Svenarud P, Källner G, Settergren M, Franco- Cereceda A, Dalén M. Percutaneous Vascular Closure Device in Minimally Invasive Mitral Valve Surgery. Ann Thorac Surg. 2020;110:85-91. &lt;a href="https://doi.org/10.1016/j.athoracsur.2019.10.038" rel="noreferrer" target="_blank"&gt;https://doi.org/10.1016/j.athoracsur.2019.10.038&lt;/a&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;III. &lt;b&gt;Kastengren M,&lt;/b&gt; Settergren M, Rück A, Feldt K, Saleh N, Linder R, Verouhis D, Meduri CU, Bager J, Dalén M. Percutaneous plug-based vascular closure device in 1000 consecutive transfemoral transcatheter aortic valve implantations. Int J Cardiol. 2022;359:7-13. &lt;a href="https://doi.org/10.1016/j.ijcard.2022.04.033" rel="noreferrer" target="_blank"&gt;https://doi.org/10.1016/j.ijcard.2022.04.033&lt;/a&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;IV. Ma K, &lt;b&gt;Kastengren M,&lt;/b&gt; Svenarud P, Green R, Dalen M. Routine use of percutaneous femoral cannulation in minimally invasive cardiac surgery. Eur J Cardiothorac Surg. 2023;63:ezad020. &lt;a href="https://doi.org/10.1093/ejcts/ezad020" rel="noreferrer" target="_blank"&gt;https://doi.org/10.1093/ejcts/ezad020&lt;/a&gt;&lt;/p&gt;

Chronic inflammatory cardiomyopathy and its overlap with arrhythmogenic cardiomyopathy: long-term follow-up of a prospective single-centre cohort study

There has been an exponential increase in the utility of mixed-reality (MR) software as a tool for medical education and training due to its immersive and interactive capabilities. Whilst it has been progressively used in surgical training or in simulation training, there is a significant lack of using it to train the “trainers”. In this single-centre prospective study, MR technology was used to deliver a dedicated 2-h tutorial in surgical training to two cohorts of postgraduate students attending a course on clinical research and education. The Microsoft HoloLens 2 was used to run mixed-reality software capable of rendering CT scan images of a normal brain, an MRI of a large meningioma, an abdominal–pelvic CT scan, and a 3D-printed cranioplasty scan. The participants were then asked to complete a post-usage questionnaire in an anonymous manner. Fourteen participants attended the teaching session and completed the post-usage questionnaire. Scores obtained on the User Experience Questionnaire (UEQ) revealed that MR technology is rated “Excellent” on quality aspects for Attractiveness, Stimulation and Novelty. This prospective study provides insight into incorporating MR in training the trainers, allowing them to be equipped with the technology to imparting education to the next generation across various disciplines.