Liver Transplantation for Hepatocellular Carcinoma: A Single Center Resume Overlooking Four Decades of Experience

Background. This is a single center oncological resume overlooking four decades of experience with liver transplantation (LT) for hepatocellular carcinoma (HCC). Methods. All 319 LT for HCC that were performed between 1975 and 2011 were included. Predictors for HCC recurrence (HCCR) and survival were identified by Cox regression, Kaplan-Meier analysis, Log Rank, and χ2-tests where appropriate. Results. HCCR was the single strongest hazard for survival (exp⁡B=10.156). Hazards for HCCR were tumor staging beyond the histologic MILAN (exp⁡B=3.645), bilateral tumor spreading (exp⁡B=14.505), tumor grading beyond G2 (exp⁡B=8.668), and vascular infiltration of small or large vessels (exp⁡B=11.612, exp⁡B=18.324, resp.). Grading beyond G2 (exp⁡B=10.498) as well as small and large vascular infiltrations (exp⁡B=13.337, exp⁡B=16.737, resp.) was associated with higher hazard ratios for long-term survival as compared to liver transplantation beyond histological MILAN (exp⁡B=4.533). Tumor dedifferentiation significantly correlated with vascular infiltration (χ2p=0.006) and intrahepatic tumor spreading (χ2p=0.016). Conclusion. LT enables survival from HCC. HCC dedifferentiation is associated with vascular infiltration and intrahepatic tumor spreading and is a strong hazard for HCCR and survival. Pretransplant tumor staging should include grading by biopsy, because grading is a reliable and easily accessible predictor of HCCR and survival. Detection of dedifferentiation should speed up the allocation process

SeminarEvaluationData.xlsx

Dataset from Seminar Evaluatio

Bedside Teaching Evaluation Data

Dataset obtained by student evaluatio

"Seeing inside out": revealing the effectiveness of otoscopy training in virtual reality enhanced practical exams - a randomized controlled trial

BackgroundThe study aimed to assess the impact of different training modalities on otoscopy performance during a practical exam using a high-fidelity simulator and to determine if objective evaluation of otoscopy is feasible using a simulator that records insertion depth and tympanic membrane coverage.MethodsParticipants were assigned to one of four groups: control and three intervention groups with varying training approaches. Participants received otoscopy training and then were assessed through a practical exam on a high-fidelity simulator that uses virtual reality to visualize the ear canal and middle ear. Performance was evaluated using a modified Objective Structured Assessment of Technical Skills checklist and Integrated Procedural Performance Instrument checklist. Insertion depth, tympanic membrane coverage, and correct diagnosis were recorded. Data were tested for normal distribution using the Shapiro-Wilk test. One-way ANOVA and, for non-normally distributed data, Kruskal-Wallis test combined with Dunn’s test for multiple comparisons were used. Interrater reliability was assessed using Cohen’s κ and Intraclass correlation coefficient.ResultsAll groups rated their training sessions positively. Performance on the OSATS checklist was similar among groups. IPPI scores indicated comparable patient handling skills. The feedback group examined larger tympanic membrane areas and had higher rates of correct diagnosis. The correct insertion depth was rarely achieved by all participants. Interrater reliability for OSATS was strong. IPPI reliability showed good correlation.ConclusionRegardless of training modality, participants perceived learning improvement and skill acquisition. Feedback improved examination performance, indicating simulator-guided training enhances skills. High-fidelity simulator usage in exams provides an objective assessment of performance

Qualitätssicherungssystem zur Bewertung eines HNO-Facharztrepetitoriums

Zusammenfassung Hintergrund Die Facharztweiterbildung ist häufig durch lokal geprägte Weiterbildungsschwerpunkte bestimmt, was zu einem heterogenen Weiterbildungsergebnis führen kann. Repetitorien vor Facharztprüfungen könnten dies harmonisieren. Ziel der Arbeit Ziel ist die Darstellung eines Qualitätssicherungssystems zur Bewertung eines Repetitoriums für HNO-Facharztkandidaten. Material und Methoden Die Lehreinheiten eines in Präsenz durchgeführten Facharztrepetitoriums wurde mittels Fragebogen evaluiert. Sowohl eine deskriptive Auswertung als auch eine multivariable binär-logistische Regressionsanalyse wurden durchgeführt. Zur Evaluation der Faktoren, die zu einer negativen Wahrnehmung einer Lehreinheit führen, erfolgte eine Fokussierung auf die schlechtesten 15 % aller Gesamtbewertungen. Für ein individuelles Dozentenfeedback wurde exemplarisch ein Stärken-Schwächen-Profil eines Dozenten erstellt. Ergebnisse Die Auswertung der Evaluationsergebnisse zeigte eine durchschnittlich sehr gute Gesamtbewertung von 12,8 (±2,4) bei maximal 15 möglichen Punkten. Die multivariable Regression bestimmte die Items „Freundlichkeit“, „Systematischer Aufbau“, „Eigene Mitarbeit“, „Vorwissen“ und „Unterrichtseinheit effizient“ als maßgeblich für eine Negativwahrnehmung einer Lehreinheit. Anhand des Dozentenprofils lassen sich in einer objektiven Form die Stärken und Schwächen des individuellen Dozenten aufzeigen. Schlussfolgerung Der entwickelte Fragebogen bildet eine gute Möglichkeit zur Qualitätssicherung einer Lehrveranstaltung in der Weiterbildung. Diese erfolgt zum einen über die Regressionsanalyse aller Fragebögen, zum anderen über die Erstellung eines individuellen Dozentenprofils, welches eine objektive Grundlage zur Verbesserung der einzelnen Lehreinheit durch ein detailliertes Feedback an den Dozenten ermöglicht. </jats:sec

Qualitätssicherungssystem zur Bewertung eines HNO-Facharztrepetitoriums

Background!#!Residency training is often characterized by locally influenced training content and focus, which can lead to heterogeneous training outcomes. Refresher courses before the speciality certificate examinations can harmonize the situation.!##!Objective!#!The current publication aims to present a quality management system for evaluation of a postgraduate refresher course for otolaryngology residents.!##!Materials and methods!#!The teaching sessions of a postgraduate course were evaluated using questionnaires. Descriptive statistics and multivariable binary logistic regression analysis were performed. To evaluate the factors leading to a negative perception of a teaching session, the focus was set on the worst 15% of all total ratings. An exemplary strength/weakness profile of a lecturer was created for individual feedback.!##!Results!#!Analysis of the evaluation results showed an overall average rating of 12.8 (±2.4) out of a maximum of 15 possible points. Multivariable regression determined the items 'friendliness,' 'systematic structure,' 'own involvement,' 'prior knowledge,' and 'efficient teaching session' to be significant for a negative perception of a teaching session. Using the lecturer profile, the strengths and weaknesses of the individual lecturer can be shown in an objective manner.!##!Conclusion!#!The developed questionnaire represents a good tool for quality management of a postgraduate refresher course for otolaryngology residents. This is achieved by regression analysis and creation of an individual lecturer profile, which provides an objective basis for improving the individual teaching session through detailed feedback to the lecturer

An Ex Vivo Perfusion Model To Study the Treatment of Thrombotic Microangiopathy during Pig-to-Human Xenogenic Kidney Transplantation.

Abstract Early rejection of xenogenic organs is associated with thrombotic microangiopathy and changes of coagulation resembling disseminated intravascular coagulation (DIC). Here, we used an ex vivo perfusion circuit as a model of pig-to-human kidney transplantation to study the nature and treatment of this pathology. Porcine kidneys were obtained following in situ cold perfusion with HTK organ preservation solution and immediately connected to a perfusion circuit containing porcine (“autologous”) or human (“xenogenic”) AB blood supplemented with complement component C1 inhibitor (1 U/ml) and heparin (1 U/ml). Perfusion of porcine kidneys with autologous blood was feasible for &gt;240 min in all experiments. In contrast, perfusion of porcine kidneys with xenogenic human blood was limited by a dramatic increase of flow resistance after 30 to 240 min. Increased concentrations of C3a as a marker for complement activation were associated with early perfusion failure. In addition, a dramatic increase of thrombin-antithrombin complex (TAT) and D Dimer (DD) was observed together with consumption of platelets, fibrinogen and antithrombin (AT). Histological examination demonstrated extensive thrombotic microangiopathy. Supplementation recombinant human activated protein C (rhAPC, 300 ug/l*h, n=3) or recombinant human antithrombin (rhAT, 3 U/ml, n=3) abolished the increase of flow resistance and allowed for a xenogenic kidney survival of &gt;240 min in all experiments. Increase of DD was abolished and the consumption of fibrinogen was abrogated by both treatments as compared to control, whereas the increase of TAT was abolished only by rhAPC. Histological examination revealed no evidence of thrombotic microangiopathy for both treatments as compared to control. In conclusion, the perfusion model introduced here is a suitable tool for studying coagulopathy during early rejection in xenotransplantation. Thrombotic microangiopathy and DIC-like activation of coagulation is associated with an increased flow resistance and failure of perfusion in this model. Pharmacological intervention such as the supplementation of rhAPC or rhAT can be studied using this model and has been shown to prevent coagulopathy and thrombotic microangiopathy.</jats:p

Regression analyses of questionnaires in bedside teaching

Abstract Background Students’ ratings of bedside teaching courses are difficult to evaluate and to comprehend. Validated systematic analyses of influences on students’ perception and valuation of bedside teaching can serve as the basis for targeted improvements. Methods Six hundred seventy-two observations were conducted in different surgical departments. Survey items covered the categories teacher’s performance, student’s self-perception and organizational structures. Relevant factors for the student overall rating were identified by multivariable linear regression after exclusion of variable correlations &gt; 0.500. The main target for intervention was identified by the 15% worst overall ratings via multivariable logistic regression. Results According to the students the success of bedside teaching depended on their active participation and the teacher’s explanations of pathophysiology. Further items are both relevant to the overall rating and a possible negative perception of the session. In comparison, negative perception of courses (worst 15%) is influenced by fewer variables than overall rating. Variables that appear in both calculations show slight differences in their weighing for their respective endpoints. Conclusion Relevant factors for overall rating and negative perception in bedside teaching can be identified by regression analyses of survey data. Analyses provide the basis for targeted improvement. </jats:sec