TEM Classification of Aortic Dissection-The Evolving Scoring System: A Literature Review

Aortic dissection is an acute presentation that, if unnoticed, poses a significant risk to life. Anatomically, it is defined as a tear in the intimal layer of the aorta, but management differs significantly based on the location of this tear. Traditionally the Stanford and DeBakey classifications have been used to distinguish tear types and thus guide the most favourable management option, be it medical optimisation or surgery. Recently, a new Type-Entry-Malperfusion classification has been proposed to more accurately define and thus risk stratify patients with aortic dissection. This review summarises the Type-Entry-Malperfusion classification and highlights its potential advantages and limitations compared to other classifications. Clinical insights and potential barriers to adopting this classification are also described in this review.

Variation in Experiences and Attainment in Surgery Between Ethnicities of UK Medical Students and Doctors (ATTAIN): Protocol for a Cross-Sectional Study

BACKGROUND

The unequal distribution of academic and professional outcomes between different minority groups is a pervasive issue in many fields, including surgery. The implications of differential attainment remain significant, not only for the individuals affected but also for the wider health care system. An inclusive health care system is crucial in meeting the needs of an increasingly diverse patient population, thereby leading to better outcomes. One barrier to diversifying the workforce is the differential attainment in educational outcomes between Black and Minority Ethnic (BME) and White medical students and doctors in the United Kingdom. BME trainees are known to have lower performance rates in medical examinations, including undergraduate and postgraduate exams, Annual Review of Competence Progression, as well as training and consultant job applications. Studies have shown that BME candidates have a higher likelihood of failing both parts of the Membership of the Royal Colleges of Surgeons exams and are 10% less likely to be considered suitable for core surgical training. Several contributing factors have been identified; however, there has been limited evidence investigating surgical training experiences and their relationship to differential attainment. To understand the nature of differential attainment in surgery and to develop effective strategies to address it, it is essential to examine the underlying causes and contributing factors. The Variation in Experiences and Attainment in Surgery Between Ethnicities of UK Medical Students and Doctors (ATTAIN) study aims to describe and compare the factors and outcomes of attainment between different ethnicities of doctors and medical students.

OBJECTIVE

The primary aim will be to compare the effect of experiences and perceptions of surgical education of students and doctors of different ethnicities.

METHODS

This protocol describes a nationwide cross-sectional study of medical students and nonconsultant grade doctors in the United Kingdom. Participants will complete a web-based questionnaire collecting data on experiences and perceptions of surgical placements as well as self-reported academic attainment data. A comprehensive data collection strategy will be used to collect a representative sample of the population. A set of surrogate markers relevant to surgical training will be used to establish a primary outcome to determine variations in attainment. Regression analyses will be used to identify potential causes for the variation in attainment.

RESULTS

Data collected between February 2022 and September 2022 yielded 1603 respondents. Data analysis is yet to be competed. The protocol was approved by the University College London Research Ethics Committee on September 16, 2021 (ethics approval reference 19071/004). The findings will be disseminated through peer-reviewed publications and conference presentations.

CONCLUSIONS

Drawing upon the conclusions of this study, we aim to make recommendations on educational policy reforms. Additionally, the creation of a large, comprehensive data set can be used for further research.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/40545.

Fetal/neonatal alloimmune thrombocytopenia: a continuing challenge

Fetal/neonatal alloimmune thrombocytopenia is the platelet counterpart of the red cell disorder, haemolytic disease of the fetus and newborn. Unlike Rhesus pregnancies, first pregnancy is commonly affected. It is a progressive disease and can cause severe fetal damage, late fetal and neonatal loss and severe handicap. No screening programme is currently available and the diagnosis is often delayed. Testing for platelet antibodies in those mothers whose babies are thrombocytopaenic is necessary for early detection of this condition.

Effect of ammonia on in vivo and in vitro immune responses

The effects of exposure of animals to ammonia on their delayed type of dermal response, the mitogenic and antigenic responses of their lymphocytes, and the bactericidal and phagocytic activities of their alveolar macrophages were examined. Experimental guinea pigs vaccinated with Mycobacterium bovis BCG were exposed to 3.75 micrograms of ammonia per dl of air (50 ppm) or 6.75 micrograms of ammonia per dl of air (90 ppm), whereas control animals also vaccinated with BCG were maintained in the normal environment. The delayed type of dermal response to tuberculin injected 3 weeks later was significantly (P less than 0.05) less in experimental animals exposed to 6.75 micrograms of ammonia per dl than in control animals. In vitro, the response of blood lymphocytes and bronchial lymphocytes to phytohemagglutinin, concanavalin A, and tuberculin stimulation was significantly (P less than 0.01) less than the response of lymphocytes from control animals. The response of normal blood lymphocytes to phytohemagglutinin incubated in medium containing 1 or 10 mg of ammonia per dl was significantly (P less than 0.01) reduced as compared with the response of lymphocytes incubated without ammonia. The viability of lymphocytes incubated with these concentrations of ammonia was significantly (P less than 0.01) affected. There was no significant difference in the bactericidal or phagocytic activities of alveolar macrophages collected from animals exposed to ammonia and control animals. However, ammonia added to the culture of alveolar macrophages from normal animals significantly inhibited their bactericidal activity.