OBJECTIVES: The amount of intense and focused training with the specific goal to improve performance (i.e. deliberate practice) is a predictor of expert-level performance in multiple domains of psychomotor skill learning. Simulation training improves surgical skills in cardiac surgery. We established a training programme that enables early surgical exposure and assessment. We investigated the training effects in coronary surgery simulations in trainees with different levels of surgical experience. METHODS: The early surgical exposure and assessment programme comprises a low- and high-fidelity simulation, self-organized training, instructed workshops and a stepwise challenge increase. Performance was assessed with a multidimensional skill matrix using video recordings. Two groups of trainees [students (N = 7), 1-/2-year residents (N = 6)] completed introductory training (pretraining, level 1) and two 3-week training periods (levels 2 and 3). Fellows (N = 6) served as controls. Residents and students underwent deliberate practice training with specific training targets. Fellows performed regularly scheduled coronary surgery cases. Entry and exit assessments were conducted for levels 2 and 3. RESULTS: Fellows did not improve overall performance. Residents and students showed significant improvements in both technical accuracy and completion times. Residents reached an overall performance level comparable to fellows. Students reached similar accuracy of surgical skills with longer completion times [level 3 exit score/time: fellows 27 (24–29)/min; residents 27 (21–30)/min, P = 0.94; students 17 (17–25)/min, P = 0.068]. CONCLUSIONS: Deliberate practice training resulted in a fast and substantial increase in surgical skills in residents and students. Unexperienced residents reach performance levels of fellows. Deliberate practice simulation programmes should be a mandatory component of surgical training.

Acute kidney injury (AKI) following cardiac surgery is a frequent complication and several risk factors increasing its incidence have already been characterized. This study evaluates the influence of preoperative increased serum uric acid (SUA) levels in comparison with other known risk factors on the incidence of AKI following cardiac surgery. During a period of 5 month, 247 patients underwent elective coronary artery bypass grafting, valve replacement/ repair or combined bypass and valve surgery. Datas were prospectively analyzed. Primary endpoint was the incidence of AKI as defined by the AKI criteria comparing patients with preoperative serum uric acid (SUA) levels below versus above the median. Multivariate logistic regression analysis was used to identify independent predictors of postoperative AKI. Thirty (12.1%) of the 247 patients developed postoperative AKI, 24 of 30 (80%) had preoperative SUA- levels above the median (≥373 μmol/l) (OR: 4.680, CI 95% 1.840; 11.904, p = 0.001). In the multivariate analysis SUA levels above the median (OR: 5.497, CI 95% 1.772; 17.054, p = 0.003), cardiopulmonary bypass (CPB) time > 90 min (OR: 4.595, CI 95% 1.587; 13.305, p = 0.005), cardiopulmonary bypass (CPB) > 30 kg/m2 (OR: 3.208, CI 95% 1.202; 8.562; p = 0.02), and preoperative elevated serum-creatinine levels (OR: 1.015, CI 95% 1.001; 1.029, p = 0.04) were independently associated with postoperative AKI. Serum uric acid is an independent risk marker for AKI after cardiac surgery. From all evaluated factors it showed the highest odds ratio.

The present Article aims to shed light on the question whether crowdinvesting regulation should favor a specific legal form or contract type for crowdinvesting. To this end, it analyzes the conditions which legal forms and contract types must fulfill to be used in crowdinvesting. As crowdinvesting in Germany benefits from a high degree of contractual freedom, the Article gives an overview not only of the types but also of the contents of crowdinvesting contracts that are in use in Germany and traces how they have evolved. Based on a sample of 81% of all crowd financing in the German market, it evaluates 255 crowdinvesting campaigns held on 18 different platforms in the period from August 1, 2011 to December 31, 2015.

Magnesium is a promising metal for resorbable cardiovascular implants due to its high biocompatibility, high corrosion tendency, and mechanical properties. However, adapting its corrosion rate to the physiological healing processes is required to ascertain a safe graft function. A protective polymeric layer is supposed to slow down the corrosion rate of magnesium. Additionally, coatings can improve the host’s tissue interaction with the implant by implementing the local delivery of antibiotic drugs and growth or cell adhesion factors. However, little is known about the interaction of polymer-based coatings, their degradation, and magnesium corrosion. This study examines the corrosion mechanism of magnesium protected by spin coatings and electrospun fiber coatings under physiological conditions. Pure magnesium specimens were coated with polycaprolactone (PCL). The corrosion of the coated magnesium was evaluated using an immersion test in simulated body fluid. Spin coatings provided efficient protection against corrosive attacks and a significantly lower corrosion rate by 75% compared to uncoated magnesium. In contrast, fiber coatings did not provide relevant corrosion protection. On the other hand, magnesium corrosion caused the accelerated degradation of the PCL layer. A reliable and safe implant function is vital, especially in cardiovascular applications. Magnesium coating, therefore, should be carried out with spin coatings.