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Background: Although indicators of surgical and medical treatment have been applied to patients with typical dissection (AD) of the descending thoracic aorta, the natural history of descending aortic intramural hematoma (AIH) is not yet clearly known.Objective: The goal of this study was to test the hypothesis that the absence of flow communication through the intimal tear in AIH involving the descending aorta has a different clinical course compared with AD.Methods: We prospectively evaluated clinical and echocardiographic data between AD (76 patients) and AIH (27 patients) of the descending thoracic aorta.Results: Patients had no differences In age, gender, or clinical presentation. The development of pleural effussion or periaortic hematoma was more frequent in patients with AIH than it was in patients with AD. AIH and AD had same predictors of complications at follow-up: aortic diameter (>5 cm) at diagnosis and persistent back pain. Although medical treatment was selected in the same proportion between groups, surgical treatment was more frequently selected in AD (39% vs. 22%, p < 0.01). AD patients who received surgical treatment had higher mortality than those with AIH (36% vs. 17%, p < 0.01). There was no difference in mortality between patients who received medical treatment (15% in AD vs 14% in AIH, p = 0.7). In follow-up imaging studies of 23 patients with AIH,6 patients (25%) showed complete resolution and 6 patients (25%) increased the descending aortic diameter. Typical AD developed in 3 patients (13%). A three-year survival rate did not show significant difference (82 ± 6% in AIH vs 75 ± 7% in AD, p = 0.37).Conclusion: AIH of the descending thoracic aorta have relatively frequent complications at follow-up including dissection and aneurysm formation. Medical treatment with very close imaging follow-up and timed elective surgery in cases with complications allow better management for patients with AIH of the descending thoracic aorta.

INTRODUCTION The COVID-19 pandemic disrupted the delivery of routine dental services in the UK. Reduced face-to-face clinical activity has resulted in reduced availability of tertiary specialist services. The impact of the pandemic on medical trainees has been explored but there is limited literature regarding dental trainees. METHODS A blended questionnaire was designed, pre-piloted and administered as an online anonymous survey. Following pre-notification, this was administered to paediatric dentistry trainees for a three-week period. Quantitative data underwent descriptive statistics and qualitative data were subject to thematic analysis. RESULTS The response rate was 63% (n=35). Two respondents were out of programme. Outpatient clinics and treatment with local anaesthesia were the most disrupted aspects of training. Academic training was less disrupted than clinical training. Thematic analysis found three key themes: personality and personal circumstance, colleagues and workplace, and changes to clinical and academic activity. Trainees perceptions ranged from optimistic to pessimistic, with many trainees identifying opportunities they had gained while others perceived none. CONCLUSIONS This survey shows variation in training disruption and opportunity during the COVID-19 pandemic. Our findings support anecdotal evidence and results emerging from trainees in medicine. Further surveys should be administered as the pandemic progresses and these should include other dental specialties.

changes included massive increase in telephone and video consultation to limit direct clinician contacts. Only about a third of clinicians were aware of pandemic-specific guidelines.