bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient-centered Reporting in Radiology
Authors: Barrett Spencer K. , Patrie James , Kitts Andrea B. , Hanley Michael , Swanson Christina M. , Vitzthum von Eckstaedt Hans , Krishnaraj Arun 
Published: May 2021

Purpose:
This study aimed to assess whether patients preferred traditional or patient-friendly radiology reports and, secondarily, whether one reporting style led to a subjective improvement in patients’ understanding of their imaging results and next steps in their clinical care.

Materials and Methods:
This randomized study included patients who had previously enrolled in an institutional comprehensive lung cancer screening program. Three hundred patients were randomly selected from the program database to receive both traditional and patient-centered radiology reports. Randomization also occurred at both the risk level of the fictitious test results (low, intermediate, or high) and the order in which the reports were read by each participant. Participants completed a survey providing demographic information and indicating which report style was preferred and which report style led to a better understanding of screening results and future options. In addition, each report style was rated (from 1 to 5) for clarity, understandability, attractiveness, and helpfulness.

Results:
A total of 46 responses for report preference data and 41 responses for attribute rating data were obtained. Overall, participants demonstrate a preference for patient-friendly reports (65.2%) over traditional reports (21.7%). On a 5-point scale, average ratings for patient-friendly reports were higher than traditional reports by 1.2 (P<0.001) for clarity, 1.5 (P<0.001) for understandability, 1.5 (P<0.001) for attractiveness, and 1.0 (P<0.001) for helpfulness.

Conclusion:
Data suggest that patients prefer patient-friendly reports over traditional reports and find them to be clearer, more comprehensible, more attractive, and more helpful.
Cystic Primary Lung Cancer
Authors: Byrne Danielle , English John C. , Atkar-Khattra Sukhinder , Lam Stephen , Yee John , Myers Renelle , Bilawich Ana-Maria , Mayo John R. , Mets Onno M. 
Published: May 2021

Purpose:
Primary lung cancers associated with cystic airspaces are increasingly being recognized; however, there is a paucity of data on their natural history. We aimed to evaluate the prevalence, pathologic, and imaging characteristics of cystic lung cancer in a regional thoracic surgery center with a focus on the evolution of computed tomography morphology over time.

Materials and Methods:
Consecutive patients referred for potential surgical management of primary lung cancer between January 2016 and December 2018 were included. Clinical, imaging, and pathologic data were collected at the time of diagnosis and at the time of the oldest computed tomography showing the target lesion. Descriptive analysis was carried out.

Results:
A total of 441 cancers in 431 patients (185 males, 246 females), median age 69.6 years (interquartile range: 62.6 to 75.3 y), were assessed. Overall, 41/441 (9.3%) primary lung cancers were cystic at the time of diagnosis. The remaining showed solid (67%), part-solid (22%), and ground-glass (2%) morphologies. Histopathology of the cystic lung cancers at diagnosis included 31/41 (76%) adenocarcinomas, 8/41 (20%) squamous cell carcinomas, 1/41 (2%) adenosquamous carcinoma, and 1/41 (2%) unspecified non–small cell lung carcinoma. Overall, 8/34 (24%) cystic cancers at the time of diagnosis developed from different morphologic subtype precursor lesions, while 8/34 (24%) cystic precursor lesions also transitioned into part-solid or solid cancers at the time of diagnosis.

Conclusions:
This study demonstrates that cystic airspaces within lung cancers are not uncommon, and may be seen transiently as cancers evolve. Increased awareness of the spectrum of cystic lung cancer morphology is important to improve diagnostic accuracy and lung cancer management.
Has the Increase of Women in Surgical Training Programs Led to a Concomitant Increase in Female Leadership Positions? A 10-Year Analysis
Authors: Yin Christine , McAuliffe Phoebe B. , Liao Christopher D. , Marquez Jocellie E. , Monroig Kaitlin G. , Hanson Olivia L. , Shroyer A. Laurie W. , Huston Tara L. , Khan Sami U. 
Published: May 2021

Introduction
Women represent greater than 50% of medical students in America and are becoming increasingly well represented in surgical fields. However, parity at the trainee level has yet to be accomplished, and surgical leadership positions have remained disproportionately biased toward men. To date, there have been no comparisons on the progress within plastic surgery and other surgical specialties. This investigates the gender disparity in resident and leadership representation over the past 10 years within surgical specialties and how these disparities compare to plastic surgery.

Methods
Counts of female and male residents and surgical society leaders were collected from 2008 to 2018. Surgical fields included plastic, vascular, urologic, neurologic, orthopedic, cardiothoracic, and general surgery. Leadership positions were defined as board seats on executive committees of major surgical societies or board associations. Data were acquired from publicly available sources or provided directly from the organizations. Resident data were obtained from the Accreditation Council of Graduate Medical Education residents' reports. Individuals holding more than 1 leadership position within a year were counted only once.

Results
In our aggregated analysis, the proportion of women in surgical leadership lags behind women in surgical residency training across all specialties (13.2% vs 27.3%, P < 0.01). General surgery had the highest proportion of female residents and leaders (35% and 18.8%, P < 0.01), followed by plastic (32.2% and 17.3%, P < 0.01), vascular (28.2% and 11.3%, P < 0.01), urologic (24.3% and 5.1%), and cardiothoracic surgery (20.5% and 7.8%, P < 0.01). Women in surgical leadership, however, increased at a faster rate than women in surgical training (11% vs 7%, P < 0.05). Plastic surgery showed the greatest rate of increase in both residents and leaders (17% and 19%, P < 0.05) followed by cardiothoracic surgery (16% and 9%, P < 0.05) and general surgery (8% and 14%, P < 0.05). For neurologic and orthopedic surgery, neither the difference in proportions between residents and leaders nor the yearly growth of these groups were significant.

Conclusions
Between 2008 and 2018, women in plastic surgery training and leadership positions have shown the most significant growth compared with other surgical subspecialties, demonstrating a strong concerted effort toward gender equality among surgical professions.
The Impact of Digital Nerve Injury on the Outcome of Flexor Tendon Tenolysis
Authors: Diehm Yannick F. , Haug Valentin , Thomé Julia , Kotsougiani-Fischer Dimitra , Böcker Arne , Bickert Berthold , Kneser Ulrich , Fischer Sebastian 
Published: May 2021

Background
Tenolysis is an established treatment for flexor tendon adhesions at the hand. Concomitant finger nerve injuries with incomplete reinnervation may negatively influence outcomes. This study investigates the impact of finger nerve injuries on outcomes of flexor tendon tenolysis.

Methods
A retrospective pair-matched study was conducted, including patients undergoing tenolysis for flexor tendon adhesion after primary repair of isolated superficial and deep flexor tendon injury and both finger nerves (test group [TG]). These were compared with patients (control group [CG]) with similar injuries without affection of nerves and pair-matched in age, zone of injury and follow-up. Patients' demographics, finger sensitivity, total active range of motion (TAM) before and after tenolysis and complications were retrieved.

Results
For both study groups, 10 patients each were included in this study. There were no significant differences regarding patients' demographics and follow-up. Mean follow-up was 37 (CG) and 41 (TG) months. Total active range of motion was preoperatively 81 ± 47° (CG) and 68 ± 54° (TG) and reached postoperatively 125 ± 57° (CG) and 79 ± 43° (TG). Hence, TAM improvement was significantly higher in patients without nerve damage (58 ± 16 vs 21 ± 11%; P > 0.05). Tendon ruptures occurred significantly more frequent in patients with nerve injury (n = 0.4 ± 0.52) compared with patients of the CG (n = 0; P < 0.05).

Conclusions
This study shows that finger nerve injury with incomplete recovery after combined flexor tendon and nerve injuries of the finger negatively influences the outcomes of flexor tendon tenolysis.
How Big Is Too Big?
Authors: Van Vliet Austin , Girardot Alexandra , Bouchez Jonathan , Bigness Alec , Wang Kevin , Moino Daniela , Theodotou Alex , Pothuraju Tejit , Felder Seth , Smith Paul , Kumar Ambuj , Dayicioglu Deniz 
Published: May 2021

BackgroundThe vertical rectus abdominis myocutaneous (VRAM) flap has been frequently used for perineal reconstruction given the high potential for wound complications associated with direct closure of this area. However, the relationship between defect size and postoperative complications remains undefined.MethodsA retrospective chart review of the last 20 years for VRAM flaps was performed. Defect size, age, body mass index (BMI), cause of defect, sex, radiation, and flap donor laterality were recorded. Complications of infection, partial flap loss, total flap loss, minor wounds, treated nonoperatively, and major wound, which required reoperation, were analyzed with respect to defect size. Descriptive statistics were used to summarize the demographic and clinical characteristics of the included patients. Associations were assessed using binary logistic regression analysis, and difference in means for compared groups was assessed using the independent samplesttest.Pvalues were set at 5% for all comparisons.ResultsThere were 65 patients with VRAM flaps identified during the review period. Mean defect size was 204.71 cm2. Mean age was 63.97, and mean BMI was 27.18. History of prior radiation was noted in 90.77% of patients (n = 59). When adjusted for age and BMI, mean defect area was significantly different for patients with minor or major wounds. Larger perineal defects were associated with increased risk of major wound complications (odds ratio, 1.012; 95% confidence interval, 1.003–1.022).ConclusionsThe vertical rectus abdominis flap has been a workhorse flap for perineal reconstruction. Defect size does not affect risk of partial flap necrosis, complete flap loss, infection, abdominal fascial dehiscence, ventral hernia, or seroma, which supports the utility of VRAM flap for perineal reconstruction. Larger perineal defects are associated with increased risk for major wound complications, which required reoperation, regardless of age or BMI. Future studies should be performed to determine if there is a maximum defect size cutoff that limits the utility of VRAM flap reconstruction or to develop a predictive model to assess the risk of major wound complications based on defect size.
Comparative Analysis of Open Reduction Internal Fixation and Closed Reduction Percutaneous Pinning of Hand Fractures
Authors: Burbano Felipe Molina , Jones Pierce , Raghava Narayan , Herrera Fernando A. 
Published: May 2021

Purpose
The purpose of our study was to compare postoperative outcomes between patients receiving closed reduction percutaneous pinning (CRPP) to open reduction internal fixation (ORIF) following metacarpal and phalanx fractures.

Methods
A retrospective chart review was performed at a single academic center for all patients suffering a metacarpal or phalanx fracture and receiving either CRPP or ORIF between 2012 and 2018. Patients were divided into fracture mechanism, high-energy mechanism of injury, low-energy mechanism of injury, or unknown, and treatment of fracture with either ORIF or CRPP. High-energy mechanism of injury included gunshot wounds, motor vehicle crash, and blast injuries, whereas low-energy mechanism of injury included all other causes. Patient demographics, postoperative complications, 30-day readmission, and return to the operating room were recorded.

Results
A total of 408 patients, with 524 fractures, were included in the study. There were 127 fractures that resulted from high-energy mechanisms and 394 fractures that resulted from low-energy mechanisms. Open reduction internal fixation was used to treat 299 fractures, whereas CRPP was used for 225 fractures. Among fracture fixation, there was a total of 8.4% complication rate with ORIF, accounting for 10.4% of complications, and CRPP accounting for 5.8%. Among the fracture mechanism, the high-energy mechanism of injury had a 21.3% complication rate, whereas the low-energy mechanism of energy was 4.3%. When comparing the above variables, only high-energy mechanism of injury was a statistically significant predictor of complications (odds ratio, 3.2; confidence interval, 1.5–7.0; P = 0.002). The average operating room time for the ORIF group was 124.82 minutes compared with 97.6 minutes for the CRPP group.

Conclusion
Patients with hand fractures corrected by ORIF appeared to have a higher postoperative complication rate. When the 2 procedures, ORIF and CRPP, were controlled for mechanism of injury, there was not a statistically significant difference in postoperative complication rate (P = 0.14). However, a fracture sustained by a high-energy mechanism was a statistically significant predictor of postoperative complications (P = 0.002).
Evaluation of National Resident Matching Program and Electronic Residency Application Service Data in the Integrated Plastic Surgery Match
Authors: Gallegos Jose , Raghava Narayan , Inglesby Dani C. , Zlomke Haley A. L. , Young Zachary T. , Herrera Fernando A. 
Published: May 2021

Introduction
The National Resident Matching Program and Electronic Residency Application Service provide data for tracking trends among applicants in each specialty over the past 5 years. The purpose of this study was to examine this information and determine sex and race/ethnicity distribution over the past 5 years.

Methods
The National Resident Matching Program and Electronic Residency Application Service databases were surveyed for trends in the following categories: number of positions, number of applicants, percent of applicants per position, and number of applicants by sex and self-identified race/ethnicity. This information was analyzed graphically for visual representation of the changes in the field.

Results
While there has been a steady increase in number of positions offered, there has also been a significant decrease in number of applicants, resulting in an increase in number of positions offered per applicant. While female and Asian applicants have increased in number, rates of applications from other diverse groups have remained stagnant.

Conclusions
The number of plastic surgery positions offered has increased, whereas the number of applicants has decreased, resulting in a reduction in the number of applicants per position. Lack of racial diversity remains a significant issue in the applicant pool.
Impact of Radiation on Implant-Based Breast Reconstruction in Prepectoral Versus Submuscular Planes
Authors: Thuman Jenna M. , Worbowtiz Nestor , Jain Abishek , Ulm Jason P. , Delaney Kevin O. , Herrera Fernando A. 
Published: May 2021

Background
Postmastectomy implant-based breast reconstruction (IBR) in the setting of radiation (XRT) comes with a high risk of perioperative complications regardless of reconstruction method. The aim of study was to identify the effects of XRT on IBR using a prepectoral versus submuscular approach.

Methods
A retrospective chart review was performed after institutional review board approval was obtained. Patients at a single institution who had 2-stage IBR from June 2012 to August 2019 were included. Patients were separated into 4 groups: prepectoral with XRT (group 1), prepectoral without XRT (group 2), submuscular with XRT (group 3), and submuscular without XRT (group 4). Patient demographics, comorbidities, and postoperative complications were recorded and analyzed.

Results
Three hundred eighty-seven breasts among 213 patients underwent 2-stage IBR. The average age and body mass index were 50.10 years and 29.10 kg/m2, respectively. One hundred nine breasts underwent prepectoral reconstruction (44 in group 1, 65 in group 2), and 278 breasts underwent submuscular reconstruction (141 in group 3, 137 in group 4). Prepectoral tissue expander placement was associated with higher complication rates in the radiated group (38.6% compared with 34.0% submuscular) and lower complication rates in the nonradiated group (26.2% compared with 29.2% submuscular), although significantly less explants were performed in prepectoral group, regardless of XRT status. The 3 most common complications overall were contracture (15.1% radiated, 10.4% nonradiated), infection (18.4% radiated, 11.9% nonradiated), and seroma (15.7% radiated, 10.9% nonradiated).

Conclusions
Two-stage, prepectoral tissue expander placement performs clinically better than submuscular in nonradiated patients compared with radiated patients; however, no statistical significance was identified. Prepectoral had a significantly less incidence of reconstructive failure than submuscular placement regardless of XRT status. Future larger-scale studies are needed to determine statistically significant difference in surgical approach.
Pediatric Orbital Entrapment
Authors: Glassman Gabriella E. , Jackson Kianna , Pontell Matthew E. , Golinko Michael , Drolet Brian C. 
Published: May 2021

Introduction
Although orbital fractures are less common in children than adults, the literature suggests that orbital entrapment occurs more frequently in the pediatric population. Orbital entrapment is an emergency, and early diagnosis and prompt management are critical. Specific radiographic manifestations such as herniation of extraocular muscles (EOMs) through orbital fractures have led to increased suspicion and overdiagnosis of orbital entrapment. This study evaluated the value of specific radiographic findings in predicting clinical findings after pediatric orbital floor fractures.

Methods
A retrospective review at a pediatric level 1 trauma center was performed. ICD-9 and ICD-10, codes identified patients with orbital fractures. Computed tomography (CT) reports were queried for the following terms: “herniation,” “herniated,” “entrapped,” and “entrapment.” Patients 16 years and older were excluded, as were all patients who were unable to undergo EOM evaluation on presentation. Electronic medical records were reviewed for fracture type, mechanism of injury, clinical and radiographic findings, surgical interventions, and demographic information. Medical diagnosis tests, including positive and negative predictive values, sensitivity, as well as specificity, were calculated to identify the relationship between radiographic findings and specific symptomology.

Results
One hundred fifty-three patients with 265 orbital fractures were included. “Entrapment” was mentioned in 34.6% of CT reports, whereas the incidence of clinical entrapment was 12.4% (19/153). Radiographic fat herniation, EOM herniation, and EOM irregularity had positive predictive values of 25%, 31%, and 10%, respectively, for clinical entrapment diagnosis at the initial examination. Overall, 32.7% (50/153) of patients with orbital fractures required surgery.

Conclusions
Although the radiographic description of soft tissue herniation has become interchangeable with entrapment, these CT findings alone are poorly predictive. Orbital entrapment should be diagnosed preoperatively by physical examination, with radiographs as an adjunct only. Radiographic statements without clinical correlation may lead to the improper management of pediatric facial trauma patients.
Metabolic Profiling Reveals Changes in Serum Predictive of Venous Ulcer Healing
Authors: Bergner Richmond T. , Onida Sarah , Velineni Rahul , Spagou Konstantina , Gohel Manjit S. , Bouschbacher Marielle , Bohbot Serge , Shalhoub Joseph , Holmes Elaine , Davies Alun H. 
Published: May 2021

Objective:
The aim of this study was to identify potential biomarkers predictive of healing or failure to heal in a population with venous leg ulceration.

Summary Background Data:
Venous leg ulceration presents important physical, psychological, social and financial burdens. Compression therapy is the main treatment, but it can be painful and time-consuming, with significant recurrence rates. The identification of a reliable biochemical signature with the ability to identify nonhealing ulcers has important translational applications for disease prognostication, personalized health care and the development of novel therapies.

Methods:
Twenty-eight patients were assessed at baseline and at 20 weeks. Untargeted metabolic profiling was performed on urine, serum, and ulcer fluid, using mass spectrometry and nuclear magnetic resonance spectroscopy.

Results:
A differential metabolic phenotype was identified in healing (n = 15) compared to nonhealing (n = 13) venous leg ulcer patients. Analysis of the assigned metabolites found ceramide and carnitine metabolism to be relevant pathways. In this pilot study, only serum biofluids could differentiate between healing and nonhealing patients. The ratio of carnitine to ceramide was able to differentiate between healing phenotypes with 100% sensitivity, 79% specificity, and 91% accuracy.

Conclusions:
This study reports a metabolic signature predictive of healing in venous leg ulceration and presents potential translational applications for disease prognostication and development of targeted therapies.
Performance of Residents During Laparoscopic Cholecystectomy: Is Self-assessment Reliable?
Authors: Yildirim Murat , Saglam Ali I. , Ugurlu Celil , Angin Yavuz S. , Dasiran Fatih , Okan Ismail 
Published: May 2021

Background:
To compare the self-assessment of surgical residents and observers (faculty members and nurses) during laparoscopic cholecystectomy (LC).

Materials and Methods:
A prospective observational study was conducted between February 2020 and July 2020 at a medical school hospital. Seventy-four LC surgeries were performed by surgical residents in the presence of faculty members. A self-assessment of the technical and nontechnical performance of the residents was requested. The self-assessment of residents was compared with observer evaluations using the Kruskal-Wallis test. Gwet AC2 fit coefficient was used to determine the consistency between the observers’ and residents’ assessments. Bland-Altman plots were generated with 95% limits of agreement to describe the agreement between the total scores of the observers.

Results:
The self-assessment of residents had a statistically significant higher score when compared with observers (faculty and nurses) (P<0.001). However, no significant difference was observed between the total scores given by the observers (faculty members and nurses) (P>0.05). There was a moderate agreement between the resident versus faculty members [0.503; 95% confidence interval (CI), 0.430-0.576] and resident versus nurse (0.518; 95% CI, 0.432-0.605) when evaluating technical skills. However, there was substantial agreement between faculty members and nurses (0.736; 95% CI, 0.684-0.789). Postoperative pain was significantly correlated with resident self-assessment (P=0.022).

Conclusion:
The self-assessment scores of surgical residents in LC operations were overestimated compared with observer assessments.