bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optimal Chest Compression Point During Pediatric Resuscitation: Implications for Pediatric Resuscitation Practice by CT Scans*
Authors: Eimer Christine , Huhndorf Monika , Sattler Ole , Feth Maximilian , Jansen Olav , Gräsner Jan-Thorsten , Lorenzen Ulf , Albrecht Martin , Grünewald Matthias , Reifferscheid Florian , Seewald Stephan 
Published: June 2024

OBJECTIVES:
Current European guidelines for pediatric cardiopulmonary resuscitation (CPR) recommend the lower half of the sternum as the chest compression point (CP). In this study, we have used thoracic CT scans to evaluate recommended and optimal CP in relation to cardiac anatomy and structure.

DESIGN:
Analysis of routinely acquired thoracic CT scans acquired from 2000 to 2020.

SETTING:
Single-center pediatric department in a German University Hospital.

PATIENTS:
Imaging data were obtained from 290 patients of 3–16 years old.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
We measured and analyzed 14 thoracic metrics in each thoracic CT scan. In 44 of 290 (15.2%) scans, the recommended CP did not match the level of the cardiac ventricles. Anatomically, the optimal CP was one rib or one vertebral body lower than the recommended CP, that is, the optimal CP was more caudal to the level of the body of the sternum in 67 of 290 (23.1%) scans. The recommended compression depth appeared reasonable in children younger than 12 years old. At 12 years old or older, the maximum compression depth of 6 cm is less than or equal to one-third of the thoracic depth.

CONCLUSIONS:
In this study of thoracic CT scans in children 3–16 years old, we have found that optimal CP for CPR appears to be more caudal than the recommended CP. Therefore, it seems reasonable to prefer to use the lower part of the sternum for CPR chest compressions. At 12 years old or older, a compression depth similar to that used in adults—6 cm limit—may be chosen.
Proximal Interphalangeal Joint Arthroplasty for Osteoarthritis: A Long-Term Follow-Up
Authors: Notermans Bo J. W. , Teunissen Joris S. , Hoogendam Lisa , de Boer Luitzen H. L. , Selles Ruud W. ,   Hand-Wrist Study Group, van der Heijden Brigitte E. P. A. 
Published: June 2024

Background:
Previously published research describes short-term outcomes after proximal interphalangeal (PIP) joint arthroplasty; however, long-term outcomes are scarce. Therefore, the authors evaluated patient-reported outcomes and complications after a follow-up of at least 5 years following PIP joint arthroplasty.

Methods:
The authors used prospectively gathered data from patients undergoing PIP joint arthroplasty with silicone or surface replacement implants. Time points included preoperatively, 1 year postoperatively, and at least 5 years postoperatively. The authors were able to include 74 patients. Primarily, the authors focused on patient satisfaction with the treatment outcome, measured using a validated 5-point Likert scale. Secondary outcomes included the questions of whether patients would undergo the same surgery again, the assessment of factors associated with satisfaction or dissatisfaction, the Michigan Hand Outcomes Questionnaire score, and the number of reoperations.

Results:
The mean follow-up was 7 ± 1.2 years (range, 5 to 11 years). Patient satisfaction was excellent in 14 patients (19%), good in 17 patients (23%), reasonable in 18 patients (24%), moderate in 10 patients (14%), and poor in 15 patients (20%). Seventy-three percent of patients (n = 54) would undergo the same procedure again. The authors found no factors associated with satisfaction or dissatisfaction. All Michigan Hand Outcomes Questionnaire scores improved significantly in the first year after surgery and did not deteriorate afterward. Sixteen fingers (16%) required a reoperation, of which 3 (4%) needed a prosthesis replacement.

Conclusions:
Patient satisfaction with treatment outcomes 7 years after PIP implant surgery ranges from moderate to good for many patients, with a notable proportion expressing dissatisfaction. Patient-reported outcomes improve primarily within the first year and remain stable at 5 years or more.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Evaluating the Mechanical Strength of 3-Dimensionally Printed Implants in Septorhinoplasty through Finite Element Analysis
Authors: Syamal Sujata , Taritsa Iulianna C. , Alvarez Angelica Hernandez , Schuster Kirsten , Foppiani Jose , Kaplan David , Lin Samuel J. 
Published: June 2024

Background:
Autologous nasoseptal cartilage grafts are used to correct nasal asymmetry and deviation in rhinoplasty, but patients who have undergone multiple operations may have limited autologous cartilage tissue available. L-strut implants created on a 3-dimensional (3D) printer may address these challenges in the future, but their mechanical strength is understudied. Silk fibroin-gelatin (SFG), polycaprolactone (PCL), and polylactide (PLA) are bioinks known for their strength. The authors present finite element analysis (FEA) models comparing the mechanical strength of 3D-printed SFG, PCL, and PLA implants with nasoseptal cartilage grafts when autologous or allografts are not available.

Methods:
FEA models compared the stress and deformation responses of 3D-printed solid and scaffold implant replacements to cartilage. To simulate a daily force from overlying soft tissue, a unidirectional load was applied at the “keystone” region given its structural role and compared with native cartilaginous properties.

Results:
The 3D-printed solid SFG, PCL, and PLA and scaffold PCL and PLA models demonstrated lower deformations compared with cartilage. Solid SFG balanced strength and flexibility. The maximum stress was below all materials’ yield stresses, suggesting that their deformations are unlikely permanent under a daily load.

Conclusions:
The authors’ FEA models suggest that 3D-printed L-strut implants carry promising mechanical strength. Solid SFG results mimicked cartilage’s mechanical behavior. Thus, scaffold SFG merits further geometric optimization for potential use for cartilage substitution. The 3D-printed septal cartilage replacement implants can potentially enhance surgical management of patients who lack available donor cartilage in select settings.

Clinical Relevance Statement:
Computational simulations can evaluate the strength of 3D-printed implants and their potential to replace septal cartilage in septorhinoplasty.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Effect of Model-Based Iterative Reconstruction on Image Quality of Chest Computed Tomography for COVID-19 Pneumonia
Authors: Liu Caiyin , Lin Junkun , Chen Yingjie , Hu Yingfeng , Wu Ruzhen , Lin Xuejun , Xu Rulin , Zhong Zhiping 
Published: June 2024

Purpose
This study aimed to compare the image quality of chest computed tomography (CT) scans for COVID-19 pneumonia using forward-projected model-based iterative reconstruction solution-LUNG (FIRST-LUNG) with filtered back projection (FBP) and hybrid iterative reconstruction (HIR).

Method
The CT images of 44 inpatients diagnosed with COVID-19 pneumonia between December 2022 and June 2023 were retrospectively analyzed. The CT images were reconstructed using FBP, HIR, and FIRST-LUNG-MILD/STANDARD/STRONG. The CT values and noise of the lumen of the main trachea and erector spine muscle were measured for each group. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Subjective evaluations included overall image quality, noise, streak artifact, visualization of normal lung structures, and abnormal CT features. One-way analysis of variance was used to compare the objective and subjective indicators among the five groups. The task-based transfer function was derived for three distinct contrasts representing anatomical structures, lower-contrast lesion, and higher-contrast lesion.

Results
The results of the study demonstrated significant differences in image noise, SNR, and CNR among the five groups (P < 0.001). The FBP images exhibited the highest levels of noise and the lowest SNR and CNR among the five groups (P < 0.001). When compared to the FBP and HIR groups, the noise was lower in the FIRST-LUNG-MILD/STANDARD/STRONG group, while the SNR and CNR were higher (P < 0.001). The subjective overall image quality score of FIRST-LUNG-MILD/STANDARD was significantly better than FBP and FIRST-LUNG-STRONG (P < 0.001). FIRST-LUNG-MILD was superior to FBP, HIR, FIRST-LUNG-STANDARD, and FIRST-LUNG-STRONG in visualizing proximal and peripheral bronchovascular and subpleural vessels (P < 0.05). Additionally, FIRST-LUNG-MILD achieved the best scores in evaluating abnormal lung structure (P < 0.001). The overall interobserver agreement was substantial (intraclass correlation coefficient = 0.891). The task-based transfer function 50% values of FIRST reconstructions are consistently higher compared to FBP and HIR.

Conclusions
The FIRST-LUNG-MILD/STANDARD algorithm can enhance the image quality of chest CT in patients with COVID-19 pneumonia, while preserving important details of the lesions, better than the FBP and HIR algorithms. After evaluating various COVID-19 pneumonia lesions and considering the improvement in image quality, we recommend using the FIRST-LUNG-MILD reconstruction for diagnosing COVID-19 pneumonia.
Optimizing Morbidity in Unplanned Soft Tissue Sarcoma Excisions
Authors: Elmorsi Rami , Camacho Luis , Krijgh David D. , Tilney Gordon S. , Lyu Heather , Traweek Raymond S. , Witt Russell G. , Roubaud Margaret S. , Roland Christina L. , Mericli Alexander F. 
Published: June 2024

Introduction
Soft tissue sarcomas (STSs) are rare and diverse primary malignant tumors that comprise approximately 1% of all malignancies. Misdiagnoses and unplanned excisions of STSs are common due to the tumor's rarity, leading to secondary tumor bed excisions (TBEs). Reconstructive outcomes for TBEs remain poorly understood, prompting this study to address the knowledge gap and inform preoperative discussions.

Methods
This was a retrospective cohort study of patients who underwent STS excisions at a quaternary cancer center. Patients were categorized into mass excision (ME) and TBE groups. Reconstructive approaches were divided into simple (primary closure, complex repair, skin grafts, local flaps) and advanced (pedicled or free flaps). The groups were compared for postoperative outcomes, including complications, recurrence, and death.

Results
When simple reconstructive techniques were used, TBEs exhibited higher rates of overall and major complications, whereas MEs had higher rates of overall and minor complications. Intergroup analysis revealed that with simple reconstruction, rates of overall and major complications were higher in TBEs than in MEs, and rates of minor complications were higher in MEs than in TBEs. Regression analyses revealed that simple reconstruction of TBEs had 90% and 180% higher odds of major complications and reoperation compared to simple reconstruction of MEs (P < 0.05).

Conclusion
TBEs, despite their smaller size, exhibited a heightened susceptibility to overall and major complications, challenging the notion that simpler techniques suffice in these cases. Our findings encourage the consideration of advanced reconstructive techniques for TBEs that may seem amenable to simple reconstructive techniques.
A Randomized Crossover Trial Evaluating the Impact of Cultural Dexterity Training on Surgical Residents’ Knowledge, Cross-Cultural Care, Skills, and Beliefs
Authors: Smink Douglas S. , Ortega Gezzer , Dacier Brittany M. , Petrusa Emil R. , Chen Yu-Jen , Shaikh Namra Q. , Allar Benjamin G. , Chun Maria B.J. , Green Alexander R. , Caldwell Katharine E. , Atkinson Rachel B. , Reidy Emma , Olufajo Olubode A. , Britt L.D. , Brittain Molly A. , Zárate Rodriguez Jorge , Swoboda Sandra M. , Cornwell Edward E. , Lynch Kenneth A. , Wise Paul E. , Harrington David T. , Kent Tara S. , Mullen John T. , Lipsett Pamela A. , Haider Adil H. ,   and the PACTS Trial Group
Published: June 2024

Objectives:
This trial examines the impact of the Provider Awareness and Cultural dexterity Toolkit for Surgeons (PACTS) curriculum on surgical residents’ knowledge, cross-cultural care, skills, and beliefs.

Background:
Cross-cultural training of providers may reduce health care outcome disparities, but its effectiveness in surgical trainees is unknown.

Methods:
PACTS focuses on developing skills needed for building trust, working with patients with limited English proficiency, optimizing informed consent, and managing pain. The PACTS trial was a randomized crossover trial of 8 academic general surgery programs in the United States: The Early group (“Early”) received PACTS between periods 1 and 2, while the Delayed group (“Delayed”) received PACTS between periods 2 and 3. Residents were assessed preintervention and postintervention on Knowledge, Cross-Cultural Care, Self-Assessed Skills, and Beliefs. χ2 and Fisher exact tests were conducted to evaluate within-intervention and between-intervention group differences.

Results:
Of 406 residents enrolled, 315 were exposed to the complete PACTS curriculum. Early residents’ Cross-Cultural Care (79.6%–88.2%, P<0.0001), Self-Assessed Skills (74.5%––85.0%, P<0.0001), and Beliefs (89.6%–92.4%, P=0.0028) improved after PACTS; knowledge scores (71.3%–74.3%, P=0.0661) were unchanged. Delayed resident scores pre-PACTS to post-PACTS showed minimal improvements in all domains. When comparing the 2 groups in period 2, Early residents had modest improvement in all 4 assessment areas, with a statistically significant increase in Beliefs (92.4% vs 89.9%, P=0.0199).

Conclusions:
The PACTS curriculum is a comprehensive tool that improved surgical residents’ knowledge, preparedness, skills, and beliefs, which will help with caring for diverse patient populations.
Comparison of COVID-19 Hospitalization and Death Between Solid Organ Transplant Recipients and the General Population in Canada, 2020–2022
Authors: Naylor Kyla L. , Knoll Gregory A. , Treleaven Darin , Kang Yuguang , Garg Amit X. , Stirling Kathryn , Kim S. Joseph 
Published: June 2024

Background.
Solid organ transplant recipients have a high risk of severe outcomes from SARS-CoV-2 infection. A comprehensive understanding of the impact of the COVID-19 pandemic across multiple waves in the solid organ transplant population and how this compares to the general population is limited. We conducted a population-based cohort study using linked administrative healthcare databases from Ontario, Canada to answer this question.

Methods.
We included 15 306 solid organ transplant recipients and 12 160 904 individuals from the general population. Our primary outcome was the rate (per 100 person-years) of severe COVID-19 (ie, hospitalization or death with a positive SARS-CoV-2 test) occurring between January 25, 2020, and November 30, 2022.

Results.
Compared with the general population, solid organ transplant recipients had almost a 6 times higher rate of severe COVID-19 (20.39 versus 3.44 per 100 person-years), with almost 5.5 times as high a rate of death alone (4.19 versus 0.77 per 100 person-years). Transplant recipients with severe COVID-19 were substantially younger (60.1 versus 66.5 y) and had more comorbidities. The rate of severe COVID-19 declined over time in the solid organ transplant population, with an incidence rate of 41.25 per 100 person-years in the first wave (January 25, 2020, to August 31, 2020) and 18.41 in the seventh wave (June 19, 2022, to November 30, 2022, Omicron era).

Conclusions.
Solid organ transplant recipients remain at high risk of severe outcomes when they are infected with SARS-CoV-2. Resources and strategies to mitigate the impact of SARS-CoV-2 exposure are needed in this vulnerable patient population.
Predictive Value of Preoperative Pain Sketches in Lower Extremity Amputees Undergoing Secondary Targeted Muscle Reinnervation for Treatment of Neuropathic Pain
Authors: Raasveld Floris V , Hao David , Gomez-Eslava Barbara , Hwang Charles D , Valerio Ian L , Eberlin Kyle R 
Published: June 2024

BACKGROUND:
Targeted muscle reinnervation (TMR) is an effective surgical treatment for neuropathic pain in amputees. Qualitative descriptions of pain, depicted by pain sketches, could enhance the understanding of symptomatic improvement after surgery. Our aim is to assess whether preoperative pain sketches, drawn by lower extremity (LE) amputees, can predict surgical outcomes after secondary TMR surgery.

STUDY DESIGN:
Eligible patients were LE amputees who underwent secondary TMR surgery between 2017 and 2023. Pain sketches and pain scores were prospectively collected both before and after surgery. The pain trajectory, as categorized by preoperative pain sketches, was analyzed and assessed for improvement, defined as reaching the minimal clinically important difference. The transition into different pain sketches and the occurrence of phantom drawings were evaluated for their association with improvement.

RESULTS:
Fifty-eight patients were included, of which 18 (31.1%) depicted diffuse pain, 26 (44.8%) depicted focal pain (FP), and 18 (24.1%) depicted radiating pain (RP) in their preoperative sketch. FP sketches were associated with the lowest pre- and postoperative pain scores and most frequently developed into sketches indicating “no pain.” RP sketches were associated with the least pain improvement, the lowest likelihood of achieving the minimal clinically important difference, and were more prevalent in patients with diabetes or depression. RP sketches were associated with phantom drawings; no other sketch types developed into RP sketches at the final follow-up.

CONCLUSIONS:
In LE amputees who underwent secondary TMR, preoperative pain sketches could serve as a helpful tool in predicting pain outcomes. RP sketches seemed to be associated with worse outcomes and FP sketches with the most improvement.
Contemporary Evaluation of Work-Life Integration and Well-Being in US Surgical Residents: A National Mixed-Methods Study
Authors: Janczewski Lauren M , Buchheit Joanna T , Golisch Kimberly B , Amortegui Daniela , Mackiewicz Natalia , Eng Joshua S , Turner Patricia L , Johnson Julie K , Bilimoria Karl Y , Hu Yue-Yung 
Published: June 2024

BACKGROUND:
The demands of surgical training present challenges for work-life integration (WLI). We sought to identify factors associated with work-life conflicts and to understand how programs support WLI.

STUDY DESIGN:
A cross-sectional national survey conducted after the 2020 American Board of Surgery In-Training Examination queried 4 WLI items. Multivariable regression models evaluated factors associated with (1) work-life conflicts and (2) well-being (career dissatisfaction, burnout, thoughts of attrition, and suicidality). Semistructured interviews conducted with faculty and residents from 15 general surgery programs were analyzed to identify strategies for supporting WLI.

RESULTS:
Of 7,233 residents (85.5% response rate), 5,133 had data available on work-life conflicts. A total of 44.3% reported completing noneducational task work at home, 37.6% were dissatisfied with time for personal life (eg hobbies), 51.6% with maintaining healthy habits (eg exercise), and 48.0% with performing routine health maintenance (eg dentist). In multivariable analysis, parents and female residents were more likely to report work-life conflicts (all p < 0.05). After adjusting for other risk factors (eg duty-hour violations and mistreatment), residents with work-life conflicts remained at increased risk for career dissatisfaction, burnout, thoughts of attrition, and suicidality (all p < 0.05). Qualitative analysis revealed interventions for supporting WLI including (1) protecting time for health maintenance (eg therapy), (2) explicitly supporting life outside of work (eg prioritizing time with family), and (3) allowing meaningful autonomy in scheduling (eg planning for major life events).

CONCLUSIONS:
Work-life conflicts are common among surgical residents and are associated with poor resident well-being. Well-designed program-level interventions have the potential to support WLI in surgical residency.
Microbial Infection among SARS-COV-2 Infected Patients in a COVID-19 dedicated tertiary care hospital of Bangladesh: a Cross Sectional Study
Authors: Islam A N M Shamsul , Khanam Fahmida , Farhana Nasreen , Choudhury Rafaat , Jahan Naznin Akter , Uddin Mohammad Jamal , Refat Md. Nazmul Hassan , Nasreen Fatima 
Published: June 2024

Objectives: This study aimed to determine patterns of respiratory, blood-borne, and uropathogenic microbial pathogens among SARS-CoV-2 infected patients in a COVID-19 dedicated hospital in Bangladesh.

Design: Cross-sectional study
Setting: In a COVID-19 dedicated tertiary care Hospital, Dhaka, Bangladesh conducted from March to June 2021
Participants: Hospitalized COVID 19 infected patients irrespective of age and sex
Primary and secondary outcome measures: Primary outcome measures were proportion of co-infection in COVID-19 patients and characterization of microbes causing co-infection. Secondary outcome measures were to find out if there is any relation between co-infection and age, co-infection and sex, co-infection and comorbidity.
Interventions: not applicable
Results:
Out of 79 patients, 61% were male, mean age was 49.53 years. Co-infection was seen in 7.7% patients and out of which 5.1% of isolates were from urine sample, followed by 2.6% from blood. Bacteria isolated from urine were Enterococci (2.6%), coagulase negative Staphylococcus CONS (1.3%), and Enterobacter spp. (1.3%). Pseudomonas spp. was found in blood sample. Mixed growth was found in NS and TS with predominant species being Staphylococcus aureus, Streptococcus spp. At the time the data was collected, 55.7% of patients had been given antimicrobials, and 30.4% of patients had been given a single antimicrobial. HBsAg was positive in 1.3% patients. None were anti HCV or Dengue NS1Ag positive.
Conclusion: Microbial infection has been seen to be associated with SARS-CoV-2 infections and is of great value in prescribing antimicrobial and reducing fatal outcomes of hospitalized patients.