Journal of Surgical Research最新文献

{"title":"Corrigendum to \"A Surgeon-Scientist's Pursuit of the Elusive R01\" Volume 303, p. 461-467, November 2024.","authors":"Jordan M Winter, Jonathan R Brody","doi":"10.1016/j.jss.2024.11.001","DOIUrl":"https://doi.org/10.1016/j.jss.2024.11.001","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Accurate Are Surgeons at Assessing the Quality of Their Critical View of Safety During Laparoscopic Cholecystectomy?","authors":"Dimitrios I Athanasiadis, Keith Makhecha, Nicholas Blundell, Tomoko Mizota, Brittany Anderson-Montoya, Robert D Fanelli, Stefan Scholz, Richard Vazquez, Sujata Gill, Dimitrios Stefanidis","doi":"10.1016/j.jss.2024.10.048","DOIUrl":"https://doi.org/10.1016/j.jss.2024.10.048","url":null,"abstract":"<p><strong>Introduction: </strong>Obtaining the critical view of safety (CVS) is considered an important step to reduce bile duct injuries during laparoscopic cholecystectomy (LC). However, existing literature suggests that few surgeons obtain adequate CVS when LC videos are directly evaluated by experts. This discrepancy calls for effective, standardized CVS teaching methods. While self-assessment (SA) remains the principal tool utilized by practicing surgeons for performance improvement, its effectiveness is controversial. The aim of this study was to compare surgeon SAs of repeated LC performance and attainment of the CVS with that of expert raters.</p><p><strong>Methods: </strong>Multi-institutional study of surgeon members from the Society of American Gastrointestinal and Endoscopic Surgeons who volunteered to participate. All surgeons were asked to submit an LC video and complete a SA of the CVS quality using the Strasberg scale (0-6 score with ≥5 score indicating appropriate CVS). The same videos were reviewed by two blinded expert raters, members of the Society of American Gastrointestinal and Endoscopic Surgeons safe cholecystectomy task force, who had received prior rater training. Surgeon self-ratings and expert ratings were compared with a Wilcoxon signed-rank test.</p><p><strong>Results: </strong>Twenty-five surgeon-participants were recruited, 13 of whom submitted an LC video. Surgeons did not achieve adequate CVS in their first submitted video based on expert ratings. Surgeons in the SA group overestimated their performance across all four scales: Operative Performance Rating System (z = -0.36, P = 0.715), Global Operative Assessment of Laparoscopic Skills (z = -0.37, P = 0.712), Strasberg (z = -1.84, P = 0.066), and Competency Assessment Tool (z = -0.73, P = 0.465). Surgeons in the coaching group overestimated their performance on each scale as well: Operative Performance Rating System (z = -0.67, P = 0.500), Global Operative Assessment of Laparoscopic Skills (z = -1.48, P = 0.138), Strasberg (z = -1.07, P = 0.285), and Competency Assessment Tool (z = -1.21, P = 0.225).</p><p><strong>Conclusions: </strong>Our study confirms that an adequate CVS is infrequently obtained during LC in a small but national sample of general surgeons. It further adds to the existing body of literature that suggests that SA alone may be inadequate for performance improvement. Effective teaching methods such as expert or artificial intelligence coaching are needed to improve the use of appropriate CVS by surgeons that may help decrease bile duct injury risk.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"36-40"},"PeriodicalIF":1.8,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Bone Mineral Density Assessment in Patients With Primary Hyperparathyroidism.","authors":"Michael J Kirsch, Elizabeth M Stoeckl, Antony Aziz, Alexandria D McDow, Kristin L Long, David F Schneider, Rebecca S Sippel, Priya H Dedhia","doi":"10.1016/j.jss.2024.10.042","DOIUrl":"https://doi.org/10.1016/j.jss.2024.10.042","url":null,"abstract":"<p><strong>Introduction: </strong>Primary hyperparathyroidism (PHPT) increases the risk of osteoporosis and fractures. Despite American Association of Endocrine Surgeons guidelines that recommend bone mineral density (BMD) assessment via dual-energy x-ray absorptiometry (DEXA) for PHPT patients, adherence to these guidelines remains suboptimal.</p><p><strong>Methods: </strong>We performed a retrospective review of preoperative and postoperative DEXA scan practices among PHPT patients at a single academic medical center between 2000 and 2018. Patient data, including demographics and history of bone pathology, was analyzed to identify factors influencing adherence to BMD assessment guidelines.</p><p><strong>Results: </strong>Of the 3384 PHPT patients evaluated for surgery, only 45.4% (n = 1535) underwent preoperative DEXA scan. Women were significantly more likely to undergo preoperative DEXA than men (49.9% versus 29.0%, P < 0.001). Female sex, age ≥65 y, and a history of bone pain or fractures were significant positive predictors of preoperative DEXA scan. Of patients with 2-y follow-up who did not receive a preoperative DEXA (n = 145), only 13.8% (n = 20) received a postoperative DEXA.</p><p><strong>Conclusions: </strong>This study highlights gaps in the adherence to national guidelines for DEXA screening among PHPT patients. This underscreening may contribute to increased morbidity due to unidentified osteoporosis. Efforts must be made to improve clinical practice and bring it into line with best practice as recommended by national guidelines.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"41-46"},"PeriodicalIF":1.8,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Surgery: Psychological Well-Being's Role in Breast Reconstruction Outcomes.","authors":"Jose Foppiani, Theodore C Lee, Angelica Hernandez Alvarez, Maria J Escobar-Domingo, Iulianna C Taritsa, Daniela Lee, Kirsten Schuster, Sasha Wood, Begum Utz, Christopher Bai, Lauren Maranhao-Wong, Bernard T Lee","doi":"10.1016/j.jss.2024.10.040","DOIUrl":"https://doi.org/10.1016/j.jss.2024.10.040","url":null,"abstract":"<p><strong>Introduction: </strong>Breast cancer is one of the most prevalent cancers worldwide, and following its treatment, many women turn to plastic surgery for reconstruction. A diagnosis of cancer is a heavy burden on patients. Yet, the effect of psychological/psychiatric comorbidities on patient satisfaction following their reconstruction remains unexplored. Thus, this paper aims to investigate how pre-existing psychological and psychiatric conditions impact patient-reported outcomes postreconstruction, compared to women without such conditions.</p><p><strong>Methods: </strong>A systematic review of PubMed, Web of Science, and Cochrane was completed. A qualitative synthesis of all included studies was then performed, and a subgroup analysis was then performed using a random effect model.</p><p><strong>Results: </strong>A total of 24 papers were included, encompassing a total population of 220,565 patients undergoing breast reconstruction between the ages of 18 and 84. The follow-up time ranged between 1.5 mo and 61 mo. In our study of breast reconstruction outcomes, the cohort with psychological/psychiatric comorbidities exhibited significant decreases in postoperative BREAST-Q scores compared to the control group: a 24-point [95% confidence interval (CI; -40, -8)] difference in satisfaction, a 20-point [95% CI (-57, -17)] difference in psychosocial well-being, an 18-point [95% CI (-28, 9)] difference in physical well-being, and a 33-point [95% CI (-51, -15)] difference in sexual well-being.</p><p><strong>Conclusions: </strong>Ultimately, our analysis suggests that presurgical psychology status is a critical determinant of postsurgical patient-reported outcomes. These results encourage the development and inclusion of well-being screening and optimization prior to surgery as a mean to improve surgical outcomes.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"26-35"},"PeriodicalIF":1.8,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oncologic Efficacy of Robotic Compared to Open Total Pancreatectomy for Pancreatic Cancer.","authors":"Jordan McKean, Austin Parrish, Doga Kahramangil Baytar, Alessandro Paniccia, Steven Hughes, Ibrahim Nassour","doi":"10.1016/j.jss.2024.10.043","DOIUrl":"https://doi.org/10.1016/j.jss.2024.10.043","url":null,"abstract":"<p><strong>Introduction: </strong>The use of robotic surgery for pancreatic cancer resections is increasing over time. There are multiple studies comparing this approach to open surgery, specifically for Whipple and distal pancreatectomies. But there are limited data on its feasibility and oncologic efficacy in patients requiring total pancreatectomy.</p><p><strong>Methods: </strong>This is a retrospective study from the 2010 to 2019 National Cancer Database comparing the postoperative, pathological, and long-term oncologic outcomes between robotic total pancreatectomy (RTP) and open total pancreatectomy (OTP) for pancreatic adenocarcinoma.</p><p><strong>Results: </strong>One hundred eighty-eight (5%) RTP and 3447 (95%) OTP patients were identified. The number of RTP increased from four in 2010 to 32 in 2019. There were no major differences in patient demographics and treatment characteristics, except that RTP patients were more likely to be performed at nonacademic centers and less likely to get radiation. After adjustment, there was similar yield of examined lymph nodes, rate of positive margin, 90-d mortality and receipt of adjuvant therapy between both groups. RTP was associated with a statistically significant shorter length of stay than OTP (9 versus 11 d respectively, P value <0.001). There was no difference in median overall survival between RTP and OTP (22.3 mo versus 23.3 mo, P value 0.688). The 1-, 3-, and 5-y overall survival rates for RTP were 78%, 31%, and 34% and those for OTP were 75%, 38%, and 30%, respectively. After adjustment, the use of robotic surgery was associated with similar overall survival to the open approach (hazard ratio 0.939, 95% confidence interval 0.760-1.161).</p><p><strong>Conclusions: </strong>RTP is associated with similar short- and long-term mortality without sacrificing oncologic outcomes including adequate lymphadenectomy and adjuvant chemotherapy receipt with the advantage of shorter length of stay.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"305 ","pages":"19-25"},"PeriodicalIF":1.8,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Markers of Endothelial Injury in Extracorporeal Membrane Oxygenation: A New Risk Assessment Method","authors":"Eriks E. Ziedins BS ,&nbsp;Edward J. Kelly MD ,&nbsp;Tuan D. Le MD, DrPH ,&nbsp;Bonnie C. Carney PhD ,&nbsp;Shane K. Mathew MD ,&nbsp;Desiree N. Pinto MD, MPH ,&nbsp;Brooke E. Pierson MS ,&nbsp;Cameron S. D'Orio BS ,&nbsp;Maxwell A. Hockstein MD ,&nbsp;Lauren T. Moffatt PhD ,&nbsp;Jeffrey W. Shupp MD","doi":"10.1016/j.jss.2024.09.088","DOIUrl":"10.1016/j.jss.2024.09.088","url":null,"abstract":"<div><h3>Introduction</h3><div>Extracorporeal membrane oxygenation (ECMO) has become more widely used in recent years. However, ECMO remains a resource-intensive modality, and identifying patients most likely to benefit from it can be a complex task. Few methods exist to help risk stratify potential ECMO patients. Syndecan-1 (SDC-1) and soluble thrombomodulin (sTM) are markers of endothelial dysfunction and are used as a sign of disease severity in various forms of trauma. Our study aims to evaluate the association between precannulation levels of SDC-1 and sTM with mortality, current scoring systems, and their ability to predict mortality on ECMO.</div></div><div><h3>Methods</h3><div>Patients initiated on venoarterial ECMO were retrospectively analyzed. Clinical data were collected, and precannulation Acute Physiology and Chronic Health Evaluation scores were calculated. Blood samples from precannulation collection were assayed for SDC-1 and sTM by enzyme linked immunosorbent assay. The primary outcome was mortality on ECMO.</div></div><div><h3>Results</h3><div>Thirty-four patients were included in the analysis. Most were male (76.5%), with a median age of 61.5 y and body mass index of 28.2. Overall mortality was 61.7%. sTM was significantly higher in patients who died on venoarterial ECMO compared to those who lived. Pre–SDC-1 level of ≥951 ng/mL is marginally predictive of a higher mortality risk (area under the receiver operating characteristic curve 0.70; <em>P</em> = 0.070). Pre-sTM levels of ≥5348 pg/mL predicted mortality (area under the receiver operating characteristic curve 0.89; <em>P</em> = 0.003).</div></div><div><h3>Conclusions</h3><div>SDC-1 and sTM are associated with a higher mortality risk in patients on ECMO. These biomarkers may be a valuable addition to current scoring systems. Furthermore, more work should focus on characterizing the effects of cardiogenic shock on the endothelium.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 391-399"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practice Patterns and Trends in the Surgical Management of Mismatch Repair Deficient Colon Cancer","authors":"Princy Gupta MBBS ,&nbsp;Peter L. Zhan MD ,&nbsp;Ira Leeds MD ,&nbsp;Anne Mongiu MD, PhD ,&nbsp;Vikram Reddy MD, PhD, MBA ,&nbsp;Haddon J. Pantel MD","doi":"10.1016/j.jss.2024.10.041","DOIUrl":"10.1016/j.jss.2024.10.041","url":null,"abstract":"<div><h3>Introduction</h3><div>Defects in the DNA mismatch repair (MMR) pathway can predispose individuals to colorectal cancer (CRC), with germline mutations in this pathway leading to Lynch syndrome. Consequently, universal MMR testing is recommended for all newly diagnosed CRC patients to detect mismatch repair deficient (MMR-D) tumors, enabling informed treatment decisions. Given the increased potential for metachronous disease in patients with Lynch syndrome, the current guidelines for surgical management of Lynch-associated colon cancer recommend extended resection in patients under age 60.</div></div><div><h3>Methods</h3><div>A retrospective analysis of nonmetastatic CRC was performed from the National Cancer Database to evaluate the current trends and practice patterns in the surgical management of MMR-D colon cancer, as well as assess the factors influencing choice of surgical procedure.</div></div><div><h3>Results</h3><div>From 2018 to 2020, 98,112 nonmetastatic CRC patients were identified, with 19.93% being MMR-D. MMR-D colon cancer patients were more likely to undergo extended resection than those with mismatch repair proficient tumors (9.4% <em>versus</em> 4.2%, <em>P</em> &lt; 0.001). When accounting for approximately one-fourth of MMR-D colon cancers being attributable to Lynch syndrome, the frequency of extended resection was less than expected (9.4% <em>versus</em> 25%, <em>P</em> &lt; 0.001). MMR-D patients under age 60 were more likely to undergo extended resection than those over age 60 (9% <em>versus</em> 3%) (odds ratio [OR] 3.57, 95% confidence interval [CI] 3.06-4.15). Several factors were associated with decreased rate of extended resection: uninsured (OR 0.42, 95% CI 0.21-0.84), Black race (OR 0.54, 95% CI 0.35-0.82), treatment at nonacademic centers (OR 0.74, 95% CI 0.56-0.97), and crowfly distance &gt;25 miles (OR 1.98, 95% CI 1.14-3.45).</div></div><div><h3>Conclusions</h3><div>These findings provide valuable insight into the current surgical practice patterns in the management of MMR-D colon cancers and possibly colon cancers associated with Lynch syndrome.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 371-382"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to Performing Essential Surgery at First-Level Hospitals in Pakistan: A Mixed Methods Study","authors":"Amna Urooba MBBS, MPH ,&nbsp;Mashal Murad Shah BS, BA, MSc ,&nbsp;Sameen Siddiqi MD, DrPH ,&nbsp;Usman Afzal MBBS ,&nbsp;Shaheen Mehboob BDS, MSc ,&nbsp;Sardar Shahmir Babar Chauhan MBBS ,&nbsp;Iqbal Azam MSc ,&nbsp;Imran Naeem MBBS ,&nbsp;Asad Latif MD, MPH ,&nbsp;Lumaan Sheikh MD ,&nbsp;Sadaf Khan MD, ABS, ABCRS","doi":"10.1016/j.jss.2024.10.031","DOIUrl":"10.1016/j.jss.2024.10.031","url":null,"abstract":"<div><h3>Introduction</h3><div>There are numerous reasons for underutilization of the public health sector for surgery in Pakistan. This results in patients being diverted to private hospitals or tertiary care centers in urban areas. Diversions overburden the hospitals and significantly increase out-of-pocket costs for the patients. This study aims to determine the barriers to surgical care in first-level hospitals in Pakistan's Sindh province.</div></div><div><h3>Methods</h3><div>We conducted a concurrent nested mixed methods study from May to June 2021 in public sector first-level hospitals in the Sindh province. Fifteen hospitals in six districts were surveyed. A consolidated hospital assessment tool adapted from the World Health Organization's Tool for Situational Analysis to Assess Emergency and Essential Surgical Care was used for quantitative data collection. Interview guides were developed for staff interviews.</div></div><div><h3>Results</h3><div>Availability of trained staff was found to be the biggest barrier to the provision of safe surgery. Only eight hospitals had a general surgeon, anesthesiologist, and obstetrician/gynecologist, while the remaining had 1-2 of the three disciplines. Thirteen hospitals had a functioning x-ray machine, while 14 facilities had functioning ultrasound machines with trained personnel to operate them. Only three facilities always had blood available for transfusion. The qualitative component corroborated that the biggest barrier to providing surgical care was the lack of human resources.</div></div><div><h3>Conclusions</h3><div>The lack of human resources is difficult to overcome. We found evidence of task-shifting to medical officers and trainee anesthesiologists, but this is without discrete regulation and monitoring. Building surgical workforce capacity must be addressed in the interest of quality care.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 383-390"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Intentional and Unintentional Firearm Injuries in Pediatric Trauma Patients: An 11-Year Retrospective Study","authors":"Marinda G. Scrushy MD ,&nbsp;Marisa Abbe PhD ,&nbsp;Shengqing Wang BA ,&nbsp;Genna Stone BSN ,&nbsp;Samir Pandya MD, FACS ,&nbsp;Mark Ryan MD, MSPH, FACS","doi":"10.1016/j.jss.2024.10.027","DOIUrl":"10.1016/j.jss.2024.10.027","url":null,"abstract":"<div><h3>Introduction</h3><div>In 2020, firearm injuries became the leading cause of death in children and adolescents and have continued to increase despite injury prevention strategies. The information obtained about these injuries is often limited to the demographic and clinical data required for trauma registries, which often lack granularity regarding the circumstances leading to the use of a firearm. The purpose of this study is to analyze admissions for firearm injuries according to intention and social vulnerability to enable the creation of targeted prevention strategies.</div></div><div><h3>Methods</h3><div>This is a retrospective cohort study using trauma registry data from a single institution from 2012 to 2022. Patients were stratified by a mechanism into unintentional, intentional, and self-inflicted firearm injuries based on chart review. Demographics were compared between groups and the overall trauma population. Social Vulnerability Index data were obtained from the Centers for Disease Control and Prevention registry.</div></div><div><h3>Results</h3><div>Of the 13,197 trauma patients admitted from January 2012 to December 2022, 153 were related to firearm injuries (1.2%). Relative to the overall trauma population, patients with firearm injuries were predominantly older (9.7 <em>versus</em> 7.4 y, <em>P</em> &lt; 0.001), male (74% <em>versus</em> 61%, <em>P</em> &lt; 0.001), Black (43% <em>versus</em> 17%, <em>P</em> &lt; 0.001), and insured via Medicaid or another government subsidized program (62% <em>versus</em> 48%, <em>P</em> &lt; 0.001). Injuries were classified as intentional (53%), unintentional (44%), and self-harm (1%). Unintentional injuries more frequently resulted in death (17.6% <em>versus</em> 8.6%), although this difference was not enough to reach the statistical significance. The proportion of intentional injuries increased significantly in the 2020-2022 period relative to previous years (<em>P</em> = 0.032).</div></div><div><h3>Conclusions</h3><div>Vulnerable populations have experienced a disproportionate increase in firearm violence starting in 2020. Unintentional injuries are a significant source of mortality in the pediatric population and represent a vital target for future injury prevention strategies.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 365-370"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter Regarding: Long-Term Outcomes of Cricothyroidotomy Versus Endotracheal Intubation in Military Personnel: A Retrospective Comparative Analysis Cohort Study.","authors":"Audrey Jarrassier, Arwad Alkahwaji, Jean-Baptiste Morvan, Pierre Pasquier","doi":"10.1016/j.jss.2024.07.128","DOIUrl":"10.1016/j.jss.2024.07.128","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":"408-409"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}