bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mismatch rate of empirical antimicrobial treatment in fracture-related infections
Authors: Jacobs Michelle MJ , Holla Micha , van Wageningen Bas , Hermans Erik , Veerman Karin 
Published: February 2024

OBJECTIVES:
To evaluate the current standard of care regarding empirical antimicrobial therapy in fracture related infections (FRI),

METHODS:

Design: Retrospective cohort study.

Setting:
Level I Trauma Center.

Patient Selection Criteria:
Adult patients treated for FRI with surgical debridement and empirical antibiotics between September 1st 2014 and August 31st 2022. Patients were excluded if less than five tissue samples for culture were taken, culture results were negative or there was an antibiotic free window of less than three days before debridement.

Outcome Measures and Comparisons:
FRI microbial aetiology, antimicrobial resistance patterns (standardised antimicrobial panels were tested for each pathogen), the mismatch rate between empirical antimicrobial therapy and antibiotic resistance of causative microorganism(s), and mismatching risk factors.

RESULTS:
In total, 75 patients were included (79% (59/75) men, mean age 51 years). The most prevalent microorganisms were Staphylococcus aureus (52%, 39/75) and Staphylococcus epidermidis (41%, 31/75). The most frequently used empirical antibiotic was clindamycin (59%, 44/75), followed by combinations of gram-positive and gram-negative covering antibiotics (15%, 11/75). The overall mismatch rate was 51% (38/75) (95% CI: 0.39-0.62) and did not differ between extremities (upper: 31% (4/13) (95% CI: 0.09-0.61), lower: 55% (33/60) (95% CI: 0.42-0.68, p=0.11)). Mismatching empirical therapy occurred mostly in infections caused by S. epidermidis and gram-negative bacteria. Combination therapy of vancomycin with ceftazidime produced the lowest theoretical mismatch rate (8%, 6/71). Polymicrobial infections were an independent risk factor for mismatching (OR: 8.38, 95% CI: 2.53-27.75, p<0.001).

CONCLUSIONS:
In patients with fracture related infections, a mismatching of empirical antibiotic therapy occurred in half of patients, mainly due to lack of coverage for S. epidermidis, gram-negative bacteria, and polymicrobial infections. Empirical therapy with vancomycin and ceftazidime produced the lowest theoretical mismatch rates. This study showed the need for the consideration of gram-negative coverage in addition to standard broad gram-positive coverage. Future studies should investigate the effect of the proposed empirical therapy on long-term outcomes.

LEVEL OF EVIDENCE:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Limited Improvement With Minimally Invasive Lumbar Decompression Alone for Degenerative Scoliosis With Cobb Angle Over 20°
Authors: Asada Tomoyuki , Simon Chad Z. , Singh Nishtha , Tuma Olivia , Subramanian Tejas , Araghi Kasra , Lu Amy Z. , Mai Eric , Kim Yeo Eun , Allen Myles R.J. , Korsun Maximilian , Zhang Joshua , Kwas Cole , Singh Sumedha , Dowdell James , Sheha Evan D. , Qureshi Sheeraz A. , Iyer Sravisht 
Published: February 2024

Study Design.
Retrospective review of a prospectively collected multisurgeon registry.

Objective.
To evaluate the outcomes of minimally invasive (MI) decompression in patients with severe degenerative scoliosis (DS) and identify factors associated with poorer outcomes.

Summary of Background Context.
MI decompression has gained widespread acceptance as a treatment option for patients with lumbar canal stenosis and DS. However, there is a lack of research regarding the clinical outcomes and the impact of MI decompression location in patients with severe DS exhibiting a Cobb angle exceeding 20°.

Materials and Methods.
Patients who underwent MI decompression alone were included and categorized into the DS or control groups based on Cobb angle (>20°). Decompression location was labeled as “scoliosis-related” when the decompression levels were across or between end vertebrae and “outside” when the operative levels did not include the end vertebrae. The outcomes, including the Oswestry Disability Index (ODI), were compared between the propensity score-matched groups for improvement and minimal clinical importance difference (MCID) achievement at ≥1 year postoperatively. Multivariable regression analysis was conducted to identify factors contributing to the nonachievement of MCID in ODI of the DS group at the ≥1-year time point.

Results.
A total of 253 patients (41 DS) were included in the study. Following matching for age, sex, osteoporosis status, psoas muscle area, and preoperative ODI, the DS groups exhibited a significantly lower rate of MCID achievement in ODI (DS: 45.5% vs. control 69.0%, P=0.047). The “scoliosis-related” decompression (odds ratio: 9.9, P=0.028) was an independent factor of nonachievement of MCID in ODI within the DS group.

Conclusions.
In patients with a Cobb angle >20°, lumbar decompression surgery, even in the MI approach, may result in limited improvement of disability and physical function. Caution should be exercised when determining a surgical plan, especially when decompression involves the level between or across the end vertebrae.

Level of Evidence.
3.
Association between metabolic syndrome and the risk of colorectal cancer: a prospective study in China
Authors: Wang zhongge , Chen Ruirui , Zhang Lizhen , Chen Yarong , Li Jing , Li Siyu , Xu Lulu , Hu Yujia , Bai Yana 
Published: February 2024

Objective
To evaluate the correlation between metabolic syndrome (MetS) and its components on the incidence of colorectal cancer (CRC) based on data from Jinchang Cohort.

Methods
This is a large prospective cohort study. Between 2011 and 2020, a total of 43 516 individuals from Jinchang Cohort were included for this study. Hazard ratios (HRs) with 95% confidence intervals (CIs) for CRC according to MetS were calculated with the Cox proportional hazard models. The restricted cubic spine models with four knots were conducted to fit the dose-response relationships.

Results
MetS was associated with increased risk of CRC (n = 141; HR: 1.64, 95% CI: 1.15–2.33) after adjusting for confounding factors (age, sex, education level, family history of CRC, smoking index and alcohol index). Participants with hyperglycemia had a significantly higher risk of developing incident CRC (HR: 1.70; 95% CI: 1.19–2.43). The positive association between MetS and CRC was observed in males (HR: 1.76; 95% CI: 1.17–2.63), but not in females (HR: 1.24; 95% CI: 0.59–2.64). Furthermore, linear dose-response relationship was found between fasting plasma glucose (FPG) and CRC risk in males (P
overall < 0.05, P
non-linear = 0.35). When stratified by smoke and drink, MetS was found to increase the incidence of CRC only in the smoke (HR: 2.07, 95% CI: 1.35–3.18) and drink (HR: 2.93, 95% CI: 1.51–5.69) groups.

Conclusion
MetS was associated with a higher risk of CRC incidence. Hyperglycemia lended strong support to the role of MetS in new-onset CRC, especially in males. Other components of MetS were not found to be associated with increased risk of CRC.
Incidence trend of neuroendocrine tumors and disparities by sex and race/ethnicity in adults from the United States, 2000–2020
Authors: Zhu Yong 
Published: February 2024

Objective
The incidence of neuroendocrine tumors (NET) has been increasing globally for several decades. The objective of the study was to examine the most recent trend in the incidence of NET as well as disparities by sex and race/ethnicity in adults in the USA.

Methods
Patients with NET aged ≥20 years were identified from the SEER 22 Registries from 2000 to 2020. The age-adjusted incidence rate was calculated for overall NET and by primary site. The incidence trend was assessed by annual percent change. Disparities by sex and race/ethnicity were examined using the incidence rate ratio.

Results
Age-adjusted incidence rate of overall NET in adults was 9.39 per 100 000 in 2000–2020. The incidence rate increased from 2000 but reached a plateau with no significant change since 2015. The lung and bronchus, small intestine, and rectum were the most common primary sites. Sex and racial/ethnic disparities in NET incidence varied by primary sites. For example, there was a female excess in NET of the lung and bronchus, stomach, and appendix; and there was a male excess in the small intestine, pancreas, colon, rectum and other/unknown NET. Compared to non-Hispanic white, non-Hispanic black had higher incidences of stomach, small intestine, liver, pancreas, colon, rectum, and other/unknown NET; they had lower incidences of lung and bronchus, and appendix NET than non-Hispanic white.

Conclusion
Age-adjusted incidence rate of overall NET has reached a plateau since 2015. However, there were sex and racial/ethnic disparities in such incidence, which varied depending on the primary site of NET.
Associations between breast cancer risk factors and mammographic breast density in a large cross-section of Korean women
Authors: Kim Soyeoun , Mai Tran Thi Xuan , Kim Mi Kyung , Chung Min Sung , Lee Eun Hye , Lee Woojoo , Park Boyoung 
Published: February 2024

Background:
We investigated the association between established risk factors for breast cancer and mammographic breast density in Korean women.

Methods
This large cross-sectional study included 8 460 928 women aged >40 years, who were screened for breast cancer between 2009 and 2018. Breast density was assessed using the Breast Imaging Reporting and Data System. This study used multiple logistic regression analyses of age, BMI, age at menarche, menopausal status, menopausal age, parity, breastfeeding status, oral contraceptive use, family history of breast cancer, physical activity, smoking, drinking and hormone replacement therapy use to investigate their associations with mammographic breast density. Analyses were performed using SAS software.

Results
Of 8 460 928 women, 4 139 869 (48.9%) had nondense breasts and 4 321 059 (51.1%) had dense breasts. Factors associated with dense breasts were: earlier age at menarche [<15 vs. ≥15; adjusted odds ratio (aOR), 1.18; 95% confidence interval (CI), 1.17–1.18], premenopausal status (aOR, 2.01; 95% CI, 2.00–2.02), later age at menopause (≥52 vs. <52; aOR, 1.23; 95% CI, 1.22–1.23), nulliparity (aOR, 1.64; 95% CI, 1.63–1.65), never breastfed (aOR, 1.23; 95% CI, 1.23–1.24) and use of hormone replacement therapy (aOR, 1.29; 95% CI, 1.28–1.29). Women with a higher BMI and the use of oral contraceptives were more likely to have nondense breasts.

Conclusion
Lower BMI, reproductive health and behavioral factors were associated with dense breasts in Korean women. Additional research should investigate the relationship between mammographic breast density, breast cancer risk factors and breast cancer risk.
Systematic review and analysis of self-efficacy in sun protection measurement instruments
Authors: Ward Jeanne M. , Hardin-Fanning Frances 
Published: February 2024

Objective
The objective of this study was toidentify and appraise available sun protection self-efficacy instruments and synthesize information.

Data source
A systematic search of electronic databases from 2005 to 2023 included PubMed, CINAHL, Embase and PsycINFO.

Background
While instruments have been developed to evaluate sun-protective behaviors and self-efficacy separately, sun-protection self-efficacy instruments have yet to be widely studied. Self-efficacy is an essential antecedent to performing health-related behaviors or practices that can promote or hinder the health of individuals and groups.

Study inclusion and exclusion criteria
Studies randomized control trials or descriptive studies that used self-efficacy measurement tools to evaluate behaviors, intentions, and sun protection knowledge were included in this review. Sun protection surveys that targeted providers or parents and non-English articles were excluded.

Data extraction
Data were extracted by one independent researcher.

Data synthesis
Fifteen studies met the inclusion criterion and included 10 scales of self-efficacy in sun protection. Study design and purpose, and the instrument’s validity and reliability statistics, including Cronbach’s alphas, were extracted.

Results
The two-factor self-efficacy in sun protection scale was the most common measure for primary prevention, with acceptable reliability and validity. However, other instruments also showed reliable psychometric properties, especially measures of sunscreen self-efficacy.

Conclusion
More research in self-efficacy measurement is warranted to examine specific populations and determine the appropriate constructs of self-efficacy. It is crucial to design evidence-based interventions that affect self-efficacy, are measured by a reliable, valid instrument, and have the potential to increase sun-protective and screening behaviors.
Psoriasis Is a Risk Factor for Surgical Site Infection After Primary TKA
Authors: Durst Caleb , Rajaee Lily , Chang Kenny , Lee Anderson , Rajaee Sean 
Published: February 2024

Background
The relationship between psoriasis and complications after primary TKA is not well defined. Current studies are limited to small, single-center studies evaluating fewer than 150 patients with psoriasis, with some studies reporting an increased risk of surgical site infection (SSI) and another reporting no associated risk. There is a need to reevaluate the risk of psoriasis and postoperative complications, including SSI, to better risk-stratify and guide practice in this patient population.

Questions/purposes
(1) Compared with patients without psoriasis, after accounting for potential confounders such as age, insurance, and comorbidities, do patients with psoriasis have a higher odds of superficial SSI after primary TKA? (2) Do patients with psoriasis have a higher odds of deep SSI after primary TKA?

Methods
Patients 18 years or older who underwent unilateral, primary TKA between 2015 and 2019 were identified in the PearlDiver database (n = 490,722). Patients with rheumatoid, septic, or posttraumatic arthritis were excluded, as well as patients with bone neoplasias (n = 188,557). Additionally, patients with less than 2 years of follow-up (n = 53,673) were excluded. In all, 248,492 patients were included in this study; 0.4% (1078) were in the psoriasis group and 99% (247,414) were in the control group. Overall 2-year superficial and deep SSI rates were stratified and compared between patients with psoriasis and a control group of patients who did not have psoriasis as the primary outcome. Secondary outcomes included the odds of undergoing an aseptic revision or manipulation under anesthesia.

Results
In the multivariable analysis, which controlled for potential confounders such as age, sex, Elixhauser comorbidity index, hypertension, diabetes mellitus, and liver disease, the odds of SSI—either superficial or deep—remained higher for patients with psoriasis (OR 1.74 [95% confidence interval 1.03 to 2.96]; p = 0.04). When focusing on superficial infections in the multivariable analysis, patients with psoriasis had a higher odds of superficial SSI than those in the control group (OR 2.83 [95% CI 1.26 to 6.34]; p = 0.01). The odds of deep SSI were not different between the two cohorts in our multivariable analysis (OR 1.32 [95% CI 0.66 to 2.66]; p = 0.43). Patients with psoriasis did not have an increased odds of undergoing an aseptic revision (OR 0.79 [95% CI 0.48 to 1.32]; p = 0.38) or manipulation under anesthesia (OR 0.74 [95% CI 0.52 to 1.06]; p = 0.10).

Conclusion
Patients with psoriasis had higher overall rates of SSI at 2 years of follow-up than patients without psoriasis. Our findings suggest that psoriasis is a risk factor for superficial SSI after primary TKA and is an important comorbidity for surgeons to consider before surgery. Further research is needed to assess the role of adjunctive interventions in patients with psoriasis to mitigate the elevated odds of superficial SSI.

Level of Evidence
Level II, prognostic study.
Preschoolers' Self-Regulation and Behavior Problems in the Midst of Caregiver Depression and Chaos
Authors: Kowalski Alysse J. , Wang Yan , Armstrong Bridget , Trude Angela C. B. , Hager Erin , Black Maureen M. 
Published: February 2024

ABSTRACT:

Objectives:
Preschoolers' self-regulation is partially developed through home and child care routines. COVID-19-related child care closures increased caregiver depressive symptoms, household chaos, and children's behavior problems. This longitudinal study examined how preschoolers' prepandemic self-regulation was related to behavior problems early in the pandemic, including buffering against the adverse effects of caregiver depressive symptoms and household chaos.

Methods:
A sample of 264 caregivers of preschoolers reported on their children's self-regulation (Behavior Rating Inventory of Executive Function–Preschool Version Inhibitory Self Control Index) before the pandemic and caregiver depressive symptoms (Center for Epidemiological Studies), household chaos (Confusion, Hubbub, and Order Scale), and children's behavior problems (Behavior Rating Index for Children) during the pandemic. We used linear mixed models to examine predictors of children's behavior problems, including prepandemic self-regulation, and further examined moderation by pandemic-related caregiver depressive symptoms and household chaos.

Results:
Children were 64% non-Hispanic White and 24% non-Hispanic Black, with mean pandemic age 5.9 years. Prepandemic self-regulation significantly predicted early pandemic behavior problems (β = −0.38 [95% confidence interval, −0.69 to −0.07]). This association was moderated by pandemic-related caregiver depressive symptoms and household chaos; the protective association was maintained at high levels of caregiver depressive symptoms or household chaos, although the association diminished when these co-occurred.

Conclusion:
The protective association between prepandemic self-regulation and subsequent behavior problems suggests longitudinal benefits of preschoolers' inhibitory and emotional control. Despite reduced protection associated with co-occurring caregiver and household challenges, self-regulation continued to demonstrate protection against subsequent behavior problems, even in the midst of a pandemic.
Physical activity and menopausal symptoms: evaluating the contribution of obesity, fitness, and ambient air pollution status
Authors: Elavsky Steriani , Burda Michal , Cipryan Lukáš , Kutáč Petr , Bužga Marek , Jandačková Vera , Chow Sy-Miin , Jandačka Daniel 
Published: February 2024

Abstract

Objective
The menopausal transition is accompanied by transient symptoms that have been linked to subclinical cardiovascular disease (CVD); CVD has also been linked to air pollution. Physical activity (PA) reduces CVD, improves body composition, and can reduce menopausal symptoms. The purpose of this study was to assess the links between PA and menopausal symptoms and whether obesity, fitness, and air pollution status play a role in this relationship.

Methods
Women (40-60 y; N = 243; mean [SD] age, 47.8 [5.6] y) from areas with high versus low air pollution enrolled in the Healthy Aging in Industrial Environment Program 4 prospective cohort study completed psychological, cardiorespiratory fitness, body composition, and menopausal status screening followed by a 14-day prospective assessment of menopausal symptoms (Menopause Rating Scale) using a mobile application. Daily PA was assessed objectively across 14 days via Fitbit Charge 3 monitor. General linear mixed models were conducted and controlled for age, menopausal status, day in the study, wear time, and neuroticism.

Results
Peri/postmenopausal women (β = 0.43, P < 0.001) and those residing in a high-air-pollution environment (β = 0.45, P < 0.05) reported more somatovegetative symptoms. Hot flashes alone were associated with peri/postmenopausal status (β = 0.45, P < 0.001), and for women residing in a high-air-pollution environment, lower reporting of hot flashes was observed on days when a woman was more physically active than usual (β = −0.15, P < 0.001). No associations were found for cardiorespiratory fitness and visceral fat with any of the symptoms.

Conclusions
PA may enhance resilience to hot flashes, especially when residing in high-air-pollution environments where we also observed higher reporting of somatovegetative menopausal symptoms.
A cross-sectional study of the association between breastfeeding history and overweight/obesity in postmenopausal women
Authors: Ran Ting , Peng Nianchun , Zhang Miao , Hu Ying , Zhuang Huijun , Zhang Tian , He Juan , Shi Lixin , Zhang Qiao , Zheng Jing 
Published: February 2024

Abstract

Objectives
This study endeavors to augment comprehension of the association between breastfeeding and maternal weight within Asian populations.

Methods
Data were obtained from the comprehensive 2011 research titled “Risk Evaluation of Cancers in Chinese Diabetic Individuals (REACTION): a longitudinal analysis,” focusing specifically on postmenopausal women residing in the metropolitan precincts of Guiyang. It presents a cross-sectional study involving 5,987 parous postmenopausal women, aged 60.1 ± 6.9 years, who underwent assessments of body mass index and waist-to-height ratio. The probability of excessive weight or obesity was evaluated in relation to the aggregate duration of breastfeeding, using single-factor and multivariate logistic regression analyses.

Results
Following multiple adjustments for different confounders, the odds ratios (ORs) demonstrated that women who had borne a single child and breastfed for more than 12 months exhibited an increased prevalence of excessive weight (body mass index ≥24 kg/m2) in contrast to those who abstained from breastfeeding (model I: OR, 1.481; 95% confidence interval, 1.124-1.952; P = 0.005; model II: OR, 1.471; 95% confidence interval, 1.113-1.944; P = 0.007). Conversely, among the subset of women who had given birth to two or more children, no noteworthy associations emerged between breastfeeding duration and the propensity for excessive weight or obesity (all models).

Conclusion
In the Asian population, the duration of breastfeeding does not appear to be necessarily linked to the prevalence of overweight or obesity in postmenopausal women.
Successful Treatment of SIADH after Removal of Ruptured Breast Implants
Authors: Thuerlimann Alice C. , Morel Jeremy , Martin Pierre-Yves , Kalbermatten Daniel F. 
Published: February 2024

Summary:
Local adverse reactions to breast implants and systemic reactions, mostly autoinflammatory, are numerously described in the literature. A patient presented at our institution with severe neurologic symptoms, including confusion and phasic troubles due to severe hyponatremia as part of syndrome of inappropriate antidiuretic hormone secretion (SIADH). Common etiologies for SIADH, primarily malignancy and central nervous system disturbances, have been ruled out by imaging. On the computed tomography scan of the thorax and abdomen, several masses were found in the pectoral region, inferior to the sternum and in the left axilla that were biopsied and verified as silicone. While evaluating the patient’s medical history, the patient remembered having undergone breast augmentation with silicone implants several decades ago. The only explanation left for the persisting SIADH was her ruptured silicone implants, causing an inflammatory systemic reaction. Literature was searched, and one abstract was found, in which a woman presenting with SIADH was treated successfully after removal of her silicone breast implants. We offered the same treatment to our patient, and siliconomas were removed through a bilateral inframammary approach as well as axillary on the left. There were no complications encountered. Postoperatively, the patient’s hyponatremia improved and normalized 1 month later even without hydric restriction. This potential form of etiology and treatment of SIADH is a novelty in the medical literature. Surgical removal of dispersed silicone is presumed to be the cure for this syndrome. It represents a diagnosis of exclusion after more life-threatening causes, such as central nervous system disturbances and malignancies, have been ruled out.