Multi-factor Regression Analysis Research Articles

10 years observation study of low and moderate cardiovascular risk hypertensive patients: the impact of anxiety and depression level in development of cardiovascular complications

Abstract Not only “classic” risk factors such as age, sex, smoking status, blood pressure (BP) and cholesterol (HS) levels, but also additional factors, one of which is the psychological status of the patient, need to be considered to improve the prediction of cardiovascular complications. This is especially true for low/moderate risk patients on the SCORE scale, whose risk of cardiovascular complications (CVC) is often underestimated. Aim To assess the contribution of psychological status of hypertensive patients and SCORE<5% to increase the risk of development of cardiovascular complications for a period of 10 years of observation. Materials and methods In 2009, 142 hypertensive patients with SCORE risk <5% (37 men and 105 women) in addition to the clinical examination, were interviewed on the HADS scale to assess the level of anxiety and depression. In 2019, these patients were interviewed by phone for CVC suffered over the past 10 years: all-cause mortality, cardiovascular death (CVD), fatal and nonfatal myocardial infarction (MI), stroke, revascularization, hospitalization for cardiac events. Results At the time of inclusion in the study, the age of the patients was 50, 9±8.2 years. At the first visit systolic BP (SBP) level was 130.0 (128.4; 133.7) mm Hg and diastolic BP (DBP) 80.0 (81.3; 84.5) mm Hg. The HS level was 6.1 (5.9; 6.3) mmol/L, triglycirides 1.4 (1.5:1.8) mmol/L, low dencity lipoproteins 3.8 (3.6; 4.0) mmol/L, high density lipoproteins 1.3 (1.4; 1.5) mmol/L. Level of anxiety (A) was 7.0 (7.0; 8.2) points, depression (D) – 5.7 (5.2; 6.2) points. The patients without the expressed symptom of D (0–7 points) – 76.8% (n=109), A (0–7 points) – 52% (n=74). The patients with clinically significant D (>11 points) – 8.5% (n=12), A (>11 points) – 18.3% (n=26). 2 CVD occurred in the observed group in 10 years (1.4%), 6 MI, 12 percutaneous coronary intervention (8 acute coronary syndrome), 4 strokes, 34 cardiovascular hospitalizations. 14 new onset cases of coronary artery disease (9.6%). Thus 31.7% of observed patients had CVC. Comparison of the initial data of the group with CVC with the group without CVC revealed a difference only in the level of D: 7.0 (5.6; 7.3) points in patients with CVC vs 5.0 (4.7; 5.8) p=0.04) – Fig. 1. The patients were comparable in sex and age. BP, lipid profile, glucose, heart rate, smoking status, levels of A did not differ significantly. Multi-factor regression analysis has demonstrated that depression levels D is an independent predictor of the development of complications in a model involving age, sex, BP, HS and A (β=0,218, p=0,03). Conclusion Level D is an independent risk factor development of CVC in hypertensive patients low/moderate risk on SCORE. Funding Acknowledgement Type of funding source: None

Retrospective analysis of the effect of current clinical medications and clinicopathological factors on viral shedding in COVID-19 patients.

The aim of the present study was to identify the risk factors associated with prolonged shedding in patients with coronavirus disease 2019 (COVID-19), and to evaluate the effects of current clinical and clinicopathological factors on viral shedding in patients. A total of 186 COVID-19 inpatients were enrolled in this multicentre retrospective analysis. Detailed clinical data of each patient were collected, and the factors that affected the duration of viral shedding were retrospectively analysed. The median duration of viral shedding in the 186 COVID-19 patients was 13 days. The median duration of viral shedding was 12 days in non-severe patients, and 17 days in severe patients, and there was a significant difference between the two groups (P<0.001). Multi-factor regression analysis suggested that the onset-hospitalization interval [odds ratio (OR), 1.27; 95% confidence interval (CI), 1.15-1.41; P<0.001] and comorbidity with a chronic disease (OR, 2.43; 95% CI, 1.14-5.17; P=0.021) were independent risk factors for prolonged viral shedding, whereas lopinavir/ritonavir (LPV/r) was an independent protective factor (OR, 0.28; 95% CI, 0.11-0.75; P=0.011). Spearman's rank correlation analysis showed that the onset-drug interval was positively correlated with the duration of viral shedding (r=0.446; P<0.0001). Umifenovir, and low and short courses of glucocorticoids were not associated with prolonged viral shedding. The prolonged viral shedding was the initial causative factor of persistent aggravation of the patient's conditions. The interval between presentation of symptoms and hospitalization as well as complications with a comorbid chronic disease were independent risk factors for prolonged viral shedding. LPV/r shortened the duration of viral shedding, and the smaller the interval between presentation and LPV/r onset was, the faster viral shedding occurred.

Development of a Risk Prediction Model for Central-Line–Associated Bloodstream Infection (CLABSI) in Patients With Continuous Renal Replacement Therapy

Background: The number of patients with end-stage renal disease and acute kidney injury in China is large and increasing year by year. Continuous renal replacement therapy (CRRT) is one of the important treatment methods. However, long-time CRRT would inevitably lead to CLABSI, which would seriously affect the treatment and prognosis of the patient. Although CLABSIs can be prevented and controlled, the rate of CLABSI in China is still higher than in other countries. Therefore, it is urgent to find new intervention methods on the basis of existing methods. Surveillance is the prerequisite of infection prevention and control. We sought to develop a risk prediction model for CLABSI in patients with CRRT according to uncontrollable risk factors, which could be used for early assessment and screening of high-risk infection groups. Such a tool would bring the supervision and infection control to the forefront in addressing these issues. Methods: We selected 3,103 CRRT patients in the West China Hospital of Sichuan University from January 2013 to December 2018 using the hospital infection and infectious disease monitoring module of electronic medical records (EMR) system with the integration and elimination criteria. Data mining and feature selection were performed using Weka software. Separately, prediction models developed by Weka software and SPSS software were compared with each other using the area under the curve (AUC) method to assess the performance of the forecasting models. Result: The incidence of CLABSI in CRRT patients was 8.01 per 1,000 catheter days (238 of 29,711). According to the multifactor regression analysis by SPSS software, the retaining time of dialysis catheter, C-reactive protein levels, total bilirubin, acute pancreatitis, and systemic inflammation reaction syndrome were the risk factors. According to the Youden’s index, the cutoff point of the retaining time of dialysis catheter was 5.5 days; the cutoff point of CRP was 112.5mg/L; and the cutoff point of total bilirubin was 14.15 μmol/L. The prediction models of CLABSI for CRRT patients were developed: The AUC of the prediction model developed by SPSS software was 0.763 (95% CI, 0.717–0.809). The receiver operating characteristic (ROC) curve analysis showed that the AUCs of the prediction models developed separately by Weka software using Bayes, logistic regression analysis, multiple layer Perceptron and J48, and SPSS software through logistic regression analysis were between 0.6 and 0.8. Using the down-sampling technique, the AUC ranged between 0.7 and 0.9, and the sensitivity, precision, and &amp;kappa; value increased. Thus, these models had definite clinical significance. Conclusion: The prediction models of CLABSI for CRRT patients, developed based on the big healthcare data, not only had good judgment ability, but also had good application value for individual evaluations and the target population.Funding: This study was supported by the Health Commission of Sichuan Province.Disclosures: None

Colistin co-administration with other nephrotoxins: experience of teaching hospital of Latvia.

Background Colistin is a potentially nephrotoxic antibiotic used for the management of multidrug-resistant bacterial infections in critically ill patients. Co-administration with other nephrotoxins was reported as a potentially modifiable risk factor of colistin acute kidney injury. Objective To establish the role of colistin dosing and co-medications in development of colistin kidney injury. Setting Community teaching hospital in Latvia. Method Adult patients from intensive care units with diagnosed Gram-negative bacterial infections, undergoing colistin treatment for longer than 72h, and not receiving renal replacement therapy were included in this retrospective study. Main outcome measure Colistin nephrotoxicity was defined as an increase in the serum creatinine level by at least 50% from the baseline after ≥ 48h. Results In 73 of 87 cases, Acinetobacter baumannii pneumonia was diagnosed. The nephrotoxicity rate was 27.6% with a median onset of 8days. In 79% of the cases, colistin was co-administrated with at least one potentially nephrotoxic agent. The most used nephrotoxins were loop diuretics (44 cases), non-steroidal anti-inflammatory drugs (19 cases) and vancomycin (11 cases). The use of nephrotoxins was similar in patients with colistin nephrotoxicity (group-1) and without it (group-2). Carbapenems were more common in group-2 (37% vs 62%, p = 0.004) and a colistin loading dose of 9 MU in group-1 (87% vs 62%, p = 0.027). However, in the multifactor regression analysis, the protective role of carbapenems was not confirmed. Conclusion Potentially nephrotoxic agents are commonly co-administrated with colistin. This study failed to prove their role in the development of acute kidney injury.

Impact of interventionalist\u2019s experience and gender on radiation dose and procedural time in CT-guided interventions\u2014a retrospective analysis of 4380 cases over 10 years

ObjectivesTo investigate the impact of the interventionalist’s experience and gender on radiation dose and procedural time in CT-guided interventions.MethodsWe retrospectively analyzed 4380 CT-guided interventions performed at our institution with the same CT scanner from 2009 until 2018, 1287 (29%) by female and 3093 (71%) by male interventionalists. Radiation dose, number of CT fluoroscopy images taken per intervention, total procedural time, type of intervention, and degree of difficulty were derived from the saved dose reports and images. All 16 interventionalists included in this analysis performed their first CT-guided interventions during the study period, and interventions performed by each interventionalist were counted to assess the level of experience for each intervention in terms of the number of prior interventions performed by her or him. The Mann-Whitney U test (MWU test), multivariate regression, and linear mixed model analysis were performed.ResultsAssessment of the impact of gender with the MWU test revealed that female interventionalists took a significantly smaller number of images (p < 0.0001) and achieved a lower dose-length product per intervention (p < 0.0001) while taking more time per intervention (p = 0.0001). This finding was confirmed for most types of interventions when additionally accounting for other possible impact factors in multivariate regression analysis. In linear mixed model analysis, we found that radiation dose, number of images taken per intervention, and procedural time decreased statistically significantly with interventionalist’s experience.ConclusionsRadiation doses of CT-guided interventions are reduced by interventionalist’s experience and, for most types of interventions, when performed by female interventionalists.Key Points• Radiation doses in CT-guided interventions are lower when performed by female interventionalists.• Procedural times of CT-guided interventions are longer when performed by female interventionalists.• Radiation doses of CT-guided interventions decrease with the interventionalist’s experience.

ABCC8 mRNA expression is an independent prognostic factor for glioma and can predict chemosensitivity

Glioma is the most common primary intracranial tumor and is associated with very low survival rates. The development of reliable biomarkers can help to elucidate the molecular mechanisms involved in glioma development. Here the expression of ABCC8 mRNA, clinical characteristics, and survival information based on 1893 glioma samples from four independent databases were analyzed. The expression patterns of ABCC8 mRNA were compared by a Chi square test. The overall survival rate of gliomas was evaluated according to the expression level of ABCC8 mRNA. The prognostic value of this marker in gliomas was tested using Cox single factor and multi factor regression analyses. We found patients with low WHO grade, oligodendrocytoma, low molecular grade, IDH mutation, and 1p19q combined deletion had high ABCC8 mRNA expression. The patients with high expression of ABCC8 mRNA had longer survival. ABCC8 mRNA expression was a new independent prognostic index for glioma. Temozolomide chemotherapy was an independent index to prolong overall survival in high ABCC8 mRNA expression glioma patients, whereas in patients with low expression, there was no significant difference. So ABCC8 mRNA expression could be an independent prognostic indicator for glioma patients and could predict the sensitivity of glioma to temozolomide.

Prevalence and risk factors of small airway dysfunction, and association with smoking, in China: findings from a national cross-sectional study

Small airway dysfunction is a common but neglected respiratory abnormality. Little is known about its prevalence, risk factors, and prognostic factors in China or anywhere else in the world. We aimed to estimate the prevalence of small airway dysfunction using spirometry before and after bronchodilation, both overall and in specific population subgroups; assess its association with a range of lifestyle and environmental factors (particularly smoking); and estimate the burden of small airway dysfunction in China. From June, 2012, to May, 2015, the nationally representative China Pulmonary Health study invited 57 779 adults to participate using a multistage stratified sampling method from ten provinces (or equivalent), and 50 479 patients with valid lung function testing results were included in the analysis. We diagnosed small airway dysfunction on the basis of at least two of the following three indicators of lung function being less than 65% of predicted: maximal mid-expiratory flow, forced expiratory flow (FEF) 50%, and FEF 75%. Small airway dysfunction was further categorised into pre-small airway dysfunction (defined as having normal FEV1 and FEV1/forced vital capacity [FVC] ratio before bronchodilator inhalation), and post-small airway dysfunction (defined as having normal FEV1 and FEV1/FVC ratio both before and after bronchodilator inhalation). Logistic regression yielded adjusted odds ratios (ORs) for small airway dysfunction associated with smoking and other lifestyle and environmental factors. We further estimated the total number of cases of small airway dysfunction in China by applying present study findings to national census data. Overall the prevalence of small airway dysfunction was 43·5% (95% CI 40·7-46·3), pre-small airway dysfunction was 25·5% (23·6-27·5), and post-small airway dysfunction was 11·3% (10·3-12·5). After multifactor regression analysis, the risk of small airway dysfunction was significantly associated with age, gender, urbanisation, education level, cigarette smoking, passive smoking, biomass use, exposure to high particulate matter with a diameter less than 2·5 μm (PM2·5) concentrations, history of chronic cough during childhood, history of childhood pneumonia or bronchitis, parental history of respiratory diseases, and increase of body-mass index (BMI) by 5 kg/m2. The ORs for small airway dysfunction and pre-small airway dysfunction were similar, whereas larger effect sizes were generally seen for post-small airway dysfunction than for either small airway dysfunction or pre-small airway dysfunction. For post-small airway dysfunction, cigarette smoking, exposure to PM2·5, and increase of BMI by 5 kg/m2 were significantly associated with increased risk, among preventable risk factors. There was also a dose-response association between cigarette smoking and post-small airway dysfunction among men, but not among women. We estimate that, in 2015, 426 (95% CI 411-468) million adults had small airway dysfunction, 253 (238-278) million had pre-small airway dysfunction, and 111 (104-126) million had post-small airway dysfunction in China. In China, spirometry-defined small airway dysfunction is highly prevalent, with cigarette smoking being a major modifiable risk factor, along with PM2·5 exposure and increase of BMI by 5 kg/m2. Our findings emphasise the urgent need to develop and implement effective primary and secondary prevention strategies to reduce the burden of this condition in the general population. Ministry of Science and Technology of China; National Natural Science Foundation of China; National Health Commission of China.

Study of the diagnostic significance of telomere length in patients with cerebral atherosclerosis

Cerebrovascular diseases are one of the most important causes of morbidity and mortality in the adult population.Objective – to determine the relationship between telomere length and lipid spectrum, structural and functional state of the heart and cerebral vessels and heart rate variability in patients with 1–3 degree cerebral atherosclerosis (CA).Materials and methods. In a comprehensive clinical and instrumental study, 161 patients with 1–3 degree CA were enrolled. Telomerase activity was determined using a real-time tandem repeat amplification protocol. The relative lengths of telomeres were measured by multiplex quantitative polymerase chain reaction in real time.Results. Patients were divided into 2 groups: І – with CA of 1–2 degree, ІІ – with CA of 3 degree (who had suffered an ischemic atherothrombotic stroke (AS)). Mean age was 65.1 ± 10.5 and 65.4 ± 9.1 years, respectively. The proportion of men was 21.2 % in group I and 52 % in group II. To identify the factors that influence telomere size as a marker of early aging, the method of constructing logistic regression models was used. In building the models, the following categories were used: shorter telomere length – T/S &lt;2.61 (low and medium tertiles); longer telomere length – T/S over 2.61. For a set of significant risk factors selection, the method of step-by-step inclusion / exclusion of signs was used (stepwise exclusion threshold value of P &gt; 0.15 and inclusion threshold value of P &lt; 0.03). A multivariate logistic regression model was developed based on the identified significant risk factors. A statistically significant positive relationship was found between the telomere length and both the E/A index (diastolic function of the heart) and LPVLD, as well as negative relationship with both the EF and the intima-media complex (IMC) on the right.Conclusions. Telomere length is comparable in elderly patients with 1–2 degree CA and those who suffered an ischemic atherothrombotic stroke. Based on the multifactor regression analysis, the relationship between telomere length and LPVLD, IMC, EF and LV diastolic function was detected in patients at different stages of CA, including type 2 diabetes (AUC = 0.79 (CI 0.69–0.87)).

Association of high-resolution computed tomography score with ventilator weaning and 28-day mortality of patients with acute respiratory distress syndrome.

ObjectiveThis study was performed to explore the association of the high-resolution computed tomography (HRCT) score with ventilator weaning and 28-day mortality of patients with acute respiratory distress syndrome (ARDS).MethodIn total, 197 patients treated for ARDS from October 2004 to December 2015 were retrospectively analyzed. Univariate analysis and multifactor regression analysis were used to determine the relationship of the HRCT score with ventilator weaning and 28-day mortality. Curve-fitting analysis and threshold analysis were further used to explore the association of the HRCT score with ventilator weaning and 28-day mortality.ResultsThe multifactor regression analysis showed that the HRCT score was significantly associated with a lower rate of ventilator weaning and a higher risk of 28-day mortality in patients with ARDS. HRCT scores of 257.0 and 243.2 were the thresholds for ventilator weaning and 28-day mortality, respectively. When the HRCT score was below the threshold, every 1-point increase in the HRCT score was associated with a 4.6% decrease in the ventilator weaning rate and a 4.6% increase in the 28-day mortality rate.ConclusionThe HRCT score was associated with ventilator weaning and 28-day mortality with a threshold of 257.0 and 243.2 points, respectively.

Salivary Cystatin SN Is a Factor Predicting Iron Bioavailability in Phytic Acid Rich Meals

Abstract Objectives Phytic acid is an inhibitor of iron bioavailability, but recent research has suggested that individuals may adapt to phytic acid, and that the salivary protein, cystatin SN, may play a role. Study objectives were: 1) to assess the relationship between cystatin SN levels and iron bioavailability during a phytic acid rich meal, and 2) whether cystatin SN would differ among participants with greater vs. lower iron bioavailability overall. Methods Three groups of ten women received meals with: 1) 500 mg phytic acid powder sprinkles 2) 500 mg phytic acid capsules, or 3) no phytic acid. Meals included 18 mg iron. Pre-meal, hemoglobin, iron, ferritin, total iron binding capacity, transferrin saturation, and C - reactive protein were measured from venous blood. Iron bioavailability was measured by the mealtime percentage of maximum iron recovery (% max iron absorption); cystatin SN was measured pre-and post-meal by enzyme-linked immunosorbent assay. All participants completed 3–24 hour dietary recalls. Data were analyzed by multifactor regression analysis and ANOVA. Results There were no significant differences in group dietary intake (P &amp;gt; 0.05). The % max iron absorption was not different among groups; after adjustment, there was significantly greater % max iron absorption in Groups 2 and 3, compared to 1 (P = 0.03, P = 0.004, respectively). Unadjusted pre-to-post meal cystatin SN levels were significantly and positively correlated with improved iron bioavailability in Group 1 (P = 0.046, R2 = 0.4), but not Groups 2 or 3. After adjusted modeling, pre-to-post meal cystatin SN was significantly associated with improved % max iron absorption in Groups 1 and 2 (P's &amp;lt; 0.0001). Overall, there were significantly greater pre-to-post meal cystatin SN levels in participants with % max iron absorption greater, compared to less than 12% (10.2 ± 20.6 vs. −20.5 ± 13.5, respectively, P = 0.01). Conclusions There was a significant relationship between improved iron bioavailability and pre-to-post meal Cystatin SN levels with phytic acid rich meals. Overall, participants with greater meal iron bioavailability had significantly greater pre-to-post meal cystatin SN recovery. Cystatin SN may be a physiological factor in predicting iron bioavailability with phytic acid rich meals. Funding Sources Funded by Wichita State University's School of Nursing.

Clinical significance of nutritional risk screening for older adult patients with COVID-19.

ObjectivesThe aim of this study was to assess the nutritional risks among older patients with COVID-19 and their associated clinical outcomes using four nutritional risk screening (NRS) tools: Nutrition Risk Screening 2002 (NRS 2002), Malnutrition Universal Screening Tool (MUST), Mini Nutrition Assessment Shortcut (MNA-sf), and Nutrition Risk Index (NRI).MethodsWe retrospectively analyzed the data of patients with COVID-19 older than 65 years who were treated in our hospital from January 28, 2020 to March 5, 2020, and explored the relationship between nutritional risk and clinical outcomes.ResultsA total of 141 patients with COVID-19 (46 common COVID-19, 73 severe COVID-19, and 22 extremely severe COVID-19) were enrolled in the study. NRS 2002 identified 85.8% of patients as having risk, with being identified 41.1% by MUST, 77.3% by MNA-sf, and 71.6% by NRI. The agreement strength was moderate between NRS 2002 and MNA-sf, NRI, fair between MUST and MNA-sf, NRI, fair between MNA-sf and NRI, poor between NRS 2002 and MUST (P < 0.01). After adjustment for confounding factors in multivariate regression analysis, patients in the risk group had significantly longer LOS, higher hospital expenses (except MNA-sf), poor appetite, heavier disease severity, and more weight change(kg) than normal patients by using NRS 2002, MNA-sf, and NRI(P < 0.05).ConclusionsThe NRS 2002, MNA-sf, and NRI are useful and practical tools with respect to screening for patients with COVID-19 who are at nutritional risk, as well as in need of additional nutritional intervention.

MP44-12 SHALL WE RE-EVALUATE THE RELATIONSHIP BETWEEN BMI, AGE AND OUTCOMES OF MICROSURGICAL VASOEPIDIDYMOSTOMY: A MULTIPLE-FACTOR ANALYSIS OF 181 PATIENTS UNDERWENT MICROSURGICAL VASOEPIDIDYMOSTOMY BY A SINGLE SURGEON

You have accessJournal of UrologyInfertility: Therapy I (MP44)1 Apr 2020MP44-12 SHALL WE RE-EVALUATE THE RELATIONSHIP BETWEEN BMI, AGE AND OUTCOMES OF MICROSURGICAL VASOEPIDIDYMOSTOMY: A MULTIPLE-FACTOR ANALYSIS OF 181 PATIENTS UNDERWENT MICROSURGICAL VASOEPIDIDYMOSTOMY BY A SINGLE SURGEON Kai Hong*, Shouyang Wang, Haitao Zhang, Hui Jiang, and Lulin Ma Kai Hong*Kai Hong* More articles by this author , Shouyang WangShouyang Wang More articles by this author , Haitao ZhangHaitao Zhang More articles by this author , Hui JiangHui Jiang More articles by this author , and Lulin MaLulin Ma More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000899.012AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Single-armed two-suture vasoepididymostomy (VE) technique has been widely used, which proved to be one of effective and safe surgical options for the treatment of obstructive azoospermia (OA) caused by primary epididymal obstruction. Factors which may affect outcomes of VE has been reported. However, some of those factors become not much important to the outcomes of VE with the improvement of surgical technic and the accumulating experience of surgeons. We focused on the new-interested factors of BMI and age affecting the surgical outcome of VE and evaluated their clinical value in improving the patency rate. At the same time, other factors what might affect the outcomes were re-evaluated. METHODS: 181 azoospermia patients cause by primary epididymal obstruction who underwent single-armed two-suture longitudinal intussusception microsurgical VEs by a single surgeon (KH) at Peking University Third Hospital, Beijing, China from September 2014 to September 2017 were followed up consecutively. Body mass index (BMI), age, together with other five factors such as methods of bilateral or unilateral anastomosis, anastomosis sites, the motility and quantity of sperms found in epididymal fluid intraoperatively, what were possibly related to the patency rates were analyzed. RESULTS: Among 181 patients, 159 (87%, 159/181) patients were followed through either telephone calls or interview. 22 patients were lost to follow-up. The mean follow-up time was 27 (12 ∼ 48) months. Patency was defined by finding sperms in semen analyses or natural impregnation during the follow-up. The patency rate was 73.0% (116/159). Then, with the logistic regression multifactor analysis, we confirmed that factors of BMI and age were related to a higher patency rate (P = 0.008 and 0.028, respectively). A younger age and a lower BMI score appeared to be associated with a higher patency rate (OR = 3.531 and 2.352, 95% CI = 1.397, 8.924 and 1.095, 5.054, respectively). CONCLUSIONS: BMI and age were confirmed to be independent influencing factors for the outcomes of microsurgical VEs on humans when the technology matured and the surgeons were experienced. We suggest patients take microsurgical VE before 28 years old and control their BMI under 26 to achieve better surgical outcomes. Other factors analyzed in this study appeared no significant relationship with patency. Source of Funding: 1. Beijing Municipal Natural Science Foundation 2. National Key Research and Development Program of China © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e661-e661 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kai Hong* More articles by this author Shouyang Wang More articles by this author Haitao Zhang More articles by this author Hui Jiang More articles by this author Lulin Ma More articles by this author Expand All Advertisement PDF downloadLoading ...

Abstract P6-14-10: A retrospective study of peri-prosthesis infection after prosthesis based breast reconstruction in a single breast center in east China and impact of an evidence-based protocol

Abstract Purpose To investigate the status of surgical site infection after prosthesis-based breast reconstruction in a single center and evaluate the role of an evidence-based protocol in infection control in immediate prosthesis-based breast reconstruction. Method Two cohorts are included in our study. In the first cohort, a retrospective analysis of consecutive post-mastectomy prosthesis-based reconstructions performed between June of 2010 and April of 2018 at Affiliated Hangzhou First People's Hospital Zhejiang University School of Medicine was performed. We reviewed clinicopathological information and the surgical outcomes through the medical record and questionnaire. Then we developed an evidence-based perioperative infection prevention protocol marked by preoperative decolonization and sterility optimization according literatures. In the second cohort, patients had undergone prosthesis-based breast reconstruction after protocol implementation between July of 2018 and April of 2019. We compared the surgical outcomes between this two cohort. In this study a patient was considered to have infection if she had any of these: (1) local inflammatory symptoms in breast that requires intravenous antibiotics or surgical intervention, (2) purulent drainage, (3) pathogenic culture positive. Infections requiring surgical intervention were defined as severe infections. T test was used to analyze quantitative data, Fisher’s two-tailed exact test was used to compare qualitative data. A multi-factor logistic regression analysis was used to analyze risk factors. Results In the first cohort,108 reconstruction procedures were performed among 93 patients. Median follow-up time was 17.5 months. The infection rate was 23.1%(25/108). Three prosthesis were explanted at postoperative 30 days, 50 days and 15 months respectively. The prosthesis salvage rate and total explantation rate were 88%(22/25), 2.8%(3/108) respectively. Culture was performed in only 17 patients with 24 samples. Pathogens were found in 4 samples: S.aureus(n=2), enterococci(n=1) and serratia marcescens(n=1). The average duration of prophylactic antibiotics was 5.4±3.9 days. Cephalosporin was the main prophylactic antibiotics. Therapeutic antibiotics for infected patients were mainly based on empirical agents, with vancomycin widely used. A multi-factor regression analysis indicated that large volume prothesis (V&amp;gt;400CC) was an independent risk factor of severe infection (p&amp;lt;0.05). After the protocol was implemented, 48 breasts were reconstructed among 45 patients. Median follow-up time was 6.5 months. Only one patient was considered as infection for tissue expander exposure following nipple necrosis. Overall, the rate of infection reduced significantly from 23.1% (25/108) to 2.1%(1/48) (P = 0.001). Conclusions Our single center data indicated that incidence of peri-prosthesis infection seems high in medium-sized hospitals in eastern China, but explantation rate is still very low. The evidence-based protocol was associated with a significant decline in infection rates among prosthesis-based breast reconstruction patients. In addition, there are many urgent problems such as inadequate application of prophylactic antibiotics, poor awareness of bacterial culture. We will continue to use this protocol in our practice to control infection. Table 1. Schematic of evidence-based protocolPreoperativeIntraoperativePostoperative*nasal swab culture*intravenous cefazolin(swab negative)or vancomycin(swab MRSA)* prophylactic antibiotics for 24 hours* chlorhexidine* chlorhexidine prep*drain removal in 3 weeks after surgery*intranasal mupirocin*glove change*re-draping*prosthesis minimal touch*betadine and antibiotics (cefazolin, gentamicin) irrigation* betadine and antibiotics rinse pocket*dermabond dressing for incision and drains Citation Format: Liu Jian, Guo Jufeng, Hu Shufang, Nie Shijiao, Chen Qiong, Wang Shuying. A retrospective study of peri-prosthesis infection after prosthesis based breast reconstruction in a single breast center in east China and impact of an evidence-based protocol [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-14-10.

Многофакторный регрессионный анализ факторов риска развития микрососудистых осложнений сахарного диабета 2 типа

Introduction. The relevance of the study of diabetes mellitus is due to social importance due to the high prevalence and progression of the disease in the form of late vascular complications, the first among which is vascular angiopathies. The results of studies on the dynamics of carbohydrate and lipid metabolism in the development of microvascular complications of 2 type diabetes mellitus remain quite contradictory. At the same time, the range of risk factors for the development of microvascular complications of 2 type diabetes mellitus and the strength of their effects vary greatly between studies and regions. Due to these circumstances, we are interested in studying the risk factors of developing microvascular complications of 2 type sugar diabetes as one of the main fatal complications of 2 type diabetes mellitus. Purpose and objectives. The most significant risk factors for developing microvascular complications of 2 type diabetes mellitus are determined using multi-factor regression analysis. Materials and methods. We used a multiple logistical regression model. Main results. As a result of multi-factor regression analysis, we determined the most significant risk factors for developing microvascular complications of 2 type diabetes mellitus: unsatisfactory compensation of carbohydrate and lipid metabolism, presence of arterial hypertension and dyslipidemia.

Pregnancy outcomes and risk factors in pregnant women with systemic lupus erythematosus

Objective: To analyze the pregnancy outcomes and risk factors in pregnant women with systemic lupus erythematosus (SLE), for providing a reference for the clinical diagnosis and treatment of the SLE. Materials and Methods: Seventy-eight SLE patients with 82 pregnancies were enrolled in this study. The general information of patients, maternal history data, clinical symptoms, and laboratory examination data one to three months before pregnancy, during pregnancy, at delivery and after childbirth, drug treatment, and pregnancy outcomes were collected. The single factor and logistic regression analyses of the risk factors related to SLE with deterioration and fetal loss were performed. Results: The single-factor analysis showed that there was significant difference in complement 3, 24-hour urinary protein, anti-dsDNA antibody, anti-CL antibody, pre-pregnancy prednisone dose, and SLE disease activity index (SLEDAI) between SLE with deterioration group and SLE without deterioration group, respectively (p &lt; 0.05 or p &lt; 0.01), with significant difference in complement 3, combined antiphospholipid syndrome (APS), SLEDAI, and SLE deterioration during pregnancy between fetal loss group and live birth group, respectively (p &lt; 0.01). The multi-factor regression analysis showed that, the complement 3 and SLEDAI were the main risk factors of SLE with deterioration during pregnancy, and the combined APS and SLEDAI were the main risk factors of fetal loss. Conclusion: The pregnancy has a high risk in women with SLE. The complement 3 and SLEDAI are the main risk factors of SLE with deterioration during pregnancy, and the combined APS and SLEDAI are the main risk factors of fetal loss. The reasonable and effective strategies should be formulated based on these factors, in order to reduce the risk of adverse pregnancy outcomes.

A retrospective study of the effectiveness of ulinastatin in the treatment of sepsis

Background: Ulinastatin (UTI) as a urinary trypsin inhibitor can inhibit the function of various enzymes. UTI has been shown to reduce the inflammatory response, suppress lymphocyte apoptosis, and improve the microcirculation, protecting the organs. However, there is no uniform recommended dose to use UTI on treating sepsis, and some studies indicate that UTI has dose-dependent effects, we aimed to explore the effects and appropriate dosage of UTI in sepsis treatment. Methods: Patients with sepsis in the intensive care unit (ICU) of the First Affiliated Hospital of Xi’an Jiaotong University from January 2012 through December 2017 were enrolled. We collected basic data, treatments, and outcomes. All patients were divided into two groups: the UTI group and the control group. Data analysis was performed with the chi-square test, t -test, and Cox multifactor regression analysis. Results: A total of 295 patients (181 males; mean age 59.98±17.78 years) were enrolled. Univariate Cox regression analysis showed that the hazard ratio (HR) for mortality with UTI treatment was 0.805 (95% confidence interval: 0.530–1.222, P>0.05). After adjustment, there are 13 factors that might affect prognosis with multivariable Cox regression analysis, the adjusted HR for mortality with UTI treatment was 0.560 (95% confidence interval: 0.346–0.906, P 4 U), the adjusted HR for mortality with UTI treatment was 0.370 (95% confidence interval: 0.204–0.672, P=0.001). And with the rising of cumulative dose (≥120×10 4 U), the adjusted HR for mortality with UTI treatment was 0.418 (95% confidence interval: 0.224–0.781, P Conclusions: Cox regression analysis showed that higher maximum dose, cumulative dose, and days of UTI use increased the protective effect. UTI reduced the HR for death in patients with sepsis. When the cumulative dose of UTI was less than 1,200,000 IU and the treatment duration was less than 5 days, there was no significant effect on the HR for death in patients with sepsis.

Study of the diagnostic significance of telomere length and telomerase activity in patients with cerebral atherosclerosis and type 2 diabetes mellitus

Cerebrovascular diseases areamongst the most important causes of morbidity and mortality in adult population. Objective — to determine the relationship between telomere length and telomerase activity with lipid spectrum, structural and functional status of the heart and cerebral vessels and heart rate variability in patients with cerebral atherosclerosis (CA) of stages 1—3and type 2 diabetes mellitus. Materials and methods. In a comprehensive clinical and instrumental study, 161 patients with CA 1—3stages were included. Telomerase activity was determined using a real-time tandem repeat amp­lification protocol. The relative lengths of telomeres were measured using multiplex quantitative poly­merase chain reaction in real time. Results and discussion. Patients were divided into 2 groups: 1 — with CA ofstage 1-2, 2 — with CA of stage 3 (with history of ischemic atherothrombotic stroke — AS). Mean age = 65.1 ± 10.5 and 65.4 ± 9.1 years, respectively. The percentage of men was 21.2 % in group1 and 52 % in the group 2. To identify factors that influence telomere size as a marker of early aging, the method of constructing logistic regression models was used. In building the models, the following categories were used: shorter telomere length — T/S < 2.61 (lowest and middle tercile); longer telomere length — T/S over 2.61. For selection of a set of significant risk factors, the method of step-by-step inclusion/exclusion of signs was used withexclusion threshold p > 0.15 and inclusion threshold p < 0.03. A multivariate logistic regression model was built on the identified significant risk factors. A statistically significant positive relationship was established between the telomere length and the E/A (diastolic function of the heart) and LPVLD, as well as negative relationships with the EF and the intima-media complex (IMC) on the right. To identify factors affecting telomerase activity, the method of constructing logistic regression models was used. In building the models, the following categories were used: lower telomerase activity — T/S < 3.16 (lowest and middle terciles); higher telomerase activity — T/S above 3.16. A sta­­tistically significant positive correlation of telomerase activity with the total stress index of the vegetative regulation HRV was also established, as well as a negative correlation with the atherogenic index. Conclusions. Telomere length and telomerase activity are comparable in elderly patients with CA of stage 1—2 and history of ischemic atherothrombotic stroke, including type 2 diabetes mellitus. Based on a multifactor regression analysis, the relationship between telomeres length and LPVLD, IMC, EF and LV diastolic function was detected in patients at different stages of CA, includingtype 2 diabetes (AUC 0.79; CI 0.69—0.87). Based on multivariate regression analysis the association of telomerase activity with atherogenic index and total stress index of vegetative regulation of heart rhythm was revealed in patients at different stages of CA, including type 2 diabetes (AUC 0.73; 95 % CI 0.63—0.83).

ҚИШЛОҚ АҲОЛИСИНИНГ ЕР УСТИ СУВЛАРИ ГИДРОКИМЁВИЙ ҲОЛАТИДАН КАСАЛЛАНИШИ ТАҲЛИЛИ

The paper provides an analysis of the influence of surface water quality, in particular the hydrochemical regime of rivers and canals of the Chirchik and Akhangaran river basins, on the health of the rural populations in districts of the Tashkent region. The method of nosogeographic analysis has been used to compare the materials of medical statistics and the observed values of the hydrochemical regime of surface waters within the Tashkent region, and the multifactor regression analysis to process the observational materials. The results of assessing the risk of morbidity growth rate in the Tashkent region are presented as equations of multifactor regression analysis with the corresponding coefficients of determination. In general, in the Tashkent region, the coefficient of multiple determination is 0.38. More than 30% of all factors affecting the morbidity of the population corresponds to the hydrochemical regime of the surface watershed, while the rest of 70% to other determining factors – genetic, medical support, conditions and lifestyle, and general state of the environment. A new approach has been applied to assess the effect of water quality on the health of the rural population and the morbidity risk. Based on this approach, preventive measures can be developed to reduce the overall morbidity of the rural population.

The number of stents was an independent risk of stent restenosis in patients undergoing percutaneous coronary intervention

Percutaneous coronary intervention (PCI) is one of the most effective therapies for coronary artery disease, but stent restenosis remains an important clinical challenge. The studies about the independent effect of the number of stents on stent restenosis were limited.The purpose was to identify the independent effect of the number of stents on stent restenosis.A retrospective cohort study of data reuse.From July 2009 to August 2011, a total of 2338 cases met the inclusion and exclusion criteria.The univariate analysis showed that the number of stents was a risk of stent restenosis, the OR value was 1.30 (95% CI:1.15 to 1.47, P < .001). The multi-factor regression analysis also showed that the number of stents was an independent risk of stent restenosis, the adjusted OR value was 1.38 (95% CI: 1.15 to 1.66, P < .001).Compared with 1–2 stents, the adjusted OR values of 3–5 stents and more than 6 stents were respectively 2.20 (95% CI: 1.24 to 3.90, P = .007) and 5.33 (95% CI: 1.89 to 15.08, P = .002), and the trend adjusted OR values was 2.26 (95% CI: 1.43 to 3.59, P < .001).The subgroup analysis of multi-factor regression analysis showed that when patients with the following conditions: 50 < Age, female, non-DES or SES, the risk of stent restenosis increased obviously.The number of stents was an independent risk of stent restenosis in patients undergoing PCI, especially for patients with the following conditions: 2<the number of stents, 50 < age, female, Non-DES (Drug-eluting stents) or SES (sirolimus-eluting stent).

Expression of CCR7 and Tim-3 in Childhood Patients with Acute Lymphoblastic Leukemia and Their Predictive Value for Prognosis

To analyze the expression of CCR7 and Tim-3 in childhood patients with acute lymphoblastic leukemia (ALL) and their predictive value for prognosis. Eighty-six newly diagnosed ALL childhood patients from January 2007 to January 2017 treated in our hospital were selected. The expression level of CCR7 and Tim-3 in bone marrow isolated cells of ALL patients were detected by flow cytometry, all the patients were divided into the recurrence group and non-recurrence group according to the follow-up results, the differences in the expressions of CCR7, Tim-3 between the two groups were compared. The correlation between the expression of CCR7 , Tim-3 and the clinicopathologic features of ALL patients were analyzed, the predictive value of CCR7 and Tim-3 for the prognosis of newly ALL patients were evaluated by ROC curve, and the relationship between serum CCR7, Tim-3 and prognosis were analyzed. The expression levels of CCR7 and Tim-3 in recurrence group were significantly higher than those in non-recurrence group(P<0.05). The critical value of CCR7 for diagnosis of recurrence was 45.97%, the sensitivity was 66.7%, the specificity was the 84.5% and the area under ROC curve (AUC) was 0.798 (95CI 0.777-0.939). The critical value of Tim-3 for diagnosis of recurrence was 53.54%, the sensitivity was 73.3%, the specificity was the 80.3% and the AUC was 0.806 (95CI 0.792-0.947). The AUC of the combined detection of CCR7 and Tim-3 was 0.895 (95CI 0.914-0.996), sensitivity 86.6%, specificity 78.9% (P<0.05); There was no significant correlation between CCR7, Tim-3 expression and age, sex, hemoglobin concentration, number of white blood cells, bone marrow blasts, platelets, central nervous system invasion, fusion gene (P>0.05). The exogenous infiltration rate of patients with high expression of CCR7 and Tim-3 was significantly higher than those in low expression group (P<005). The high expression rate 76.9% of Tim-3 in patients with T-ALL was significantly higher than that of B-ALL patients with Tim-3 high expression rate 45.2% (P<0.05). The median OS of patients with CCR7 level ≥45.97% and <45.97% were 9.3 months and 13.6 months respectively(P=0.004), and the Tim-3≥53.54% and Tim-3<53.54% were 9.1 months and 13.6 months respectively(P=0.001). The results of Cox's multi-factor regression analysis showed that CCR7 level(HR=1.024, 95 CI 1.001-1.049) and Tim-3 level (HR=1.879, 95 CI 1.183- 2.985) were the independent risk factors that affect the OS in ALL patients(P<0.05). The expression of CCR7 and Tim-3 in bone marrow isolated cells of ALL patients shows good predictive value for prognosis, and the combination of CCR7 and Tim-3 can improve the sensitivity of the detection, the higher expression of CCR7 and Tim-3 can be used as potential indexes in prognosis evaluate.