Forward Stepwise Logistic Regression Research Articles

Association Between Vitamin D Deficiency and Disease Activity, Disability, and Radiographic Progression in Early Rheumatoid Arthritis: The ESPOIR Cohort.

To evaluate the association of baseline serum level of vitamin D with disease activity, disability, and radiographic damage over the first year in early rheumatoid arthritis (RA). Among early arthritis patients included in the ESPOIR cohort, patients with early RA were evaluated. Levels of 25-hydroxy vitamin D2 and D3 were measured at baseline. Baseline associations between vitamin D level and 28-joint count Disease Activity Score based on erythrocyte sedimentation rate (DAS28-ESR), Health Assessment Questionnaire-Disability Index (HAQ-DI), and van der Heijde modified total Sharp score (mTSS) were assessed. Bivariate analysis was used to assess the association between vitamin D level and radiographic progression (mTSS increased by ≥ 1 point) or disability (HAQ-DI ≥ 0.5) over 12 months. Forward stepwise multiple logistic regression was used to evaluate the independent association of baseline variables and outcomes. Among 813 patients with early arthritis, data for 645 patients with RA were analyzed. Vitamin D level was < 10 ng/mL (deficiency, group 1), 10-29.9 ng/mL (low level, group 2), and ≥ 30 ng/mL (normal, group 3) for 114 (17.7%), 415 (64.54%), and 114 (17.7%) patients, respectively. At baseline, DAS28-ESR and HAQ-DI were higher with vitamin D deficiency compared with groups 2 and 3 combined (P = 0.007 and P = 0.001, respectively), as was mean mTSS, but not significantly (p = 0.076). On multivariate analysis, baseline vitamin D deficiency was associated with HAQ-DI at 6 months (OR 1.70) and mTSS at 12 months (OR 1.76). Vitamin D deficiency was associated with more active and severe disease at baseline and may predict disability and radiographic progression over 1 year in early RA patients. [ClinicalTrials.gov: NCT03666091].

Intra-operative blood transfusion significantly increases the risk of post-operative pulmonary embolism.

Pulmonary embolism (PE) is a serious and preventable complication after surgery. Blood transfusion is a common event during surgery. The aim of the present study was to identify whether intra-operative blood product transfusions increase the risk of symptomatic post-operative PE. A retrospective, single-center case-control study at Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University between 1 January 2013 and 31 December 2016 was performed. Adult hospitalized patients with confirmed symptomatic PE after surgery were defined as case group. Each patient was matched with two adult patients without symptomatic PE who underwent the same procedure on the same day or within one week. Perioperative data especially detailed blood transfusion was collected. Forward stepwise logistic regression analysis was performed. During the study period, altogether 188,512 procedures were included, and postoperative PE were confirmed in 40 (0.02%) patients. Twelve (30.0%) case patients and 16 (20.0%) control patients received intra-operative blood transfusion. Intra-operative blood transfusion was revealed as a significant predictor for symptomatic post-operative PE (OR 80.669, 95% CI: 3.312-1,964.641, P=0.007), along with female sex (OR 86.921, 95% CI: 4.242-1,781.124, P=0.004), older age (OR 1.078, 95% CI: 1.005-1.156, P=0.035), longer length of stay before surgery (OR 1.124, 95% CI: 1.040-1.214, P=0.003) and longer operation time (OR 1.013, 95% CI: 1.002-1.025, P=0.024). Intra-operative blood transfusion was associated with an increased risk of symptomatic post-operative PE. PE prophylaxis and selective screening should be considered in patients who had received intra-operative blood transfusion, especially in female patients.

Risk factors for recurrent Pelvic Inflammatory Disease

ObjectivePelvic inflammatory disease (PID) is a common infection which can result in severe long term morbidity, such as chronic pelvic pain and infertility. The morbidity increases in correlation to the number of PID events. Our study aim to assess the risk factors for recurrence of pelvic inflammatory disease. MethodsA retrospective case control study was conducted using data for all women who were admitted to a tertiary medical center for a recurrent PID over a duration of 15 years. Women who had a recurrent PID were compared to women admitted for PID treatment without further recurrence. Forward stepwise multivariate logistic regression analysis was subsequently carried out. ResultsThe study included 133 women of whom 33 had recurrent PID. Women in the recurrent PID group had a higher rate of previous pelvic surgery (12 (36 %) vs. 20 (20 %), adjusted odds ratio [OR] 2.2 (95 % confidence interval CI 1.06–5.4, p = 0.05) and more had intrauterine devices (IUD) still in place if they had been previously present (5 (71.4 %) vs. 9(25.7 %), OR 7.2, (95 % CI 1.18–43.9), p = 0.02). The majority were treated with a combination of Ampicillin and Gentamycin, fewer received Augmentin or a cephalosporin base regimen (28 (84.8 %) vs 56 (56.0 %), OR 4.4, (95 % CI 1.5–12.3, p = 0.02), (1 (3.0 %) vs 27 (27.0 %), OR 0.08, (95 % CI 0.01-0.64), (4 (12.2 %) vs 17 (17.0 %)) respectively. In addition, invasive treatment had been required in more patients who later had a recurrent PID (6 (18.1 %) vs. 4(4.0 %), OR 5.3 (95 % CI 1.1.4-20.2), p = 0.007). Antibiotic regimens and invasive treatment were independently associated with recurrent PID (OR 2.69; 95 % CI 1.13–6.41, OR 2.10; 95 % CI 1.19–3.71, respectively). ConclusionAmong women with PID, special awareness should be given to women with previous pelvic surgery, who required an additional interventional treatment and have an IUD inserted. Efforts should be made to achieve treatment success and optimal prevention to prevent recurrent PID.

Multi-Dimensional Factors Associated with Illegal Substance Use Among Gay and Bisexual Men in Taiwan.

Illegal substance use in sexual minorities is an important health issue worldwide. The present cross-sectional study aimed to investigate the multi-dimensional factors associated with illegal substance use among gay and bisexual men in Taiwan. This questionnaire-survey study recruited 500 gay or bisexual men aged between 20 and 25 years. Their experiences of using eight kinds of illegal substances in the preceding month were collected. Their previous experiences of homophobic bullying, satisfaction with academic performance, truancy, perceived family and peer support in childhood and adolescence, and social-demographic characteristics, were also collected. Potential factors associated with illegal substance use were identified using univariate logistic regression, and further selected into a forward stepwise logistic regression model to identify the factors most significantly related to illegal substance use. A total of 22 (4.4%) participants reported illegal substance use in the preceding month, and mean age was 22.9 ± 1.6. Forward stepwise logistic regression revealed that being victims of homophobic cyberbullying in childhood and adolescence (odds ratio (OR) = 1.26; p = 0.011), disclosure of sexual orientation at junior high school (OR = 4.67; p = 0.001), and missing classes or truancy in senior high school (OR = 2.52; p = 0.041) were significantly associated with illegal substance use in early adulthood. Multi-dimensional factors in childhood and adolescence that were significantly associated with illegal substance use in early adulthood among gay and bisexual men were identified. Besides traditional bullying, the effect of cyberbullying and school performance on illegal substance use should not be ignored. This study is limited to the cross-sectional design and possible recall bias. Mental health professionals must routinely assess these significant factors to prevent and intervene in illegal substance use among gay and bisexual men.

Trust in Physicians and Regional Brain Volumes: A Population-Based Study.

Trust, a fundamental part of human interpersonal relationships, is known to be associated with specific brain regions and demographic characteristics. Level of trust in medical professionals can alter population health outcomes and influence the nature of the doctor-patient relationship. This study utilized structural magnetic resonance imaging (MRI) and trust data from the Dallas Heart Study (DHS), a large community-based study, to determine brain regions associated with degree of trust in physicians and the medical profession. The first phase of the DHS was conducted from 2000 to 2002 and the second phase from 2007 to 2009. The MRI data were analyzed as part of the DHS using automated FreeSurfer software. Forward stepwise binary logistic regression was performed to investigate the association between measures of trust and bilateral brain region volumes and thickness followed by confirmatory multiple regressions of significant brain regions. A total of 1,596 participants were included in the final analysis. Left caudal anterior cingulate cortex (ACC) thickness was inversely correlated with trust of physicians (P < .01). There were no significant associations between trust in physicians and age, race or ethnicity, or education. The ACC is an integral part of the salience network, the brain network responsible for communication and social behavior. Trust in physicians did not appear to be influenced by demographic characteristics. The findings suggest there are neuroanatomical correlates of trust in physicians.

1261 Risk Factors for Recurrent Ectopic Pregnancy Following Single-Dose Methotrexate Treatment

Study Objective We aimed to investigate the predisposing factors for recurrent ectopic pregnancy (REP) following single-dose methotrexate (MTX) treatment. Design A retrospective cohort study. Setting A tertiary medical center. Patients or Participants All patients diagnosed with a first EP and treated by intention of single-dose regimen of intramuscular MTX. Interventions Cases (REP) and controls (first-time only EP) were compared in order to identify risk factors for REP. Forward stepwise multivariate logistic regression analyses were subsequently carried out. Measurements and Main Results 272 women were included in the cohort of the study. Of those 22 (8.1%) had a REP. Women in the REP group had higher proportion of history of abortions (45.4% vs. 23.6%, p=0.02), higher rates of previous pelvic surgery and a history of both pelvic and uterine surgery (45.4% vs. 6.4%, 4.5% vs. 1.6%, respectively, p Conclusion Among women with EP, attention should be paid to women with previous pelvic surgery. Efforts should be made in order to achieve medical treatment success to prevent REP.

273P - A nomogram to predict pathologic complete response of neoadjuvant chemotherapy in triple-negative breast cancer based on simple blood indicators

BackgroundTriple-negative breast cancer (TNBC) patients who achieve a pathologic complete response (pCR) after Neoadjuvant chemotherapy (NAC) have better prognoses. This study intended to develop an intuitive nomogram based on simple blood indexes to predict the pCR of standard NAC in TNBC patients with an ultimate aim to tailor more beneficial treatments and improve outcomes. MethodsA total of 80 TNBC patients who received standard NAC, 4 cycles of anthracycline (epirubicin or adriamycin) and cyclophosphamide followed by 4 cycles of taxane, and subsequent surgery in Zhejiang Cancer Hospital between January 2016 and December 2018 were retrospected and their pre-treatment clinical features and several simple blood indexes were collected. The optimal cutoff values of blood indexes were determined by Youden index using the receiver operating characteristic (ROC) curve analysis. The forward stepwise logistic regression (likelihood ratio) analysis was applied to identify predictive factors for pCR of NAC. Then a nomogram was developed according to the logistic model. The calibration of the nomogram was carried out by internal validation with the bootstrap resampling approach and displayed using a calibration curve. The goodness of fit for the model was checked by a Hosmer-Lemeshow test. The discrimination of the nomogram was graphically shown by the ROC curve and quantified by the area under the curve (AUC). ResultsThe pCR was achieved in 39 (48.8%) patients after NAC. Multivariate logistic regression analysis identified four independent indicators: clinical tumor stage, lymphocyte monocyte ratio, fibrinogen and D-dimer. The nomogram established based on those factors showed its discrimination with an AUC of 0.803 (95% CI 0.706-0.899) and a bias-corrected AUC of 0.771. The calibration curve and Hosmer-Lemeshow test showed the prediction of the nomogram was a good fit with actual observation. ConclusionsBased on four simple, easily accessible, inexpensive and objective factors, the nomogram proposed in the present study exhibited a sufficient ability of discrimination for predicting pCR of NAC in TNBC patients. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

P5014The NPAC score for predicting survival after incident acute myocardial infarction

Abstract Background Risk stratification in acute myocardial infarction (AMI) is important for guiding clinical management. Current risk scores are mostly derived from clinical trials with stringent patient selection. We aimed to establish and evaluate a composite scoring system to predict short-term mortality after index episodes of AMI, independent of electrocardiography (ECG) pattern, in a large real-world cohort. Methods Using electronic health records, patients admitted to our regional teaching hospital (derivation cohort, n=2127) and an independent tertiary care center (validation cohort, n=1276) with index acute myocardial infarction between January 2013 and December 2017 as confirmed by principal diagnosis and laboratory findings, were identified retrospectively. Results Univariate logistic regression was used as the primary model to identify potential contributors to mortality. Stepwise forward likelihood ratio logistic regression revealed that neutrophil-to-lymphocyte ratio, peripheral vascular disease, age, and serum creatinine (NPAC) were significant predictors for 90-day mortality (Hosmer-Lemeshow test, P=0.21). Each component of the NPAC score was weighted by beta-coefficients in multivariate analysis. The C-statistic of the NPAC score was 0.75, which was higher than the conventional Charlson's score (C-statistic=0.63). Application of a deep learning model to our dataset improved the accuracy of classification with a C-statistic of 0.81. Multivariate binary logistic regression Variable β Adjusted Odds ratio (95% CI) P-value Points Age ≥65 years 1.304 3.68 (2.63–5.17) &lt;0.001 2 Peripheral vascular disease 1.109 3.03 (1.52–6.04) 0.002 2 NLRt ≥9.51 1.100 2.73 (2.12–3.51) &lt;0.001 1 Creatinine≥109 μmol/L 1.003 3.00 (2.35–3.85) &lt;0.001 2 NPAC deep learning model Conclusions The NPAC score comprised of four items from routine laboratory parameters and basic clinical information and can facilitate early identification of cases at risk of short-term mortality following index myocardial infarction. Deep learning model can serve as a gate-keeper to provide more accurate prediction to facilitate clinical decision making.

Postoperative Recurrent Gout Flares: A Cross-sectional Study From China.

To investigate the morbidity, clinical characteristics, and risk factors for postoperative recurrent gout flares (PRGFs). This cross-sectional study included all surgical patients at 2 academic institutions between 2010 and 2018. Data including demographics, prior history of gout, clinical variables, medications, and the occurrence of PRGFs were abstracted from medical records. Forward stepwise multivariable logistic regression analysis was used in the statistical analyses. Among the 518 (0.5% [518/114,760]) surgical patients with a prior diagnosis of gout, 474 had sufficient documentation for analysis. Of these, 191 (40.3%) had experienced a PRGF. Most PRGFs (54.4%) were polyarticular gout; 79.6% had a pretreatment pain score of PRGFs ≥7, and 59.2% required combination pharmacologic therapy. The mean (SD) serum urate (SU) level decreased postoperatively (500.33 [122.77] vs. 380.15 [118.35] μmol/L; p = 0.000), with an average decrease of 125.86 μmol/L. The decrease in the postsurgical SU level was greater in patients who received postoperative total parenteral nutrition (PTPN) than in those who did not (p = 0.009), and it was correlated with the duration of PTPN (r = 0.156, p = 0.031). Factors independently associated with PRGFs were decrease in the postsurgical SU level by ≥126 μmol/L, previous flares involving the ankle, failure to take prophylactic colchicine therapy, and abdominal surgery. Recurrent gout flares often occur postoperatively and are severe. For high-risk patients, especially those undergoing abdominal surgeries, timely monitoring of postsurgical SU level, colchicine prophylaxis, and avoiding the overuse of PTPN may help prevent PRGFs.

Groundwater aquifer potential modeling using an ensemble multi-adoptive boosting logistic regression technique

Machine learning and data-driven models have achieved a favorable reputation in the field of advanced geospatial modeling, particularly for models of groundwater aquifer potential over large areas. Such models built using standalone machine learning techniques retain some uncertainty, including errors associated with the modeling process, sampling approach, and input hyper-parameters. Some of these techniques cannot be applied in data-scarce regions because high bias and variance can lead to oversimplification. Therefore, in the current study, we developed and validated a novel ensemble multi-adaptive boosting logistic regression (MABLR) model for groundwater aquifer potential mapping. This model was validated in a large area of the Gyeongsangbuk-do basin in South Korea and the results were compared to those of different types of machine learning models including multiple-layer perception (MPL), logistic regression (LR), and support vector machine (SVM) models. A forward stepwise LR technique was implemented to assess the importance of contributing morphological factors; we found 15 factors that contributed significantly: topographic wetness index (TWI), topographic roughness index (TRI), stream power index (SPI), topographic position index (TPI), multi-resolution valley bottom flatness (MVBF), slope, aspect, slope length (LS), distance from the river, distance from the fault, profile curvature, plane curvature, altitude, land use/land cover (LULC), and geology. We optimized the MABLR model using a fuzzy logic supervised (FLS) approach with 184 iterations and then validated the results using accuracy assessment metrics including the κ coefficient, root-mean-square error (RMSE), receiver operating characteristics (ROC), and the precision-recall curve (PRC). Our model had superior predictive performance among the models tested, with higher overall goodness-of-fit and validation values according to the κ coefficient (0.819 and 0.781, respectively), ROC (0.917 and 0.838), and PRC (0.931 and 0.872). Our experimental results demonstrate that MABLR is more effective at reducing bias and variance error than other constituent machine learning methods.

Risk factors of post-surgery complications in children with thyroid cancer

IntroductionThyroid cancer in children is a hot topic because of the large clinical heterogeneity and the risk of severe complications. We aimed to study 1. The frequency, 2. Etiology, and 3. Risk factors of post-surgery complications of thyroid cancer. Material and methodsA retrospective analysis including risk factors for post-surgery complications of patients treated for thyroid malignancies in years 2006–2018 was performed. ResultsOver a period of 12 years 22 patients with thyroid malignancy (68% female; 12.6 ± 4.0 years of age, median follow-up 6 years) were identified. Histologically, 12 (55%) patients had papillary carcinoma. Six patients (27.3%) had multiple endocrine neoplasia type 2 (MEN2) syndrome, 3 (13.7%) patients had medullary carcinoma and 1 patient had follicular carcinoma. Neck lymph node metastases were diagnosed in 8 (36.4%), distant metastases in 6 (27.3%), and both locations were involved in 4 (18.2%) patients. Six (27.3%) children had surgical complications: 1 child had unilateral vocal cord paralysis and transient hypoparathyroidism and 5 had transient hypoparathyroidism. The higher risk of surgery complications in forward stepwise logistic regression was associated in with distant metastases (R2 = 0.584, OR 52.63, p = 0.010). ConclusionsPostoperative complications were significantly associated with presence of distant metastases. Favorable results were observed in with children with MEN2 syndrome.

Refining Heel Pressure Injury Risk Factors in the Hospitalized Patient.

To replicate previous research that found four independent and significant predictors of heel pressure injuries (HPIs) in hospitalized patients using a larger and more diverse patient population. Researchers conducted a retrospective, case-control study with a main and a validation analysis (N = 1,937). The main analysis had 1,697 patients: 323 patients who had HPIs and 1,374 who did not. The validation analysis had 240 patients: 80 patients who developed HPIs and 160 who did not. Researchers used a series of diagnosis codes to define variables associated with an HPI. Data were extracted from the New York Statewide Planning and Research Cooperative System for January 2014 to June 2015. Study authors conducted a series of forward stepwise logistic regression analyses for both samples to select the variables that were significantly and independently associated with the development of an HPI in a multivariable setting. Researchers generated a receiver operating characteristic curve using the final model to assess the regression model's ability to predict HPI development. Seven variables were significant and independent predictors associated with HPIs: diabetes mellitus, vascular disease, perfusion issues, impaired nutrition, age, mechanical ventilation, and surgery. The receiver operating characteristic curve demonstrated predictive accuracy of the model. Beyond a risk assessment scale, providers should consider other factors, such as comorbidities, which can predispose patients to HPI development.

Does Asymmetric Hearing Loss Affect the Ability to Understand in Noisy Environments?

This study aimed to determine whether, in asymmetric hearing loss, the presence of an ear with a better or worse hearing threshold is related to either better or worse speech-in-noise (SiN) intelligibility. A total of 618 subjects with different degrees of hearing loss were evaluated for their ability to understand SiN. A stepwise forward logistic regression analysis was performed to identify the factors that affect performance. The influencing factors of very high or very low performance were determined. Age, especially after 70 years of age, and hearing loss, especially from moderate hearing loss, negatively influence SiN intelligibility. Remarkably high intelligibility was identified in subjects with a contralateral ear presenting a better auditory threshold. Although age and hearing loss are known factors that affect SiN intelligibility, the presence of a healthy contralateral ear is presented as the first description of preservation of SiN hearing ability.

A Nomogram to Predict the Pathologic Complete Response of Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer Based on Simple Laboratory Indicators.

Triple-negative breast cancer (TNBC) patients who achieve a pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) have better prognoses. This study aimed to develop an intuitive nomogram based on simple laboratory indexes to predict the pCR of standard NAC in TNBC patients. A total of 80 TNBC patients who received eight cycles of thrice-weekly standard NAC (anthracycline and cyclophosphamide followed by taxane) and subsequently underwent surgery in Zhejiang Cancer Hospital were retrospectively enrolled, and data on their pretreatment clinical features and multiple simple laboratory indexes were collected. The optimal cut-off values of the laboratory indexes were determined by the Youden index using receiver operating characteristic (ROC) curve analyses. Forward stepwise logistic regression (likelihood ratio) analysis was applied to identify predictive factors for a pCR of NAC. A nomogram was then developed according to the logistic model, and internally validated using the bootstrap resampling method. pCR was achieved in 39 (48.8%) patients after NAC. Multivariate analysis identified four independent indicators: clinical tumor stage, lymphocyte to monocyte ratio, fibrinogen level, and D-dimer level. The nomogram established based on these factors showed its discriminatory ability, with an area under the curve (AUC) of 0.803 (95% confidence interval 0.706-0.899) and a bias-corrected AUC of 0.771. The calibration curve and Hosmer-Lemeshow test showed that the predictive ability of the nomogram was a good fit to actual observation. The nomogram proposed in the present study exhibited a sufficient discriminatory ability for predicting pCR of NAC in TNBC patients.

HIV and sexually transmitted infection knowledge among women who have sex with women in four Southern African countries

Women who have sex with women in Southern Africa, where HIV prevalence is high, are often presumed to have minimal risk for sexually transmitted infections (STI) and HIV despite research documenting female-to-female transmission. This study examined the demographic and social factors contributing to female-to-female STI/HIV transmission knowledge among Southern African women who have sex with women using an integrated model of health literacy. In collaboration with community-based organisations in Botswana, Namibia, South Africa and Zimbabwe, data were collected through anonymous surveys (N = 591). Multivariable stepwise forward logistic regression assessed independent associations between participant characteristics and high vs. low knowledge using five items. Overall, 64.4% (n = 362) of women had high knowledge; 35.6% (n = 200) had low knowledge. Higher education (adjusted odds ratio [aOR]: 2.24, 95% confidence interval [CI]: 1.48, 3.40), regular income (aOR: 2.14, 95% CI: 1.43, 3.21), residence in Botswana (aOR: 3.12, 95% CI: 1.15, 8.48) and having ever received tailored STI/HIV information (aOR: 2.17, 95% CI: 1.41, 3.32) predicted significantly higher odds of high knowledge in the final multivariable model. Results suggest opportunities for peer-led sexual health programming and expanded HIV prevention campaigns addressing women who have sex with women.

Are health care providers making the most of patient encounters to promote HPV vaccination among cigarette smokers?

ObjectiveTo examine providers’ HPV vaccine communication among adult cigarette smokers with household members aged ≤26 years. MethodsIn this cross-sectional study, we used 2017 Health Information National Trends Survey (HINTS 5, Cycle 1; N = 3191) data to derive a subsample (n = 725/3191; 22.7%) of adults with household members aged ≤26 years. Forward stepwise multivariable logistic regression analyses were performed to examine providers’ HPV vaccine communication, adjusting for patients’ smoking status (main independent variable); HPV awareness and knowledge; HPV vaccine awareness and beliefs; and sociodemographic characteristics that contribute to disparities in HPV vaccine coverage. ResultsCurrent/former smokers (35.0%) had lower HPV-related awareness/knowledge than nonsmokers (65%). Few reported providers discussed (27.4%) or recommended (24.0%) HPV vaccine. Non-Hispanic Whites who knew HPV was a sexually transmitted disease and heard of HPV vaccine were 2–6 times more likely to report provider HPV vaccine communication. Provider HPV vaccine communication differences by smoking status were not statistically significant. ConclusionProviders’ HPV vaccine communication was higher among adults who had higher HPV-related awareness/knowledge. Although active/passive exposure to cigarette smoke increases cervical cancer risk, providers’ HPV vaccine communication was not increased for current/former smokers. Practice ImplicationsCurrent/former smokers’ HPV-related awareness/knowledge and providers’ HPV vaccine communication need to be increased.

Predictors of Bowel Resection During Nonelective Ladd Procedure for Pediatric Malrotation

BackgroundThe objective of this study was to identify risk factors for bowel resection in a modern cohort of patients undergoing nonelective Ladd procedures. Materials and methodsRetrospective descriptive analysis of patients with Ladd procedure (CPT 44055) in the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database (2012-2015). Exclusion criteria were elective case, duodenal atresia, or other known congenital anomaly (except cardiac, structural central nervous system, or airway anomaly) and open wounds from prior surgery or drains. Independent variables included all preoperative variables within NSQIP-P. The primary outcome variable was bowel resection as a concurrent procedure. Multivariate analysis was performed by incorporating all independent variables into a stepwise forward logistic regression model to identify independent risk factors for bowel resection. ResultsOf 267,289 patients in NSQIP-P, 1284 had a Ladd procedure. Of these, 292 were performed urgently or emergently in children with no known atresias, congenital anomalies, or open wounds. Twenty-nine (10%) had a bowel resection. On univariate analysis, bowel resection rates did not differ by age, weight, prematurity, ventilator dependence, asthma, chronic lung disease, tracheostomy, esophageal or gastrointestinal disease, hepatobiliary or pancreatic disease, cerebral palsy, central nervous system abnormality, neuromuscular disorder, intraventricular hemorrhage, steroid use, hematologic disorder, malignancy, sepsis, inotropic support, or CPR (P = nonsignificant). Higher rates of bowel resection were observed in patients with cardiac risk factors, white blood count (WBC) >15K, oxygen support, nutritional support, and developmental delay (P < 0.05). Only cardiac risk factors and WBC >15K were significant on multivariate analysis. ConclusionsBowel resections (10% in this cohort of nonelective Ladd procedures) were independently associated with cardiac risk factors and WBC >15K. Level of evidenceIII.

Prediction of gender employing mandibular measurements: Application of Cone beam computerized tomography

The identification of skeletal remains is of fundamental value in medico-legal fields. The skeletal components most often investigated for gender determination are the pelvis and skull, with the mandible especially in cases of destroyed bodies. The purpose of this study was to define the validity of mandibular measures taken through cone beam computerized tomography in sex determination and to establish a formula for such differentiation. The sample consisted of 100 cone beam computerized tomography (CBCT). The CBCT images were analyzed for five measurements; the distance from the inferior border of the mandibular body to the highest point of the alveolar crest ( IBM-HAC), the distance between the inferior margins of the mental foramen to the inferior border of mandibular body (IMMF-IBM),the distance between the superior margins of the mental foramen to the highest point of the alveolar crest (SMMF-HAC),the distance between the superior margins of the mental foramen to the inferior border of the mandible (SMMF-IBM) ,and volume of mental foramen. (VMF). Data analysis was achieved using SPSS version 22. Forward stepwise binary logistic regression analysis was accomplished to predict the probability of identifying male based on one or more independent variables. The logistic regression for the different varies revealed only the distance between the superior margins of the mental foramen to the inferior border of the mandible (SMMF-IBM), and volume of mental foramen. (VMF) as the significant contributors to the regression model. The logistic regression model was statistically significant and able to 75% of the difference in sex and accurately categorized all cases. Based on the logistic regression model, an equation for prediction of sex was derived. In conclusion, the current study demonstrates the probability of sex determination employing mandibular measurements taken thought CBCT that is proved as a superior tool if compared with the other radiological techniques.

Relationship between elite athletes’ psychological skills and their training in those skills

The objectives of this study were (i) to analyse how differences in psychological skills among elite athletes depend on sex and psychological skills training (PST), and (ii) to identify predictors of whether an elite athlete has sought PST. Three hundred and ninety-six Icelandic members of youth and senior national teams (49.2% men 21.4 ± 7.1 years old) in basketball, equestrian sports, football, golf, handball and weightlifting participated in the study. The participants completed a background information questionnaire and the Test of Performance Strategies questionnaire (TOPS). The former collected information about age, sex, sport practiced, and whether or not the respondent used or was interested in using PST. The latter assessed the psychological skills the respondent used in training and competition. An independent-samples t-test was used to compare the means on the TOPS sub-scales between sexes and between the use or not of PST. A forward stepwise logistic regression model was constructed to determine which of the variables (age, sex and TOPS sub-scales) could predict whether or not the sportsperson had used PST. PST was used by 42% of the respondents, but the 90% were interested in this type of training. Golfers used PST the most (56%), and men used PS more than women, especially in competition. It was possible to correctly classify 59% of the cases (23% of the variance explained) as to whether or not the participant used PST using just five variables: relaxation in practice, negative thinking in competition, age, self-talk in competition and imagery in practice.

Risk factors for recurrent ectopic pregnancy following single-dose methotrexate treatment

Objective: Our study aimed to investigate the predisposing factors for recurrence of an ectopic pregnancy (EP) following single-dose methotrexate (MTX) treatment for a primary EP.Methods: This was a retrospective cohort study performed in a tertiary care medical centre including all patients diagnosed with primary EP and treated with a single-dose regimen of intramuscular MTX. EPs with future recurrence were compared with first time only EPs, to identify risk factors for recurrent EP. Forward stepwise multivariate logistic regression analyses were subsequently carried out.Results: The study included 272 women. Of those, 22 (8.1%) had a recurrent EP. Women in the recurrent EP group had a higher rate of abortions (45.5% vs 32.7%; p = 0.02), previous pelvic surgery (45.5% vs 6.5%; p < 0.001) and both pelvic and uterine surgery (4.5% vs 1.6%; p < 0.001). Conception by assisted reproductive technology (ART) was more common among the non-recurrent EP group (23.0% vs 4.5%; p = 0.04). Success of single-dose MTX treatment was lower in the recurrent EP group compared with the non-recurrent EP group (36.4% vs 65.7%; p = 0.006). A history of pelvic surgery was independently associated with recurrent EP (adjusted odds ratio [OR] 17.6; 95% confidence interval [CI] 4.9, 63.2; p = 0.001). Treatment success of single-dose MTX was independently protective for recurrent EP (adjusted OR 0.25; 95% CI 0.08, 0.76; p = 0.02).Conclusions: Among women with an EP, attention should be paid to those with previous pelvic surgery. Efforts should be made to achieve medical treatment success to prevent recurrent EP.