Forward Stepwise Regression Analysis Research Articles

Associations between cord blood metabolic factors and early-childhood growth and overweight and obesity.

This prospective cohort study was aimed at investigating the associations between cord blood metabolic factors and early-childhood growth, further elucidating the relationships between cord blood metabolites and overweight and obesity in early life. A total of 2,267 pairs of mothers and offspring were recruited in our study. Cord blood plasma was assayed for triglycerides (TGs), total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), C-peptide, insulin, and glycosylated hemoglobin type A1C (HbA1c) levels. Data of anthropometric measurements were collected from offspring at birth, 6 months, 12 months, and 18 months. Multiple linear regression models were used to evaluate the correlations between cord blood metabolic factors and weight Z-scores, body mass index (BMI) Z-scores, and weight gains at the early stage of life. Forward stepwise logistic regression analyses were applied to explore the associations between cord blood metabolic factors and early-childhood overweight and obesity. Receiver operating characteristic (ROC) curve analyses were applied to determine the optimal cutoff points for cord blood metabolic factors in predicting early-childhood overweight and obesity. After adjustments for covariates, cord blood TG concentrations and TG/TC ratios were negatively associated with weight Z-scores from birth to 18 months. Cord blood C-peptide and HbA1c levels were inversely associated with weight Z-scores at 6 months and 18 months. Cord blood TG concentrations and TG/TC ratios were negatively correlated with BMI Z-scores up to 18 months. Cord blood C-peptide levels and HbA1c levels were inversely correlated with BMI Z-scores at 18 months. Cord blood TG, TG/TC ratios, C-peptide, and HbA1c had negative correlations with weight gains from birth to 6 months, but the correlations attenuated as time went on. Increase in cord blood TG and HbA1c levels and TG/TC ratios were significantly associated with decreased risks of overweight and obesity at 6 months, 12 months, and 18 months. Cord blood metabolic factors were significantly associated with early-childhood growth patterns.

Student satisfaction with a micro-learning approach in distance translation and interpreting training: an empirical investigation

ABSTRACT The new contexts in higher education, shifting from face-to-face to online scenarios, encourage the application of disruptive methodologies adapted to distance learning. Translation and interpreting (T&I) programmes ideally foster the acquisition of competencies such as self-study, which graduates need to enter a largely freelance and assignment-based labour market. The aim of this study is to describe a micro-learning-based experience delivered at the undergraduate programme in T&I at the University of Granada (Spain), as well as to analyse student satisfaction with the experience. To meet this aim, a survey was conducted among 61 students to evaluate their satisfaction with the course, with distance learning and with the micro-learning methodology on a 1–5 Likert scale. The data were analysed by means of frequency, correlations and stepwise forward regression analysis. The results showed that students were notably satisfied with the methodology proposed but dissatisfied with environmental and interaction issues.

Effects of real-time remote cardiac rehabilitation on exercise capacity and quality of life: a quasi-randomised controlled trial

BackgroundThe impact of real-time remote cardiac rehabilitation (CR) on health and disability-related outcomes and its correlation with physical function are unknown. We compared the effectiveness of real-time remote CR with that of hospital-based CR on physical function improvement and physical functions of improvement (Δ) to clarify the relationship between health and disability at baseline.MethodsPatients with cardiovascular diseases (CVDs) were enrolled (n = 38) in this quasi-randomised controlled trial and underwent 4 weeks of hospital-based CR, followed by 12 weeks of remote or hospital-based CR based on quasi-randomised allocation. Patients were assessed at baseline and after 12 weeks of remote or hospital-based CR using the shortened version of the World Health Organization (WHO) Quality of Life scale (WHOQOL-BREF) for subjective satisfaction, WHO Disability Assessment Schedule (WHODAS2.0-J) for objective performance, and cardiopulmonary exercise test for physical function and peak oxygen uptake (peak VO2). The trends in measured variables from baseline to the post-CR stage were analysed.ResultsSixteen patients (mean age, 72.2 ± 10.4 years) completed remote CR, and 15 patients (mean age, 77.3 ± 4.8 years) completed hospital-based CR. The post-CR physical function differed significantly between the groups (Δpeak VO2, 2.8 ± 3.0 versus 0.84 ± 1.8 mL·min−1·kg−1; p < 0.05). The differences in post-CR changes in the WHOQOL-BREF scores between the groups were insignificant. The post-CR changes in the WHODAS2.0-J scores were significantly lower in the remote CR group than in the hospital-based CR group (ΔWHODAS2.0-J score, –8.56 ± 14.2 versus 2.14 ± 7.6; p < 0.01). Forward multiple stepwise regression analysis using overall data showed that the intervention method (β = 0.339, p < 0.05), baseline cognition (β = − 0.424, p < 0.05), and social interaction level (β = 0.658, p < 0.01; WHODAS2.0-J) were significant independent contributors to Δpeak VO2 (r2 = 0.48, F = 8.13, p < 0.01).ConclusionsRemote CR considerably improved physical function and objective performance in patients with CVDs. Remote CR can be used to effectively treat stable patients who cannot visit hospitals.Trial registrationThis interventional trial was registered at the UMIN-CTR registry (trial title: Development of remote programme for cardiac rehabilitation using wearable electrocardiograph; trial ID: UMIN000041746; trial URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000046564; registration date: 2020/09/09).

Stress and Avoidant Coping: Predictors of Quality of Life Among Filipino Graduating Students

&lt;p style="text-align:justify"&gt;The responsibilities of emerging adulthood and academic pressure are some stressful situations encountered among graduating students. Those graduating students used different coping that deals with stressful situations that may affect their quality of life. This study, a predictive correlational design, was conducted on 202 Filipino graduating university/college students to determine if stress and avoidant coping can predict their quality of life. Results showed a significant relationship existed between stress, avoidant coping, and quality of life. Stepwise forward regression analysis tested two regression models, where model 1 revealed that stress negatively predicted the quality of life. Whereas model 2 suggested that stress and avoidant coping (i.e., behavioral disengagement) was significantly higher in predicting the quality of life among graduating students.&lt;/p&gt;

Estimating cardiopulmonary fitness with a new sampling technology in patients with rheumatoid arthritis-associated interstitial lung disease.

Although peak oxygen uptake (VO2peak ) is one of the most important measures in clinical practice, the high cost and time consumption have led to the search for simpler devices and the development of the estimating cardiopulmonary fitness (eCPF) equation. Since the lungs are one of the sites most affected by rheumatoid arthritis (RA), this study aimed to create a predictive equation for VO2peak obtained by simple sampling technology in women with RA-associated interstitial lung disease (RA-ILD). This cross-sectional study evaluated 47 women with RA-ILD. The participants underwent the following evaluations: computed tomography (CT); evaluation of disease activity through the Clinical Disease Activity Index (CDAI); measurement of physical function using the Health Assessment Questionnaire disability index (HAQ-DI); pulmonary function testing, including spirometry, diffusing capacity for carbon monoxide (DlCO ), nitrogen single-breath washout (N2 SBW) test, and impulse oscillometry; and cardiopulmonary exercise testing (CPET) using FitMate™. VO2peak was correlated with age (r=-0.550, p<0.0001), rheumatoid factor (r=-0.443, p=0.002), anti-cyclic citrullinated peptide antibodies (r= -0.410, p=0.004), CDAI (r=-0.462, p=0.001), HAD-DI (r=-0.486, p=0.0005), forced vital capacity (r=0.491, p=0.0004), DlCO (r=0.621, p<0.0001), phase III slope of N2 SBW (r=-0.647, p<0.0001), resonance frequency (Fres , r=-0.717, p<0.0001), integrated low-frequency reactance (r=-0.535, p=0.0001), and the inhomogeneity of respiratory system resistance between 4 and 20Hz (r=-0.631, p<0.0001). In the CT examination, patients with extensive ILD had significantly lower VO2peak than patients with limited ILD (p<0.0001). In the stepwise forward regression analysis, Fres , DlCO and age explained 61% of the VO2peak variability. As assessed by CPET, women with RA-ILD show reduced cardiopulmonary fitness, which can be explained at least in part by the presence of small airway disease, deterioration of pulmonary gas exchange, and advanced age. These associations of pulmonary variables with eCPF may be clinically important and support the use of the eCPF equation to improve patient outcomes.

A visualized MAC nomogram online predicts the risk of three-month mortality in Chinese elderly aneurysmal subarachnoid hemorrhage patients undergoing endovascular coiling.

Aneurysmal subarachnoid hemorrhage (aSAH) is an aggressive disease with higher mortality rate in the elderly population. Unfortunately, the previous models for predicting clinical prognosis are still not accurate enough. Therefore, we aimed to construct and validate a visualized nomogram model to predict online the 3-month mortality in elderly aSAH patients undergoing endovascular coiling. We conducted a retrospective analysis of 209 elderly aSAH patients at People's Hospital of Hunan Province, China. A nomogram was developed based on multivariate logistic regression and forward stepwise regression analysis, then validated using the bootstrap validation method (n = 1000). In addition, the performance of the nomogram was evaluated by various indicators to prove its clinical value. Morbid pupillary reflex, age, and using a breathing machine were independent predictors of 3-month mortality. The AUC of the nomogram was 0.901 (95% CI: 0.853-0.950), and the Hosmer-Lemeshow goodness-of-fit test showed good calibration of the nomogram (p = 0.4328). Besides, the bootstrap validation method internally validated the nomogram with an area under the curve of the receiver operator characteristic (AUROC) of 0.896 (95% CI: 0.846-0.945). Decision curve analysis (DCA) and clinical impact curve (CIC) indicated the nomogram's excellent clinical utility and applicability. An easily applied visualized nomogram model named MAC (morbid pupillary reflex-age-breathing machine) based on three accessible factors has been successfully developed. The MAC nomogram is an accurate and complementary tool to support individualized decision-making and emphasizes that patients with higher risk of mortality may require closer monitoring. Furthermore, a web-based online version of the risk calculator would greatly contribute to the spread of the model in this field.

Serum copeptin as a predictor of risk of hyponatremia after transurethral prostatectomy.

Transurethral resection of the prostate gland (TURP) frequently leads to the development of dilutional hyponatremia. Copeptin has been established as a surrogate marker of vasopressin and is measured for clinical assessment of various sodium and water disturbances. This study aims to assess the utility of serum concentration of copeptin and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) for prediction of post-TURP alterations of serum sodium concentration. Forty-three patients with benign prostatic hyperplasia undergoing TURP were enrolled. Serum sodium and copeptin were measured before the procedure, then 12 hours after its completion. NT-proBNP was assessed at baseline. The total amount of fluids and sodium administered intravenously and used to flush the bladder during TURP was calculated in each patient. Receiver operator characteristic (ROC) curve analysis was used to determine value of copeptin and NT-proBNP for prediction of hyponatremia after TURP. In forward stepwise multiple regression analysis of serum copeptin before surgery and the duration of TURP explained the significant portion of the sodium concentration variation 12 hours from the start of the surgery. ROC curve analysis showed that serum copeptin before surgery predicted development of hyponatremia 12 hours after TURP (area under the curve, 0.775; 95% confidence interval, 0.62-0.89; p &lt; 0.001) with a cut-off point of &gt;78.6 pg/mL with 77% sensitivity and 64.7% specificity. Serum NT-proBNP before surgery did not predict hyponatremia 12 hours after TURP. Serum copeptin before TURP surgery, but not NT-proBNP, may be a clinically useful marker of the risk of serum sodium decrease after TURP.

Incidence, features and outcome of disease relapse after COVID-19 vaccination in patients with idiopathic inflammatory myopathies.

Vaccination against coronavirus disease (COVID-19) is relatively safe in patients with idiopathic inflammatory myopathies (IIM), however, myositis flares following vaccination have been poorly studied. We aimed to evaluate the frequency, features and outcomes of disease relapses in patients with IIM following COVID-19 vaccination. A cohort of 176 IIM patients were interviewed after the 3rd wave of the COVID-19 pandemic and followed prospectively. Relapses were determined using the disease state criteria and the outcome of the flares with myositis response criteria, calculating the total improvement score (TIS). A total of 146 (82.9%) patients received a vaccination, 17/146 (11.6%) patients had a relapse within 3 months, and 13/146 (8.9%) patients within one month. The relapse rate of unvaccinated patients was 3.3%. Three months after the post-vaccination relapses, 70.6% of the patients (12/17) achieved an improvement of disease activity (average TIS score: 30±15.81; 7 minor, 5 moderate and 0 major improvements). Six months after flares improvement was detected in 15/17(88.2%) of relapsed patients (average TIS score: 43.1±19.53; 3 minimal, 8 moderate and 4 major). Forward stepwise logistic regression analysis revealed that the active state of myositis at the time of injection (p<0.0001; OR:33; CI:9-120) was significantly associated with the occurrence of a relapse. A minority of the vaccinated IIM patients had a confirmed disease flare after COVID-19 vaccination and the majority of the relapses improved after individualized treatment. An active disease state at the time of vaccination probably contributes to the increased risk of a post vaccination myositis flare. This article is protected by copyright. All rights reserved.

A predictive model for prognosis in very low birth weight infants with late-onset sepsis.

This study aims to develop a predictive model to assess the probability of poor prognosis in very low birth weight infants (VLBWI) with late-onset sepsis (LOS). A total of 309 eligible VLBWI with LOS were included in the study. Logistic regression was used to determine prognostic factors for VLBWI with LOS. A nomogram incorporating these factors was created to predict the probability of poor prognosis. Poor prognosis includes death and survival with severe complications. In the developmental cohort, the incidence of poor prognosis was 59.5% (147/247). Forward stepwise logistic regression analysis showed that HCO3, albumin (ALB), ionized calcium (iCa), blood urea nitrogen (BUN), gestational age (GA), and birth weight (BW) were independent predictors of poor prognosis in VLBWI with LOS. The predictive model showed good discrimination and calibration. In the developmental cohort, the prediction model had a sensitivity of 83.7%, a specificity of 74.0%, and a C-index of 0.845 (95% confidence interval: 0.795-0.894). Our study identified independent predictors of poor prognosis in VLBWI with LOS and used them to construct a predictive model. This model can help clinicians to identify high-risk groups with poor prognosis early and provide important clinical reference information. This article highlights the development of a predictive model to assess the probability of poor prognosis in very low birth weight infants with late-onset sepsis (LOS). The model constructed in this manuscript was the first model to predict the poor prognosis of VLBWI with LOS. We mean a poor prognosis that includes death and some severe complications that may lead to long-term disability. Clinicians can use the model's scoring results to assess a patient's condition and accurately identify the occurrence of poor prognosis.

Acute Kidney Injury in Very Low Birth Weight Infants: A Major Morbidity and Mortality Risk Factor.

Very low birth weight (VLBW) infants are at high risk of developing acute kidney injury (AKI), presumably secondary to low kidney reserves, stressful postnatal events, and drug exposures. Our study aimed to identify the prevalence, risk factors, and outcomes associated with AKI in VLBW infants. Records of all VLBW infants admitted to two medical campuses between January 2019 and June 2020 were retrospectively reviewed. AKI was classified using the modified KDIGO definition to include only serum creatinine. Risk factors and composite outcomes were compared between infants with and without AKI. We evaluated the main predictors of AKI and death with forward stepwise regression analysis. 152 VLBW infants were enrolled. 21% of them developed AKI. Based on the multivariable analysis, the most significant predictors of AKI were the use of vasopressors, patent ductus arteriosus, and bloodstream infection. AKI had a strong and independent association with neonatal mortality. AKI is common in VLBW infants and is a significant risk factor for mortality. Efforts to prevent AKI are necessary to prevent its harmful effects.

Associated factors for prenatally diagnosed fetal congenital heart diseases

ObjectiveCurrent studies have suggested that fetal congenital heart diseases (CHDs) are caused by various factors. However, few data in this field is available in China.This study aimed to detect associated factors of prenatally diagnosed fetal CHD in a large sample in China.Study designPregnant women who underwent fetal echocardiography were recruited in our hospital between May 2018 and September 2019. The maternal sociodemographic and lifestyle characteristics and some fetal factors were obtained. We used forward stepwise logistic regression analysis to assess risk of fetal CHD associated with various factors.ResultsA total of 5024 subjects were enrolled, of whom 875 had CHD fetuses. Among the fetal CHD group (N = 875), critical CHDs account for 27%, of which Tetralogy of Fallot is the most (7.1%), followed by coarctation of aorta (4.0%), double-outlet right ventricle (2.9%). The forward stepwise logistic regression models revealed that history of spontaneous abortion (OR = 1.59, 95% CI 1.33–1.91, P = 0.000), upper respiratory tract infection during early pregnancy (OR = 1.30, 95% CI 1.04–1.62, P = 0.020), mental stress during early pregnancy (OR = 2.37, 95% CI 1.15–4.91, P = 0.020), single umbilical artery (OR = 2.30, 95% CI 1.18–4.51, P = 0.015), and paternal smoking (OR = 1.21, 95% CI 1.02–1.44, P = 0.027) are positively associated with an increased risk of fetal CHD.ConclusionWe identified several factors positively associated with fetal CHD. These findings suggest that it is important to strengthen healthcare and prenatal counseling for women with these factors.

Dynamics of dissolved organic carbon in runoff discharge under different rainfall patterns in a representative agricultural catchment

Rainfall-induced runoff transported plentiful terrestrial dissolved organic carbon (DOC) to downstream waters, significantly regulating the biogeochemical cycling of carbon in downstream waters. However, the dynamics of DOC exporting from agricultural catchments in response to different rainfall patterns remain largely unknown. This study aimed to understand the effects of rainfall patterns on the runoff DOC quantity and quality in a representative agricultural catchment in Southwest China. Six rainfall events producing runoff, including three moderate rainfalls, two heavy rainfalls, and one rainstorm, were recorded to investigate the shifts in runoff DOC concentration and its quality indicators, i.e., SUVA254 (indicating the aromaticity content), C:C ratio (denoting the proportion of colored substances to uncolored substances), and E4:E6 ratio (denoting the fulvic acid to humic acid of DOC). The results showed that DOC concentration in runoff discharge was highest in the moderate and heavy rainfalls occurring at the early rainy season, while was much lower in the rainstorm. Exported DOC flux reached 1.82 kg hm-2 h−1 in the rainstorm, which was 3.95–60.67 times that in the other rainfall events. SUVA254 and C:C ratio fluctuated softly during the moderate rainfalls and rainstorm, and changed strongly during the heavy rainfall with longest antecedent dry day. The moderate and heavy rainfalls with longer antecedent dry day and the rainstorm delivered DOC with higher SUVA254 and C:C ratio than the other rainfall events did. Discharge was positively correlated with DOC concentration during rainfall across all rainfall patterns, while was negatively correlated with SUVA254 and C:C ratio. Forward stepwise regression analysis showed that DOC flux per hour was only positively linearly correlated with rainfall intensity. Our results were valuable for understanding the biogeochemical cycling of DOC in analogous catchments worldwide.

Independent predictors and equation of six-minute walk test in post-cardiac surgery

BackgroundThe six-minute walk test (6MWT) has been used to evaluate postsurgical recovery in cardiac patients. No previous study has compared the 6MWT at follow-up with a baseline, or evaluated the long-term effects of cardiac surgery on post-discharge 6MWT ObjectivesTo identify the factors independently associated with 6MWD, and to develop an equation to predict 6MWT at the 4–6-week follow-up after post-cardiac surgery hospital discharge. MethodsPatient data of elective coronary artery bypass graft (CABG) or non-CABG surgery patients were retrospectively collected. The 6MWT was performed at hospital discharge and at the 4–6-week follow-up. Available demographic and clinical data of patients were analyzed to determine the independent factors of 6MWT. An equation to predict 6MWT were generated by forward stepwise multiple linear regression analysis. ResultsThe data of 275 patients (mean age: 62.20±14.57 years, 64.7% male) were analyzed. The mean 6MWT was 179.14±92.18 m at discharge, and increased to 335.20±115.51 m at the 4–6-week follow-up. The 6MWT at the 4–6-week follow-up was independently correlated with 6MWT at discharge, regular exercise, age, gender, and preoperative New York Heart Association (NYHA) classification. ConclusionThe independent predictors: 6MWT at discharge, regular exercise, age, gender, and NYHA classification were used to generate an equation to predict 6MWT at 4–6 weeks after hospital discharge.

The relationship of retinal vessel calibres with cardiovascular risk factors in apparently healthy young eyes

AbstractPurpose: Although retinal vascular calibre has been linked to increased cardiovascular (CV) risk, it remains unclear whether retinal vascular morphologic changes are already evident in young adults and correlate with modifiable CV risk factors. The purpose of this study was to explore the relationship of retinal arteriolar and venular calibre with CV risk factors and ocular parameters in healthy young subjects.Methods: A cross‐sectional study was performed in 52 apparently healthy subjects (mean 21.6 ± 2.2 years of age). Retinal vascular calibres were measured from fundus photographs using semi‐automated imaging software and expressed as central retinal arteriolar (CRAE) or venular (CRVE) equivalent and arterio‐venous ratio (AVR). CV risk factors and ocular parameters were assessed. Forward stepwise multiple linear regression analysis was used to detect the independent relationship between retinal vascular calibre and CV and ocular parameters.Results: Means for CRAE and CRVE were 191 ± 15.4 μm and 209 ± 15.8 μm respectively. The mean CRAE but not CRVE was significantly higher in women than in men (p = 0.009). Systolic blood pressure (SBP) and spherical equivalent were significant contributing factors to CRAE (SBP: p &lt; 0.001; SE: p = 0.021). However, CRVE was not significantly predicted by CV risk factors or ocular parameters. SBP was the only one independent contributor to AVR (p = 0.018).Conclusions: In young adults, higher SBP was found to be related to narrower retinal arterioles, but not to retinal venules. Sex and other confounding CV or ocular factors had no effect on the relationship of SBP and retinal vessel calibre.

Association of social determinants of health with frailty, cognitive impairment, and self-rated health among older adults.

Recently, the role of social determinants of health on frailty and dementia has received increased attention. The aim of the present study is to explore the association of social determinants on cognitive impairment, frailty, and self-rated health. As health is influenced by many factors, we also examine other health determinants including lifestyle, health seeking behaviour, socio-demographics, and multimorbidity in the analysis. Cross-sectional analysis of the Healthy Older People Everyday (HOPE) study in Singapore was carried out on 998 older adults above the age of 65. We used forward stepwise multivariable logistic and linear regression analyses to assess the association of five health determinants (social determinants, lifestyle, health seeking behaviour, socio-demographics and multimorbidity) on frailty, cognitive impairment, and self-rated health. Mean age of participants was 71.1 ± 0.2 years; 154 (15.4%) were cognitively impaired; 430 (43.1%) were pre-frail or frail; mean self-rated health was 80.4 ± 15.6. Social determinants contributed between 29% to 57% of the overall variation found in the full model with all five health determinants adjusted for. Participants with higher education had significantly lower odds of cognitive impairment and frailty. Leisure physical activity was significantly associated with lower odds of frailty and cognitive impairment, and better self-rated health. Understanding the dynamics of different health determinants is crucial to protect the vulnerable in an ageing population. Our study highlights the need for a multidimensional, multidisciplinary and multisectoral approach in the prevention of frailty, cognitive impairment, and associated disability.

Occupational balance, changes in occupations and psychological well-being of university students during the COVID-19 pandemic

Background Occupational balance (OB) is related to physical health as well as physical and psychological well-being (PWB). The COVID-19 pandemic has significantly changed the occupations of people probably affecting their OB and PWB. Aims The aim of the study was to determine OB of university students during the COVID-19 pandemic and establish relationships between a. OB and changes in occupations in comparison with the pre-pandemic period as perceived by the study group, b. OB and PWB. Materials and methods An exploratory study was performed using a cross-sectional research design during the second wave of the pandemic in November 2020. 1,330 university students aged 18–30 took part in the study. The Occupational Balance Questionnaire and the Psychological General Well-Being Index were used. Three-Way ANOVA as well as Forward Stepwise Regression analyses were used, and ρ Spearman’s correlation coefficients were calculated. Results A greater OB was found in men, people studying in a small city and first year students. The respondents declared changes in the time spent on almost all occupations, especially an increase in the time spent on using the Internet and passive resting, but a decrease in the time of meetings friends. OB positively correlated with the increase in time spent on almost all occupations, except for the Internet and with PWB. Conclusions Polish university students observe that the COVID-19 pandemic has changed their daily occupations. Some of these changes may adversely affect their OB and, consequently, PWB. Significance Occupational therapists should increase students’ awareness of the importance of OB, support them in pursuing their hobbies, meeting friends, and getting sufficient sleep and physical activity.

Issa Score: An Innovative Tool for Predicting Lateral Parametrial Involvement at Preoperative Ultrasound in Deep Endometriosis

<h3>Study Objective</h3> to build a preoperative predictive model based on indirect ultrasonographic markers for estimating the presence of lateral parametrial endometriosis (LPE) at surgery in women with deep endometriosis (DE). <h3>Design</h3> retrospective analysis of a prospectively collected database (NCT05239871). <h3>Setting</h3> referral center for endometriosis. <h3>Patients or Participants</h3> consecutive patients undergoing preoperative ultrasound (ULS) for suspected DE. <h3>Interventions</h3> preoperative ULS was done according to the IDEA criteria. A stepwise forward regression analysis was performed considering the presence of concomitant DE (hard markers) and the following ULS soft markers: diffuse adenomyosis, endometriomas, ovary fixity to the lateral pelvic wall/uterine wall, absence of anterior/posterior sliding sign, and hydronephrosis. The gold standard for the presence of LPE was surgical confirmation of endometriosis. Beta-coefficients of variables in the derivation set were used to generate a nomogram (0-35 points; ISSA score); its predictive performance was measured by concordance index (C index) by calibration with 1000 bootstrap samples to decrease the overfit bias. <h3>Measurements and Main Results</h3> 198 out of 523 patients enrolled had a surgical diagnosis of LPE. A significant predictive model (χ2=141.069; p<0.001) for LPE (any side) was built, including (OR; 95%CI), as soft markers, presence of hydronephrosis (11.3; 1.3-98.6; p=0.028), complete absence of posterior sliding sign (3.0; 1.8-4.9; p<0.001), presence of ovary fixity to uterine wall (2.5; 1.6-4.0; p=0.001), and presence of multiple endometriomas per ovary (2.4; 1.1-5.8; p=0.04); as hard markers, presence of rectal endometriosis with largest diameter >25 mm (3.1; 1.4-7.0; p=0.007), presence of uterosacral nodules with largest diameter >10 mm (2.7; 1.5 - 4.8; p=0.001), and presence of rectovaginal septum infiltration (2.1; 1.0-4.3; p=0.046). The nomogram deriving from these variables showed an AUC of 0.79 (0.72-0.83) with an elevate C index (mean absolute error=0.054) for predicting LPE. <h3>Conclusion</h3> ISSA score is a reliable tool based on specific ultrasonographic markers that estimates the likelihood of LPE at preoperative assessment for DE.

Ultrasonographic Findings Indirectly Predicting Parametrial Involvement in Patients with Deep Endometriosis: The ULTRA-PARAMETRENDO I Study

To evaluate ultrasonographic findings as a first-line imaging tool to indirectly predict the presence of parametrial endometriosis (PE) in women with suspected deep endometriosis (DE) undergoing surgery. Retrospective analysis of a prospectively collected database (ULTRA-PARAMETRENDO I study; NCT05239871). Referral center for DE. Consecutive patients undergoing laparoscopic surgery for DE. Preoperative transvaginal ultrasonography was done according to the International Deep Endometriosis Analysis consensus statement. A stepwise forward regression analysis was performed considering the simultaneous presence of DE nodules and the following ultrasonographic indirect signs of DE: diffuse adenomyosis, endometriomas, ovary fixed to the lateral pelvic wall or the uterine wall, absence of anterior/posterior sliding sign, and hydronephrosis. The gold standard for the presence of PE was surgery with histologic confirmation. Of 1079 patients, 212 had a surgical diagnosis of PE (left: 18.5%; right: 17.0%; bilateral: 15.9%). The obtained prediction model (χ2=222.530; p <.001) for PE included, as independent indirect DE signs presence of hydronephrosis (odds ratio [OR]=14.5; p=.002), complete absence of posterior sliding sign (OR=3.3; p <.001), presence of multiple endometriomas per ovary (OR=3.0; p=.001), and ovary fixation to the uterine wall (OR=2.4; p <.001); as independent concomitant DE nodules, presence of uterosacral nodules with the largest diameter >10 mm (OR=3.2; p <.001), presence of rectal endometriosis with the largest diameter >25 mm (OR=2.3; p=.004), and rectovaginal septum infiltration (OR=2.3; p=.003). The optimal diagnostic balance was obtained considering at least 2 concomitant DE nodules and at least 1 indirect DE sign (area under the curve 0.75; 95% confidence interval, 0.72-0.79). Specific indirect ultrasonographic findings should raise suspicion of PE in women undergoing preoperative assessment for DE. The suspicion of parametrial invasion may be critical to address patients to expert leading centers, where proper diagnosis and surgical treatment for PE can be performed.

Prediction of dry matter intake and gross feed efficiency using milk production and live weight in first-parity Holstein cows.

Direct measurement of dry matter intake (DMI) presents a major challenge in estimating gross feed efficiency (GFE) in dairy cattle. This challenge can, however, be resolved through the prediction of DMI and GFE from easy-to-measure traits such as milk production (i.e. milk yield, energy-corrected milk (ECM), butterfat, protein, lactose) and live weight (LW). The main objective of this study was, therefore, to investigate the feasibility of predicting dry matter intake and gross feed efficiency for first-parity Holstein cows using milk production traits and LW. Data comprised of 30 daily measurements of DMI and milk production traits, and 25 daily LW records of a group of 100 first-parity Holstein cows, fed a total mixed ration. Gross feed efficiency was calculated as kg ECM divided by kg DMI. The initial step was to estimate correlations of milk production traits and LW with DMI and GFE, to identify the best potential predictors of DMI and GFE. Subsequently, a forward stepwise regression analysis was used to develop models to predict DMI and GFE from LW and milk production traits, followed by within-herd validations. Means for DMI, butterfat yield (BFY) and LW were 21.91 ± 2.77kg/day, 0.95 ± 0.14kg/day and 572 ± 15.58kg/day, respectively. Mean GFE was 1.32 ± 0.22. Dry matter intake had positive correlations with milk yield (MY) (r = 0.32, p < 0.001) and LW (r = 0.76, p < 0.0001) and an antagonistic association with butterfat percent (BFP) (r = - 0.55, p < 0.001). On the other hand, GFE was positively associated with MY (r = 0.36, p < 0.001), BFP (r = 0.53, p < 0.001) and BFY (r = 0.83, p < 0.0001), and negatively correlated with LW (r = - 0.23, p > 0.05). Dry matter intake was predicted reliably by a model comprising of only LW and MY (R2 = 0.79; root mean squared error (RMSE) = 1.05kg/day). A model that included BFY, MY and LW had the highest ability to predict GFE (R2 = 0.98; RMSE = 0.05). Live weight and BFY were the main predictor traits for DMI and GFE, respectively. The best models for predicting DMI and GFE were as follows: DMI (kg/day) = - 54.21 - 0.192 × MY (kg/day) + 0.146 × LW (kg/day) and GFE (kg/day) = 4.120 + 0.024 × MY (kg/day) + 1.000 × BFY (kg/day) - 0.008 × LW (kg/day). Thus, daily DMI (kg/day) and GFE can be reliably predicted from LW and milk production traits using these developed models in first-parity Holstein cows. This presents a big promise to generate large quantities of data of individual cow DMI and GFE, which can be used to implement genetic improvement of feed efficiency.

Can systemic immune inflammation index at admission predict in-hospital mortality in chronic kidney disease patients with SARS-CoV-2 infection?

Background and aimPatients with chronic kidney disease (CKD) are susceptible to SARS-CoV-2 infection and more prone to develop severe disease. It is important to know predictors of poor outcomes to optimize the strategies of care. Methods93 patients with CKD and 93 age-sex matched patients without CKD were included in the study. Data on demographic, clinical features, hematological indices and outcomes were noted and compared between the groups. Neutrophile to lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII) (platelet counts×neutrophil counts/lymphocyte counts) and lymphocyte-to-CRP ratio (LCR) were calculated on admission and the association of these markers with disease mortality in CKD patients was identified. ResultsCKD patients had higher risk of severe disease, and mortality compared to non-CKD patients (72% vs 50.5%, p=0.003, 36.6% vs 10.8%, p<0.001, respectively) and were more likely to have higher values of immuno-inflammatory indices (leukocyte count, neutrophil, NLR, SII and C-reactive protein, etc.) and lower level of lymphocyte and LCR. Also, higher levels of NLR, SII, PLR and lower level of LCR were seen in CKD patients who died compared to those recovered. In a receiver operating characteristic curve analysis, NLR, SII, PLR and LCR area under the curve for in-hospital mortality of CKD patients were 0.830, 0.811, 0.664 and 0.712, respectively. Among all parameters, NLR and SII gave us the best ability to distinguish patients with higher risk of death. Based on the cut-off value of 1180.5, the sensitivity and specificity of the SII for predicting in-hospital mortality were found to be 67.5% and 79.6%, respectively. The corresponding sensitivity and specificity of the NLR were 85.2% and 66.1%, respectively, at the cut-off value of 5.1. Forward stepwise logistic regression analysis showed that NLR (≥5.1), SII (≥1180.5) and LCR (≤9) were predictors for in-hospital mortality. ConclusionWe report for the first time that SII is able to distinguish COVID-19 infected CKD patients of worse survival and it is as powerful as NLR in this regard. As SII is easily quantified from blood sample data, it may assist for early identification and timely management of CKD patients with worse survival.