Linear Logistic Regression Analysis Research Articles

A long-term follow-up study of adults with Chiari malformation type I combined with syringomyelia.

There is a considerable amount of controversy regarding the treatment and prognosis of adult patients with Chiari malformation type I (CM-I) at home and abroad; furthermore, no large-sample, long-term, follow-up studies have examined CM-I patients with syringomyelia (SM) comparing posterior fossa decompression with resection of tonsils (PFDRT) vs. posterior fossa decompression with duraplasty (PFDD). This study retrospectively analyzed the factors affecting the treatment and long-term prognosis of adults with CM-I combined with SM. We retrospectively analyzed data from 158 adult CM-I patients combined with SM who underwent PFDRT or PFDD, including 68 patients in group PFDRT and 90 patients in group PFDD. We examined the clinical manifestations, imaging features, and follow-up data of patients. Clinical outcomes were assessed using the Chicago Chiari Outcomes Scale (CCOS), and radiographic outcomes were indicated by the syrinx remission rate. Multivariate logistic regression analysis and multiple linear regression analysis were used to explore the relevant factors affecting the long-term prognosis of patients. This study showed that compared with preoperative patients in the PFDRT group and PFDD group, the sensory impairment, cough-related headache, and movement disorder were significantly improved (p < 0.01); meanwhile, the diameter of the syrinx and the volume of the syrinx decreased significantly (p < 0.001). Additionally, the study found that there were significant differences in the syrinx remission rate (p = 0.032) and the clinical cure rates (p = 0.003) between the two groups. Multivariate logistic regression analysis showed that age (p = 0.021), cerebellar-related symptoms (p = 0.044), preoperative cisterna magna volume (p = 0.043), and peak systolic velocity (p = 0.036) were independent factors for clinical outcomes. Multiple linear regression analysis showed that different surgical procedures were positively correlated with the syrinx remission rate (p = 0.014), while preoperative syrinx diameter (p = 0.018) and age (p = 0.002) were negatively correlated with the syrinx remission rate. In conclusion, this study suggested that, in a long-term follow-up, although both surgical procedures are effective in treating patients with CM-I and SM, PFDRT is better than PFDD; age and cerebellar-related signs independently affect the patient's prognosis. Additionally, an effective prognosis evaluation index can be developed for patients, which is based on imaging characteristics, such as preoperative cisterna magna volume, preoperative syrinx diameter, and preoperative cerebrospinal fluid (CSF) hydrodynamic parameters to guide clinical work.

Diabetes Self-Efficacy and Its Relationship with Self-Care and Glycaemic Control Among Elderly Patients with Type 2 Diabetes Mellitus

Context: Type 2 Diabetes mellitus burden is high in the elderly. Despite effective control measures, complications are aggravated due to lack of self-efficacy. The aim is to assess the role of self-efficacy in influencing self-care and glycaemic control. Methodology: This was an observational, analytical study among elderly diabetics attending Medicine OPD in a tertiary- hospital. 318 patients were enrolled by interviewing every fifth patient on three randomly chosen days per week. Data collection was done using pretested, validated schedule followed by statistical analysis using bivariate, binary logistic and multiple linear regression analysis. Results: Mean age was 59.4 ± 6.5 years, 16.9% patients had glycaemic control. Mean self-efficacy and self-care scores were 5.6 + 3.1 and 2.6 + 1.7 respectively. Multiple linear regression showed higher self-efficacy scores (b =0.14; 95% CI: 0.11, − 0.16), male gender (b =2.01; 95% CI: 0.29-3.74;), glycaemic control (b=-1.81, 95% CI -0.01, - 1.98) and positive family history (b= 3.34; 95% CI 1.23-3.11), were significantly associated with better self-care. Self-efficacy predicted good glycaemic control (AOR= 0.9, SE=0.01; p=0.03) while hypertensives were 2.88 times more likely to have poor glycaemic control (p&lt;0.05). Conclusions: Self-efficacy was positively associated with better self-care and glycaemic control among elderly diabetics.

Associations of ApoE Polymorphisms with Postoperative Atrial Fibrillation and Cardiac Injury in Patients with Coronary Artery Bypass Graft Surgery.

Genetic factors may be involved in postoperative atrial fibrillation (PoAF) development and cardiac injury. However, the associations of the apolipoprotein E (ApoE) gene polymorphisms with PoAF and cardiac injury after coronary artery bypass graft surgery (CABG) remain unclear.We recruited 150 patients with CABG, comprising 92 and 58 cases for the ApoE4 and ApoE3 groups, respectively, and analyzed PoAF incidence and the levels of cardiac biomarkers, including N-terminal prohormone of brain natriuretic peptide, cardiac troponin T (cTnT), and cardiac troponin I (cTnI). The linear regression model or logistic regression analysis was applied to investigate the associations of ApoE gene polymorphisms with PoAF and biomarkers for cardiac injury.A total of 58 (38.7%) patients with CABG developed PoAF, with 40 and 18 cases in the ApoE4 and ApoE3 groups (43.5% versus 31.0%, P < 0.05), respectively. Logistic regression analysis revealed that the ApoE4 allele was an independent risk factor for PoAF (OR = 3.340, P = 0.001), while the ApoE3 allele was a protective factor for the PoAF (OR = 0.841, P = 0.043). Patients carrying the ApoE4 allele had higher levels of cTnT and cTnI than those carrying the ApoE3 allele. ApoE3 was a protective factor for cardiac injury (β = -0.220, P = 0.001), whereas ApoE4 was a risk factor for cTnI (β = 0.335, P = 0.015).Our study reveals that the ApoE allele contributes to the occurrence of PoAF and severity of cardiac injury in an allele-dependent manner, with the ApoE4 allele increasing the risk and the ApoE3 allele reducing the risk.

General Self-Efficacy in Association With Insomnia Symptoms and Suicidal Ideation Among Chinese Community-Based Population.

Previous studies supported the association between insomnia symptoms and suicidal ideation in patients with mental or psychological diseases. This study aimed to examine the associations between insomnia symptoms, general self-efficacy, and suicidal ideation among community-based adult population. Standardized questionnaire was distributed to 2051 community-dwelling adults in Lishui district of Jiangsu Province in China, to assess their socio-demographics, insomnia symptoms, general self-efficacy, and suicidal ideation. Multiple binary logistic regression or linear regression and mediation analysis with bootstrap resampling method were performed. Results showed that the weighted prevalence of lifetime suicidal ideation was 6.38%. Insomnia symptom was associated with higher odds of suicidal ideation after adjusting for sociodemographics and mental health status (odds ratio [OR] = 2.85, and the OR of insomnia symptom with suicidal ideation decreased but remained significant after additionally adjusting for general self-efficacy (OR = 2.62). Participants with insomnia symptom were also significantly associated with lower general self-efficacy (β = -0.96), whereas higher general self-efficacy was associated with a lower odds of suicidal ideation (OR = 0.92). In conclusion, general self-efficacy was associated with both insomnia symptom and suicidal ideation among the community-dwelling adult population.

Impact of cognitive decline on medical outcomes and nursing workload: A retrospective cohort study.

Few reports have quantitatively investigated the effect of dementia on medical outcomes and nurse workload. Therefore, we aimed to investigate whether cognitive decline can be identified from a nurse assessment and determined its effect on medical outcomes and nurse workload. This retrospective cohort study used electronic medical record data to investigate whether patients judged by nurses to have cognitive decline were as affected as those with a dementia diagnosis. Further, a model formula was created and validated to predict the probability of needing physical restraint, the nursing care workload, and the record volume. The subjects were 43,330 patients aged ≥40 years who were hospitalized at the study hospital during the four-year study period. Data were analyzed using the chi-square test, Welch's t-test, logistic regression analysis and linear regression analysis. The implementation of physical restraint and a discharge support conference was significantly higher in patients deemed by nurses to have cognitive decline. Nurse-deemed patients with cognitive decline were affected by the outcome and workload as much as those with dementia. The false discovery rate for the Probability model formula of physical restraint and discharge support conference were 0.198 and 0.266. The correlation coefficient of the model formula for predicting nursing care and recording volume was 0.5-0.6. Combining nurse assessment and patient attribute information in a model was useful for predicting nurse workload. These findings may serve as a foundational component for the Clinical Decision Support System, aiding in the evaluation of intervention methods from the early stages of hospital admission and improving care delivery.

Association between bilirubin and chronic kidney disease inhypertensive patients: The China hypertension registry study.

Limited data exists on the association between Direct bilirubin (DBIL) and Indirect bilirubin (IBIL) with the risk of chronic kidney disease (CKD) among patients with hypertension. This study aimed to assess the relationship between DBIL and IBIL with the risk of CKD in a cohort of Chinese adults diagnosed with hypertension. This study included 14182 Chinese patients with hypertension between the ages of 27 and 96. CKD, the outcome variable, was defined by an estimated glomerular filtration rate (eGFR) <60mL/min/1.73m2 . The study employed multivariate linear and multivariate logistic regression analysis to evaluate the correlation between DBIL and IBIL with the risk of CKD. The prevalence of CKD in the study population was 9.77%. Multivariate logistic regression analysis showed that the increase in DBIL (OR: 0.66; 95% CI: 0.61, 0.71) and IBIL (OR: 0.75; 95% CI: 0.71, 0.81) were independently and negatively correlated with CKD. Further analyses using a restricted cubic spline (smooth-fitting curve) confirmed the linearly negative association between DBIL and IBIL with the risk of CKD. The subgroup analysis showed that the correlation between IBIL and CKD was stronger among men and populations<65 years of age (p for interaction<.05). DBIL and IBIL were independently and negatively associated with CKD. Furthermore, the correlation between DBIL and IBIL with CKD in the hypertensive population is more significant in those under 65 years of age. These findings may inform future strategies for the management of CKD.

Monitoring of surface deformation in mining area integrating SBAS InSAR and Logistic Function.

SBAS InSAR has long been used to monitor the mining surface deformation, and its research has been of great interest to researchers worldwide. For the unsatisfactory accuracy of SBAS InSAR-monitored mining surface deformation results, a new corrected model is proposed by integrating SBAS InSAR and Logistic Function. Firstly, the time series deformation results of the mining area were obtained by SBAS InSAR, and the variation law of the differences between SBAS InSAR- and leveling-monitored deformation values was statistically analyzed. Subsequently, the corrected model was constructed using the logistic linear regression analysis function and solved using the Levenberg-Marquardt algorithm. Finally, the corrected high-precision time series deformation results in the mining area were obtained. A mining area in Shandong Province of China was taken as the research object, and the practical application effect of the proposed corrected model was verified. Results showed that the Logistic Function could describe the variation law of the differences relatively accurately, and the corrected results were significantly better than the SBAS InSAR-monitored results, and the RMSEs of the corrected results were improved by 33-58%. The accuracy of SBAS InSAR-monitored mining surface deformation was effectively improved.

Associations between High Protein Intake, Linear Growth, and Stunting in Children and Adolescents: A Cross-Sectional Study.

Childhood and adolescence are critical periods for linear growth and preventing stunting. Current evidence indicates that dietary protein intake in children and adolescents is often two to three times higher than the recommendations in many regions worldwide. However, few studies have focused on the association between high protein intake and linear growth and stunting in this population. We aim to investigate this association in children and adolescents aged 6 to 18 years in a population with relatively high protein consumption. We conducted a large cross-sectional study involving 3299 participants from Shenzhen, a modern metropolis of China. Protein intake, including total protein, animal protein, and plant protein, was evaluated by a food-frequency questionnaire and expressed as grams per kilogram of body weight per day (g·kg-1·d-1) and as a percentage of total energy intake (%E). The primary outcomes were body height and height-for-age Z score (HAZ). Generalized linear models and logistic regression analyses were employed to examine the associations between protein intake and outcomes. We also conducted stratified analyses across different genders and pubertal stages in the aforementioned associations. The mean protein intake was 1.81 g·kg-1·d-1 (17% E). After adjusting for serum calcium, zinc, vitamin D3, vitamin A levels, birth outcomes, lifestyle, and parental characteristics, each standard deviation increase of 1 in protein intake (0.64 kg-1·d-1) is found to be associated with a -5.78 cm change in body height (95% CI: -6.12, -5.45) and a -0.79 change in HAZ (95% CI: -0.84, -0.74). Consistent results were observed when protein intake was expressed as %E or specifically as animal or plant protein. Moreover, the relationship between protein intake and linear growth remained consistent across genders in different pubertal stages, similar to that of the overall participants. Our findings highlight the potential hazards of high protein intake on linear growth in children and adolescents. Caution should be exercised when promoting increased protein consumption in children and adolescents who already have a high intake of protein.

Role of Charlson comorbidity index in predicting the ICU admission in patients with thoracic aortic aneurysm undergoing surgery

ObjectivesThis study aimed to explore the value of the Charlson comorbidity index (CCI) in predicting ICU admission in patients with aortic aneurysm (AA).MethodsThe clinical data of patients were obtained from the Medical Information Mart for Intensive Care-IV database. The association between CCI and ICU admission was explored by restricted cubic spline (RCS), threshold effect analysis, generalized linear model, logistic regression, interaction, and mediation analyses. Its clinical value was evaluated by decision curve analysis (DCA), receiver operating characteristic curve (ROC), DeLong's test, and net reclassification index (NRI) analyses.ResultsThe ICU admission was significantly associated with the thoracic AA (TAA), unruptured status, and surgery status. Therefore, 288 candidate patients with unruptured TAA who received surgery were enrolled in the further analysis. We found that CCI was independently associated with the ICU admission of candidates (P = 0.005). Further, their nonlinear relationship was observed (adjusted P = 0.008), and a significant turning point of 6 was identified. The CCI had a favorable performance in predicting ICU admission (area under curve = 0.728) and achieved a better clinical net benefit. New models based on CCI significantly improved the accuracy of prediction. Besides the importance of CCI in ICU admission, CCI also exerted important interaction effect (rather than mediating effects) on the association of other variables (such as age and blood variables) with ICU admission requirements (all P < 0.05).ConclusionsThe CCI is an important predictor of ICU admission after surgery in patients with unruptured TAA.

Inbound Logistics Metrics and Performance of Freight Forwarders Association in Kicukiro District, Rwanda

The Rwandan Freight forwarders federation (RWAFFA) was established in 2013 to deal with the fragility that was in the clearing and forwarding industry, which worked without defined and professional procedures that led to poor and inefficient practices within the industry. The objective of this study was to examine inbound logistics metrics on the performance of Freight forwarders federation in Rwanda. A case of RWAFFA in Kicukiro District. This study was guided by three specific objectives which are toto evaluate order fulfilment accuracy level of freight forwarders in Rwanda, to determine the status of on time delivered shipments, in case of freight forwarders in Rwanda and to analyse the degree of safety for goods handled by freight forwarders in Rwanda. The research was of great significant to the researcher, MKU and freight forwarding Industry in Rwanda. The descriptive research design with two mixed approach of qualitative and quantitative was used to collect data by use of interview guide and questionnaire. The 160 respondents of the study were selected from the target population of 246 including employees from RWAFFA management team, clearing agents and importers firms operating in Kicukiro District using the Krejcie and Morgan table with a simple random and census method of selecting the sample size. The collected results were analyzed using descriptive statistical analysis with use of percentage, mean and standard deviation and inferential statistics by the use of Pearson correlation (r) and multiple linear logistic regression analysis. Data were also presented in figure, tables and narratives because the qualitative data were analyzed with the use of thematic analysis which require the researcher to present the qualitative results in narrative. In this study, research findings showed that inbound logistic metrics were adopted to reduce the damaged shipment in freight forwarding within Rwandan Freight Forwarders association (RWAFFA).Therefore,The intercept of the regression was 13.803 and statistically significant p= 0.000).While the coefficient of order accuracy was 0.100 and p = 0.003. On time delivery had an intercept of 0.043 but significant at 0.002 and finally safety of goods had it at 0.065 and also positive. Despite the problem arising within Rwandan freight forwarders association in Kicukiro District such as Inadequate Performance measurement and metrics pertaining to SCM, lack of professionalism, clear regulations and to some extend absence of documented procedures to follow, delays and unreliability, lack of previous empirical research that examined the effects of inbound logistics metrics on performance of freight forwarders. The current success in implantation of inbound logistic metrics was contributed to the performance of freight forwarders federations. Keywords: Supply Chain Efficiency, Freight Forwarding, Kicukiro District Logistics, Inbound Logistics Metrics, Rwanda Transportation Industry

Insights regarding in-hospital outcomes of COVID-19 hospitalisations and co-existing premature ventricular contractions : from national inpatient sample 2020

Abstract Introduction Since the emergence of the COVID-19 pandemic, several reports have highlighted COVID-19 infection's arrhythmogenic consequences on the cardiac conduction system (1). SARS-CoV-2 has a well-established predilection to cardiomyocytes and is associated with myocardial injury with worse predicted outcomes. A wide range of electrocardiographic findings was significantly associated with COVID-19 infection (2). However, literature is scarce on the outcomes of such ECG findings, and its implications are yet to be understood. Purpose We sought to illustrate the significant outcomes of patients hospitalised for COVID-19 infection and premature ventricular contractions. Methods The National Inpatient Sample database (NIS) - 2020 was analysed to identify adult hospitalisations with a primary diagnosis of COVID-19 with or without co-existing premature ventricular contractions (PVC) using International Classification of Diseases – 10 Clinical Modification (ICD-10-CM) codes. The primary outcome was inpatient mortality, while secondary outcomes included inpatient morbidity, mean length of stay (LOS), and mean total hospital charge (THC). Multivariate logistic regression and linear regression analyses were used to adjust for possible confounders. Results Out of 1,050,045 COVID-19 hospitalisations, 7,729 (0.73%) had PVCs. Encounters with COVID-19 and co-existing PVCS had higher adjusted odds of inpatient mortality (Adjusted odds ratio [aOR]: 1.18, 95% confidence interval [CI]: 1.014-1.38, p=0.033), longer mean LOS of 1.8 days (95% CI: 1.4-2.3, p &amp;lt;0.001), and higher mean THC of $21,869 (95% CI: $13,902-$29,835, p &amp;lt;0.001) than those without co-existing PVCs. Figure 1 shows a forest plot illustrating the multivariate analysis of in-hospital morbidities when adjusted for patient demographics, comorbidities, and hospital characteristics. Conclusion Among patients hospitalised with COVID-19 infection, those with premature ventricular contractions had worse outcomes regarding in-hospital mortality, sepsis, need for endotracheal intubation, mechanical ventilation, and vasopressors use, in addition to the longer length of hospital stay, and higher total hospital charges. Although PVCs are commonly encountered in hospitalised patients and often require no medical interventions in most cases, they are associated with poor prognosis in patients with COVID-19 infection.Forest plot for adjusted outcomes

Effects of different obesity evaluation indexes on long-term blood pressure variability in adults

Abstract Background In recent years, people have a new understanding of the treatment of hypertension. Even at the optimal blood pressure levels recommended by the guidelines, further attention to blood pressure variability is warranted. Obesity and overweight are associated with blood pressure variability, but existing studies mainly focus on the effect of traditional obesity indicators on blood pressure variability (BPV). Objectives To explore the correlation between the new obesity assessment indicators LAP, BRI, CVAI and blood pressure variability. Methods A total of 7092 subjects who had regular physical examination in a community health center, were included for analysis. We used new measures to assess obesity, including LAP, BRI, CVAI. Subjects were grouped according to the baseline CVAI quartile. We used variation independent of mean(VIM) to assess long-term variations in blood pressure. Variance analysis was used to analyze the differences among different blood pressure variables and their baseline characteristics. Stepwise multivariate linear regression and multiple logistic regression analyses were used to assess the impact of CVAI/LAP/BRI on VIM. Results The average age of the subjects was 60.7±6.8 years old. With the increase of CVAI and BRI, the mean blood pressure variability increased gradually. In contrast, the mean blood pressure variability decreases with increasing LAP. After adjusting for other confounding factors, multiple linear regression analysis showed that VIMSBP increased by 0.007 and 0.216 for each unit increase in CVAI and BRI, respectively. LAP found no correlation. Multiple logistic regression analysis showed that increased CVAI and BRI were risk factors for increased VIMSBP, and increased LAP was protective factor for increased VIMSBP. Conclusion Compared with traditional indicators, the novel obesity indicators were also associated with blood pressure variability. And it has a stronger correlation than traditional indicators.

CHA2DS2-VASc score as a predictor of clinical outcomes in hospitalized patients with and without chronic kidney disease

BackgroundHigh CHA2DS2-VASc score (Congestive heart failure, Hypertension, Age > 75 years, Diabetes mellitus, prior Stroke or transient ischemic attack or thromboembolism, Vascular disease, Age 65–74 and Sex category) was associated with adverse clinical outcomes in different settings.The aim of the present study was to evaluate the association between CHA2DS2-VASc score and R2CHA2DS2-VASc score (which includes renal impairment) with in-hospital mortality and length of hospital stay in patients hospitalized in an internal medicine ward.MethodsWe enrolled 983 consecutive patients admitted during 3 years in an internal medicine ward. R2CHA2DS2-VASc score was calculated by adding 2 points to CHA2DS2-VASc for the presence of chronic kidney disease (CKD), defined according to K-DOQI. The primary outcome was a composite of all-cause mortality and length of hospital stay > 10 days.ResultsPatients with CKD stages 3–5 presented with increased CHA2DS2-VASc vs stages 1–2 (p < 0.001). The composite outcome occurred in 47.3% of inpatients. Multivariable linear logistic regression analyses adjusted for presence of infectious diseases and cancer, with the occurrence of composite outcome showed an adjusted OR of 1.349 (95% CI 1.248–1.462) and 1.254 (95% CI 1.179–1.336) for CHA2DS2-VASc and R2CHA2DS2-VASc scores, respectively. No differences were found in the association between CHA2DS2-VASc and R2CHA2DS2-VASc scores with the composite outcome (AUC 0.631 vs 0.630), and furthermore, adding the presence/absence of infectious diseases during hospitalization and positive cancer history to the models increased the AUC (0.667 and 0.663).ConclusionsIncrementally higher CHA2DS2-VASc score is associated with increased length of hospital stay and mortality in patients hospitalized in an internal medicine ward, regardless of the presence of CKD.Graphical abstract

Effects of heavy metal exposure during pregnancy on birth outcomes

Exposure to heavy metals such as lead, cadmium, and mercury poses serious health risks to pregnant women because of their high toxicity. In this study, we investigated the associations of heavy metal exposure with birth outcomes of Korean infants. Data of 5,215 women between 2015 and 2019 were analyzed. This study was part of the Korean Children’s Environmental Health (Ko-CHENS) study. Linear regression and logistic regression analyses were used to examine effects of concentrations of lead, cadmium, and mercury on birth weight, small for gestational age, and large for gestational age after adjusting for maternal age groups, parity, infant sex, education, income, smoking, drinking, body mass index, stillbirth, premature birth, diabetes, hypertension, and gestational diabetes. Besides adjusting for these covariates, each metal was mutually adjusted to estimate birth weight and large for gestational age status. Maternal cadmium concentrations during early pregnancy (β = − 39.96; 95% confidence interval (CI): − 63.76, − 16.17) and late pregnancy (β = − 37.24; 95% CI − 61.63, − 12.84) were significantly associated with birth weight. Cadmium levels during early pregnancy (adjusted OR = 0.637; 95% CI 0.444, 0.912) were also associated with large for gestational age status. Our findings suggest that prenatal cadmium exposure, even at a low level of exposure, is significantly associated with low birth weight.

Effect of Renal Impairment on the Pharmacokinetics of a Single Oral Dose of Danuglipron in Participants With Type 2 Diabetes.

Danuglipron (PF-06882961) is an oral, small-molecule glucagon-like peptide-1 receptor agonist in development for the treatment of type 2 diabetes (T2D) and obesity. Impaired renal function is prevalent in patients with T2D. This Phase 1, open-label study evaluated the effect of renal impairment on the pharmacokinetics, safety, and tolerability of danuglipron (20 mg) in healthy participants with normal renal function (estimated glomerular filtration rate [eGFR] unnormalized for body surface area: ≥90 mL/min), in participants with T2D and normal renal function (eGFR ≥90 mL/min), and in participants with T2D and mild (eGFR 60-89 mL/min), moderate (eGFR 30-59 mL/min), or severe (eGFR <30 mL/min) renal impairment (N = 39). Log-linear regression analyses and analyses of variance showed no evidence of a clinically significant effect of reduced renal function on danuglipron pharmacokinetics. Renal clearance of unchanged danuglipron was minimal (<1% across all renal function groups). Danuglipron pharmacokinetics were similar between healthy participants and participants with T2D and normal renal function. A single 20-mg oral dose of danuglipron was generally safe and well tolerated in all participant groups. In participants with T2D, renal impairment had no clinically meaningful effect on the pharmacokinetic, safety, and tolerability profiles of danuglipron, indicating that dose adjustment of danuglipron will not be required when administered to patients with T2D and reduced renal function.

Outcomes of Sarcoidosis on Patients with Sickle Cell Disease - a Review of the National Inpatient Database 2016-2020

Introduction: Sickle Cell Disease (SCD) is an inherited hemolytic disorder due to an autosomal recessive mutation affecting mainly African Americans. SCD can lead to various complications, including Sickle Cell Crisis (SCC), Acute Chest Syndrome (ACS), strokes, and different osseous complications. Notably, these complications can be provoked using steroids. Sarcoidosis is a multisystem inflammatory disorder that is characterized by the presence of bilateral hilar lymphadenopathy that is commonly treated with steroids. Unfortunately, it is also preferentially affecting African Americans. The complication rates in patients with both diseases have rarely been described. We aim to describe the effect of sarcoidosis on the mortality and complication rates of admitted patients with SCC. Methods: Using the National Inpatient Sample (NIS) 2016-2020, we analyzed adult SCC and ACS hospitalizations with and without sarcoidosis using International Classification of Diseases - 10 Clinical Modification (ICD-10-CM) codes. The primary outcome was inpatient mortality. Secondary outcomes were inpatient morbidities, mean length of stay (LOS), and mean total hospital charge (THC). A multivariate logistic regression and linear regression analyses were used to adjust for potential confounders. Results: Out of 359655 patients hospitalized with SCC, only 4.6% had concomitant sarcoidosis. Of these, 70% were females, with a mean age of 38.4 compared to an average age of 32 in patients without sarcoidosis (p-value &amp;lt;0.05). The mean LOS for patients with sarcoidosis and SCC was 6.4 days, while it was 5.1 days for patients without sarcoidosis (p-value 0.001). While adjusting for common comorbidities and patients' characteristics, patients with SCC and sarcoidosis did not have a statistical mortality difference compared to patients without sarcoidosis [adjusted odds ratio (aOR): 2.3, CI: 0.4-14). On stratified analysis, patients with ACS and sarcoidosis had increased odds of mortality with an aOR of 6.68, CI: 1.1-39.7, and a p-value of 0.037. Moreover, amongst patients who had SCC, patients with concomitant sarcoidosis had a higher risk of acute coronary syndrome (aOR: 5.1, CI 1.24-21.0) and avascular necrosis (aOR: 1.57, CI: 1.12-2.20). There were no statistically significant differences in the odds of ischemic strokes, transient ischemic attacks, acute and chronic kidney disease, risk of intubation, pulmonary edema, osteoporosis, venous thrombosis, and THC. Figure 1 shows the Forrest plot for multivariate analysis of in-hospital morbidities when adjusted for patient demographics, comorbidities, and hospital characteristics. Conclusion: Patients admitted with ACS and sarcoidosis had higher odds of mortality. Patients with SCC and sarcoidosis also had higher odds of acute coronary syndrome, avascular necrosis, and mean LOS. Nevertheless, this has not impacted other inpatient comorbidity.

Preoperative valgus-corrected hip-knee-ankle angle and medial meniscal extrusion are useful for evaluating postoperative alignment in mobile-bearing UKA

PurposeThe purposes of the study were to analyze the correlation between preoperative variables (valgus corrected hip-knee-ankle angle (vcHKA), medial osteophyte areas of the tibia and femur, and medial meniscus extrusion (MME)) and the postoperative alignment in mobile-bearing unicompartmental knee arthroplasty (UKA). MethodsThis study enrolled 109 patients (118 knees) who underwent mobile-bearing UKA between January 1, 2019 and January 1, 2023, retrospectively. Radiographic parameters, including the HKA, hip-knee-shaft angle (HKS), and valgus-corrected femorotibial angle (vcFTA), were measured using preoperative radiographs. The vcHKA was calculated as vcFTA – HKS. The medial osteophyte areas of the tibia and femur and MME were measured using knee magnetic resonance imaging (MRI). Simple and multiple linear regression analyses, univariate and multivariate logistic regression analyses, and receiver operating characteristic (ROC) curves were performed. ResultsIn total, 109 patients (118 knees) were enrolled in this study. In the multiple linear regression analysis, vcHKA (β = 0.732, 95 % confidence interval (95%CI) = 0.582 to 0.881; p < 0.001) and MME (β = 0.203, 95%CI = 0.001 to 0.405; p = 0.049) were positively correlated with postoperative HKA, and postoperative HKA was modeled according to the following equation: 45.420 + (0.732° * vcHKA) + (0.203 mm × MME). In the multivariate logistic regression analysis, vcHKA (odds ratio (OR) = 2.007, 95 % CI = 1.433 to 2.810, p < 0.001) was associated with postoperative valgus malalignment independently. In the ROC curve, vcHKA (cutoff value: 180°) was predictive of postoperative valgus malalignment, with an accuracy (95%CI) of 0.862 (0.780–0.944). ConclusionOvercorrection of a varus knee under valgus stress radiograph (VSR) and excessive MME on preoperative MRI increase the possibility of overcorrection of postoperative alignment in mobile-bearing UKA.

Social Determinant of Health Impact on Diabetes Device Use and Clinical Outcomes in Youth with Type 1 Diabetes

Background. Youth with Type 1 diabetes (T1D) who are Black, Hispanic, or lower socioeconomic status (SES) have lower rates of diabetes device use, higher hemoglobin A1c (HbA1c), and higher rates of diabetic ketoacidosis (DKA). However, the associations of individual-level social determinants of health (SDoH) and neighborhood-level factors with device use and clinical outcomes are unknown. Area deprivation index (ADI) is a neighborhood level measure of SES reported in deciles (range 1–10 with 10 representing most deprived neighborhood). Methods. We evaluated the association of ADI and other SDoH factors with pump/continuous glucose monitor (CGM) use, HbA1c, and DKA in 1,461 youth with T1D (50% female, age 12.8 ± 3.6 years, HbA1c 8.7 ± 2.1%, 52% pump, 70% CGM) seen between October 1, 2020 and September 30, 2021 at a large pediatric diabetes center. Multiple logistic regression and multiple linear regression analyses were used to determine statistically significant associations adjusting for potential confounders. Results. Youth were less likely to use an insulin pump if they lived in a higher ADI neighborhood, were Black or Hispanic, had Medicaid or were uninsured, or received government assistance (e.g., Supplemental Security Income, Supplemental Nutritional Assistance Program). Youth were less likely to use a CGM if they lived in a higher ADI neighborhood, were Black or Hispanic, had Medicaid or were uninsured. Youth had higher risk of DKA event in the past year if they used government assistance, whereas pump and CGM use were associated with lower DKA risk. HbA1c (%) increased by 0.09 (95% CI: 0.05, 0.13) per unit increase in ADI. HbA1c was 0.62 lower (95% CI: −0.82, −0.42) in pump users vs. nonusers and 0.78 lower (95% CI: −0.99, −0.56) in CGM users vs. nonusers. Conclusions. Interventions that tailor care plans to address SDoH in families living in deprived neighborhoods may be needed to increase successful technology uptake, optimize HbA1c, and prevent DKA.

Feasibility and Measurement Value of Pancreatic 2-D Shear Wave Elastography in Healthy Adults: Evaluation, Influencing Factors, Reference Range, Measurement Stability and Reproducibility

The present study was aimed at assessing the success rate and measurement value, determining the influencing factors and reference range and examining the intra-operator stability and inter-operator reproducibility of pancreatic 2-D shear wave elastography (SWE) measurement in healthy adults. In 2022, 387 healthy adults were prospectively recruited. Logistic regression and linear regression analyses were used to explore the factors influencing the success rate and the measurement value of pancreatic 2-D SWE measurement, respectively. A two-sided 95% reference range was estimated accordingly. The intraclass correlation coefficient was calculated to evaluate the intra-operator stability and inter-operator reproducibility of the pancreatic 2-D SWE measurement. The pancreatic body (89.6%) bore the highest while the tail (72.8%) bore the lowest success rate of pancreatic 2-D SWE measurement. Sex and body mass index (BMI) were the independent factors influencing measurement success rate in all three parts of the pancreas. Mean measurement values (Emean) were not the same in the three parts of the pancreas of the same participant. BMI and image depth were the independent factors influencing Emean in the pancreatic body, while region of interest depth and BMI were the only independent factors influencing Emean in the pancreatic head and tail, respectively. The intra-operator stability of pancreatic 2-D SWE measurement was found to be excellent, whereas its inter-operator reproducibility was poor to good. Pancreatic 2-D SWE is a reliable technique for evaluating pancreatic stiffness in healthy adults, but its success rate and measurement value are influenced by multiple factors.

Validation of the Twenty-Four-Hour Threshold for Bladder Repair: Impact on Infection Rates Using the National Trauma Data Bank.

This study aimed to validate the previously reported association between delayed bladder repair and increased infection rates using the National Trauma Data Bank (NTDB). Bladder injury patients with bladder repair in the NTDB from 2013 to 2015 were included. Propensity score matching (PSM) was used to compare mortality, infection rates, and hospital length of stay (LOS) between patients who underwent bladder repair within 24h and those who underwent repair after 24h. Linear regression and multivariate logistic regression analyses were also performed. A total of 1658 patients were included in the study. Patients who underwent bladder repair after 24h had significantly higher infection rates (5.4% vs. 1.2%, p = 0.032) and longer hospital LOS (17.1 vs. 14.0days, p = 0.032) compared to those who underwent repair within 24h after a well-balanced 1:1 PSM (N = 166). Linear regression analysis showed a positive correlation between time to bladder repair and hospital LOS for patients who underwent repair after 24h (B-value = 0.093, p = 0.034). Multivariate logistic regression analysis indicated that bladder repair after 24h increased the risk of infection (odds = 3.162, p = 0.018). Subset analyses were performed on patients who underwent bladder repairs within 24h and were used as a control group. These analyses showed that the time to bladder repair did not significantly worsen outcomes. Delayed bladder repair beyond 24h increases the risk of infection and prolongs hospital stays. Timely diagnosis and surgical intervention remain crucial for minimizing complications in bladder injury patients.