Logistic Regression Analysis Research Articles

Prevalence of occult endometrial carcinoma in patients with endometrial intraepithelial neoplasia who underwent hysterectomy

ObjectivesTo determine the prevalence of occult endometrial carcinoma in patients with endometrial intraepithelial neoplasia (EIN) post-hysterectomy and identify pre-hysterectomy risk factors predictive of occult carcinoma.MethodsThis retrospective study included patients diagnosed with EIN between 2007 and 2021 who underwent hysterectomy as primary treatment. An expert gynecologic pathologist reviewed pathological slides. Data collected from medical records included demographic and gynecologic information, sonographic findings, and surgical and pathological outcomes. The prevalence of occult endometrial carcinoma was calculated. Descriptive statistics evaluated carcinoma incidence, and logistic regression analysis identified independent risk factors.ResultsA total of 113 patients were evaluated. The median time to hysterectomy was 9.1 weeks (range 5.8–12.8 weeks). Post-hysterectomy, 36 patients (31.8%) were diagnosed with endometrial carcinoma, all endometrioid type. Of these, 88.9% were stage I per the International Federation of Gynecology and Obstetrics classification system, and 11.1% were at high risk for nodal metastasis. Predictive factors for occult carcinoma included the intraoperative gross lesion size (2 cm or larger and less than 2 cm) and endometrial aspiration. Adjusted odds ratios were 6.723 (95% CI 2.338 to 19.333) for lesions 2 cm or larger, 3.381 (95% CI 1.128 to 10.132) for lesions less than 2 cm, and 2.752 (95% CI 1.092 to 6.936) for endometrial aspiration.ConclusionsOccult endometrial carcinoma was identified in 31.8% of patients with a pre-hysterectomy EIN diagnosis. The significant predictors were endometrial aspiration and the presence of a gross lesion during surgery.

Diabetes Is Positively Associated With High Risk of Depression in Korean Cervical Cancer Patients: Korean National Health and Nutrition Examination Survey 2010–2021

Objective Objective of this study is to evaluate the association between high risk of depression and metabolic diseases such as hypertension, diabetes, and dyslipidemia in Korean cervical cancer patients.Methods A total of 330 women with cervical cancer were included in this study, using data from the Korea National Health and Nutrition Examination Survey from 2010 to 2021. Participants were categorized into two groups—high risk of depression and non-depression—based on their answers to survey items related to depression. A multivariate logistic regression analysis was used to evaluate the influence of metabolic diseases on high risk of depression in patients with cervical cancer.Results A total of 78 (23.64%) and 252 (76.36%) women were classified into the high risk of depression and non-depression groups, respectively. In multivariate logistic regression analysis adjusting for age, menopausal status, and smoking status, diabetes was associated with an odds ratio of 2.47 (95% confidence interval: 1.205, 5.071) for high risk of depression in cervical cancer patients. However, among the metabolic diseases, hypertension, and dyslipidemia were not associated with high risk of depression in patients with cervical cancer.Conclusion This study suggests that diabetes may be associated with a increased risk of high risk of depression in cervical cancer patients. Therefore, appropriate treatment of diabetes in cervical cancer patients may contribute to lowering the risk of depression in the future.

Warrick score in rheumatoid-arthritis interstitial lung disease: a promising tool for assessing the extent and progression of lung involvement

BackgroundThe clinical manifestations and course of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) exhibits considerable heterogeneity. In this study, we aimed to explore radiographic progression over a defined period, employing the Warrick score as a semi-quantitative measure in early RA-ILD, and to assess the associated risk factors for progression.MethodsRA-ILD patients underwent consecutive Warrick scoring based on initial high-resolution computed tomography (HRCT) at diagnosis and the first follow-up. Associations between Warrick scores, pulmonary function tests, and patient characteristics were analyzed. The ROC curve assessed the predictive performance of the Warrick score change rate for ILD progression, while multivariable logistic regression analysis identified risk factors for progression.ResultsSignificant correlations were found between Warrick scores and age at RA-ILD diagnosis, age at ILD diagnosis, and baseline DAS28-ESR. For the severity score, correlations were r = 0.359, r = 0.372, and r = 0.298 (p = 0.001, p < 0.001, p = 0.014, respectively); for the extent score, r = 0.364, r = 0.318, and r = 0.255 (p = 0.001, p = 0.005, p = 0.038, respectively); and for the total score, r = 0.376, r = 0.367, and r = 0.280 (p < 0.001, p = 0.001, p = 0.022, respectively). Annual changes in severity, extent, and total Warrick scores showed sensitivities of 91–97% and specificities of 98% for predicting progression over a 5-year follow-up. Cut-off values were 0.0278 for the severity score (AUC 0.954), 0.0227 for extent score (AUC 0.976), and 0.0694 for total score (AUC 0.946). Warrick severity, extent, and total scores increased significantly during follow-up. Age > 50 years (OR 7.7; p = 0.028) and baseline usual interstitial pneumonia (UIP) pattern (OR 3.1, p = 0.041) were identified as risk factors for progression.ConclusionsAdvanced age and UIP pattern were significant risk factors for progression. Warrick scoring may may help predict progression in RA-ILD, particularly through changes in severity, extent, and total scores. Due to the retrospective design and small sample size, further prospective studies with larger cohorts are needed to confirm these findings and validate Warrick scoring as a reliable marker for RA-ILD progression.

Predictive nomogram for postoperative lower-limb deep vein thrombosis in patients undergoing endoscopic endonasal surgery during hospitalization: a retrospective cohort study

Deep vein thrombosis (DVT) in patients undergoing endoscopic endonasal surgery remains underexplored, despite its potential impact on postoperative recovery. This study aimed to develop and validate a predictive nomogram for assessing the risk of lower-limb DVT in such patients without chemoprophylaxis. A retrospective analysis was conducted on 935 patients with postoperative lower-limb vein ultrasonography. Clinical data, including potential risk factors, were used to construct a predictive model via multivariate logistic regression analysis. The resulting nomogram was validated using an independent cohort and evaluated through concordance index (C-index), calibration plots, and decision curve analysis. The incidence of postoperative DVT was 28.9%, with most cases being distal (27.2%). Significant predictors included older age, intraoperative bleeding, female gender, prolonged surgery duration, elevated postoperative APTT and D-dimer levels, and disturbance of consciousness. The nomogram demonstrated good predictive performance, with C-index values of 0.81 in the training cohort and 0.75 in the validation cohort. Calibration and decision curve analyses confirmed the model’s clinical applicability. This nomogram offers a practical tool for individualized DVT risk assessment in patients undergoing endoscopic endonasal surgery, facilitating more targeted prophylactic measures.

Enzymatic hydrolysis of acyl glucuronide metabolites in human liver microsomes correlates to the risk of idiosyncratic drug toxicity.

Acyl glucuronide (AG) is a reactive metabolite that causes idiosyncratic drug toxicity (IDT). Although the instability of AG is used to predict the IDT risk of novel drug candidates, it sometimes overestimates the IDT risk. We investigated whether the rate of enzymatic AG hydrolysis in human liver microsomes (HLM) can predict the risk of IDT. We used 16 drugs classified into three categories in terms of IDT risk: drugs withdrawn from the market owing to severe IDT (withdrawn, WDN) and drugs still being on the market, regardless of IDT risk (warning, WA) or not (safe, SA). AG was incubated with HLM, and the resulting parent drugs for AG hydrolysis were quantified using HPLC. The rate of enzymatic AG hydrolysis in the HLM of WDN was higher than that in WA and SA, and no difference was observed between WA and SA. We categorized WA and SA as commercially available (CA) drugs and performed a logistic regression analysis. The rate of enzymatic AG hydrolysis in HLM significantly distinguished WDN drugs from CA drugs, with an estimated classification value of 0.189 nmol/min/mg protein. In conclusion, the rate of enzymatic AG hydrolysis in HLM may be useful for predicting the risk in drug development.

Exploring potential targets and mechanisms of renal tissue damage caused by N-(1,3-dimethylbutyl)-N'-phenyl-p-phenylenediamine quinone (6-PPDQ) through network toxicology and animal experiments: A case of chronic kidney disease.

6-PPDQ is a new type of environmental contaminant contained in tire rubber. No studies have been reported on the potential targets and mechanisms of action of 6-PPDQ on renal tissue damage. In the present study, we used CKD as an example to explore the potential targets and biological mechanisms of renal injury caused by 6-PPDQ using Network toxicology and animal experiments. A total of 1361 6-PPDQ-related target genes were obtained from the CTD database. 17,296 CKD-related target genes were obtained through the GeneCards database. After intersecting the two, a total of 908 intersecting genes were obtained. Next, we constructed a PPI protein interaction network. Using different algorithms in Cytoscape software and "Logistic regression analysis", five key target genes were finally identified as NOTCH1, TP53, TNF, IL1B and IL6. We constructed a diagnostic model using five key target genes, and the ROC curves, calibration curves and DCA curves proved that the model has good diagnostic value. Molecular docking demonstrated high affinity between 6-PPDQ and five key target gene proteins. In animal experiments, repeated intraperitoneal injections of 6-PPDQ using different concentration gradients for 28days revealed that the expression levels of five key target genes in renal tissues increased progressively with the increase of the concentration, and the damage to renal tissues was also aggravated. ssGSEA and animal experiments revealed a key role for activation of the MAPK signaling pathway. Finally, we also identified a significant correlation between five key target genes and the level of infiltration of multiple immune cells. In conclusion, these findings suggest that 6-PPDQ can cause damage to renal tissue and that the level of damage progressively increases with increasing concentration. Among them, NOTCH1, TP53, TNF, IL1B and IL6 may be its potential targets of action. Activation of the MAPK signaling pathway is a potential mechanism of action.

Anesthesia Trauma Guidelines: A Systematic Review of Global Accessibility and Quality.

This systematic review describes the available clinical practice guidelines (CPGs) for the anesthetic management of trauma and appraises the accessibility and quality of these resources. This review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was conducted across 8 databases (MEDLINE, Embase, Web of Science, CABI Digital Library, Global Index Medicus, SciELO, Google Scholar, and National Institute for Health and Care Excellence) for guidelines from 2010 to 2023. Two independent reviewers assessed guideline eligibility and extracted data, which were audited by a third reviewer. Data regarding author demographics, accessibility, clinical topics, and quality were collected. The quality of guidelines was evaluated according to the National Guideline Clearinghouse Extent Adherence to Trustworthy Standards (NEATS) Instrument. A total of 2426 articles were identified, of which 165 met eligibility criteria and were included. Guidelines were developed by 122 professional societies and authors from 51 countries. By region, Europe contributed with the most authors (61%), while Africa had the fewest (4%). Most CPGs were developed by authors from high-income countries (HIC) and only 12% had a first or last author from low- and middle-income countries (LMIC). The United States was the country with the most guideline authors. While 70% were open access, the average cost for paid access was US$36.61. Among the 8 languages identified, English was the most common. The most common topics were blood and fluid management, shock, and airway management. The overall quality of included guidelines was considered moderately high, with an average NEATS score of 3.13 of 5. Quality scores were lowest for involvement of patient perspectives, plans for updating, and presence of a methodologist. On logistic regression analysis, the involvement of a methodological expert was the only predictor of having a high-quality NEATS score, with no association observed with open accessibility, English language, society endorsement, first author from a HIC, or a multidisciplinary group composition. Though many countries and societies have contributed to the development of anesthesia CPGs for trauma, there has been a disproportionate lack of representation from LMICs, where the burden of trauma mortality is highest. In this study, we identify barriers to accessibility and areas for improving future guideline quality. We recommend ongoing efforts to incorporate perspectives from diverse settings and to increase the availability of high-quality, open-access guidelines to improve worldwide health outcomes in trauma.

Machine-learning model based on ultrasomics for non-invasive evaluation of fibrosis in IgA nephropathy.

To develop and validate an ultrasomics-based machine-learning (ML) model for non-invasive assessment of interstitial fibrosis and tubular atrophy (IF/TA) in patients with IgA nephropathy (IgAN). In this multi-center retrospective study, 471 patients with primary IgA nephropathy from four institutions were included (training, n = 275; internal testing, n = 69; external testing, n = 127; respectively). The least absolute shrinkage and selection operator logistic regression with tenfold cross-validation was used to identify the most relevant features. The ML models were constructed based on ultrasomics. The Shapley Additive Explanation (SHAP) was used to explore the interpretability of the models. Logistic regression analysis was employed to combine ultrasomics, clinical data, and ultrasound imaging characteristics, creating a comprehensive model. A receiver operating characteristic curve, calibration, decision curve, and clinical impact curve were used to evaluate prediction performance. To differentiate between mild and moderate-to-severe IF/TA, three prediction models were developed: the Rad_SVM_Model, Clinic_LR_Model, and Rad_Clinic_Model. The area under curves of these three models were 0.861, 0.884, and 0.913 in the training cohort, and 0.760, 0.860, and 0.894 in the internal validation cohort, as well as 0.794, 0.865, and 0.904 in the external validation cohort. SHAP identified the contribution of radiomics features. Difference analysis showed that there were significant differences between radiomics features and fibrosis. The comprehensive model was superior to that of individual indicators and performed well. We developed and validated a model that combined ultrasomics, clinical data, and clinical ultrasonic characteristics based on ML to assess the extent of fibrosis in IgAN. Question Currently, there is a lack of a comprehensive ultrasomics-based machine-learning model for non-invasive assessment of the extent of Immunoglobulin A nephropathy (IgAN) fibrosis. Findings We have developed and validated a robust and interpretable machine-learning model based on ultrasomics for assessing the degree of fibrosis in IgAN. Clinical relevance The machine-learning model developed in this study has significant interpretable clinical relevance. The ultrasomics-based comprehensive model had the potential for non-invasive assessment of fibrosis in IgAN, which helped evaluate disease progress.

Development of a nomogram model to predict postoperative urinary retention risk after transabdominal preperitoneal inguinal hernia repair.

To explore independent risk factors and to establish a predictive model for postoperative urinary retention (POUR) following transabdominal preperitoneal inguinal hernia repair (TAPP). Between January 2017 and December 2023, 598 patients with inguinal hernia who underwent TAPP at the General Surgery Department of Zunyi Medical University Affiliated Liupanshui Hospital were enrolled in the study. Participants were randomly divided into training and validation sets (7:3 ratio). The training set was further divided into POUR and non-POUR groups (38 and 381 cases, respectively). Independent risk factors for POUR were screened by logistic regression analysis. A nomogram predictive model was established based on the independent risk factors. The model's predictive ability was evaluated. Logistic regression revealed recurrent hernia (P = 0.013, OR = 0.279, 95% confidence interval [CI]: 0.105-0.805), BPH (P = 0.002, OR = 5.09, 95% CI: 2.658-96.282), preoperative catheterization (P = 0.004, OR = 0.087, 95% CI: 0.012-0.370), operation time (P < 0.001, OR = 0.015, 95% CI: 1.006-1.023), and use of narcotic analgesics (P = 0.042, OR = 2.224, 95% CI: 1.021-5.222) as independent risk factors for POUR after TAPP. Discriminant analysis showed the training set AUC was 0.763 (95% CI: 0.684-0.842, P < 0.001) while that for the validation set was 0.812 (95% CI: 0.677-0.947, P < 0.001). The Hosmer-Lemeshow test was performed to assess calibration of the training (P = 0.696) and validation (P = 0.194) sets. Recurrent hernia, BPH, preoperative catheterization, operation time, and use of narcotic analgesics were identified as independent risk factors for POUR after TAPP. The nomogram model for risk prediction based on these factors has strong predictive performance and application prospect.

Anxiety and depression prevalence and associated factors in patients with knee osteoarthritis

ObjectiveWith the evolving spectrum of diseases, psychological conditions such as anxiety and depression have emerged as significant global public health concerns. Notably, these psychological disorders are prevalent among patients suffering from knee osteoarthritis (KOA). Consequently, this study included 360 hospitalized patients diagnosed with KOA to examine their levels of anxiety and depression and to analyze the factors influencing these psychological states.MethodsA cohort of KOA patients from the Second Hospital of Shanxi Medical University was assessed using a general condition questionnaire, European five-dimensional health status scale (EQ5D), Western Ontario and McMaster University Osteoarthritis (WOMAC), Social Support Rating Scale (SSRS), and Hospital Anxiety and Depression Scale (HADS). Logistic regression analysis was employed to identify the factors affecting anxiety and depression.ResultsAmong 360 patients with KOA, 28.06% experienced anxiety, and 30.27% experienced depression. Multivariate logistic regression analysis showed that lower BMI, QOL, and utilization of social support scores are risk factors for anxiety and depression in KOA patients (P&amp;lt;0.05). Additionally, in patients with KOA, younger age, lower subjective support, and higher scores in function and daily activities emerged as significant risk factors for depression (P&amp;lt;0.05).ConclusionAnxiety and depression in patients with KOA warrant significant attention due to their impact on overall well-being. The factors influencing these mental health conditions are multidimensional. In clinical practice, it is essential to integrate these various influencing factors to develop targeted mental health care services. By doing so, healthcare providers can enhance the overall mental health and QOL for individuals suffering from KOA.

The Effects of Maternal Subclinical Hypothyroidism on Fetal Thymus Size: A Prospective Study

Objective: This study investigated the impact of maternal subclinical hypothyroidism on fetal thymus size and development and explored how inadequate thyroid hormone production in pregnant women affects the fetal thymus. Methods: Conducted at the Giresun Obstetrics, Gynecology, and Pediatrics Training and Research Hospital, this case–control study involved 86 pregnant women, 43 with hypothyroidism and 43 without. Maternal thyroid function was assessed using TSH and free T4 levels, and fetal thymus size and thymus–thorax ratio were measured using ultrasound. Exclusion criteria were chronic hypertension, gestational hypertension or eclampsia, multiple pregnancies, infectious diseases, renovascular diseases, diagnosed with hypothyroidism prior to pregnancy and other endocrine disorders, fetal cardiac diseases, and morbid obesity. Data collected included maternal age, gestational week, number of pregnancies, parity, number of living children, thyroid-stimulating hormone (TSH) and Free thyroxine 4 (T4) levels, and fetal thymus measurements (transverse diameter and thymus/thorax ratio). Statistical analyses were performed using the Mann–Whitney U test and logistic regression analysis. The relationships between TSH, thymus diameters, thorax diameters, and the thymus–thorax ratio were evaluated using Spearman’s correlation coefficient. Results: The thymus–thorax ratio was significantly reduced in the hypothyroid group (p = 0.003). Logistic regression analysis identified TSH as an independent risk factor for a low thymus–thorax ratio, with each unit increase in TSH associated with a 1.345-fold higher likelihood of having a low thymus–thorax ratio. A significant negative correlation was found between TSH levels and the TTR ratio (Spearman’s correlation coefficient r = −0.338, p = 0.001). Conclusions: An association was identified between maternal TSH levels and the thymus–thorax ratio, with increasing TSH levels correlating with a decrease in the thymus–thorax ratio. Regular monitoring of thyroid hormone levels during pregnancy and appropriate replacement treatment in cases of deficiency are crucial for optimal fetal thymus development. Further multicenter studies are needed to confirm these findings and investigate the long-term implications of altered fetal thymus development.

Exploring healthcare workers’ immunisation behaviour towards COVID-19 vaccines through psychological patterns

Background: The psychological approach can provide valuable insights into vaccination behaviour, especially in high-risk contexts. It offers new perspectives for effective interventions to improve vaccination behaviour.Aim: To investigate key factors influencing stress related to vaccination in emergency situations among healthcare professionals.Setting: Eastern region of Morocco.Methods: We conducted a descriptive and analytical cross-sectional study involving 221 healthcare professionals in the Eastern region of Morocco. A snowball sampling method was used to select the participants who were administered a questionnaire. Logistic regression analysis was performed with p 0.05 being the level of statistical significance.Results: The participants had a median age of 25.5 years (30–34.5) and were predominantly females (68.3%). Vaccination coverage stood at 84.6%, with a positive perception of 77.8%. The analysis of the Perceived Stress Scale (PSS) revealed that 51.6% (n = 114) of healthcare professionals experienced stress towards vaccination. Females were almost two times more susceptible to experiencing vaccination stress (p = 0.03). Furthermore, the analysis showed that vaccination profile (p = 0.02), accepting the vaccine for any reason other than its accessibility (p = 0.03) and having a previous coronavirus disease 2019 infection (p = 0.03), were significantly associated with stress. In contrast, healthcare professionals based at the university hospital had a significantly lower stress level (p = 0.01).Conclusion: Moroccan healthcare professionals exhibited high vaccine acceptance and positive perceptions, particularly among vaccinated individuals despite notable stress around immunisation.Contribution: These insights can guide governments and policymakers in developing strategies to enhance healthcare workers’ awareness and understanding of vaccination.

The development and evaluation of nine obesity-based indices for gallstones in U.S. adults.

Gallstones have gradually become a highly prevalent digestive disease worldwide. This study aimed to investigate the association of nine different obesity-related indicators (BRI, RFM, BMI, WC, LAP, CMI, VAI, AIP, TyG) with gallstones and to compare their predictive properties for screening gallstones. Data for this study were obtained from the National Health and Nutrition Examination Survey (NHANES) for the 2017-2020 cycle, and weighted logistic regression analyses with multi-model adjustment were conducted to explore the association of the nine indicators with gallstones. Subject working curves were analyzed to assess the screening ability of the nine indicators. In addition, the association between the most predictive indicator and gallstones was investigated with smooth curve fitting, and differences in risk across populations were explored with subgroup analyses. In total, 3654 participants were involved in the final analysis and 383 (10.48%) carried gallstones. The results of weighted multifactorial logistic regression analysis indicated that BRI, RFM, BMI, WC, LAP, and CMI were independent risk factors for gallstones. The ORs for the highest quartile were 4.13 for RFM, 3.13 for BRI, 2.85 for BMI, 2.86 for WC, 2.45 for LAP, and 1.49 for CMI. The area under the ROC curve for RFM was 0.70. The Delong test compared the performance of different ROCs and revealed that the difference between the area under the curve of RFM and the other metrics was significant (P < 0.05). Smooth curve fitting suggested a linear positive correlation between RFM and gallstones (LLR > 0.05), especially in women, non-Hispanic White, insufficient physical activity, hypertensive, and diabetic populations. RFM, BRI, BMI, WC, LAP, and CMI were essential indicators for recognizing gallstones. By comparison, we realized that RFM was a better predictor of gallstones.

Validation of the Caregiver Analysis of Reported Experiences with Swallowing Disorders (CARES) Screening Tool for Neurodegenerative Disease.

Swallowing difficulties have a substantial impact on the burden experienced by care partners of individuals with neurodegenerative disease. Given this, there is a clear need to easily identify and quantify the unique aspects of swallowing-related burden. The purpose of this study was to establish the validity and reliability of the Caregiver Analysis of Reported Experiences with Swallowing Disorders (CARES) screening tool in care partners of individuals with neurodegenerative disease. Survey data were collected from an international sample of 212 individuals caring for family members with amyotrophic lateral sclerosis (n = 49), dementia (n = 110), or Parkinson's disease (n = 53). Respondents completed the CARES, Eating Assessment Tool-10, International Dysphagia Diet Standardisation Initiative-Functional Diet Scale, and Zarit Burden Interview. Reliability and validity of the CARES were evaluated via internal consistency alpha coefficients, Spearman's rho correlations, and logistic regression analyses with receiver operating characteristic (ROC) curves. CARES scores demonstrated excellent internal consistency (α = .90-.95) and high test-retest reliability (r = .86-.91). The CARES was found to be valid, as increased swallowing-related burden was associated with increased severity of swallowing difficulties (r = .79 to .84), diet restrictiveness (r = -.50 to -.54), and general caregiver burden (r = .36 to .40). The CARES had excellent discrimination between care partners with and without self-reported swallowing-related burden, with a score of ≥ 4 suggesting a heightened risk of experiencing this burden. Results establish the CARES as a valid and reliable screening tool that can detect burden related to swallowing difficulties among care partners of individuals living with neurodegenerative disease (score ≥ 4). Clinical implementation of the CARES requires the concerted efforts of the larger multidisciplinary team who can collaboratively identify the presence of burden and target the multifaceted sources of burden that a care partner may be experiencing.

A nomogram to predict postoperative new-onset cerebral infarction after revascularization of moyamoya disease in adults and its validation: a retrospective study

BackgroundThe new-onset cerebral infarction is frequent after revascularization of moyamoya disease (MMD) in adults, serving as a major public health issue worldwide. The present study aims to construct a nomogram to predict postoperative new-onset cerebral infarction (POCI) after revascularization of adult MMD.Materials and methodsClinical data of 653 cases of adult MMD treated with revascularization were retrospectively analyzed. They were randomly divided into a training set (n = 457) and a validation set (n = 196) at a ratio of 7:3. Based on the risk factors of POCI after revascularization of adult MMD identified by logistic regression analysis and the corresponding regression coefficients, a nomogram was constructed. Its performance to predict POCI after revascularization of adult MMD was validated by calculating the area under the curve (AUC) and the decision curve analysis.ResultsUnivariate and multivariate logistic regression analyses showed that preoperative cerebral infarction (OR 2.548, 95% CI 1.357–4.787; p = 0.004), posterior cerebral artery anomalies (OR 2.106, 95% CI 1.157–3.834; p = 0.015), post-transit arterial development (OR 2.983, 95% CI 1.336–6.661; p = 0.008), pre-anesthesia mean arterial pressure &amp;gt; 102.830 mmHg (OR 3.329, 95% CI 1.938–5.721; p &amp;lt; 0.001), total operating time &amp;gt; 212.500 min (OR 2.256, 95% CI 1.239–4.140; p = 0.008), preoperative fibrinogen level &amp;gt; 2.750 g/L (OR 1.852, 95% CI 1.072–3.200; p = 0.027), and mean corpuscular hemoglobin concentration (OR 1.021, 95% CI 1.001–1.040; p = 0.038) were independent risk factors of POCI after revascularization of adult MMD. The AUC was 0.772 (95% CI 0.714–0.772) in the training set, and 0.718 (95% CI 0.603–0.833) in the validation set.ConclusionCollectively, the newly established nomogram effectively and intuitively predicts the POCI after revascularization of adult MMD.Clinical trial registrationwww.chictr.org, identifier ChiCTR2400087946.

Factors influencing the occurrence of ischemic stroke in elderly patients with hypertension and type 2 diabetes mellitus: a case-control study

ObjectiveTo investigate the risk factors for ischemic stroke in elderly patients with hypertension and type 2 diabetes mellitus.MethodsA total of 112 elderly patients with hypertension and type 2 diabetes, treated at Jiangmen Central Hospital from January 2023 to December 2023, were selected and categorized into a stroke group and a non-stroke group, each comprising 56 patients. The two groups were examined for demographic data, risk variables were evaluated by multifactorial logistic regression analysis, and the predictive value was determined using ROC curves.ResultsThe comparison of hyperhomocysteinemia (HHcy), fibrinogen (FIB), and high-density lipoprotein cholesterol (HDL-C) between the non-stroke and stroke groups revealed statistically significant differences (P < 0.05). Logistic regression analysis indicated that HHcy (OR 16.936; 95% CI 1.946–146.071; P = 0.010), FIB (OR 1.773; 95% CI 1.238–2.540; P = 0.002), and HDL-C (OR 0.182; 95% CI 0.043–0.775; P = 0.021) were significant factors in the onset of ischemic stroke among elderly patients with hypertension and type 2 diabetes. ROC curve analysis revealed that the area under the curve (AUC) for FIB, HDL-C, and HHcy in diagnosing stroke associated with hypertension and type 2 diabetes mellitus in the elderly were 0.704, 0.640, and 0.598, respectively, while the AUC for the combined diagnosis of all three was 0.784.ConclusionsHHcy, FIB, and HDL-C independently influence the occurrence of ischemic stroke in elderly patients with hypertension combined with type 2 diabetes mellitus, and their combined enhanced predictive capability for ischemic stroke occurrence.

Construction and validation of a prediction model for arteriovenous fistula thrombosis in patients with AVF using Lasso regression.

The primary objective of this study is to develop and validate a high-risk model for Arteriovenous Fistula Thrombosis (AVFT) in patients undergoing autogenous arteriovenous fistula surgery for hemodialysis. Retrospectively, we collected general information, clinical characteristics, laboratory examinations, and dialysis-related factors from a cohort of 1465 patients who received continuous arteriovenous fistula surgery at the Hemodialysis Access Center of Sichuan Provincial People's Hospital between January 2019 and June 2022. The patients were randomly divided into a training set and a validation set in a 2:1 ratio. The training set was utilized to select AVFT-related features using LASSO regression. A predictive model was constructed using logistic regression analysis, and its performance was assessed in the validation set. Through LASSO regression, we initially identified 13 candidate factors. Subsequently, based on the Akaike Information Criterion (AIC) principle, the following factors were selected to construct the AVFT prediction model: monocytes_ratio, Fistula blood velocity, cystatin-c, homocysteine, parathormone, artery_dysfunction, C-reactive protein, fibrinogen, and d-dimer. The discrimination C-index of the model in the training set was 0.8767. For this training set, the sensitivity was 48.05% and the specificity was 96.84%. In the validation set, the model's discrimination C-index, as evaluated by the ROC curve analysis, was 0.7888. The sensitivity was 14.29%, and the specificity was 97.04%. We assessed the calibration of the model using calibration curves, obtaining a maximum absolute difference of Emax = 0.205 and an average absolute difference of Eave = 0.032. Furthermore, we evaluated calibration and accuracy using the Spiegelhalter Z-test, yielding an S:P ratio of 0.704. AVFT is a multifactorial outcome influenced by factors such as injury, inflammatory factors, blood glucose levels, blood velocity, coagulation, electrolyte metabolism, and vascular endothelial function.

D-dimer cutoff values for predicting functional prognosis in patients with severe head trauma: a multi-centre prospective observational study.

D-dimer, a fibrinolysis indicator, may predict functional and life outcomes in traumatic brain injury (TBI) patients. We aimed to identify optimal D-dimer cutoff values for poor functional outcomes in severe TBI. We used data from a multi-centre prospective observational cohort study that included patients with TBI with a Glasgow Coma Scale (GCS) score ≤ 8 within 48h after injury or required neurosurgical procedures. We selected patients admitted ≤ 1h after injury. Neurological function at discharge was assessed using the modified Rankin Scale (mRS). The association between D-dimer levels at admission and neurological function (mRS ≥ 4 or < 4), adjusted for age, GCS, systolic blood pressure, and head abbreviated injury scale (AIS) score, was determined by logistic regression analysis. The predictive utility of D-dimer levels was assessed using the area under the receiver operating characteristic curve (AUC), with the cutoff value being determined using Youden's index. Among the 336 patients, most were male; approximately half had experienced motor vehicle accidents. The median (interquartile range) of age, GCS scores, and head AIS scores were 65 (40.25 - 78.75) years, 7 (4 - 9), and 5 (4 - 5), respectively. Overall, 214 (63.7%) patients had poor neurological function (mRS ≥ 4). D-dimer levels > 28µg/mL predicted poor functional prognosis (odds ratio = 3.84 [95% confidence interval 1.62 - 9.11]); the AUC and cutoff values were 0.73 and 27.2µg/mL, respectively. A cutoff value of 27.2µg/mL for early-stage D-dimer levels could predict the functional prognosis of patients with severe isolated TBI.

Effectiveness of vitrectomy with inverted internal limiting membrane flap in the treatment of macular hole retinal detachment in high myopia

PurposeThis study evaluates the effectiveness of the inverted internal limiting membrane (ILM) flap technique during vitrectomy for treating macular hole-induced retinal detachment (MHRD) in high myopia patients, a challenging complication for vitreoretinal surgeons due to its treatment complexity.MethodsWe conducted a prospective study analyzing 92 eyes diagnosed with MHRD, all undergoing vitrectomy using the inverted ILM flap technique between February 2022 and September 2024. Successful surgery was defined as achieving retinal reattachment, macular hole closure, and improvement in visual acuity by the 12-month postoperative follow-up. Microstructural recovery was assessed using spectral domain optical coherence tomography. Logistic regression analysis was performed to identify prognostic factors of surgical outcome.ResultsOf the 92 eyes, 94.6% achieved retinal reattachment, and 92.4% experienced macular hole closure. Visual acuity significantly improved in 91.3% of cases, with a mean improvement of 0.95 logarithm of the minimum angle of resolution. Recovery rates for the external limiting membrane, the ellipsoid zone, and the cone outer segment tip were 76.1%, 66.3%, and 66.3%, respectively. Larger retinal detachments and macular holes were important predictors of lower surgical success (p < 0.001; p = 0.015, respectively). There was a significant correlation between vision improvement and the recovery of structural integrity and foveal microstructures.ConclusionsThe ILM coverage technique represents a breakthrough in the treatment of MHRD, promoting both anatomical and functional recovery. This approach enhances the management of this complex condition, ultimately improving the quality of life for affected individuals.

Effects of pregnancy-induced hypertension on early-onset neonatal thrombocytopenia

BackgroundGestational hypertension and preeclampsia are potentially linked to similar pathophysiological processes. Maternal preeclampsia increases the occurrence of early-onset neonatal thrombocytopenia. We hypothesized that maternal gestational hypertension may impact the incident early-onset neonatal thrombocytopenia.MethodsWe included 538 neonates, comprising 318 and 220 neonates born to healthy mothers and those with pregnancy-induced hypertension. The minimum platelet count within 72 h of birth was recorded for these neonates. The incidence of early-onset thrombocytopenia in neonates in relation to maternal gestational hypertension, preeclampsia, and health status was evaluated. Logistic regression analysis was conducted to assess the relationship between maternal gestational hypertension and the risk of early-onset neonatal thrombocytopenia.ResultsThe incidence of early-onset thrombocytopenia was significantly higher in neonates born to mothers with preeclampsia than in those born to mothers with gestational hypertension or healthy mothers. Significant differences were observed among the three groups (30.0% vs. 13.3% vs. 7.9%, p < 0.001). Maternal gestational hypertension (OR = 2.79, 95%CI 1.19–6.54) increased the risk of early-onset neonatal thrombocytopenia when compared to healthy mothers.ConclusionsMaternal gestational hypertension increases the occurrence of early-onset neonatal thrombocytopenia. Therefore, we recommend conducting platelet count screening at the early stages of neonates of mothers with gestational hypertension.