Multivariate Logistic Analysis Research Articles

Exploring the association of metabolic factors and chronic musculoskeletal pain over a period of 10years - the Doetinchem Cohort Study.

To examine (a) the association between metabolic factors and chronic musculoskeletal pain (CMP), (b) metabolic predictors of CMP 10years later, and (c) the association and evolution of metabolic factors across different CMP trajectory groups. Data from the longitudinal Doetinchem Cohort Study were used. We used round 4 (2003-2007), with 4519 participants aged 36-75years, as the baseline for the present study, with follow-up measurements in round 5 (2008-2012), and 6 (2013-2017), including self-reported pain and metabolic factors, which were measured either via self-report or physical assessment. For the three research aims, (a) generalized linear mixed-effects models, (b) binary logistic regression analyses and (c) linear mixed-effects models were used. (a) Female sex, higher age, presence of diabetes, higher BMI, lower diastolic blood pressure (BP), and elevated cystatin C were significantly associated with CMP in multivariable logistic analyses. (b) Female sex and elevated BMI were predictors of CMP 10years later. (c) Those pain-free for 10years had the lowest BMI levels compared to other CMP groups (development, recovery, persistent, and recurrent CMP). BMI was higher in the persistent CMP group than in the development and recovery groups. The pain-free group had higher diastolic BP compared to those in the persistent CMP group. Participants in the persistent CMP group had higher Cystatin C levels than the free, development and recovery CMP groups. Regarding the evolution of metabolic factors over time, BMI, glucose and diastolic BP evolved differently across the CMP trajectory groups. Our findings indicate the importance of metabolic factors, especially BMI, in the onset and progression of CMP. These findings underscore the need to consider metabolic health in the prevention and treatment of CMP. Key Points • Metabolic factors are associated with the presence of chronic musculoskeletal pain. • Female sex and elevated BMI are predictive of musculoskeletal pain (MP) 10 years later. • Metabolic factors evolve differently over time across different pain trajectory groups, with variations in BMI, glucose, and diastolic blood pressure.

Preoperative patient teaching practices and associated factors among nurses working at hospitals in West Shoa Zone, Ethiopia, 2022: a cross-sectional study

IntroductionPreoperative teaching is fundamental nursing activity in which a nurse educates the patient about surgery and what to anticipate following the procedure. It is a process via which nurses give standard preoperative information to patients before surgery, and it enables the patients to understand their diagnosis and treatment, actively participate in their own care, overcome feelings of incapacity in relation to their condition, regain health, and maintain home care. However, there is a dearth of studies that determine the extent of preoperative teaching practice in Ethiopia in general and in the study area in particular.ObjectiveThis study aimed to assess preoperative patient teaching practices and the factors associated with these practices among nurses working in hospitals in the West Shoa, Oromia region, Ethiopia, in 2022.MethodsAn institution-based cross-sectional study was conducted among 267 nurses from 1 September to 30 September 2022, at hospitals in the West Shoa Zone. Two-stage simple random sampling technique was used to select study participants. Data were collected using a pretested and structured self-administered questionnaire. The quantitative data were checked and entered using Epi-data version 4.6 and exported to SPSS version 26.0 for analysis. Bivariable and multivariable logistic analyses were performed, and p-values of <0.05 at a 95% confidence interval were considered statistically significant.ResultA total of 253 nurses returned the entire questionnaire, yielding a response rate of 94.75%. The study enrolled 132 (52.2%) male, the highest percentage (231, 91.3%) of the participants were in the age group of 18–35, the majority of participants (152, 60.1%) were married, and 164 (64.8%) were protestant. Approximately 101 (39.9%) participants demonstrated good preoperative teaching practice. Lack of teaching material, lack of training workload, time constraints, insufficient staffing, language barrier, severity of patient cases, patient and family’s anxiety, and complexity of patients’ status were significantly associated with preoperative patient teaching practice.ConclusionThe proportion of preoperative patient teaching practices among nurses working at hospitals in the West Shoa Zone was low. Concerned bodies should emphasize ways to improve preoperative teaching practice.

Prevalence and correlates of post-traumatic stress disorder and depression among welfare- and justice-involved adolescents in Nigeria

ABSTRACT Background: Childhood maltreatment (CM) is higher among welfare- and justice-involved youth than in those not involved in these systems, which increases the risk of depression and post-traumatic stress disorder (PTSD). However, the mechanisms underlying the link between CM and these two psychiatric conditions are less well understood among at-risk populations in low- and middle-income countries. Objective: This study attempts to fill this gap by examining the prevalence of and risk factors for depression and PTSD among at-risk groups in Nigeria. Method: A cross-sectional research design using multistage sampling was adopted. The sample comprised 205 adolescents: justice-involved [102 (49.8%)] and welfare-involved [103 (50.2%)]. In total, 151 (73.7%) were males, while 54 (26.3%) were females. Multivariate logistic regression analysis and multivariate analysis of variance were applied. Results: The results showed that 66.1% of welfare-involved adolescents and 69.6% of justice-involved adolescents reported PTSD, while 68.9% of welfare-involved adolescents and 75.5% of justice-detained adolescents reported depression. Neglect (OR = 0.253; 95% CI 0.146–0.571; p < .001) and witnessing violence (OR = 0.230; 95% CI 0.114–0.597; p < .004) predicted depression. Emotional abuse (OR = 0.186; 95% CI 0.090–0.80; p < .015), witnessing violence (OR = 0.147; 95% CI 0.014–0.876; p < .043), neglect (OR = 0.187; 95% CI 0.14–0.90; p < .008), and physical abuse (OR = 0.27; 95% CI 0.254–0.937; p < .001) predicted PTSD. Also, PTSD significantly differed based on type of placement (F = 6.08, p < .014, η 2 = .029), but depression did not differ based on type of placement (F = 2.46, p > .118, η 2 = .012). Conclusions: CM profiles are risk factors in PTSD and depression among at-risk groups. CM screening should be included in mental health services of out-of-home placements to prevent the cycle of mental health problems and reoffending. Trauma-focused and cognitive–behavioural therapies have the potential to alleviate the suffering of traumatized adolescents.

Predictors of neonatal mortality among neonates in Tigray regional state, Ethiopia: A cross-sectional study.

Since 2015, Ethiopia is committed to lowering the death rate for children under five and it is one of the countries in Sub-Saharan Africa that has accomplished the fourth Millennium Development Goal. However, in Ethiopia, neonatal death has remained a serious public health concern, with greater rates found in Tigray regional state and the predictors aren't well recognized. The goal of this study was to ascertain the prevalence of neonatal death in the Tigray regional State as well as any relevant risk factors. This study performed a secondary data analysis of the 2016 Ethiopia Demographic and Health Survey (EDHS) report. Information was gathered on 716 neonates who were born five years before the survey began. Risk factors for neonatal mortality were thought to include mother and neonate demographics, health, and environmental factors. The study employed multivariable logistic regression model analysis and descriptive statistics to identify significant correlates of neonatal mortality. In Tigray regional state, the overall prevalence of neonatal mortality was 4.3% (95% CI: 3.06, 6.10). The multivariable logistic regression model analysis revealed that factors such as multiple birth types (AOR = 15.3, 95% CI: 3.54, 65.84), birth order (2-4) (AOR = 4.88, 95% CI: 1.52, 15.7), sex of the neonate (being male) (AOR = 3.75, 95% CI: 1.45, 9.75), home place of delivery (AOR = 7.4, 95% CI: 2.0, 27.6), and neonates born to mothers aged 20-34 years (AOR = 0.23, 95% CI: 0.087, 0.58) were significantly risk factors associated with a higher risk of neonatal mortality rate. The study recognized the sex of the neonate, birth order, mother's age, place of delivery, and birth type as potential risk factors for neonatal mortality. The prevalence of neonatal mortality indicated that the neonatal mortality rate in Tigray regional state was higher than the national average. To reduce neonatal mortality, targeted interventions should focus on high-risk groups, such as mothers delivering at home and those with multiple births.

EUS-guided fine-needle biopsy versus fine-needle aspiration for histopathological evidence for type 1 autoimmune pancreatitis: A single-center retrospective study in China

ABSTRACT Background and Objectives EUS is recommended for guiding pancreatic tissue acquisition in suspected autoimmune pancreatitis (AIP) cases. However, there is a lack of comparative research on the effectiveness between EUS-guided fine-needle aspiration (EUS-FNA) and EUS-guided fine-needle biopsy (EUS-FNB) for diagnosing AIP in China. This study aimed to evaluate the diagnostic accuracy of EUS-guided tissue acquisition (EUS-TA) specifically for type 1 AIP. Methods Between 2010 and 2023, individuals with AIP who received EUS-TA at Changhai Hospital were included in the study. Results A total of 173 patients diagnosed with AIP who underwent EUS-TA were included in the final analysis. Of these, 104 patients (60.1%) received EUS-FNA, and 69 patients (39.9%) underwent EUS-FNB. Sufficient pancreatic tissue samples (&gt;5 cells/high-power field) were obtained in 164 of 173 patients (94.8%), with success rates of 94.2% for EUS-FNA and 95.7% for EUS-FNB (P &gt; 0.05). EUS-FNB exhibited higher rates of reliable level 1 histopathological findings (40.9% vs. 16.3%, P &lt; 0.001) and reliable level 2 histopathological findings (33.3% vs. 12.2%, P &lt; 0.001) compared with EUS-FNA. Furthermore, a higher occurrence of IgG4-positive plasma cell infiltration (&gt;10 cells/high-power field) was observed with EUS-FNB compared with EUS-FNA (74.2% vs. 27.9%, P &lt; 0.001). The multivariate logistic analysis also revealed that EUS-FNA was less effective in obtaining reliable evidence compared with EUS-FNB, as evident in both level 2 (P = 0.002; odds ratio, 0.21; 95% confidence interval, 0.08–0.56) and level 1 (P = 0.001; odds ratio, 0.19; 95% confidence interval, 0.08–0.49) histopathological evidence. Conclusions EUS-FNB demonstrates higher rates of level 1 and level 2 histopathological findings, as well as more abundant IgG4-positive plasma cell infiltration, compared with EUS-FNA.

Knowledge, attitude and practice towards postoperative management among patients with type A aortic dissection or their relatives: a cross-sectional study in China

ObjectivesTo assess the knowledge, attitude and practice (KAP) of patients with type A aortic dissection (AD) or their relatives regarding postoperative management.DesignCross-sectional study.SettingThe participants were recruited from three hospitals between...

Cardiometabolic Index is associated with heart failure: a cross-sectional study based on NHANES

IntroductionHeart failure is a complex syndrome characterized by impaired cardiac function. Despite improvements in treatment, the prevalence of heart failure continues to rise. The Cardiometabolic Index (CMI), a novel measure combining abdominal obesity and lipid levels, has emerged as a potential predictor of cardiac metabolic risk.MethodsWe analyzed data from the National Health and Nutrition Examination Survey (NHANES) involving 22,586 participants to investigate the association between CMI and heart failure. Multivariable logistic regression models and RCS analysis were used to explore the association between heart failure and CMI after adjusting for potential confounders. Subgroup analyses were performed among populations with different demographic and clinical characteristics.ResultsOur results revealed a significant positive correlation between CMI and heart failure, with odds ratios of 2.77 and 1.87 for the highest quartile after adjusting for confounders. Subgroup analyses indicated heightened risks among older adults and those with hypertension or diabetes. ROC curve analysis demonstrated that CMI offers good diagnostic value for heart failure, surpassing traditional measures like BMI.DiscussionOur findings suggest that CMI is a valuable tool for assessing the risk of heart failure, particularly in individuals with increased abdominal obesity or abnormal lipid profiles. This highlights the importance of addressing cardiac metabolic health in both prevention and treatment strategies for heart failure. Future research should focus on exploring causal relationships and refining predictive models that incorporate CMI to enhance early detection and intervention.

Relationship between the risk of intestinal mucosal Epstein-Barr virus and/or cytomegalovirus infection and peripheral blood NK cells numbers in patients with ulcerative colitis: a cross-sectional study in Chinese population.

This study aimed to analyze the relationship between the risk of common opportunistic pathogens Epstein-Barr virus (EBV) and cytomegalovirus (CMV) infection in intestinal mucosal tissues of Ulcerative Colitis (UC) patients and the number of peripheral blood NK cells. UC patients admitted to a third-grade class-A hospital from January 2018 to December 2023 were selected as research population. Clinical data of the patients were collected from the electronic medical record system. Additionally, samples of intestinal mucosal tissues were obtained for real-time fluorescence quantitative PCR to detect and analyze the viral load of CMV and EBV. Blood samples were collected for lymphocyte subsets analysis. Multivariable logistic regression models analyses was used to determine the odds ratio (OR) and 95% confidence interval (95% CI) for the independent association between NK cells and EBV/CMV infections in UC. We further applied the restricted cubic spline analysis and smooth curve fitting to examine the non-linear relationship between them. 378 UC patients were enrolled. Of these patients, there were 194 patients (51.32%) with EBV /CMV infection. In multivariable logistic regression analyses NK cells was independently associated with EBV and/or CMV infection after adjusted potential confounders (OR 8.24, 95% CI 3.75-18.13, p < 0.001). A nonlinear relationship was found between NK cells and EBV/CMV infections, which had a threshold around 10.169. The effect sizes and CIs below and above the threshold were 0.535 (0.413-0.692), p < 0.001 and 1.034 (0.904-1.183), p > 0.05, respectively. There was a non-linear relationship between NK cells and EBV/CMV infections. The risk for EBV/CMV infections was not increased with increasing NK cells in individuals with NK cells ≥ 10.169%, whereas the risk for EBV and/or CMV infection was increased with an decreasing NK cells in those with NK cells < 10.169%. The risk of EBV/CMV infections increases when NK cells were below a certain level.

Prognostic value of nomogram model based on clinical risk factors and CT radiohistological features in hypertensive intracerebral hemorrhage.

To construct a nomogram model based on clinical risk factors and CT radiohistological features to predict the prognosis of hypertensive intracerebral hemorrhage (HICH). A total of 148 patients with HICH from April 2022 to July 2024 were retrospectively selected as the research subjects. According to the modified Rankin scale at the time of discharge, they were divided into good group (Rankin scale score 0-2) and bad group (Rankin scale score 3-6). To compare the clinical data and the changes of CT radiographic characteristics in patients with different prognosis. Relevant factors affecting the prognosis were analyzed, and nomogram model was established based on the influencing factors. The fitting degree, prediction efficiency and clinical net benefit of the nomogram model were evaluated by calibration curve, ROC curve and clinical decision curve (DCA). Compared with the good group, the hematoma volume in the poor group was significantly increased, the serum thromboxane 2(TXB2) and lysophosphatidic acid receptor 1(LPAR1) levels were significantly increased, and the energy balance related protein (Adropin) level was significantly decreased. The proportions of irregular shape, promiscuous sign, midline displacement, island sign and uneven density were all significantly increased (p < 0.05). In Logistic multivariate analysis, hematoma volume, Adropin, TXB2, LPAR1 and CT radiological features were all independent factors influencing the poor prognosis of HICH (p < 0.05). A nomogram prediction model was established based on the influencing factors. The calibration curve showed that the C-index was 0.820 (95% CI: 0.799-0.861), the goodness of fit test χ2 = 5.479, and p = 0.391 > 0.05, indicating a high degree of fitting. The ROC curve showed that the AUC was 0.896 (95% CI: 0.817-0.923), indicating that this model had high prediction ability. The DCA curve shows that the net benefit of the nomogram model is higher when the threshold probability is 0.1-0.9. The nomogram prediction model established based on hematoma volume, Adropin, TXB2, LPAR1 and other clinical risk factors as well as CT radiographic characteristics has high accuracy and prediction value in the diagnosis of poor prognosis in patients with HICH.

Predictors of mortality at 3 months in patients with skull base tumor resections in a low-income setting.

Globally, skull base tumors are among the most challenging tumors to treat and are known for their significant morbidity and mortality. Hence, this study aimed to identify robust associated factors that contribute to mortality of patients following surgical resection for a variety of skull base tumors at the 3-month follow-up period. This in turn helps devise an evidence-based meticulous treatment strategy and baseline input for quality improvement work. A retrospective cohort study of patients undergoing skull base tumor resection was conducted at two large-volume neurosurgery centers in Ethiopia. The categorical variables were expressed in frequencies and percentages. Normal distribution of continuous data was checked by histogram and the Shapiro-Wilk test. Median with interquartile range (IQR) was calculated for skewed data, while mean with standard deviation (SD) was used for normally distributed data. Odds ratio and adjusted odds ratio (AOR) were used to express the result of univariate and multivariate binary logistic analyses, respectively. A p-value <0.005 was considered statistically significant at 95% confidence interval (CI). The study involved 266 patients. Of this, women accounted for 63.5% of patients. The median age of patients was 37 (±IQR = 17) years while the median size of the tumor in this study was 4.9 (±IQR 1.5) cm. The mean duration of symptoms at time of presentation was 17.3 (±SD = 11.1) months. Meningioma, pituitary adenoma, and craniopharyngioma contributed to 68.4%, 19.2%, and 9% of the skull-based tumors, respectively. Mortality following skull base tumor resection was 21.1%. On multivariable binary logistic regression analysis, intraoperative iatrogenic vascular insult (AOR = 28.76, 95% CI: 6.12-135.08, p = 0.000), intraventricular hemorrhage (AOR = 6.32, 95% CI: 1.19-33.63, p = 0.031), hospital-associated infection (AOR = 6.96, 95% CI: 2.04-23.67, p = 0.002), and extubation time exceeding 24 h (AOR = 12.89, 95% CI: 4.89-40.34, p = 0.000) were statistically significant with 3-month mortality. Mortality from skull base tumor resection remains high in our setting. Holistic pre-operative surgical planning, meticulous intraoperative execution of procedures, and post-operative dedicated follow-up of patients in a neurointensive care unit alongside quality improvement works on identified risks of mortality are strongly recommended to improve patient outcomes. The urgent need for setup improvement and further training of neurosurgeons is also underscored.

Relationship Between Perioperative Medication and Prolonged Postoperative Hospital Stay in Older Adults with Spinal Surgery: a Retrospective Cohort Study.

Older people are prone to multiple chronic diseases and, as a result, require multiple medications. At present, there is no study to verify whether the use of high-risk perioperative medications (HRPOMs) will adversely affect postoperative outcomes in the relatively old patient. In this study, we aimed to analyze the risks of HRPOMs for prolonged length of hospital stay (LOS) in advanced-aged (≥ 75 years) patients undergoing spinal surgery. Medical records of advanced-aged patients who underwent spinal surgeries were retrospectively reviewed. Patients were divided into those who had prolonged LOS (≥ eight days) versus those who did not (< eight days). The demographics, medical comorbidities, and perioperative medications were analyzed. Univariate and multivariate regression were used to determine perioperative risk factors for prolonged LOS. A total of 268 patients were included with a median age of 79 years (interquartile range [IQR]=76, 82) and 127 (47.4%) patients had a prolonged LOS. In multivariate logistic analysis, higher body mass index (odds ratio [OR] = 1.116; 95% CI, 1.031-1.209), operation time (OR) = 1.009; 95% CI, 1.005-1.012), and number of postoperative HRPOMs (OR= 1.910; 95% CI, 1.464-2.492) were identified as independent predictors for prolonged LOS. The use of metformin was associated with lower likelihood of prolonged LOS in diabetic patients (OR = 0.365; 95% CI, 0.157-0.846). Our results indicate that the higher number of postoperative HRPOMs, rather than a specific HRPOMs type, is a risk factor for prolonged LOS. The continued preoperative use of metformin in patients with diabetes has a positive impact on the postoperative outcomes.

Impact of Arch Disease Pathology on Outcomes of Zone 0 Branched Thoracic Endovascular Arch Repair.

Zone 0 branched thoracic endovascular arch repair (Z0BTEVAR) has emerged as an alternative to open repair for high-risk patients with aortic arch pathology. However, it is unclear how disease characteristics in this population impacts clinical outcomes. The study aimed to compare Z0BTEVAR according to arch disease pathology and to identify potential predictors of post-operative outcomes. From 2011 to 2023, patients who underwent Z0BTEVAR for chronic aortic dissection (C-AD) or for non-aortic dissection (N-AD) etiology at 3 European centers were included. The primary outcome was a composite of in-hospital mortality and disabling stroke. Multivariable logistic analyses were conducted to identify independent predictors of the outcomes. Overall, 213 patients underwent Z0BTEVAR, including 111 patients treated for C-AD and 102 patients treated for N-AD. The median age was 72 years old. Overall composite outcome was 10.3%, higher for N-AD patients compared to C-AD patients (15.7% vs. 5.4%; p=0.01). Similarly, N-AD patients had more post-operative strokes (17.7% vs. 4.5%; p<0.01). On multivariable analysis, previous type A aortic dissection was protective for the composite outcome (OR 0.2; C.I. 0.1-0.6), while degenerative aneurysm with zone 0 or 1 involvement was predictive of post-operative stroke (OR 3.7; CI 1.2-11.8). At 4 years, survival for the N-AD group was 71.8±6.6%, and for the C-AD group was 71.5±6.5% (p=0.81). Z0BTEVAR could be performed with satisfactory short- and mid-term outcomes for high-risk patients, particularly those with previous dissection. Patient selection is important, and continued effort should be placed on minimizing post-operative stroke.

Predictors and long-term prognostic significance of bailout stenting during percutaneous coronary interventions with sirolimus-coated balloon: a subanalysis of the EASTBOURNE study.

Percutaneous coronary intervention (PCI) with drug-coated balloon (DCB) has been expanding progressively in recent years. Convincing evidence demonstrated the ability of some DCB to promote positive vessel remodeling with potential clinical benefits at follow-up. When PCI with DCB results in suboptimal angiographic results (residual stenosis >30% or type C-F dissection), bailout stenting (BS) implantation is recommended to mitigate the risk of abrupt vessel occlusion or restenosis. However, clinical studies focusing on BS during PCI with DCB are scarce. The aim of this study was to compare the 2-year clinical outcomes of patients requiring BS with those who underwent sirolimus-coated balloon (SCB)-only PCI and to investigate clinical and angiographic predictors of BS. We conducted a post-hoc analysis of the prospective, multicenter, EASTBOURNE study. The overall cohort was stratified into two study groups: patients requiring BS versus those who underwent SCB-only PCI. The primary endpoint was target lesion revascularization (TLR) at 24-month follow-up. Propensity Score Matching (PSM) was utilized to balance clinical and procedural characteristics between the two study groups. The study population included 2084 patients for a total of 2318 treated lesions. Of them, 181 [7.8%] required BS for suboptimal results during PCI with SCB. Coronary lesions requiring BS were more frequently de-novo stenoses (p = 0.016) and were longer (p = 0.012) and with a smaller median reference vessel diameter (p < 0.001). At 24 months, TLR occurred in 133 [6.4%] patients. The two study groups experienced a similar rate of TLR both in the unmatched cohort (6.3% in the SCB-only group vs. 7.3% in the BS group, p=0.683) and after PSM analysis (4.2% in the SCB-only group vs. 8.5% in the BS group, p=0.223). These results were consistent when considering subpopulations with de-novo lesions, ISR, large and small vessel disease. Revascularization of de-novo lesions and smoking habit were independent positive predictors of BS, while the SCB inflation time was an independent negative predictor of BS by multivariable logistic analysis in the overall population. On the other hand, we did not record any case of vessel thrombosis during follow up. In conclusion, bailout stenting was associated with similar 2-year outcomes compared to SCB-only PCI and thus appear to be a safe bailout strategy for suboptimal angiographic results after DCB angioplasty.

The elderly population’s social networks and HIV perceptions: Evidence from China

ABSTRACT Background: Previous studies have found that people with low participation in social activities and living alone were prone to have risky sexual behaviors, while people with high participation in social activities were less prone to have risky sexual behaviors. Based on the above assumptions, we conducted an analysis on elderly population’s social networks and human immunodeficiency virus (HIV) risky behaviors in China. In the survey study, considering the sensitivity of sexual behavior, HIV risk behavior of the elderly population is more difficult to measure, so the intermediate variable of HIV perceptions was used instead of the sexual behavioral variable. Methods: A cross-sectional study was conducted in July to September 2023 among the elderly aged ≥ 50 years in China to measure the social networks with the Social Support Rate Scale (SSRS) and to measure the HIV perceptions of the elderly with the degree of knowledge of acquired immunodeficiency syndrome (AIDS) prevention and treatment and the degree of discrimination of HIV/AIDS patients, and the data were statistically analyzed with SPSS 27.0 software. Statistical analysis methods included descriptive analyses such as frequency, percentage, mean ± standard deviation, and median, two independent samples t-test analysis, and multivariate logistic regression model analysis. Results: Among the 1022 elderly people surveyed, the proportion of those with weak and strong levels of social support was 46.9% and 53.1%, respectively; the proportion of those with low, medium, and high levels of HIV knowledge perceptions was 4.8%, 5.9%, and 89.3%, respectively; and the proportion of those with low, medium, and high levels of attitudinal perceptions was 24.7%, 35.0%, and 40.3%, respectively. Based on the Goodman–Kruskal Gamma test, it was found that there was a positive correlation between social support and HIV knowledge perceptions in the elderly population, and there was a negative correlation between social support and HIV attitudinal perceptions in the elderly population. Ethnicity, current occupation or pre-retirement occupation, personal average after-tax monthly income, attitudinal perceptions, and social support were the influencing factors for the knowledge perceptions in the elderly population (P &lt; 0.05); literacy, number of children, mode of residence, personal average monthly income after tax, knowledge perceptions, and social support were the influencing factors of attitudinal perceptions in the elderly population (P &lt; 0.05). Conclusions: There is a correlation between social networks and HIV perceptions in China’s elderly population, which is positively correlated with HIV knowledge perceptions and negatively correlated with HIV attitudinal perceptions, and it is important to improve the HIV prevention and knowledge of the elderly population and reduce their HIV-related discrimination.

Clinical features and outcomes of basilar invagination.

Basilar invagination has been classified into two types by Goel: Type A is defined mechanical instability of the atlantoaxial joint with upward displacement of the odontoid process while Type B is characterized by stable atlantoaxial joints. This study reviews the association between radiological features and symptomatology and prognosis of two types of basilar invagination for better clinical management. A retrospective analysis was conducted including 141 patients diagnosed with basilar invagination who underwent surgical treatment from January 2016 to December 2020. The neurological function was assessed by the JOA scores, and Short-Form 12 scores. Logistic univariate and multivariate analyses were performed to predict prognostic risk factors. Type A patients (21/101, 20.8%) with more cases of dizziness, lower preoperative JOA scores and SF-12 PCS scores (JOA, 13.0 vs. 13.9, P = 0.042; SF-12 PCS, 37.48 vs. 38.42, P = 0.034) compared to type B (2/40, 5%) (P = 0.022). Type B (22/40, 55%) with more cases of ataxia than type A (35/101, 34.7%) (P = 0.026). Patients with type B demonstrated a significantly higher improvement rate in SF-12 PCS than type A (P = 0.018). Further logistic regression revealed that onset age ≥ 45 years (OR 4.654, 95% CI 1.645-13.165; p = 0.004) and basal angle ≥ 125° (OR 28.139, 95% CI 1.090-726.239; p = 0.044) were independent risk factors for type A and type B, respectively. Type A patients with more cases of dizziness, and type B patients with more cases of ataxia, can achieve better long-term prognosis following clinical intervention.

High C-reactive protein is associated with the efficacy of neoadjuvant chemotherapy for hormone receptor-positive breast cancer.

C-reactive protein (CRP) is a nonspecific biomarker for systemic inflammatory response and is linked to the prognosis of breast cancer (BC); however, few studies have investigated the correlation between CRP and the effectiveness of neoadjuvant chemotherapy treatment for BC. We recruited 177 patients with BC who underwent neoadjuvant chemotherapy in our clinical trial. the median CRP level (0.24 mg/L), patients were categorized into high and low groups. We examined the relationship between CRP levels and various clinicopathological factors, including pathological complete response (pCR), using the chi-square test or Fisher exact test. Furthermore, we evaluated the predictive capacity of CRP for different molecular subtypes by constructing receiver operating characteristic curves. To identify the independent variables associated with pCR, we conducted logistic regression multivariate analysis. No association was found between C-reactive levels at baseline and pCR rates. CRP level was significantly associated with higher body mass index, and the high CRP group had more overweight patients (47.06% vs. 16.30%, P < .001). In hormone receptor-positive patients, the high CRP group demonstrated a significantly higher pCR rate (OR = 4.115, 95% CI: 1.481-11.36, P = .009). The areas under the curve was 0.670 (95% CI: 0.550-0.792, P < .001). Multivariate logistic analysis showed that the CRP level was a significant independent predictor of pCR (OR = 5.882, 95% CI: 1.470-28.57, P = .017). High CRP levels were found to be associated with a higher pCR rate, indicating their independent predictive value in determining the efficacy of neoadjuvant chemotherapy in hormone receptor-positive BC patients.

Discovering journals: A strategy for enhancing the introductory statistics course for undergraduate students

AbstractUndergraduate students outside Statistics major frequently take only one class of Basic Statistics or Introductory Statistics during their studies. As a consequence, many of them have little knowledge about advanced statistical methods, such as logistic regression, nonparametric procedures, and multivariate analysis, although they might need to perform it in the future. We have developed a teaching strategy to introduce these topics to first‐year students who take the Introductory Statistics course by asking them to discovering scientific journals in groups and present them. A discussion feature in the Moodle e‐learning systems really helps us to carry out this strategy effectively. We discuss some benefits of this strategy as well as some pitfalls that can be occurred during its implementation.

Higher density of CD4+ T cell infiltration predicts severe renal lesions and renal function decline in patients with diabetic nephropathy.

More evidence have shown that the combination of immune and inflammatory mechanism was critical in diabetic nephropathy (DN). However, the relationship between CD4+ T cells and the development of DN is still unclear. Therefore, this study will focus on this issue from the perspective of clinicopathology. From September 2019 to December 2022, a total of 112 adult patients with DN were enrolled in the study. According to the density of CD4+ T cell infiltration based on immunostaining, the patients were divided into high-CD4 group (56 patients) and low-CD4 group (56 patients). Another 25 diabetic patients with minimal change disease (non-diabetic nephropathy, NDN) was reviewed as control group in clinical and molecular analysis. The clinical parameters, morphological features, and molecular characteristics were compared. The predictive value of CD4+ T cells for DN prognosis was also investigated. DN patients in the high-CD4 group suffered from higher proteinuria and lower estimated glomerular filtration rate (eGFR) level than those in the low-CD4 group and NDN patients. Renal biopsy in the high-CD4 group presented with more severe glomerular lesions, higher density of interstitial inflammation, and more severe tubular atrophy/interstitial fibrosis than in the low-CD4 group. Multivariate logistic analysis indicated that the density of CD4+ T cell infiltration could independently predict the severity of tubular atrophy/interstitial fibrosis. In addition, more severe mitochondrial damage of renal tubular epithelial cells and a more obvious expression of Bcl6, IL-6, STAT3, and TGFβ1 were observed in DN patients of the high-CD4 group, indicating the possible mechanism of CD4+ T cells involving the progression of DN. Multivariate Cox regression analysis revealed that a higher intensity of interstitial CD4+ T cell deposition remained as an independent predictor of the double endpoint with doubling of baseline serum creatinine or end-stage renal disease. The high density of CD4+ T cell infiltration was associated with renal function decline and severity of renal lesions and predicted poor renal survival for DN patients.

Development and validation of a novel prognostic nomogram for hepatitis B virus-related acute-on-chronic liver failure patients receiving artificial liver therapy

BackgroundHepatitis B virus-related acute-on-chronic liver failure (HBV–ACLF) is frequently accompanied by short-term morbidity and mortality. However, there have been no studies on the associations between baseline clinicopathologic characteristics at hospital admission and clinical prognosis after receiving artificial liver therapy. Therefore, the current study aimed to develop a prognostic nomogram for predicting the outcomes of patients with HBV–ACLF following artificial liver support.MethodsA retrospective study of 110 consecutive patients who were diagnosed with HBV–ACLF between January 2018 and August 2022 was conducted. First, univariate and multivariate logistic regression analyses were performed to determine the independent prognostic factors significantly associated with patient outcomes. Moreover, a predictive nomogram model underlying the prognostic factors was established and further evaluated. The area under the curve (AUC) was used to gauge the predictive accuracy. The calibration curve and decision curve analysis (DCA) were employed to assess the discriminability and clinical effectiveness, respectively.ResultsIn patients with HBV–ACLF, multivariate logistic analysis revealed that age ≥ 40 years (OR 6.76, p = 0.025), middle-stage liver failure (OR 49.96, p < 0.001), end-stage liver failure (OR 19.27, p = 0.002), hepatic encephalopathy (OR 7.06, p = 0.032), upper gastrointestinal hemorrhage (OR 47.24, p = 0.047), and artificial liver therapy consisting of plasma exchange (PE) + plasma exchange double plasma molecular adsorption system (DPMAS) (OR 0.26, p = 0.04) were identified as prognostic factors. Then, we established and evaluated a predictive nomogram with an AUC of 0.885, which showed better predictive accuracy than the model for end-stage liver disease (MELD) score (AUC of 0.634) and the Child–Pugh score (AUC of 0.611). Moreover, the calibration curve showed good agreement between the ideal and bias-corrected curves. Decision curve analysis confirmed the better clinical utility of this approach.ConclusionsWe developed and evaluated a unique nomogram that was more accurate than conventional prognostic models for predicting the clinical prognosis of HBV–ACLF patients receiving artificial liver therapy. As a result, the nomogram may be a helpful tool in clinical decision-making to predict the outcomes of patients with HBV–ACLF.

Elevated systemic inflammation response index is associated with poor outcomes in minor ischemic stroke.

Patients with minor ischemic stroke (MIS) have substantial disability rates at 90 days. Our study aimed to explore the association between the systemic inflammation response index (SIRI) and 3-month functional outcomes in patients with MIS. We conducted a prospective observational study in patients with MIS [defined as a National Institutes of Health Stroke Scale (NIHSS) score of 0-3] admitted within 24 h from symptoms onset. Blood samples for the SIRI measurement were collected on admission. The primary outcome measure was poor outcomes at 90 days (defined as a modified Rankin Scale score of 2-6). Univariate and multivariate logistic analyses were performed to assess the association between the SIRI and the risk of 3-month poor outcomes. A total of 152 patients with MIS were enrolled, of which 24 cases (15.8%) had poor outcomes at 90 days. The median SIRI level was 1.27 [interquartile range (IQR), 0.77-1.92, ×10^9 /L] on admission. MIS patients with poor outcomes had higher levels of the SIRI than patients with good outcomes (poor outcomes: median, 1.93, IQR: 1.17-3.28, ×10^9 /L; good outcomes: median, 1.21, IQR: 0.71-1.80, ×10^9 /L; p = 0.003). The high SIRI level group (SIRI >1.27 × 10^9 /L) had significantly higher rates of poor outcomes at 90 days (22.4% vs. 9.2%, p = 0.026). After adjusting for age, baseline NIHSS score, prehospital delay, Trial of Org 10,172 in Acute Stroke Treatment (TOAST) classification, and other confounders in multivariate analyses, an elevated SIRI level remained independently associated with an increased risk of poor outcomes in patients with MIS [odds ratio (OR): 1.57, 95% confidence interval (CI): 1.12-2.20; p = 0.010]. Meanwhile, a high level of the SIRI (>1.27 × 10^9/L) was still an independent risk factor for 3-month poor outcomes (OR: 4.80, 95%CI: 1.51-15.29; p = 0.008) in MIS patients. Disability at 90 days was common in patients with MIS. An elevated SIRI was associated with poor outcomes in MIS patients. The SIRI might be a promising biomarker candidate that can help identify high-risk MIS patients with poor outcomes for reaching individual therapeutic decisions in clinical trials.