Logistic Regression Model Analysis Research Articles

Exposure to air pollution and non-neoplastic digestive system diseases: findings from the China health and retirement longitudinal study

ObjectivesIncreasing concern about air pollution’s impact on public health underscores the need to understand its effects on non-neoplastic digestive system diseases (NNDSD). This study explores the link between air pollution and NNDSD in China.MethodsWe conducted a national cross-sectional study using 2015 data from the China Health and Retirement Longitudinal Study (CHARLS), involving 13,046 Chinese adults aged 45 and above from 28 provinces. Satellite-based spatiotemporal models estimated participants’ exposure to ambient particulate matter (3-year average). An analysis of logistic regression models was conducted to estimate the association between air pollutants [particulate matter with a diameter ≤ 2.5 μm (PM2.5) or ≤10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3), and carbon monoxide (CO)] and NNDSD. Interaction analyses were conducted to examine potential modifiers of these associations.ResultsThe prevalence of NNDSD among participants was 26.29%. After adjusted for multivariate factors, we observed a 6% [odd ratio (OR) = 1.06, 95% confidence interval (CI): 0.94, 1.19], 23% (OR = 1.23, 95% CI: 1.09, 1.38), 26% (OR = 1.26, 95% CI: 1.12, 1.41), 30% (OR = 1.30, 95% CI: 1.16, 1.46), 13% (OR = 1.13, 95% CI: 1.01, 1.27) and 27% (OR = 1.27, 95% CI: 1.13, 1.43) increase in NNDSD risk with an interquartile range increase in PM2.5 (23.36 μg/m3), PM10 (50.33 μg/m3), SO2 (17.27 μg/m3), NO2 (14.75 μg/m3), O3 (10.80 μg/m3), and CO (0.42 mg/m3), respectively. Interaction analyses showed that PM2.5, SO2, and O3 had stronger effects on NNDSD risk among older adults, highly educated individuals, smokers, and married people, respectively.ConclusionThis study demonstrates that long-term exposure to PM2.5, PM10, SO2, NO2, O3, and CO is positively associated with NNDSD risk in Chinese adults aged 45 and above. Implementing intervention strategies to enhance air quality is essential for reducing the burden of NNDSD.

Phase angle is a useful predicting indicator for protein-energy wasting and cardiovascular risk among maintenance hemodialysis patients.

Protein-energy wasting (PEW) is a major contributor to the high mortality among maintenance hemodialysis (MHD) patients. Cardiovascular disease (CVD) is the leading cause of death in dialysis patients, and PEW can significantly increase cardiovascular mortality in MHD patients. Previous studies have confirmed that PA may be a good objective indicator for determining the nutritional status and prognosis of MHD patients. Our study aimed to determine the predictive value of phase angle (PA) as detected by bioelectrical impedance analysis (BIA) on PEW and cardiovascular (CV) risk among MHD patients. Our retrospective observational study involved 161 adult patients with HD. The Cardiovascular risk score is a risk model based on the Japan Dialysis Outcome and Practice Patterns Study (J-DOPPS). We established LASSO logistic regression analysis model to identify key parameters related to body composition that can predict PEW in MHD patients. The area under the curve (AUC) values for PA, appendicular skeletal muscle mass index (ASMI), body cell mass (BCM), and mid-arm circumference (MAC) in predicting PEW in male MHD patients were relatively large, with 0.708, 0.674, 0.663, and 0.735, respectively. The predicted PEW values of these parameters were slightly lower in female patients than in men. We incorporated PA, ASMI, BCM, and MAC into a model that predicted the incidence of PEW in maintenance hemodialysis patients using LASSO technology. We discovered that the model predicted a greater AUC of PEW occurrence than any single factor, 0.877 for men and 0.76 for women. The results of the univariate logistic regression analysis showed that the low PA tertile array group had a greater incidence of PEW than the high PA group (P < 0.001). Additionally, we also found that lower PA was associated with higher CV risk scores. The PA detected by bioelectrical impedance analysis could predict the risk of PEW and cardiovascular events among patients with MHD. When used in conjunction, PA, ASMI, BCM, and MAC have a high diagnostic efficacy for PEW in patients on maintenance hemodialysis.

Dietary patterns and bone density among school-aged children: a cross-sectional study in China.

Diet is an essential modifiable determinant of bone health, yet the associations between dietary patterns (DPs) and bone mineral density (BMD) in Chinese children remain limited. This study aimed to investigate the relationship between overall diet and low BMD risk among school-aged children in China. A total of 1,099 children aged 9-12 in China were recruited for this cross-sectional study. A semi-quantified food frequency questionnaire (FFQ) was used to assess dietary intake. A priori numerical index, the Chinese Dietary Guidelines Index for Children and Adolescents [CDGI (2021)-C] was utilized to assess dietary quality. Specific DPs were identified by using principal components analysis (PCA). The BMD of the left forearm was assessed using dual-energy X-ray absorptiometry (DXA). Spearman correlation test was conducted to investigate the associations between DPs. Multivariate logistic regression analysis and restricted cubic spline models (RCS) were applied to explore the associations between DPs and BMD. Three distinct DPs were identified: the plant-animal balanced pattern, the grain-tuber-meat pattern, and the bean-dairy pattern. We found a weak but significant positive correlation of the CDGI (2021)-C with the plant-animal balanced pattern (R = 0.318, P < 0.001), and with the bean-dairy pattern (R = 0.266, P < 0.001), respectively. After adjusting for covariates, adherence to the CDGI (2021)-C (Q4 vs. Q1, OR = 0.45, 95% CI: 0.27-0.75), the plant-animal balanced pattern (Q4 vs. Q1, OR = 0.50, 95% CI: 0.31-0.81), and the bean-dairy pattern (Q3 vs. Q1, OR = 0.57, 95% CI: 0.33-0.96) were associated with a lower risk of low BMD. No significant association was observed between the grain-tuber-meat pattern and low BMD (Q4 vs. Q1, OR = 1.09; 95% CI: 0.90-1.31). Adherence to the CDGI (2021)-C and the plant-animal balanced pattern is advantageous for bone health and inversely correlated with the risk of low BMD among school-aged children in China. Additionally, moderate adherence to the bean-dairy pattern may also confer benefits to bone health. A balanced and overall healthy diet should be recommended in our daily life.

Clinical efficacy and its influencing factors of ustekinumab in the treatment of patients with Crohn's disease

To analyze the clinical efficacy and its influencing factors of ustekinumab (UST) in the treatment of patients with Crohn's disease (CD). From January 2021 to January 2024, CD patients who received UST treatment were retrospectively collected from the Second Affiliated Hospital of Wenzhou Medical University. Harvey-Bradshaw index were applied to assess clinical activity of CD patients, C-reactive protein was used to evaluate biochemical remission rate, and simplified Crohn's disease endoscopy score was used to evaluate the degree of intestinal inflammation. Logistic regression model was used to analyze the influencing factors for the clinical response rate at week 8, as well as the clinical remission rate and endoscopic remission rate at week 32. A total of 138 CD patients were included, including 93 males and 45 females. The age of diagnosis [M (Q1, Q3)] was 24 (19, 32) years old. At week 8, the clinical response rate and biochemical remission rate was 58.0% and 49.3%, respectively. Multivariate logistic regression model analysis showed that disease behavior (stenosis or penetration) was the risk factor of the clinical response rate at week 8 (OR=0.46, 95%CI: 0.23-0.95). The clinical remission rate and endoscopic remission rate at week 32 were 56.5% and 37.7%, respectively. Multivariate logistic regression model analysis showed that disease behavior (stenosis or penetration) was the risk factor of the clinical remission rates (OR=0.18, 95%CI: 0.08-0.42) and endoscopic remission rates (OR=0.25, 95%CI: 0.11-0.55) at week 32. Failure to achieve clinical response at week 8 was the risk factor of the clinical remission rates (OR=0.21, 95%CI: 0.09-0.52) and endoscopic remission rates (OR=0.19, 95%CI: 0.07-0.50) at week 32. UST treatment has good clinical efficacy in CD patients. CD patients with intestinal stenosis or penetrating lesions can decrease the efficacy of UST treatment. Failure to achieve clinical response at week 8 can decrease the efficacy at week 32.

Critical risk factors analysis of infection-associated hemophagocytic lymphohistiocytosis in children.

To analyze the critical factors of infection-associated Hemophagocytic lymphohistiocytosis (HLH) in children, so as to provide theoretical basis for clinicians to evaluate the disease condition, formulate treatment plan and improve prognosis.This study is a retrospective analysis. 60 cases of children with infection-associated HLH were divided into critical and non-critical groups based on the presence of multiple organ dysfunction syndrome (MODS), and the clinical characteristics and laboratory data of the two groups of children were analyzed. A multifactor logistic regression analysis model was used to assess the independent risk factors affecting critical illness in children with infection-associated HLH, and the Receiver Operating Characteristic (ROC) curve analysis was used to evaluate the predictive value of risk factors for critical illness in children with infection-associated HLH. Children in the critical group with HLH had a younger age at onset. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), gamma-glutamyl transferase (GGT), D-dimer (DD), and triglycerides (TG) were significantly higher in the critical group, while albumin (ALB) was significantly lower, showing statistical significance (P < 0.05). Multifactorial logistic regression analysis of age, ALB, and TG showed that younger age and lower ALB were associated with a higher risk of MODS in children with infection-associated HLH, with age and ALB being independent risk factors for critical illness. ALB predicted the ROC area under the curve for critical children with infection-associated HLH was 0.765 (95% CI: 0.643-0.888, P = 0.011), with the optimal cut-off value being 32.50g/L (sensitivity = 68.3%, specificity = 84.2%); age predicted the ROC area under the curve for critical children with infection-associated HLH was 0.711 (95% CI: 0.570-0.851, P = 0.009), with the optimal cut-off value being 1.50 years (sensitivity = 70.7%, specificity = 68.4%). This study suggests that younger patients and those with hypoalbuminemia among infection-related HLH patients are more likely to develop MODS. In the future, verification will be required through large-scale, multi-center studies.

Temporal Trends in Single- and Multiple-Sports Team Participation Among Adolescents in the United States: Analysis Using the Youth Risk Behavior Surveillance System, 1999-2019.

It is unclear how levels of sport participation have changed among adolescents in the United States (US) in recent years, particularly considering evidence of increasing sport professionalization and attrition. To evaluate the differences and trends in single- and multiple-team sport participation among US high school students between 1999 and 2019. Descriptive epidemiology study. Using the Youth Risk Behavior Surveillance System of the US Centers for Disease Control and Prevention, a biannual representative survey of US high school students, data on self-reported sport participation (no participation, single team, multiple teams) within the previous year were evaluated. Differences in sport participation prevalence between 1999 and 2019 were assessed in sex strata by grade, race/ethnicity, and US region. Weighted trends using the National Center for Health Statistics Guidelines for Analysis of Trends and logistic regression models were employed for analyses. The study sample over the 20-year period (N = 149,404) was 49.8% female; the majority were in ninth grade (27.7% female, 28.7% male), were non-Hispanic White (56.1% female, 56.8% male), and resided in the Southern US (57.6% female, 57.4% male). Among girls, 27.2% (95% CI, 25.8-28.6) reported multiple sports team participation in 1999, while 21.3% (95% CI, 20.1-22.6) reported the same in 2019. Among boys, 39.5% (95% CI, 38.4-40.7) reported multiple sports team participation in 1999 versus 29.1% (95% CI, 27.7-30.6) in 2019. Analyses of trends indicated that girls experienced increasing trends in single-sport team participation (β = 0.04, SE = 0.01, P < .001). Among boys, there were increasing trends in no sport participation (β = 0.06, SE = 0.01, P < .001), while multiple-sport team participation decreased over the 20-year period (β = -0.10, SE = 0.01, P < .001). Disparities in trends were observed among female and male groups by race/ethnicity, grade, and region. Sport participation over a 20-year period in the US decreased significantly for boys and increased for single-sports teams among girls. Sport specialization may be contributing some of the observed trends, though limitations in the data require additional research to confirm these hypotheses. Tailored efforts to increase sport participation among both sexes is needed.

Mediating Effect of Physical Activity on The Relationship between High Dietary Live Microbe Intake and Obesity among U.S Adolescents, Finding from NHANES 1999-2018

Background and AimsThe impact of dietary live microbe intake on adolescent obesity is still not fully understood. This study aims to investigate the potential relationship between dietary live microbe intake and obesity among U.S. adolescents, and to explore the mediating role of physical activity (PA). Methods and ResultsData from NHANES (1999-2018) were analyzed, and dietary live microbe intake was categorized into low, medium, and high groups using a developed framework. Survey-weighted logistic regression and mediation analysis models were used to examine the association between live microbe intake and adolescent obesity, as well as the potential mediating effect of PA. Our study included 8,443 participants aged 6-18, representing the noninstitutionalized U.S population of 184.5 million. We found that participants with a high dietary intake of live microbes had lower odds of developing obesity compared to those with the lowest exposure to live microbes (AOR = 0.900, 95% CI: 0.812, 0.997). Additionally, our mediation analysis revealed a significant indirect effect of live microbes on obesity risk through physical activity (P-value < 0.001), with 39.4% (95% CI: 24.5%, 86.5%) of the effect mediated by PA. ConclusionOur study highlights the association between consuming a higher amount of live microbes in the diet and a decreased risk of obesity among U.S adolescents. It also suggests that PA may act as a mediator in this relationship. Therefore, it is crucial to emphasize the incorporation of both dietary interventions and PA in the development of prevention and therapy policies for managing adolescent obesity.

Prevalence of Salmonella Typhi, its associated factors and antimicrobial susceptibility profile among patients attending Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia

IntroductionSalmonella Typhi infections cause significant morbidity and mortality worldwide, especially in developing countries including Ethiopia. This study aimed to determine the prevalence of Salmonella Typhi, its associated factors and antibiotic susceptibility profile among suspected typhoid patients.MethodsA cross-sectional study was conducted on 270 typhoid fever suspected patients at Hawassa University Comprehensive Specialized Hospital from June 2022 to September 2022. Data were collected using questionnaires by face-to-face interview. Stool samples for microbiological culture, blood samples for S. Typhi IgM/Entero-check WB rapid test and isolates for antimicrobial susceptibility tests were used through standard procedures and according to the reagents manufactures’ instructions. Hygiene implementation of patients was also assessed using interview. Sociodemographic and clinical characteristics of the patient’s were considered. Descriptive statistics were used to summarize the data, and logistic regression model analysis was performed to assess associations between S. Typhi infection and the associated sociodemographic and clinical factors.ResultsThe prevalence of S. Typhi IgM/Entero-check WB rapid test and stool culture results were 3.3%; (95% CI: 1.5–5.6) and 3.7%; (95% CI: 1.9–6.3) respectively. Not washing hands after latrine [AOR = 0.85, 95% CI (0.15–4.79), p = 0.05] is not significant but, not washing hands before meal [AOR = 0.053, 95% CI (0.08–0.36), p = 0.03], eating raw vegetables [AOR = 0.024, 95% CI (0.001–0.48), p = 0.015] and drinking water from a stream [AOR = 0.12, 95% CI (0.19–0.70), p = 0.001] were significantly associated with S. Typhi infection, but in terms of AOR, all are preventive. Susceptibility of isolates was 9/10 (90%), 8/10 (80%), and 8/10 (80%) to ciprofloxacin, ceftriaxone, and chloramphenicol, respectively. The majorities 100% and 80% of the isolates were resistant to ampicillin and cotrimoxazole, respectively. About 40% of the isolates were MDR.ConclusionThe prevalence of Salmonella Typhi with MDR has been observed. Therefore, health programmers and stakeholders should make efforts to improve the habit of sanitation, strengthen the capacity of laboratory diagnostic methods and increase awareness of the misprescription and misuse of antibiotics to reduce the impact of MDR bacteria.

Comparative Analysis of Decision Tree and Logistic Regression Models in Employee Recruitment and Selection for Enterprise Success

Enterprise success is determined by competent Human Resources (HR). The recruitment and selection process of employee candidates plays an important role in producing competent human resources as an effective initial selection increases the chances of finding the right candidate for a particular role. This research predicts the likelihood of a candidate being further selected in the interview phase based on behavioral and functional recruitment and selection which are important aspects of a candidate's potential fit and contribution to the enterprise. The research uses a comparison of decision tree analysis models and logistic regression to make predictions with several measurement metrics to see the accuracy and confusion matrix of each model used. Based on evaluation and validation, the decision tree analysis model is superior in prediction even though the results tend to be the same as the logistic regression model. The accuracy value of the classification using the decision tree model was 86.67% with correct prediction results of 78 data from 90 testing data and the accuracy value of the logistic regression model was 85.55% with correct prediction results of 77 data from 90 testing data. The results of the comparison of the two models show that the performance of the decision tree classifier model tends to be better.

A classification system for identifying persons with an unknown cardiovascular disease (CVD) status for a multiracial/ ethnic Caribbean population.

The need for classification systems for cardiovascular disease (CVD) that is population-specific is important towards understanding the clinical disease and diagnostics associated with the disease. This paper presents the form and validation results of this classification system. The survey data used was captured from 778 participants, 526 persons with no prior CVD, and 252 who reported prior CVD. Binomial logistic regression and Discriminant analysis were utilised to develop classification models. This classification system provided a general measure of severity of disease by utilising scores estimated from two algorithms developed from 13 routine physiologic measurements, along with demographic information of age and ethnicity, inter alia, and previous health status. For each model, specific score ranges were identified, which gave the best classification for those with a prior CVD incident (higher scores) and for others labelled as non-CVD (lower scores). The two classification models (Logistic Regression Model and Discriminant Analysis Model) developed had high area under the receiver-operating characteristic (AUROC) values (98% & 99%) and sensitivity (86 and 90%), which improved discrimination between Non-CVD and CVD participants and, more importantly, correctly classified a greater proportion of CVD participants. New to this type of research was the estimation and detailed evaluation of a range of scores, labelled non-differentiating, which fell in the middle of the spectrum and which contained the higher-end scores for the non-CVD individuals and the lower-end scores for CVD patients, all of whom were incorrectly classified, based on their prior history. The classification system of scores is able to differentiate the CVD status of individuals, with good predictability, and could assist physicians with recommending different treatment plans. The two models in this classification system each individually outperformed the three established models in terms of the strength of their correct classifications of individuals with or without prior reported CVD incidents. More importantly, they have smaller non-differentiating ranges than the three known models and, in that range, the two new models have lower CVD/non-CVD ratios suggesting they are more likely to misclassify non-CVD individuals compared to CVD patients, which is a more benign misclassification. Further, when used in combination, the two models increased the sensitivity, in classifying individuals of different ethnicities, beyond that of either one used independently or of any of the three standard European/North American models. These efforts will be instrumental in advancing personalised CVD management strategies and improving health outcomes across diverse populations.

New-generation tetracyclines for severe macrolide-resistant Mycoplasma pneumoniae pneumonia in children: a retrospective analysis

BackgroundMacrolide-resistant Mycoplasma pneumoniae (MRMP) strains are increasingly prevalent, leading to a rise in severe Mycoplasma pneumoniae pneumonia incidence annually, which poses a significant threat to children’s health. This study aimed to compare the effectiveness and safety of oral minocycline and doxycycline for the treatment of severe MRMP pneumonia in children.MethodsThis retrospective analysis included children treated for severe MRMP pneumonia at the Pediatric Department of Tongji Hospital, Shanghai, China, between September 2023 and January 2024 using minocycline and doxycycline. The patients were divided into four groups according to treatment: oral doxycycline alone (DOX group), oral minocycline alone (MIN group), oral doxycycline with intravenous glucocorticoids (DOXG group), and oral minocycline with intravenous glucocorticoids (MING group). Student’s t-test, Mann–Whitney U test, and χ2 or Fisher’s exact tests were used for group comparisons.ResultsA total of 165 patients were included in this study: 84 received minocycline, and 81 received doxycycline. The DOX group had higher fever resolution rates within 24, 48, and 72 h compared to the MIN group (63.2% vs. 31.8%, 79.0% vs. 63.6%, and 100% vs. 90.9%, respectively; all p < 0.05). The DOXG group showed higher fever resolution rates within 24 and 48 h than the MING group (92.3% vs. 83.4%, 100% vs. 92.7%, all p > 0.05). There were no statistically significant differences in time to imaging improvement, cough improvement, and disappearance of wet rales between groups, regardless of glucocorticoid combination. The longer the duration of fever prior to tetracycline therapy, the greater the likelihood of hypoxemia (p = 0.039) and a greater than two-fold elevation in the D-dimer level (p = 0.004).Univariate binary logistic regression model analysis revealed that CRP and erythrocyte sedimentation rate at disease onset were associated with defervescence within 24 h after treatment with tetracyclines alone (p = 0.020, p = 0.027), with erythrocyte sedimentation rate also influencing defervescence within 48 h (p = 0.022).ConclusionDoxycycline treatment resulted in a higher rate of defervescence than minocycline. Prompt treatment reduced the probability of pleural effusion, hypoxemia, pulmonary atelectasis, and D-dimer levels > 2 times the reference value.

Association of dietary patterns with serum uric acid and hyperuricemia in Chinese adults

Objective: To analyze the dietary patterns of Chinese adults and explore the relationship with serum uric acid (SUA) and hyperuricemia (HUA). Methods: A total of 9 358 adults were selected in the 2018 China Health and Nutrition Survey. Dietary intake data were collected by three consecutive 24-hour dietary recalls and weighing method. The social demographic information of the survey subjects was obtained through questionnaire surveys. The dietary patterns were extracted using factor analysis, and the relationship between dietary patterns and SUA was analyzed using multiple linear regression analysis. The correlation between HUA and dietary patterns was analyzed using logistic regression analysis models. Results: Four dietary patterns were identified: northern (high intakes of wheat, other cereals,and tubers); modern (high intakes of fruit, dairy, eggs, and nuts); southern (high intakes of rice and vegetables);animal food-wine (high intake of organ meats, seafood, and wine). The multiple linear regression analysis results showed that the northern pattern was negatively correlated with SUA (β=-0.438, 95%CI: -0.500--0.376); the modern pattern was negatively correlated with SUA (β=-0.134, 95%CI: -0.219--0.049); the southern model was significantly correlated with higher SUA (β=0.146, 95%CI: 0.079-0.214); the animal food-wine pattern was positively correlated with SUA (β=0.188, 95%CI: 0.123-0.252). Logistic regression analysis showed that compared with the northern model score Q1 group, the risk of developing HUA was reduced in Q3 and Q4 groups, with ORs values of 0.777 (95%CI: 0.650-0.929) and 0.509 (95%CI: 0.423-0.613), respectively; and compared with the modern model score Q1 group, the higher the scores in Q3 and Q4 groups, the HUA was lower, with ORs of 0.793 (95%CI: 0.660-0.953) and 0.768 (95%CI: 0.631-0.934), respectively. Compared with the animal food-wine pattern score Q1 group, the risk of developing HUA was increased in both Q3 and Q4 groups (Q3 group: OR=1.224, 95%CI: 1.012-1.480; Q4 group: OR=1.312, 95%CI: 1.086-1.584). Conclusions: Dietary patterns are associated with HUA. The northern and modern patterns are related to lower SUA levels and reduced risk of HUA, while the animal food-wine pattern increases the risk of HUA.

The Association between Fatty Liver Index and Lower Limb Arterial Calcification in Patients with Type 2 Diabetes Mellitus.

Peripheral arterial calcification is a prevalent condition in patients with type 2 diabetes mellitus (T2DM), resulting in lower-limb amputation and reduced life quality. Non-alcoholic fatty liver disease (NAFLD), which can be simply evaluated using the fatty liver index (FLI), is closely associated with T2DM development. In this study, we aimed to explore the relationship between FLI and lower limb arterial calcification (LLAC) in T2DM patients and to reveal the value of T2DM patients with NAFLD in predicting the occurrence of LLAC. A total of 77 T2DM patients with LLAC who underwent comprehensive physical and health examinations, serological examinations, as well as lower limb computed tomography imaging at Sun Yat-sen Memorial Hospital of Sun Yat-sen University between January 2018 and January 2019 were enrolled in this study. The FLI was calculated using body mass index, waist circumference, triglycerides, and γ-glutamyl transferase. Additionally, LLAC was evaluated using computed tomography with the Agatston scoring algorithm. The patients were divided into three groups based on their FLI values: Non-liver disease group (FLI <30, n = 29), borderline-liver disease group (30 ≤ FLI < 60, n = 32), and NAFLD group (FLI ≥60, n = 16). Univariate and multivariate binary logistic regression analyses were employed to investigate the association between FLI and LLAC in T2DM patients. Furthermore, differences in LLAC among groups were analyzed using post-hoc multiple comparisons and ordinal logistic regression model analysis. Univariate and multivariate analyses showed that age and FLI influenced LLAC severity in T2DM patients. Moreover, T2DM patients in the NAFLD group had significantly lower LLAC scores than those in the Non-liver disease group. The correlation analysis showed that FLI was negatively associated with LLAC scores (R = -0.31, p = 0.006), while age was positively associated (R = 0.361, p = 0.001). Our study revealed an inverse relationship between FLI and the degree of LLAC. This indicates that, based on evidence in the current research, NAFLD may not be reliable as a predictor of LLAC in T2DM patients.

The characteristics of pediatric primary retroperitoneal teratoma and the influencing factors of perioperative complications

To explore the characteristics of pediatric primary retroperitoneal teratoma and the influencing factors of perioperative complications. The clinical data, imaging data, pathology results, perioperative complications, etc of patients with primary retroperitoneal teratoma admitted and treated at Shanxi Children's Hospital from March 2013 to September 2023 were retrospectively analyzed. The patients were divided into no complication group and complication group according to whether there were perioperative complications. The differences between the two groups were compared, and the influencing factors of complications were analyzed by multivariate logistic regression model. A total of 33 patients were included in this study, including 7 males and 26 females, with an age of [M (Q1, Q3), 9.0 (4.0, 24.0)] months. Nineteen cases had tumors located in the left upper abdomen and 14 cases in the right upper abdomen, among which 17 cases grew across the midline, with the maximum tumor diameter of (12.9±4.5) cm. All patients had anatomical displacement of retroperitoneal vessels and organs: the number of anatomical displaced arteries was 3 (3, 4), the number of anatomical displaced veins was 4 (3, 5), the number of anatomical displaced organs was 5 (4, 6). Pathologic examination revealed 28 mature teratomas (Grade 0 and Grade 1) and 5 immature teratomas (Grade 2 and Grade 3). There were 18 cases in no complication group and 15 cases in the complication group. The incidence of perioperative complications was 45.5% (15/33). The number of tumors crossing the midline (6/18 vs 11/15, P=0.037), the number of tumors adhering closely to the surrounding tissues (7/18 vs 12/15, P=0.033), the number of anatomical displaced veins [4 (3, 4) vs 5 (4, 5), P=0.001], and the number of anatomical displaced organs [4 (3, 5) vs 6 (5, 6), P=0.001] were significantly different between the two groups. Multivariate logistic regression model analysis showed that the number of anatomical displaced organs (OR=8.781, 95%CI: 2.155-35.784, P=0.002) was the influencing factor for perioperative complications of pediatric primary retroperitoneal teratoma.

Long-term efficacy of mepolizumab in patients with eosinophilic granulomatosis with polyangiitis: a propensity score matching analysis in the multicenter REVEAL cohort study.

Mepolizumab (MPZ) has demonstrated efficacy in clinical trials for eosinophilic granulomatosis with polyangiitis (EGPA); however, few studies compare the disease course between patients treated with MPZ (MPZ group) and those who were not treated with MPZ (non-MPZ group) in real-world settings. This study aimed to compare the disease course and outcomes between the two groups and assess the long-term efficacy of MPZ in a multicenter cohort in Japan. Methods: We enrolled 113 EGPA patients registered in the cohort until June 2023. Data on clinical characteristics, disease activity, organ damage, treatments, and outcomes were retrospectively collected. To minimize potential confounding factors, we conducted propensity score matching (PSM). After PSM, 37 pairs of matched patients were identified. Clinical characteristics, including age at disease onset, sex, disease duration at last observation, antineutrophil cytoplasmic antibody positivity at disease onset, Birmingham Vasculitis Activity Score (BVAS) at disease onset, and Five-factor score at disease onset, were comparable between the groups. The median BVAS at the last observation was 0 in both groups; however, more cases in the non-MPZ group exhibited elevated BVAS, resulting in a significantly higher BVAS in the non-MPZ group at the last observation (median; MPZ group: 0, non-MPZ group: 0, p=0.028). The MPZ group had significantly lower glucocorticoid (GC) doses at the last observation (median; MPZ group: 4 mg/day, non-MPZ group: 5 mg/day, p=0.011), with a higher proportion achieving a GC dose ≤ 4 mg/day at the last observation (MPZ group: 51.4%, non-MPZ group: 24.2%, p=0.027). Three models of multivariable logistic regression analyses were performed to identify factors associated with GC doses ≤ 4 mg/day at the last observation. In all models, achieving a GC dose ≤ 4 mg/day was positively associated with MPZ administration and inversely associated with asthma at disease onset. Finally, we evaluated the survival rates between the groups, and the 5-year survival rates were significantly higher in the MPZ group compared to the non-MPZ group (MPZ group: 100%, non-MPZ group: 81.3%, p=0.012). Mepolizumab not only contributes to disease activity control but also reduces the GC dose, which may lead to improved survival in EGPA patients.

Prevalence of and Risk Factors for Hearing Impairment in Craniofacial Microsomia

BackgroundWhile ear anomalies and hearing impairment are common in patients with craniofacial microsomia (CFM), their prevalence, characteristics, and relationship to speech-language development remain unclear. PurposeThis study analyzed the prevalence and risk factors for hearing impairment in patients with CFM. Study Design, Setting, SampleThis retrospective cohort study included patients with unilateral or bilateral CFM from a single center between January 1980 and July 2023 who had evidence of a hearing assessment at <18 years. Exclusion criteria were inconclusive CFM diagnosis by clinical examination and/or radiographs or incomplete medical records. Predictor VariablesThe predictor variables included presence or absence of cleft lip and/or palate, laterality of CFM, and external ear and mandibular anomaly scores measured using the Orbit, Mandible, Ear, Nerve, and Soft Tissue (OMENS) and Pruzansky-Kaban classifications. Main Outcome VariablesPrimary outcome variable was hearing impairment, measured through air and bone conduction audiometry and categorized by type, severity, and side. Secondary outcome variable was speech-language delay, evaluated through assessments of expressive and receptive language skills, vocabulary, speech intelligibility, general articulation, and phonological speech. CovariatesThe covariates included sex and age at first hearing assessment. AnalysesLogistic regression models were used to analyze the effect of predictors on outcomes. P-value <0.05 was considered significant. ResultsThe sample included 213 patients (61.5% male). Hearing assessments were performed at a mean age of 4.6 ± 4.8 years. Hearing impairment was found in 183 (85.9%) and was predominantly conductive (n=130, 91.5%). Of subjects with hearing impairment, 158 (86.3%) had external ear anomalies (P<0.001). In patients with unilateral CFM, 38 (21.8%) had bilateral hearing loss and 9 (5.2%) had contralateral-only hearing loss. Both M3 and E3 scores were associated with the presence and severity of hearing loss (P=0.01 and P<0.001, respectively). There was no significant association between hearing impairment and speech-language development (P>0.05). Conclusion and RelevanceAlthough the severity of mandibular and external ear anomalies was significantly associated with the prevalence and severity of hearing loss, clinicians should remain alert for concomitant or isolated contralateral hearing loss, given the high prevalence of hearing loss in ears without ipsilateral facial involvement or external abnormalities.

Factor associated with postoperative complications of inguinal lymph node dissection for penile cancer Test

Background: Inguinal lymph node dissection (ILND) is the standard of care for palpable, biopsy-proven lymph node metastases or high-risk groups for nonpalpable lymph nodes in the treatment of penile cancer. ILND is associated with a significant incidence of complications and adverse events, specifically wound complications. Few studies have identified risk factors related to postoperative ILND complications. Objective: The objective of this study was to assess the prevalence of 30-day postoperative complications and to identify risk factors associated with postoperative complications of ILND for penile cancer. Materials and Methods: This was a retrospective review of medical records for all patients who had ILND for penile cancer between January 2012 and December 2022. According to the modified Clavien–Dindo classification, the 30-day postoperative complications were collected. Using an ordinal univariate logistic regression model and multivariate analysis, potential risk variables for complications were determined. Results: A total of 60 patients were performed ILND. Sixty percent of the patients had a postoperative complication including wound infection 50%, wound dehiscence 36.7%, skin necrosis 26.6%, lymphocele 33.3%, leg edema 46.7%, and scrotal edema 16.7%. Higher grade of modified Clavien–Dindo classification was associated with body mass index (BMI) (odds ratio [OR] = 1.15; P = 0.03), diabetes mellitus (OR = 3.13; P = 0.04), American Society of Anesthesiologist classification ≥3 (OR = 1.14; P = 0.03), radical ILND (OR = 1.57; P = 0.01), and bilateral ILND (OR = 1.60; P = 0.02). In multivariate analysis, a higher grade of modified Clavien–Dindo classification was correlated with BMI (OR = 1.48; P = 0.01) and bilateral ILND (OR = 4.56; P = 0.01). Conclusion: ILND is associated with high rates of complication. The severity of the modified Clavien–Dindo classification was associated with BMI and bilateral ILND.

Idiopathic cervical abscesses in dogs follow seasonal trends and geographic risk factors, predominantly affecting young, large breeds: a case-control study of 67 dogs in New England.

Describe and identify risk factors and spatiotemporal trends associated with the development of idiopathic cervical abscesses (CAs) in dogs in the Cape Cod region. The authors hypothesized that CAs without an external communicating tract would have a seasonal trend and would not be associated with identifiable foreign material. 67 dogs. Retrospective observational case-control study enrolling dogs between 2016 and 2020. Compiled patient information included age, breed, sex, weight, date of presentation, and ZIP code. Statistical evaluation was performed by use of multivariate logistic regression modeling and spatiotemporal analyses with government-compiled land cover data. Control dogs were randomly selected in a 3:1 ratio to cases. 67 cases were investigated. The final multivariable logistic regression model found a significant seasonal effect, with most cases in September (OR, 4.80; 95% CI, 1.91 to 12.02). Spatial analyses revealed increased risk in a cluster of 13 ZIP codes, with OR of 4.40 (95% CI, 1.95 to 9.95). Weight was a risk factor; each additional kilogram was associated with an 18.8% increase in odds (OR, 1.188; 95% CI, 1.053 to 1.341) until a maximum risk at 15 kg. Younger dogs were at greater odds; for each additional year of age, the odds of having CAs were reduced by 8.9% (OR, 0.911; 95% CI, 0.837 to 0.991). No foreign material inciting cause was identified in any of the 67 cases. Idiopathic CAs should be a differential for young, large-breed dogs with cervical swelling in the Northeastern US. This study documented seasonality, geographical trends, and signalment predispositions for idiopathic CAs.

Characteristics of altered biventricular hemodynamics after arterial switch operation for patients with d-transposition of the great arteries with preserved ejection fraction: a four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) study.

The long-term monitoring of biventricular function is essential to identify potential functional decline in patients following the arterial switch operation (ASO). The underlying pathophysiological mechanisms responsible for altered biventricular hemodynamics in ASO patients are not yet well understood. This study sought to: (I) compare the biventricular kinetic energy (KE) and vorticity of ASO patients and age- and sex-matched controls; (II) investigate the associations of four-dimensional (4D) flow biventricular hemodynamics parameters and neo-aortic root dilation, supravalvular pulmonary stenosis, and pulmonary artery transvalvular pressure difference. A total of 34 patients with dextro-transposition of the great arteries (D-TGA) who underwent ASO, and 17 age- and gender-matched healthy controls were prospectively recruited for this study. All the subjects underwent cine and 4D flow and late gadolinium enhancement scans, and all the patients underwent echocardiography within two weeks of cardiovascular magnetic resonance (CMR) imaging. The following four flow components were analyzed: direct flow, retained inflow, delayed ejection flow, and residual volume. In addition, the following six phasic blood flow KE parameters, normalized to the end-diastolic volume (EDV) and vorticity, were analyzed for both the left ventricle (LV) and right ventricle (RV): peak systolic phase, average systolic phase, peak diastolic phase, average diastolic phase, peak E-wave phase, and peak A-wave phase. The independent sample Student's t-test, Mann-Whitney U-test, univariable and multivariable stepwise regression analyses, intra and inter-observer variability analyses were used to compare patients and controls. In relation to the LV, the D-TGA patients had significantly decreased average vorticity, peak systolic vorticity, systolic vorticity, diastolic vorticity, and peak A-wave vorticity compared to the controls (all P<0.01). In relation to the RV, the pulmonary stenosis group had significantly increased peak E- and A-wave kinetic energy normalized to the end-diastolic volume (KEiEDV), and peak and average vorticity compared to the non-pulmonary stenosis group (all P<0.05). in the multivariable logistic regression model analysis, diastolic KEiEDV, peak E-wave KEiEDV peak A-wave KEiEDV, and average vorticity were associated a with transvalvular pressure difference (β=13.54, P<0.001 for diastolic KEiEDV; β=105.26, P<0.001 for peak E-wave KEiEDV; β=-49.36, P=0.027 for peak A-wave KEiEDV; and β=-56.37, P<0.001 for average vorticity). We found that 4D flow biventricular hemodynamics were more sensitive markers than the ejection fraction in the postoperative D-TGA patients. The RV diastolic KEiEDV parameters and average vorticity were risk factors for pulmonary artery obstruction in the multivariable model.

Impact of serum cholinesterase on calcified nodules in patients with stable coronary artery disease.

Calcified nodules (CNs) are an advanced stage of coronary calcification that can have significant clinical implications. We investigated factors associated with CNs, the etiology of which is not fully understood. We retrospectively evaluated 619 patients with stable coronary artery disease who underwent intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI). CNs in the culprit lesion were evaluated via IVUS, and all-cause mortality and major cardiovascular and cerebrovascular events (MACCEs) were compared between the CN and non-CN groups. The CN group (n = 40 patients) had a significantly lower survival rate and a higher incidence of MACCE than the non-CN group (P = 0.020 and P < 0.001, respectively). Multivariate logistic regression analysis models revealed that chronic kidney disease and serum cholinesterase (ChE) level were associated with CN formation [odds ratio (OR): 3.15, 95% confidence interval (CI): 1.30-7.69, P = 0.001 and OR: 0.94, 95% CI: 0.88-0.99, P = 0.042]. The optimal cutoff of serum ChE level as per the receiver operating characteristic curve was 309 units/l (Area under the curve = 0.67, sensitivity = 93%, specificity = 40%, P = 0.001). The low-ChE group divided according to the optimal cutoff value showed significantly higher cumulative incidence of MACCEs after PCI than the high-ChE group as per Kaplan-Meier analysis. The presence of CNs is significantly associated with a poor prognosis and MACCE after PCI among patients with stable coronary artery disease. Serum ChE levels may affect CN formation.