Major Independent Factor Research Articles

Adenovirus (ADV) Infection In Pediatric Allogeneic Stem Cell Transplantation (AlloSCT) Recipients Is A Major Independent Factor For Significantly Increasing The Risk Of Treatment Related Mortality

Summary Adenovirus infection is a significant complication in paediatric AlloSCT recipients with a mortality rate for disseminated adenovirus that may exceed 80%. We sought to determine the incidence, risk factors, and associated outcomes of adenovirus infection in 123 consecutive paediatric AlloSCT recipients. Adenovirus was diagnosed by antigen detection or viral culture, and was defined by isolation of virus with presence of correlating clinical symptoms. The probability of developing adenovirus infection was 12AE3% (CI95 6AE0‐18AE6). There were no statistically significant differences in probability of adenovirus infection in univariate analysis of risk factors including donor source, use of ATG/Alemtuzumab, ‡Grade II GVHD, among others (age, diagnosis, conditioning regimen). Probability of overall survival for patients that experienced adenovirus infection was 15AE4% vs. 50% for those without adenovirus (P =0 AE0286). In multivariate analysis, the most important risk factor for an increased risk of death was adenovirus infection [HR 3AE15 (CI95 1AE6‐6AE18) P =0 AE0009]. In this series of paediatric AlloSCT recipients, the development of adenovirus infection was the leading multivariate predictor of treatment-related mortality. Enhanced surveillance with adenovirus PCR and identification of the risk factors associated with poor outcomes from adenovirus infection may identify patients that may benefit from pre-emptive therapeutic interventions including adenovirusspecific cellular immunotherapies.

Migraine Predicts Self-Reported Muscle Tension in Patients With Major Depressive Disorder

The aim of this study was to identify factors related to muscle tension in patients with major depressive disorder (MDD) with comorbid anxiety and migraine. Consecutive psychiatric outpatients with MDD were enrolled. Self-reported muscle tension (SMT) during the previous week was evaluated with a 0-10 scale. Of 135 participants with MDD, 63 (46.7%) had migraine. Multiple-regression analyses showed that migraine and headache intensity were two major independent factors related to SMT. Further studies on musculoskeletal symptoms in MDD should not neglect the impact of migraine.

Land use effects in groundwater composition of an alluvial aquifer (Trussu River, Brazil) by multivariate techniques

Multivariate statistical techniques, cluster analysis (CA) and factor analysis/principal component analysis (FA/PCA), were applied to analyze the similarities or dissimilarities among the sampling sites to identify spatial and temporal variations in water quality and sources of contamination (natural and anthropogenic). The aquifer under study is supplied by the Trussu River, which has a general direction from west to east, within Iguatu County, Ceará, Brazil. Groundwater samples were collected in four shallow wells, located at the Trussu River alluvial, from October 2002 to February 2004. The samples were analyzed for 13 parameters: pH, electrical conductivity (EC), Na, Ca, Mg, K, Cl, HCO 3, PO 4, NH 4–N, NO 3–N, SO 4, and sodium adsorption ratio (SAR). Two zones were very well differentiated based on cluster analysis results, and implied a relation to geographic position and time variation. One zone called UL—upland region—corresponds to upland of studied area, used mainly for irrigation and livestock activities. The other zone called DL—downland region—corresponds to the region downstream and is occupied by human settlements. These results may be used to reduce the number of samples analyzed both in space and time, without too much loss of information. Three major independent factors that define water quality in the UL region and four in DL region were identified in the PCA. At both regions, rotated component (RC) loadings identified that the variables responsible for water quality composition are mainly related to soluble salts variables (natural process) and nutrients (high loads of NO 3–N, NH 4–N), expressing anthropogenic activities. RC also revealed that hydrochemical processes were the major factors responsible for water quality.

Prognostic significance of metastatic lymph nodes ratio in patients with T2-T3 stage gastric cancer

To evaluate the prognostic significance of metastatic lymph nodes ratio in patients with T(2)~T(3) stage gastric cancer. Clinical data of 238 patients with T(2)-T(3) stage gastric cancer undergone radical gastrectomy and D(2) lymphadenectomy, at least 15 lymph nodes was dissected per patient, were analyzed retrospectively. Spearman correlation analysis was used to determine the correlation coefficient. Survival was determined by the Kaplan-Meier method and differences were assessed by the Log-rank test. Multivariate analysis was performed using the Cox proportional hazard regression model in forward stepwise regression. Receiver working characteristic curve was used to compare the accuracy of the metastatic lymph nodes ratio in predicting the death of patients 5 years postoperatively and that of metastatic lymph nodes number. The metastatic lymph nodes ratio didn't correlate with the total number of dissected lymph nodes, whereas metastatic lymph nodes number did. Kaplan-Meier survival analysis demonstrated the metastatic lymph nodes ratio significantly influenced the postoperative survival time and Cox proportional hazard regression model analysis showed the metastatic lymph nodes ratio was an independent poor prognostic factor. There was no significant difference between the area under the receiver working characteristic curve of metastatic lymph nodes ratio and metastatic lymph nodes number in predicting the death of patients 5 years postoperatively. The metastatic lymph nodes ratio in T(2)-T(3) stage gastric cancer patients is not correlated with the total number of dissected lymph nodes if at least 15 lymph nodes are dissected. The metastatic lymph nodes ratio is a major independent poor prognostic factor of the patients of T(2)-T(3) stage gastric cancer. The ability of the metastatic lymph nodes ratio in predicting the death of T(2)-T(3) stage gastric cancer patients 5 years postoperatively is the same as that of metastatic lymph nodes number.

Risk factors for hospitalization in elderly cancer patients receiving chemotherapy

9035 Background: Chemotherapy-associated hospitalization is a major source of morbidity and cost in cancer care, particularly for elderly (age ≥ 65) cancer patients. Hospitalization in the elderly often leads to an irreversible decline in functional status unrelated to the acute event that prompted hospital admission. Currently, little is known about the risk factors that may lead to increased risk of hospitalization in elderly patients receiving chemotherapy (CTX). Methods: 871 patients with solid tumors or lymphoma initiating a new CTX regimen were prospectively enrolled at 60 randomly selected US community oncology sites between 8/2004 and 10/2005. Of these, 361 elderly patients aged 65–91 were identified and followed. Primary endpoint of this investigation was hematologic toxicity and hospitalization was secondary. Pre- CTX patient data were analyzed for increased risk of hospitalization in univariate analysis using the chi-square test. Results: A total of 155 (18%) patients were hospitalized resulting in 215 hospitalizations. Median time to first hospitalization was the second cycle of CTX. 81/361 (22%) of elderly patients were hospitalized compared to only 74/510 (15%) of younger patients (p=0.003). The rate of hospitalization increased in a linear fashion between ages 65–80. Reasons for hospitalization in the elderly included infection, fever, or febrile neutropenia (36%), cardiopulmonary disease (CPD) (12%), vomiting or dehydration (13%), other gastrointestinal (11%), transfusion (8%), thrombosis (4%), CTX administration (4%), and other (13%). Major independent pre-CTX factors that predicted hospitalization in the elderly included male gender (p=0.0004), hemoglobin <11 g/dL (p=0.02), abnormal platelet count (<150k or >350k) (p=0.05), CPD (p=0.03), creatinine >1.5 mg/dL (p=0.05), and ≥ 2 concomitant medications (p=0.0008). Elderly patients with lung cancer (p=0.001) and lymphoma (p=0.05) had significantly higher rates of hospitalization when compared to other solid tumors. Conclusions: These data suggest that the risk of hospitalization increases in elderly cancer patients with age and that pre-CTX factors may be useful in identifying a subpopulation at increased risk for hospitalization. No significant financial relationships to disclose.

Prognóstico em médio prazo da cintilografia de perfusão miocárdica de estresse na unidade de dor torácica

To evaluate the prognostic value of stress myocardial perfusion scintigraphy (MPS) applied to patients with suspected acute coronary syndrome (ACS). Retrospective study. Patients with suspected acute coronary syndrome (ACS) admitted into the chest pain unit (CPU) from December 2002 to April 2004, after exclusion of acute myocardial infarction (AMI) and high risk unstable angina they underwent stress MPS. Selected 301 patients, 65.3 +/- 12.5 years and 164 (54.5%) male gender. The test was performed 13 +/- 12 hours after admission. Myocardial ischemia (ISQ) was found in 142 patients (47.2%). Male gender (n=94, p=<0.0001), history of diabetes mellitus (n=31, p=0.033), past of AMI (n=52, p=<0.0001), past of surgical myocardial revascularization (n=46, p=<0.0001) and past of percutaneous revascularization (n=68, p=<0.0001) presented correlation with ISQ. The follow-up was 697.7 +/- 326.6 days. No MPS variable correlated with the occurrence of primary outcome. Abnormal scintigraphy (n=76, p < 0.0001), ISQ (n=73, p < 0.0001) and post-stress left ventricular ejection fraction below 45% (n=21, p=0.006) correlated with secondary outcome. The presence of ISQ was the major variable in the multivariate analysis for the prediction of secondary outcome (RR = 6.5; CI 95% = 0.009). Presence of ISQ was the major independent factor in prediction of adverse events for patients admitted into the CPU.

L'hypothermie thérapeutique

The benefit of therapeutic hypothermia after severe head injury is highly controversial. However, hypothermia is still used and studied in this context for multiple reasons. Efficacy of hypothermia is demonstrated after cerebral ischemia in numerous animal studies and after cardiac arrest in human studies. Hyperthermia is a major independent factor of outcome after cerebral ischemic or traumatic brain injury. Moreover, ICP is related to core temperature, and hypothermia may be used to decrease intracranial hypertension. However, many questions are still unresolved and can explain discrepancies between clinical studies: direct measurement of cerebral temperature, relationship between ICP, temperature and PaCO 2, level and duration of hypothermia and precise methods for cooling and particularly for rewarming.

Financial Success and Time-Management Factors in a Chemical Environment: A Case Study

Time management and the need for management to relinquish control to the technical team members are important complements of the project management process. However, how do firmstrackthe time spentbytheir project team members on the different tasks and assignments? In addition, how do these project characteristics associated with innovative product development impact the firm's financial success factors in the manufacturing process? An empirically based study of project managers of NOVA Chemicals, located in Pittsburgh, Pennsylvania, USA, was executed to determine which selected project characteristics positively impacted the firm's ability to enhance its financial success of its various manufacturing projects. Exploratory research via principal components and factor analyses resulted in four major independent factor score constructs of time management, cross-functional teams, management relinquishing authority, and co-location of project team members, with the varimax rotation method and eigenvalue greater than one criterion. The factor scores were used to test the hypothesis that proper management of these constructs would result in greater financial success of the manufacturing projects. The overall relationship was found to be statistically significant at the 0.05 levels of a one-tailed test (F = 3.508, p = 0.029). More importantly, the factor scores of time management and cross-functional teams, few manufacturing problems were found as the most important constructs to positively impact financial success of innovative product development projects.

A risk model for first cycle febrile neutropenia in cancer patients receiving systemic chemotherapy

8122 Introduction: Myelosuppression remains the major dose-limiting toxicity of cancer chemotherapy. A prospective, nationwide study was undertaken to develop and validate a risk model for febrile neutropenia (FN) in cancer patients receiving chemotherapy. Methods: More than 2,300 patients with cancers of the breast, lung, colon and ovary or lymphoma initiating a new regimen have been prospectively registered at 137 randomly selected sites. Data on at least 1 cycle of chemotherapy are available on 2,106. A standard regimen has been defined in 1,464 patients permitting an estimation of planned dose intensity (PDI). A logistic regression model for cycle 1 FN in those with known PDI was developed and test performance characteristics estimated. Results: Of 222 patients experiencing FN events, 125 (56%) did so in cycle 1 with prophylactic growth factors reported in only 3.5%. Major independent clinical factors in the risk model include: anthracycline chemotherapy (OR=7.80;P=.001); immune disorders (OR=5.14;P=.014); pretreatment neutropenia (OR=4.00;P<.001); elevated bilirubin (OR=3.73;P=.009); ECOG PS ≥2 (OR=2.84;P=.010); stage 1–2 disease (OR=2.66;P=.009); pretreatment lymphopenia (OR=2.51;P=.001); elevated alkaline phosphatase (OR=2.15; P=.012); pretreatment thrombocytopenia (OR=1.5;P=.024), and anemia (OR=1.43;P=.069). The risk model was adjusted for practice, planned dose intensity, BSA and patient demographics. The risk model accounted for over 80% of the variability (R2=0.829) with a c-statistic of 0.874 [0.847,0.902](P<.0001). Model discrimination was optimized for an estimated risk ≥5% distinguishing high and low risk groups with average cycle 1 FN risks of 20% and 1%, respectively. The model was associated with a sensitivity[±95%CL] of 93%[86–96], specificity of 66%[63–68], predictive value + and - of 20%[17–24] and 99%[98–100], respectively and diagnostic odds ratio of 22[12–43]. Discussion: Based on excellent test performance characteristics, the risk model identified patients at increased risk for first cycle FN for possible targeted prophylaxis with filgrastim or pegfilgrastim. Validation of the model in phase 2 of this ongoing registry study is currently underway. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Amgen Amgen Amgen

Obesity in type 2 diabetes, its features and specificity

To study the features and specificity of body fat depot abnormalities in type 2 diabetic patients. 366 Chinese aged >or= 40, 287 with type 2 diabetics and 79 without type 2 diabetics, hypertension and dyslipidemia, underwent the following examinations: (1) total body fat depots, defined by body mass index (BMI); (2) regional body fat depots, including waist circumference (W), hip circumference (H), femoral circumference (F), intra-abdominal fat area (VA), abdominal subcutaneous fat area (SA) and femoral subcutaneous fat area (FA); (3) ratio between regional and body fat depots (W/BMI, H/BMI, F/BMI, VA/BMI, SA/BMI and FA/BMI); (4) body fat distribution, including W and H ratio (WHR), W and F ratio (WFR), VA + SA/FA, and VA/SA; and (5) tissue insulin sensitivity, expressed by homeostasis model assessment index for insulin resistance (HOMA-IR). The body fat depot abnormalities observed in type 2 diabetes were as follows: (1) increase in total body fat depots (BMI) (P = 0.0013); (2) increase in abdominal fat depots (W) (P < 0.0001), mainly accounted for absolute and relative increases in intra-abdominal fat depots (VA, VA/SA and VA/BMI) P = 0.0011, 0.0025, 0.0008 respectively; (3) relative decrease in hip and femoral subcutaneous fat depots (H/BMI, F/BMI and FA/BMI) (P < 0.0001, < 0.00001, = 0.0014 respectively); (4) central distribution of body fat (WHR, WFR and VA + SA/FA) (P < 0.0001, = 0.0002, = 0.0002 respectively) by increase in intra-abdominal fat depots as well as decrease in hip or femoral body fat depots. The degree of abnormalities in body fat depots and the degree of tissue insulin resistance were in parallel with the number of other metabolic diseases (hypertension and dyslipidemia) associated in type 2 diabetic patients. Stepwise regression analysis indicated that increase in total body fat depots was the major independent contibuting factor for tissue insulin resistance. Moreover, increase in intra-abdominal fat depots and decrease in femoral fat depots were also independent contributing factors for insulin resistance. Increase in intra-abdominal fat depots as well as decrease in femoral subcutaneous fat depots is not only the features of body fat distribution observed in diabetic patients, but also in subjects with metabolic syndrome.

BNIP3 expression is linked with hypoxia-regulated protein expression and with poor prognosis in non-small cell lung cancer.

BNIP3 is a proapoptotic protein regulated by hypoxia-inducible factor 1. We analyzed BNIP3 expression in 105 tumor samples from early operable, non-small lung cancer and the relationship of expression to hypoxia-inducible factor 1alpha, other hypoxia-regulated pathways, and prognosis. There was strong cytoplasmic expression in >10% of cells in 40 of 105 cases. BNIP3 expression was associated significantly with high hypoxia-inducible factor 1alpha (P = 0.003), carbonic anhydrase 9 (P = 0.04), and was inversely associated with bcl-2 expression (P = 0.009). High BNIP3 expression was a major independent factor for overall survival. Thus, high expression of a hypoxia regulated proapoptotic pathway was associated with a selection of an aggressive phenotype in vivo.

Medical predictive factors of glaucoma treatment costs.

To describe the patterns and the economics of glaucoma treatment. Ophthalmologists selected at random were asked to include 4 consecutive patients over 18 years of age seen in consultation during a week. Socio-demographics, general and eye comorbidities, glaucoma risk factors, clinical data, and medical item consumption data for the preceding 5 years were collected for each patient. The economic perspective was societal, and predictive medical factors of costs were identified using a stepwise regression. Eighty-eight ophthalmologists included 337 patients, with a gender ratio of 4 males to 6 females, and a mean age of 62. Thirty-four percent had OHT. Glaucoma patients were older and no difference was found on the known confounding factors. Patients with glaucoma visited practitioners more often than those with OHT, had more exams, more often used expensive drug combination therapies, and had more hospitalizations. Drugs represented 37.1% to 63.1% of the expenses followed by exams (17.7% to 34.3%) and visits (13.8% to 28.0%). Two clinical factors contributed to costs: abnormalities of the optic nerve head the day of the study visit and the number of treatment changes. These were followed by intraocular pressure (IOP) and visual acuity. Two major independent factors explained the bulk of total cost variance: drug treatment changes and the presence of glaucoma instead of OHT. They contributed independently in an additive way to total cost.

Role of dietary vitamin K intake in chronic oral anticoagulation: prospective evidence from observational and randomized protocols

Purpose The potential association between vitamin K intake and coagulation instability has been explored primarily in case reports and small, retrospective, uncontrolled studies. We prospectively evaluated the effects of dietary vitamin K intake on anticoagulation parameters. Methods In an observational protocol, clinical characteristics and vitamin K intake, assessed semiquantitatively, were evaluated in 39 outpatients who made 230 visits to our anticoagulation clinic. In a randomized crossover protocol, 12 patients with stable anticoagulation underwent 4-day in-hospital dietary interventions, 1 to 2 weeks apart, providing a 500% increase and an 80% decrease in vitamin K intake relative to the baseline level. Results Univariate analysis of the observational data demonstrated a progressive, statistically significant inverse association between the vitamin K intake score and different levels of anticoagulation. Multivariate logistic regression analysis showed that vitamin K intake was independently associated with both overcoagulation and undercoagulation. In the randomized protocol, the international normalized ratio increased from 2.6 ± 0.5 at baseline to 3.3 ± 0.9 at day 7 ( P = 0.005) in subjects on the vitamin K–depleted diet and decreased from 3.1 ± 0.8 at baseline to 2.8 ± 0.6 at day 4 ( P = 0.04) in those on the vitamin K–enriched diet. Conclusion Our prospective data strengthen the concept that the interaction between vitamin K and coumarin is a clinically relevant, major independent factor that interferes with anticoagulation stability.

Factors influencing the patterns of T lymphocyte allorecognition.

Strong alloreactive T cell responses are a menace in transplantation surgery and their menagement requires understanding the basis of alloreactivity. Alloantigen recognition can be peptide independent, peptide specific, or peptide dependent. The mechanisms influencing each recognition pattern are largely unknown. Peptide dependence was examined in vitro by adding peptides to antigen processing-deficient cell line used as target in cytotoxic T cell assays. Responses to major histocompatibility complex (MHC) alleles most homologous to self were recently shown to be more peptide dependent than to those with lesser homology to self. Hence, peptide reactivity in vivo was estimated based on relative strengths of alloreactive responses to more homologous and less homologous MHC alleles. Alloreactive CD8+ TCR repertoire in beta2-microglobulin-deficient mice is preferentially peptide independent. The peptide-specific component is acquired as a function of wild-type thymic epithelium grafting. Irrespective of the presence of the peptide-specific component, in vivo alloantigenic priming was associated with a greater sensitivity to the MHC structure than was in vitro priming. Thymic positive selection and the mode of alloreactivity induction are the major independent factors determining the patterns of alloantigen recognition.

Seizure frequency affects event-related potentials(P300) in epilepsy

To analyse the effect of epilepsy an P300 event-related potentials we studied 27 patients with idiopathic generalized epilepsy (IGE), 13 patients with temporal lobe epilepsy (TLE) and 60 normal controls. The prolongation of P300 latencies was highly cor related with increasing age in controls but not epileptic patients. The age-corrected P300 latency used in this study was actual P300 latency–predicted P300 latency (predicted P300 (msec)=306.20+0.79 age,P =0.001, R2=0.32). By using ANOVA analysis, the age-corrected latencies of P300 were significantly longer in TLE patients (19.72±47.82msec, mean±SD) than in IGE patients (10.97±36.97msec) and controls (0.23±20.28msec). Likewise, significantly prolonged P300 latencies were seen in the epileptic patients with a seizure frequency more than 400 times (37.21±47.50msec). The multivariate-adjusted odds ratio for those who had TLE was 10.97 (95% CI=3.99 − 30.14 ) in the prolonged latencies of P300 compared with that of IGE patients. The odds ratio of longer latencies of P300 was 7.43 (95% CI=2.75 − 20.08) among those who had a high seizure frequency (≧400 times) compared with those who had a low seizure frequency. No interaction between TLE and high frequency of attacks was found. The age at onset of seizure and duration of illness was not associated with P300 latency prolongation. From the above results, we might infer that the seizure type of TLE and a high frequency of seizure are two major independent precipitate factors for abnormal latencies of P300 in the epileptic patients.

Predictors of intracranial hemorrhage during neonatal extracorporeal membrane oxygenation

Objective: To identify independent predictors of intracranial hemorrhage (ICH) during neonatal extracorporeal membrane oxygenation (ECMO). Study design: This retrospective cohort consisted of all neonates who did not have an ICH before treatment with ECMO identified in the Extracorporeal Life Support Organization Registry from 1992 to 1995 (n = 4550). Multiple logistic regression analysis was used to identify factors independently correlated with ICH and to develop a model that could be used to predict the risk of ICH in neonates treated with ECMO. Results: ICH was identified in 9.9% of patients. The factors associated with ICH remaining after adjusting for other significant variables ( P < .01) were gestational age (GA) <34 weeks (odds ratio [OR] 12.1, 95% confidence intervals [CI] [6.6, 22]), GA 34 to <36 weeks (OR 4.1, CI [2.9, 5.8]), GA 36 to <38 weeks (OR 2.1, CI [1.6, 2.8]) primary diagnosis of sepsis (OR 1.8, CI [1.4, 2.3]), epinephrine use (OR 1.9, CI [1.5, 2.5]), coagulopathy (OR 1.6, CI [1.1, 2.2]), arterial pH <7.0 (OR 2.5, CI [1.6, 3.9]), and arterial pH 7.0 to <7.2 (OR 1.8 CI [1.3, 2.5]). ICH rates for neonates receiving venovenous versus venoarterial ECMO and for those treated with or without cephalic jugular venous drainage were not significantly different. Conclusions: Gestational age, acidosis, sepsis, coagulopathy, and treatment with epinephrine are major independent factors associated with ICH in neonates treated with ECMO. In particular, GA <34 weeks remains a major barrier for use of current ECMO technologies. (J Pediatr 1999;134:156-9)

Determination of independent risk factors and comparative analysis of diagnostic methods for immediate type latex allergy in spina bifida patients.

Development of allergy to natural rubber latex in spina bifida patients is determined by several risk factors, such as age, number of interventions and atopic disease that are, however, interdependent. Furthermore, several diagnostic procedures have been analysed, but a comprehensive analysis of their diagnostic significance is lacking. To determine the independent major risk factor(s) for development of natural rubber latex allergy and the most valuable diagnostic procedure. In aselectively collected spina bifida patients, we correlated existing natural rubber latex allergy with age, sex, atopy and the number of hospitalizations and of surgical interventions in appropriately matched subgroups. Allergy to natural rubber latex was established by application of a latex glove fragment on the skin. Skin-prick tests with glove eluate, a natural latex extract and a commercial latex extract were carried out as were specific IgE measurements by radioimmuno assay (RAST-CAP). The results of the latex application test are compared with the other diagnostic methods. Out of 74 fully evaluated patients, 17 had a positive application test. The number of surgical interventions correlates strongly with the presence of natural rubber latex allergy (P<0.0002), independent of age, sex and presence of atopy. Skin-prick tests with unstandardized allergens made from known high allergenic latex gloves represent the most sensitive diagnostic method, with the highest negative predictive value and a specificity of 0.95. RAST-CAP was the next best method with a specificity of 0.93, a sensitivity of 0.89 and a negative predictive value of 0.97. The number of surgical interventions is the major independent determining factor for allergy to natural rubber latex in spina bifida patients. Unstandardized skin-prick tests are the most sensitive and specific diagnostic tool, but RAST-CAP is almost equally performant and therefore a valid alternative.

Effect of aging on left ventricular filling in untreated hypertensive patients

The aim of this study was to evaluate the influence of age and other clinical and echocardiographic parameters on left ventricular filling in a group of 174 untreated patients with mild to moderate hypertension (aged 20–82 years; mean 51.2 years) and in 189 age-matched normotensive subjects. All subjects underwent an echocardiographic study with pulsed Doppler evaluation of left ventricular filling. Left ventricular dimensions and indexes of systolic function were similar and within normal limits in both groups. Left ventricular filling was altered in hypertensive subjects < 65 years with a decrease of peak early velocity (peak E), an increase of peak atrial velocity (peak A) and a reduced E A ratio. However in subjects ≥65 years, we did not observe any differences in transmitral flow velocity pattern between hypertensive and normotensive subjects. The stepwise regression analysis showed that age alone explains up to 8% of peak E variance, 14% of peak A and 26% of E A ratio in hypertensives, while in normotensives it explains up to 18% of peak E variance, 50% of peak A and 61% of E A ratio. The other variables entered into the regression slightly improved the predictive power. In conclusion, age is the major independent factor affecting left ventricular filling in both groups, even if its predictive power was smaller in the hypertensive group. The similarity of diastolic filling pattern in elderly hypertensive and normotensive subjects suggests that the ‘aging factor’ plays an important role in influencing left ventricular filling pattern so as to mask the effect of hypertension in the elderly patients.

Multivariate analysis of the variables affecting left ventricular filling in normal subjects.

Pulsed Doppler measurements of left ventricular filling (LVF), two-dimensional and M-mode echocardiograms were performed in 189 healthy subjects, in order to evaluate factors influencing LVF Doppler indexes in normal subjects. LVF Doppler indexes (peak E, peak A, peak E/peak A, deceleration rate of peak E (ED) were related by univariate and multivariate analyses with the following parameters: age, sex, heart rate, systolic and diastolic blood pressure, aortic root and left atrial dimensions, left ventricular mass index, left ventricular shortening fraction. The stepwise analysis showed that age by itself explained up to 18% of peak E variance, 50% of peak A variance, 61% of peak E/peak A variance and 25% of ED variance. The other variables entered into the regression, slightly improved the predictive power (less than 10%). In conclusion, age is the major independent factor affecting LVF in normal subjects, although other variables show significant correlation also after age adjustment.

Multivariate analysis of family risk factors in predicting appointment attendance in a pediatric otology and communication clinic.

Parents of pediatric patients attending regional otologic medical clinics were given a questionnaire to document family risk factors predictive of poor appointment attendance, and to determine barriers which caused non-attendance of medical appointments. Family risk factors which affected clinic attendance were studied using univariate and multivariate analyses. Univariate analyses revealed all factors except patients' sex and family size to be correlated with attendance. However, multivariate analysis revealed that parental age (p less than 0.0153), ownership of car (p less than 0.0012), parental education (p less than 0.0048), and age of patient (p less than 0.0023) were major predictors of clinic attendance. Although ownership of a car was a major independent factor, it was highly correlated with parental age and parental education and only shown to be significant in the subset of patients not having access to public transportation. The identified parental factors which affect pediatric health care delivery underscores the importance of family centered case management in promoting the health care of children and casts doubt on the effectiveness of interventions which are solely centered on the patient or are designed to mitigate only one of these factors.