Multivariate Conditional Logistic Regression Analysis Research Articles

Association of CHI3L1 gene variants with YKL-40 levels and hypertension incidence: A population-based nested case-control study in China.

YKL‐40 was reported to be associated with the risk of hypertension. Whether the variants of CHI3L1 gene were associated with both YKL‐40 levels and hypertension needs to be further elucidated. In a 1:1 matched case‐control study of 507 pairs with available YKL‐40 levels and DNA samples nested in a prospective cohort of Chinese subjects, the 15 tag single nucleotide polymorphisms (SNPs) of CHI3L1 gene were genotyped. The levels of YKL‐40 among different genotypes of each SNP were compared after false discovery rate adjustment. Multivariable conditional logistic regression analyses were used to explore the association between the genotypes and the risk of hypertension. Subjects with the genetic variants for rs10399931, rs1538372, rs2071580, rs2297839 and rs4950928 had lower YKL‐40 levels. The genetic variant for rs10399805 was associated with higher YKL‐40 level. Subjects with the genotype of GA/AA of rs10399805 had a 1.34‐fold risk of hypertension compared with those with GG genotype in the total population (P = .05). Subjects with heterozygote/rare homozygote genotype of rs4950928 and rs2297839 both had a significantly lower risk of hypertension compared with those with major homozygote genotype among men. The ORs (95% CIs) were 0.46 (0.23‐0.89) and 0.49 (0.26‐0.91), respectively. The above three SNPs could significantly improve the accuracy of risk prediction for hypertension based on the conventional factors. The genotypes of rs10399805, rs4950928 and rs2297839 may hopefully become stable biomarkers for predicting the risk of hypertension.

High Risk and Trajectories of Physical Illnesses before the Diagnosis of Bipolar Disorder

Objective: The authors investigated the distributions and trajectories of physical illnesses preceding the diagnosis of bipolar disorder with comparison to schizophrenia and general populations.Methods: Using data from the Taiwan National Health Insurance Research Database entered from 1996 to end of 2012, we identified 13,079 patients newly diagnosed as having bipolar disorder between the age of 13 and 40 years (ie, cases). For each case with bipolar disorder, two age- and sex- and diagnosis year- schizophrenia comparisons (n=26,158)(n=26,158) and four age- and sex-matched comparisons representing the general population (n=52,316)(n=52,316) were randomly selected from the cohort. Multivariate conditional logistic regression analyses were conducted to estimate the risk of physical illness before the diagnosis (index date). Variables exhibiting a powerful association (p<0·001) were retained in the final model.Results: During the year before diagnosis, patients with newly diagnosed bipolar disorder had a higher risk of numerous physical illnesses across the cardiovascular, respiratory, gastrointestinal, endocrine/metabolic, and musculoskeletal/integument systems compared with those with schizophrenia and the general population. Trends in the risk of specific physical illnesses, mainly hypertension, heart disease, asthma, ulcer disease, hyperlipidemia, and connective tissue disease, were increased across the 3-year prodromal phase of bipolar disorder relative to schizophrenia.Conclusions: Intriguingly, physical illnesses before the diagnosis of bipolar disorder are pervasive with higher risk. Moreover, the trajectories of physical illnesses markedly differ from those of schizophrenia before full manifestation.

Notch Volume Measured on Magnetic Resonance Imaging Is Better Than 2-Dimensional Notch Parameters for Predicting Noncontact Anterior Cruciate Ligament Injury in Males

PurposeTo evaluate and compare intercondylar notch volume with other 2-dimensional notch parameters (measured on magnetic resonance imaging [MRI]) for prediction of noncontact anterior cruciate ligament (ACL) injury in males. MethodsRetrospective case-control study in males based on MRI images. The case group consisted of 80 noncontact ACL-injured males and a control group of 80 age- and height-matched ACL-intact males. Inclusion criteria were 18 to 50 years old, full-thickness tear, MRI obtained within 1 year of injury, and ACL tear visually documented during arthroscopy. Multiligamentous, bilateral, or concomitant bony injuries were excluded. Notch volume and 2D parameters in both planes, including notch depth, notch width, intercondylar notch angle, notch-width index, and notch-shape index, were measured on MRI and compared. Slice interval was included in the formula for notch-volume assessment. Bivariate Pearson correlation between notch volume and 2D parameters was estimated. Multivariate conditional logistic regression analysis was used for predictor model. Receiver operating characteristic (ROC) curves were plotted. ResultsAll MRIs had a standard slice thickness of 3 mm and slice interval of 0.3 mm. Notch volume (P < .001), notch angle in the axial plane (P = .001), and notch width in the coronal plane (P = .009) were significantly smaller in the ACL-injured group. Notch volume had inconsistent and negligible to low correlation with 2D parameters. Notch volume was the only significant contributor in the predictor model (P < .001). ROC curve showed that notch volume had highest area under the curve of 84.1% and optimal cutoff at 7.1550 cm3 (specificity, 88.7%; sensitivity, 65%). ConclusionSignificantly smaller intercondylar notch volume is associated with noncontact ACL injury in men and is the most important predictor for such an injury (optimal cutoff of 7.1550 cm3). Two-dimensional notch parameters are inconsistently associated with noncontact ACL injury in men, and none of the 2D parameters can be used as a surrogate for notch volume. Two-dimensional notch parameters fare poorly in predicting noncontact ACL injury in males. Notch volume measurement should include slice interval as a factor. Level of EvidenceIII, retrospective case-control study.

Risk Factors Associated With School Bullying Behaviors: A Chinese Adolescents Case-Control Study, 2019.

This research aimed to identify risk factors including individual characteristics and environment circumstances related to different types of school bullying (physical, relational, verbal, sexual, and possession bullying) among middle school students in China. Cases were the respondents reporting perpetrating bullying behaviors three or more times in the past year. One control was selected for each case from those participants who were not involved in school bullying in the past 12 months. Data were collected between April 2019 and May 2019 in China. After considering potential confounding variables including gender, grade level, and school, multivariable conditional logistic regression analysis was performed based on the univariate logistic analysis including 1,594 adolescents. According to conditional logistic regression analysis, alcohol use and lack of emotional management and control were the significant individual characteristics positively associated with involvement in school bullying. Alcohol use was related to all five types of school bullying perpetration. Poor relationships between family members, father's alcohol use, and parental neglect were strong risk factors for relational bullying. Lack of a sense of safety and absence of trusted people were associated with physical, relational, and verbal bullying perpetration. Results of this study provide evidence about risk factors for school bullying and have implications for potential policies to reduce bullying. Effective policies and programs need to take individual characteristics (social-emotional skills, anger control), family (parent training in conflict resolution, appropriate disciplining), peer and school factors (promoting prosocial networks, zero tolerance for bullying, appropriate disciplining policies against students who bully others, teacher training on building positive teacher-student relationships and positive discipling techniques) into consideration in order to develop effective prevention programs.

Parental occupational exposure and congenital heart diseases in a Hungarian case\u2013control study

PurposeOur study aimed to explore the effect of parental occupational exposure to endocrine disrupting chemicals (EDCs) on the development of congenital heart diseases (CHDs) in the offspring, and to compare job-exposure matrix (JEM)-assessed and self-reported occupational exposures with each other.MethodsLive-born infants born in 2007–2008 were selected from the population-based Hungarian Case–Control Surveillance of Congenital Abnormalities Study. 577 cases with any CHDs were compared to 1731 matched controls. Parental periconceptional occupational exposure to EDCs was assessed by a JEM and by questionnaire-based self-reporting of parents. Multivariate conditional logistic regression analyses were conducted to explore associations between parental occupational exposure to EDCs and the entire spectrum of CHDs and by CHD subtypes in the offspring. Kappa statistics were also performed to determine the consistency among JEM-assessed and self-reported occupational exposure of parents.ResultsJEM-assessed paternal exposure to polychlorinated organic substances, phthalates, biphenolic compounds, and solvents were significantly associated with the entire spectrum of CHDs. Ventricular septal defects were significantly associated with paternal self-reported exposure to pesticides, while atrial septal defects were significantly associated to paternal JEM-assessed phthalate exposure. Paternal solvent exposure was significantly associated with atrial septal defects and right ventricle outflow tract obstructions. JEM-assessed and self-reported exposures to pesticides, heavy metals, and solvents exhibited poor agreement for mothers and slight agreement for fathers.ConclusionEven though parental occupational exposure to EDCs seems to have a minor impact on the occurrence of CHDs, the results of biological and environmental monitoring should be taken into consideration as well.

Factors Associated with Catheter-Related Thrombosis in Autologous Stem Cell Transplant Patients: Can We Predict Risk?

Central venous catheters (CVCs) are central to the process of autologous hematopoietic stem cell transplantation (AHCT) for hematologic malignancies. Large bore (14F to 15F) CVCs are routinely used for stem cell collection, administration of medications and blood products, and total parental nutrition. Up to 20% of patients experience catheter-related thrombosis (CRT), a major complication typically requiring at least 3 months of anticoagulation. This can lead to bleeding, further complicating the post-transplant course. Factors associated with CRT include endothelial damage due to conditioning regimens, bacteremia, and immobilizations. Furthermore, in ambulatory patients with cancer, increased risk of venous thromboembolism has been seen in patients with low hemoglobin (&amp;lt;10 g/dL), elevated pre-chemotherapy leukocyte count (&amp;gt;11 x 109/L), elevated pre-chemotherapy platelet count (&amp;gt;350 x 109/L), those receiving erythropoiesis-stimulating agents, and obesity (body mass index &amp;gt; 35 kg/m2). We hypothesized that these factors may also confer CRT risk in those undergoing AHCT. To test this hypothesis and to further refine our understanding of the risks of CRT in this population, we compare characteristics of patients with CRT to those without in this retrospective, case-control study. Using prospectively collected data from the University of Minnesota Blood and Marrow Transplantation Database, we studied 1049 consecutive adults (age &amp;gt; 18 years) with lymphoma or multiple myeloma who underwent AHCT between 2006 and 2019. Available medical records were manually curated for the occurrence of CRT. We identified 92 subjects with CRT events, which were defined as mural thrombus with partial or total occlusion of a vessel, pulmonary embolism, or right atrial thrombus in which a catheter was present or had been present within the prior 30 days. CRT diagnosis was made by imaging, which was performed for either symptoms or signs of venous thrombosis, or for routine disease surveillance. We then identified 184 controls who were matched for age, sex, disease, and transplant date. We excluded from our control group those who received prophylactic anticoagulation in the peri-transplant period. In a univariate analysis, we observed an increased risk in CRT in those patients with history of VTE (OR 32.00, 95% CI: 4.24-241.30), mucositis in the peri-transplant period (OR 1.65, 95% CI: 1.00-2.73), hemoglobin increased above the median of 10.3 g/dL (OR 1.48, 95% CI: 1.26-1.73), those with indwelling port in addition to CVC (OR 1.76, 95% CI: 1.02-3.05), and those with body mass index (BMI) &amp;gt; 35 kg/m2 (OR 2.44, 95% CI: 1.12-5.34). Multivariate conditional logistic regression analysis upheld the impact of BMI &amp;gt; 35 kg/m2 (OR 2.53, 95% CI: 1.05-6.13). CRT is a major contributor to morbidity in the AHCT setting. Mucositis, presence of a port, and history of VTE have previously been associated with CRT events. Our study elucidates additional risk factors that may contribute to CRT risk, including obesity and higher than average hemoglobin concentration in comparison to the controls. Further study in larger cohorts is warranted to clarify the magnitude of risk of these factors in the adult AHCT population. Figure Disclosures Bachanova: BMS: Research Funding; Incyte: Research Funding; Gamida Cell: Membership on an entity's Board of Directors or advisory committees, Research Funding; Karyopharma: Membership on an entity's Board of Directors or advisory committees; FATE: Research Funding; Kite: Membership on an entity's Board of Directors or advisory committees. Shah:Aspen Pharma: Research Funding.

Troponin T but not C-reactive protein is associated with myocardial mass and risk for, and time to future surgery for aortic stenosis; a population-based study

Abstract Objective High-sensitivity troponin T (hs-TnT) and high-sensitivity C-reactive protein (hs-CRP) may convey prognostic information in patients with aortic stenosis (AS). However, many association studies were cross-sectional, and the presence of myocardial hypertrophy and concomitant coronary artery disease (CAD) were usually not described. This study evaluated if hs-TnT and hs-CRP relate to myocardial mass, and associate with risk of and time to future surgery for AS in patients with and without concomitant CAD. Design In total, 336 patients who underwent surgery due to AS after participation in large population surveys were identified. Median age [interquartile range] was 59.8 [10.3] years at survey and 68.3 [12.7] years at surgery, and 48% were women. The median time between survey and surgery was 10.9 [9.3] years. Preoperatively, myocardial mass and the presence of CAD were assessed. Two matched referents were allocated for each case, and hs-TnT and hs-CRP were determined in stored plasma samples from the baseline survey. Uni- and multivariable conditional logistic regression analyses were used to estimate the risk (odds ratio [95% confidence interval]) related to one (ln) standard deviation increase in hs-TnT and hs-CRP. Time to surgery was evaluated by Kaplan-Mayer analysis and Cox regression. Results Hs-TnT was independently associated with surgery for AS in patients with concomitant CAD (odds ratio [95% confidence interval]) (1.22 [1.02–1.46]) and without concomitant CAD (1.39 [1.05–1.84]). Hs-CRP was not associated with surgery for AS after adjustment for traditional cardiovascular risk factors (1.06 [0.92–1.23]). Patients with high hs-TnT levels had shorter time to surgery compared those with low levels (Figure, p&amp;lt;0.001) whereas hs-CRP did not associate with time to surgery. Hs-TnT levels at survey associated independently with myocardial mass at surgery (p=0.002) but not with CAD and severity of stenosis. Conclusions Hs-TnT – but not hs-CRP – was associated with increased risk for, and shorter time to future surgery for AS. Hs-TnT associated with myocardial mass at surgery which indicates that Hs-TnT may be used as a clinical tool and allow for identification of patients with AS who could benefit from earlier intervention. Time to surgery; tertiles of hs-TnT Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): The Swedish Heart–Lung Foundation

Expression of TRPC1 and SBEM protein in breast cancer tissue and its relationship with clinicopathological features and prognosis of patients.

This study investigated the relationship of the expression of transient receptor potential channel 1 (TRPC1), small breast epithelial mucin (SBEM) in breast cancer tissues with clinical pathological features and prognosis of patients. Altogether 50 patients with breast cancer who were treated in Weifang People's hospital from April 2017 to November 2018 were selected, and the mRNA and protein differences of TRPC1 and SBEM in breast cancer patients and normal breast cancer tissues were detected by qRT-PCR and Western blot. Spearman test was used for correlation analysis. Logistic univariate and multivariate analysis were performed on the risk factors related to breast cancer metastasis in breast cancer patients. The expression of TRPC1 and SBEM in breast cancer tissues was significantly higher than that in normal breast tissues (P<0.001). The mRNA expression of TRPC1, SBEM and protein was not related to age, tumor size and tissue grade of breast cancer patients, but related to TNM stage, clinical stage and lymph node metastasis (P<0.001). The relative expression of TRPC1 was positively correlated with clinical stage of breast cancer (r=0.992, P<0.001). The relative expression of SBEM was positively correlated with the clinical stage of breast cancer (r=0.853, P<0.001). The relative expression of TRPC1 was positively correlated with TNM staging of breast cancer (r=0.860, P<0.001). The relative expression of SBEM was positively correlated with TNM staging of breast cancer (r=0.880, P<0.001). Multivariate conditional Logistic regression analysis showed that TNM staging, TRPC1, SBEM were independent risk factors for malignant breast cancer metastasis. On the contrary, expression of TRPC1 and SBEM in breast cancer tissues was up-regulated. TRPC1 and SBEM may be involved in the process of breast cancer occurrence, development and metastasis, and can be used as potential tissue biomarkers in diagnosis of breast cancer metastasis and disease assessment.

Invasive pneumococcal disease in children with cancer: Incidence density, risk factors and isolated serotypes

BackgroundPediatric oncology patients (POP) have a high risk of infections due to impaired immunity. Invasive pneumococcal disease (IPD) is an important cause of severe infection in these patients and it is associated with high mortality. This study aimed to evaluate the incidence and risk factors associated with IPD at a Pediatric Oncology Center in Brazil. MethodsThis was a retrospective case-control study. All IPD cases in children with cancer from 2005 through 2016 were reviewed. Each case of IPD was matched with two controls from a cohort of patients matched for year of IPD, age and disease in order to assess risk factors. The incidence density was calculated as the number of IPD per 100,000 patients-year. ResultsA total of 51 episodes of IPD in 49 patients was identified. All pneumococci were isolated from blood cultures. The median age was five years and 67% were male; mortality rate was 7.8%. The IPD incidence density rate in POP was 311.21 per 100,000 patients-year, significantly higher than the rate in the general pediatric population. Severe neutropenia was the only risk factor associated with IPD, after multivariate conditional logistic regression analysis. ConclusionAlthough pneumococcal disease decreased after the introduction of 10-valent pneumococcal vaccine in the Brazilian national immunization schedule in 2010, there was no decrease in the IPD incidence rate in our cohort. A higher coverage rate of pneumococcal vaccination in children in the general population might be necessary to reduce the incidence rate in this high-risk population.

Risk of hospitalization from drug-drug interactions in the Elderly: real-world evidence in a large administrative database.

The aim of this study was to assess the risk of hospitalization associated with the concomitant prescription of 10 highly prevalent drug-drug interactions (DDIs) among all individuals aged ≥65 residing in Bologna’s area, Italy. We used incidence density sampling, and the effect of current (last month) and past (≥30 days before) exposure to DDI was investigated through conditional multivariable logistic regression analysis.Two DDIs were associated with increased hospitalization due to DDI related conditions: ACE-inhibitors/ diuretics plus glucocorticoids (current DDI: OR 2.36, 95% CI 1.94-2.87; past DDI: OR 1.36, 95% CI 1.12-1.65) and antidiabetic therapy plus current use of fluoroquinolones (OR 4.43, 95% CI 1.61-11.2). Non-Steroidal Anti-inflammatory Drugs (NSAIDs) increased the risk of re-bleeding in patients taking Selective Serotonin Reuptake Inhibitors (OR 5.56, 95% CI 1.24-24.9), while no significant effect was found in those without a history of bleeding episodes. Concomitant prescription of NSAIDs and ACE-inhibitors/diuretics in patients with a history of high-risk conditions was infrequent.Within the pattern of drug prescriptions in the older population of Bologna’s area, we distinguished DDIs with actual clinical consequences from others that might be considered generally safe. Observed prescribing habits of clinicians reflect awareness of potential interactions in patients at risk.

Predictors of postoperative acute exacerbation of interstitial lung disease: a case–control study

IntroductionPatients with interstitial lung disease (ILD) are known to develop an acute exacerbation (AE) after surgery. Previous studies have evaluated the predictors of postoperative AE. However, it remains unclear whether...

Effect of contralateral augmentation on postoperative complications after the second stage of tissue expander/implant breast reconstruction.

Contralateral augmentation mammoplasty in implant-based reconstruction could potentially lead to deterioration of the thickness of the mastectomy skin flap and increase postoperative complications of the reconstructed breast. We compared the complication rates of the reconstructed breast in the augmentation and no-augmentation groups among patients undergoing tissue expander/implant breast reconstruction. Patients who underwent mastectomy followed by tissue expander/implant breast reconstruction between February 2010 and April 2018 were retrospectively reviewed. The primary outcome measures were complications and the need for a revision operation. The augmentation and no-augmentation groups underwent propensity score-matched analysis and the matched cases underwent multivariable logistic regression analysis. From the 234 patients in the augmentation group and 517 patients in the no-augmentation group, 200 propensity score-matched pairs were obtained. Analysis of the matched pairs revealed that the augmentation group as compared to the no-augmentation group showed a significantly higher overall complication rate (13.5 percent versus 6.5 percent; P=0.025) and revision operation rate (9.0 percent versus 3.0 percent; P=0.019). Multivariable conditional logistic regression analyses of the matched cases revealed that contralateral augmentation (odds ratio, 3.457; 95% confidence interval, 1.039-11.498; P=0.043) was associated with increased odds for a revision operation of the reconstructed breast. This study investigated the postoperative complications of the reconstructed breast associated with contralateral augmentation mammoplasty in patients who underwent mastectomy followed by tissue expander/implant breast reconstruction. The augmentation group had a higher revision operation rate than did the no-augmentation group. A clinical evaluation of the risks and benefits of contralateral augmentation and preoperative counseling may be indicated for patients who are undergoing implant-based breast reconstruction and are candidates for contralateral augmentation mammoplasty.

Priorities for intervention of childhood stunting in northeastern Ethiopia:A matched case-control study.

Stunting is a worldwide public health problem caused by factors that vary across regions, including in Ethiopia. Limited evidence to prevent stunting makes it difficult to design and prioritize appropriate interventions. Therefore, this study investigated the intervention priorities for the prevention of stunting among children 6-59 months old in Kemissie City Administration, northeastern Ethiopia. A community-based individual matched case-control study was conducted from January to April 2017 including 107 cases and 214 controls. Controls were selected and matched with cases using the matching variable of child's age. Data were collected by open data kit (ODK) software using a structured questionnaire. Data were analyzed using STATA version 13.0 and WHO (World Health Organization) Anthro 2005. A conditional logistic regression model was used for data analysis. From multivariable conditional logistic regression analysis, determinants of stunting were identified. A statistically significant level was declared by a conditional adjusted odds ratio (cAOR) with 95% confidence interval (CI) and p-value of less than 0.05. The wealth index 52 (48.6%) of the cases and 108 (50.5%) controls were categorized as poor. The mean height-for-age z-score (HAZ) for the cases and controls was -2.79±.67 and -0.55±.92, respectively. One-sixth (16.8%) of the cases and 29 (13.6%) of the controls were given prelacteal feeding. A majority 82 (86.9%) of the cases and 137 (69.1%) of the controls had undernourished mothers/care-givers. Slightly less than one-third 35 (32.7%) of cases and one-fourth 53 (24.8%) of controls were affected by repeated episodes of diarrhea. Mother's body mass index (BMI) (conditional adjusted odds ratio [cAOR]) = 2.64; 95% CI: 1.28, 5.43), giving food priority to father (cAOR = 2.42; 95% CI: 1.23, 4.75), lack of exclusive breastfeeding for at least 6 months (cAOR = 2.44; 95% CI: 1.15, 5.17), no intake of meat by child (cAOR = 2.35; 95% CI: 1.21, 4.58) and child having repeated diarrheal episodes (cAOR = 2.0: 95% CI: 1.07, 3.86) were factors associated with childhood stunting. Maternal nutritional status, food priority, duration of exclusive breastfeeding, no intake of meat and repeated episodes of diarrhea were the main determinants of stunting among children aged 6-59 months. Therefore, intervention measures to avert childhood stunting should include strengthening action on provision of essential nutrition, providing counseling to parents on giving food priority to children, promotion of optimal duration of breastfeeding and preventing diarrheal disease among children 6-59 months old.

Breastfeeding association with autism spectrum disorders: A case-control study from Lebanon

BackgroundAutism spectrum disorders (ASD) in Lebanon are rising whereas breastfeeding is declining. This case-control study investigates the association between breastfeeding and ASD. MethodsChildren below 36 months recently diagnosed with ASD were matched to healthy controls by gender and gestational age. The association between ASD and breastfeeding was investigated in univariate and multivariate conditional logistic regression analyses, adjusting for the confounding effects of socio-demographic, pregnancy, and birth variables; parental characteristics, and family history. ResultsCases (n = 46) were older than controls (n = 184), mean (SD) 31.6 (4.9) versus 25.5 (5.6) months, (p < 0.001). ASD was associated with lack of exclusive breastfeeding in univariate (OR = 0.37, 95% CI: 0.19 to 0.72) and multivariate regression analyses (OR = 0.37, 95% CI: 0.16 to 0.88). There were no significant associations between ASD and the durations of exclusive breastfeeding or any breastfeeding. Other independent predictors of ASD in the adjusted analysis were the lack of intake of prenatal vitamins, advanced paternal age, lower paternal education, higher intake of drugs prenatally, and family history of ASD. ConclusionsThis study provides further evidence on the protective effect of exclusive breastfeeding against ASD. Future studies may help determine whether advising pregnant women to exclusively breastfeed their infants would reduce ASD, especially those at high risk for ASD such as those with a family history of ASD. Further research to understand the physiological basis of the protective effects of breastfeeding is essential, as well as studies that target the optimal duration of exclusive breastfeeding that can protect from ASD.

Clinical Outcomes of Patients with Intermediate-to-High-Risk Pulmonary Embolism Undergoing Ultrasound-Assisted Catheter-Based Fibrinolysis Therapy in a Mid-Term Follow-Up Period - A Retrospective Observational Study.

Endovascular therapy with ultrasound-assisted catheter-directed thrombolysis (UACDT) theoretically provides higher efficacy while reducing the bleeding risk compared with conventional systemic thrombolysis. The clinical outcomes of UACDT in treating intermediate-to-high-risk pulmonary embolism (PE) are lacking in an Asian population. Forty-two patients who presented with intermediate-to-high-risk PE received UACDT. The patients were divided into two groups based on the incidence of procedure-related bleeding events, and baseline demographics were compared between the two groups. A paired-Student's t test was conducted to evaluate the efficacy of UACDT. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for significant bleeding events. The average age was 58.93 ± 20.48 years, and 33.33% of the study participants were male. A total of 85.7% of the participants had intermediate-risk PE. Compared with pre-intervention pulmonary artery pressure, the mean pulmonary artery pressure decreased significantly (37.61 ± 9.57 mmHg vs. 25.7 ± 9.84 mmHg, p < 0.01) after UACDT. The cumulative total tissue plasminogen activator dosage and total infusion duration were 44.54 ± 20.55 mg and 39.14 ± 19.06 hours respectively. Overall, 21.43% of the participants had severe bleeding events during the endovascular fibrinolysis treatment period. Forward conditional multivariate logistic regression analysis revealed that the lowest fibrinogen level during thrombolysis was an independent factor associated with moderate-to-severe bleeding (odds ratio: 0.40, 95% confidence interval: 0.19-0.88, p = 0.02). UACDT exhibited high efficacy, but resulted in a higher-than-expected bleeding rate in this real-world study of an Asian population. The lowest fibrinogen level during thrombolysis was an independent risk factor associated with procedure-related bleeding events.

Association between oral lichen planus and systemic conditions and medications: Case-control study.

The aim of this study is to investigate the association between oral lichen planus (OLP) and a variety of systemic conditions, medication, and supplement usage. A total of 156 patients diagnosed with OLP and 156 controls at Columbia University Irving Medical Center from 2000 to 2013 were selected as part of the matched (1:1) case-control study. Demographics, systemic conditions, prescription medications and supplements were extracted from the patients' medical records. A univariable conditional logistic regression (CLR) analysis was performed to calculate unadjusted odds ratio, to identify significant variables associated with OLP (p<.10). Significant variables were further tested using multivariable CLR analysis with both forward and backward selection to calculate adjusted odds ratio (aOR) and further distinguish variables associated with OLP (p<.05). This analysis identified six significant variables: thyroid disorder (aOR:5.1,95%CI:2.3-11.2), any form of cancer (aOR:3.4,95%CI:1.4-8.4), type 2 diabetes (aOR:2.8,95%CI:1.2-6.3), hyperlipidemia (aOR:2.3,95%CI:1.3-4.1), oral sedative usage (aOR:6.3,95%CI:1.8-22.5), and vitamin D supplementation (aOR:2.7,95%Cl:1.3-6.0). Thyroid disorders, cancer, type 2 diabetes, hyperlipidemia, sedatives, and vitamin D supplementation were found to be associated with OLP. Additional investigation is required to explore these associations, which could shed light on the potential mechanism of OLP and reinforce the idea that oral lesions could be predicative of previously undetected systemic conditions.

Results from the Population-Based Gutenberg Health Study Revealing Four Altered Autoantibodies in Retinal Vein Occlusion Patients.

Purpose Retinal vein occlusion (RVO) is the second most common retinal vascular disease and a major cause of visual impairment. In this study, we aimed to observe whether RVO cases have different antibody profiles as a new potential risk factor and whether a conversion of retinal vein occlusion (RVO) to neovascular glaucoma (NVG), one of the major complications, is occurring within a 5-year timeframe. Methods We performed a nested case-control study (1 : 4) within the Gutenberg Health Study (GHS), a population-based, prospective cohort study in the Rhine-Main Region of Germany including 15,010 participants. RVO subjects (n = 59) were identified by grading of fundus photographs. Optic nerves of RVO subjects and age- and sex-matched controls (n = 229) at baseline and their follow-up examination after 5 years were analyzed for glaucomatous alterations. Of all RVO subjects and controls, serum autoantibody profiles were measured using in-house manufactured antigen-antibody microarrays. Results Of the 59 RVO patients, 3 patients (5%) showed glaucomatous optic disc alterations at baseline, whereas no new glaucoma case was detected at 5-year follow-up. Four of the autoantibodies measured (against dermcidin, neurotrophin-3, superoxide dismutase 1, and signal recognition particle 14 kDa protein) were significantly increased in the serum of RVO patients (p < 0.001). Multivariable conditional logistic regression analysis showed that 3 of these 4 antibodies were independent of cardiovascular risk factors. Conclusions We found several autoantibodies associated with RVO, targeting proteins and structures possibly involved in RVO pathogenesis.

Seven-Year Case-Control Study in California of Risk Factors for Infant Botulism

To ascertain possible risk factors for infant botulism, the intestinal infectious form of human botulism, in the years immediately following its initial recognition in California in1976. Parents of 159 California laboratory-confirmed cases of infant botulism from 1976 to 1983 and 318 healthy controls were interviewed using a comprehensive (>300 factors) questionnaire. "Neighborhood controls" (n=184) were matched on date of birth, sex, race/ethnicity, and neighborhood of residence. "County controls" (n=134) were matched only on date of birth, sex, and county of residence. Age-stratified bivariate and multivariate conditional logistic regression analyses were performed using SAS. All cases required hospitalization. Bivariate analyses identified several risk factors that in multivariate analyses were not significant. In multivariate analyses, risk factors differed with stratification by age. For the ≤2 month-old neighborhood controls comparison, birth order >1, cesarean delivery, ≤1 bowel movements (BMs) per day, and windy residence area were associated with illness hospitalization, and for the county controls comparison, only pacifier use was associated. For the <2 month-old neighborhood controls comparison, <1 bowel movements (BMs) per day, cesarean delivery, birth order >1, and windy residence area were associated with illness hospitalization, and for the county controls comparison, pets in the home was an additional risk factor. With the exception of the ≤2-month-old county controls group, slower intestinal transit time (≤1 BM/d) was associated with illness. Otherwise, our case-control investigation identified few physiologic, environmental, and maternal factors associated with infant botulism hospitalization in California.

Association between tears of the posterior root of the medial meniscus and far posterior femoral condyle osteoarthritis.

We aimed to evaluate whether tears of the posterior horn of the medial meniscus root ligament (PHMM RL) are associated with osteoarthritis of the far posterior femoral condyles (FPFC). Retrospective review of 1158 patients who underwent arthroscopy identified 49 patients with confirmed tears of the medial meniscus posterior root ligament attachment. Preoperative magnetic resonance imaging (MRI) studies were reviewed to identify advanced osteoarthritis involving the medial and lateral FPFC. Control patients (n=48) had no meniscal tears confirmed by arthroscopy. Cases and controls were age- and sex-matched exactly 1:1. One case patient was excluded since there was no age- and sex-matched control available. The International Cartilage Research Society (ICRS) MRI cartilage grade was recorded for the medial and lateral FPFC. Associations were evaluated using univariate and multivariable conditional logistic regression analyses. There were 48 case and 48 control patients (10 men in each group, 20.8%) with median age 53 years (range, 21-67). Medial FPFC ICRS Grade 2 or higher lesions were present in 34 (70.8%) of case patients and 16 (33.3%) of control patients. Lateral FPFC ICRS Grade 2 or higher lesions were present in 24 (50%) of case patients and 14 (28.2%) of control patients. Increased body mass index (BMI) was associated with PHMM RL tears (OR=1.11, 95% CI [1.01, 1.22], P = 0.020). MRI was 81.2% (39/48) sensitive and 91.2% (44/48) specific for detection of PHMM RL tears. PHMM RL tears were associated with Grade 2 or higher medial FPFC osteoarthritis (OR=10.00, 95% CI (2.34, 42.78), P < 0.001). This association remained after adjusting for BMI (OR=11.79, 95% CI [2.46, 56.53], P = 0.002). There was also an association between PHMM RL tears and lateral FPFC osteoarthritis, which persisted after adjusting for BMI (OR =3.00, 95% CI [1.07, 8.37], P = 0.036). PHMM RL tears are associated with advanced osteoarthritis of the FPFC. Radiologists identifying FPFC osteoarthritis should look carefully for PHMM RL tears.

Association between fasting glucose levels and adhesive capsulitis in a normoglycemic population: a case-control study

Hyperglycemia is the most commonly cited risk factor for adhesive capsulitis. However, no study has established whether fasting glucose levels within the normoglycemic range are associated with idiopathic adhesive capsulitis (IAC). This study hypothesized that increments of fasting glucose levels within the normoglycemic range would be linked to IAC. This study investigated any association between normoglycemic fasting glucose levels and IAC. This case-control study comprised a group of 151 patients with IAC without intrinsic shoulder lesions, extrinsic causes, or known metabolic risk factors such as diabetes, dyslipidemia, and thyroid dysfunction. The control group comprised 453 age- and sex-matched persons seeking general check-ups at the authors' health promotion center during the same period as the case group. Control subjects had normal shoulder function, no previous diagnosis of adhesive capsulitis or of metabolic disease, and no history of trauma or of shoulder surgery. The studied variables were body mass index, serum lipid profiles, thyroid hormone levels, fasting glucose levels, glycosylated hemoglobin A1c, and high-sensitivity C-reactive protein. Fasting glucose levels were studied as scale data and categorical data (<85, 85-89, 90-94, and 95-99 mg/dL). Multivariable conditional logistic regression analysis evaluated the matched sets of subjects. Odds ratiosand 95% confidence intervalswere determined for various potentially associated factors. Fasting glucose level, hypercholesterolemia, and high-sensitivity C-reactive protein were significantly associated with IAC (P ≤ .030). Fasting glucose levels in the <85 mg/dL quartile were significantly negatively associated with IAC (P ≤ .001). In contrast, fasting glucose levels in the 90-94 mg/dL quartile or higher were significantly positively associated with IAC (P ≤ .034). IAC is positively associated with fasting glucose levels of 90-99 mg/dL, which are currently considered normoglycemic.