Multivariate Logistic Regression Analysis Research Articles

Prediction of distant metastases in penile squamous cell carcinoma: a SEER population-based study.

Due to the limited number of patients with penile cancer, there is currently no prospective randomized study on patients with penile cancer, especially on patients with distant metastasis of penile cancer. The objective of this study was to develop a nomogram based on a large cohort to predict the probability of distant metastasis in patients with penile squamous cell carcinoma. 1453 patients were included in our study. Univariate and multivariate logistic regression analyses were employed to identify the independent variables, which were used to construct a nomogram. In this nomogram, high grade, high N stage, and primary site surgery (OR 0.354, 95% CI 0.146-0.859) were predictors of distant metastasis in patients with penile squamous cell carcinoma. The area under the curve (AUC) for internal validation of this nomogram was 0.880. Incisional biopsy of regional lymph nodes had been demonstrated to be associated with a poorer survival prognosis in patients with one distant metastatic site. Furthermore, patients with two metastases had a significantly worse survival rate than those with a single metastasis. These findings may prove instrumental in the surgical decision-making process.

Conversion of Robotic Distal Pancreatectomy: Predictors and Outcomes in an International Multicenter Study.

The aim of this study was to identify risk factors for conversion and assess its consequences on clinical outcomes after robotic distal pancreatectomy (RPD). RDP has gained popularity due to its lower conversion rate (3-8%) when compared to laparoscopic distal pancreatectomy (10-20%). This retrospective multicenter study included RDPs performed at 16 international centers from May 2007 to March 2024. Perioperative outcomes of patients requiring conversion were compared to fully robotic RDP patients. Risk factors for conversion were identified by multivariable logistic regression analysis. Of 2,452 patients undergoing RDP, 75 (3.1%) required conversion to open surgery. In converted RDPs, operative time was longer (300 (243-376) vs. 180 (120-240) minutes; P<0.001), and blood loss was greater (500 (200-990) vs. 100 (50-200) ml; P<0.001). Converted patients experienced more overall complications (53% vs. 39%; P=0.017), major complications (41% vs. 25%; P<0.001), and a higher 90-day mortality (5% vs. 3%; P<0.001). Furthermore, both postoperative pancreatic fistula (35% vs. 18%; P<0.001) and delayed gastric emptying (10% vs. 3%; P<0.001) were more frequent in the conversion group. The rate of patients achieving textbook outcome was lower after conversion (57% vs. 74%; P=0.003). In the multivariable analysis, lesion size (>51mm; OR 2.86 (95% CI 1.56-5.08)), BMI (>28kg/m2; OR 3.03 (1.75-5.30)), previous abdominal surgery (OR 2.48 (1.31-4.51)), patients outside benchmark criteria (OR 2.09 (1.19-3.72)), and age (>62 years; OR 2.21 (1.24-4.05)) were associated with conversion. This international cohort study confirmed a very low conversion rate for RDP. Yet, converted cases experienced substantially impaired postoperative outcomes, highlighting the need for adequate patient selection through validated difficulty scoring systems.

The Impact of Fecal Diversion on Immune Checkpoint Inhibitor Adverse Gastrointestinal Toxicities

Background/Objective: Immune checkpoint inhibitors (ICIs) are highly effective cancer therapies used across a broad spectrum of malignancies. They function by disrupting immune inhibitory pathways, resulting in an amplified immune response against tumors. However, this heightened immune activity can predispose patients to immune-mediated colitis (IMC), which is graded using the Common Terminology Criteria for Adverse Events (CTCAE) and can range from mild diarrhea to severe colitis. Prior studies have shown that fecal stream diversion can modify the gut microbiome and influence the severity of intestinal inflammation. This study investigates the impact of fecal stream diversion on IMC outcomes in cancer patients receiving ICIs. Methods: We conducted a retrospective cohort study of patients treated with ICIs from 2016 to 2023 who had a history of fecal stream diversion. Demographic, oncologic, and toxicity-related data were collected. Patients with active gastrointestinal infections, autoimmune GI diseases, or graft-versus-host disease were excluded. Descriptive statistics and univariate and multivariate logistic regression analyses were performed using SAS version 9.4. Results: A total of 44 patients were included and categorized into two groups based on the timing of bowel stoma creation relative to the IMC event. CTCAE grade for diarrhea was used to assess GI toxicity. While overall CTCAE grade distribution for diarrhea did not differ significantly between groups (p = 0.22), Hispanic ethnicity was significantly associated with a lower CTCAE grade compared to non-Hispanic or Latino individuals (OR [95% CI] = 0.12 [0.02, 0.62], p = 0.011). In contrast, higher CTCAE grades were significantly associated with ileostomy versus colostomy (OR [95% CI] = 3.21 [1.01, 10.18], p = 0.048) and in patients without an ostomy at the time of diarrhea onset compared to those with an ostomy (OR [95% CI] = 8.87 [2.51, 31.31], p = 0.0007). Conclusions: Our findings suggest that the CTCAE diarrhea grade is significantly associated with ethnicity, type of stoma, and presence of ostomy at the time of diarrhea. Limitations include the retrospective study design and small sample size. These results contribute to understanding potential strategies for mitigating the serious gastrointestinal toxicities of ICIs.

Association Between Hemoglobin, Albumin, Lymphocyte, and Platelet Score and Diabetic Foot Ulcer: A Cross-Sectional Study.

BackgroundDiabetic foot ulcer (DFU) is a common and serious complication of diabetes mellitus, with high rates of disability and mortality. Early diagnosis and prevention can effectively reduce its incidence. The relationship between hemoglobin, albumin, lymphocyte count, and platelet (HALP) score, which are biomarkers reflecting the inflammatory and nutritional status of the body, and DFU has not been investigated. This study aimed to investigate the association between HALP score and DFU.MethodsThis cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004. Logistic regression models assessed the relationship between HALP scores (as both continuous and categorical variables) and DFU, adjusting for confounders. Restricted cubic spline (RCS) analysis was employed to evaluate potential non-linear relationships. Subgroup and sensitivity analyses were conducted to ensure the robustness of the findings.ResultsA total of 1604 participants (mean age: 61.67 ± 11.88 years; 52.9% male) were included. Multivariate logistic regression analysis, after adjusting for multiple confounders, revealed a negative correlation between the HALP score and DFU (OR = 0.98, 95% CI: 0.97-0.99, P = 0.041). This association remained significant when the HALP was categorized into quartiles. RCS analysis identified a non-linear relationship, with an inflection point at 44.98 (non-linear P = 0.017). Subgroup analyses confirmed the consistency of these findings across different demographic and clinical groups. Sensitivity analysis excluding extreme outliers confirmed the stability and reliability of the results.ConclusionLower HALP scores are significantly associated with an increased risk of DFU. This study underscores the potential utility of the HALP score as a tool for identifying individuals at higher risk, supporting its use in the prevention and management of DFU.

Association between serum carotenoid levels and gallstones in adults: a cross-sectional study using the National Health and Nutrition Examination Survey

BackgroundCarotenoids, known for their antioxidant properties and potential health benefits, have attracted considerable attention. Nonetheless, the association between carotenoid levels and gallstone prevalence has not been adequately explored. This study aimed to investigate the association between serum carotenoid levels and gallstone risk in an adult population.MethodsThis cross-sectional study utilized the 2017–2018 NHANES data. Multivariate logistic regression analyses were performed to assess the association between serum carotenoid levels and gallstone prevalence. Subgroup and interaction analyses were conducted to confirm these findings. Additionally, generalized additive model (GAM) regression combined with smooth curve fitting techniques was utilized to clarify potential non-linear associations, and a mediation analysis was conducted to identify possible mediators in the association between serum carotenoid levels and gallstones.ResultsThis study included 3,809 participants aged ≥20 years, among whom 412 had gallstones. After adjusting for confounders (Model 3), serum carotenoid levels were inversely associated with gallstone prevalence. The participants in the highest quartile of total carotenoid levels had a 48% lower gallstone risk than those in the lowest quartile (Q4: odds ratio [OR] = 0.52, p = 0.0005). Individual carotenoids showed similar trends: α-carotene (49% lower risk, OR = 0.51, p = 0.0010), α-cryptoxanthin (54% lower risk, Q4: OR = 0.46, p &amp;lt; 0.0001), β-carotene (47% lower risk, Q4: OR = 0.53, p = 0.0010), β-cryptoxanthin (42% lower risk, Q4: OR = 0.58, p = 0.0061), lutein/zeaxanthin (44% lower risk, Q4: OR = 0.56, p = 0.0025), and lycopene (30% lower risk, Q4: OR = 0.70, p = 0.0441). GAM analysis detected non-linear associations between carotenoids and gallstone risk. The subgroup and interaction analyses confirmed these results. Mediation analysis revealed that body mass index (BMI) accounted for 16.7% of the total effect.ConclusionObservational data demonstrated inverse associations between serum carotenoid levels and gallstone prevalence, with BMI mediating 16.7% of the total effect. These findings suggest that maintaining high serum carotenoid levels may reduce the gallstone risk. Future studies should explore the protective mechanisms of carotenoids and validate their causal relationships using longitudinal studies.

Baseline terminal ileal CT and MRI measurements are associated with imaging outcomes in pediatric Crohn's disease: a cohort study.

Cross-sectional imaging is increasingly used for both initial diagnosis and long-term monitoring of Crohn's disease. The quantitative morphology of the terminal ileum may predict treatment response. We aimed to identify baseline qualitative and quantitative imaging features that are associated with clinical and radiologic treatment response in a large cohort of children with Crohn's disease. This was a retrospective study of the RISK cohort study in pediatric Crohn's disease. This multicenter study included 1,136 children <18 yearsfrom 28 sites in North America. Subjects enrolled with newly diagnosed Crohn's disease who underwent endoscopy with baseline and follow-up CT or MRI were considered for this study. Exclusion criteria were incomplete data or surgical resection prior to follow-up imaging. Imaging analysis included assessing a qualitative terminal ileum (TI) categorical score based on SAR-AGA consensus definitions ((1) normal, (2) inflammation only without luminal narrowing, (3) inflammation with luminal narrowing, or (4) stricture with pre-stenotic dilation ≥3cm) and quantitative measurements (maximum bowel wall thickness and maximum/minimum lumen diameter). Two endpoints were considered: (1) clinical response (off corticosteroids and quiescent Physician Global Assessment at follow-up imaging) and (2) CT and MRI response (follow-up imaging normalization). Multivariable logistic regression analyses were developed for each endpoint. Ninety-six subjects were included. Clinical response endpoint was achieved in 38% (n=36) of participants, and imaging normalization was achieved in only 20% (n=19) of participants. Follow-up imaging showed disease progression in 24 (25%) patients, 7 (7%) of whom were radiologically normal at baseline (7%). A higher baseline TI categorical score was associated with lower odds of imaging normalization during follow-up (OR 0.4 [0.2, 0.8], P=0.009). Larger TI minimum lumen diameter (OR 1.1 [1.01, 1.3], P=0.04) and smaller maximum bowel wall thickness at baseline (OR 0.8 [0.6, 0.97], P=0.03) were associated with imaging normalization. There were no baseline imaging measurements associated with clinical response. Baseline increased terminal ileal minimum lumen diameter and decreasing wall thickness were associated with imaging normalization at follow-up, but not clinical response.

Using computed tomography imaging for the quantitative assessment of bowel viability in incarcerated groin hernia.

Rapid assessment of bowel viability in patients with incarcerated groin hernia (IGH) is crucial. However, there have been few studies on the quantitative indicators to assess bowel viability objectively. This study investigates the usefulness of the computed tomography (CT) value of the intestinal contents in this context. The subjects of this retrospective study were 84 patients with IGH diagnosed at our hospital between April, 2011 and March, 2023. The patients were divided into two groups according to whether they had necrotic (n = 24) or non-necrotic (n = 60) IGH. We reviewed the clinic-radiological factors associated with bowel necrosis. The CT value of the incarcerated intestinal contents was significantly higher in the necrotic group than in the non-necrotic group (24.67 vs 9.33 HU, p < 0.001). Furthermore, multivariate logistic regression analysis identified the CT value of the incarcerated intestinal contents as an independent predictor of bowel necrosis (hazard ratio 275; 95% confidence interval 21.9-3450; p < 0.001). The CT value of the incarcerated intestinal contents in IGH is a reliable and objective indicator for bowel viability preoperatively. This quantitative method of evaluation is effective and independent of clinical experience and can improve decision-making in the management of this condition.

Corpus Callosum to Choroid Plexus Distance for the Prenatal Diagnosis of Partial Agenesis or Hypoplasia of the Corpus Callosum: A Multicenter Study.

Prenatal diagnosis of partial agenesis (pACC) or hypoplasia of the corpus callosum (CC) is hindered by the lack of objective and reproducible ultrasound signs. The aim of this study was to report the role of a new ultrasound sign, the distance between the choroid plexus (CP) of the third ventricle and the distal part of the CC, in identifying fetuses with partial agenesis (pACC) or hypoplasia of CC. Retrospective multicenter case-control study including fetuses with pACC or hypoplasia of the CC confirmed at post-natal imaging or autopsy. The distance between the CP of the third ventricle and its ratio with the length of the CC were compared with unaffected cases on stored images assessed by 2 different examiners. Intraclass correlation, Bland-Altman, univariate, and multivariate logistic regression analyses were used to analyze the data. One hundred and four (29 with pACC or hypoplasia of the CC and 75 controls) were included in the analysis. At univariate analysis, fetuses with pACC or hypoplasia had a larger transverse diameter (3.9 ± 0.7 versus 5.3 ± 1.6 mm; P < .001) and an increased area (31.6 ± 8.8 versus 41.6 ± 15.6 mm2; P < .001) of the CSP compared to unaffected cases. Fetuses with pACC or hypoplasia of the CC had a shorter distance between the CP of the third ventricle and the distal part of the CC (1.6 ± 0.9 versus 8.4 ± 1.8; P < .001) and a higher ratio between the length of the CC and the distance between the CP of the third ventricle and the CC (13.5 ± 9.3 versus 2.6 ± 0.5; P < .001) compared to controls. At multivariate logistic regression analysis, the distance between the CP and the CC (OR: 0.67, 95% CI 0.5-0.7, per 1 mm increase; P < .001) and the ratio between the CC length and the distance between the CP and the CC (OR: 1.4, 95% CI 1.0-1.6; per 1 mm increase; P < .001) were independently associated with pACC or hypoplasia of the CC. Fetuses with pACC or hypoplasia of the CC had a shorter distance between the distal part of the CC and the CP of the third ventricle and a higher ratio of this measurement with the length of the CC. Further prospective study aimed at longitudinally evaluate the relationship between the CC and the CP of the third ventricle are needed to confirm these findings and to elucidate whether these measurements can be integrated in the diagnostic algorithm applied to fetuses with suspected pACC or hypoplasia of the CC.

Polysubstance Use and Social Sequelae in Women of Reproductive Age with Recent Marijuana Use

Polysubstance use (PSU) involving marijuana among women of reproductive age (WRA) is linked to psychosocial harm, yet research on the combined effects of marijuana with stimulants, opioids, tobacco, and binge drinking remains limited. The purpose of this study was to assess the prevalence of PSU in WRA with past month MJ use and examine the association between PSU status and social sequelae, including getting in trouble with the law, relationship difficulty with others, and lower achievement in job or educational settings, in this group of women. We used data from the United States 2015–2019 National Survey on Drug Use and Health, which included 11,895 non-institutionalized WRA (18–44 years old) with reported use of MJ in the past month. Descriptive statistics, chi-squared tests, and multivariable logistic regression analyses were conducted to describe the sample and assess associations between PSU and social sequelae. Nearly 4.5% of the women who used MJ in the past month had experienced social sequelae regardless of PSU status. Women who used three or more substances along with MJ had the highest adjusted odds (AOR = 3.18, 95% CI 1.90, 5.31) of social sequelae relative to monosubstance MJ users. Concurrent use of multiple substances significantly increased the likelihood of social sequelae among women MJ users.

An Analysis of Major Adverse Cardiovascular Events, Other Adverse Events, and Efficacy in Patients with Rheumatic Disease Receiving Targeted Therapy: Experience from a Third-Level Hospital

Objectives: We wished to evaluate the safety profile of the Janus kinase (JAK) inhibitors used in the Spanish population; to study the onset of major adverse cardiovascular events (MACEs) and thrombotic events (arterial and venous); and to analyze the factors associated with the onset of these events. Methods: We conducted a retrospective observational study of a cohort of patients with rheumatoid arthritis (RA), spondyloarthritis (SpA), and psoriatic arthritis (PsA) included in the biological therapy registry of the Rheumatology Department of Virgen Macarena University Hospital (HUVM), Seville, Spain, who started targeted treatment between 2019 and late 2024. We collected data on disease activity, traditional cardiovascular risk factors, the Charlson comorbidity index, previous synthetic or biologic drug therapy, the use of corticosteroids (and their dose), severity data (structural damage, extra-articular manifestations), and adverse events at the end of follow-up (e.g., MACEs, infections, neoplasms, and herpes zoster). We performed a descriptive bivariate analysis and a multivariate logistic regression analysis (dependent variable: MACEs) to identify factors that were independently associated with MACEs. Results: The study population comprised 137 patients (110 with RA, 18 with PsA, and 9 with SpA) who were followed up for a mean of 3.9 (2.6) years. Most patients had received JAK inhibitors as their second-line or subsequent treatment. At the end of the follow-up, 82 patients (66.7%) continued their treatment. Nine patients (6.6%) experienced a MACE, and five experienced a heart attack. All of these patients had RA. We found no differences between JAK inhibitors in terms of the incidence of the adverse events studied. Patients who experienced MACEs were more often male and smokers (current or former) and more often had hypertension and diabetes. No significant differences were found in the association with disease activity or previous or concomitant treatment. The factors that were independently associated with MACEs were a previous cardiovascular event (OR, 10.74; 95%CI, 1.05–113.7; p = 0.036), male sex (OR, 9.7; 95%CI, 1.6–76.5; p = 0.016), diabetes mellitus (OR, 10.3; 95%CI, 1.75–83; p = 0.013), and the duration of treatment with JAK inhibitors (OR, 1.47; 95%CI, 1.13–2.01; p = 0.005). Conclusions: We found no differences in the onset of adverse events, specifically MACEs, between the different JAK inhibitors analyzed. These events are more common in patients who already have cardiovascular risk factors, such as diabetes mellitus, or who have already experienced a cardiovascular event. JAK inhibitors broadly suppress cytokines in patients whose disease is refractory to other treatments. However, we must continue to evaluate their long-term safety in real-world studies.

Serum uric acid to creatinine ratio in patients with early-onset post-stroke cognitive impairment: a retrospective cohort study

BackgroundCognitive impairment is the major complication of acute ischemic stroke, which is a significant health concern imposing a heavy economic burden on families and society. Studies have shown that the serum uric acid (SUA) level is correlated to clinical outcomes of stroke and neurogenerative diseases. The serum uric acid to serum creatinine ratio (SUA/SCr) is an independent risk factor for poor outcomes of acute ischemic stroke and can potentially become an effective diagnostic indicator for cognitive decline. In this study, we aimed to investigate the association between SUA/SCr and early-onset post-stroke cognitive impairment.MethodsConsecutive acute ischemic stroke patients from our hospital were enrolled between June 2023 and September 2024. All blood samples were collected within 24 h after admission, and the cognitive function of patients was assessed within 2 weeks using the Chinese version of the Montreal Cognitive Assessment (MoCA). SUA/SCr was calculated by serum uric acid (umol/L)/serum creatinine (umol/L) and was split into three layers according to tertiles. The subjects were divided into a post-stroke cognitive impairment group and a non-post-stroke cognitive impairment group based on cognitive assessment. Binary logistic regression with different models, multivariate logistic regression analysis, and receiver operating characteristic (ROC) curves were adopted to evaluate the predictive ability of SUA/SCr in early-onset post-stroke cognitive impairment.ResultsThe current study showed that the post-stroke cognitive impairment group had lower SUA/SCr (p = 0.005) and the lower tertile of SUA/SCr is associated with a higher prevalence of post-stroke cognitive impairment (p = 0.008). The multivariate logistic analysis indicated that SUA/SCr (OR = 0.560, 95% CI = 0.321–0.976, p = 0.024) was independently associated with early-onset post-stroke cognitive impairment, and the lowest tertile was independently associated with a 5.903-fold increased risk of post-stroke cognitive impairment after adjusting for confounders. The optimal cutoff value of SUA/SCr to predict post-stroke cognitive impairment was 4.874, which gave a sensitivity of 72.22% and a specificity of 63.16%.ConclusionOur study revealed that SUA/SCr can be a potential indicator for post-stroke cognitive impairment in the early phase, a lower level of SUA/SCr upon admission was independently correlated to cognitive dysfunction after stroke.

Classification of Japanese type 1 diabetes based on clinical phenotypes and its association with diabetic complications: Across-sectional study.

Despite the increasing number of studies using machine learning to develop individualized treatment strategies, only a few have been conducted in patients with type 1 diabetes. This study aimed to identify the characteristics of Japanese patients with type 1 diabetes, classified into subgroups using data-driven cluster analysis based on pancreatic beta-cell function, obesity, and glycemic control, and clarify the association between these subgroups and diabetic complications. In this cross-sectional study, a cluster analysis using three variables (C-peptide, body mass index, and glycated hemoglobin) in 206 Japanese patients with type 1 diabetes was performed. Multivariate logistic regression analysis was performed to compare the risk of diabetic complications by subgroup. The cluster analysis identified four subgroups. Group 2 (n = 58), characterized by high body mass index levels, had a higher risk of hepatic steatosis than the control group (Group 1, n = 90). Meanwhile, Group 3 (n = 44), characterized by high glycated hemoglobin levels, had higher risks of retinopathy, polyneuropathy, elevated brachial-ankle pulse wave velocity, and hepatic steatosis than Group 1 and Group 4 (n = 14), characterized by residual endogenous insulin, had a higher risk of chronic kidney disease than Group 1. The risks of diabetic complications differed between subgroups of Japanese patients with type 1 diabetes. Tailored treatment approaches based on subgroup characteristics are a potential treatment option for reducing the risks of diabetic complications in this population.

Creatine Kinase and New-Onset Hypertension: a 10-Year Follow-Up Study.

Creatine Kinase and New-Onset Hypertension: a 10-Year Follow-Up Study.

Problematic Internet Use Among Medical Students: Examination of Social, Lifestyle, Personality Characteristics and Mental Health

Problematic internet use (PIU) can be defined as internet use that is not well-controlled. The aim of this study was to examine the validity and reliability of the Problematic Internet Use Questionnaire Short Form (PIUQ-SF-6) among Serbian medical students and to examine the prevalence of students at risk of problematic internet use and social, lifestyle, and mental health characteristics associated with it. We conducted a cross-sectional study that included a total of 735 medical students (66.8% female and 33.2% male) attending classes in Social Medicine during the 2023/2024 school year. The instrument used was a questionnaire developed based on the questionnaires in similar studies. A total of 160 students (21.8%) were in the problematic internet use group, and 575 were in the non-problematic internet use group. Multivariate logistic regression analysis with PIU as the outcome variable showed an association between PIU and the Patient Health Questionnaire−9 score (OR: 1.10, 95% CI: 1.03–1.16) and impulsivity (OR: 1.07, 95% CI: 1.05–1.10). The mental health of medical students, as future health professionals, should be promoted through tailored interventions that are widely accessible and long-lasting.

Serum lipids, oxidative stress, and systemic inflammation mediate the association between circadian syndrome and periodontitis

BackgroundCircadian rhythm disruption is an underlying cause of metabolic syndrome (MetS) and is associated with the development of periodontitis. Circadian syndrome (CircS) is an emerging measure of circadian rhythm disruption based on MetS. We aimed to explore the cross-sectional association between CircS and periodontitis through the National Health and Nutrition Examination Survey 2009–2014.MethodsWe included 7,555 eligible participants. CircS was assessed by the five components of the MetS, depression, and short sleep duration, with fulfillment of ≥4 of the 7 components indicating the presence of CircS. Periodontitis was evaluated according to the Centers for Disease Control and Prevention-American Academy of Periodontology criteria. Multivariable logistic regression analysis was used to explore the association between CircS and periodontitis. In addition, restrictive cubic spline analysis, mediation analysis, and stratified analysis were used to comprehensively evaluate these associations.ResultsAfter adjusting for all confounders, CircS was significantly associated with periodontitis (odds ratio 1.509, 95% CI 1.326–1.716, p &amp;lt; 0.0001). Similar findings were found for CircS components. A higher number of components was associated with increased odds of periodontitis compared to participants without any components. However, among CircS participants, higher components were not associated with the odds of periodontitis. The number of CircS components was nonlinearly associated with periodontitis, and a positive association existed only when the number of components was &amp;lt;4. Mediation analyses suggested that several serum lipids, oxidative stress, and systemic inflammation markers mediated the association of CircS with periodontitis. This association was more pronounced in participants &amp;lt;60 years of age, income-poverty ratio &amp;gt;3, and non-vigorous physical activity.ConclusionThe presence of CircS was significantly associated with increased odds of periodontitis, serum lipids, oxidative stress, and systemic inflammation may mediate this association. These findings emphasize that CircS may serve as an independent risk factor for periodontitis and provide insights for individualized prevention of periodontitis.

The volume of Gleason grade group 1 prostate cancer at biopsy predicts unfavorable pathology but not upgrading after radical prostatectomy.

To investigate whether volume of Gleason grade group 1 (GGG1) prostate cancer at prostate biopsy predicts unfavorable pathologic findings after radical prostatectomy (RP). We retrospectively reviewed clinical and pathologic data from patients with biopsy-confirmed GGG1 prostate cancer and prostate-specific antigen < 20ng/mL who underwent RP at our institution between May 2014 and May 2023. The percentage of positive biopsy cores (PPC) was defined as the number of cancer positive cores divided by the total number of cores at biopsy. The primary outcome was unfavorable pathology at RP, defined as ≥ GGG3, and/or pT3/4, and/or pN1. Gleason upgrading (≥ GGG2) and biochemical recurrence after RP were also evaluated. Multivariable logistic regression analyses were performed to assess the association between PPC and the risk of unfavorable pathology and Gleason upgrading. A total of 213 patients were analyzed. Median PPC was 17.0%. Unfavorable pathology was observed in 41.8%, while 53.1% had Gleason upgrading. PPC ≥ 17% was significantly associated with unfavorable pathology (odds ratio = 1.02; p = 0.030), but not with Gleason upgrading (odds ratio = 1.01; p = 0.189). The 5-year biochemical recurrence-free survival was 98.2% for PPC < 17% and 97.8% for PPC ≥ 17%, with no significant difference between the groups (log-rank p = 0.417). Higher PPC was associated with unfavorable pathologic outcomes, but not with upgrading or recurrence, in biopsy-confirmed GGG1 prostate cancer patients treated with RP.

Prediction Score for Major Bleeding in Patients With Venous Thromboembolism Receiving Direct Oral Anticoagulants - Insights From the COMMAND VTE Registry-2.

Predicting the bleeding risk during anticoagulation therapy is a key clinical challenge in patients with venous thromboembolism (VTE). However, there is no established prediction score for major bleeding (MB) in patients with VTE treated with direct oral anticoagulants (DOACs). Using the COMMAND VTE Registry-2, which enrolled 5,197 patients with acute symptomatic VTE between 2015 and 2020 among 31 centers in Japan, we investigated the risk factors for MB beyond 7 days and within 180 days in patients who received DOACs. A prediction score was developed in the derivation cohort (n=1,618), and prediction performance was evaluated in the validation cohort (n=809). Multivariate logistic regression analysis in the derivation cohort identified factors associated with MB. Based on β coefficients for each factor, the prediction score assigned 2 points to active cancer, history of MB, and thrombocytopenia, and 1 point to creatinine >1.2 mg/dL and anemia, summing them. The C statistic of the prediction score was 0.74 (95% confidence interval [CI] 0.68-0.80) in the derivation cohort and 0.74 (95% CI 0.67-0.81) in the validation cohort (P=0.98). When a cut-off value of 3 was used for the risk score, the sensitivity and specificity were 56.1% and 79.2%, respectively. The prediction score developed for MB during DOAC therapy (COMMAND-BLEED score) could be clinically useful for decision-making regarding anticoagulation strategies with DOACs.

White blood cells, monocytes and thrombin time in predicting symptomatic hydrocephalus in patients with aneurysmal subarachnoid hemorrhage

ObjectiveTo investigate the value of admission blood routine and coagulation function parameters in predicting acute symptomatic hydrocephalus in patients with aneurysmal subarachnoid hemorrhage (aSAH).MethodsThis retrospective study included 423 patients with aSAH admitted to the Department of Neurosurgery of the Third Affiliated Hospital of Soochow University from November 2013 to September 2020. Demographic, clinical and laboratory data were collected. The patients were divided into hydrocephalus group (n = 96) and non-hydrocephalus group (n = 327) according to the presence of hydrocephalus on the first head CT. Univariate and multivariate logistic regression analyses were used to determine the independent risk factors for acute symptomatic hydrocephalus after aSAH.ResultsAmong the 423 aSAH patients, 96 (22.70%) developed acute symptomatic hydrocephalus. Multivariate logistic regression analysis showed that, after adjusting for confounding factors, white blood cells (WBC) (OR = 1.121, 95% CI = 1.067–1.181), monocytes (M) (OR = 2.812, 95% CI = 1.183–6.699), and thrombin time (TT) (OR = 0.843, 95% CI = 0.729–0.948) were independently associated with the development of hydrocephalus. Further analysis of the area under the receiver operating characteristic (ROC) curve indicated that, compared to basic clinical data, the combined prediction model of “basic clinical data + WBC + M + TT” performed better (AUC = 0.728, 95% CI = 0.682–0.769, P = 0.004).ConclusionsThe WBC, M and TT within 24 h of admission in aSAH patients can be used to predict the occurrence of acute symptomatic hydrocephalus.

A cross-sectional questionnaire survey on the prevalence and risk factors of 4 major functional gastrointestinal disorders among children in Shanghai

Objective: To investigate the prevalence and risk factors of the 4 most common functional gastrointestinal disorders (FGID) among school-aged children in Shanghai. Methods: A cross-sectional questionnaire survey was conducted from January to December 2019. Using stratified cluster sampling, 26 097 students in grades 1-12 from Huangpu and Jiading District, Shanghai were enrolled. The questionnaire of pediatric gastrointestinal symptoms-Rome Ⅳ (QPGS-Ⅳ) and the pediatric quality of life inventory (PedsQL) were used to assess the prevalence and health-related quality of life (HRQoL) of functional dyspepsia (FD), irritable bowel syndrome (IBS), functional abdominal pain-not otherwise specified (FAP-NOS), and functional constipation (FC). Multivariate Logistic regression analysis was performed to identify correlations between sociodemographic factors, lifestyle habits, comorbidities and 4 major FGID. A trend chi-square test was used to explore the relationship between HRQoL scores and FGID prevalence. Results: A total of 26 097 valid participants (26 097/27 036, 96.5%) were included in the study, with the age of (10.8±3.1) years and 12 441 cases (47.7%) were female. The prevalence of FC was found to be the highest (5 537 cases, 21.2%), followed by IBS (797 cases, 3.1%), FAP-NOS (267 cases, 1.0%) and FD (218 cases, 0.8%). Multivariate Logistic regression analysis revealed the following findings: junior high school (FD: OR=1.88 (95%CI 1.35-2.61); IBS: OR=1.42 (95%CI 1.18-1.71); FAP-NOS: OR=1.39 (95%CI 1.02-1.90)), senior high school (FD: OR=2.67 (95%CI 1.84-3.86);IBS:OR=2.36 (95%CI 1.93-2.89) ;FAP-NOS: OR=2.20 (95%CI 1.56-3.11)) and frequent respiratory infections (FD: OR=2.15 (95%CI 1.45-3.18); IBS: OR=2.59 (95%CI 2.12-3.16); FAP-NOS:OR=1.49 (95%CI 1.00-2.21)) were common risk factors for FD, IBS and FAP-NOS. Allergic symptoms (FD: OR=2.21 (95%CI 1.56-3.14); IBS: OR=2.30 (95%CI 1.04-1.51); FAP-NOS: OR=2.54 (95%CI 1.85-3.50); FC: OR=1.09 (95%CI 1.01-1.17)) was a common risk factor for FD, IBS, FAP-NOS and FC. Family history of allergy was a risk factor for IBS (OR=1.41 (95%CI 1.20-1.65)) and FAP-NOS (OR=1.33 (95%CI 1.01-1.74)). Female exhibited increased risks for FD (OR=1.49 (95%CI 1.13-1.96)), IBS (OR=1.50 (95%CI 1.30-1.74)) and FC (OR=1.10 (95%CI 1.03-1.17)). The presence of dietary bias was associated with of IBS (OR=1.46 (95%CI 1.26-1.69)) and FC (OR=1.26 (95%CI 1.19-1.34)); late bedtime (OR=1.32 (95%CI 1.06-1.64)) and allergen exposure (OR=1.25 (95%CI 1.04-1.51)) were risk factors for IBS. Insufficient sleep (OR=1.11 (95%CI 1.02-1.21)), insufficient outdoor time (OR=1.20 (95%CI 1.01-1.43)) and severe lack of outdoor time (OR=1.48 (95%CI 1.23-1.76)) were significant risk factors for FC. Pet ownership (OR=1.39 (95%CI 1.07-1.81)) was a risk factor for FAP-NOS. HRQoL scores were significantly lower in children with FD, IBS, or FAP-NOS compared to non-FGID peers (all P<0.05). χ² trend test analysis showed that the Pearson correlation coefficients between the prevalence of FD, IBS, FAP-NOS, FC and HRQoL scores were -0.93, -0.93, -0.97 and -0.84, respectively. Conclusions: The prevalence of FGID among school-aged children in Shanghai varies by sub-type. FC was the most prevalence. Junior and senior high school, female sex, allergic symptoms and frequent respiratory infections were major risk factors. Meanwhile, dietary bias, late bedtime, insufficient outdoor time and pet ownership were associated with specific subtypes. The HRQoL is significantly reduced in children with FD, IBS and FAP-NOS.

The predictive value of MUC5AC levels in the sputum of children with Mycoplasma pneumoniae pneumonia treated with fiberbronchoscopy.

To investigate the predictive value of mucin 5AC (MUC5AC) levels in the sputum of children with Mycoplasma pneumoniae pneumonia (MPP) treated with fiberbronchoscopy. Children with lobar MPP who were hospitalized in the pediatric pulmonary department of Shengjing Hospital of China Medical University from October 2022 to September 2023 were enrolled. The expression of MUC5AC in sputum was detected by enzyme-linked immunosorbent assay (ELISA). Fiberbronchoalveolar lavage fluid (BALF) was collected, and MUC5AC and epidermal growth factor (EGF) levels in BALF were detected by ELISA, followed by retrospective analysis of the clinical and laboratory test data from each group. The risk factors for fiberbronchoscopy treatment in children with lobar MPP were analyzed by multivariate logistic regression, a nomogram model created, and a receiver operating characteristic curve drawn. Multivariate logistic regression analysis revealed that increased MUC5AC in sputum, lactate dehydrogenase (LDH), IgM levels in serum, and neutrophil-to-lymphocyte ratio (NLR) were risk factors for requiring fiberbronchoscopy treatment in children with lobar MPP (P < 0.05); the MUC5AC level in sputum had the highest predictive value (AUC = 0.806). The level of MUC5AC in sputum positively correlated with the levels of LDH, C-reactive protein (CRP), D-dimer, and NLR in serum, and the level of MUC5AC in sputum correlated with the levels of MUC5AC and EGF in BALF in each group. Increased sputum MUC5AC levels, and serum LDH, IgM, and NLR in children with lobar MPP are risk factors for requiring fiberbronchoscopy treatment, and sputum MUC5AC level has superior predictive value to predict the necessity of fiberbronchoscopy treatment to remove a mucus plug.IMPORTANCEMycoplasma pneumoniae is a common pathogen of pneumonia in children, and some severely affected children are accompanied by mucus plugs. The level of MUC5AC has important predictive value for mucus hypersecretion. To develop a means of predicting airway mucus secretion in children as early as possible when fiberbronchoscopy could be used to clear airway mucus plugs and reduce sequelae, this article analyzed the risk factors for fiberbronchoscopy treatment in children with lobar M. pneumoniae pneumonia (MPP). We identified that the level of MUC5AC in sputum positively correlated with the levels of Lactate dehydrogenase (LDH), C-reactive protein (CRP), D-dimer, and neutrophil-to-lymphocyte ratio (NLR) in serum and the levels of MUC5AC and EGF in BALF of the children with lobar MPP. Increased sputum MUC5AC levels, and serum LDH, IgM, and NLR in children with lobar MPP are risk factors for requiring fiberbronchoscopy treatment, and sputum MUC5AC level has superior predictive value to predict the necessity of fiberbronchoscopy treatment to remove a mucus plug.