Multivariate Unconditional Logistic Regression Analysis Research Articles

Establishment and validation of a predictive model for peripherally inserted central catheter-related thrombosis in patients with liver cancer.

Peripherally inserted central catheters (PICCs) are commonly used in hospitalized patients with liver cancer for the administration of chemotherapy, nutrition, and other medications. However, PICC-related thrombosis is a serious complication that can lead to morbidity and mortality in this patient population. Several risk factors have been identified for the development of PICC-related thrombosis, including cancer type, stage, comorbidities, and catheter characteristics. Understanding these risk factors and developing a predictive model can help healthcare providers identify high-risk patients and implement preventive measures to reduce the incidence of thrombosis. To analyze the influencing factors of PICC-related thrombosis in hospitalized patients with liver cancer, construct a predictive model, and validate it. Clinical data of hospitalized patients with liver cancer admitted from January 2020 to December 2023 were collected. Thirty-five cases of PICC-related thrombosis in hospitalized patients with liver cancer were collected, and 220 patients who underwent PICC placement during the same period but did not develop PICC-related thrombosis were randomly selected as controls. A total of 255 samples were collected and used as the training set, and 77 cases were collected as the validation set in a 7:3 ratio. General patient information, case data, catheterization data, coagulation indicators, and Autar Thrombosis Risk Assessment Scale scores were analyzed. Univariate and multivariate unconditional logistic regression analyses were performed on relevant factors, and the value of combined indicators in predicting PICC-related thrombosis in hospitalized patients with liver cancer was evaluated using receiver operating characteristic (ROC) curve analysis. Univariate analysis showed statistically significant differences (P < 0.05) in age, sex, Karnofsky performance status score (KPS), bedridden time, activities of daily living impairment, parenteral nutrition, catheter duration, distant metastasis, and bone marrow suppression between the thrombosis group and the non-thrombosis group. Other aspects had no statistically significant differences (P > 0.05). Multivariate regression analysis showed that age ≥ 60 years, KPS score ≤ 50 points, parenteral nutrition, stage III to IV, distant metastasis, bone marrow suppression, and activities of daily living impairment were independent risk factors for PICC-related thrombosis in hospitalized patients with liver cancer (P < 0.05). Catheter duration of 1-6 months and catheter duration > 6 months were protective factors for PICC-related thrombosis (P < 0.05). The predictive model for PICC-related thrombosis was obtained as follows: P predictive probability = [exp (Logit P)]/[1 + exp (Logit P)], where Logit P = age × 1.907 + KPS score × 2.045 + parenteral nutrition × 9.467 + catheter duration × 0.506 + tumor-node-metastasis (TNM) staging × 2.844 + distant metastasis × 2.065 + bone marrow suppression × 2.082 + activities of daily living impairment × 13.926. ROC curve analysis showed an area under the curve (AUC) of 0.827 (95%CI: 0.724-0.929, P < 0.001), with a corresponding optimal cut-off value of 0.612, sensitivity of 0.755, and specificity of 0.857. Calibration curve analysis showed good consistency between the predicted occurrence of PICC-related thrombosis and actual occurrence (P > 0.05). ROC analysis showed AUCs of 0.888 and 0.729 for the training and validation sets, respectively. Age, KPS score, parenteral nutrition, TNM staging, distant metastasis, bone marrow suppression, and activities of daily living impairment are independent risk factors for PICC-related thrombosis in hospitalized patients with liver cancer, while catheter duration is a protective factor for the disease. The predictive model has an AUC of 0.827, indicating high predictive accuracy and clinical value.

The synergy of morphokinetic parameters and sHLA-G in cleavage embryo enhancing implantation rates.

Objective: This study aimed to assess the relationship between implantation and soluble HLA-G (sHLA-G) expression in cleavage embryo culture medium (ECM) in conjunction with early developmental kinetics determined by time-lapse imaging (TLI). Methods: A retrospective, single-center study was conducted involving 238 embryos from 165 patients who underwent Frozen-thawed embryo transfer (FET) using autologous oocytes, with either single or double embryo transfer. TLI morphokinetic parameters (t2, t3, t4, t5, t6, t7, t8, cc2, s2, cc3, s3) of embryos were analyzed, and sHLA-G levels in D3 ECM were measured using an enzyme-linked immunosorbent assay (ELISA). A hierarchical classification model was developed to categorize embryos into five groups (A, B, C, D, E). The correlation between sHLA-G levels, TLI classification of embryos, and embryo implantation was investigated to establish a non-invasive method for evaluating implantation potential. Multivariate logistic regression analysis was performed to identify potential influencing factors, and receiver operating characteristic (ROC) curves were used to evaluate the predictive value for implantation. Results: Multivariate unconditional logistic regression analysis indicated that TLI parameters t5 and s3 and sHLA-G level in ECM were independent risk factors affecting embryo implantation. The implantation rate decreased from TLI classification A to E. The proposed classification model effectively assessed the implantation potential of embryos. The implantation rate was higher in the sHLA-G positive group compared to the sHLA-G negative group (p < 0.001). The expression of sHLA-G in D3 ECM, combined with the TLI classification model, accurately evaluated the implantation potential of embryos with an AUC of 0.876. Conclusion: The integration of cleavage kinetics and embryonic sHLA-G expression could reliably identify embryos with a high likelihood of successful implantation.

Plasma biomarkers in patients with familial cavernous malformation and their first-degree relatives.

We aimed to explore the differences in plasma biomarker levels between patients with familial cerebral cavernous malformations (FCCM) and their healthy first-degree relatives (FDRs) and between FCCM patients with and without severe chronic disease aggressiveness (CDA). Magnetic resonance imaging (MRI) scanning and genetic testing was performed in patients with multiple CCMs and their FDRs. Sixty-seven plasma biomarkers were tested using a customised multiplex bead immunoassay kit. Univariate and multivariate unconditional logistic regression analyses were conducted to determine the associations between plasma factors and the risk of developing FCCM and severe CDA. Receiver operating characteristic (ROC) curves were generated for each independent risk factor. Plasma factors of 37 patients with FCCM and 37 FDRs were examined. Low CD31 (P < 0.001) and BDNF levels (P = 0.013) were independent risk factors for FCCM. The best model was achieved by combining the results of CD31 and BDNF (AUC = 0.845, sensitivity 0.838, specificity 0.784, cutoff score - 4.295) to distinguish patients with FCCM from healthy FDRs. Low serpin E1/PAI-1 (P = 0.011) and high ROBO4 levels (P = 0.013) were independent risk factors for severe CDA in patients with FCCM. The best model was achieved by combining the results of E1/PAI-1 and ROBO4 levels (AUC = 0.913, sensitivity 1.000, specificity 0.760, cutoff score - 0.525) to identify patients with FCCM and severe CDA. The plasma concentrations of CD31 and BDNF seem to be lower in patients with FCCM than in their healthy FDRs. Low serpin E1/PAI-1 and high ROBO4 concentrations may be correlated with high lesion burden and risk of recurrent bleeding.

Association of Antihypertensive Drug-Related Gene Polymorphisms with Stroke in the Chinese Hypertensive Population.

Antihypertensive therapy is crucial for preventing stroke in hypertensive patients. However, the efficacy of antihypertensive therapy varies across individuals, partially due to therapy-related genetic variations among individuals. We investigated the association of antihypertensive drug-related gene polymorphism with stroke in patients with hypertension. Demographic information, medication, and outcome data were obtained from a hypertensive patient management system, and a PCR fluorescence probe technique was used to detect 7 gene polymorphic loci (CYP2D6∗10, ADRB1, CYP2C9∗3, AGTR1, ACE, CYP3A5∗3, and NPPA), and these loci were compared between patients with and without stroke. Logistic regression was performed to analyze the association of these genetic variations with stroke risk in hypertensive patients while controlling for potential factors. The prevalence of stroke in the hypertensive population in Changsha County of Hunan Province was 2.75%. The mutation frequencies of ADRB1 (1165G > C), CYP2D6∗10, CYP2C9∗3, AGTR1 (1166A > C), ACE (I/D), NPPA (2238T > C), and CYP3A5∗3 were 74.43%, 57.23%, 4.26%, 5.71%, 31.62%, 1.17%, and 69.58%, respectively. Univariate analysis revealed that ADRB1 polymorphism was associated with stroke (χ2 = 8.659, P < 0.05), with a higher stroke risk in the CC group than in the GC and GG groups (GC + GG). Multivariate unconditional logistic regression analysis showed that the CC genotype in ADRB1 (vs. the GC + GG genotype) was associated with an increased risk of stroke [odds ratio (OR) = 1.184, P<0.05] in hypertensive patients. No association was observed between CYP2D6∗10, CYP2C9∗3, AGTR1 (1166A > C), ACE (I/D), CYP3A5∗3, and NPPA (2238T > C) polymorphisms and stroke. ADRB1 (1165G > C) gene polymorphism is associated with the risk of stroke in Chinese hypertensive patients. The CC genotype is correlated with a higher risk of stroke than the GC + GG genotype.

Risk factors for breast cancer among women in Ekurhuleni Metropolitan Municipality, Gauteng province of South Africa, 2017‒2020: a case-control study.

Breast cancer (BC) is the most common cancer among women in South Africa (SA), with an age-standardised incidence rate of 52.6 and an age-standardised mortality rate of 16.0 per 100,000 population. There is a paucity of evidence on the risk factors for BC among women of all races in SA. Given the rising prevalence of BC in SA, literature-based evidence is critical for the appropriate dissemination of preventative measures. This study aimed to identify the risk factors associated with the development of BC among women in Ekhuruleni Metropolitan Municipality. An unmatched case-control study was conducted from 1 January 2017 to 31 December 2020 using secondary data extracted from the Ekurhuleni Population-Based Cancer Registry. Unconditional multivariable logistic regression analysis was carried out using the adjusted odds ratio (aOR). The variables race, employment, human immunodeficiency virus (HIV), smoking and alcohol status were included in the multivariable logistic regression model while the model was adjusted for age. A total of 2,217 cases and 851 controls were enrolled in the study. The mean age (±SD) in years was 55.7 (±15.2). The White population group, being self-employed and being HIV positive was significantly associated with reduced odds of BC development. HIV-positive women were 61% less likely to have BC than women who were HIV-negative (aOR 0.39; 95% confidence interval (CI): 0.27‒0.57). White women were 65% less likely to have BC than women of other races (aOR 0.35; 95% CI: 0.29‒0.43). Self-employed women were 59% less likely to have BC than women who were formally employed (aOR 0.41; 95% CI: 0.18‒0.97). No evidence of association was observed between tobacco smoking and BC as well as alcohol consumption and BC. There was a 65% reduction in BC risk among White women compared to other races. HIV-positive women demonstrated a 61% lower likelihood of BC while self-employed women showed a 59% reduced risk of developing BC. These findings suggest that being White, self-employed or HIV-positive may provide some protection against BC. However, additional research is needed to validate these results and establish the underlying reasons behind these associations.

Characteristics and resuscitation effects of out-of-hospital sudden death: a study based on Internet data

To collect the Internet news about "sudden death", analyze its characteristics and resuscitation effects, so as to provide reference for formulating intervention strategies. The Internet was used to search for "sudden death" and "cardiac arrest" on "Baidu" and "360" websites. Reports of sudden death events were collected from January 2013 to December 2022. The age, gender, characteristics of sudden death, implementation characteristics of cardiopulmonary resuscitation (CPR), and pre-hospital and final clinical outcomes of sudden death patients were recorded and analyzed. Subgroup analyses were performed for pre-hospital and final clinical outcomes. Unconditional multivariate Logistic regression analysis was used to screen the related factors affecting the pre-hospital and final clinical outcomes in patients with sudden death. 177 news reports were finally confirmed, involving 177 sudden death patients, including 152 males (85.9%) and 25 females (14.1%), aged (37.27±16.82) years old, and 53.1% in the 16-45 years old group. Triggering factors included strenuous exercise (29.9%), heart disease history (7.9%), overwork (6.2%), staying up late and insomnia (4.0%), activation of emotion (2.8%), and no obvious inducement (48.0%). After on-site first aid, 104 cases (58.8%) achieved restoration of spontaneous circulation (ROSC) before hospital admission, and 18 cases (10.2%) recovered consciousness. After clinical treatment, 109 cases (61.6%) achieved ROSC, 86 cases (48.6%) recovered consciousness, and 22 cases (12.4%) did not report the final outcome. Subgroup analysis showed that compared with patients who achieved pre-hospital ROSC (n = 104), sudden death in non-ROSC patients (n = 73) mainly occurred during sleep, in residence and without immediate CPR, full CPR, or automated external defibrillator (AED); and patients who ultimately did not recover consciousness clinically (n = 91) showed similar characteristics compared with patients who recovered consciousness (n = 86). Multifactorial Logistic regression analysis showed that immediate CPR [pre-hospital ROSC: odds ratio (OR) = 8.06, 95% confidence interval (95%CI) was 2.36-27.46; final recovery of consciousness: OR = 9.10, 95%CI was 2.46-33.68] and AED defibrillation (pre-hospital ROSC: OR = 36.31, 95%CI was 4.53-291.19; final recovery of consciousness: OR = 3.53, 95%CI was 1.45-8.61) facilitated pre-hospital achievement of sudden death patients ROSC and final recovery of consciousness. Out-of-hospital sudden death mainly occurs in young people, and vigorous exercise is one of the potential factors for out-of-hospital sudden death, with nearly half having no obvious cause. Immediate and rapid CPR and defibrillation are the simplest and most effective on-site first aid methods. Strengthening public CPR and defibrillation education and training, and advocating healthy lifestyle are effective ways to improve the survival rate of sudden death and reduce the occurrence of sudden death. Based on practical clinical rescue experience, the implementation of bystander CPR by medical personnel is also a factor that cannot be ignored in affecting the clinical outcomes of sudden death patients.

Development and validation of a predictive model for stone-free failure after extracorporeal shockwave lithotripsy in patients with ureteral stone in a large prospective cohort

To develop and validate a nomogram for predicting stone-free failure after shock wave lithotripsy (SWL) guided by ultrasound in patients with ureteral stones. The development cohort consisted of 1698 patients who underwent SWL guided by ultrasound at our center from June 2020 through August 2021. Multivariate unconditional logistic regression analysis was used for building a predictive nomogram with regression coefficients. An independent validation cohort consisted of 712 consecutive patients from September 2020 through April 2021. The performance of the predictive model was assessed in regard to discrimination, calibration, and clinical usefulness. Predictors of stone-free failure included distal stone location (odds ratio = 1.540, P < 0.001), larger stone size (odds ratio = 1.722, P < 0.001), higher stone density (odds ratio = 1.722, P < 0.001), larger skin to stone distance (SSD) (odds ratio = 1.058, P < 0.001), and higher grade of hydronephrosis (odds ratio = 1.755, P = 0.010). For the validation cohort, the model showed good discrimination with an area under the receiver operating characteristic curve of 0.925 (95% confidence interval, 0.898, 0.953) and good calibration (unreliability test, P = 0.412). Decision curve analysis demonstrated that the model was also clinically useful. This study demonstrated that stone location, stone size, stone density, SSD, and hydronephrosis grade were significant predictors of stone-free failure after SWL guided by ultrasound in patients with ureteral stones. This may guide clinical practice.

Analysis of characteristics of intracranial cavernous angioma and bleeding factors in middle-aged and elderly patients.

Intracranial cavernous angioma (ICA) is a cerebrovascular malformation. It causes local neurological dysfunction, epilepsy, intracranial hemorrhage (ICH) and other symptoms, seriously affecting the safety of patients. This study analyzed middle-aged and elderly patients with ICA in our hospital, summarized the characteristics of the disease and investigated the related factors of ICH. We conducted a retrospective analysis of 120 middle-aged and elderly patients who were diagnosed with ICA by magnetic resonance imaging in our hospital from March 2018 to September 2021. The cases were assigned to either a bleeding group (i.e., the experimental group) or a non-bleeding group (i.e., the control group). The characteristics of the disease, including gender, age, number of lesions, form and symptoms of onset, distribution of lesions, blood supply vessels in the lesion area, size of the lesion and presence of bleeding, were summarized and analyzed. The relationship between these factors and ICH was investigated, and the data were analyzed using SPSS 25.0 software. There were 56 cases in the experimental group and 64 cases in the control group. A univariate analysis showed that gender, age, body mass index, blood lipids, number of lesions, course of the disease, onset of symptoms and disease characteristics were not associated with ICH in the middle-aged and elderly patients with ICA (P > 0.05). The maximum diameter, volume, location and blood supply area of the lesions were related to ICA complicated with ICH (P < 0.05). A multivariate unconditional logistic regression analysis revealed that the maximum diameter, volume, location and blood supply area of the lesions were independent risk factors for ICH in the middle-aged and elderly patients with ICA. The odds ratio (OR) of the maximum diameter of the lesion was 4.410, the OR of the lesion volume was 7.316, the OR of the lesion site was 7.470, and the OR of the blood supply area was 1.6588. Intracranial cavernous angioma lesions in middle-aged and elderly patients occur mainly in the supratentorial area, with a small part located in the infratentorial area. The main form of the disease is chronic recurrence. The occurrence of bleeding is related to the size, location and blood supply of the lesion.

Low Intake of Fruits and Vegetables and High Intake of Processed Meats and Juices Are Associated with Risk of MGUS in the National Health and Nutrition Examination Survey (NHANES) Database

Introduction Monoclonal gammopathy of undetermined significance (MGUS) is a plasma cell disorder with a prevalence of about 3% in adults over age 50. The annual average risk of progression to multiple myeloma (MM) is approximately 1%. MGUS has also been reported to be associated with excess risk of cardiac, renal, neurologic, and immune-related conditions. Although inflammatory or insulinemic diets or diets low in plant-based foods have been associated with risk of MM, there is limited information on dietary factors and risk of MGUS from one Icelandic cohort study which focused on Caucasians (Thordardottir et al. 2018). Given that food intake can vary greatly across ethnic/racial groups, we were motivated to conduct a large population-based study including Caucasians, African-Americans, Hispanics, Asians, Pacific Islanders, and other ethnic/racial groups. Methods Using the National Health and Nutrition Examination Survey (NHANES), we conducted a case-control study including 373 individuals with MGUS (cases) and 1,406 frequency-matched controls. Diet was characterized by 24-hour dietary recall (DR) and food frequency questionnaire (FFQ). MGUS status was determined by screening. Unconditional multivariable logistic regression analyses were used to model the association between MGUS and daily intake of macronutrients, 18 micronutrients, and nine USDA food groups from the DR, and analogous food groups from the FFQ, with odds ratios (OR) and 95% confidence intervals (CI) for MGUS as the measures of association. Results Descriptive characteristics of the study sample are shown in Table 1. Over 40% of the participants were members of racial or ethnic minorities. Among the micronutrients, only sodium intake achieved significance (Figure 1); individuals with insufficient daily sodium intake were 54% more likely to have MGUS than those with sufficient intake (OR=1.54; 95% CI=1.07-2.21), which could be indicative of individuals with kidney disease or hypertension (both associated with MGUS) or heart failure following low-sodium diets. Excessive sodium intake was not significantly associated with MGUS in this study. Daily gram intake of "Fruits, excluding juices, and vegetables" was higher in non-MGUS, with the highest quartile associated with 33% lower odds of MGUS (Q4 OR=0.67; 95% CI=0.48-0.94; p for trend=0.02). Daily gram intake of "Sugars, sweets, and beverages" was significantly associated with an increased odds of MGUS (Q4 OR=1.45; 95% CI= 1.01-2.08; p for trend=0.02). Monthly frequency of intake of "Meat, poultry, seafood, stews" (Q4 OR=1.61; 95% CI=1.03-2.50, p for trend<0.05) was associated with MGUS, with most of the effect coming from processed meat (data not shown). Frequency of intake of "Fruit juice" (Q3 OR=1.91; 95% CI=1.24-2.96; Q4 OR=1.81; 95% CI= 1.17-2.81; p for trend<0.01) was also associated with MGUS. There was a suggestion of an inverse association between monthly intake of "Bread, cereal, rice, starchy entrees, cakes" and MGUS. Compared to Q1, Q2 was significantly associated with reduced risk of MGUS (Q2 OR=0.62; 95% CI=0.41-0.96); Q3 and Q4 supported this trend but were not significant. Most of the category effect was due to dry cereals and yeast breads (data not shown). No other micronutrient or food group, measured by DR or FFQ, was found to be associated with MGUS. Conclusions Our study shows that certain dietary characteristics, including low intake of sodium, fruits and vegetables, and cereals and yeast breads, and high intake of sugars, sweets, and beverages, juices, and processed meat, are associated with MGUS. The identification of novel dietary risk factors for MGUS in a diverse population are of direct public health relevance. The findings of this study also provide rationale for exploration of mechanistic links between diet and the microbiome, immune system, metabolism, and epigenetics, such as the ongoing plant-based diet pilot study at Memorial Sloan Kettering Cancer Center (NCT04920084) and intermittent fasting study at Roswell Park Comprehensive Cancer Center (NCT05312255). Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Obesity and Complication Risk From Radical Cystectomy: Identifying a Body Mass Index Threshold.

There are conflicting reports regarding radical cystectomy complication risk from obesity subcategories, and a BMI threshold below which complication risk is notably reduced is undefined. A BMI threshold may be helpful in prehabilitation to aid patient counseling and inform weight loss strategies to potentially mitigate obesity-associated complication risk. This study aims to identify such a threshold and further investigate the association between BMI subcategories and perioperative complications from radical cystectomy. Data were extracted from the Canadian Bladder Cancer Information System, a prospective registry across 14 academic centers. Five hundred and eighty-nine patients were analyzed. Perioperative (≤90 days) complications were compared between BMI subcategories. Unconditional multivariable logistic regression and cubic spline analysis were performed to determine the association between BMI and complication risk and identify a BMI threshold. Perioperative complications were reported in 51 (30%), 97 (43%), and 85 (43%) normal, overweight, and obese patients (P = .02). BMI was independently associated with developing any complication (OR 1.04 95% CI 1.01, 1.07). Predicted complication risk began to rise consistently above a BMI threshold of 34 kg/m2. Both overweight (OR 2.00 95% CI 1.26-3.17) and obese (OR 1.98 95% CI 1.24-3.18) patients had increased risk of complications compared to normal BMI patients. Complication risk from radical cystectomy is independently associated with BMI. Both overweight and obese patients are at increased risk compared to normal BMI patients. A BMI threshold of 34 kg/m2 has been identified, which may inform prehabilitation treatment strategies.

Associations of alcohol consumption with the risk and surgical outcomes of chronic rhinosinusitis in China: A case-control study.

To investigate the associations between weekly alcohol consumption and the risk and surgical outcome of Chronic Rhinosinusitis (CRS). A case-control study. The study population consisted of 1095 CRS patients and 909 healthy collected from the first affiliated hospital of Zhengzhou University between May 2018 and December 2019. Unconditional multivariate logistic regression analysis and Cox proportional hazards regression analysis were performed to estimate the association of alcohol consumption with the risk and surgical outcomes of CRS. Odds ratios (OR) or hazard ratio (HR) with 95% confidence intervals (CI) were calculated separately. The Kruskal-Wallis test was used to explore the possible molecular mechanisms. As compared with nondrinkers, the multivariable-adjusted OR (95% CI) values of current drinkers consuming 7.5-22 drinks and >22 drinks per week were 2.158 (1.249-3.729) and 5.373 (2.912-9.911), respectively. The rate of mucosal epithelialization after CRS surgery for patients who drank 7.5-22 drinks and >22 drinks per week was lower than that of nondrinkers [HR (95% CI)=0.487 (0.351-0.675) and 0.252 (0.184-0.346), respectively]. The association of alcohol consumption with the risk and surgical outcome of CRS was dose dependent (p < .01). Alcohol consumption increased the risk of CRS and extended the time of mucosal epithelialization after CRS surgery by possibly increasing serum IgE levels (p < .05). Higher alcohol consumption of >7.5 drinks per week was an independent risk factor for CRS and extended the time of mucosal epithelialization after surgery. As a potential underlying mechanism, alcohol consumption increases serum IgE levels.

Correlation between abnormal left atrial appendage function and thrombotic events in patients with non-valvular atrial fibrillation

Objective: To investigate the association between abnormal left atrial appendage function and thrombotic events in patients with non-valvular atrial fibrillation, and the independent risk factors affecting left atrial appendage function. Methods: Patients with non-valvular atrial fibrillation, who visited the Atrial Fibrillation Center of the First Affiliated Hospital of Xinjiang Medical University from June 1, 2019 to June 1, 2021, were selected. According to left atrial appendage flow velocity (LAAFV), they were divided into normal left atrial appendage function group (297 patients with LAAFV ≥ 40 cm/s) and abnormal left atrial appendage function group (85 patients with LAAFV<40 cm/s). Baseline data and transesophageal echocardiography images were collected from all the patients. The occurrence of thrombotic events was recorded. Univariate and multivariate unconditional logistic regression analyses were conducted to investigate the correlation between abnormal left atrial appendage function and the occurrence of thrombotic events. Results: There were significant differences in gender, type of atrial fibrillation, CHA2DS2-VASc score, anticoagulant therapy, total cholesterol, low-density lipoprotein cholesterol, international normalized ratio (INR), left atrial diameter, proportion of patients with right atrial enlargement, left ventricular ejection fraction, inner diameter, sum of inner diameter, depth, and sum of depth of all angles of the left atrial appendage, and incidence of thrombotic events between the two groups (all P<0.05). After adjusting for confounders, multivariate unconditional logistic regression analyses showed that abnormal left atrial appendage function was closely associated with thrombotic events (β=1.168 P=0.002), and left atrial diameter (OR=1.084, 95%CI 1.019-1.153, P=0.011) and persistent atrial fibrillation (OR=2.323, 95%CI 1.226-4.403, P=0.010) were independent risk factors affecting left atrial appendage function. Conclusions: Abnormal left atrial appendage function is closely associated with thrombosis. The left atrial diameter and persistent atrial fibrillation were independent risk factors affecting left atrial appendage function.

Infant feeding practices and childhood acute leukemia: Findings from the Childhood Cancer & Leukemia International Consortium.

Increasing evidence suggests that breastfeeding may protect from childhood acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). However, most studies have limited their analyses to any breastfeeding, and only a few data have examined exclusive breastfeeding, or other exposures such as formula milk. We performed pooled analyses and individual participant data metaanalyses of data from 16 studies (N=17 189 controls; N=10 782 ALL and N=1690 AML cases) from the Childhood Leukemia International Consortium (CLIC) to characterize the associations of breastfeeding duration with ALL and AML, as well as exclusive breastfeeding duration and age at introduction to formula with ALL. In unconditional multivariable logistic regression analyses of pooled data, we observed decreased odds of ALL among children breastfed 4 to 6months (0.88, 95% CI 0.81-0.96) or 7 to 12 months (OR 0.85, 0.79-0.92). We observed a similar inverse association between breastfeeding ≥4months and AML (0.82, 95% CI 0.71-0.95). Odds of ALL were reduced among children exclusively breastfed 4 to 6months (OR 0.73, 95% CI 0.63-0.85) or 7 to 12 months (OR 0.70, 95% CI 0.53-0.92). Random effects metaanalyses produced similar estimates, and findings were unchanged in sensitivity analyses adjusted for race/ethnicity or mode of delivery, restricted to children diagnosed ≥1year of age or diagnosed with B-ALL. Our pooled analyses indicate that longer breastfeeding is associated with decreased odds of ALL and AML. Few risk factors for ALL and AML have been described, therefore our findings highlight the need to promote breastfeeding for leukemia prevention.

Research on Adoption Behavior and Influencing Factors of Intelligent Pension Services for Elderly in Shanghai.

With the rapid development of artificial intelligence and Internet-of-Things technology, the traditional pension service mode has changed, and intelligent pension services have become a new direction of development. Descriptive statistical analysis is conducted on the supply status and demand of intelligent pension services. It is believed that the current intelligent pension services are still in the initial stage of development, and the contradiction between supply and demand is prominent. The demand for intelligent pension of the elderly is high, but the user acceptance and satisfaction are not high. On this basis, variables were selected from individual characteristics, family situation, economic status, education level, living conditions, and other indicators for multivariate unconditional logistic regression analysis. It was found that the adoption behavior of intelligent pension service users was most significantly affected by age, number of children, living conditions, service cost, service docking channel, and equipment operation difficulty. Based on the conclusion, this article puts forward some suggestions such as taking the government as the center to realize the multi-governance of intelligent pension services, improving the supply of intelligent pension service-related facilities guided by demand, optimizing the service mode based on the platform to realize dynamic combination, and taking talents as the core to promote the high-quality development of intelligent pension services.

COMPARING SHORT- AND LONG-TERM TMD PAIN COMORBIDITIES: A CROSS-SECTIONAL STUDY AMONG ADOLESCENTS

<h3>Objectives</h3> The primary aim of this study was to compare painful and nonpainful comorbidities between short- and long-term temporomandibular disorder (TMD) pain. The secondary aim was to assess the impact of persistent TMD pain on school absence. <h3>Study Design</h3> Adolescents were enrolled in Montreal (Canada), Nice (France), and Arceburgo (Brazil). The presence of TMD pain, comorbidities (i.e., asthma, allergies, back pain, neck pain, stomach pain, and headache), and school absence were assessed using reliable and validated questionnaires. TMD pain lasting <6 months was considered short-term, and that lasting ≥6 month was deemed long-term. Chi-square tests and analysis of variance were used to test statistical differences between adolescents with short- and long-term TMD pain and those without (controls). Univariate and multivariate unconditional nominal logistic regression analyses were used to assess the association between TMD pain (dependent variable) and the independent variables. <h3>Results</h3> This study enrolled 1400 adolescents with short-term (n = 312, 22.29%) and long-term (n = 139, 9.93%) TMD pain and controls (n = 949, 67.79%). The number of comorbidities was associated with short-term (odds ratio [OR] = 1.71; 95% confidence interval [CI], 1.53-1.90) and long-term (OR = 1.79; 95% CI, 1.55-2.08) TMD pain compared with controls. Allergies were only associated with short-term TMD pain (OR = 1.54; 95% CI, 1.13-2.10). In comparison to controls, adolescents with long- and short-term TMD pain were more likely to have frequent headaches (≥once a week; OR short-term = 4.39; 95% CI, 3.23-5.98; OR long-term = 3.69; 95% CI, 2.45-5.57) and frequent back pain (OR short-term = 1.46; 95% CI, 1.06-2.03; OR long-term = 1.69; 95% CI, 1.11-2.59). Frequent stomach pain was only associated with long-term TMD pain (OR = 2.01; 95% CI, 1.35-3.26), whereas frequent neck pain was only associated with short-term TMD pain (OR = 2.23; 95% CI, 1.53-3.26). Adolescents with long-term TMD pain had higher rates of missing school than those with short-term TMD pain (n long-term = 39, 28.26%; n short-term = 48, 15.43%; <i>P</i> = .0015). <h3>Conclusions</h3> Frequent headache and back pain are very common among adolescents with both short- and long-term TMD pain. The specific association between stomach pain and long-term TMD pain suggests a central dysregulation mechanism.

Quality of life and its influencing factors among diabetic patients two years after a self-management intervention in six provinces and cities in China: a follow-up study

Objective To analyze the quality of life (QoL) and its influencing factors among diabetes mellitus patients two years after undergoing a community-based diabetes self-management and to provide references for improving medical service to diabetes. Methods From August to October of 2013, 1 653 diabetic patients were recruited in 84 communities in three cities (Beijing, Shanghai and Chongqing) and three provinces (Jiangsu, Guangdong and Zhejiang) to carry out a 2-month diabetes self-management group intervention. A follow-up survey was conducted during September – December 2015 to analyze changes in QoL and its influencing factors before and after the self-management intervention. The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) was used in QoL evaluation. Results Among the 1 653 diabetic patients recruited in 2013, 1 603 (96.98%) completed a baseline survey, of which, 1 299 patients were followed up and 304 (18.96%) were lost to follow-up in 2015. Compared to those before the intervention, the patients′ median (quartile range, QR) of SF-36 physical health score increased significantly two years after the self-management intervention (76.50 [23.75] vs. 75.00 [25.00], Z = – 2.53; P = 0.011), but the patients′ median (QR) of SF-36 mental health score was not significantly different (78.44 [25.03] vs. 78.44 [23.31], P > 0.05). The results of unconditional multivariate logistic regression analysis demonstrated that two years after receiving the diabetes self-management intervention, the patients suffering from diabetes 5 years or more and smoking were less likely to have an increased physical health score, while those with an improved self-efficacy were more likely to have an increased physical health score; the patients with following characteristics were less likely to have an increased mental health score: female, with medication reimbursement by medical insurance for urban workers, having complication of other chronic disease, smoking, and being capable of self-injection of insulin or not needing insulin injection. Conclusion The quality of life was improved to a certain extent among a group of community diabetic patients in China two years after a self-management intervention and the improvement was influenced by the patients′ gender, major payer of the medication cost, disease course, comorbidity of other chronic diseases, self-efficacy, smoking, and self-injection of insulin.

Status and influencing factors of blood pressure control among 35 – 74 years old community hypertensive patients in Luohu district of Shenzhen, 2019

Objective To investigate the condition and impact factors of blood pressure control among 35 – 74 years old hypertension patients in Luohu district, Shenzhen city of Guangdong province and to provide evidences to improve health management of the patients. Methods Using stratified random sampling, we recruited 1 205 hypertension patients aged 35 – 74 years at 10 community health service centres affiliated to Shenzhen Luohu Hospital Group. Face-to-face interviews with a self-designed questionnaire, physical examination and laboratory test were conducted among the patients during February 2019. Results Of all the patients, 618 (51.3%) had their blood pressure well-controlled. The results of unconditional multivariate logistic regression analysis showed that the patients with following characteristics were more likely to have well-controlled blood pressure: with locally registered permanent residence (odds ratio [OR] = 1.379, 95% confidence interval [95% CI]: 1.088 – 1.748), taking antihypertensive medication regularly (OR = 1.598, 95% CI: 1.173 – 2.177), and having a physical examination every year (OR = 1.578, 95% CI: 1.221 – 2.040); the results also revealed that male patients were less likely to have well-controlled blood pressure (OR = 0.762, 95% CI: 0.603 – 0.963) compared to female patients. Conclusion Among 35 to 74 years old community hypertension patients in Luohu district of Shenzhen city, the blood pressure control rate was relatively high and was mainly influenced by gender, whether having local household registration, whether having antihypertensive medication regularly and whether taking a physical examination every year.

The Prevalence of Diabetes, Prediabetes and Associated Risk Factors in Hangzhou, Zhejiang Province: A Community-Based Cross-Sectional Study

ObjectiveLittle information is available on the prevalence and associated risk factors of diabetes and prediabetes in the community located in Hangzhou city, Zhejiang Province, southeast China. This study aims to investigate the prevalence of adult diabetes and prediabetes and their associated risk factors among a community population in Hangzhou.MethodsA multistage sampling method was used in this study. Ten communities located in Shangcheng district of Hangzhou city were selected, and 3096 permanent residents (resident for ≥6 months) aged 18 years and above were enrolled into this study. Finally, a total of 2986 participants were included. A questionnaire interview and physical examination were conducted for all participants by trained investigators in a local medical center. Anthropometric measurements covered height, weight, waist circumference (WC) and blood pressure, while the blood tests included fasting blood glucose, an oral glucose tolerance test and fasting lipid profiles. The American Diabetes Association diabetes diagnosis criteria were used to discriminate among normal blood glucose, diabetes and prediabetes. The Rao–Scott adjusted χ2 test and complex sampling design-based unconditional multivariate logistic regression analysis were used to evaluate factors associated with diabetes and prediabetes. Descriptive and inferential statistics were calculated in Stata version 15. P-values <0.05 indicate statistical significance.ResultsThe overall prevalence of diabetes was 13.97%, of which 81.54% had prediagnosed diabetes and 18.46% were newly diagnosed with diabetes in the present study. The prevalence of prediabetes was 18.89%. Multivariable logistic regression analysis showed that age, education, once smoking, family history of diabetes, obesity, central obesity and hypertension were factors associated with diabetes, while age, smoking, drinking, central obesity and hypertension were significant factors related to prediabetes.ConclusionThe prevalence of diabetes and prediabetes in adults in Hangzhou city remains high. Interventions aiming to modify risk factors such as drinking, obesity, central obesity and hypertension are urgently required.

Periodontal disease as a risk factor for sporadic colorectal cancer: results from COLDENT study

Colorectal cancer remains the top leading cancer worldwide. Accumulating evidence suggests periodontal pathogens are involved in colorectal carcinogenesis, indicating the need for high-quality epidemiological evidence linking periodontal disease (PD) and colorectal cancer (CRC). Thus, we conducted the first population-based case–control study that was specifically designed to investigate the association between compromised oral health and sporadic CRC. A total of 348 incident cases of colon or rectal cancer, and 310 age and sex frequency-matched controls, from the Montreal island and Laval population participated in the study. Data were collected on PD and on several CRC risk factors using validated questionnaires. A life-course approach was used to document long-term history regarding lifestyle factors. Multivariable unconditional logistic regression analysis was used to estimate the rate ratio (RR) quantifying the association between CRC and PD. Results showed that the rate of new diagnosis of CRC in persons with a positive history of PD was 1.45 times higher than in those with a negative history of PD adjusting for age, sex, BMI, education, income, diabetes, family history of CRC, regular use of non-steroidal anti-inflammatory drugs, lifetime cumulative smoking, lifetime consumption of red meats, processed meats, and alcoholic drinks, and lifetime total physical activity score (adjusted RR = 1.45; 95% CI 1.04–2.01; p = 0.026). Our results support the hypothesis of an association between PD and sporadic CRC risk.

Associations of breastfeeding history with metabolic syndrome and cardiovascular risk factors in community-dwelling parous women: The Japan Multi-Institutional Collaborative Cohort Study.

The aim of the present study was to investigate the associations between breastfeeding and the prevalence of metabolic syndrome in community-dwelling parous women and to clarify whether the associations depend on age. The present cross-sectional study included 11,118 women, aged 35-69 years. Participants' longest breastfeeding duration for one child and their number of breastfed children were assessed using a self-administered questionnaire, and their total breastfeeding duration was approximated as a product of the number of breastfed children and the longest breastfeeding duration. The longest and the total breastfeeding durations were categorized into none and tertiles above 0 months. Metabolic syndrome and cardiovascular risk factors (obesity, hypertension, dyslipidemia, and hyperglycemia) were defined as primary and secondary outcomes, respectively. Associations between breastfeeding history and metabolic syndrome or each cardiovascular risk factor were assessed using multivariable unconditional logistic regression analysis. Among a total of 11,118 women, 10,432 (93.8%) had ever breastfed, and 1,236 (11.1%) had metabolic syndrome. In participants aged <55 years, an inverse dose-response relationship was found between the number of breastfed children and the prevalence of metabolic syndrome; multivariable-adjusted odds ratios for 1, 2, 3, and ≥4 breastfed children were 0.60 (95% confidence interval [CI]: 0.31 to 1.17), 0.50 (95% CI: 0.29 to 0.87), 0.44 (95% CI: 0.24 to 0.84), and 0.35 (95% CI: 0.14 to 0.89), respectively. The longest and total breastfeeding durations of longer than 0 months were also associated with lower odds of metabolic syndrome relative to no breastfeeding history in participants aged <55 years. In contrast, all measures of breastfeeding history were not significantly associated with metabolic syndrome and cardiovascular risk factors in participants aged ≥55 years old. Breastfeeding history may be related to lower prevalence of metabolic syndrome in middle-aged parous women.