Multivariate Analysis Of Variables Research Articles

Relevance of recurrent venous thromboembolism according to location of metastasis in patients with cancer-associated thrombosis. A cohort study

BackgroundRisk of VTE recurrence (VTEr) in patients with cancer-associated thrombosis (CAT) is high. Cancer-related risk factors for VTEr have been studied, but information about the importance of location of metastasis is scarce. Objectives1) Evaluate rate of VTEr in CAT patients according to location of metastasis, and 2) Identify variables associated to VTEr during long-term follow-up. MethodsA retrospective, single-center, non-interventional study of consecutives patients with CAT conducted between 2007 and 2022. Haematological neoplasms were excluded. ResultsAmong 1248 patients with CAT (age 64.1 ± 12.8 years; 48.2 % female) followed-up for 13.19 months (p25–75, 5.6–26.9) there were 141 VTEr. The rate of VTE recurrence in patients without and with metastasis were 4.72 per 100 patient-years (95%CI: 3.66–6) and 10.05 per 100 patient-years (95 % CI: 7.89–12.61), respectively. The metastases locations associated with VTEr, compared to those without metastasis, were lung (rate ratio [RR]: 2.21; 95 % CI: 1.42–3.43), liver (RR: 2.02; 95%CI: 1.26–3.24), pancreas (RR: 6.21; 95 % CI: 1.52–25.35), pleura (RR: 2.93; 95%CI: 1.58–5.41), bone (RR: 2.16; 95 % CI: 1.29–3.64) and adrenal (RR: 6.18; 95%CI: 2.97–12.86). Multivariate analysis of variables associated with VTEr beyond 12 months were male sex (hazard ratio [HR] 1.54, 95%CI: 1.08–2.19), ECOG performance status >1 (HR 1.74, 95%CI: 1.03–2.94), metastasis in 1–2 locations (HR 2.38, 95%CI: 1.68–3.37) and metastasis in >2 locations (HR 3.88, 95%CI: 1.68–8.98). ConclusionsThe rate of VTEr differs according to the location of metastasis. We identified variables related to VTEr during long-term follow-up which may help clinicians decide whether to continue anticoagulation.

Determinants of Neonatal and Postneonatal Mortality in Northeastern Brazil: A Cohort Study of Newborns Admitted to the Neonatal Intensive Care Unit.

Despite advances in neonatology, neonatal mortality from preventable causes remains high in the North and Northeast regions of Brazil. This study aimed to analyze the determinants associated with neonatal and postneonatal mortality in newborns admitted to a neonatal intensive care unit. A cohort study was carried out in a capital in the Brazilian Northeast from 2013 to 2018. The outcome studied was death. Poisson regression was performed in the multivariate analysis of variables. Four hundred and eighty newborns were eligible, and 8.1% (39 newborns) died. Among them, 34 died in the neonatal period. The determinants that remained significantly associated with neonatal and postneonatal mortality in the final adjustment model (p < 0.05) were history of abortion, perinatal asphyxia, early neonatal sepsis and umbilical venous catheterization. All causes of this outcome were preventable. The neonatal mortality rate, although it did not include twins, neonates with malformations incompatible with life and other conditions, was 3.47 deaths per thousand live births (95% CI:1.10-8.03‱), well below the national average. In this study, pregnant women from different social classes had in common a private plan for direct access to health services, which provided them with excellent care throughout pregnancy and postnatal care. These results indicate that reducing neonatal mortality is possible through public policies with strategies that promote improvements in access to health services.

Radiological predictive remission factors of pulmonary involvement in systemic sarcoidosis: a computed tomography scan study.

As little is known about the prognostic value of CT scan findings at onset in patients presenting with sarcoidosis, we aimed to identify factors independently associated with radiological remission of pulmonary involvement in systemic sarcoidosis on CT scan findings. We conducted a retrospective descriptive and analytic study of patients with a biopsy proven systemic sarcoidosis. We compared patients on radiological remission (group 1) to those on stabilization or progression (group 2). Multivariate analysis of variables significantly associated with radiological remission in univariate analysis was performed using binary logistic regression. Out of 65 records of systemic sarcoidosis, 43 were analyzed. 18.6% where male and 81.6% female with a sex-ratio of 0.22 and a mean age at diagnosis of 47.2 ±13.6 years. We found atypical lesions in CT scan findings in 16 patients (37.2%). Comparative pulmonary CT scan findings at admission and at 12 months follow-up revealed 13 patients (30.2%) in remission (group1) and 30 patients in radiological stabilization or progression (group 2). On multivariate analysis, lymphopenia, calcifications, and typical CT scan findings at presentation were predictive factors of remission of pulmonary involvement in systemic sarcoidosis (aOR=27.57; 95%IC=2.67-284.63; p=0.005) (aOR= 37.2; 95%IC= 2.08-663.89; p= 0.014) (aOR=47.1; 95%IC= 1.79-1238.7; p=0.021) respectively. In patients with systemic sarcoidosis with no lymphopenia at onset or calcifications or typical CT scan findings at presentation, we suggest a close follow-up as well as an intensive treatment.

Validating the Systemic Inmmune-Inflamation Index (SII) As a Prognostic Biomarker of Overall Survival in Diffuse Large B-Cell Lymphoma: A Retrospective Analyses By the Gruppo De Estudio Latinoamericano De Linfoproliferativos (GELL)

Introduction: Diffuse Large B-cell lymphoma (DLBCL) is an aggressive malignancy and the most common type of non-hodgkin´s lymphoma. Biologically, survival of neoplastic lymphoid cells depends on self-mediated mechanisms and the tumor microenvironment ( Steen CB,2021) leading to an inflammatory state. Although a better understanding of lymphoma biology has helped predict outcomes in DLBCL, modern tools such as next generation sequencing are not available in Latin America ( LATAM). The systemic immune-inflammation index (SII) is a score based on neutrophil, platelet, and lymphocyte counts that has proven to be useful in DLBCL ( ZanZan W, 2021 &amp; Xiao-Bo,2021). Moreover, its variables can be easily evaluated at resource-limited healthcare setting. Thus, we aim to validate this new SII score in our LATAM DLBCL population. Methods. A retrospective analysis of patients aged ≥18 years with a new diagnosis of DLBCL between 2010 and 2018 were included. Data were obtained from 7 LATAM countries: Argentina, Colombia, Chile Mexico, Peru, Uruguay, and Venezuela. Clinical features including the international Prognostic Index (IPI) variables (i.e. age≥60 years, ECOG performance status ≥2, &amp;gt;1 site extranodal involvement, elevated serum LDH, and advanced clinical stage) and low serum albumin defined as &amp;lt;3.5mg/dL (divided in low 3.4-2.5mg/dL &amp; very low &amp;lt;2.5mg/dL) were recorded. We calculated the neutrophil/lymphocyte ratio (NLR) and use the cut-off previously published by our group (Beltran&amp;Villela,2020). The SII score was calculated using the following formula: (absolute neutrophil count x platelet count) divided by absolute lymphocyte count x100; The cut-off was calculated by the ROC method. Demographics characteristics are reported using descriptive statistics. Cox proportional-harzard regression model was used to evaluate parameters associated with OS curves estimated with the Kaplan-Meier (KM) method. Outcomes. A total of 1032 patients were identified of whom 1029 received standard dose RCHOP (n=862,84%), R-miniCHOP (43,4.17%), R-EPOCH (n=61,5.92%) and CHOP (n=63,6.12%) with a curative intent. A total of 992 patients had suffcient data for analysis. Median follow.up for all cohort was 45 months (IQR: 7 to 60). Median age at diagnosis was 63 years (58.4%, age ≥60;IQR: 50 to 73), 50% was female, 33% had ECOG ≥2, 22% extranodal involvement (EN) &amp;gt;1 sites, 48% elevated serum lactate dehydrogenase (LDH), 41% advanced stage (Stage III/IV). Patients with hypoalbuminemia (Low &amp; very low) were 25% &amp; 6%, respectively; NLR &amp;gt;4 was 14%. The median calculated SII score for the entire cohort was 1774 (IQR:523 to 1856) with a cut-off of &amp;gt;1636 (AUC 0.55[95%C.I. 0.53 to 0.59], p=0.004). The clinical characteristics of non-inflammation group [NIG,n=736,71.5%] (below cut-off) and inflammation group [IG,n=293,28.5%] (above cut-off) are presented in Table 1. ECOG ≥2; elevated serum LDH, advanced stage; low &amp; very low albumin; and NLR &amp;gt;4 were assocated to de IG ( all of them p&amp;lt;0.0001). The KM for NIG and IG showed better OS for the NIG at 3 years (67% vs. 49%, p&amp;lt;0.0001). Table 2 shows the univariate and multivariate analysis of variables with independent influence on OS. All but EN involvement were independent factors to prognosticate OS with a Harrell´s C-Index of 0.73 (95% C.I. 0.69 to 0.76). Conclusions. In this large cohort of LATAM DLBCL patients, we were able to validate the SII score. We found the SII score was able to discriminate low from hogh risk DLBCL inflammatory groups. Moreover, these findings were coupled to the validation of other prognostic factors such as the IPI score, hypoalbuminemia, and high NLR.

Indolent Lymphoma: High CR and VGPR Rate with Fixed Duration Bendamustine, Rituximab and Acalabrutinib in Waldenstroms Macroglobulinaemia (BRAWM)

Background: Waldenström's macroglobulinaemia (WM) is an uncommon lymphoproliferative disorder. Although many options are available, an optimal first-line therapy for WM has not been defined. We postulated that combining bendamustine and rituximab (BR) with a next generation BTK inhibitor would result in deeper responses as measured by complete response (CR) and very good partial response (VGPR) rates, and provide a longer duration of response. Objectives: The primary objective of this trial is to document the CR and VGPR rates Methods: The BRAWM clinical trial combines BR with acalabrutinib in a one-year, fixed duration treatment course including six cycles of BR and 12 months of acalabrutinib (6 months of monotherapy). This ongoing trial is taking place at 9 clinical sites across Canada and 44 patients have been enrolled as of July 1, 2023, with a recruitment goal of 59. Results: Median age of participants was 68; 34 were male; 3 participants were low risk, 21 intermediate and 20 high risk. 27 participants completed combination therapy, 17 completed monotherapy and 7 were followed-up at 18 months, and 3 at 24 months after first dose. Table 1 shows the observed Clinical Responses using 6 th IWWM; 2 participants improved from a VGPR to a CR between cycles 7 and 12, both of whom have not reached month 18 for assessment. The interim primary endpoint of combined CR and VGPR rate is 13/17 (77%), with no participants having progressed at this interim analysis. 3 participants discontinued treatment early: 1 at cycle 7 (with a VGPR) who experienced an adverse event requiring treatment; 1 at cycle 3 with inter-current illness, and 1 at cycle 2 for personal reasons not related to treatment. The total observed Treatment Related Adverse Events (TRAEs) in combination therapy was 188 amongst 35 participants, and n= 24 in 10 participants during monotherapy. There were 24 Grade 3/4 TRAEs (combination n= 20, monotherapy n= 4). Total observed Serious Adverse Events was 18, and 7 TRSAEs 7; 6 during combination therapy (3 febrile neutropenia and 1 for each fever, allergic reaction and bowel obstruction) and 1 pneumonia during monotherapy. Grade 3/4 TRAEs resulted in 29 dose interruptions in 13 participants, and 2 dose reductions. Mutational analysis of participants with adequate sample for assessment (n=35), showed 33 with MYD88 mutation, 10 with a CXCR4 mutation, and 1 with a TP53 mutation. Minimal residual disease (MRD) analysis of Peripheral Blood (PB) and Bone Marrow, using next generation sequencing, is underway. Initial review shows that most evaluable patients (those with samples at two or more time-points) have become MRD undetectable in PB. Uni- and multi-variate analyses of variables that may be associated with outcomes is underway. Conclusions: Bendamustine, rituximab and acalabrutinib front-line therapy for WM is safe and well tolerated and initial clinical results show that this treatment induces a high percentage of CR + VGPRs. Table 1: Clinical Responses using 6 th IWWM. *The 2 participants observed to have a CR at month 12 have not reached month 18 for progression or survival follow-up.

Influence of two agroforestry systems on the nitrification potential in temperate pastures in Brittany, France

Background and aimsAgroforestry, whereby trees are associated with crops and/or livestock, is expected to mitigate nitrogen (N) losses from agriculture. However, little is known about how nitrification potential, an important process that drives N losses, is affected by agroforestry systems. This study aimed to investigate the effect of different silvopastoral agroforestry systems on soil nitrification potential.MethodsNitrification potential was evaluated in two agroforestry systems (hedgerow and alley cropping) associated with temporary grasslands in Brittany, France. In each system, soil was sampled along a transect spanning from the center of the tree row into the grass alley. Soil nitrification potential was determined ex situ and was explained by univariate and multivariate analysis of variables describing vegetation, physicochemical soil properties, and soil organisms.ResultsNitrification potential differed between the two agroforestry systems and among the positions in relation to the trees. In the alley cropping system, nitrification potential was on average 1.5 times higher in the tree row than at 1.5 and 10 m into the grass alley, while in the hedgerow system, nitrification potential at 1.5 m into the grass alley was on average 40% lower than at 10 m into the grass alley. Nitrification potential was strongly correlated with soil pH, whereas no correlation was observed between nitrification potential and community size of soil nitrifiers.ConclusionOur results point out the diverse effects of agroforestry systems on nitrification, a key soil process that is involved in the regulation of N losses.

Advanced Hepatocellular Carcinoma Patients with Poor Access to Systemic Therapy Treated with Definitive Stereotactic Body Radiation Therapy: A Single-Institution Experience in Latin America

The standard treatment for patients with advanced hepatocellular carcinoma (aHCC) is systemic therapy with or without stereotactic body radiation therapy (SBRT). We present our experience using SBRT as a definitive treatment for aHCC patients with poor access to systemic therapy. We performed a retrospective review of patients treated with SBRT at the largest institution in Santiago, Chile between June 2016 and September 2022. All patients were deemed unsuitable for another locoregional treatment by the tumor board. We registered demographic, clinical and treatment characteristics. Additionally, treatment response rates using mRECIST criteria, overall survival (OS), local control (LC) and treatment toxicity were reported. We performed a multivariate analysis of variables using Cox proportion hazard ratio for OS and logistic regression for LC. A total of 59 patients were included (41 males and 18 females; median age: 70 years [range: 38 - 85 years]), with a total of 63 treatment courses. Most common etiologies of chronic liver disease were nonalcoholic fatty liver disease (23%) and chronic alcohol consumption (20%). Most patients were classified as Child-Pugh Class A (80%). Barcelona Clinic Liver Cancer (BCLC) stage was 2%, 11%, 49% and 38% for stages 0, A, B and C, respectively, while macrovascular invasion was present in 10 (18%) of patients. Forty-six patients (73%) had been subjected to prior locoregional therapy and only 5 patients (8,5%) received systemic therapy after SBRT. Median tumor size was 7 cm. (range: 0.95 - 32 cm). Median radiation dose was 40 Gy (range: 26.5 - 50 Gy) in 5 fractions. Evaluation of radiological response was performed in 46 patients (79%), with complete response, partial response, stable disease and progressive disease in 41%, 43%, 7% and 9% of the cohort, respectively. With a median follow-up of 9 months (range: 0 - 58), 34 patients (58%) died with a median OS of 10.8 months (range: 0 - 28 months). At 12 months, OS was 65.2% (95% CI: 50.9 - 76.3) and at 24 months was 40.7% (95% CI: 26.2 - 54.6) In multivariate analysis tumor size (as a continuous variable) was the only significant variable for LC (OR 2.9 [CI 1.1 - 5.3; p 0.03]) and for OS (HR 3.4 [CI 1.3 - 6.7; p< 0.01]). Four patients developed grade 3 toxicity (3 thrombocytopenia and 1 duodenal ulcer) and only two treatments were suspended definitively. Despite systemic therapy is the standard treatment for aHCC, a minor proportion of patients received the standard of care. SBRT is safe, feasible and a well-tolerated treatment option for aHCC with good clinical outcomes. To our knowledge, this is the first cohort reported of patients with aHCC treated with SBRT in Latin America.

Mortality of COVID-19 patients with comorbidity of diabetes mellitus: a retrospective study

Background: Chronic diseases such as diabetes mellitus (DM) are risk factors that cause COVID-19 patients to experience high morbidity and mortality rates. Diabetes becomes the most hazardous comorbid during the pandemic because it increases the likelihood of more serious effects when infected with the coronavirus. This study aims to provide an overview of mortality in patients with COVID-19 who have comorbid DM. Methods: The research design used was a case-control study design with a retrospective approach. The population in this study were all COVID-19 patients with comorbid DM. The study criteria were COVID-19 patients with comorbid diabetes mellitus. Multivariate analysis using logistic regression analysis was performed to determine the parametric analysis of correlation tests. Results: The results of a multivariate analysis of variables related to mortality rates in COVID-19 patients with comorbid diabetes mellitus, one of which is other comorbidities. Concomitant acute respiratory distress syndrome became the only variable with a p-value &lt;0.05. Conclusion: Acute respiratory distress syndrome is another comorbid disease that is the number one cause of COVID-19 patients dying during the treatment period, apart from the pure diabetes mellitus that they suffer.

Predicting mortality among patients with severe COVID-19 pneumonia based on admission vital sign indices: a retrospective cohort study

BackgroundCoronavirus disease 2019 (COVID-19) pneumonia remains a major public health concern. Vital sign indices—shock index (SI; heart rate [HR]/systolic blood pressure [SBP]), shock index age (SIA, SI × age), MinPulse (MP; maximum HR–HR), Pulse max index (PMI; HR/maximum HR), and blood pressure–age index (BPAI; SBP/age)—are better predictors of mortality in patients with trauma compared to traditional vital signs. We hypothesized that these vital sign indices may serve as predictors of mortality in patients with severe COVID-19 pneumonia. This study aimed to describe the association between vital sign indices at admission and COVID-19 pneumonia mortality and to modify the CURB-65 with the best performing vital sign index to establish a new mortality prediction tool.MethodsThis retrospective study was conducted at a tertiary care center in southern Thailand. Adult patients diagnosed with COVID-19 pneumonia were enrolled in this study between January 2020 and July 2022. Patient demographic and clinical data on admission were collected from an electronic database. The area under the receiver operating characteristic (AUC) curve analysis was used to assess the predictive power of the resultant multivariable logistic regression model after univariate and multivariate analyses of variables with identified associations with in-hospital mortality.ResultsIn total, 251 patients with COVID-19 pneumonia were enrolled in this study. The in-hospital mortality rate was 27.9%. Non-survivors had significantly higher HR, respiratory rate, SIA, and PMI and lower MP and BPAI than survivors. A cutoff value of 51 for SIA (AUC, 0.663; specificity, 80%) was used to predict mortality. When SIA was introduced as a modifier for the CURB-65 score, the new score (the CURSIA score) showed a higher AUC than the Acute Physiology and Chronic Health Evaluation II and CURB-65 scores (AUCs: 0.785, 0.780, and 0.774, respectively) without statistical significance.ConclusionsSIA and CURSIA scores were significantly associated with COVID-19 pneumonia mortality. These scores may contribute to better patient triage than traditional vital signs.

Factors associated with deep sternal wound infection after open-heart surgery in a Danish registry

ObjectiveTo conduct a comprehensive multivariate analysis of variables associated with deep sternal wound infection, after open-heart surgery via median sternotomy. MethodA retrospective cohort of all adult patients, who underwent open-heart surgery at Odense University Hospital between 01‐01-2000 and 31-12-2020 was extracted from the West Danish Heart Registry. Data were analyzed using maximum likelihood logistic regression. ResultsA total of 15,424 patients underwent open-heart surgery and 244 developed a deep sternal wound infection, equivalent to 1,58 %. After data review 11,182 entries were included in the final analysis, of which 189 developed DSWI, equivalent to 1,69 %. Multivariate analysis found the following variables to be associated with the development of deep sternal wound infection (odds ratios and 95%confidens intervals in parentheses): Known arrhythmia (1.70; 1.16–2.44), Left Ventricular Ejection Fraction (1.66; 1.02–2.58), Body Mass Index 25–30 (1.66; 1.12–2.52), Body Mass Index 30–35 (2.35; 1.50–3.71), Body Mass Index 35–40 (3.61; 2.01–6.33), Body Mass Index 40+ (3.70; 1.03–10.20), Age 60–69 (1.64; 1.04–2.67), Age 70–79 (1.95; 1.23–3.19), Chronic Obstructive Pulmonary Disease (1.77; 1.21–2.54), Reoperation (1.63; 1.06–2.45), Blood transfusion in surgery (1.09; 1.01–1.17), Blood transfusion in intensive care unit (1.03; 1.01–1.06), Known peripheral atherosclerosis (1.82; 1.25–2.61), Current smoking (1.69; 1.20–2.35), Duration of intubation (1.33; 1.12–1.57). ConclusionIncreased risk of deep sternal wound infection after open-heart surgery is a multifactorial problem, while some variables are unchangeable others are not. Focus should be on optimizing the condition of the patient prior to surgery e.g. weight loss and smoking. But also factors surrounding the patient e.g. preventing blood loss and minimizing intubation time.

Preoperative Platelet-Lymphocyte Ratio (PLR) as a prognostic inflammation biomarker in Asian HIV-infected patients with gastric cancer: a single-center study

BackgroundThe serum systemic inflammation biomarkers have been established as predictors of prognosis in gastric cancer (GC) patients, but their prognostic value in human immunodeficiency virus (HIV)-infected patients with GC has not been well studied. This retrospective study aimed to evaluate the prognostic value of preoperative systemic inflammation biomarkers in Asian HIV-infected patients with GC.MethodsWe retrospectively analyzed 41 HIV-infected GC patients who underwent surgery between January 2015 and December 2021 at the Shanghai Public Health Clinical Center. Preoperative systemic inflammation biomarkers were measured and patients were divided into two groups based on the optimal cut-off value. Overall survival (OS) and progression-free survival (PFS) were measured using the Kaplan–Meier method and the log-rank test. Multivariate analysis of variables was performed using the Cox proportional regression model. As a comparison, 127 GC patients without HIV infection were also recruited.ResultsThe median age of the 41 patients included in the study was 59 years, with 39 males and two females. The follow-up period for OS and PFS ranged from 3 to 94 months. The cumulative three-year OS rate was 46.0%, and the cumulative three-year PFS rate was 44%. HIV-infected GC patients had worse clinical outcomes compared to the normal GC population. The optimal cut-off value for preoperative platelet to lymphocyte ratio (PLR) was 199 in HIV-infected GC patients. Multivariate Cox regression analysis revealed that a low PLR was an independent predictor of better OS and PFS (OS: HR = 0.038, 95% CI: 0.006–0.258, P < 0.001; PFS: HR = 0.027, 95% CI: 0.004–0.201, P < 0.001). Furthermore, higher preoperative PLR in HIV-infected GC was significantly associated with lower BMI, hemoglobin, albumin, CD4 + T, CD8 + T, and CD3 + T cell counts.ConclusionThe preoperative PLR is an easily measurable immune biomarker that may provide useful prognostic information in HIV-infected GC patients. Our findings suggest that PLR could be a valuable clinical tool for guiding treatment decisions in this population.

THE STUDY OF CONDUCTION BLOCKS IN ACUTE MYOCARDIAL INFARCTION PATIENTS ADMITTED IN TERTIARY CARE HOSPITAL IN CENTRAL INDIA: A PROSPECTIVE OBSERVATIONAL STUDY

Background: Acute Myocardial infarction (AMI) is one of the most fatal diseases of human community. Various types of conduction blocks (CB) develop following an AMI. Hence the present study was undertaken to study the various types of conduction blocks in acute ST elevation myocardial infarction (STEMI) patients admitted in Tertiary care hospital in central India. Method: A total 140 patients of age ≥18 years with symptoms and signs suggestive of AMI having ECG changes consistent with STEMI and rise in cardiac markers presenting with conduction disturbances were included in the study. Results: Among the 140 patients, 62.2% survived, 37.8% were non-survivors.Highest incidence of conduction blocks (28.57%) and maximum non-survivors (22.64%) were in age group of 51-60 years. Most common risk factor among non survivors was HTN+Dyslipidemia 70%, followed by HTN+ DM+ Dyslipidemia (69.23%). Among 22 non-survivors in AWMI, maximum non-survivors seen in killips class 2. In IWMI out of 17 non-survivors, 10(53.8 %) seen in killips class 1. In ALWMI 3 (75%) non-survivors seen in killips class 1. In ASWMI maximum non-survivors 4(66.7%) seen in killips class 3. In IRPWMI non survivors seen in class 2,3,4 (33.33% each). In patients with QRBBB maximum non-survivors seen in killips class 2. Maximum non-survivors seen in killips class1 seen the in patients with CHB. Multivariate analysis of variables showed that patients having CHB, first degree AV block, QRBBB and patients with killips class4 have significant independent prediction for in hospital non-survivors. Highest Non-survivors in QRBBB (41.51%) and in AWMI (52.83%). Conclusion:The conduction blocks are associated with higher in-hospital mortality rate and are important predictors of poor outcome in patients with AMI (STEMI).

Surgical treatment for recurrent cholangiocarcinoma: a single-center series.

The present study aims to assess the results obtained after surgical treatment of cholangiocarcinoma (CC) recurrences. We carried out a single-center retrospective study, including all patients with recurrence of CC. The primary outcome was patient survival after surgical treatment compared with chemotherapy or best supportive care. A multivariate analysis of variables affecting mortality after CC recurrence was performed. Eighteen patients were indicated surgery to treat CC recurrence. Severe postoperative complication rate was 27.8% with a 30-day mortality rate of 16.7%. Median survival after surgery was 15 months (range 0-50) with 1- and 3-year patient survival rates of 55.6% and 16.6%, respectively. Patient survival after surgery or CHT alone, was significantly better than receiving supportive care (p< 0.001). We found no significant difference in survival when comparing CHT alone and surgical treatment (p=0.113). Time to recurrence of <1 year, adjuvant CHT after resection of the primary tumor and undergoing surgery or CHT alone versus best supportive care were independent factors affecting mortality after CC recurrence in the multivariate analysis. Surgery or CHT alone improved patient survival after CC recurrence compared to best supportive care. Surgical treatment did not improve patient survival compared to CHT alone.

Factors Associated with Recurrence in Chronic Subdural Hematoma following Surgery

Abstract Background Recurrence is a frequent complication after surgery in a chronic subdural hematoma (CSDH). This study aimed to describe the recurrent rate of CSDH after surgery. In addition, a secondary objective aimed to explore factors associated with the recurrence of CSDH after surgery. Methods A total of 141 surgical CSDH patients were analyzed in this retrospective study. The Cox regression method was used to conduct both univariate and multivariate analyses of variables associated with recurrence. As a result, the cumulative incidence of recurrence for each covariate survival curve was built after the final model. Results Twenty-two percent of the patients showed evidence of recurrence. Initially, four variables (Glasgow coma scale score 3–8, clopidogrel, operative time, and amount of irrigated saline) had potential factors in univariate analysis but only clopidogrel and amount of saline irrigation were significantly associated with CSDH recurrence. Conclusion Preoperative clopidogrel and the amount of saline irrigation were found to be associated with the recurrence rate. Factors associated with CSDH recurrence should be developed and validated as the clinical prediction tool for implication in general practice.

The role of quantitative MRI-based prostate zonal parameters in predicting clinically significant prostate cancer: A U.S. cohort.

We aimed to investigate the clinical utility of quantitative prostatic zonal measurements on in multiparametric magnetic resonance imaging (mpMRI) for the predication of clinically significant prostate cancer (csPCa). A retrospective, single-institution study included 144 men who underwent mpMRI from 2015- 2017. Prostate zone parameters were measured on mpMRI. Correlation and multivariable analysis evaluated relationship between prostate zone parameters and the presence of csPCa. The mean age was 66.9±7.8 years old. The median (interquartile range [IQR]) prostate volume and prostate-specific antigen (PSA) were 51.6 ml (37.1-74.5) and 6.1 ng/ml (4.5-8.2), respectively. Men with csPCa had significantly smaller total prostate volume (TPV), transitional zone volume (TZV), and transitional zone thickness (TZT), and larger transitional zone density (TZD) compared to those without PCa; however, on multivariate variable analysis, only TZD maintained significance. TZD had a comparable area under the curve to PSA density (PSAD) and PSA (0.74 vs. 0.73 vs. 0.60, respectively). Subgroup analysis of men with PCa, PSAD and TZD were significantly higher in men with Gleason grade group (GG) ≥2 compared to those with GG <2 (p=0.002); however, this significance is not maintained on logistic regression in predicting GG. Quantitative features of prostate zones on MRI may aid in identifying better predictors of csPCa. Zonal-based PSA density (TZD) may be a useful marker in identifying csPCa. Further exploration is needed to understand the clinical application of larger TZV in men with csPCa compared to those with insignificant disease.

Direct mass spectrometry analysis of biological tissue for diagnosis of thyroid cancer using wooden-tip electrospray ionization.

Direct mass spectrometry (MS) analysis of human tissue at the molecular level could gain insight into biomarker discovery and disease diagnosis. Detecting metabolite profiles of tissue sample play an important role in understanding the pathological properties of disease development. Because the complex matrices in tissue samples, complicated and time-consuming sample preparation processes are usually required by conventional biological and clinical MS methods. Direct MS with ambient ionization technique is a new analytical strategy for direct sample analysis with little sample preparation, and has been proven to be a simple, rapid, and effective analytical tools for direct analysis of biological tissues. In this work, we applied a simple, low-cost, disposable wooden tip (WT) for loading tiny thyroid tissue, and then loading organic solvents to extract biomarkers under electrospray ionization (ESI) condition. Under such WT-ESI, the extract of thyroid was directly sprayed out from wooden tip to MS inlet. In this work, thyroid tissue from normal and cancer parts were analyzed by the established WT-ESI-MS, showing lipids were mainly detectable compounds in thyroid tissue. The MS data of lipids obtained from thyroid tissues were further analyzed with MS/MS experiment and multivariate variable analysis, and the biomarkers of thyroid cancer were also investigated.

Association between coronary artery calcium score and COVID-19 prognosis

Background: Research has examined the relationships between coronary artery calcium (CAC) scores and mortality, mechanical ventilation, and intensive care unit admissions. This paper summarizes the predictive value of coronary artery calcification scoring for hospitalized COVID-19 patients in terms of mortality, mechanical ventilation, and intensive care unit admission. Methods: The patients in this single-center retrospective analysis have COVID-19 and were hospitalized at the Firouzabadi hospital in Tehran between 2019 and 2020. coronary artery calcificationscore was estimated based on chest non-contrast CT scans on the day of admission. Based on the coronary artery calcification score, the patients were categorized into Very Low, Mild to Moderate, and Moderate to Severe. After a univariate analysis of the critical factors, odds ratio (OR) analysis and multivariate analysis of variables that could be linked to COVID-19 advancement were carried out. Results: a total of 719 patients were examined. Among them, 414 patients were men. Mortality with a 17.1 % prevalence was statistically significant between CAS score levels (P &lt; 0.001). This factor has high OR with mild to moderate and moderate to severe CAS (OR: 2.14; 95% CI: 1.71 to 3.06, and OR: 2.31; 95% CI: 1.84 to 3.57). Oxygen saturation was a significant statistic between CAS score levels (P = 0.02). This factor has a high OR with mild to moderate and moderate to severe CAS (OR: 1.09; 95% CI: 0.71 to 3.60, and OR: 2.38; 95% CI: 0.89 to 2.9). There was no statistical difference between the groups’ outcomes of mechanical ventilation and admission types. Conclusion: In this study, the coronary artery calcification scores of patients with COVID-19 were compared, while the outcomes of interest mortality, mechanical ventilation, and intensive care unitU admission were closely investigated. In light of these findings, coronary artery calcificationscoring can help in patient stratification, enabling earlier therapies for disorders to progress quickly.

FAKTOR -FAKTOR YANG MEMPENGARUHI PEMILIHAN ALAT KONTRASEPSI PADA AKSEPTOR KELUARGA BERENCANA

The strategy to reduce fertility rates is through contraception to prevent pregnancy, but not all contraceptives are suitable for the physical health condition of the wearer. Active family planning participants in Metro City in 2020 amounted to 21917 (72.73%). The coverage of intrauterine contraceptive users in Metro City is 3439 (15.%), and the lowest is in the Karangrejo Health Center working area, which is 10.61% (106 out of 999 acceptors). This study aimed to determine the factors that influence the selection of contraceptives in family planning in Karangrejo Village. Methods: Quantitative research with a cross-sectional design, the population of family planning acceptors is 1374 family planning acceptors. With the results of the calculation of the sample size obtained, a sample of 94 respondents—was sampled with a simple random sampling technique. The data was collected using a questionnaire, and the analysis used univariate, bivariate, and multivariate multiple regression analysis. Results: The results of the bivariate test conducted on nine variables related to the use of IUD contraception only five variables, namely knowledge (p=0.03), occupation (p=0.002), economy (p=0.041), husband's support (p= 0.000) and health status during family planning (p= 0.000) while the other four variables were not related because the p-value was more than 0.05, namely education (p=0.210), number of children (p=0.670), history of the hereditary disease (p= 1,000) and confidence (p=1,000). In the multivariate analysis of variables, because the husband's support and maternal health status during family planning were constant, they were not included in the modeling. The final result of modeling obtained knowledge (p=0.07, 95% CI: 0.35 - 0.597) and occupation (p=0.12, 95% CI: 1.493 - 25,631). Conclusion: Results The most dominant factor is the husband's support factor, followed by maternal health during family planning, knowledge of contraceptives, and mothers who do not work / homemakers. Suggestion: In promoting the family planning program, the first step is to approach and educate the husbands of prospective acceptors. It is necessary to increase knowledge about family planning contraceptives, especially for wives who do not work or are homemakers.

Direct adsorption sampling and ambient mass spectrometry analysis of tobacco smoke with porous paper strips.

Chemical analysis of atmospheric aerosols by conventional analytical methods is usually required to perform complicated and time-consuming sample preparation processes. In recent decades, ambient ionization mass spectrometry (AI-MS) methods have been proven to be simple, rapid, and effective analytical tools for direct analysis of various complex samples. In this work, we applied porous paper filters for direct adsorptive sampling of tobacco smoke, and then the sampled paper filters were performed the emitters of the paper spray ionization (PSI) device. An auto-sampling device was made to control the generation and collection of tobacco smoke. Nicotine, the typical compound of tobacco smoke, was used to optimize the key conditions of auto-sampling. Moreover, different types of tobacco smoke were also compared with multivariate variable analysis, and the makers of tobacco smoke from different sources of tobacco smoke were investigated. By using this method, direct sampling and analysis of a single tobacco sample can be completed within minutes. Overall, our results show that PSI-MS is a powerful tool that integrates collection, extraction, ionization, and identification analytes in smoke.

Dosimetric Variables and Clinical Correlation of Toxicities and Breast Cosmesis in Adjuvant Hypofractionated Whole Breast Irradiation Using Field in Field 3DCRT

<h3>Purpose/Objective(s)</h3> The objective of our study was to assess the change in breast cosmesis, Acute skin toxicity, Late Skin Toxicity, Late Subcutaneous Tissue Toxicity at different points of time in patients receiving adjuvant Hypofractionated Whole Breast Radiotherapy schedule (HF-WBRT) and to find out any existing relation with any other dosimetric variables responsible for their outcomes. <h3>Materials/Methods</h3> The START B protocol for dose fractionation was followed. The cosmetic outcome of the patients was assessed using the Harvard Breast Cosmesis Grading Scale. Similarly, Acute toxicities, Late skin toxicities, Late subcutaneous tissue toxicities were recorded using the RTOG/EORTC scoring scheme. Data was generated on the different volumes of tissue receiving 95%,102%,105% and 107% of the prescribed dose respectively. Further, all these volumes were divided into two subgroups – dose volumes within the Whole Breast PTV and dose volumes outside the Whole Breast PTV. Multivariate Analysis of variables were done. Bivariate Correlations of differences were performed and outcomes were analyzed using Spearman's rho correlation coefficient test. We also ran the Binary Logistic Regression Analysis test for predicting the outcomes of interest with the different variables. <h3>Results</h3> 125 patients were accrued and analyzed for this study. For acute skin toxicity, significant positive correlations existed with the volume of tissue within the PTV receiving 95% (0.695) and 102% (0.430) and with the volume of tissue outside the PTV receiving 95% (0.333) of the prescribed dose. The volume of tissue outside the PTV receiving 102% had a significant predictive probability for acute skin toxicity [p=0.001, OR 1.056 (1.024-1.029)]. For late skin toxicity, a significant positive correlation existed with the volume of tissue within the PTV receiving 95% (0.465). For late subcutaneous tissue toxicity, there was a significant positive correlation with the volume of tissue within the PTV receiving 95% (0.516). Significant predictive associations were found with the volume of tissue within the PTV receiving 105% [p=0.014, OR 1.014(1.003-1.026)] and volume of tissue outside the PTV receiving 102 % [p=0.00, OR 1.052(1.025-1.080)]. For a change in breast cosmesis, Significant predictive associations were found with volume of tissue within the PTV receiving 95% [p=0.00, OR 1.006(1.004-1.009)] and 102% [p=0.02, OR 1.003(1.001-1.005)]. <h3>Conclusion</h3> The volume of tissue receiving more than 105% was found to be a factor for the development of late toxicities The volume of tissue outside the breast PTV receiving more than 102% also should be kept at a minimum as it had a significant association with both changes in breast cosmesis and with acute and late toxicities. Therefore, newer variables like excess dose above the prescribed dose received by tissue, outside the PTV, also needs to be looked into. This study thus hypothesizes use of more conformal planning techniques in whole breast irradiation.