Multivariate Stepwise Linear Regression Analysis Research Articles

Aerobic capacity correlates with health-related quality of life after breast cancer surgery.

To investigate the relation of physical functions to health-related quality of life (HRQOL), physical activity and fatness of patients during breast cancer treatment within 1year after surgery. We retrospectively reviewed the patients with breast cancer at the cancer rehabilitation clinic within 1year after surgery. Physical function assessment included aerobic capacity, muscle strength, flexibility and oedema. Physical activity was assessed using the International Physical Activity Questionnaire-Short Form, and HRQOL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30. Stepwise multivariate linear regression analysis was used to find the association factors. Of the physical functions in subjects, aerobic capacity was 88.64% compared to predictive value. The mean overall QOL was 60.82±20.98. The mean physical activity was 2,245.49±3,687.66MET/week and 39 patients (41.5%) were inactive. As the results of stepwise multivariate linear regression analysis, aerobic capacity was a significant factor of HRQOL and physical activity. The impairment of physical functions affects the HRQOL of patients within 1year after breast cancer surgery. Among the physical functions, the decrease in aerobic capacity was significantly associated with the decrease in the overall QOL of the patients.

Histopathologic Features that Predict Transplant Glomerulopathy Progression in a Chinese Cohort

Background: Transplant glomerulopathy (TG) represents a major cause of long-term allograft failure and is the leading cause of overall post-transplant proteinuria. The extent to which histopathologic features predicts prognostication is uncertain. Methods: A single-center retrospective cohort with biopsy-proven TG was investigated. Renal biopsies were scored according to Banff 2017. The primary outcome was death-censored graft failure defined as return to dialysis or estimated glomerular filtration rate (eGFR) decreased to <15 mL/min/1.73 m². The prognostic significance of clinical and histopathologic parameters was determined using Cox proportional hazards models. Results: Data from 180 cases were available for analysis with a median follow-up of 5.0 (2.6–8.2) years. In multivariable models, ci + ct score (HR 3.1; 95% CI 2.0–4.9), cg score (HR 1.7; 95% CI 1.1–2.8), eGFR (HR 2.1; 95% CI 1.4–3.2) and proteinuria (HR 2.4; 95% CI 1.6–3.7) were independent predictors of the primary outcome. Mesangial Immunoglobulin A deposition did not significantly affect allograft survival. The only significant pathologic factors for the severity of proteinuria were cg and g + ptc (adjusted R² = 0.46) as determined by multivariable stepwise linear regression analysis. Conclusions: Severe ci + ct and cg at biopsy were predictors of unfavorable allograft prognosis in TG patients even after taking into consideration clinical characteristics. Histologic severity of cg and g + ptc was significantly associated with clinical proteinuria.

Frequent sit-to-stand transitions and several short standing periods measured by hip-worn accelerometer are associated with smaller waist circumference among adults

ABSTRACTThis cross-sectional study analysed the association of sedentary behaviour (SB) and standing with waist circumference. Finnish adults aged 30-75 years from a sub-sample of population-based Health 2011 Study used a hip-worn tri-axial accelerometer (Hookie AM20, Traxmeet, Ltd, Espoo, Finland) for seven days. Those 1405 participants (57% women) who used accelerometer at least four days, minimum of 10 hours/day, were included. SB and standing were analysed in 6s epochs using validated algorithm. Daily total time, daily number and accumulated time from bouts (30s–5min,30s–10min,30s–15min,30s 30min,>5min,>10min,>15min, >30min) as well as daily number of sit-to-stand transitions were determined. Waist circumference (cm) was measured in standardized way. Participants’ mean age was 52 years (SD 12.2). Mean waist circumference was 97cm (SD 12.3) in men and 87cm (SD 12.7) in women. According to multivariable stepwise linear regression analysis, sit-to-stand transitions [standardised regression coefficient (β)= -0.14, 95%CI -0.20 to -0.09], standing bouts of 30s–5min (β= -0.21, 95%CI -0.26 to -0.15) and number of 30s-30min SB bouts (β=0.12, 95%CI 0.06 to 0.17) were most strongly associated with waist circumference. Besides assessing total SB time, future studies should assess also different bout lengths of SB and sit-to-stand transitions and standing times should be assessed separately.

Successful catheter ablation of atrial fibrillation improves but not reverses the abnormalities of left atrial mechanics and energy loss.

Dissipative energy loss (EL), a new index to quantify the inefficient blood flow, has not been explored within left atrium (LA) in patients with atrial fibrillation (AF). We aimed to study the intra-atrial flow and mechanics in patients with AF before and after successful catheter ablation by evaluating EL and LA global longitudinal strain (LAS). In our study, there were 53 patients undergoing catheter ablation for AF at baseline (AF group) and 33 age- and sex-matched controls. They were both assessed of LA EL using vector flow mapping (VFM) and of LAS using two-dimensional tracking (2DTT) during systole (sys), early diastole (ed), and atrial contraction phase (ac). Out of 53 patients, 37 patients who sustained sinus rhythm and carried out the echocardiographic examination at 3 and 6months follow-up were evaluated of change in EL and LAS. The independent predictors of EL during three phases in AF group were performed using stepwise multivariate linear regression analyses. Left atrium EL and LAS among all phases in AF group were significantly lower than controls (all P<0.01). During follow-up, LASsys and LASac both significantly improved at 3 and 6months (both P<0.01), and ELac significantly increased after 6months (P<0.05); ELsys, ELed and LASed were no significant change; EL and LAS among all phases were no normalized during follow-up. The independent predictors of EL were: for ELsys, BSA (P=0.004) and LASac (P=0.025); for ELed, E (P=0.001) and A (P=0.014); for ELac, E/A (P<0.001). Vector flow mapping and 2DTT revealed impaired intra-atrial flow and mechanics. Successful catheter ablation for AF slightly improves but not reverses the aforementioned impairment, indicating the continuous LA dysfunction.

Correlation between the level of glucagon like peptide-1 and the extent of coronary lesions in patients with coronary heart disease at different glucose tolerance state

Objective To explore the correlation between the level of glucagon like peptide-1(GLP-1)and the extent of coronary lesions in coronary heart disease(CHD). Methods One hundred and ninety-two CHD patients included in the study were divided into simple CHD group(n=60), CHD accompanied with impaired glucose tolerance(IGT)group(n=67), and CHD accompanied with type 2 diabetes mellitus(T2DM)group(n=65). 48 subjects were used as controls. The levels of GLP-1 in all the patients were analyzed by ELISA. Oral glucose tolerance test (OGTT) was performed. Blood glucose, insulin, and C-peptide levels were measured. The area under curves of insulin(AUCINS), C-peptide (AUCC-P), glucose (AUCGlu), and GLP-1 (AUCGLP-1) were calculated. All the patients underwent coronary angiography and the extent of coronary lesions was analyzed by total amount of coronary narrow degree integral. The association of GLP-1 level with coronary narrow degree was analyzed by correlation analysis and multivariate linear stepwise regression analysis. Results The levels of blood glucose and AUCGlu during OGTT in CHD accompanied with T2DM group were significantly higher than those in CHD with IGT group (P<0.01), while the levels of insulin and C-peptide, AUCINS, and AUCC-P were decreased (P<0.05). The levels of blood glucose, insulin, C-peptide, AUCGlu, AUCINS, and AUCC-P in CHD accompanied with IGT group were significantly higher than those in control group and simple CHD group (P<0.01). Compared with simple CHD group and CHD accompanied with IGT group, GLP-1 level in CHD accompanied with T2DM group was markedly decreased(P<0.01) while coronary artery narrow degree was raised(P<0.05). Compared with simple CHD group, CHD accompanied with IGT group showed lower GLP-1 level and higher coronary artery narrow degree(P<0.01). Correlation analysis revealed that GLP-1 level was negatively correlated with the coronary artery narrow degree in CHD patients(P<0.01). Multivariate linear regression analysis showed that systolic blood pressure, high density lipoprotein-cholesterol, fasting C-peptide and GLP-1 had a predictive effect on the coronary narrow degree integral in CHD patients. Conclusion The level of GLP-1 is closely correlated with the coronary artery narrow degree in CHD patients, especially in patients accompanied by hyperglycemia. Key words: Coronary heart disease; Glucagon like peptide-1; Coronary narrow degree integral

Association of serum CMPF level with fatty acid metabolism and obesity in community population

Objective To detect the serum level of 3-carboxy-4-methyl-5-propyl-2-furanpropanoic acid (CMPF), a significant metabolite of fish oil, in subjects with normal glucose tolerance (NGT) in local communities, and to investigate the association of CMPF with fatty acid metabolism. Methods A total of 272 NGT participants from screening for diabetes in Shanghai in 2013 were enrolled. Anthropometric measurements, biochemical evaluation, and questionnaire interview were performed for all the participants. The participants were divided into normal weight group [body mass index (BMI)≤23.9 kg/m2,n=143]and overweight/obesity group (BMI≥24 kg/m2,n=129). The serum CMPF concentrations were determined using an enzyme-linked immunosorbent assay. Results Serum CMPF level in overweight/obesity group was lower than that in normal weight group [96.50(46.11, 169.56)μmol/L vs 153.20(83.16, 282.97)μmol /L, P<0.05]. The serum CMPF level was negatively correlated with BMI (r=-0.256, P<0.01), triglycerides (r=-0.175, P=0.004), and free fatty acid (r=-0.126, P=0.041) according to bivariate correlation analyses. A multivariate stepwise linear regression analysis showed that the serum CMPF level was independently associated with BMI, triglycerides, free fatty acid, and HbA1C. A logistic regression analysis showed that the CMPF was a protective factor against obesity (OR=0.324, 95%CI 0.158, 0.664). Conclusion Serum CMPF level is reduced in overweight/obese subjects. CMPF is beneficial to lipid metabolism. Key words: 3-carboxy-4-methyl-5-propyl-2-furanpropanoic acid; Obesity; Triglycerides; Free fatty acids

Performance of waterjet on cutting maize stalks: A preliminary investigation

Large amounts of crop stalks left in the field as a result of conservation agriculture cause blockage during no-till planting. To solve this issue, pure waterjet was used to cut off the maize stalks so that the rear furrow opener could pass through without blockage. In this investigation, an experimental study on depth of cut, which was the main performance indicator of pure waterjet on cutting maize stalks, was presented. A full factorial design with 200 tests was implemented with respect to three operation parameters, that is traverse speed, waterjet pressure, and standoff distance were considered as variables. An analysis of variance (ANOVA) was carried out in order to determine the statistical significance of individual operation parameters. Using multilinear stepwise regression analysis, a model to predict the cut of depth from the predicted pure waterjet operation to cut maize stalks was then developed. All three operation parameters significantly influenced the cutting performance. Moreover, the results indicated that depth of cut increased with the increase of waterjet pressure, the decrease of traverse speed, and decrease in standoff distance. Waterjet pressure provided major contribution to depth of cut, followed by traverse speed, then standoff distance, which was demonstrated by both ANOVA and regression analysis. The experimental results showed that when the standoff distance was closer than 10 mm and waterjet pressure was 280 MPa, all maize stalks specimen could be cutoff thoroughly. With the consideration of field operating conditions, waterjet pressure of 280 MPa or higher and 10 mm to 15 mm standoff distance were recommended for maize stalks cutting. This analysis provided a realistic approach for the optimization of the ultra-high pressure pure waterjet parameters in maize stalks cutting, which could be used to relieve the occurrence of straw blockage in no-till planting. Keywords: waterjet, ultra-high pressure, conservation tillage, maize stalks, cutting, traverse speed, standoff distance DOI: 10.25165/j.ijabe.20191205.5088 Citation: Hu H N, Li H W, Wang Q J, He J, Lu C Y, Wang Y B, et al. Performance of waterjet on cutting maize stalks: A preliminary investigation. Int J Agric & Biol Eng, 2019; 12(5): 64–70.

Correlates of haemodynamic flow characteristics of sequential saphenous vein grafts in coronary artery bypass grafting.

A sequential bypass technique has been widely used in the saphenous vein grafts (SVGs) during coronary artery bypass grafting (CABG) surgery. The aim of the present study was to investigate the correlates of haemodynamic flow characteristics of sequential SVGs using transit-time flow measurement. From January 2013 to December 2016, 235 patients underwent isolated CABG using 1 aortosequential SVG to non-left anterior descending targets and the left internal mammary artery to the left anterior descending coronary artery. Among them, 212 patients have completed computed tomography angiography at 1-year follow-up and were included in the present study. The intraoperative flow rate and pulsatility index (PI) of sequential SVGs were assessed with transit-time flow measurement. The univariable and multivariable stepwise linear regression analyses of the possible correlating variables, including distal-end coronary artery (DECA) characteristics, were performed. For sequential SVGs, the mean proximal flow rate was 45.8 ± 19.2 ml/min, and the mean PI was 3.17 ± 1.00. We assessed the following correlates for proximal flow rate and PI: patient characteristics and DECA characteristics. Independent correlates of proximal flow rate were triple sequential SVG (by 21.0 ± 2.5 ml/min; P < 0.001), the DECA with more severe proximal stenosis (3.6 ± 1.3 ml/min per 10% increase; P = 0.007) and the DECA with larger diameter (≥1.5 mm) (by 4.8 ± 2.3 ml/min; P = 0.038). For PI, independent correlate was triple sequential SVG (by -0.55 ± 0.15; P < 0.001), and the DECA with larger diameter (≥1.5 mm) showed a strong trend (P = 0.069). The flow rate plotted against the logarithmic transformation of PI showed a significant inverse relationship in the linear regression analysis (P < 0.001). At 1-year follow-up, the patency of the proximal segment (between the aorta and the first side-to-side anastomosis) was 99.5% (211 of 212). Triple sequential SVG, the DECA with a larger diameter and more severe proximal stenosis were associated with higher proximal flow rate, whereas triple sequential SVG was associated with lower PI. These findings provide new data on flow characteristics and may guide subsequent studies towards improving sequential SVG patency.

Better understanding of acute gouty attack using CT perfusion in a rabbit model.

To assess hemodynamic changes related to acute gouty knee arthritis in a rabbit with CT perfusion (CTP) METHODS: Forty-two rabbits were randomly separated into two groups: the treated group of 30 and the control group of 12. The right knee was injected with monosodium urate solution and polymyxin in the treated group and saline and polymyxin in the control group. At 2, 16, 32, 48, 60, and 72h after injection, five rabbits from the treated group and two rabbits from the control group were selected for CTP. At each time point, blood flow (BF), blood volume (BV), and clearance rate (CL) were measured, and microvessel density (MVD) was evaluated with a microscope. In the treated group, BF, BV, CL, and MVD were significantly higher than in the control group (p < 0.001). Differences within paired comparison of BV, BF, CL, and MVD were all significant (all p < 0.001). Peak time of BV, BF, and MVD was 32h and 48h for CL. After multivariate stepwise linear regression analysis, BV was linearly associated with MVD and vice versa, which also applied to BF with MVD and BF with CL, separately. The ascending rate of MVD was the highest among that of all parameters; so was the descending rate of CL. CTP in this rabbit knee model accurately detected hemodynamic changes during a gouty attack. • Acute gouty arthritis can be evaluated with CTP in a rabbit knee model. • Following injection of MSU crystals, producing an acute gouty attack, CTP successfully assessed hemodynamic changes. • The ascending rate of MVD was the highest among that of all parameters; so was the descending rate of CL.

Blood loss of total knee arthroplasty in osteoarthritis: an analysis of influential factors

BackgroundTotal knee arthroplasty is regarded as the most effective treatment for severe knee osteoarthritis. The influential factors of blood loss in total knee arthroplasty remain controversial. The study aims to explore the influential factors of blood loss in total knee arthroplasty comprehensively.Material and methodsThree hundred and four osteoarthritis patients undergoing unilateral primary total knee arthroplasty were enrolled. Demographic characteristics, laboratory results, surgical protocol, and hemostatic and anticoagulation drugs were collected. Estimation of blood loss was calculated using the Gross equation. Multivariable stepwise linear regression analysis was performed to find out the influential factors.ResultsTotal blood loss reached the biggest volume (1346 ± 671 mL) in the post-operative third day. Hidden blood loss reached 465 ± 358 mL. Gender, tranexamic acid, prosthesis type, and drainage were proven to be positively correlated with the total blood loss (all P < 0.05). Male appeared to suffer more surgical blood loss than female. Posterior cruciate stabilizing prosthesis might lead to more surgical blood loss than posterior cruciate retaining prosthesis. Tranexamic acid could effectively reduce total blood loss while drainage might increase bleeding. Gender and anticoagulation drugs were correlated with hidden blood loss (both P < 0.05). Low molecular weight heparin resulted in less hidden blood loss than rivaroxaban.ConclusionsPosterior cruciate retaining prosthesis and topical use of tranexamic acid were preferred to reduce total blood loss. Drainage was not recommended due to the risk of increasing bleeding. Low molecular weight heparin was recommended to prevent venous thrombosis.

Serum levels of sclerostin as a potential biomarker in central arterial stiffness among hypertensive patients

BackgroundSclerostin is known to be a canonical Wnt/β-catenin signaling pathway inhibitor, while the Wnt/β-catenin signaling pathway is proposed to be involved in the development of arterial stiffness. This study aims to investigate the relationship between serum sclerostin levels and carotid–femoral pulse wave velocity (cfPWV) among hypertensive patients.MethodsFasting blood samples were obtained from 105 hypertensive patients. Patients with cfPWV values of > 10 m/s were classified in the high arterial stiffness group, whereas those with cfPWV values of ≤10 m/s were assigned to the low arterial stiffness group. Serum sclerostin and Dickkopf-1 (DKK1) levels were quantified using commercially available enzyme-linked immunosorbent assays.ResultsThirty-six hypertensive patients (34.3%) who belonged to the high arterial stiffness group were generally older (p < 0.001), presented with lower estimated glomerular filtration rates (eGFR, p = 0.014), higher incidence of diabetes mellitus (p = 0.030), average systolic blood pressures (SBP, p = 0.013), pulse pressure (p = 0.026), serum creatinine levels (p = 0.013), intact parathyroid hormone levels (iPTH, p = 0.003), and sclerostin levels (p < 0.001) than their counterparts in the low arterial stiffness group. A multivariable logistic regression analysis identified sclerostin as an independent predictor of arterial stiffness in hypertensive patients (odds ratio, 1.042; 95% confidence interval (CI), 1.017–1.068; p = 0.001). Multivariable forward stepwise linear regression analysis also showed that serum sclerostin level (β = 0.255, adjusted R2 change: 0.146, p = 0.003) was positively associated with cfPWV values in patients with hypertension.ConclusionsIn this study, serum sclerostin level, but not DKK1, is found to be positively correlated with cfPWV values and is identified as an independent predictor of arterial stiffness in hypertensive patients after adjusting for significant confounders.

Fearful Attachment Linked to Childhood Abuse, Alexithymia, and Depression in Motor Functional Neurological Disorders.

Insecure attachment is a predisposing risk factor for the development of functional neurological disorder (FND). There is limited research investigating connections between attachment styles, other predisposing vulnerabilities, and symptom severity in patients with motor FND. By using a within-group design with prospective data collection, the authors performed univariate tests followed by multivariate linear regressions to investigate neuropsychiatric factors associated with four attachment styles (secure, fearful, preoccupied, and dismissing) among 56 patients with motor FND (mean age=40.2 years [SD=13.0]; women, N=41; men, N=15). In univariate analyses, fearful attachment style was associated with self-reported adverse life event burden, alexithymia, dissociation, depression, anxiety, impaired stress coping skills, functional neurologic symptom severity, and marital status. In a multivariate stepwise linear regression analysis, childhood abuse, alexithymia, depression, and not being married independently predicted fearful attachment. In a post hoc analysis, childhood sexual and emotional abuse were each independently associated with fearful attachment tendencies. There were no independent predictors of secure, preoccupied, or dismissing attachment styles in this study population. Future studies with larger cohorts are needed to investigate nuanced relationships among predisposing vulnerabilities for the development of FND, as well as potential links between risk factors, functional neurologic symptom severity, and clinical outcomes.

Impact of body mass index on long-term blood pressure variability: a cross-sectional study in a cohort of Chinese adults

BackgroundObesity and overweight are related to changes in blood pressure, but existing research has mainly focused on the impact of body mass index (BMI) on short-term blood pressure variability (BPV). The study aimed to examine the impact of BMI on long-term BPV.MethodsParticipants in the Kailuan study who attended all five annual physical examinations in 2006, 2008, 2010, 2012, and 2014 were selected as observation subjects. In total, 32,482 cases were included in the statistical analysis. According to the definition of obesity in China, BMI was divided into four groups: underweight (BMI < 18.5 kg/m2), normal weight (18.5 ≤ BMI < 24.0 kg/m2), overweight (24.0 ≤ BMI < 28.0 kg/m2), and obese (BMI ≥ 28.0 kg/m2). We used average real variability to evaluate long-term systolic BPV. The average real variability of systolic blood pressure (ARVSBP) was calculated as (|sbp2 − sbp1| + |sbp3 − sbp2 | + |sbp4 − sbp3| + |sbp5 − sbp4|)/4. Differences in ARVSBP by BMI group were analyzed using analysis of variance. Stepwise multivariate linear regression and multiple logistic regression analyses were used to assess the impact of BMI on ARVSBP.ResultsParticipants’ average age was 46.6 ± 11.3 years, 24,502 were men, and 7980 were women. As BMI increases, the mean value of ARVSBP gradually increases. After adjusting for other confounding factors, stepwise multivariate linear regression analysis showed that ARVSBP increased by 0.077 for every one-unit increase in BMI. Multiple logistic regression analysis indicated that being obese or overweight, compared with being normal-weight, were risk factors for an increase in ARVSBP. The corresponding odds ratios of being obese or overweight were 1.23 (1.15–1.37) and 1.10 (1.04–1.15), respectively.ConclusionsThere was a positive correlation between BMI and ARVSBP, with ARVSBP increasing with a rise in BMI. BMI is a risk factor for an increase in ARVSBP.Trial registrationRegistration No.: CHiCTR-TNC1100 1489; Registration Date: June 01, 2006.

Impact of Sustained Viral Remission in Patients With Chronic Hepatitis C Infection on Surrogate Markers of Hepatic Fibrosis

Introduction: Direct-acting antivirals (DAAs) have resulted in improvement in the virologic cure rate of HCV infection. However, tools to measure regression of hepatic fibrosis after HCV eradication are not perfect. Liver biopsy is not always appropriate and transient elastography has limited availability. Alternative ways to monitor for regression of fibrosis are required in clinical practice. The AST-to-Platelet-Ratio-Index (APRI) and Fibrosis-4 (Fib-4) are validated tools that predict presence of hepatic fibrosis. We examined if treatment of HCV infection resulted in sustained improvement in the APRI and Fib-4 scores. Methods: Clinic records of adult patients with chronic HCV infection who received treatment in a single center were reviewed over a 5-year period. Sustained virologic response (SVR) was achieved if the HCV RNA titer was undetected 12 weeks or more after treatment completion. APRI and Fib-4 scores were calculated before and 12-24 weeks after treatment completion. Cirrhosis was ascertained based on laboratory and imaging data or biopsy. Continuous variables are reported as mean (± SD). Multivariable linear and stepwise linear regression analyses were performed to examine the association between SVR12 and the APRI/FIB-4 scores 12-24 weeks after treatment completion. The analyses were adjusted for baseline APRI/FIB-4 scores, BMI, cirrhosis, use of peg-interferon, and genotype 3. Results: 153 patients were identified. Mean age was 51.2 ± 14.0 years. Mean treatment duration was 14.7 ± 8.2 weeks. 68% were men, 3.3% were HIV co-infected. Genotype 1 was predominant (1a 46%, 1b 17%), followed by genotype 2 (18%), genotype 3 (16%), and genotypes 4-6 (3%). 22% of patients had cirrhosis, 14% received an interferon containing regimen. In the unadjusted analysis, patients who achieved SVR12 had a significant decline in the mean APRI and Fib-4 scores compared to those who did not achieve SVR12. These results remained robust in the multivariable linear regression analyses where all the covariates of interest were forced into the models, as well as in the stepwise analyses where non-significant covariates were eliminated from the models. Conclusion: We herein demonstrate that treatment of chronic HCV infection results in improvement in the APRI and Fib-4 scores among patients who achieved SVR12 suggesting regression of hepatic fibrosis. In the absence of transient elastography, physicians should consider relying on these surrogate markers for risk stratification.847_A Figure 1 No Caption available.847_B Figure 2 No Caption available.

Nonadherence to potassium replacement protocol leads to prolonged management of diabetic ketoacidosis.

Introduction Diabetic ketoacidosis is a life-threatening condition that requires prompt management. Objectives We aimed to assess the impact of adherence to potassium replacement protocol according to the guidelines of Diabetes Poland on the duration of diabetic ketoacidosis (DKA) treatment. Patients and methods This retrospective analysis included 242 adults (median age, 27 years; range, 21-38 years). Nonadherence to potassium replacement protocol was assessed, along with the relationship between nonadherence and duration of DKA management. Nonadherence to the protocol was defined as too low or too high doses of potassium compared with the recommended potassium replacement protocol. Results The median duration of DKA treatment was longer in the nonadherent group than in the adherent group: 37 hours (interquartile range [IQR], 27-48) and 30 hours (IQR, 17-43), respectively (P = 0.005). Treatment duration correlated positively with nonadherence to potassium replacement protocol (r = 0.18; P = 0.005) and severity of DKA (r = 0.52; P <0.0001). Stepwise multivariate linear regression analysis indicated nonadherence to the protocol (β = 0.14; P = 0.02) and severity of DKA (β = 0.43; P <0.0001) as predictors of treatment duration, after adjustment for body mass index and age (R2 = 0.28; P <0.0001). Conclusions Nonadherence to potassium replacement protocol leads to prolongation of DKA management. Medical staff should be educated about the benefits of potassium replacement and precision in potassium administration and dosing in patients with DKA.

Characterization of fibroblast growth factor 1 in obese children and adolescents

BackgroundFibroblast growth factor 1 (FGF1) can regulate glucose and lipid metabolism in obese mice. Serum FGF1 has increased in type 2 diabetes mellitus adults and correlated with BMI. This study aimed to indicate conventional weight loss effects on FGF1 in obese children and adolescents.Materials and methodsClinical and metabolic parameters of 88 lean and obese individuals (ages 5–15 years) and 39 obese individuals followed with 6 months of lifestyle intervention were collected. Serum FGF1 levels were detected through enzyme-linked immunosorbent assays.ResultsFGF1 levels were increased in obese individuals. Serum FGF1 levels were significantly correlated with BMI and waist circumferences (r = 0.377, P = 0.012; r = 0.301, P = 0.047, respectively). Multivariate stepwise linear regression analyses showed that FGF1 levels were significantly correlated with HbA1c and HOMA-IR (β = 0.371, P = 0.008; β = 0.323, P = 0.021, respectively). Weight loss (2.3 ± 0.1 kg) was accompanied by a significant reduction of circulating FGF1 levels (7.2 ± 0.4 pg/mL). Changes in FGF1 were significantly correlated with changes in fasting glucose, HOMA-IR and low-density lipoprotein cholesterol (β = 0.277, P = 0.020; β = 0.474, P < 0.001; β = 0.320, P = 0.008, respectively).ConclusionFGF1 was related to increased risk of insulin resistance in obese children and adolescents. Serum FGF1 reduced after weight loss in obese individuals and was associated with the improvement of insulin resistance. Changes in serum FGF1 were more correlated with insulin resistance than changes in obesity per se.

Environmental phenols and parabens in adipose tissue from hospitalized adults in Southern Spain

Urinary concentrations of non-persistent environmental pollutants (npEPs) are widely assessed in biomonitoring studies under the assumption that they are metabolised and eliminated in urine. However, some of these chemicals are moderately lipophilic, and their presence in other biological matrices should also be evaluated to estimate mid/long-term exposure to npEPs and its impact on human health. The present study aims to explore concentrations and potential determinants of npEPs in adipose tissue from a hospital-based adult cohort (GraMo cohort, Southern Spain).Concentrations of bisphenol-A (BPA), benzophenone-3 (BP-3), triclosan (TCS), three chlorophenols (2,4-DCP, 2,5-DCP and 2,4,5-TCP) and two phenylphenols (2-PP and 4-PP), triclocarban (TCCB) and parabens [methyl- (MeP), ethyl- (EtP), propyl- (n-PrP and i-PrP), butyl- (n-BuP and i-BuP) and benzyl-paraben (BzP)] were analysed in adipose tissue samples from a subcohort of 144 participants. Spearman correlation tests were performed, followed by stepwise multivariable linear regression analyses to assess determinants of the exposure.Detection frequencies and median concentrations were: BPA (86.8%, 0.54 ng/g tissue), BP-3 (79.2%, 0.60 ng/g tissue), TCS (45.8%, <LOD), 2-PP (18.8%, <LOD), MeP (100.0%, 0.40 ng/g tissue), EtP (20.1%, <LOD) and n-PrP (54.2%, 0.06 ng/g tissue). The remaining npEPs were detected in <10% of the samples. BPA, MeP, EtP and n-PrP levels were significantly and positively correlated, while BP-3 showed a positive correlation with TCS and 2-PP. Older participants showed higher concentrations of TCS and MeP, while BMI was inversely associated with most of the analysed compounds and perceived recent weight loss was inversely associated with 2-PP. Female participants and residents of rural areas had increased BP-3 concentrations. npEP concentrations were positively associated with the consumption of fatty food but negatively associated with the consumption of vegetables and fruit.This study reveals the widespread presence of numerous npEPs in adipose tissue from adults in southern Spain, suggesting a generalized distribution of these environmental compounds in fatty tissues. In these adults, many of the determinants of npEP concentrations in adipose tissue were similar to those of more lipophilic and persistent compounds.

Detection of carnosinase-1 in urine of healthy individuals and patients with type 2 diabetes: correlation with albuminuria and renal function.

Low serum carnosinase (CN-1) concentrations are associated with low risk for development of diabetic nephropathy (DN) in patients with type 2 diabetes (T2D). Although CN-1 is expressed in the kidney, urinary CN-1 (CNU) excretion and its pathological relevance in patients with T2D have not been investigated to date. The present study therefore assessed the extent of CNU excretion in healthy subjects (n = 243) and in patients with T2D (n = 361) enrolled in the DIAbetes and LifEstyle Cohort Twente-1 (DIALECT-1) in relation to functional renal parameters. CNU was detected in a high proportion of healthy individuals, 180 (74%); median CNU excretion was 0.25mg/24h [(IQR 0-0.65mg/24h]. In patients with T2D the prevalence and extent of CNU increased in parallel with albuminuria (r = 0.59, p < 0.0001; median CNU 0.1 vs 0.2 vs 1.5mg/24h, p < 0.0001; prevalence of CNU 61 vs. 81 vs. 97% p < 0.05 in normo- (n = 241), micro- (n = 80) and macroalbuminuria (n = 40), respectively). Patients with estimated glomerular filtration rate (eGFR) < 30ml/min/1.73m2 displayed higher median CNU excretion rates in comparison to patients with preserved eGFR (> 90ml/min/1.73m2) (1.36 vs 0.13mg/24h, p < 0.05). Backward stepwise multivariate linear regression analysis revealed albuminuria, eGFR and glycosuria to be independent factors of CNU excretion rates, all together explaining 37% of variation of CNU excretion rates (R2 = 0.37, p < 0.0001). These results show for the first time that CN-1 can be detected in urine and warrants prospective studies to assess the relevance of CNU for renal function deterioration in diabetes patients.

GFR-estimation by serum creatinine during glucocorticosteroid therapy

While glucocorticosteroids (GCS) are widely used in patients with kidney disease, little is known about their effect on serum creatinine, the most commonly used endogenous marker of kidney function. We assessed the effect of GCS on the relationship between estimated GFR using the Schwartz equation (eGFR) and measured GFR using a single-injection inulin clearance (Cin) in children both in a paired analysis and a cross-sectional study. Primary outcome variable was the difference between eGFR and Cin (ΔGFR) in a paired analysis involving 22 patients during and off GCS treatment (mean GFR 103.8ml/min/1.73m2, mean prednisone dose 34.8mg/m2/day). In a cross-sectional analysis in 42 patients receiving GCS (mean dose of 25.7mg/m2/day), a dose-dependent effect was explored using univariate and multivariate linear regression of various variables including GCS dosage with serum creatinine as dependent variable. The paired analysis showed no significant difference in ΔGFR with or without GCS [- 23 (SD 53) vs. - 9 (SD 41) ml/min/1.73m2, p = 0.203]. Stepwise multivariate linear regression analysis showed a significant correlation between age and Cin, while GCS dose was not related to serum creatinine. GCS use had no significant effect on serum creatinine as a marker for kidney function in a mixed population of renal outpatient clinic children.

Social comparison orientation in chronic pain patients and its effectiveness on coping style

Objective To explore the social comparison orientation in chronic pain patients and its effectiveness on coping style. Methods A total of 246 patients with chronic pain hospitalized in Pain Department of West China Hospital of Sichuan University from April 2017 to August 2018 were selected by convenience sampling. Chinese Version of the Social Comparison Orientation Scale and Medical Coping Modes Questionnaire were used to investigate the social comparison orientation and coping style. Univariate analysis and correlation analysis were performed using Pearson correlation analysis, t-test, analysis of variance test. Multivariate linear stepwise regression analysis was used to analyze influencing factors of coping style. Results Among 246 patients, the score of social comparison orientation was (36.32±8.25) , with (21.04±4.96) in dimension of ability and (15.28±4.43) in dimension of viewpoint. The scores of facing, avoidance and yield coping style were (18.27±4.10) , (16.45±3.69) and (16.22±3.58) respectively. Pearson correlation analysis showed that social comparison orientation negatively correlated with facing coping style (r=-0.347, P 0.05) . Multivariate linear stepwise regression analysis revealed that social comparison orientation and marital status were influencing factors of patients' facing coping style; course of disease, religious and living alone affected avoidance coping style of patients; social comparison orientation and course of disease were influencing factors of yield coping style of patients. Conclusions Medical staff should emphasize spousal support, establish individual regular visiting and home follow-up for patients living alone, and use a variety of comparative methods to improve active coping methods combining with individual social comparison orientation. Key words: Pain; Social comparison orientation; Coping style