Multivariable Logistic Models Research Articles

Efficacy and safety of percutaneous post-closure technique during the decannulation for veno-arterial extracorporeal membrane oxygenation.

In recent years, during the decannulation process for veno-arterial extracorporeal membrane oxygenation (VA-ECMO), methods for suturing the femoral artery have included the pre- and post-closure techniques. The safety and efficacy of the pre-closure technique are widely recognised; however, reports on the post-closure technique are scarce. This study aimed to evaluate the safety and efficacy of the post-closure technique using ProGlide (Abbott Healthcare, Green Oaks, IL, USA) device during VA-ECMO decannulation. We reviewed 170 patients who underwent VA-ECMO between January 2021 and June 2023. All patients had their femoral artery puncture sites closed using the post-closure technique upon decannulation. The success rate of this technique and incidence of lower limb complications were recorded and analysed. Technical success was achieved in 157 (92.4%) patients. Sixteen patients (9.4%) experienced lower limb-related complications, including 8 (4.7%) with lower limb arterial thrombosis and 11 (6.5%) with pseudo-aneurysms. Among all lower limb-related complications, four patients (2.4%) required interventional procedures. This study included 170 patients: 80 in the 'S' (15-16F) group and 90 in the 'M' (17-19F) group. In the univariate analysis of different arterial cannula sizes for in-hospital lower limb-related complications, the differences were not statistically significant (p > 0.05). The multivariate logistic model indicated that, compared to the S (15-16F) group, the M (17-19F) group was not associated with an increased rate of in-hospital lower limb-related complications. The suture-mediated closure of the femoral artery during VA-ECMO decannulation is a promising therapeutic strategy.

The impact of Life's Essentials 8 on sarcopenia prevalence among adults in the United States.

Sarcopenia is closely associated with cardiovascular disease. We aimed to examine the association of Life's Essential 8 (LE8), the recently updated measurement of cardiovascular health (CVH), with the presence of sarcopenia among US adults. This population-based cross-sectional study used data from the National Health and Nutrition Examination Survey in 2005-2006 and 2011-2018, and included adults aged 20 years or older. LE8 score was measured according to American Heart Association definitions. Sarcopenia was measured according to the National Institutes of Health definition, the ratio of appendicular skeletal muscle mass (ASM) to body mass index (BMI). Multivariable logistic and restricted cubic spline models were used to assess the associations between LE8 and sarcopenia. Among the 11,078 participants, 1021 (9.22 %) were diagnosed with sarcopenia. After adjusting for potential confounders, higher LE8, health behavior and health factors scores were associated with reduced odds ratios (OR) of sarcopenia (OR for per 10 scores increase in LE8, 0.65; 95 % CI 0.61-0.70; OR for per 10 scores increase in health behaviors score, 0.90; 95 % CI 0.84-0.97; OR for per 10 scores increase in health factors score, 0.67; 95 % CI 0.63-0.71). A non-linear dose-response relationship was observed between LE8 scores, health factors scores, and sarcopenia. The inversed association between LE8 score and sarcopenia was significantly stronger among males and participants with a high school education or above. LE8 was negatively associated with the prevalence of sarcopenia in a nonlinear fashion. Promoting adherence to optimal CVH levels may benefit to reduce the risk of sarcopenia.

Dietary patterns and bone density among school-aged children: a cross-sectional study in China.

Diet is an essential modifiable determinant of bone health, yet the associations between dietary patterns (DPs) and bone mineral density (BMD) in Chinese children remain limited. This study aimed to investigate the relationship between overall diet and low BMD risk among school-aged children in China. A total of 1,099 children aged 9-12 in China were recruited for this cross-sectional study. A semi-quantified food frequency questionnaire (FFQ) was used to assess dietary intake. A priori numerical index, the Chinese Dietary Guidelines Index for Children and Adolescents [CDGI (2021)-C] was utilized to assess dietary quality. Specific DPs were identified by using principal components analysis (PCA). The BMD of the left forearm was assessed using dual-energy X-ray absorptiometry (DXA). Spearman correlation test was conducted to investigate the associations between DPs. Multivariate logistic regression analysis and restricted cubic spline models (RCS) were applied to explore the associations between DPs and BMD. Three distinct DPs were identified: the plant-animal balanced pattern, the grain-tuber-meat pattern, and the bean-dairy pattern. We found a weak but significant positive correlation of the CDGI (2021)-C with the plant-animal balanced pattern (R = 0.318, P < 0.001), and with the bean-dairy pattern (R = 0.266, P < 0.001), respectively. After adjusting for covariates, adherence to the CDGI (2021)-C (Q4 vs. Q1, OR = 0.45, 95% CI: 0.27-0.75), the plant-animal balanced pattern (Q4 vs. Q1, OR = 0.50, 95% CI: 0.31-0.81), and the bean-dairy pattern (Q3 vs. Q1, OR = 0.57, 95% CI: 0.33-0.96) were associated with a lower risk of low BMD. No significant association was observed between the grain-tuber-meat pattern and low BMD (Q4 vs. Q1, OR = 1.09; 95% CI: 0.90-1.31). Adherence to the CDGI (2021)-C and the plant-animal balanced pattern is advantageous for bone health and inversely correlated with the risk of low BMD among school-aged children in China. Additionally, moderate adherence to the bean-dairy pattern may also confer benefits to bone health. A balanced and overall healthy diet should be recommended in our daily life.

Do the Activity Indices Used in Axial Spondyloarthritis Capture the Relationships Between Obesity, Smoking and Disease Activity in the Same Way?

Background/Objectives: Obesity and smoking have been related to increased disease activity in axial spondyloarthritis (axSpA), but these associations might vary depending on the composite index chosen to assess disease activity. We aimed to check this possibility. Methods: Three hundred and thirty consecutive patients were recruited from the monographic axSpA unit of a university center. To assess disease activity, BASDAI and ASDAS-CRP measurements were collected. The factors associated with the different disease activity thresholds of these instruments were analyzed using univariate and multivariate logistic regression models. Results: This study included 127 women and 203 men, with a mean age of 47.6 (SD 12.9) years, median disease duration of 8 years [IQR: 4–16], and 63% on biologic therapies. Most patients met the therapeutic goals, with a BASDAI &lt; 4 in 187 (56.7%) and ASDAS inactive/low category in 182 (55.2%). Being male was associated with BASDAI remission (OR 2.63), but smoking reduced this likelihood (OR 0.28). Similar findings were found for ASDAS inactive disease (male: OR 2.09; smoking: OR 0.39). The variables associated with BASDAI ≥ 4 in the multivariate logistic model were the male gender (OR 0.36), age (OR 1.02), smoking (OR 2.39), and obesity (OR 2.94), whereas those associated with active/very active ASDAS categories were the male gender (OR 0.49), age (OR 1.02), and smoking (OR 2.34). However, obesity was not associated with these higher ASDAS categories (p = 0.183). Conclusions: While the association between smoking and increased disease activity was consistent across all composite activity indices, the obesity–activity relationship was only apparent through the BASDAI.

Abstract 4119250: Partial versus Full ECMO Support in Combined Cardiogenic and Septic Shock – ELSO Registry Analysis

Background: There remains paucity of data on patient outcomes with combined cardiogenic and septic shock requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support. While guidelines exist on target VA-ECMO flow in cardiogenic shock patients, optimal (partial versus full) flow in combined shock remains largely unknown. Methods: We queried the Extracorporeal Life Support Organization registry to identify patients in combined cardiogenic and septic shock supported with VA-ECMO between 2017 and 2022. Patients were categorized into either partial or full ECMO support based on ECMO flow at 24 hours indexed to body surface area. Partial support was defined as &lt; 2.2 liters/m2 while full support was ≥2.2 liters/m2. Patients with other forms of mechanical circulatory support, VA-ECMO as bridge to advanced therapies or discharged on VA-ECMO were excluded from the analysis. Primary outcome of interest was survival to discharge. Baseline characteristics including center volumes and Charlson co-morbidity index were compared between survivors and non survivors. Predictors of mortality were identified using multivariable logistical regression model. Results: A total of 452 patients with combined shock supported with VA-ECMO were identified. Overall mortality was 63%. Patients that survived to discharge were younger (46.3 vs 53 years, p &lt; 0.001) and had lower BMI (29.3 vs 31.1, p = 0.041), Charlson co-morbidity index (1.4 vs 2.0, p = 0.01) and rates of pre-ECMO cardiac arrest (28.7% vs 39.4%, p = 0.023). Survivors were also more likely to be at high [&gt; 25 ECMO runs per year] volume centers compared to low [≤ 10 ECMO runs per year] volume centers (62.3% vs 20.4%, p = 0.04). Patients receiving full ECMO support had a higher likelihood of survival to discharge than partial support (42.6% vs 33.8%, p = 0.063), although it did not reach statistical significance. [Table 1] Indexed VA-ECMO flow at 24 hours was also associated with improved outcomes when assessed as continuous variable. [ Figure 1] Advanced age [aOR 1.02, 95% CI 1.01-1.04, p &lt; 0.001], pre-ECMO cardiac arrest [aOR 1.71, 95% CI 1.11-2.65, p = 0.016] and baseline Charlson co-morbidity index [aOR 1.13, 95% CI 1.01-1.28, p = 0.043] were all associated with increased mortality after adjustment for baseline differences. Conclusion: Mortality among patients requiring VA-ECMO for combined cardiogenic and septic shock is high. Full circulatory support may be associated with improved survival in this cohort.

Use of Intravascular Micro-Axial Left Ventricular Assist Devices as a Bridging Strategy for Cardiogenic Shock: Mid-Term Outcomes

Objectives: Patients in cardiogenic shock (CS) may be successfully bridged using intravascular micro-axial left ventricular assist devices (M-LVADs) for recovery or determination of definitive therapy. Methods: One hundred and seven CS patients implanted with M-LVADs from January 2020 to May 2024 were divided into four groups; group-1: 34 patients (transplant); group-2: 25 patients (LVAD); group-3: 42 patients (postcardiotomy CS (PCCS)); group-4: 6 patients (decision/recovery but excluded from analysis). Multivariable logistic regression and Multivariable Coxregression models identified predictors of early -hospital and late mortality, and Odds ratios (ORs) and hazard ratios (HRs) with p &lt; 0.05, respectively, were considered statistically significant. SPSS 29.0 and Python 3.11.1. were used for analyses. Results: Complications included device-malfunction (6%), gastrointestinal bleed (9%), long-term hemodialysis (21%), axillary hematoma requiring re-exploration (10%), heparin-induced thrombocytopenia (4%) requiring heparin therapy cessation/initiation of argatroban infusion, and non-fatal stroke (11%). Early hospital mortality included 13 patients: 2 in group-1, 1 in group-2, 10 in group-3 (p = 0.02). In the Logistic-Regression model, category of CS requiring an M-LVAD was significant (OR = 4.7, p = 0.05). Patients were followed for 4.5 years (mean follow-up was 23 ± 17 months), and 23 deaths occurred; group-1: 3 patients, group-2: 5 patients, and group-3: 15 patients (p = 0.019). At 4.5 years, actuarial survival was 90.7 ± 5.1% in group-1, 79.2 ± 8.3% in group-2, 62.8 ± 7.7% in group-3 (p = 0.01). In the Cox-Regression model, M-LVAD category (HR = 3.63, p = 0.04), and long-term postoperative dialysis (HR = 3.9, p = 0.002) emerged as predictors of long-term mortality. Conclusions: In cardiogenic shock, mid-term outcomes demonstrate good survival with M-LVADs as bridge to transplant/durable LVADs and reasonable survival with M-LVADs as a bridge to recovery following cardiotomy, accompanied by reduced ECMO usage, and early ambulation/rehabilitation.

Abstract Su903: Prognostic Value of Early Grey-White Ratio in the presence of Hypercapnia after Cardiac Arrest

Background: Cerebral edema following cardiac arrest can be quantified by measuring the ratio of grey matter to white matter radiodensity (GWR). Decreased GWR may reflect edema from irrecoverable neuronal cell death or reversible hyperemia driven by hypercapnia. We tested for an interaction between GWR and partial pressure of carbon dioxide (PCO2) predicting outcomes. Methods: We identified comatose post-arrest patients treated at our single center between 2010 and 2023 who underwent brain computed tomography (CT) imaging within 24 hours and PCO2 measured within one hour of CT. We extracted demographics, GWR, and PCO2 from our prospective registry and electronic health record. We scaled and centered data, then fit a multivariate logistic model to quantify the interaction between GWR and PCO2 in predicting survival. Results: Of 901 included patients, 356 (40%) were female, median [IQR] age was 61 [51-70], and 221 (25%) survived to discharge. CTs were obtained 4.18 [2.8-5.7] hours post-arrest. PCO2 was sampled within 36 median [24-47] minutes of CT. The median PCO2 was 47 [39-59] mmHg. GWR predicted survival (coefficient estimate 1.16, 95% confidence interval [CI], 0.91-1.44, p &lt; 0.001, but PCO2 (-0.11, 95% CI -0.32-0.09, p = 0.29) did not. There was no significant interaction between GWR and PCO2 (0.009, 95% CI -0.24-0.29, p = 0.95). Conclusion: There is no evidence of PCO2 modifying the association of early GWR with survival after resuscitation from cardiac arrest.

The impact of board gender diversity on green building practices: Moving beyond traditional linear and logistic specifications

AbstractThis article examines the relationship between sustainability and gender equality by analyzing how the percentage of women on the board of directors (still less than 50% in most cases) influences a company's commitment to green building practices. For this analysis, we estimate 30 competing multivariate pooled and panel data logistic specifications, including the gender diversity factor in both its traditional and polynomial forms. This methodological innovation (the polynomial form) allows for the examination of gender diversity's relationship with other variables beyond conventional models that assume constant effects, thus enabling a more realistic depiction of impacts that vary with the degree of diversity. Our dataset includes companies listed on the Euro Stoxx 300 and Standard &amp; Poor's 500 for the period 2010–2021. The findings indicate that, in both indices, an increased percentage of women on the board (and a higher Blau diversity index) correlates with a greater propensity for sustainable building practices, up to a threshold nearing parity. The impacts are more significant in Europe than in the U.S., where board gender diversity appears to have a lesser influence on green building initiatives. The specification that best models the relationship between sustainable building practices and gender diversity, along with other relevant factors, is a multivariate panel data logistic model with the gender diversity factor included as a cubic polynomial for companies listed on the Euro Stoxx 300. A similar model, but with the gender factor in a quadratic polynomial form, was selected for companies listed on the Standard &amp; Poor's 500. Therefore, the impact function of gender diversity on sustainable building practices is not constant but depends on the existing degree of board gender diversity, with the shape of the impact function differing between Europe and the U.S. Additionally, the study finds that other board characteristics—larger boards, longer tenures of directors, and higher compensation for senior executives—are associated with an increased propensity towards green practices in both the European and U.S. contexts. Conversely, linking CEO compensation to shareholder returns reduces this propensity. Moreover, the number of non‐executive directors and the overlap between the Chairperson and CEO positions do not significantly impact this propensity.

Onsite training-mentoring intervention improves data quality: an implementation research.

The quality of health data is not satisfactory in Low and Middle Income Countries (LMICs). Haramaya University, in collaboration with Ministry of Health and Regional Health Bureau, conducted an implementation research in selected public health facilities and administrative units. This research was aimed to test the onsite training-mentoring (OTM) intervention and adaptation of the implementation strategy to improve the routine health information system (RHIS) data quality in the context of public health sector. An interrupted time series design with an onsite training-mentoring intervention was used to improve data quality in public health sector of Jigjiga Woreda, eastern Ethiopia from July 2021 to June 2022. Both the pre and post intervention assessments data were collected by experienced and trained public health professionals using interviewer guided self-administered interview, record review and observation data collection techniques. Data were analyzed using descriptive, bivariate, and multivariate logistic models to identify predictors of data quality. The overall data accuracy was increased from 88.12% before to 95.0% after intervention; and it was above 90% in all the facilities. The overall data content completeness was increased from 75.75% to 89.9%, though it varied among the facilities. The timeliness and report completeness were 100% in all the facilities. The odds of those health workers who had poor knowledge were less likely to ensure data quality (AOR = 0.39; 95%CI: 0.19, 0.83) than their counterparts. The intervention was brought substantial changes of data quality in the study setting. Knowledge of the workers towards data quality is a crucial factor to ensure data quality in the sector. Thus, collective efforts is required to continue this tested intervention to ensure the quality of the routine health information system in the lower levels of the sector.

Predictive Value of NT-proBNP, FGF21, Galectin-3 and Copeptin in Advanced Heart Failure in Patients with Preserved and Mildly Reduced Ejection Fraction and Type 2 Diabetes Mellitus

Background and Objectives: Heart failure (HF) is one of the most common initial presentations of cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM). There are different cardiac biomarkers related to the pathophysiological mechanisms of HF in T2DM. The current research aims to identify additional biomarkers that could improve the diagnosis and prognosis of HFpEF, which is currently assessed using NT pro-BNP levels. NT pro-BNP is a valuable tool for diagnosing heart failure but may not always correlate with clinical symptom severity or can present normal levels in certain cases, such as obesity. Biomarkers like FGF-21 and galectin-3 could provide greater insight into heart failure severity, especially in diabetic patients. The main objective of the current study is to assess the performance of NT-proBNP, FGF21, Galectin-3 and Copeptin to discriminate between advanced and mild HF. Materials and Methods: A total of 117 patients were enrolled in this study and divided into two groups: 67 patients in NYHA functional class I-II (mild HF) and 50 patients in NYHA III-IV (advanced HF). NT-pro BNP, FGF21, Galectin 3 and Copeptin serum levels were determined with the ELISA method. Receiver operating characteristic (ROC) analysis and binomial logistic regression analysis were used to measure the ability of the studied biomarkers to distinguish between advanced and mild HF patients. Results: In patients with T2DM with advanced HF, serum FGF21 level was significantly positively correlated with eGFR (ρ = 0.35, p = 0.0125) and triglycerides (ρ = 0.28, p = 0.0465) and significantly negatively correlated with serum levels of HDL cholesterol (ρ = −0.29, p = 0.0386) and with RV-RA gradient (ρ = −0.30, p = 0.0358). In patients with mild HF, serum FGF21 level was significantly negatively correlated with NT-proBNP levels (ρ = −0.37, p = 0.0022), E/e’ ratio (ρ = −0.29, p = 0.0182), TR velocity (ρ = −0.24, p = 0.0470) and RV-RA gradient (ρ = −0.24, p = 0.0472). FGF21 (AUC = 0.70, 95% CI: 0.60−0.79) and NT-proBNP (AUC = 0.73, 95% CI: 0.63–0.82) demonstrated significant predictive value to discriminate T2DM patients with advanced HF from those with mild HF. Elevated values for FGF21 (≥377.50 ng/mL) or NTproBNP (≥2379 pg/mL) were significantly associated with increased odds of advanced HF after adjusting for demographic and clinical covariates. Conclusions: NTpro-BNP and FGF21 have a similar ability to discriminate T2DM patients with advanced HF from those with mild HF. Univariable and multivariable logistic models showed that, FGF21 and NTproBNP were independent predictors for advanced HF in patients with preserved and mildly reduced ejection fraction and T2DM.

Nephroprotective effect of SGLT2 inhibitors in elderly patients with type 2 diabetes mellitus and hypertension: a real-world population-based cohort study

ABSTRACT Objectives This study aimed to investigate the nephroprotective effect of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in elderly patients with type 2 diabetes mellitus (T2DM) and hypertension based on real-world clinical data. The study aimed to provide a theoretical basis for evidence-based pharmacological treatment of chronic kidney disease in this population. Methods The ‘Health Cloud’ platform of the Shanghai Municipal Health Commission was employed to identify and screen elderly patients with T2DM and hypertension. The propensity score matching cohort was further constructed to estimate the effect of SGLT2i on the risk of rapid decline in renal function (∆eGFR≤-5 ml/min/1.73 m2 or ∆eGFR%≤-5%). Multiple sensitivity analyses were conducted to assess the robustness of the results. Results After propensity score matching, no significant differences of covariates were identified between the SGLT2i and non-SGLT2i groups. The results of multivariate logistic models demonstrated a consistent and inverse correlation between SGLT2i use and the risk of rapid eGFR decline, whether defined as ∆eGFR≤-5 ml/min/1.73 m2 (OR = 0.60, 95% CI:0.38-0.96) or ∆eGFR%≤-5%（OR = 0.57, 95% CI:0.37-0.89). In the stratification of renin-angiotensin system inhibitor (RASi) treatment, SGLT2i was associated with a lower risk of rapid eGFR decline in the RASi group (all ORs < 1, p < 0.05), with no interaction between SGLT2i and RASi (all P for interaction > 0.05) detected. Conclusions SGLT2i significantly reduced the risk of rapid eGFR decline in elderly patients with T2DM and hypertension, but the synergistic effect with RASi remains unclear.

Development and validation of a novel comorbidity score specific for prostate cancer patients treated with robotic platform and its implication on DaVinci single-port system.

To develop and validate a novel Comorbidity score for Robotic Surgery (CRS) in predicting severe complications after robot-assisted radical prostatectomy (RARP). Furthermore, we investigated the impact of the surgical platform (Multi-Port - MP vs Single-Port - SP) according to this score. We included 2085 ("development cohort") and 595 ("validation cohort") patients undergoing RARP at two tertiary referral centers between 2014 and March 2024 in a retrospective study. Statistical analyses included validation of the Charlson Comorbidity Index (CCI) to predict 30-day severe complications (Clavien-Dindo ≥ 3a), development and external validation of CRS using calibration plots and decision curve analysis. Lastly, locally weighted scatterplot smoothing (LOWESS) analysis was used to graphically explore the impact of the robotic platform according to novel CRS. CCI exhibited limited predictive ability for severe complications (60% in the validation cohort). In multivariable logistic regression analyses testing the correlation between each condition included in CCI and severe complications, diabetes and myocardial infarction resulted as independent predictors (OR 1.75 [95%CI 1.05-2.82]; OR 1.92 [95%CI 1.26-2.88]) and were subsequently fitted into a multivariable logistic model including age, previous abdominal surgery and obesity (BMI > 30). The resulting predictive model demonstrated superior discrimination and clinical net benefit in predicting severe complications compared to CCI (AUC 64 vs 60%). At LOWESS analysis, SP platform was associated with lower risk of severe complications as CRS increased compared to MP system. The validated CRS showed better accuracy compared to CCI in predicting severe complications after RARP. Additionally, the use of SP robotic platform may reduce the risk of severe complications in highly comorbid patients according to CRS.

Predictive factors of immediate continence after conventional robot-assisted radical prostatectomy: a single-institution retrospective study.

To assess the predictive factors of immediate urinary continence after robot-assisted radical prostatectomy. This study included 282 patients who underwent conventional robot-assisted radical prostatectomy at our institution from April 2019 to March 2024. The primary outcome was immediate urinary continence, defined as the absence of urine leakage immediately after urinary catheter removal on postoperative day 6 or 7. In addition, the immediate urine loss rate, defined as the 24-h urine loss volume divided by the total urine volume after catheter removal, was calculated. The multivariable logistic model was used to assess the possible predictive factors of immediate continence (urine loss rate of 0%). The factors included age, body mass index, Charlson Comorbidity Index, pre-existing lower urinary tract symptoms, presence of an inguinal hernia, prostate volume, membranous urethral length, stratified cancer risk, surgeon's experience, and nerve-sparing procedure. In addition, a multiple linear regression model was established to investigate the associations of the same predictors with immediate urine loss rate (%). We also presented our techniques to achieve immediate continence. The patients' median age was 70 (interquartile range: 63.0-73.0) years. Approximately 39% (n = 111) of patients presented with immediate continence. Age, inguinal hernia, membranous urethral length, and low risk for prostate cancer were associated with immediate continence. These were also statistically significant predictors of immediate urine loss rate. Our study identified factors predicting immediate urinary continence after conventional robot-assisted radical prostatectomy. This information is potentially valuable for preoperative counseling in patients undergoing robot-assisted radical prostatectomy.

Re-excision rates after breast-conserving surgery for invasive breast cancer: an Albertan perspective.

Re-operation after breast-conserving surgery for invasive breast cancer is variable among centres and individual surgeons. In this study, we aimed to characterize the current landscape of practice regarding re-operation for invasive breast cancer in the province of Alberta. This study was a retrospective review of the Synoptec database for patients undergoing primary breast-conserving surgery for invasive breast cancer or reoperation in the province of Alberta in the year 2020. We extracted data on demographic and tumour characteristics, use of intraoperative margin-assessment strategies, and surgical facility. We conducted univariate and multivariate logistic model analyses. We included 1391 breast surgeries in the study. A total of 158 patients underwent re-operation during the study period. The median time to first reoperation was 34 days. The overall re-operation rate was 11.4% (range 5.4%-18.5%) among surgical facilities. The completion mastectomy rate was 5.2%, and 1.5% of patients underwent multiple revisional surgeries. Tumour multifocality was associated with increased revisional surgery rates on multivariate analysis (odds ratio 2.80). The results of this study are consistent with the published literature. We have identified heterogeneity among sites in Alberta for revisional surgery after breast-conserving surgery for invasive breast cancer. This highlights an opportunity for ongoing education and quality improvement in breast cancer care in the province of Alberta.

Association between cardiometabolic index (CMI) and periodontitis in US adults: analysis of NHANES data (2009–2014)

BackgroundThe cardiometabolic index (CMI) is a new predictor of obesity-related diseases, but its link to periodontitis is under-researched. This study aims to examine the potential association between the CMI and periodontitis.MethodsWe conducted a cross-sectional study using the National Health and Nutrition Examination Survey (NHANES) database (2009–2014) to examine the potential association between CMI and periodontitis. The study utilized a weighted multivariate logistic model to assess the association between TG, HDL-C, TG/HDL-C, obesity indices (BMI, WC, WHtR, CMI), and periodontitis, employing the area under the receiver operating characteristic curves (ROC) to estimate areas under the curve (AUC). Furthermore, generalized smooth curve fitting was conducted to examine the relationship between CMI and periodontitis. Finally, the study incorporated subgroup analysis and interaction tests to examine consistency across different populations.ResultsTG/HDL-C, WHtR, and CMI were positively associated with periodontitis in the fully adjusted classification model. It was observed that for each unit increase in CMI, there was a corresponding 17.8% increase in the prevalence of periodontitis [1.178 (1.049, 1.322) 0.00562] and 18.7% increase in the prevalence of moderate/severe [1.187 (1.057, 1.334) 0.00376] in the fully adjusted model. When CMI was used as a categorical variable, the adjusted OR for periodontitis prevalence increased significantly with increasing CMI after adjusting for all potential covariates (T3 vs. T1: OR, 1.28 [1.06, 1.55], p < 0.05). The ROC analysis indicated that a larger area under the curve was found in the CMI [0.554 (0.538–0.570)] than in the WC [0.544 (0.528–0.560)] and WHtR [0.544 (0.528–0.561)]. Nonetheless, the discrepancy observed did not reach statistical significance (all p > 0.05). Further generalized smooth curve fitting and threshold effect models indicated a positive linear correlation between CMI and periodontitis. Moreover, there is no interactive association between TG/HDL-C, WHtR, CMI, and periodontitis.ConclusionsThis cross-sectional study revealed a positive relationship between CMI and periodontitis. Further prospective studies are warranted to validate our findings.

Association of blood vitamin A with osteoarthritis: a nationally representative cross-sectional study

ObjectivesVitamin A plays an important role in health, especially regarding its impact on bone tissue. Vitamin A can lead to bone damage and deformity, thus becoming an important causative factor in osteoarthritis. In this study, we aimed to evaluate the association of serum vitamin A with osteoarthritis.MethodsWe included participants who self-reported whether they had OA in NHANES 2001–2006 and NHANES 2017–2018 to explore the association and dose–response relationship between vitamin A concentration and risk of osteoarthritis through weighted multivariate logistic models and restricted cubic splines. Sensitivity and stratification analyses were also used to assess the robustness of the results.ResultsA total of 18,034 participants were included in this study, and a linear association between serum vitamin A concentration and osteoarthritis risk was observed. The OR of osteoarthritis was 1.22 (95% CI: 0.98, 1.52), 1.40 (95% CI: 1.05,1.85), and 1.47 (95% CI: 1.14, 1.91) for participants in the second, third, and fourth quartiles, respectively, compared with the lowest vitamin A reference group. Similar results were obtained when sensitivity and stratification analyses were performed.ConclusionSerum vitamin A is positively associated with osteoarthritis risk. Within a certain range of vitamin A concentrations, vitamin A is a protective factor against osteoarthritis, beyond which it becomes a causative factor for osteoarthritis.

The Wellbeing Thermometer in Patients with Colorectal Cancer: A Validation Study

Background: Wellbeing is a valuable outcome with benefits for patients and the wider healthcare system. Different instruments are available to measure wellbeing; however, each has its own limitations. Existing wellbeing models focus mostly on a single aspect (e.g., social). The Wellbeing Thermometer (WbT) was developed based on a more holistic framework for wellbeing. Objective: The aim of this research was to validate the WbT on patients receiving treatments using a sample of patients with colorectal cancer in England. Methods: A survey, including GAD-7, PHQ-9, WHO-5, and WbT, was administered to two independent cohorts of adult patients diagnosed with colorectal cancer. The WbT consists of 25 questions/items: 5 for each domain of health, thoughts, emotions, spiritual, and social. We investigated the psychometric properties of the WbT to characterize item difficulty, discrimination, and reliability. Pearson’s correlation coefficient was used to compare WbT scores to those from other validated tools. A multivariable logistic model explored associations between WbT domains and other validated tools. Results: Cronbach’s alpha for WbT was 0.872 (95% confidence interval: 0.829–0.902), indicating good internal consistency. The item difficulty for WbT showed low scores for questions 6 (0.39) and 9 (0.49) and high scores for the other items. Item 3 in the health subgroup indicated weak discrimination towards the health item score (r = 0.35) and no discrimination towards the total score (r = 0.03). Item 1 in the spiritual subgroup showed weak discrimination towards the spiritual item score (r = 0.37). The WbT showed moderate to strong correlation with all other validated tools (r range: GAD-7, −0.49 to −0.77; PHQ-9, −0.69 to −0.83; WHO-5, 0.66 to 0.85). For Cohort 1, the WbT thought domain was associated with GAD-7 (p = 0.004) and WHO-5 (p = 0.002), and the health domain was associated with PHQ-9 (p = 0.014). For Cohort 2, the WbT thought domain was associated with GAD-7 (p = 0.02), the health domain was associated with WHO-5 (p = 0.02), and the emotion domain was associated with WHO-5 (p = 0.02). Conclusions: The WbT is a valid tool for assessing wellbeing in patients with colorectal cancer. The WbT may be a useful addition to both clinical practice and future research and may help shed light on a new area with regards to patients with cancer, specifically how they feel and function. This will ultimately increase wellbeing and reduce suffering.

Clinical and subclinical arteriosclerotic disease in octagenarians with hip fracture. A case–control study

Background and objectivesEvaluate clinical and subclinical arteriosclerotic disease in older patients with hip fracture compared with patients without fracture in order to increase knowledge about the relation between both diseases in older individuals. Patients and methodsAge- and sex-matched case–control study of octogenarians with and without recent hip fracture. Vascular risk factors, subclinical vascular diseases (assessed by carotid plaques, carotid intima media thickness and arterial stiffness) as well as cardiovascular diseases were analyzed. Univariate and multivariate logistic models were used to estimate odds ratios (OR) with their 95% confidence intervals (CI) to assess the association of the arteriosclerosis and hip fracture. ResultsWe analyzed 95 patients per group with a median age of 82 [79–87] years of whom 77.9% were female. Patients in both groups have elevated rates of vascular disease (25%) without differences between them. Patients with hip fracture had higher subclinical arteriosclerotic alterations with higher percentage of carotid plaques (OR 3.25 [1.06–9.97]) compared with the control group. ConclusionsOlder patients with hip fracture had significantly higher presence of subclinical alterations but not increase on rate of cardiovascular arteriosclerotic disease compared with those without hip fracture.

Factors Associated with Increased Risk of Contamination in Bone Marrow Transplants.

Hematopoietic cell transplantation (HCT) remains the definitive therapeutic modality for numerous malignant and non-malignant hematologic disorders. Conventional bone marrow remains a viable donor source for HCT. However, microbial contamination of bone marrow harvests may present a risk to immunocompromised recipients. This analysis sought to identify clinical factors associated with bone marrow contamination. We analyzed a single institution experience comprising 667 unique bone marrow harvests collected between 1999 and 2021. We trended the yearly microbial contamination rate over this time span. Harvest type (autologous vs allogenic), donor age, donor sex, physician experience, total nucleated cell (TNC) count, volume collected, and TNC concentration were included in a univariate (UV) and multivariate (MV) logistic model to assess which factors were associated with contamination. Males comprised 55.8% of the donor population and the median age of the cohort was 35 [IQR: 27-45]. There were 19 autologous, 151 related allogenic, and 497 unrelated allogenic transplants in this cohort. 87 of the 667 (13.0%) harvests were contaminated and essentially all contaminants were common skin flora. The yearly contamination rates displayed substantial variability, ranging from 0% to 42.9%, with no discernible trend. Harvest type did not exhibit a significant association with contamination risk. However, male donor sex was found to be significantly associated with a higher contamination rate (18%) compared to female sex (6.8%, p < 0.001). In both UV and MV logistic models, male sex emerged as the sole factor linked to contamination risk (OR: 2.90, 95% CI: 1.65 - 5.35). This analysis represents the largest single center investigation of bone marrow harvest microbial contamination rates. Notably, it is the first to establish an association between contamination and male donor sex. We propose that this association may be attributed to differences in skin flora composition or innate immune function between sexes, general hygiene practices or possibly the result of the frequent clipping of body hair in males prior to the harvest procedure. Further research is warranted to explore the underlying mechanisms and clinical implications of this novel finding.

LGBTQ+ Health Inequities in a Rural, Conservative Context: Alabama Compared with Other Southern States.

There are no statewide statistics regarding the health of lesbian, gay, bisexual, transgender, and queer (LGBTQ+) Alabamians. To fill this gap, we used data collected by the Southern Equality Research and Policy Center to compare Alabama with other southern US states regarding the health and well-being of LGBTQ+ people. We tested for unadjusted differences between Alabama and other southern states using χ2 tests for dichotomous outcomes and the Wilcoxon rank-sum test for ordinal outcomes. Multivariate logistic models predicted dichotomous outcomes from an Alabama indicator, a continuous rurality variable, and a racial and ethnic minority indicator to control for differences in rurality and racial and ethnic composition; multivariate linear regression was used to approximate the point estimate of adjusted differences. Alabama and other southern states had statistically similar and high levels of abuse, harassment, and poor mental and physical health. Alabamians lived in ZIP codes with somewhat higher rural-urban commuting area code rurality scores (AL 1.76; South 1.70; P = 0.036, where 1 is the most urban category). More than one-fourth of Alabama respondents reported experiencing self-harming behaviors; one-third reported suicidal ideation (33.1%); more than half reported anxiety disorders (57.6%); more than two-thirds reported being depressed (69.2%); and 25% to 75% experienced or feared emotional and physical abuse because of their identity. Multivariate adjusted results were generally similar to unadjusted results. Alabama LGBTQ+ populations, who live in more rural settings than in most prior studies, experience markedly poor outcomes.