Multivariate Logistic Regression Model Analysis Research Articles

Factors affecting decision making among nurse managers working in government hospitals

BackgroundEffective nursing management and leadership are essential for the provision of desired patient care that will contribute to the improvement of any country's health indicators. However, nurses' views and experiences on the multitude of personal and organizational factors which may impact their decision-making abilities are often neglected in the literature. The study aimed to assess magnitude of poor decision making and its associated factors among nurse managers in South Wollo Zone Governmental Hospitals, Amhara Regional State, Ethiopia, 2023.MethodsNon experimental cross-sectional study was conducted among 168 nurse managers in South Wollo Zone Public Hospitals from April 01 2023 to May 15/2023. Participants were selected by using a simple random sampling technique. The data were collected by using structured questionnaire from the study participants. Data were entered using EPI data version 4.6 and exported to SPSS version 26 for analysis. The bi-variable logistic regression analysis model was used to identify the potential predictor variable, with p-value <0.25 was fitted into the multivariable logistic regression analysis model; p-value less than 0.05 and an adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to declare, factors associated with the outcome variable. The model fitness was checked by using the Hosmer and Lemeshow test. Data were presented with frequency tables, graphs, and pie charts.ResultsThe study found that the overall magnitude of poor decision-making among nurse managers was 35.7%. Being self-confident [AOR = 0.01, 95% CI: (00.002, 0.05)], receiving feedback [AOR = 0.24, 95% CI: 0.08, 0.76], and getting managerial support [AOR = 0.22, 95% CI: (0.06, 0.81)] were negatively associated with poor decision-making among nurse managers.ConclusionSelf-confidence, receiving feedback, and getting managerial support were variables significantly associated with poor decision-making. Authors strongly emphasize providing managerial support for nurse managers, increasing their habit of receiving feedback from colleagues, and encouraging them to build their self-confidence.

Predictors of neonatal mortality among neonates in Tigray regional state, Ethiopia: A cross-sectional study.

Since 2015, Ethiopia is committed to lowering the death rate for children under five and it is one of the countries in Sub-Saharan Africa that has accomplished the fourth Millennium Development Goal. However, in Ethiopia, neonatal death has remained a serious public health concern, with greater rates found in Tigray regional state and the predictors aren't well recognized. The goal of this study was to ascertain the prevalence of neonatal death in the Tigray regional State as well as any relevant risk factors. This study performed a secondary data analysis of the 2016 Ethiopia Demographic and Health Survey (EDHS) report. Information was gathered on 716 neonates who were born five years before the survey began. Risk factors for neonatal mortality were thought to include mother and neonate demographics, health, and environmental factors. The study employed multivariable logistic regression model analysis and descriptive statistics to identify significant correlates of neonatal mortality. In Tigray regional state, the overall prevalence of neonatal mortality was 4.3% (95% CI: 3.06, 6.10). The multivariable logistic regression model analysis revealed that factors such as multiple birth types (AOR = 15.3, 95% CI: 3.54, 65.84), birth order (2-4) (AOR = 4.88, 95% CI: 1.52, 15.7), sex of the neonate (being male) (AOR = 3.75, 95% CI: 1.45, 9.75), home place of delivery (AOR = 7.4, 95% CI: 2.0, 27.6), and neonates born to mothers aged 20-34 years (AOR = 0.23, 95% CI: 0.087, 0.58) were significantly risk factors associated with a higher risk of neonatal mortality rate. The study recognized the sex of the neonate, birth order, mother's age, place of delivery, and birth type as potential risk factors for neonatal mortality. The prevalence of neonatal mortality indicated that the neonatal mortality rate in Tigray regional state was higher than the national average. To reduce neonatal mortality, targeted interventions should focus on high-risk groups, such as mothers delivering at home and those with multiple births.

Predicting Renal Cell Carcinoma Subtypes and Fuhrman Grading Using Multiphasic CT-Based Texture Analysis and Machine Learning Techniques

Abstract Objectives The aim of this study is to evaluate computed tomography texture analysis (CTTA) on multiphase CT scans for distinguishing clear cell renal cell carcinoma (ccRCC) from non-ccRCC and predicting Fuhrman's grade in ccRCC using open-source Python libraries. Methods Conducted retrospectively, the study included 144 patients with RCCs (108 ccRCCs and 36 non-ccRCCs) who underwent preoperative multiphasic CT. Ninety ccRCCs were categorized into 71 low-grade and 19 high-grade ccRCCs. Tumor was marked on the largest axial tumor slice using “LabelMe” across different CT phases. First- and second-order texture features were computed using Python's scipy, numpy, and opencv libraries. Multivariable logistic regression analysis and machine learning (ML) models were used to evaluate CTTA parameters from different CT phases for RCC classification. The best ML model for distinguishing ccRCC and non-ccRCC was externally validated using data from the 2019 Kidney and Kidney Tumor Segmentation Challenge. Results Entropy in the corticomedullary (CM) phase was the best individual parameter for distinguishing ccRCC from non-ccRCC with (F1 score: 0.83). The support vector machine (SVM) based ML model, incorporating CM phase features, performed the best, with an F1 score of 0.87. External validation for the same model yielded an accuracy of 0.82 and an F1 score of 0.81. ML models and individual texture parameters showed less accuracy for classifying low- versus high-grade ccRCCs, with a maximum F1 score of 0.76 for the CM phase SVM model. Other CT phases yielded inferior results for both classification tasks. Conclusion CTTA employing open-source Python tools is a viable tool for differentiating ccRCCs from non-ccRCCs and predicting ccRCC grade.

Awareness, willingness, and status of using HIV pre-exposure prophylaxis among men who have sex with men in Shaanxi Province

Objective: To analyze awareness, willingness, the status of using, and related factors of HIV pre-exposure prophylaxis (PrEP) in men who have sex with men (MSM) in Shaanxi Province to provide a reference for the next step of HIV prevention and control strategy. Methods: Using a cross-sectional study design from March to May 2022, with the assistance of MSM social organizations in Xi'an, relying on the network platform and MSM Social organizations, a convenient sampling method was used to recruit MSM with an estimated sample size of 900. The inclusion criteria were male aged ≥18, having had same-sex sexual intercourse in the last twelve months, HIV-negative or unknown status of infection. An electronic questionnaire was made with the help of questionnaire-star and an anonymous self-administered questionnaire was used to collect information on socio-demographic characteristics, sexual behavior, awareness and using of PrEP, etc. A logistic regression model was used to analyze related factors of PrEP awareness and use in MSM. SPSS 25.0 software was used for statistical analysis. Results: Among 981 MSM subjects, 76.55% (751/981) had heard of PrEP, and 42.51% (417/981) were aware of PrEP. Among those who knew about PrEP, 74.34% (310/417) had homosexual sexual activity in the last six months, 99.03% (307/310) were willing to use PrEP, and 40.97% (127/310) were using PrEP. The multivariate logistic regression analysis model results showed that nationality (other ethnic groups:aOR=4.48,95%CI:1.28-15.68),education level (high school or technical secondary school: aOR=3.01,95%CI:1.49-6.07; universities or colleges: aOR=2.86,95%CI:1.47-5.57; master degree: aOR=5.10,95%CI:2.37-10.98), monthly income 5 000-10 000 yuan (aOR=1.70,95%CI: 1.00-2.88), tested for HIV in the past 12 months (aOR=1.87,95%CI:1.34-2.61) were related factors of PrEP knowledge awareness. Singlehood (aOR=0.46,95%CI:0.26-0.81) and consulted professionals about PrEP (aOR=9.56,95%CI:4.58-19.96) were related factors of PrEP use. Conclusions: The proportion of willingness to use PrEP was higher among MSM in Shaanxi Province, but the awareness rate and utilization rate of MSM for PrEP were low. The cognition of PrEP should be further improved to promote the correct use of PrEP among MSM.

Analysis on the status quo of awareness of knowledge about hepatitis C prevention and treatment and its influencing factors among people aged 15-65 years in Henan Province, 2021

From June to September 2021, residents aged 15-65 years from 18 provincial cities and 10 directly administered counties (cities) in Henan Province were collected for a questionnaire survey, so as to understand the status quo of the knowledge and related influencing factors of hepatitis C prevention and treatment. Among 11 627 subjects, the adjusted awareness rate of knowledge about hepatitis C prevention and treatment was 59.2% (95%CI: 58.3%-60.1%). The awareness rate was higher among people aged 15-24 years [63.7% (95%CI: 61.4%-66.1%)] and those with education level of college or above [72.8% (95%CI: 70.8%-74.8%) (both P<0.05). The multivariate logistic regression model analysis showed that compared with urban and aged 15-24 years residents, rural, aged 25-34 years, 35-44 years, 45-54 years, and 55-65 years residents had lower awareness rates, with OR (95%CI) values of 0.825 (0.754-0.902), 0.733 (0.624-0.863), 0.746 (0.626-0.889), 0.766 (0.643-0.912), and 0.580 (0.484-0.695), respectively; compared with unmarried, junior high school and below residents, marriage/cohabitation, high school or vocational school, college or above residents had higher awareness rates, with OR (95%CI) values of 1.523 (1.315-1.764), 1.624 (1.474-1.789) and 2.212 (1.945-2.516), respectively.

Factors associated with predicting knee pain using knee X-ray and personal factors: A multivariate logistic regression and XGBoost model analysis from the Nationwide Korean Database (KNHANES).

With increasing life expectancy, knee pain has become more prevalent, highlighting the need for early prediction. Although X-rays are commonly used for diagnosis, knee pain and X-ray findings do not always match. This study aims to identify factors contributing to knee pain in individuals with both normal and abnormal knee X-ray results to bridge the gap between X-ray findings and knee pain. Data from the fifth Korea National Health and Nutrition Examination Survey (KNHANES), collected from 2010 to 2012, including data from 5,191 participants, were analyzed. The focus was on epidemiological characteristics, medical histories, knee pain, and X-ray grades. Multivariate logistic regression and extreme gradient boosting (XGBoost) models were used to predict knee pain in individuals with normal and abnormal knee X-rays, categorized by Kellgren-Lawrence grades. For normal X-rays, the logistic regression model identified aging, being female, higher BMI, lower fat percentage, osteoporosis, depression, and rural living as factors associated with knee pain. The XGBoost model highlighted BMI, age, and sex as key predictors, with a feature importance >0.1. For abnormal X-rays, logistic regression indicated that aging, being female, higher BMI, osteoporosis, depression, and rural living were associated with knee pain. The XGBoost model highlighted age, BMI, sex, and osteoporosis as key predictors, with a feature importance >0.1. Aging and being female were associated with knee pain due to hormonal changes in women, as well as cartilage and bone deterioration. Lower fat percentage was significantly associated with increased pain, which might be attributable to higher activity levels. Higher BMI and osteoporosis were significantly associated with knee pain, possibly due to increased stress and reduced resistance on knee structures, respectively. Depression was identified as a key predictor of knee pain in patients with normal X-rays, potentially attributable to psychosomatic factors. The study's limitations include its cross-sectional nature, which does not allow for the establishment of causal relationships, the lack of detailed medical history such as trauma history, and recall bias due to self-reported questionnaires. Future research should address these limitations to support our hypothesis.

The elderly population's social networks and HIV perceptions: Evidence from China.

Previous studies have found that people with low participation in social activities and living alone were prone to have risky sexual behaviors, while people with high participation in social activities were less prone to have risky sexual behaviors. Based on the above assumptions, we conducted an analysis on elderly population's social networks and human immunodeficiency virus (HIV) risky behaviors in China. In the survey study, considering the sensitivity of sexual behavior, HIV risk behavior of the elderly population is more difficult to measure, so the intermediate variable of HIV perceptions was used instead of the sexual behavioral variable. A cross-sectional study was conducted in July to September 2023 among the elderly aged ≥ 50 years in China to measure the social networks with the Social Support Rate Scale (SSRS) and to measure the HIV perceptions of the elderly with the degree of knowledge of acquired immunodeficiency syndrome (AIDS) prevention and treatment and the degree of discrimination of HIV/AIDS patients, and the data were statistically analyzed with SPSS 27.0 software. Statistical analysis methods included descriptive analyses such as frequency, percentage, mean ± standard deviation, and median, two independent samples t-test analysis, and multivariate logistic regression model analysis. Among the 1022 elderly people surveyed, the proportion of those with weak and strong levels of social support was 46.9% and 53.1%, respectively; the proportion of those with low, medium, and high levels of HIV knowledge perceptions was 4.8%, 5.9%, and 89.3%, respectively; and the proportion of those with low, medium, and high levels of attitudinal perceptions was 24.7%, 35.0%, and 40.3%, respectively. Based on the Goodman-Kruskal Gamma test, it was found that there was a positive correlation between social support and HIV knowledge perceptions in the elderly population, and there was a negative correlation between social support and HIV attitudinal perceptions in the elderly population. Ethnicity, current occupation or pre-retirement occupation, personal average after-tax monthly income, attitudinal perceptions, and social support were the influencing factors for the knowledge perceptions in the elderly population (P < 0.05); literacy, number of children, mode of residence, personal average monthly income after tax, knowledge perceptions, and social support were the influencing factors of attitudinal perceptions in the elderly population (P < 0.05). There is a correlation between social networks and HIV perceptions in China's elderly population, which is positively correlated with HIV knowledge perceptions and negatively correlated with HIV attitudinal perceptions, and it is important to improve the HIV prevention and knowledge of the elderly population and reduce their HIV-related discrimination.

Gender-specific relationships between hyperuricemia and idiopathic deep venous thrombosis in the Chinese population: a case‒control study

BackgroundMany studies have indicated that hyperuricemia is positively correlated with secondary deep venous thrombosis (DVT); however, the risk factors for idiopathic DVT based on gender differences, such as serum uric acid (SUA) and hyperuricemia, have not been fully examined.ObjectivesTo investigate the association between hyperuricemia and the occurrence of idiopathic lower extremity DVT based on gender differences.MethodsThis was a retrospective analysis of 4299 patients who were hospitalized at the Affiliated Hospital of Qingdao University from January 2012 to October 2021 and who underwent ultrasound of the lower limbs. A total of 930 patients were diagnosed in the DVT group, and 3369 patients were diagnosed in the control group without DVT. The baseline SUA and other important baseline data were compared between the two groups, and sex was stratified. Multivariate logistic regression analysis models adjusted for potential confounders were used to investigate the associations between hyperuricemia and idiopathic lower extremity DVT.ResultsThe SUA level in patients with idiopathic DVT was significantly greater than that in patients without DVT (total: 6.00 ± 1.75 vs. 5.40 ± 1.56 mg/dL, respectively; male: 6.42 ± 1.60 vs. 5.87 ± 1.57 mg/dL, respectively; female: 5.58 ± 1.79 vs. 4.72 ± 1.27 mg/dL, respectively; all P < 0.001). The proportion of patients with hyperuricemia in the idiopathic DVT group was significantly greater than that in the control group (total: 29.03% vs. 16.10%, respectively; male: 35.26% vs. 23.19%, respectively; female: 22.73% vs. 5.74%, respectively; all P < 0.001). The incidence of DVT in patients with hyperuricemia was significantly greater than patients with normouricemia (33.29% vs. 18.92%, respectively), and this difference was particularly prominent among women (58.01%). According to the univariate model, hyperuricemia was significantly associated with a grester risk of idiopathic DVT. After adjustment for potential confounders, this association remained significant. The risk of idiopathic lower extremity DVT in patients with hyperuricemia was 2.643-fold greater than that in patients with normouricemia (Model 3: OR: 2.643, 95% CI: 2.165–3.228). After stratification by sex, the risk of idiopathic lower extremity DVT in female patients with hyperuricemia was 7.482-fold greater than that in patients with normouricemia (Model 3, OR: 7.482, 95% CI: 4.999–11.199).ConclusionIn the Chinese population, hyperuricemia is closely related to an increased risk of idiopathic lower extremity DVT, especially in female patients.

Longitudinal change in cervical length measured after prophylactic cerclage in predicting spontaneous preterm birth.

To evaluate the value of serial post-cerclage cervical length measurements in predicting preterm birth. This was a retrospective study of women with a singleton pregnancy who underwent prophylactic transvaginal cerclage from 2017 to 2023. Prophylactic cerclage was performed in women with an obstetric history of cervical insufficiency. After cerclage, all participants underwent routine transvaginal cervical measurement every 2-4 weeks until 32-34 weeks of gestation. Trajectory patterns of changes in cervical length were identified through latent class trajectory modeling. The association of patterns with spontaneous preterm birth and pregnancy interval was analyzed by multivariable logistic regression analysis and Cox proportional hazards regression models. The specific characteristics of changes in cervical length associated with preterm birth were identified. We involved 225 women and acquired a total of 1248 measurements of cervical length. Two distinct trajectories of cervical length change along gestation were identified: Class 1 (persistent shortening of cervix, n = 52 [23.11%]) and class 2 (stable cervix, n = 173 [76.89%]). Women in class 1 were highly associated with spontaneous preterm birth, with a hazard ratio (95% confidence interval [CI]) of 2.00 (1.36, 2.96). The average shortening rate ≥0.24 cm per week and cervical length ≤1.1 cm was significantly associated with spontaneous preterm birth at different gestational age. Serial sonographic cervical length measurements after prophylactic cerclage are valuable in predicting preterm birth.

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.

Clinical efficacy and its influencing factors of ustekinumab in the treatment of patients with Crohn's disease

To analyze the clinical efficacy and its influencing factors of ustekinumab (UST) in the treatment of patients with Crohn's disease (CD). From January 2021 to January 2024, CD patients who received UST treatment were retrospectively collected from the Second Affiliated Hospital of Wenzhou Medical University. Harvey-Bradshaw index were applied to assess clinical activity of CD patients, C-reactive protein was used to evaluate biochemical remission rate, and simplified Crohn's disease endoscopy score was used to evaluate the degree of intestinal inflammation. Logistic regression model was used to analyze the influencing factors for the clinical response rate at week 8, as well as the clinical remission rate and endoscopic remission rate at week 32. A total of 138 CD patients were included, including 93 males and 45 females. The age of diagnosis [M (Q1, Q3)] was 24 (19, 32) years old. At week 8, the clinical response rate and biochemical remission rate was 58.0% and 49.3%, respectively. Multivariate logistic regression model analysis showed that disease behavior (stenosis or penetration) was the risk factor of the clinical response rate at week 8 (OR=0.46, 95%CI: 0.23-0.95). The clinical remission rate and endoscopic remission rate at week 32 were 56.5% and 37.7%, respectively. Multivariate logistic regression model analysis showed that disease behavior (stenosis or penetration) was the risk factor of the clinical remission rates (OR=0.18, 95%CI: 0.08-0.42) and endoscopic remission rates (OR=0.25, 95%CI: 0.11-0.55) at week 32. Failure to achieve clinical response at week 8 was the risk factor of the clinical remission rates (OR=0.21, 95%CI: 0.09-0.52) and endoscopic remission rates (OR=0.19, 95%CI: 0.07-0.50) at week 32. UST treatment has good clinical efficacy in CD patients. CD patients with intestinal stenosis or penetrating lesions can decrease the efficacy of UST treatment. Failure to achieve clinical response at week 8 can decrease the efficacy at week 32.

The characteristics of pediatric primary retroperitoneal teratoma and the influencing factors of perioperative complications

To explore the characteristics of pediatric primary retroperitoneal teratoma and the influencing factors of perioperative complications. The clinical data, imaging data, pathology results, perioperative complications, etc of patients with primary retroperitoneal teratoma admitted and treated at Shanxi Children's Hospital from March 2013 to September 2023 were retrospectively analyzed. The patients were divided into no complication group and complication group according to whether there were perioperative complications. The differences between the two groups were compared, and the influencing factors of complications were analyzed by multivariate logistic regression model. A total of 33 patients were included in this study, including 7 males and 26 females, with an age of [M (Q1, Q3), 9.0 (4.0, 24.0)] months. Nineteen cases had tumors located in the left upper abdomen and 14 cases in the right upper abdomen, among which 17 cases grew across the midline, with the maximum tumor diameter of (12.9±4.5) cm. All patients had anatomical displacement of retroperitoneal vessels and organs: the number of anatomical displaced arteries was 3 (3, 4), the number of anatomical displaced veins was 4 (3, 5), the number of anatomical displaced organs was 5 (4, 6). Pathologic examination revealed 28 mature teratomas (Grade 0 and Grade 1) and 5 immature teratomas (Grade 2 and Grade 3). There were 18 cases in no complication group and 15 cases in the complication group. The incidence of perioperative complications was 45.5% (15/33). The number of tumors crossing the midline (6/18 vs 11/15, P=0.037), the number of tumors adhering closely to the surrounding tissues (7/18 vs 12/15, P=0.033), the number of anatomical displaced veins [4 (3, 4) vs 5 (4, 5), P=0.001], and the number of anatomical displaced organs [4 (3, 5) vs 6 (5, 6), P=0.001] were significantly different between the two groups. Multivariate logistic regression model analysis showed that the number of anatomical displaced organs (OR=8.781, 95%CI: 2.155-35.784, P=0.002) was the influencing factor for perioperative complications of pediatric primary retroperitoneal teratoma.

Characteristics of altered biventricular hemodynamics after arterial switch operation for patients with d-transposition of the great arteries with preserved ejection fraction: a four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) study.

The long-term monitoring of biventricular function is essential to identify potential functional decline in patients following the arterial switch operation (ASO). The underlying pathophysiological mechanisms responsible for altered biventricular hemodynamics in ASO patients are not yet well understood. This study sought to: (I) compare the biventricular kinetic energy (KE) and vorticity of ASO patients and age- and sex-matched controls; (II) investigate the associations of four-dimensional (4D) flow biventricular hemodynamics parameters and neo-aortic root dilation, supravalvular pulmonary stenosis, and pulmonary artery transvalvular pressure difference. A total of 34 patients with dextro-transposition of the great arteries (D-TGA) who underwent ASO, and 17 age- and gender-matched healthy controls were prospectively recruited for this study. All the subjects underwent cine and 4D flow and late gadolinium enhancement scans, and all the patients underwent echocardiography within two weeks of cardiovascular magnetic resonance (CMR) imaging. The following four flow components were analyzed: direct flow, retained inflow, delayed ejection flow, and residual volume. In addition, the following six phasic blood flow KE parameters, normalized to the end-diastolic volume (EDV) and vorticity, were analyzed for both the left ventricle (LV) and right ventricle (RV): peak systolic phase, average systolic phase, peak diastolic phase, average diastolic phase, peak E-wave phase, and peak A-wave phase. The independent sample Student's t-test, Mann-Whitney U-test, univariable and multivariable stepwise regression analyses, intra and inter-observer variability analyses were used to compare patients and controls. In relation to the LV, the D-TGA patients had significantly decreased average vorticity, peak systolic vorticity, systolic vorticity, diastolic vorticity, and peak A-wave vorticity compared to the controls (all P<0.01). In relation to the RV, the pulmonary stenosis group had significantly increased peak E- and A-wave kinetic energy normalized to the end-diastolic volume (KEiEDV), and peak and average vorticity compared to the non-pulmonary stenosis group (all P<0.05). in the multivariable logistic regression model analysis, diastolic KEiEDV, peak E-wave KEiEDV peak A-wave KEiEDV, and average vorticity were associated a with transvalvular pressure difference (β=13.54, P<0.001 for diastolic KEiEDV; β=105.26, P<0.001 for peak E-wave KEiEDV; β=-49.36, P=0.027 for peak A-wave KEiEDV; and β=-56.37, P<0.001 for average vorticity). We found that 4D flow biventricular hemodynamics were more sensitive markers than the ejection fraction in the postoperative D-TGA patients. The RV diastolic KEiEDV parameters and average vorticity were risk factors for pulmonary artery obstruction in the multivariable model.

Impact of serum cholinesterase on calcified nodules in patients with stable coronary artery disease.

Calcified nodules (CNs) are an advanced stage of coronary calcification that can have significant clinical implications. We investigated factors associated with CNs, the etiology of which is not fully understood. We retrospectively evaluated 619 patients with stable coronary artery disease who underwent intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI). CNs in the culprit lesion were evaluated via IVUS, and all-cause mortality and major cardiovascular and cerebrovascular events (MACCEs) were compared between the CN and non-CN groups. The CN group ( n = 40 patients) had a significantly lower survival rate and a higher incidence of MACCE than the non-CN group ( P = 0.020 and P < 0.001, respectively). Multivariate logistic regression analysis models revealed that chronic kidney disease and serum cholinesterase (ChE) level were associated with CN formation [odds ratio (OR): 3.15, 95% confidence interval (CI): 1.30-7.69, P = 0.001 and OR: 0.94, 95% CI: 0.88-0.99, P = 0.042]. The optimal cutoff of serum ChE level as per the receiver operating characteristic curve was 309 units/l (Area under the curve = 0.67, sensitivity = 93%, specificity = 40%, P = 0.001). The low-ChE group divided according to the optimal cutoff value showed significantly higher cumulative incidence of MACCEs after PCI than the high-ChE group as per Kaplan-Meier analysis. The presence of CNs is significantly associated with a poor prognosis and MACCE after PCI among patients with stable coronary artery disease. Serum ChE levels may affect CN formation.

High levels of blood lipid and glucose predict adverse prognosis in patients with aneurysmal subarachnoid hemorrhage

ObjectiveWe conducted a retrospective study on the prognostic factors of aneurysmal subarachnoid hemorrhage (aSAH) patients in the author's Hospital from January 2019 to May 2023. To discuss the association of the blood lipid and glucose levels of patients with the prognosis of aSAH, and verify that high blood lipid and glucose levels are important factors affecting adverse prognosis. MethodsAll patients with aSAH were collected as the case group, which was divided into two groups according to the modified Rankin Scores (mRS), the good prognosis group (Group A, mRS ＜ 3) and the adverse prognosis group (Group B,mRS ≥3). The clinical data of age, gender, accompanied chronic diseases (hypertension, diabetes), smoking, drinking, Glasgow Coma Scale (GCS), Hunt-Hess (H-H) grade, Modified Fisher grade, total cholesterol (TC) , triglyceride (TG) , high-density cholesterol lipoprotein (HDL-C) , low-density cholesterol lipoprotein (LDL-C) , blood glucose (BG) , responsible aneurysm diameter and location were recorded too. Correlations between blood lipid and glucose levels and Modified Fisher grade were assessed by the Spearman correlation analysis. The receiver operating characteristic (ROC) curve was utilized to evaluate the diagnostic efficacy. The effect of blood lipid and glucose levels on adverse prognosis was analyzed by Logistic regression models. ResultA total of 259 patients with aSAH were enrolled. The average age of all patients is (56.54 ± 10.52) years, including 96 males and 163 females. They were divided into Group A (n = 146) and Group B (n = 113). Univariate analysis results show that age, the levels of TC, TG, LDL-C, and BG were higher in Group B (P < 0.05). Besides, Group B had more severe GCS, H-H grade, and Modified Fisher grade than Group A, and a higher proportion of intracranial aneurysms with larger diameter (P < 0.05). Correlation analysis showed that TC, TG, LDL-C, and BG levels were positively correlated with Modified Fisher grade (P < 0.05) and H-H grade (P < 0.05). Multivariate logistic regression model analysis showed that high level of Modified Fisher grade (OR = 0.079, 95%CI: 0.027–0.230) , high level of H-H grade (OR = 0.204, 95%CI: 0.067–0.622) , TC (OR = 10.711, 95%CI: 2.457–46.700) , LDL-C (OR = 0.178, 95%CI: 0.039–0.823) and BG (OR = 1.273, 95%CI: 1.012–1.602) increased the risk of adverse prognosis. The AUC of “H-H grade”, “Modified Fisher grade”, “TC level”, “LDL-C level” and “BG level” was 0.822, 0.885, 0.860, 0.772, and 0.721, respectively, in the ROC curve. ConclusionModified Fisher grade, H-H grade, TC, LDL-C, and BG levels at admission were independent predictors of adverse prognosis of aSAH. Besides, TC, LDL-C, and BG levels were positively correlated with Modified Fisher grade and Hunt-Hess grade. What's more, high levels of TC, LDL-C, and BG combined with Modified Fisher grade and H-H grade can identify high-risk groups with adverse prognoses in aSAH patients.

Interaction between trouble sleeping and diabetes on metabolic dysfunction-associated fatty liver disease and liver fibrosis in adults results from the National Health and Nutrition Examination Survey 2017-2018.

Metabolic dysfunction-associated fatty liver disease (MAFLD), trouble sleeping, and diabetes, as major public health problems, were closely related. The study examined the interaction between trouble sleeping and diabetes on MAFLD and liver fibrosis in adults with MAFLD. The data were obtained from the National Health and Nutrition Examination Survey 2017-2018. Multivariate logistic regression model and subgroup analyses were conducted to assess the relationship between either trouble sleeping or diabetes on MAFLD and liver fibrosis. Relative excess risk due to interaction (RERI), attributable proportion of interaction (AP), and synergy index (S) were utilized to assess the additive interaction. Ultimately, 3747 participants were included, with 2229 known MAFLD subjects. Compared with participants without diabetes, those with diabetes had a higher risk of MAFLD [odds ratio (OR) = 5.55; 95% confidence interval (CI) = 4.07-7.56] and liver fibrosis risk (OR = 3.61; 95% CI = 2.67-4.89). We also found a significant association of trouble sleeping with an increased risk of MAFLD (OR = 1.54; 95% CI = 1.17-2.02) and liver fibrosis risk (OR = 1.51; 95% CI = 1.06-2.16), compared with those without trouble sleeping. Moreover, there was a significant interaction between diabetes and trouble sleeping on MAFLD [RERI = 1.76 (95% CI: -0.22 to 3.73), AP = 0.35 (95% CI: 0.08-0.63), S = 1.80 (95% CI: 1.02-3.16)] and liver fibrosis risk [RERI = 1.79 (95% CI: 0.37-3.21), AP = 0.44 (95% CI: 0.20-0.69), S = 2.44 (95% CI: 1.18-5.08)]. The findings highlight that trouble sleeping and diabetes had a synergistic effect on MAFLD and liver cirrhosis. The study highlights the importance of addressing both trouble sleeping and diabetes management in adults to mitigate the risk of MAFLD and liver fibrosis.

Integrating surgical complexity and nutritional parameters to enhance prediction of postoperative complications in liver resection

BackgroundIn patients undergoing liver resection, postoperative complications remain high. We hypothesized that the incidence of postoperative complications after liver resection would be predicted well by liver resection complexity and nutritional status. MethodsWe retrospectively assessed patients undergoing liver resection at The University of Tokyo Hospital from 2011 to 2021. Liver resection procedures were categorized by surgical complexity using a 3-level complexity classification. Nutritional parameters (including cholinesterase and albumin levels) were evaluated together with well-known nutritional indexes, including the modified Glasgow Prognostic Score, prognostic nutritional index, platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, and controlling nutritional status. ResultsOf 1,258 patients, 570 (44.5%) experienced postoperative complications, with 506 (39.9%) requiring treatment (Clavien–Dindo grade II or greater). Multivariate logistic regression model analyses showed that cholinesterase and albumin levels, complexity classification, and open approach were associated with postoperative complications. The cholinesterase–liver resection complexity/approach model (area under the curve, 0.634) performed significantly better in predicting complications than the prognostic nutritional index (area under the curve, 0.560; P < .001), modified Glasgow Prognostic Score (area under the curve, 0.557; P < .001), controlling nutritional status (area under the curve, 0.502; P < .001), platelet-to-lymphocyte ratio (area under the curve, 0.513; P < .001), and neutrophil-to-lymphocyte ratio scores (area under the curve, 0.515; P < .001). On the basis of the cholinesterase–liver resection complexity/approach model, estimated complications ranged from 9.6% to 53.4%, and patients with well-maintained cholinesterase levels were estimated to have a 5–15% lower probability of complications than patients with impaired cholinesterase levels. This finding was validated with an external Western cohort. ConclusionThe cholinesterase–liver resection complexity/approach model better predicted postoperative complications than nutritional indicators alone and may be useful for selecting patients who may benefit from nutritional support.

Operative outcomes 24 hours after retrograde intrarenal surgery for solitary renal calculi using a flexible and navigable suction ureteral access sheath. A prospective global multicenter study by the European Association of Urology Section on Urolithiasis.

Suction techniques showed potential to improve outcomes of retrograde intra-renal surgery (RIRS). We assessed the 24-hour stone-free rate (SFR) and complications after RIRS using flexible and navigable suction ureteral access sheaths (FANS-UAS). Sixteen centers prospectively contributed to data (August 2023-October 2023). Inclusion criteria: age ≥18 years, single renal stone, pre and 24-hour post-RIRS CT scan. Exclusion criteria were: ureteral stone, anomalous kidney, multiple stones. SFR was divided into: 1) grade A - no fragments; 2) grade B - fragments ≤2 mm; 3) grade C - fragments 2.1-4 mm; and 4) grade D - fragments >4 mm. A multivariable logistic regression analysis model was performed to assess factors associated with the odds of having grade A stone-free status. Data are expressed as median (interquartile range), absolute numbers and frequencies, odds ratio (OR), and 95% confidence interval (CI). One hundred forty-two patients with a median age of 52 years (40-61) were enrolled. 61.3% were males. Median stone volume was 1165 mm3 (656-1936). Median operative time was 48.5 (36.25-71.75) min. Transient fever (37°C-37.5°C) occurred in 10 (7%) patients. No sepsis case occurred. 96.5% of patients were stone-free (Grade A+B). Grade A SFR was 52.8%. All patients were discharged within 48 hours. Bone window (OR 3.156 95% CI 1.177-9.130, P=0.027) was the only factor significantly associated with higher odds of 100% SFR, while stone volume (OR 0.999, 95% CI 0.999-1.000, P=0.007) was significantly associated with lower odds. Imaging and clinical evidence demonstrate excellent perioperative outcomes just 24 hours post RIRS with FANS-UAS. The technique demonstrates a good safety profile, ability for immediate high SFR, and a low rate of infective complications.

Health data management practice and associated factors among health professionals working in public health facilities in Oromia Special Zone, Amhara, Ethiopia: a cross-sectional study

ObjectiveData and information are vital to the decision-making process surrounding health sector reform. In spite of the vast amounts of capital invested in the development of health information systems, health...

Association between oxidative balance score and diabetic kidney disease, low estimated glomerular filtration rate and albuminuria in type 2 diabetes mellitus patients: a cross-sectional study.

The oxidative balance score (OBS) is a comprehensive concept that includes 20 oxidative stressors and can be used to assess individual pro-oxidant versus antioxidant exposure, and the aim of the present study was to investigate the association between OBS and the risk of diabetic kidney disease (DKD), low estimated glomerular filtration rate (low-eGFR) and albuminuria in patients with diabetes mellitus (DM). This cross-sectional study included nationally representative consecutive National Health and Nutrition Examination Survey DM patients aged 18 years and older from 2003-2018. The continuous variable OBS was converted into categorical variables by quartiles, and weighted multiple logistic regression analyses and restricted triple spline models were used to explore the relationships. We also performed subgroup analyses and interaction tests to verify the stability of the results. A total of 5389 participants were included, representing 23.6 million non-institutionalized US residents. The results from both multivariate logistic regression analysis and restricted cubic spline models indicated that OBS and dietary OBS levels were negatively associated with the risk of DKD, low-eGFR, and albuminuria, without finding a significant correlation between lifestyle OBS and these clinical outcomes. Compared to the lowest OBS quartile group, the prevalence risk of DKD (OR = 0.61, 95% CI: 0.46-0.80), low-eGFR (OR = 0.46, 95% CI: 0.33-0.64) and albuminuria (OR = 0.68, 95% CI: 0.51-0.92) decreased by 39%, 54% and 32%, respectively, in the highest OBS quartile group. The results remained stable in subgroup analyses and no interaction between subgroups was found. Higher levels of OBS and dietary OBS were associated with a lower risk of DKD, low-eGFR, and albuminuria. These findings provided preliminary evidence for the importance of adhering to an antioxidant-rich diet and lifestyle among individuals with diabetes.