Stepwise Multivariate Logistic Regression Research Articles

Prevalence, influencing factors, and prediction model construction of anemia in ankylosing spondylitis based on real-world data: An exploratory study.

This study aimed to explore the prevalence and influencing factors of anemia in patients with ankylosing spondylitis (AS) using real-world data and to construct a predictive model for anemia in AS. In November 2023, we accessed the database from China Rheumatoid Arthritis Registry of Patients with Chinese Medicine (CERTAIN). Clinical data of AS collected from the CERTAIN between March 2022 and September 2023 were analyzed. Demographic information, clinical assessment scales, and laboratory test results of the patients were collected. According to the anemia diagnostic criteria established by the World Health Organization (WHO) in 2018, patients were divided into anemia group and non-anemia group. Statistical analyses were performed using SPSS 25.0 software, including χ2 tests, independent sample t-tests to compare differences between the two groups, and multivariate stepwise logistic regression analysis to explore the influencing factors of anemia in AS. The predictive efficacy of the model was evaluated by plotting receiver operating characteristic (ROC) curves. Calibration was assessed through the Hosmer-Lemeshow goodness-of-fit test, and a calibration curve was plotted to comprehensively evaluate the predictive capability of the model. A total of 251 patients were included in this study, among which 58 cases had anemia (23.1%). There were significant differences in gender, ossification, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) indicators, and clinical assessment scale results between the two groups (P < 0.05). The results of multivariate stepwise logistic regression analysis showed that female gender, underweight, ossification, abnormal CRP and ESR were independent risk factors for anemia in AS (P < 0.05). Based on the results of multivariate stepwise logistic regression analysis, a predictive model for anemia in AS was established as Logit(P) = -5.02 + 2.041 × gender -1.11 × BMI(body mass index) category + 1.103 × ossification category + 0.942 × CRP category + 1.476 × ESR category. The ROC curve analysis showed that the area under the curve of the model for predicting anemia in AS was 0.857 (95% CI: 0.808 ~ 0.906). The Omnibus test of model coefficients yielded χ2 = 85.265, P < 0.001. The Hosmer-Lemeshow test showed χ2 = 7.005, P = 0.536 (P > 0.05). Analysis of real-world AS diagnosis and treatment data showed that the prevalence of anemia in Chinese AS was 23.1%. The occurrence of anemia was closely related to female gender, underweight, ossification, and abnormal CRP and ESR. The logistic model constructed based on these indicators for predicting the risk of anemia in AS demonstrated good efficacy.

Development and internal validation of a model predicting successful trial of labour among pregnant individuals with previous one caesarean section: A cohort study (DEVI-CS model).

To develop and internally validate a model predicting successful trial of labour among pregnant women with previous caesarean scar. Cohort study. Tertiary care and teaching hospital. All pregnant women with one previous caesarean delivery, presenting with singleton pregnancies in cephalic presentation at a gestation age of 37weeks or more between 2018 and 2022. A stepwise multivariable logistic regression, followed by bootstrapping, was used to develop and validate the model. Success was defined as vaginal birth after caesarean section (VBAC) without complications for the mother and baby. Out of 4515 cases of TOLAC, 39.8% had a successful trial of labour. Maternal age (OR=0.950, 95%CI: 0.927-0.974), previous baby weight (OR=1.000, 95%CI: 1.000-1.001), indication of previous caesarean section such as breech presentation (OR=0.453, 95%CI: 0.315-0.652), failed induction (OR=0.346, 95%CI: 0.267-0.447), BISHOP score (OR=1.725, 95%Cl: 1.673-1.774) and induction of labour (OR=0.587, 95%CI: 0.466-0.741) were the strongest predictors of successful TOLAC. DEVI-CS model showed good discrimination with an area under the curve (AUC) of 0.928(95%CI: 0.921-0.936) and good agreement between predicted and observed probabilities. Decision curve analysis showed a net benefit between 5% and 90% between the predicted thresholds. The new DEVI-CS prediction model, based on easily captured clinical variables, can quantify the chances of a successful trial of labour after a previous caesarean section. It could aid in shared decision-making regarding the mode of delivery among women with planning the trial of labour after caesarean section.

Age-Related Clinical and Polysomnographic Features of Severe Obstructive Sleep Apnea in Infants.

To use clinical and polysomnographic (PSG) parameters to define the features of severe OSA in infants including PSG parameters, risk factors, and interventions. Retrospective comparison of PSG features in 207 infants (<12 months) referred for sleep-disordered breathing. Stepwise multivariate logistic regression was used to define risk factors for severe OSA including sleep stage-specific PSG parameters. Oxygenation was assessed as % of time with SpO2 < 90% nadir with apneic events and frequency of SpO2 desaturations (>3%) calculated as stage-specific O2 desaturation indexes. We found that 43% of the infants had an OAHI ≥10/h (90/207) with 152 analyzed due to lack of follow-up. Age is the strongest predictor for severe OSA with infants at or less than 3 months of age with 6.22 higher risk of severe OSA (95% CI, 3.16-12.27). Age-stratified analyses showed that infants ≤3 months had significantly higher total and OSA sleep stage-specific apnea hypopnea (OAHI) indexes (REM and NREM), hypopnea indexes (HI), obstructive apnea indexes (OI), arousal indexes, and more severe hypoxemia, both sustained and intermittent. The top risk factor in infants ≤3 months was craniofacial abnormality, which occurred in 57.9% of cases. No intervention was the most common management for each group (61.1% in ≤3 months and 56.6% in 4-12 months). The most common procedures in infants ≤3 months were mandibular distraction osteogenesis (MDO) and supraglottoplasty (SGP) while adenoidectomy was the most common in the 4- to 12- month group. Diagnosis ≤3 months is the strongest predictor for severe OSA, demonstrated across PSG parameters. No surgical intervention is the most common management. 3 Laryngoscope, 135:958-963, 2025.

Interferon gamma release assay has potential in the prediction of chronic graft-versus-host disease in recipients of myeloablative allogeneic hematopoietic stem cell transplantation with post-transplantation cyclophosphamide-based graft-versus-host disease prophylaxis.

The rate of immune reconstitution after allogeneic hematopoietic stem cell transplantation (allo-HSCT) plays the principal role in the development of serious post-transplant complications. However, the post-transplantation course has a significant impact on shaping the immune system of the recipient, per se, thus representing risk factors for subsequent unfavorable outcomes. The predictive power of an interferon gamma (IFNγ) release assay (IGRA) on graft-versus-host disease (GVHD) or hematological relapse in recipients of allo-HSCT treated with post-transplantation cyclophosphamide and the impact of these complications on the restoration of cellular immune responsiveness was evaluated. A prospective observational study in which 62 adult patients with myeloid hematological malignancies who underwent allo-HSCT with a myeloablative conditioning regimen combined with post-transplantation cyclophosphamide were enrolled. Clinical data were collected and the IGRA was performed before commencement of the conditioning regimen and for 12months post-allo-HSCT. Multivariate Cox regression and logistic regression models with backward stepwise analyses were used to calculate the predictive values for acute or chronic GVHD, or hematological relapse. Pre-transplantation and early post-transplantation IGRA values and other selected covariables (age, diagnosis, relapse risk, conditioning type, pre-T lymphocyte count, and donor sex), enabled prediction of the 12-month incidence of chronic GVHD with positive and negative predictive values of 75% and 88%, respectively. However, the IGRA did not improve the predictive value for acute GVHD or hematological relapse. Patients with myelodysplastic syndrome (MDS) had a significantly lower pre-transplant IGRA value (p=0.021) and a delayed IFNγ response in IGRA, post-HSCT, than patients with acute myeloid leukemia (AML) (p=0.015 and p=0.0063 for 3 and 4months post-HSCT, respectively). The IGRA can be used to monitor the recovery of total cellular immunity, post-HSCT and it has shown potential for use in personalized post-transplantation care. In the multivariate backward stepwise logistic regression model, pre-and early post-transplantation IGRA values showed potential for predicting chronic GVHD. Patients with MDS had a significantly lower pre-transplantation IGRA value and delayed IFNγ response in IGRA, post-HSCT, than patients with AML.

Risk factors associated with higher WHO grade in meningiomas: a multicentric study of 552 skull base meningiomas

The histological grade is crucial for therapeutic management, and its reliable preoperative detection can significantly influence treatment approach. Lacking established risk factors, this study identifies preoperative predictors of high-grade skull base meningiomas and discusses the implications of non-invasive detection. A multicentric study was conducted on 552 patients with skull base meningiomas who underwent primary surgical resection between 2014 and 2019. Data were gathered from clinical, surgical and pathology records and radiological diagnostics. The predictive factors of higher WHO grade were analysed in univariate analysis and multivariate stepwise selection logistic regression analysis. Histological analysis revealed 511 grade 1 (92.6%) and 41 grade 2 (7.4%) meningiomas. A prognostic model predicting the probability of WHO grade 2 skull base meningioma (AUC 0.79; SE 0.04; 95% Wald Confidence Limits (0.71; 0.86)) based on meningioma diameter, presence of an arachnoid plane and cranial nerve palsy was built. Accurate preoperative detection of WHO grade in skull base meningiomas is essential for effective treatment planning. Our logistic regression model, based on diameter, cranial nerve palsy, and arachnoid plane, is tailored for detecting WHO grade 2 skull base meningiomas, even in outpatient settings.

P-1415. Social Determinants of Health and Side Effects Significantly Predict Pre-Exposure Prophylaxis (PrEP) Preferences for Every 2 Month Long-Acting Injectable vs. Daily Oral PrEP among Cisgender Women in the United States and the Dominican Republic

Abstract Background Significant HIV inequities exist among cisgender women (CGW) across settings. Black CGW in the United States (US) have an HIV diagnosis rate 10.8 times greater than White CGW. Female sex workers (FSW) have 30-times increased odds of acquiring HIV vs. CGW globally. HIV disparities and low pre-exposure prophylaxis (PrEP) uptake in CGW are driven by social determinants such as stigma. As long-acting injectable (LAI) PrEP rolls out, it is critical to understand CGW’s PrEP preferences. Methods Cross-sectional surveys were conducted among CGW who were: ≥18 years and HIV- in Washington, DC, US (n=302) and Santo Domingo, Dominican Republic (DR) (n=300). US CGW [86.4% Black; 30 yrs (mean) were recruited in reproductive health clinics. DR CGW [100% mixed race; 32 yrs (mean)] were FSW recruited by peer navigators. Stepwise multivariate logistic regression assessed demographic, behavioral and social determinants of PrEP preference (every 2-month LAI vs. daily oral) including aggregate measures of perceived PrEP stigma (Table 1) and PrEP medication optimization (Table 2) based on existing HIV scales. Results The majority of CGW preferred LAI vs. daily oral PrEP: 71.0% (DR); 73.2% (DC). In both settings (Table 3), LAI preference was inversely associated with whether they would be bothered by injection site pain or tenderness for a few days to a week (DC AOR 0.54; 95% CI 0.31-0.96; DR AOR 0.46; 95% CI 0.23-0.93). In DC, each additional item considered important in the PrEP optimization scale was associated with a greater odds of LAI PrEP preference (AOR 1.06; 95% CI 1.01-1.10). Having had an HIV test and PrEP stigma were marginally significant (p&amp;lt; 0.10) in DC. In DR, greater odds of LAI preference was associated with prior injectable medication or contraception experience (AOR 2.39; 95% CI 1.37-4.18) and greater alcohol use (AOR 1.90; 95% CI 1.11-3.25); lower odds of LAI preference was associated with PrEP stigma (AOR 0.93; 95% CI 0.88-0.99) and sexual partner violence (AOR 0.39; 95% CI 0.18-0.82). Conclusion Shared and context specific factors drive PrEP preferences among diverse groups of CGW. Social determinants and side effects management should be addressed in tailored interventions to ensure equitable PrEP uptake including LAI PrEP in CGW. Disclosures Deanna Kerrigan, PhD, MPH, ViiV Healthcare: Grant/Research Support Rachel Scott, MD,MPH,FACOG, DHHS Perinatal Guidelines: Board Member|UW STD Prevention Training Center (UW STD PTC): Honoraria|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support|Vindico CME: Honoraria Allison O’Rourke, MPH, ViiV Healthcare: Grant/Research Support Wendy W. Davis, EdM, ViiV Healthcare: Grant/Research Support Aimee A. Metzner, PharmD, AAHIVP, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee Alan Oglesby, MPH, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee Tamara Taggart, PhD, MPH, HealthHIV: Honoraria

Study the role of vertebral artery tortuosity and hemodynamics in the association with headache and cerebrovascular diseases

The complex and unpredictable path of the vertebral artery is closely related to symptoms such as headaches, dizziness, and cerebrovascular diseases. This study aims to explore the role of vertebral artery tortuosity and hemodynamics in the association with headaches and cerebrovascular lesion by quantitatively analyzing the morphological parameters and hemodynamics of the vertebral artery. A total of 85 patients with headache symptoms and vascular lesions identified through computed tomography (CT) scans were included. A comparative analysis was then conducted to assess how different levels of vascular tortuosity affect these hemodynamic parameters. These findings indicate that vertebral artery tortuosity is more prevalent among the elderly, women, and patients with headache and vascular disease. A multivariate stepwise Logistic regression analysis highlights the ratio of the distal diameter to the tortuosity index of the left vertebral artery (d1) as a significant risk factor for headache symptoms in patients with vascular lesions. Hemodynamic analysis reveals complex flow patterns within the highly tortuous left vertebral artery, including vortices at areas of significant vascular tortuosity. The left vertebral artery with a high degree of distortion presents with high time-averaged wall shear stress (TAWSS), a high oscillatory shear index (OSI) region, and a low relative residence time (RRT). This discovery not only provides essential reference information for the morphological and hemodynamic analysis of the vertebral artery but also offers critical predictive insights for future clinical evaluations and interventions targeting patients with vertebral artery tortuosity, aiding in predicting their risk of experiencing headaches or the onset of cerebrovascular diseases.

Caregiver acceptability of seasonal malaria chemoprevention in two districts in the Upper West region, Ghana: a cross-sectional study

BackgroundAcceptability of malaria chemoprevention interventions by caregivers is crucial for overall programme success. This study assessed coverage and acceptability of Seasonal Malaria Chemoprevention (SMC) in selected communities in the Northern part of Ghana.MethodsAn analytical cross-sectional design was conducted from “July 23rd to August 4th, 2020—a 12-day period that covered 5 days of the first SMC implementation cycle and 7 days post-implementation. Using a stratified multi-stage sampling technique, a total of 495 caregivers providing care for 569 eligible children aged 3–59 months from randomly selected households in the study communities were enrolled into the study. Acceptability of SMC was assessed on a set of 19 questionnaire items-8 of the items measured caregivers’ perceptions and 11 items measured children’s reaction to administered medicines. Univariable and stepwise multivariable logistic regression analyses were performed to assess the predictors of acceptability of SMC at a 95% confidence interval and a p-value of 0.05.ResultsSMC coverage was 95.1% (541/569). Caregivers had a good level of knowledge of SMC (n = 475; 96.0%; 95% CI 94.2—97.7%) and a good perception of SMC (n = 471; 95.2%; 95% CI 93.3–97.0). Seven out of ten caregivers (70.9%; 95% CI 66.9–74.9%) had good acceptability of SMC. For 7 out of 28 children who did not receive the SMC intervention, their caregivers intentionally refused them the intervention. Of those that received the treatment, 17.2% (n = 85; 95%CI 13.8–20.5%) of caregivers had at least one leftover amodiaquine tablet after the third day of treatment. Caregivers who practice Christianity or Islam had better acceptability than caregivers who practice African traditional religion (p < 0.001).ConclusionHealth authorities and stakeholders can work towards bridging the gap between knowledge and SMC treatment practices of caregivers through continuous education, adherence counseling, and effective monitoring of SMC practices in malaria-endemic countries.

Higher dietary zinc intake increases the risk of autoimmune thyroiditis.

Autoimmune thyroiditis (AIT), encompassing Hashimoto's thyroiditis (HT), is a prevalent chronic autoimmune disorder characterized by lymphocytic infiltration and the presence of anti-thyroid antibodies. It is the primary cause of primary hypothyroidism and affects women more frequently than men. Nearly 95% of individuals with HT exhibit thyroid peroxidase antibodies or thyroglobulin antibodies. Dietary factors, including vitamins and trace elements such as zinc, play a significant role in thyroid health; yet, clinical guidelines lack explicit dietary recommendations for AIT. This study investigates the relationship between dietary zinc intake (Zinc) and AIT using data from the 2007-2008 National Health and Nutrition Examination Survey. A total of 5467 participants were analyzed, including 273 individuals with AIT and 5194 without AIT. Clinical characteristics, dietary Zinc, and other relevant variables were assessed. Multivariate logistic bidirectional stepwise regression analysis was conducted to identify independent risk factors for AIT, and a risk prediction model was developed. The prevalence of AIT was 5%. Individuals with AIT were older, had a higher proportion of females, and showed elevated levels of various biomarkers, including zinc. Dietary Zinc was significantly higher in the AIT group (22.6mg vs. 15.3mg, P < .001). The regression analysis identified dietary Zinc, along with other factors, as an independent risk factor for AIT. The risk prediction model, including zinc, demonstrated a better performance (area under the curve = 0.8) compared to the model without zinc. The findings indicate that higher dietary Zinc is positively correlated with the risk of AIT and serves as an independent risk factor. Excessive Zinc may disrupt immune balance, potentially increasing the risk of autoimmune diseases. These results suggest that dietary Zinc should be carefully considered in the management of AIT, and further research is needed to explore the causal relationship and determine safe zinc consumption levels to avoid increasing the risk of autoimmune diseases.

Relationship between VEGF to PEDF ratio and in-hospital mortality in acute respiratory distress syndrome patients

Acute respiratory distress syndrome (ARDS) has a high mortality rate worldwide; thus, identifying death risk factors related to ARDS is critical for risk stratification in patients with ARDS. In the present study, we conducted a single-center retrospective cohort analysis. Out of 278 patients with ARDS admitted from January 2016 to June 2022, 226 were included in this study. The patients were classified based on whether they were alive or dead during hospitalization. Their demographic and laboratory data and results were analyzed by performing a standard statistical analysis. Patients in the death group were older, with worse respiratory functions and blood biochemistry than those in the non-death group. Moreover, statistically significant differences were observed in the levels of vascular endothelial growth factor (VEGF) and pigment epithelium-derived factor (PEDF) between the two groups. Multivariate stepwise logistic regression analysis showed that the VEGF/PEDF ratio was strongly associated with the risk of death. The area under the curve of the VEGF/PEDF ratio was 0.829 (95% confidence interval: 0.772–0.885; P < 0.001), sensitivity was 86.3%, and specificity was 68.0%. Therefore, a VEGF/PEDF ratio is positively correlated with the risk of death in patients with ARDS.

Effect of Older Age on Postoperative Urinary Retention After Prolapse Surgery.

Postoperative urinary retention (POUR) is common after reconstructive pelvic surgery. Little is known about the relationship between older age (≥70 years) and POUR after pelvic organ prolapse surgery. We aimed to investigate the relationship between age ≥70 years and POUR. Secondarily, we aimed to determine if duration of urinary catheterization differed by age in women with POUR. This was a secondary analysis of a dual-center retrospective study on perioperative adverse events in biologic females aged ≥61 years undergoing prolapse surgery. The primary outcome was POUR, defined as a failed retrograde voiding trial requiring bladder catheterization. The secondary outcome was duration of temporary bladder catheterization. We developed a stepwise multivariable logistic regression model, which included relevant variables with P < 0.10 on univariate analyses and a forced age variable. In this cohort of 2,665 women, mean ± standard deviation age was 71.2 ± 6.7 years, and 54.6% were ≥70 years, POUR occurred in 830 (31.1%) patients. Women with POUR had a lower body mass index and were more likely to have undergone a vaginal prolapse surgery and concomitant hysterectomy/incontinence procedure (P < 0.05). They had higher estimated blood loss (75 vs 50 mL, P < 0.001). On multivariable logistic regression, age ≥70 years was not associated with POUR (adjusted odds ratio 1.02, 95% CI [0.83-1.26]). Age ≥70 years was associated with longer duration of catheterization (5 vs 4 days, P < 0.01). Age was not associated with POUR when controlling for other clinical factors (body mass index, surgical approach, concomitant hysterectomy/incontinence surgery, and estimated blood loss). These factors may affect POUR in older women and should be considered in perioperative management.

High perioperative lactate levels as a potential predictor for severe acute kidney injury following aortic arch surgery.

Acute type A aortic dissection (ATAAD) is a life-threatening condition that often requires total aortic arch replacement (TAR) combined with frozen elephant trunk (FET) implantation. Despite advancements in surgical techniques and preoperative management, postoperative acute kidney injury (AKI) remains a prevalent complication that significantly affects patient prognosis, particularly severe AKI. The aim of this study was to investigate the predictive value of perioperative lactate levels in severe postoperative AKI after TAR. A cohort analysis of 328 patients who underwent TAR with frozen elephant trunk implantation at Xijing Hospital, Xi'an, China, between September 2019 and September 2023 was conducted. Patients were categorized according to AKI severity into non-AKI, mild-AKI, and severe-AKI cohorts, and lactate levels were measured at nine perioperative time points. The primary endpoint was severe AKI (Kidney Disease: Improving Global Outcomes stage 3). Uni-and multivariate logistic regression analyses were performed to identify risk factors for severe AKI. Subgroup analysis substantiated the robustness of lactate levels in predicting severe AKI. In total, 45.4% of patients developed mild AKI postoperatively and 20.7% developed severe AKI. Patients with severe postoperative AKI exhibited higher preoperative lactate levels. Multivariate stepwise backward logistic regression analysis identified lactate levels at 12 h postoperatively ([Lacpo12h], cutoff value: 3.3 mmol/L; sensitivity: 63.2%; specificity: 72.3%) as an independent predictor of severe AKI. The subgroup analysis underscored the consistent predictive capacity of Lacpo12h. The 30-day mortality rate was markedly elevated in the severe-AKI cohort, with deceased patients exhibiting a significantly higher Lacpo12h. Among patients with acute type A aortic dissection undergoing TAR, high perioperative lactate levels were closely associated with postoperative AKI. Lacpo12h is a reliable and effective predictor of severe postoperative AKI, highlighting its clinical utility in risk stratification and management strategies.

Determinants of nosocomial infections and emerging antibiotic resistance in the Intensive Care Unit: A prospective evidence-based study

Objective: To determine the incidence, risk factors, antibiotic resistance patterns, and outcomes of various nosocomial infections in Intensive Care Unit (ICU) patients. Methods: The present prospective observational study was conducted in the multidisciplinary ICU of a tertiary care hospital for 6 months. Incidence, risk factors, and outcome parameters were calculated using Mann Whitney U test, Chi-square test, and stepwise univariate and multivariate logistic regression analysis. Results: The overall incidence of nosocomial infections was 23.5% (74/314). Ventilator-associated pneumonia was the most common infection (54.1%, 52/96), followed by catheter-related bloodstream infections (22.9%, 22/96). Stress ulcer prophylaxis (aOR 7.691, 95% CI 2.202-26.860, P=0.001), endotracheal intubation (aOR 3.251, 95% CI 1.251-8.420, P=0.015), Foley’s catheter (aOR 11.917, 95% CI 1.335-106.410, P=0.027), and ICU stay &gt; 7 days (aOR 30.915, 95% CI 10.062-94.980, P=0.001) were statistically significant risk factors associated with nosocomial infection in ICU patients. Gram­negative bacteria showed a high degree of resistance to most of antibiotics except colistin and tigecycline. Infected group's mortality was significantly greater than the uninfected group (21.62% vs. 5.83% P&lt;0.001) and had considerably longer ICU length of stay [21 (12) vs. 7 (4) days, P&lt;0.001)] and duration of mechanical ventilation [20 (11) days vs. 0 (5) days, P&lt;0.001]. Conclusions: This study highlights the high incidence rate of ventilator-associated pneumonia, with extensive drug resistance in ICU patients, highlighting the need for an optimized antimicrobial stewardship program to develop effective strategies for the management of nosocomial infections. Multifaceted interventions targeting modifiable risk factors are essential to reduce the occurences of these nosocomial infections in ICU patients.

Associations of food addiction symptomatology with bariatric surgical attrition: a cross-sectional analysis.

Despite the effectiveness of bariatric surgery, there remains a high rate of attrition from surgical programs, highlighting the need to understand factors that influence presurgical attrition rates. To investigate the association between food addiction (FA) symptomatology and attrition from bariatric surgery. Surgical weight-loss program at a single academic medical center. Data for this analysis were collected from August 2020 until August 2022. Measures included sociodemographic variables, mental health, eating assessments, and FA symptomatology. Data were analyzed using a combination of descriptive statistics, univariable logistic regressions, and a multivariable stepwise logistic regression model. A total of 505 adult patients were included (76.98% female, mean age 42.61 years, 263 [52.08%] undergoing surgery). FA scores were significantly and positively correlated with surgical attrition, current food insecurity, anxiety and depression symptoms, internalized weight bias, lower dietary quality, and distress and impairment due to FA. In the multivariable model, only current food insecurity, depressive symptoms, internalized weight bias, and impairment caused by FA were significant predictors of surgical attrition. Although the number of FA symptoms was not associated in the multivariable model, impairment attributable to FA remained a significant predictor of surgical attrition. This trend suggests that an evaluation of FA may reflect a complex network of factors. Further, FA may not be a predictor of surgical attrition in the absence of perceived clinically significant impairment. Additional research should explore the relationship between impairment attributable to FA and surgical attrition to test the generalizability of these findings.

Preprocedural Screening Tool to Guide Nonpulmonary Vein Trigger Testing in First-Time Atrial Fibrillation Ablation.

Patients undergoing first-time atrial fibrillation (AF) ablation can benefit from targeting non-pulmonary vein (PV) triggers. Preprocedural identification of high-risk individuals can guide planning of ablation strategy. This study aimed to create a preprocedural screening tool to identify patients at risk of non-PV triggers during first-time AF ablation. All patients who underwent first-time AF ablation at the Hospital of the University of Pennsylvania between 2018 and 2022 were identified. Those who underwent non-PV trigger provocative maneuvers or had spontaneous non-PV trigger firing were included. Non-PV triggers were defined as non-PV ectopic beats triggering AF or sustained focal atrial tachycardia that occurred spontaneously, after AF cardioversion, or after standard provocative maneuvers. The provocative maneuvers included incremental isoproterenol infusion (3, 6, 12, and 20-30 µg/min) and an atrial burst pacing protocol. Risk factors associated with non-PV triggers in a stepwise multivariable logistic regression model with backward elimination were used to create a risk score. A total of 163 (8.0%) of 2038 patients had non-PV triggers during first-time AF ablation. Based on the multivariable model, we created a risk score using female sex (1 point; odds ratio [OR], 1.90 [95% CI, 1.36-2.67]), sinus node dysfunction (1 point; OR, 1.84 [95% CI, 1.04-3.24]), prior cardiac surgery (1 point; OR, 2.26 [95% CI, 1.45-3.53]), moderate to severe left atrial enlargement (2 points; OR, 3.43 [95% CI, 2.46-4.79]), and cardiac sarcoidosis/amyloidosis (4 points; OR, 7.24 [95% CI, 3.03-17.33]). Internal validation using bootstrap resampling showed an optimism-adjusted C statistic of 0.715 (95% CI, 0.678-0.751). Among all first-time AF ablations, 68.1% of procedures were low-risk for non-PV triggers (scores 0-1, 4.3% risk), 17.8% were intermediate-risk (score 2, 10.5% risk), and 14.1% were high-risk (score ≥3, 22.6% risk). A preprocedural screening tool can classify patients based on their risk of non-PV triggers during first-time AF ablation. This risk score can guide operators to identify patients who would benefit most from adjunctive non-PV trigger testing. However, further validation is needed to confirm these findings.

Development and validation of a nomogram model for predicting immune-mediated hepatitis in cancer patients treated with immune checkpoint inhibitors

Immune checkpoint inhibitors (ICIs) have been widely used in various types of cancer, but they have also led to a significant number of adverse events, including ICI-induced immune-mediated hepatitis (IMH). This study aimed to explore the risk factors for IMH in patients treated with ICIs and to develop and validate a new nomogram model to predict the risk of IMH. Detailed information was collected between January 1, 2020, and December 31, 2023. Univariate logistic regression analysis was used to assess the impact of each clinical variable on the occurrence of IMH, followed by stepwise multivariate logistic regression analysis to determine independent risk factors for IMH. A nomogram model was constructed based on the results of the multivariate analysis. The performance of the nomogram model was evaluated via the area under the receiver operating characteristic curve (AUC), calibration curves, decision curve analysis (DCA), and clinical impact curve (CIC) analysis. A total of 216 (8.82%) patients developed IMH. According to stepwise multivariate logistic analysis, hepatic metastasis, the TNM stage, the WBC count, LYM, ALT, TBIL, ALB, GLB, and ADA were identified as risk factors for IMH. The AUC for the nomogram model was 0.817 in the training set and 0.737 in the validation set. The calibration curves, DCA results, and CIC results indicated that the nomogram model had good predictive accuracy and clinical utility. The nomogram model is intuitive and straightforward, making it highly suitable for rapid assessment of the risk of IMH in patients receiving ICI therapy in clinical practice. Implementing this model enables early adoption of preventive and therapeutic strategies, ultimately reducing the likelihood of immune-related adverse events (IRAEs), and especially IMH.

WHAT FACTORS ARE ASSOCIATED WITH SELF-PERCEPTION OF INTENSE FAMILY CAREGIVING?

Abstract The stress and anxiety associated with family caregiving can contribute to the caregiver’s own health and well-being and can also be linked to less effective caregiving. As part of the 2023 National Survey of Older Americans Act (OAA) Participants, the following item was asked among 1,187 clients of the National Family Caregiver Support Program (NFCSP): “On a scale of 1 to 5, where 5 is very intense, how intense is the care you provide?” Fifty-one percent responded that the care is intense or very intense. Of the remaining caregivers, 15% responded that the care was not intense and 34% felt neutral. We first tested 62 survey variables for bivariate significant differences between “intense care” vs. “not intense care” and then used stepwise multivariable logistic regression. Variables included caregiver demographics, caregiving situational factors, caregiver nutrition, caregiver well-being, care receiver (CR) demographics and health conditions, and the number of activities of daily living (ADL) difficulties experienced by the CR. From the final logistic regression model (c-statistic = 0.74), the factors associated with a significant increase (p &amp;lt; 0.01) in the likelihood of self-reported intense care were: 1) CR’s number of ADL difficulties, 2) caregiver food insecurity score, 3) CR has Alzheimer’s or other memory-related disease, 4) caregiver provides all or almost all the care, and 5) the caregiver has no time for self. These findings provide a deeper understanding of the type of caregivers that may need more support from the NFCSP and from the OAA’s case management and home-delivered meals programs.

Bleeding disorders, longer operative time, and nongeneral anesthesia increase are associated with overnight admission after hip arthroscopy

Abstract Overnight admission is a rare but major complication after hip arthroscopy (HA), and the paucity of data surrounding its causes limits patient education and quality of care. The purpose of this study was to identify risk factors for an unanticipated overnight admission after HA and assess for associated complications. This analysis queried the American College of Surgeons National Surgical Quality Improvement Program database using Current Procedural Terminology codes to identify hip arthroscopies from 2005 to 2017. Patient demographics, perioperative variables, and comorbidities were compared between ambulatory and nonambulatory patients [length of stay (LOS) ≥ 1] using bivariate analysis. Multivariate stepwise logistic regression then identified independent risk factors of adverse outcomes. Linear regression analyzed correlation of LOS with age, operative time, modified fragility index (mFI-5), and year of operation. A total of 2420 cases were included in this study with 400 (16.5%) overnight admissions. The mean subject age was 40 ± 13.9 years old (58.1% female). Admitted patients generally had higher American Society of Anesthesiologists (ASA) scores and a higher mFI-5 index. Multivariate logistic regression showed that mFI-5 &amp;gt; 0, bleeding disorders, operative time &amp;gt;1.5 h, and nongeneral anesthesia were independent risk factors for prolonged hospital stay. Patients aged 31–40 years had decreased risk of LOS ≥1. Nonambulatory surgery was associated with significantly increased risk for any complication, readmission, wound complication, and venous thromboembolism. This analysis demonstrates that operations &amp;gt;1.5 h and increased medical comorbidities predispose patients to greater risk of being admitted to the hospital after HA. Surgeons should consider these data to optimize controllable factors and patient selection to reduce the risk of postoperative admission.

Uptake and service preferences of human papillomavirus vaccination in men who have sex with men.

Human papillomavirus (HPV) vaccination could reduce HPV infection in men who have sex with men (MSM), but the published statistics on HPV vaccination uptake in MSM were scarce globally. This study estimated the uptake and profiled the service preferences of HPV vaccination of Chinese MSM in Hong Kong. Adult MSM were recruited through non-governmental organizations (NGOs) and online channels for completing an online baseline survey. Factors associated with self-reported history of HPV vaccination were identified using multivariable stepwise logistic regression model. Totally 701 Chinese MSM completed the online baseline survey, with the median age of 30 y (interquartile range [IQR] 26-35, range 18-67), and 23% of them had received HPV vaccination. More than half of vaccinated MSM (72%) rated convenient or very convenient for local HPV vaccination services. Among unvaccinated MSM, 50% considered high cost of HPV vaccine as the barrier of vaccination, 67% expressed willingness to pay below USD 128 per vaccine dose, and 65% preferred receiving vaccination in private clinics. MSM who had taken HIV pre-exposure prophylaxis (PrEP) (p < .001), had been tested for HPV (p = .018), and had (p = .005) multiple regular sex partners in the past 6 months were more likely to be vaccinated. The HPV vaccination uptake of Chinese MSM in Hong Kong remains low (23%), and high HPV vaccine cost is the main barrier. Preventive behaviors (HIV PrEP use and HPV testing) and high-risk sexual behavior (multiple regular sex partners) are potential targets for intervention to increase the uptake of HPV vaccination in MSM.

Single-Position Prone Lateral Interbody Fusion is Associated with Improved Radiographic and Clinical Outcomes at One Year compared to Single-Position Lateral Interbody Fusion: A Single Institution Experience.

Recent studies highlight the increasing adoption of single-position prone lateral(SP-PL) and single-position lateral decubitus(SP-LD) in Minimally Invasive Spine Surgery(MISS) to reduce operative time, enhance patient safety, and improve surgical accessibility. To assess the differences between SP-PL and SP-LD achievement of optimal postoperative outcomes and post-operative complication rates. Retrospective review of prospectively collected MIS database. Consecutive series of 152 Patients with baseline(BL) and 1-year(1Y) postoperative radiographic/HRQL data were included. Patients placed in the SP-PL or SP-LD were isolated. Optimal Outcome(OO) was defined as patients who experienced no complication requiring reoperation and achieved Substantial Clinical Benefit(SCB) for NRS-leg or NRS-back. Means comparison analysis assessed differences in radiographic and clinical outcomes. ANCOVA and multivariable backward stepwise logistic regression were used to adjust for confounders. 59 SP-PL and 93 SP-LD patients were included. At baseline, cohorts were comparable in terms of age, gender, BMI, and CCI. Peri-operatively, SP-PL patients had a significantly lower operative time(207.22 vs. 317.5 min;P<0.001), LOS(3.1 vs. 3.6 days;P=0.033), EBL(244.5 vs. 376.3mL;P=0.023), and demonstrated lower perioperative complication rate(25.4% vs. 41.9%;P=0.038). Multivariable analysis indicated that SP-PL patients had a lower likelihood of cardiac perioperative complications(OR 0.012;CI95%: 0.0-0.6;P=0.026). Immediate postoperatively, SP-PL has a greater degree of segmental lordosis improvement from L1-L2 to L5-S1(all;P<0.05). SP-PL patients have a higher likelihood of achieving SCB NRS-Back at 1Y(OR: 8.0;CI95%: 1.5-42.0;P=0.014) and MCID NRS-leg at 1Y(OR:4.6;CI95%:1.002-21.2;P=0.49). The SP-PL cohort had a significantly greater percentage of OO(96.6% vs. 78.5%;P=0.002) and a higher likelihood of achieving OO in adjusted analysis (OR:10.6;CI95%: 2.1-53.3;P=0.004). Patients placed in the SP-PL during minimally invasive spine surgery exhibit a reduced rate of perioperative complications, higher incidence of SCB, and a superior rate of achieving optimal outcome at the one-year follow-up. These findings underscore the SP-PL position as a potentially advantageous approach for minimally invasive lumbar fusion.