Stepwise Multivariate Regression Analysis Research Articles

Influence of Lens Thickness on Accuracy of Kane, Hill-RBF 3.0, Barrett Universal II, Emmetropia Verifying Optical, and Pearl-DGS Formulas in Eyes with Nonhigh Myopia and High Myopia

Purpose To investigate the influence of lens thickness (LT) on accuracy of Kane, Hill-RBF 3.0 Barrett Universal II (BUII), Emmetropia Verifying Optical (EVO), and Pearl-DGS formulas in eyes with different axial lengths (AL). Methods The prospective cohort study was conducted at Eye and ENT Hospital of Fudan University. Patients who had uneventful cataract surgery between March 2021 and July 2023 were recruited. Manifest refraction was conducted two-month post-surgery. Eyes were divided into 4 groups based on AL: short (<22mm), medium (22-24.5 mm), medium long (24.5-26mm) and very long (≥26mm). In each AL group, eyes were then divided into 3 subgroups based on the LT measured with IOLmaster700: thin (<4.5 mm), medium (4.5-5.0 mm), and thick (≥ 5 mm). The influence of LT on accuracy of Kane, Hill-RBF 3.0, BUII, EVO, and Pearl-DGS formulas were investigated in each AL group. Results A total of 327 eyes from 327 patients were analyzed, with 64, 102, 73 and 88 eyes in each AL group, respectively. In eyes with AL < 24.5 mm, myopic PE was significantly associated with greater LT using all the 5 formulas (all p < 0.05). Backward stepwise multivariate regression analyses revealed that LT was an important influencing factor for PE in all 5 formulas, particularly in eyes with AL <24.5 mm. In eyes with AL <24.5 mm and LT > 5.0 mm, PE of all 5 formulas calculated with the optional parameter LT were more myopic than those calculated without LT. Conclusions Thicker LT was associated with more myopic PE among eyes with AL <24.5 mm when using all 5 formulas. Further optimization of current formulas is necessary, especially for eyes with short AL and thick LT.

Burnout syndrome in Spanish, Portuguese and Latin American ophthalmologists: a cross-sectional analysis.

Despite the well-known consequences of burnout syndrome, there has been little research into this syndrome in the field of ophthalmology. Our objective is to determine the frequency of burnout syndrome between Spanish, Portugal and Latin-American ophthalmologists, as well as to analyse its relationship with different sociodemographic variables. This is an observational cross-sectional descriptive study including ophthalmologists from Spain, Portugal and 15 Latin American countries. Burnout syndrome was evaluated by the Maslach Burnout Inventory-Human Services Survey. Burnout syndrome was defined as high emotional exhaustion, high depersonalization or low personal accomplishment. In addition, we recorded sociodemographic variables and aspects related to the type of work. A conditional backwards stepwise multivariate binomial logistic regression analysis was run to assess the variables associated with burnout syndrome, expressed as an odds ratio (OR). A total of 527 surveys were analysed, the majority from Spain (401; 76.1%), followed by Argentina (45; 8.5%), and Mexico (31; 5.9%). The number of ophthalmologists with burnout syndrome was 351 (66.6%). The results show the profile of a young ophthalmologist (age OR 0.985), carrying out a public activity (OR 2.118) and dedicated to general ophthalmology (OR 1.860). The frequency detected in this study confirms a steady increase in rates of burnout among ophthalmologists. As the consequences of this are well known, it is vital for health centre managers to develop a strategic plan to allow the causes to be understood better and to implement steps to improve the situation in each medical centre.

Hydronephrosis severity as a predictor of postoperative renal function decline following laparoscopic radical nephroureterectomy.

This study aimed to investigate factors, including the degree of hydronephrosis, that may be associated with decreased renal function after radical nephroureterectomy (RNU). This study included 252 patients who underwent laparoscopic RNU with an estimated glomerular filtration rate (eGFR) ≥ 30ml/min/1.73 m2 in three institutions. We assessed the association between hydronephrosis grade and perioperative renal function and performed a stepwise multivariate linear regression analysis to identify factors associated with postoperative eGFR. Patients with preoperative eGFR ≥ 50ml/min/1.73 m2 were divided into a training set and an independent external validation set to develop a predictive model for postoperative renal function. The median preoperative and postoperative eGFR were 61.1 and 46.4ml/min/1.73 m2, respectively. The eGFR preservation rates were 66.9%, 66.6%, 88.1%, and 100.0% in groups without, with mild, moderate, and severe hydronephrosis, respectively, and this difference was statistically significant (p < 0.001). Multivariate analysis revealed that factors predictive of postoperative eGFR included sex, preoperative eGFR, clinical T stage (cT3-4), and the presence of moderate or severe hydronephrosis. Our predictive model, based on these factors, positively correlated with actual postoperative renal function, and the similarity in categories with or without renal function insufficiency between predicted and actual postoperative renal functions was 78% in both training and validation sets. Moderate or severe hydronephrosis is associated with a modest postoperative decline in renal function, while mild hydronephrosis is not. Our predictive model may be useful in predicting postoperative renal function insufficiency and guiding decision-making for perioperative medical treatment.

Association of SGLT2 inhibitor dapagliflozin with risks of acute kidney injury and all-cause mortality in acute myocardial infarction patients

ObjectiveSodium-glucose cotransporter 2 (SGLT2) inhibitors have well-documented effects in reducing hospitalization or cardiovascular mortality, while the association of SGLT2 inhibitor dapagliflozin (DAPA) and the risk of acute kidney injury (AKI) in acute myocardial infarction (AMI) patients has not been comprehensively investigated. Therefore, we aimed to assess the association between DAPA and AKI risk in AMI patients after percutaneous coronary intervention (PCI) therapy.MethodsUsing the Changzhou Acute Myocardial Infarction Registry database, we retrospectively included AMI patients from January 2017 to August 2021 and analyzed the risk of AKI and all-cause mortality after PCI therapy. The patients were divided into two groups according to the use of DAPA (DAPA group and Ctrl group). Patients in the DAPA group started to use DAPA after admission and continued its use during hospitalization and follow-up period. Baseline characteristics were balanced between the two groups with a propensity score matching (PSM) analysis. The outcome was AKI within 7 days after PCI and all-cause mortality during a follow-up of 2 years. Univariate and multivariate logistic regression analyses were used to assess the association between DAPA and AKI risk.ResultsA total of 1839 AMI patients undergoing PCI were enrolled. DAPA was used in 278 (15.1%) patients. Postoperative AKI occurred in 351 (19.1%) cases. A 1:1 PSM analysis was used to reduce confounding factors. The multivariate stepwise regression analysis showed that DAPA (odds ratio, OR 0.66; 95% confidence interval, CI 0.44–0.97; P = 0.036) was an independent protective factor in the entire cohort. After matching, the use of DAPA in AMI patients was independently associated with a decline of AKI risk (OR 0.32; 95% CI, 0.19–0.53; P < 0.001) after hospital admission. Meanwhile, there were significant differences in mortality between the DAPA group and Ctrl group (2.5% vs. 7.6%, P = 0.012).ConclusionSGLT2 inhibitor DAPA was associated with lower risks of incident AKI and all-cause mortality in AMI patients after PCI therapy.

Serum Elabela expression is decreased in hypertensive patients and could be associated with the progression of hypertensive renal damage

BackgroundElabela, a recently discovered hormonal peptide containing 32 amino acids, is a ligand for the apelin receptor. It can lower blood pressure and attenuate renal fibrosis. However, the clinicopathological relationship between Elabela level and renal damage caused by benign hypertension (BHT) and malignant hypertension (MHT) has not been elucidated. Therefore, we investigated the clinicopathological correlation between serum Elabela level and renal damage caused by BHT and MHT.MethodsThe participants comprised 50 patients and 25 age-matched healthy adults. The 50 patients were separated into two groups: MHT (n = 25) and BHT groups (n = 25). We analyzed their medical histories, demographics, and clinical examinations, including physical and laboratory tests. ResultsThe results showed that serum Elabela level decreased gradually with a continuous increase in blood pressure from the healthy control group, BHT, to MHT. Moreover, Elabela levels negatively correlated with BMI (R = − 0.27, P = 0.02), SBP (r = − 0.64, P < 0.01), DBP (r = − 0.58, P < 0.01), uric acid (r = − 0.39, P < 0.01), bun (r = − 0.53, P < 0.01), and Scr (r = − 0.53 P < 0.01) but positively correlated with eGFR (r = 0.54, P < 0.01). Stepwise multivariate linear regression analysis showed that SBP was the variable most related to Elabela (t = − 5.592, P < 0.01).ConclusionsSerum Elabela levels decreased in patients with hypertension, especially malignant hypertension, and has the potential to be a marker of hypertension-related kidney damage.

Development and validation a nomogram for predicting new-onset postoperative atrial fibrillation following pulmonary resection

BackgroundThe new-onset postoperative atrial fibrillation (NOPAF) following pulmonary resection is a common clinical concern. The aim of this study was to construct a nomogram to intuitively predict the risk of NOPAF and offered protective treatments.MethodsPatients who underwent pulmonary resection between January 2018 and December 2020 were consecutively enrolled. Forward stepwise multivariable logistic regression analyses were used to screen independent predictors, and a derived nomogram model was built. The model performance was evaluated in terms of calibration, discrimination and clinical utility and validated with bootstrap resampling.ResultsA total of 3583 patients who met the research criteria were recruited for this study. The incidence of NOPAF was 1.507% (54/3583). A nomogram, composed of five independent predictors, namely age, admission heart rate, extent of resection, laterality, percent maximum ventilation volume per minute (%MVV), was constructed. The concordance index (C-index) was 0.811. The nomogram showed substantial discriminative ability, with an area under the receiver operating characteristic curve of 0.811 (95% CI 0.758-0.864). Moreover, the model shows prominent calibration performance and higher net clinical benefits.ConclusionWe developed a novel nomogram that can predict the risk of NOPAF following pulmonary resection, which may assist clinicians predict the individual probability of NOPAF and perform available prophylaxis. By using bootstrap resampling for validation, the optimal discrimination and calibration were demonstrated, indicating that the nomogram may have clinical practicality.

Associations between insomnia symptoms and inflammatory cytokines in adolescents with first-episode and recurrent major depressive disorder

BackgroundInsomnia symptoms are often associated with increased levels of inflammatory biomarkers. However, such associations have not been adequately explored in adolescents with major depressive disorder (MDD). This study aimed to examine the associations between insomnia symptoms with inflammatory cytokines in adolescents with first-episode and recurrent MDD. MethodsFrom January to December 2021, this study included 164 adolescents with MDD and 76 healthy controls (HCs). The Center for Epidemiological Studies Depression Scale (CES—D) and the Insomnia Severity Index Scale (ISI) were used to assess depressive and insomnia symptoms, respectively. Also, plasma levels of interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-17 A and tumor necrosis factor-α (TNF-α) were measured. ResultsThe prevalence of mild, moderate and severe insomnia in adolescents with MDD was 40.24 %, 36.59 % and 6.71 %, respectively. The patients had higher levels of IL-1β, IL-6 and TNF-α than HCs (all p < 0.05). ISI score was positively correlated with CES-D score and levels of IL-1β, IL-6 and TNF-α in first-episode patients but not in recurrent patients. A further multivariate stepwise linear regression analysis showed that ISI score was independently associated with CES-D score (beta = 0.523, t = 5.833, p < 0.001) and TNF-α levels (beta = 0.254, t = 2.832, p = 0.006). LimitationsThe cross-sectional design leads to failure to make causal inferences. ConclusionInsomnia symptoms are common in adolescents with MDD and associated with elevated levels of inflammatory cytokines in first-episode patients. The findings suggest that inflammatory cytokines may relate to the pathogenesis of insomnia symptoms in adolescents with MDD, but further longitudinal studies are needed to explore the causal association between insomnia symptoms and inflammatory cytokines in MDD.

Clinical significance, molecular characterization, and immune microenvironment analysis of coagulation-related genes in clear cell renal cell carcinoma.

Numerous studies have revealed a tight connection between tumor development and the coagulation system. However, the effects of coagulation on the prognosis and tumor microenvironment (TME) of clear cell renal cell carcinoma (ccRCC) remain poorly understood. We employed the consensus clustering method to characterize distinct molecular subtypes associated with coagulation patterns. Subsequently, we examined variations in the overall survival (OS), genomic profiles, and TME characteristics between these subtypes. To develop a prognostic coagulation-related risk score (CRRS) model, we utilized the least absolute shrinkage and selection operator Cox regression and stepwise multivariate Cox regression analyses. We also created a nomogram to aid in the clinical application of the risk score, evaluating the relationships between the CRRS and the immune microenvironment, responsiveness to immunotherapy, and targeted treatment. The clinical significance of PLAUR and its biological function in ccRCC were also further analyzed. There were significant differences in clinical features, prognostic stratification, genomic variation, and TME characteristics between the two coagulation-related subtypes. We established and validated a CRRS using six coagulation-related genes that can be employed as an effective indicator of risk stratification and prognosis estimation for ccRCC patients. Significant variations in survival outcomes were observed between the high- and low-risk groups. The nomogram was proficient in predicting the 1-, 3-, and 5-year OS. Additionally, the CRRS emerged as a novel tool for evaluating the clinical effectiveness of immunotherapy and targeted treatments in ccRCC. Moreover, we confirmed upregulated PLAUR expression in ccRCC samples that was significantly correlated with poor patient prognosis. PLAUR knockdown notably inhibited ccRCC cell proliferation and migration. Our data suggested that CRRS may be employed as a reliable predictive biomarker that can provide therapeutic benefits for immunotherapy and targeted therapy in ccRCC.

Construction and evaluation of neonatal respiratory failure risk prediction model for neonatal respiratory distress syndrome

BackgroundNeonatal respiratory distress syndrome (NRDS) is a common respiratory disease in preterm infants, often accompanied by respiratory failure. The aim of this study was to establish and validate a nomogram model for predicting the probability of respiratory failure in NRDS patients.MethodsPatients diagnosed with NRDS were extracted from the MIMIC-iv database. The patients were randomly assigned to a training and a validation cohort. Univariate and stepwise Cox regression analyses were used to determine the prognostic factors of NRDS. A nomogram containing these factors was established to predict the incidence of respiratory failure in NRDS patients. The area under the receiver operating characteristic curve (AUC), receiver operating characteristic curve (ROC), calibration curves and decision curve analysis were used to determine the effectiveness of this model.ResultsThe study included 2,705 patients with NRDS. Univariate and multivariate stepwise Cox regression analysis showed that the independent risk factors for respiratory failure in NRDS patients were gestational age, pH, partial pressure of oxygen (PO2), partial pressure of carbon dioxide (PCO2), hemoglobin, blood culture, infection, neonatal intracranial hemorrhage, Pulmonary surfactant (PS), parenteral nutrition and respiratory support. Then, the nomogram was constructed and verified.ConclusionsThis study identified the independent risk factors of respiratory failure in NRDS patients and used them to construct and evaluate respiratory failure risk prediction model for NRDS. The present findings provide clinicians with the judgment of patients with respiratory failure in NRDS and help clinicians to identify and intervene in the early stage.

Impact of the COVID-19 Pandemic on Children with Autism and Their Caregivers: Findings from an Online Survey

Abstract Background: The coronavirus pandemic has had an unparalleled impact on the social, economic, physical, and subjective well-being of individuals in general, and children with special needs and their families in particular. Objectives: The objective is to examine the emotional and behavioral impact of the COVID-19 pandemic on children with autism and their families. Methodology: The study utilized an online Google Form and elicited information on sociodemographic background, types of therapies utilized before the pandemic, services available during the pandemic, utilization of services, satisfaction, challenges faced in management, perceived stress, and behavioral and emotional functioning of children during the ongoing COVID-19 pandemic. Parenting stress was measured using the Perceived Stress Scale (PPS) and the Strengths and Difficulties Questionnaire (SDQ) measured the emotional and behavioral functioning of autism spectrum disorders children. Results: A total of 62 caregivers responded to the survey. The COVID-19 restrictions were found to have significantly limited access to face-to-face educational and therapeutic services for the majority of the patients and only 17.7% reported receiving health-care services. Among the families that utilized the online intervention services, only 36.4% were satisfied and the satisfaction among families utilizing virtual educational services (43.5%) was even lower (14.5%). The stepwise multivariate regression analysis indicated that 16.1% of the variance in the total SDQ score of the child was accounted for by the PPS score (F = 11.47, P = 0.001). Conclusions: The worsening of challenging behaviors during COVID-19 underscores the need to intervene early and to expand the outreach of empirically supported telehealth interventions, especially among the underserved communities.

Online gaming motives, family relationships, and personality among Indian youth

Background: Youth involvement in gaming has become an important concern for mental health professionals due to its significant impact on functionality and relationships. However, the gaming motives and associated family relationships and personality traits in the Indian context are poorly understood. Aim: The study examined problematic online gaming, including Internet gaming disorder in connection to gaming motives and personality, especially as they impact family relationships among Indian youth. Materials and Methods: The study consisted of 179 participants (86 males; 93 females) with the age range of 18–25 years who were involved in Internet gaming in the last 1 year. The subjects were recruited using an online survey. Tools used were brief and included the Gaming Usage Questionnaire, Internet Gaming Disorder Scale-Short-Form, Motivation for Online Gaming Questionnaire UCLA Loneliness Scale, Sheehan Disability Scale, Brief Family Relationships Questionnaire, and MINI International Personality Item Pool. Results: The mean age of the participants was 21.99 ± 2.202 years. A stepwise multivariate regression analysis indicated that escape and competition motives, low cohesion in family relationships, low level of conscientiousness, and low level of intellect/imagination contributed to problematic gaming behaviors. Conclusions: The study established a relationship between gaming motives and both internal and external factors associated with problematic online gaming. Generalizing the findings across a larger youth population would help in developing informed preventive measures to reduce the risk of developing a gaming disorder.

Blood glucose and lactate levels as early predictive markers in patients presenting with cardiogenic shock: A retrospective cohort study.

Lactate and glucose are widely used biochemical parameters in current predictive risk scores for cardiogenic shock. Data regarding the relationship between lactate and glucose levels in cardiogenic shock are limited. Thus, we aimed to analyze glucose and lactate as early markers for in-hospital mortality in cardiogenic shock. In this retrospective cohort study, 312 patients presenting with cardiogenic shock to a tertiary-care hospital between 2016 and 2018 were included. Apparent cardiogenic shock was defined as hypoperfusion with hemodynamic compromise and biochemical marker increase due to diminished tissue perfusion, corresponding to SCAI shock stages. In-hospital mortality was assessed as the primary endpoint. The median age of the study population was 71 (60-79) years and the etiology of cardiogenic shock was acute myocardial infarction in 45.8%. Overall in-hospital mortality was 67.6%. In the receiver operating curve analysis, the area under the receiver-operating curve (AUC) for prediction of in-hospital mortality was higher for lactate (AUC: 0.757) than for glucose (AUC: 0.652). Both values were significantly associated with outcome (groups created with best cutoff values obtained from the Youden index). Correlation analysis showed a significant non-linear association of both values. In a multivariable stepwise Cox regression analysis, lactate remained an independent predictor for in-hospital mortality, whilst glucose, despite being implicated in energy metabolism, was not independently predictive for mortality. Together, these data suggest that lactate at admission is superior for mortality prediction in patients with apparent cardiogenic shock. Glucose was not independently predictive for mortality.

Blood Eosinophil Count and Its Determinants in a Chinese Population-Based Cohort

Introduction: Blood eosinophil count has been shown markedly variable across different populations. However, its distribution in Chinese general population remains unclear. We aimed to investigate blood eosinophil count and its determinants in a Chinese general population. Methods: In this population-based study, general citizens of Sichuan province in China were extracted from the China Pulmonary Health study. Data on demographics, personal and family history, living condition, lifestyle, spirometry, and complete blood count test were obtained and analyzed. A stepwise multivariate binary logistic regression analysis was performed to identify determinants of high blood eosinophils (>75th percentile). Results: A total of 3,310 participants were included, with a mean age (standard deviation) of 47.0 (15.6) years. In total population, the median blood eosinophil count was 110.0 (interquartile range [IQR]: 67.2–192.9) cells/μL, lower than that in smokers (133.4 cells/μL, IQR: 79.3–228.4) and patients with asthma (140.7 cells/μL, IQR: 79.6–218.2) or post-bronchodilator airflow limitation (141.5 cells/μL, IQR: 82.6–230.1), with a right-skewed distribution. Multivariate analyses revealed that oldness (aged ≥60 years) (odds ratio [OR]: 1.66, 95% confidence interval [CI]: 1.11–2.48), smoking ≥20 pack-years (OR: 1.90, 95% CI: 1.20–3.00), raising a dog/cat (OR: 1.72, 95% CI: 1.17–2.52), and occupational exposure to dust, allergen, and harmful gas (OR: 1.58, 95% CI: 1.15–2.15) were significantly associated with high blood eosinophils. Conclusion: This study identifies a median blood eosinophil count of 110.0 cells/μL and determinants of high blood eosinophils in a Chinese general population, including oldness (aged ≥60 years), smoking ≥20 pack-years, raising a dog/cat, and occupational exposure to dust, allergen, and harmful gas.

Long-Term Prognostic Value of Infarct Transmurality Determined by Contrast-Enhanced Cardiac Magnetic Resonance after ST-Segment Elevation Myocardial Infarction.

The long-term prognostic significance of maximal infarct transmurality evaluated by contrast-enhanced cardiac magnetic resonance (CE-CMR) in ST-segment elevation myocardial infarction (STEMI) patients has yet to be determined. This study aimed to see if maximal infarct transmurality has any additional long-term prognostic value over other CE-CMR predictors in STEMI patients, such as microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH). The study included 112 consecutive patients who underwent CE-CMR after STEMI to assess established parameters of myocardial injury as well as the maximal infarct transmurality. The primary clinical endpoint was the occurrence of major adverse cardiac events (MACE), which included all-cause death, non-fatal reinfarction, and new heart failure hospitalization. The MACE occurred in 10 patients over a median follow-up of 7.9 years (IQR, 5.8 to 9.2 years) (2 deaths, 3 nonfatal MI, and 5 heart failure hospitalization). Patients with MACE had significantly higher rates of transmural extent of infarction, infarct size >5.4 percent, MVO, and IMH compared to patients without MACE. In stepwise multivariable Cox regression analysis, the transmural extent of infarction defined as 75 percent or more of infarct transmurality was an independent predictor of the MACE after correction for MVO and IMH (hazard ratio 8.7, 95% confidence intervals [CIs] 1.1-71; p=0.043). In revascularized STEMI patients, post-infarction CE-CMR-based maximal infarct transmurality is an independent long-term prognosticator. Adding maximal infarct transmurality to CE-CMR parameters like MVO and IMH could thus identify patients at high risk of long-term adverse outcomes in STEMI.

Risk factors for venous ulceration in patients with varicose veins of lower extremities.

The aim of this case-control study was to explore the potential risk factors for venous ulceration in patients with varicose veins of lower extremities and to establish a simplified diagnostic score model. Seventy subjects with varicose veins of lower extremities and venous ulceration were compared with 1164 controls with varicose veins of lower extremities and no history of venous ulceration. Stepwise multivariate logistic regression analysis was used to identify the risk factors for venous ulceration. The steps in developing the diagnostic score model were based on the Framingham Heart study. The area under the receiver operating characteristic curve (AUC) was calculated to assess the diagnostic ability of the diagnostic score model. Multivariate analysis showed that men, overweight, obesity, longer duration varicose veins, deep venous valve insufficiency, low lymphocyte counts, and high fibrinogen content were independently associated with an increased risk of venous ulceration. The AUC for the diagnostic score model was 0.75, which indicated good discriminatory ability. Special attention should be paid to the high-risk group of patients with lower extremity varicose veins. The diagnostic score model might be a useful screening tool for clinicians, policy makers, and patients.

A decision-making model for prediction of a stable disease course in chronic hepatitis B patients

Patients with chronic hepatitis B (CHB) are regularly monitored for HBV DNA and liver enzymes in order to assess disease progression and the need for antiviral therapy. Identifying patients with a stable course of disease can potentially prolong the intervals between visits, withhold unnecessary tests and save money. Accordingly, we aimed to find predictors for a stable disease course in patients with CHB. 579 patients with CHB, who were followed in a tertiary referral center between January 2004–December 2018, were retrospectively analyzed. Patients with low and steady viral load titer (< 2000 IU/ml) and normal ALT levels (< 40 IU/ml) in 6 consecutive clinic encounters were considered to have a stable course of CHB. A stepwise multivariate logistic regression analysis and a decision tree model were used to identify predictors of a stable disease course. Following exclusion of ineligible patients, a total of 220 patients were included in the final analysis. 64/220 patients had a stable disease course. Patients with a stable disease were older (62.99 ± 12.36 Vs. 54.07 ± 13.64, p < 0.001) with a higher percentage of women (53% vs. 38%) and had lower baseline levels of AST, ALT and viral load (VL). In a multivariate analysis, age (OR 0.94, 95% CI 0.91–0.98), baseline ALT (OR 1.06, 95% CI 1.01–1.1) and VL (OR 1.05 95% CI 1.02–1.08), were significantly associated with a stable disease. In a decision tree model, patients 46–67 years old, with baseline VL < 149 IU/mL and ALT < 40 IU/mL had the best probability (91%) for a stable disease course over 4.4 ± 2.2 years. We conclude that integrating patients’ age with baseline VL and ALT can predict a stable disease course in patients with CHB off treatment.

Serum Angiopoietin-like Protein 3 Levels Are Associated with Endothelial Function in Patients with Maintenance Hemodialysis.

Angiopoietin-like protein 3 (ANGPTL3) plays an important role in lipid and lipoprotein trafficking and metabolism and is positively correlated with cardiovascular disease. Our objective was to evaluate the association between serum ANGPTL3 levels and endothelial function in patients on maintenance hemodialysis (MHD). We enrolled 116 patients on MHD and obtained their blood test results from their medical records. Using a noninvasive digital thermal monitor, we determined the vascular reactivity index (VRI) as a measure of endothelial function. Serum ANGPTL3 concentration was measured by a commercial-enzyme-linked immunosorbent assay. Vascular reactivity was classified as poor in 17 (14.7%) patients, intermediate (1.0 ≤ VRI < 2.0) in 50 (43.1%) patients, and high (VRI ≥ 2.0) in 49 (42.2%) patients. Serum levels of ANGPTL3 (p < 0.001) and alkaline phosphatase (ALP, p = 0.025) increased significantly as the VRI decreased. The log-transformed serum ALP (log-ALP, r = -0.187, p = 0.045) and log-ANGPTL3 (r = -0.319, p < 0.001) showed a negative correlation with the VRI on univariate linear regression analysis. A significant negative correlation was found between log-ANGPTL3 and VRI (p < 0.001) on multivariate stepwise linear regression analysis. The findings of our investigation showed that, in patients with MHD, the ANGPTL3 concentration had a negative correlation with the VRI.

MYOGENIC CONTRIBUTORS TO PHYSICAL FUNCTION IN OLDER ADULTS WITH SYMPTOMATIC KNEE OSTEOARTHRITIS

Abstract Knee osteoarthritis (OA) is a leading cause of mobility disability among middle-aged and older adults, and contributes to significant global disease burden. The impact of knee OA on physical function varies widely across individuals, and the factors contributing to this heterogeneity are poorly understood. Recent compelling research suggests that myogenic factors, including muscle quality (MQ), may underly symptoms in knee OA. While MQ is gaining attention in aging research, the role of MQ on functional outcomes in persons with knee OA remains unknown. This pilot study examined morphological and neuromuscular biomarkers of MQ among adults aged 50 years and older (N=44) who met clinical criteria for symptomatic knee OA. Physical performance was assessed using the Short Physical Performance Battery (SPPB). MQ was quantified using B-mode ultrasound (echo intensity) and isokinetic strength measures (force/body mass). Associations between MQ and physical performance were determined, with consideration for clinical pain, age, sex, and body mass index. Pearson correlation analysis indicated SPPB scores were associated with clinical pain, strength, and MQ (r values ranged -.42 – 0.60, p’s&amp;lt; 0.05). Multivariable backward stepwise linear regression analysis demonstrated that MQ biomarkers contributed 39% to variance for SPPB score independent of clinical pain and strength, after adjustment for age, sex, and BMI (b’s = -0.32 – 0.45; p’s &amp;lt; 0.05). MQ is an important consideration for physical function in older adults with chronic knee OA pain, regardless of pain severity, and represents a potentially potent treatment target for disability prevention.

A Decision Tree Model-based Study on the Grouping of Hospitalization Expenses of Type 2 Diabetes Patients in a Traditional Chinese Medicine Hospital

Objective To discover the case-mix approach for TCM treatment of dominant disease type 2 diabetes patients and to analyze the hospitalization expense standards for different combinations of patients to provide theoretical references for better participation of TCM hospitals in the DRG payment method as well as reasonable regulation of hospitalization expenses for TCM type 2 diabetes patients in the future. Methods Case data were collected from 1,171 patients discharged with a principal diagnosis of type 2 diabetes from September 2021 to April 2023 from a tertiary care Chinese medicine hospital in Tianjin. Univariate and multivariate stepwise regression analyses determined categorical node variables. The decision tree model was used to perform case combinations and to analyze the expense standards and weights of different groups of disease types. Results The number of days of hospitalization, conditions in admission, and whether complicated cardiovascular and cerebrovascular diseases are the main factors affecting the hospitalization expense of type 2 diabetes patients in Chinese medicine hospitals, and the decision tree model was used to group the patients to form nine groups of patient case combinations. The standard of hospitalization expense for each combination was set reasonably. Conclusion The grouping results are more satisfactory, and the grouping scheme and hospitalization expense standards can provide a scientific basis for DRG grouping, adopting differentiated expense management, and improving the medical resource efficiency in TCM hospitals.

Estimation of Average and Maximum Daily-Life Mobility Performance Using the Timed Up-and-Go: Exploring the Added Value of an Instrumented Timed Up-and-Go

Introduction: The association between specific motor capacity variables obtained in a laboratory and parameters of daily-life mobility performance (MP) obtained via wearables is still unclear. The Timed Up-and-Go (TUG) test is a widely used motor capacity tests available either as traditional hand-stopped TUG or as instrumented TUG (iTUG), providing specific information about its subphases. This study aimed to: (1) estimate the association between the TUG and specific parameters reflecting average and maximum daily-life MP, (2) estimate the benefits of the iTUG in terms of explaining MP in daily life compared to the TUG. Methods: The present study was a cross-sectional analysis using baseline data of 294 older persons (mean age: 76.7 ± 5.3 years). Univariate linear regression analysis was performed to delineate the coefficient of determination between TUG time and participants’ MP. MP variables containing mean cadence (MCA) to represent average performance and the 95th percentile of mean cadence of walks with more than three steps (p95>3stepsMCA) to represent maximum performance. To determine whether the iTUG variables give more information about MP, a stepwise multivariate regression analysis between iTUG variables and the p95>3stepsMCA variable to represent maximum performance was conducted. Results: The univariate regression models revealed associations of the TUG with MCA (adjusted R2 = 0.078, p < 0.001) and p95>3stepsMCA (adjusted R2 = 0.199, p < 0.001). The multivariate stepwise regression models revealed a total explanation of maximum daily-life MP (p95>3stepsMCA) of the TUG (adjusted R2 = 0.199, p < 0.001) versus iTUG (adjusted R2 = 0.278, p < 0.010). Discussion/Conclusion: This study shows that the TUG better reflects maximum daily-life MP than average daily-life MP. Moreover, we demonstrate the added value of the iTUG for a more accurate estimation of daily MP compared to the traditional TUG. The iTUG is recommended to estimate maximum daily-life MP in fall-prone older adults. The study is a step toward a specific assessment paradigm using capacity variables from the iTUG to estimate maximum daily-life MP.