Odds Ratio For Occurrence Research Articles

Association between triglyceride‑glucose index and carotid atherosclerosis in patients with psoriatic arthritis.

To investigate the association of triglyceride-glucose (TyG) index with atherosclerotic risk among patients with psoriatic arthritis (PsA). This cross-sectional study included 165 consecutive PsA patients receiving carotid ultrasonography with integrated TyG index, calculated as ln [fasting triglycerides (mg/dl)×fasting glucose (mg/dl)/2]. Logistic regression models were applied to analyze the association of TyG index as continuous variables and tertiles with carotid atherosclerosis and carotid artery plaque. Fully adjusted model included sex, age, smoking, body mass index, comorbidities, and psoriatic related variables. Overall, PsA patients with carotid atherosclerosis had substantially higher TyG index than those without (8.82 ± 0.50 vs 8.54 ± 0.55, p= 0.002). The frequency of carotid atherosclerosis was increased with increases in TyG index tertiles, showing 14.8%, 34.5%, 44.6% for tertile 1, 2 and 3, respectively (p= 0.003). Multivariate logistic analyses showed that each 1-unit increase in TyG index was significantly associated with prevalent carotid atherosclerosis (unadjusted OR 2.65 [1.39-5.05]; fully-adjusted OR 2.69 [1.02-7.11]). Compared with patients with tertile 1 of TyG index, the unadjusted and fully-adjusted OR for occurrence of carotid atherosclerosis were 4.64 (1.85-11.60) and 5.10 (1.54-16.93) in patients with tertile 3. Similarly, higher prevalent carotid artery plaque was observed with increasing TyG index (unadjusted OR 3.11 [1.54-6.26]; fully-adjusted OR 3.61 [1.15-11.38]) or with tertile 3 vs. tertile 1 (unadjusted OR 10.20 [2.83-36.82]; fully-adjusted OR 17.89 [2.88-111.11]). Additionally, TyG index provided incremental predictive capacity beyond established risk factors, shown by an increase in discrimination ability (all P < 0.001). TyG index was positively correlated with the burden of atherosclerosis in PsA patients, independent of traditional cardiovascular risk factors and psoriatic-related factors. These findings suggest that TyG index may be a promising atherosclerotic marker for PsA population.

155 A META-ANALYSIS OF EFFICACY AND SAFETY OF ANTI-BODIES TARGETING PD-1 IN TREATMENT OF ADVANCED ESOPHAGEAL CANCER

Abstract Systemic chemotherapy is the first choice for patients with advanced esophageal cancer. However, due to drug resistance and dose-limiting toxicity, a large number of patients in China have not been treated. A novel therapy based on programed death 1 (PD-1) inhibitors has been proved to be effective in advanced esophageal cancer.This article is a meta-analysis aiming to systematically evaluate the efficacy and safety of anti-PD-1 therapy in patients with esophageal cancer. Methods Data were collected from eligible studies searched from PubMed, Web of Science, Cochrane Library and Embase. Pooled hazard ratio (HR) for overall survival (OS) and progression-free survival (PFS) was estimated to assess the efficacy of PD-1 inhibitors versus chemotherapy, and pooled odds ratio (OR) was calculated for objective response rate (ORR). The analysis among patients tested with different PD-1 status was also performed to figure out the relationship between PD-1 status and efficacy of anti-PD-1 therapy. The OR for occurrence of treatment-related adverse effect was calculated to assess the safety of anti-PD-1 therapy. Results A total of 8 studies were analyzed. Compared with patients with chemotherapy, patients with anti-PD-1 therapy had a significant improvement in OS (HR = 0.80, 95% CI: 0.70–0.91, P = 0.001), but no significant relationship was observed in ORR (HR = 1.87, 95% CI: 0.82–4.25, P = 0.13) and PFS (HR = 0.94, 95% CI: 0.70–1.26, P = 0.67). A similar result was observed in esophageal squamous cell carcinoma (ESCC). The PD-L1 status has no obvious connection with the efficacy of anti-PD-1 therapy. The incidence of grade 3 to 5 treatment-related adverse effect(AE) in anti-PD-1therapy was distinctly lower than that in chemotherapy, but there is no statistical difference in all treatment-related AE. Conclusion Anti-PD-1 therapy significantly prolonged the OS when compared with chemotherapy, while no significantly difference in PFS and ORR for the population of esophageal cancer, ESCC， PD-L1 positive. Based on the analysis of grade 3 to 5 treatment-related adverse effect events, a lower risk was associated with the anti-PD-1 therapy versus chemotherapy.

A meta-analysis of efficacy and safety of antibodies targeting PD-1/PD-L1 in treatment of advanced nonsmall cell lung cancer.

Background:Nonsmall cell lung cancer (NSCLC)-patients treated with standard chemotherapy experienced progression rapidly. A novel therapy based on programed death 1 (PD-1)/programed death ligand 1 (PD-L1) inhibitors showed an increasing potential in several malignancies including advanced NSCLC.Objectives:This article is a meta-analysis aiming to systematically evaluate the efficacy and safety profiles of PD-1/PD-L1 agents in patients with NSCLC.Data sources:Data were collected from eligible studies searched from PubMed, ScienceDirect, and Web of Science.Synthesis methods:Pooled hazard ratio (HR) for overall survival (OS) and progression-free survival (PFS) was estimated to assess the efficacy of PD-1/PD-L1 inhibitors versus docetaxel, pooled odds ratio (OR) was calculated for objective response rate (ORR). The overall frequency was estimated for 1-year OS, 1-year progression-free survival, and ORR. A subgroup analysis among NSCLC patients tested with different epidermal growth factor receptor (EGFR) status was also performed to figure out the relationship between EGFR status and efficacy of PD-1/PD-L1 therapies. OR for occurrence of any grade and grade 3 to 5 treatment-related adverse effect was calculated for evaluating the safety of PD-1/PD-L1 therapies.Results:Nine studies were included in this analysis. The pooled HRs for OS and PFS were 0.68 (95% confidence interval [CI] 0.61–0.75) and 0.83 (95% CI 0.75–0.91), respectively, the pooled OR for ORR was 1.83 (95% CI 1.41–2.36), indicating a significant improvement in OS, PFS, and ORR. In the results of subgroup analysis, the HR for OS in NSCLC patients was 1.05 (95% CI 0.69–1.59) in patients with mutant EGFR and 0.66 (95% CI 0.57–0.77) in patients with wild-type EGFR status. OR for occurrence was 0.36 (95% CI 0.28–0.46) in any grade treatment-related adverse effect and 0.18 (95% CI 0.14–0.22) in grade 3 to 5 treatment-related adverse effect, suggesting a superior safety profile of PD-1/PD-L1 inhibitors.Conclusion:The PD-1/PD-L1 therapy significantly prolonged the OS and improved the ORR, simultaneously lowering the treatment-related adverse effect events versus docetaxel.

Surgical Treatment of Femoral Neck Fractures After 24 Hours in Patients Between the Ages of 18 and 49 Is Associated With Poor Inpatient Outcomes

To determine (1) the incidence of delayed surgical treatment, (2) risk factors associated with delayed surgical intervention, (3) inpatient adverse events and discharge disposition, and (4) the association of delayed surgery with inpatient adverse events. Retrospective cohort study. 2011 and 2012 National Trauma Data Bank. All adult patients younger than 50 years of age with femoral neck fractures. Not applicable. (1) Time to surgical intervention after inpatient admission, (2) odds ratio (OR) for delayed surgery (later than 24 hours after admission), (3) incidence of inpatient adverse events and discharge disposition, (3) rates of inpatient adverse events and discharge disposition, and (4) OR for occurrence of serious adverse events, minor adverse events, and any adverse events. Of a total of 1361 patients, 67.8% of patients underwent surgery within 24 hours of presentation. In multivariate analysis (controlling for patient and injury characteristics), Charlson comorbidity index of 3+ compared with Charlson comorbidity index of 0 (OR: 3.62), pelvic fracture (OR: 2.01), and treatment at an American College of Surgeons level I trauma center (compared with levels II-IV; OR: 1.56) were associated with delayed surgery. The overall rate of mortality and inpatient adverse events was 0.2% and 12.1%, respectively. Delayed surgery was independently associated with increased occurrence of serious adverse events, minor adverse events, and any adverse events. Although a majority of nonelderly patients with femoral neck fractures underwent surgery within the first 24 hours of admission and had good outcomes in the short-term, certain subpopulations have a higher risk of delayed surgery. As delayed surgery is associated with worse outcomes, and short-term and long-term outcomes, efforts should focus on expediting care of these patients. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

The Kidney Early Evaluation Program (KEEP) of Japan.

The International Kidney Evaluation Association Japan (IKEAJ) was created to improve public health awareness of chronic kidney disease (CKD) by screening high-risk CKD populations. This study aimed to retrospectively examine data from KEEP Japan and detect the CKD risk factors for the onset and the progression of CKD. A total of 1,947 participants (mean age: 56.9 ± 16.4 years) to KEEP Japan were enrolled. More than 70% of the participants had no CKD. However, 7.5% of the participants were classified as high risk. The participants with a history of hypertension and older than 60 years had significantly higher odds ratio for occurrence of CKD. In addition, the participants with history of diabetes or cardiovascular disease, high blood pressure (BP), anemia, and low HDL-C had high odds ratios. It is therefore suggested that the appropriate control of BP, blood glucose, anemia, and HDL-C is important for populations with CKD risk factors to reduce the likelihood of CKD.

Lipid Levels Are Regionally Associated with Cerebral Microbleeds in Patients with Intracerebral Hemorrhage

Lipid levels may be involved in intracerebral hemorrhage (ICH) etiology, which suggested that lipid levels may be associated with the etiology of microbleeds (MBs) in patients with ICH. To explore this, we examined the association between lipid levels and MBs in different cerebral regions in patients with ICH. Patients admitted to our hospital with ICH were consecutively and prospectively included. Demographic and clinical information were collected and analyzed according to the occurrence and location of MBs and levels of triglycerides (TGs). Of the 77 patients included in our study, 63 (81.8%) were found to have MBs. Prevalence of MBs in the "deep or infratentorial" region and any region increased with increasing tercile in TG concentration; however, no such trend was observed for strictly lobar MBs. The odds ratio (OR) for occurrence of MBs in deep or infratentorial region was even higher for the third tercile relative to the first: 6.77 (95% confidence interval [CI] 1.31-34.96). The OR for occurrence of MB in any region was even higher for the third tercile relative to the first: 12.24 (95% CI 1.40-106.83). However, the OR for occurrence of deep or infratentorial region and any region in the second tercile relative to the first tercile did not reach significance. Moreover, TG levels did not appear to be associated with the occurrence of strictly lobar MBs. High TGs were associated with deep or infratentorial and any MBs but not with lobar MBs. This finding may shed light on the role of lipids in MB and ICH etiology.

Analysis of Longitudinal Multinomial Outcome Data

Analysis of categorical outcomes in a longitudinal study has been an important statistical issue. Continuous outcome in a similar study design is commonly handled by the mixed effects model. The longitudinal binary or Poisson-like outcome analysis is often handled by the generalized estimation equation (GEE) method. Neither method is appropriate for analyzing a multinomial outcome in a longitudinal study, although the cross-sectional multinomial outcome is often analyzed by generalized linear models. One reason that these methods are not used is that the correlation structure of two multinomial variables can not be easily specified. In addition, methods that rely upon GEE or mixed effects models are unsuitable in instances when the focus of a longitudinal study is on the rate of moving from one category to another. In this research, a longitudinal model that has three categories in the outcome variable will be examined. A continuous-time Markov chain model will be used to examine the transition from one category to another. This model permits an unbalanced number of measurements collected on individuals and an uneven duration between pairs of consecutive measurements. In this study, the explicit expression for the transition probability is derived that provides an algebraic form of the likelihood function and hence allows the implementation of the maximum likelihood method. Using this approach, the instantaneous transition rate that is assumed to be a function of the linear combination of independent variables can be estimated. For a comparison between two groups, the odds ratios of occurrence at a particular category and their confidence intervals can be calculated. Empirical studies will be performed to compare the goodness of fit of the proposed method with other available methods. An example will also be used to demonstrate the application of this method.

Genetic Polymorphisms of Aldehyde Dehydrogenase 2, Cytochrome p450 2E1 for Liver Cancer Risk in HCV Antibody-Positive Japanese Patients and the Variations of CYP2E1 mRNA Expression Levels in the Liver due to its Polymorphism

Background: Hepatocellular carcinoma (HCC) in persons with liver cirrhosis (LC) arises following hepatitis virus infection. Alcohol may accelerate the risk of development of LC and HCC. Cytochrome p450 2E1 (CYP2E1) oxidizes ethanol to form acetaldehyde and aldehyde dehydrogenase 2 (ALDH2) detoxifies acetaldehyde, which is carcinogenic in humans, and both alcohol-metabolizing enzymes show the genetic polymorphisms in a Japanese population. Methods: Using polymorphism analysis, we studied the frequency of ALDH2 functional deletion due to the G to A single-bp mutation in exon 12 and CYP2E1 polymorphism in the transcriptional region, both associated with higher levels of acetaldehyde, in 135 patients with LC and/or HCC, including 99 with HCC, and 135 non-cancer controls. The mRNA expression levels of CYP2E1 in the liver were also examined in 55 surgical specimens. Results: The allelic frequency of the homozygous ALDH2 2-2 genotype, coding for the enzyme deletion, was significantly higher compared to that of the homozygous or heterozygous ALDH2 1-1 genotypes in cases with HCC (OR r = r 5.4, 95% CI 2.1-14.0). There were no differences in the frequencies of specific genotypes of CYP2E1 in cases of HCC, but combined analysis of ALDH2 and CYP2E1 revealed that the odds ratio of occurrence of the C1/C1 homozygosity of CYP2E1 and the ALDH2 2-2 homozygosity was as high as 23.0 (2.9-182). The mRNA levels of CYP2E1 were higher in the liver of patients with the C1/C1 homozygosity of CYP2E1 than in those with other genotypes ( P r < r 0.05). Conclusions: ALDH2 and CYP2E1 polymorphisms may modify the risk of development of HCC against the background of LC in the Japanese. Polymorphism analysis of alcohol-metabolizing enzymes using molecular techniques may be useful in the risk assessment of liver cancer in patients with hepatitis C virus infection.