On Odds Ratio Research Articles

The role of germline BRCA1 & BRCA2 mutations in familial pancreatic cancer: A systematic review and meta-analysis.

Familial Pancreatic Cancer (FPC) presents a notable risk, with 3-10% of pancreatic adenocarcinoma cases having a family history. Studies link FPC to syndromes like HBOC, suggesting BRCA1/BRCA2 mutations play a role. BRCA gene functions in DNA repair impact FPC management, influencing sensitivity to therapies like PARP inhibitors. Identifying mutations not only aids FPC treatment but also reveals broader cancer risks. However, challenges persist in selectively applying genetic testing due to cost constraints. This Systematic Review focuses on BRCA1/BRCA2 significance in FPC, diagnostic criteria, prognostic value, and limitations. Original articles published from 2013 to January 2023 were sourced from databases such as Scopus, PubMed, ProQuest, and ScienceDirect. Inclusion criteria comprised observational cohort or diagnostic studies related to the role of BRCA1/2 mutation in correlation to familial pancreatic cancer (FPC), while article reviews, narrative reviews, and non-relevant content were excluded. The assessment of bias used ROBINS-I, and the results were organized using PICOS criteria in a Google spreadsheet table. The systematic review adhered to the PRISMA 2020 checklist. We analyzed 9 diagnostic studies encompassing 1325 families and 4267 patients from Italy, USA, and Poland. Despite the limitation of limited homogenous PICO studies, our findings effectively present evidence. BRCA1/2 demonstrates benefits in detecting first-degree relatives FPC involvement with 2.26-10 times higher risk. These mutation findings also play an important role since with the BRCA1/2 targeted therapy, Poly-ADP Ribose Polymerase inhibitors (PARP) may give better outcomes of FPC treatment. Analysis of BRCA1 and BRCA2 administration's impact on odds ratio (OR) based on six and five studies respectively. BRCA1 exhibited non-significant effects (OR = 1.26, P = 0.51), while BRCA2 showed significance (OR = 1.68, P = 0.04). No heterogeneity observed, indicating consistent results. Further research on BRCA1 is warranted. Detecting the BRCA1/2 mutation gene offers numerous advantages, particularly in its correlation with FPC. For diagnostic and prognostic purposes, testing is strongly recommended for first-degree relatives, who face a significantly higher risk (2.26-10 times) of being affected. Additionally, FPC patients with identified BRCA1/2 mutations exhibit a more favorable prognosis compared to the non-mutated population. This is attributed to the availability of targeted BRCA1/2 therapy, which maximizes treatment outcomes.

ПРИЧИНЫ ФОРМИРОВАНИЯ БОЛЬШИХ ОСТАТОЧНЫХ ПОСТТУБЕРКУЛЕЗНЫХ ИЗМЕНЕНИЙ У ДЕТЕЙ И ПОДРОСТКОВ НА СОВРЕМЕННОМ ЭТАПЕ

Objective: to identify factors contributing to the development of large residual changes in children of different age groups with pulmonary TB. Materials and methods. A retrospective comparative nonrandomized study included 455 patients aged 2–17 years admitted to hospital of the Central TB Research Institute. The patients were divided into 3 age groups: group 1 – early age children, group 2 – children of preschool age or young schoolchildren, and group 3 – prepubertal children and adolescents. Each group was divided into two subgroups based on treatment outcomes: subgroup a – patients with large residual changes and subgroup b – children with small residual changes after pulmonary TB. The influence of predictors on the volume of residual changes was assessed based on odds ratio (OR) in subgroups a and b in different age groups. Results. In group 1 the most significant predictors of large residual changes after pulmonary TB were late detection of TB, lack of contact observation and continuous exposure to TB (OR = 14.9, 6.2 and 5.8 respectively); in group 2 – late detection of TB, residence in the area with high prevalence of TB, and previous TB treatment failure (OR = 47.6, 5.8 and 5.6 respectively); in group 3 – concomitant diseases, previous TB treatment failure (OR = 8.4 and 5.8 respectively), residence in the area with high prevalence of TB, and late detection of TB (OR = 4.7 and 4.6 respectively). Conclusions. 1. The main factors influencing the volume of post-tuberculosis residual changes in all age subgroups were time of detection and treatment effectiveness. 2. Less significant predictors influencing residual changes were: lack of contact observation and duration of exposure to TB, concomitant diseases, lack of BCG vaccination, residence with a sociopathic family in a high burden territory or rural area. 3. Defective preventive examinations resulted in both large and small residual changes and contributed to untimely detection, but were not determinant factors of the development of large post-tuberculosis residual changes. 4. Highly informative diagnostic methods (intradermal testing with RTA and chest CT) result in early detection of TB only in cases of timely application.

Interprofessional Immersive Virtual Reality Training on Sepsis Recognition

Introduction: The implementation of evidence-based care relies on timely recognition of sepsis. Virtual reality (VR) represents a new simulation modality that can evaluate pediatric sepsis situation awareness. Methods: We evaluated situation awareness through a multiuser immersive VR experience (Fig. 1). A physician/APRN and nurse donned VR headsets to assess and provide initial management for a pediatric patient with sepsis during a team-based clinical simulation scenario. Participants were paused at 3 time points and asked to independently complete open-ended questions, including “what is the most likely cause for the patient’s clinical condition?” We compared experienced providers (nurses with ≥5 years’ experience and critical care or emergency medicine APRNs, fellows, or attendings) and novice providers (nurses with <5 years’ experience and pediatric residents) recognition of sepsis. Odds ratios were calculated for sepsis recognition with group differences assessed via the T test. Results: From January to July of 2021, 144 participants (72 physicians/APRNs and 72 nurses) participated in the experience (Table 1). When assessing for recognition of sepsis at the 2-minute time point, 81% of experienced nurses (N = 48) and 50% of novices (N = 24) recognized sepsis for, on odds ratio (OR) of 4.37 (1.28–14.96), P = 0.019. For physicians/APRNs, 92% of experienced (N = 37) compared to 71% of novices (N = 35) recognized sepsis [OR, 4.61 (0.87–14.97), P = 0.078]. When combined, 85.9% of experienced clinicians (N = 85) and 62.7% of novices (N = 59) recognized sepsis [OR, 3.70 (1.15–9.07), P = 0.004]. Conclusions: These data provide validity evidence for use of this immersive VR experience for assessment and training; potentially addressing a remaining barrier to improving pediatric sepsis outcomes.

Relationship Between Hypertension and Basilar Atherosclerosis in Chinese Han Population: A High-Resolution Magnetic Resonance Imaging Study

ObjectiveTo investigate the relationship between hypertension and basilar atherosclerosis evaluated by high-resolution magnetic resonance imaging (HR-MRI) in the Chinese Han population.MethodsHigh resolution-MRI vessel wall imaging was performed in selected 193 patients for various indications. Multivariable logistic regression models based on odds ratio (OR) with their associated 95% confidence interval (CI) were used to assess the relationship between hypertension and basilar artery (BA) plaque, moderate or severe stenosis of BA plaque, and vulnerable plaque. A linear regression model was used to assess the relationship between hypertension and BA plaque numbers.ResultsPatients with hypertension had a higher proportion of BA plaque and vulnerable plaque as well as more number of enhancements of BA plaque and serious plaque compared with normotensive patients (all values of p < 0.05). Multivariable logistic regression analysis indicated that patients with hypertension had an increased risk for and more number of enhancements of BA plaque (adjusted-OR: 4.32, 95% CI 1.89–9.88, p < 0.001; adjusted-β: 0.55, 95% CI 0.14–0.96, p = 0.009, respectively) and had a higher proportion of moderate or severe stenosis of BA plaque and vulnerable plaque (adjusted-OR: 3.08, 95% CI 0.77–12.32, p = 0.111; adjusted-OR: 4.52, 95% CI 1.50–13.64, p = 0.007, respectively) compared with the normotensive group. Moreover, there was a saturation effect of age on the prevalence of BA plaque and vulnerable plaque.ConclusionHypertension was the independent risk factor of BA plaque and vulnerable plaque assessed by HR-MRI in the Chinese Han population.

IDF21-0355 Puzzle and Muddle in the Guidelines for Diagnosing Gestational Diabetes Mellitus-Efforts to Solve

Background: The countries and associations introduced several guidelines to diagnose gestational diabetes mellitus (GDM). After many years, the International Association of Diabetes in Pregnancy Study Group (IADPSG) is the latest guideline. This study group suggests that anyone value of OGTT with 75 g glucose may be diagnosed as GDM based on Odds Ratio (OR) 1.75, but it does not happen on the ground. Center-to-center differences occur in GDM frequency and relative diagnostic importance of fasting, 1-hour and 2-hour glucose levels, which may impact different strategies for diagnosing GDM. In the IADPSG consensus panel, a few countries suggested OR 1.5 for diagnosing GDM. The outcome of a study found the prevalence of GDM was almost the same by following OR 1.5 whether it is in the fasting, 1 hour or 2 hours, which is the idea of suggesting anyone value to diagnose GDM. Aim: The outcome of a study found the prevalence of GDM was almost the same by following OR 1.5 whether it is in the fasting, 1 hour or 2 hours, which is the idea of suggesting anyone value to diagnose GDM. Method: Where is the problem, and What is the problem for not universally accepting IADPSG guidelines? We analyzed our data of n = 1463 antenatal women who underwent OGTT with 75g oral glucose. In this cohort, the cumulative prevalence of GDM was 14.60% based on the IADPSG methodology. Table 1:Tabled 1StepsWorking methodologyNo of GDMSTEP 1FPG > 92 mg/dl is 136 (9.30%)9.30%STEP 2Detect 136 form 1463 and the balance is 1327. Out of 1327 1hr PG > 180 mg/dl is 36 (2.46%).2.46%STEP 3Detect 36 from 1327 and the balance is 1291. Out of 1291 2hr PG > 153 mg/dl is 42 (2.87%).2.87%Total cumulative prevalence14.60% Open table in a new tab Results: Table 2:Tabled 1S.noWorking methodology N =1463No of antenatal womenPercentage1Only FPG ≥ 92 mg/dl1369.30%2Only 1hr PG ≥ 180 mg/dl654.40%3Only 2hr PG ≥ 153 mg/dl986.70%Total cumulative prevalence29920.40% Open table in a new tab The methodology of working out the prevalence of GDM by applying OR 1.5, which few countries suggested during consensus meeting at Pasadena, USA: Table 3. If IADPSG had accepted OR 1.5, the prevalence would be the same for FPG, 1 hr, and 2 hr.Tabled 1S.noWorking methodology n =1463No of antenatal womenPercentage1Only FPG ≥ 90 mg/dl18312.50%2Only 1hr PG ≥ 160 mg/dl19012.90%3Only 2hr PG ≥ 140 mg/dl19613.40% Open table in a new tab Discussion: All the diagnostic criteria require women to be in fasting, but most of the time, pregnant women do not come in the fasting state because of commutation. Many health services, especially in low-resource settings, cannot routinely perform an OGTT in pregnant women. The guidelines and diagnostic criteria which are feasible and straightforward on the ground are essential. as the procedure of following OR 1.5 is cost-effective and suitable for the population belonging to any economic status.

C-Reactive Protein Monitoring and Clinical Presentation of Fever as Predictive Factors of Prolonged Febrile Neutropenia and Blood Culture Positivity after Autologous Hematopoietic Stem Cell Transplantation-Single-Center Real-Life Experience.

Background: Febrile neutropenia (FN) is a medical emergency that requires urgent evaluation, timely administration of empiric broad-spectrum antibiotics and careful monitoring in order to optimize the patient’s outcome, especially in the setting of both allogeneic and autologous hematopoietic stem cell transplant (ASCT). Methods: In this real-life retrospective study, a total of 49 consecutive episodes of FN were evaluated in 40 adult patients affected by either multiple myeloma (thirty-eight) or lymphoma (eleven), following ASCT, with nine patients having fever in both of the tandem transplantations. Results: Febrile neutropenia occurred a median of 7 days from ASCT. Median duration of FN was 2 days, with 25% of population that had fever for at least four days. Ten patients had at least one fever spike superior to 39 °C, while the median number of daily fever spikes was two. Twenty patients had positive blood cultures with XDR germs, namely Pseudomonas aeruginosa and Klebsiella pneumoniae, present in seven cases. ROC analysis of peak C-reactive protein (CRP) values was conducted based on blood culture positivity and a value of 12 mg/dL resulted significant. Onset of prolonged fever with a duration greater than 3 days was associated with the presence of both a peak number of three or more daily fever spikes (p = 0.02) and a body temperature greater than 39 °C (p = 0.04) based on odds ratio (OR). Blood culture positivity and peak CRP values greater than 12 mg/dL were also associated with prolonged fever duration, p = 0.04, and p = 0.03, respectively. The probability of blood culture positivity was also greater in association with fever greater than 39 °C (p = 0.04). Furthermore, peak CRP values below the cut-off showed less probability of positive blood culture (p = 0.02). Conclusions: In our study, clinical characteristics of fever along with peak CRP levels were associated with a higher probability of both prolonged fever duration and positive blood culture, needing extended antibiotic therapy.

A systematic review of nerve-sparing surgery for high-risk prostate cancer.

We provide a systematic analysis of nerve-sparing surgery (NSS) to assess and summarize the risks and benefits of NSS in high-risk prostate cancer (PCa). We have undertaken a systematic search of original articles using 3 databases: Medline/PubMed, Scopus, and Web of Science. Original articles in English containing outcomes of nerve-sparing radical prostatectomy (RP) for high-risk PCa were included. The primary outcomes were oncological results: the rate of positive surgical margins and biochemical relapse. The secondary outcomes were functional results: erectile function (EF) and urinary continence. The rate of positive surgical margins differed considerably, from zero to 47%. The majority of authors found no correlation between NSS and a positive surgical margin rate. The rate of biochemical relapse ranged from 9.3% to 61%. Most of the articles lacked data on odds ratio (OR) for positive margin and biochemical relapse. The presented results showed no effect of nerve sparing (NS) on positive margin (OR=0.81, 0.6-1.09) or biochemical relapse (hazard ratio [HR]=0.93, 0.52-1.64). A strong association between NSS and potency rate was observed. Without NSS, between 0% and 42% of patients were potent, with unilateral 79-80%, with bilateral - up to 90-100%. Urinary continence was not strongly associated with NSS and was relatively good in both patients with and without NSS. NSS may provide benefits for patients with urinary continence and significantly improves EF in high-risk patients. Moreover, it is not associated with an increased risk of relapse in short- and middle-term follow-up. However, the advantages of using such a surgical technique are unclear.

Water Dynamics in Unilateral Biportal Endoscopic Spine Surgery and Its Related Factors: An In Vivo Proportional Regression and Proficiency-Matched Study

Stable water dynamics during endoscopic spine surgery improves the surgeon's comfort and patient's outcomes. We aimed to measure the water dynamics during spinal surgery and identify the factors that facilitate stable water dynamics. This open-label, prospective, proficiency-matched, invivo study included patients with single-level degenerative spinal disease. After assessing their heights and balancing the matched instrument, we measured the irrigation fluid pressure in various situations. We performed multiple regression analysis based on odds ratio(OR), confidence interval (CI), and relationships (proficiency-matched) with possible instrumental and physical characteristics. The instrumental factors were the presence and length of a rigid cannulation, and the physical characteristics were body mass index (body mass index [BMI]), skin-to-dura depth, height (interaction with BMI), and body weight (interaction with BMI). Of the 36 patients, 29 were included. The mean pressure of the operation cavity was 16.66 ± 9.12 cm H2O (12.25 ± 6.71 mm Hg). Water pressure with the rigid cannulation (9.41 ± 2.94 cm H2O [6.92 ± 2.16 mm Hg]) was significantly lower than that without cannulation (23.43 ± 7.57 cm H2O [17.26 ± 5.57 mm Hg], P < 0.01). Water pressure correlated with cannular length (OR=-1.08, CI=-1.79,-0.37, P < 0.01) and BMI (OR= 0.56, CI= 0.12, 0.99, P < 0.01). BMI showed a proportional relationship (r=0.84, P < 0.01). During biportal endoscopy, we suggest maintaining water pressure between 4.41 cm H2O (2.41 mm Hg) and 31.00 cm H2O (22.83 mm Hg). Compared to physical characteristics, placement of the cannula and appropriate cannula length are important factors that affect water dynamics.

Epidemiological study of metabolic syndrome in Brazilian soldiers.

The aim of this study was to carry out an epidemiological analysis of metabolic syndrome among Brazilian Army soldiers. Two thousand seven hundred and nineteen male soldiers of the Brazilian Army were evaluated from 2014 to 2016. Characteristics: age = 27.77 (± 8.59) years and BMI = 25.15 (± 3.41) kg/m2. Blood tests and anthropometric measures were performed following the criteria of the International Diabetes Federation Task Force on MS Epidemiology and Prevention, 2009. The epidemiological analysis was based on Odds ratio (OR) with confidence interval (CI). The prevalence of MS found was 12.21%. Both WC and BMI proved to be good predictors of changes in MS physiological markers. Increased WC and BMI were strongly associated with all physiological markers. Soldiers with WC ≥ 90 were more likely to present MS with OR = 33.37 (24.37-45.7). Soldiers with WC ≥ 90 also presented high risk of: high triglycerides with OR = 5.98 (4.69-7.61); low HLD-c with OR = 1.78 (1.47-2.16); and increased systolic blood pressure OR = 3.10 (2.55-3.76). Soldiers with BMI ≥ 30 had a high risk of: increased glucose with OR = 2.69 (1.93-3.75); and increased diastolic blood pressure with OR = 3.02 (2.22-4.10). Both WC and BMI can be considered as good predictors of changes in MS physiological markers. We believe that WC and BMI should be used as screening tools to indicate the soldiers that must undergo blood tests to monitor MS prevalence.

Comparative efficacy of adjuvant trastuzumab-containing chemotherapies for patients with early HER2-positive primary breast cancer: a network meta-analysis

Trastuzumab (H) with chemotherapy benefits patients with HER2+ breast cancer (BC); however, we lack head-to-head pairwise assessment of survival or cardiotoxicity for specific combinations. We sought to identify optimal combinations. We searched PubMed, updated October 2017, using keywords "Breast Neoplasms/drug therapy," "Trastuzumab," and "Clinical Trial" and searched Cochrane Library. Our search included randomized trials of adjuvant H plus chemotherapy for early-stage HER2+ BC, and excluding trials of neoadjuvant therapy or without data to obtain hazard ratios (HRs) for outcomes. Following PRISMA guidelines, one investigator did initial search; two others independently confirmed and extracted information; and consensus with another investigator resolved disagreements. Before gathering data, we set outcomes of overall survival (OS), event-free survival (EFS), and severe cardiac adverse events (SCAEs). Analyzing 6 trials and 13,621 patients, we made direct and indirect comparisons using network meta-analysis on HR for OS or EFS and on odds ratio (OR) for SCAE; ranked therapy was done based on outcomes using p scores. Compared with anthracycline-cyclophosphamide with taxane (ACT), ACT with concurrent H (ACT+H) showed best OS (HR 0.63, 95% confidence interval [CI] 0.55, 0.72), followed by taxane and carboplatin (TC) with concurrent H (TC+H) (HR 0.77, 95% CI 0.59, 1) and ACT with sequential H (ACT-H) (HR 0.85, 95% CI 0.68, 1.05). Pairwise comparisons showed statistically significant OS benefit for ACT+H over others; similar results for EFS. TC+H showed statistically significant lower SCAE risk compared to ACT+H (OR 0.13, 95% CI 0.03, 0.61). Concurrent H with ACT or TC showed most clinical benefit for early-stage HER2+ BC; TC+H had lowest cardiotoxicity.

Association between homocysteine and conventional predisposing factors on risk of stroke in patients with hypertension

Previous studies have focused mostly on independent effects of the stroke risk factors, whereas little attention has been paid to interactions between individual factors which may be important for stroke prevention. We collected data related to the patients’ demographic characteristics, history of chronic diseases and lifestyle factors in 2258 patients with primary hypertension. Logistic regression models based on odds ratio (OR) with their associated 95% confidence interval (CI) were used to estimate an independent effect of homocysteine (Hcy) on the risk of stroke but also include the interactions between Hcy and other risk factors. Hcy was associated with an increased OR of the risk of stroke in both hypertension patients (OR, 1.027; 95% CI, 1.016–1.038; P < 0.001) and H-type hypertension patients (OR, 1.026; 95% CI, 1.014–1.037; P < 0.001), after adjustment for potential confounding factors. Among the hypertension participants, three tests of interactions between Hcy and other risk factors were statistically significant: sex, systolic blood pressure and diastolic blood pressure. In conclusion, complexities of the interactions of Hcy stratified by sex and blood pressure need to be considered in predicting overall risk and selecting certain treatments for stroke prevention.

Efficacy of nepafenac ophthalmic suspension 0.1% in improving clinical outcomes following cataract surgery in patients with diabetes: an analysis of two randomized studies.

ObjectiveTo assess the efficacy of nepafenac 0.1% ophthalmic suspension in improving the clinical outcomes following cataract surgery (CS) in patients with nonproliferative diabetic retinopathy.MethodsIn two similar multicenter, randomized studies, patients received either nepafenac 0.1% or vehicle, instilled three times daily starting a day prior to surgery and continuing for 90 days postoperatively. A post hoc analysis of these two studies was conducted to assess 1) the likelihood for development of postoperative macular edema (ME), based on the percentage of patients who developed ME (≥30% increase from preoperative baseline in central subfield macular thickness) within 90 days following CS and 2) best-corrected visual acuity (BCVA) endpoints, including the percentage of patients with a BCVA improvement of ≥15 letters from preoperative baseline to Day 14 and maintained through Day 90. Results for individual studies and their pooled estimates (only visual acuity endpoints) are reported. Primary inference was based on odds ratio (OR).ResultsThis post hoc analysis included 411 patients (nepafenac 0.1%: 205; vehicle: 206). The incidence of postoperative ME within 90 days of CS was notably lower in the nepafenac-treated patients than in vehicle-treated patients (study 1: 3.2% vs 16.7%; OR =0.2, 95% confidence interval [CI] =0.1, 0.5, P=0.001; study 2: 5.0% vs 17.5%; OR =0.2, 95% CI =0.1, 0.8, P=0.018). A higher percentage of nepafenac-treated patients than vehicle-treated patients gained ≥15 letters from preoperative baseline to Day 14, which was maintained through Day 90 (study 1: 38.4% vs 21.4%; OR =2.4, 95% CI =1.4, 4.2, P=0.003; study 2: 35.0% vs 25.0%; OR =1.6, 95% CI =0.8, 3.2, P=0.172; pooled: 37.1% vs 22.8%; OR =2.0, 95% CI =1.3, 3.1, P=0.001). The odds of >5-letter and >10-letter loss in BCVA from postoperative Day 7 were higher in vehicle-treated than in nepafenac-treated patients.ConclusionThese results support the clinical benefit of prophylactic use of nepafenac 0.1% for reducing the risk of postoperative ME and for improvement in BCVA outcomes following CS in patients with nonproliferative diabetic retinopathy.

RISK FACTORS FOR AND SPATIAL DISTRIBUTION OF LYMPHOPROLIFERATIVE DISEASE VIRUS (LPDV) IN WILD TURKEYS (MELEAGRIS GALLOPAVO) IN NEW YORK STATE, USA.

Lymphoproliferative disease virus (LPDV) is an oncogenic avian retrovirus that was previously thought to exclusively infect domestic turkeys but was recently shown to be widespread in Wild Turkeys ( Meleagris gallopavo ) throughout most of the eastern US. In commercial flocks, the virus spreads between birds housed in close quarters, but there is little information about potential risk factors for infection in wild birds. Initial studies focused on distribution of LPDV nationally, but investigation of state-level data is necessary to assess potential predictors of infection and detect patterns in disease prevalence and distribution. We tested wild turkey bone marrow samples (n=2,538) obtained from hunter-harvested birds in New York State from 2012 to 2014 for LPDV infection. Statewide prevalence for those 3 yr was 55% with a 95% confidence interval (CI) of 53-57%. We evaluated a suite of demographic, anthropogenic, and land cover characteristics with logistic regression to identify potential predictors for infection based on odds ratio (OR). Age (OR=0.16, 95% CI=0.13-0.19) and sex (OR=1.3, 95% CI=1.03-1.24) were strong predictors of LPDV infection, with juveniles less likely to test positive than adults, and females more likely to test positive than males. The number of birds released during the state's 40-yr translocation program (OR=0.993, 95% CI=0.990-0.997) and the ratio of agriculture to forest cover (OR=1.13, 95% CI=1.03-1.19) were also predictive of LPDV infection. Prevalence distribution was analyzed using dual kernel density smoothing to produce a risk surface map, combined with Kulldorff's spatial scan statistic and the Anselin Local Moran's I to identify statistically significant geographic clusters of high or low prevalence. These methods revealed the prevalence of LPDV was high (>50%) throughout New York State, with regions of variation and several significant clusters. We revealed new information about the risk factors and distribution of LPDV in New York State, which may be beneficial to game bird managers and producers of organic or pasture-raised poultry.

The LSP1 rs3817198 T > C polymorphism contributes to increased breast cancer risk: a meta-analysis of twelve studies.

The association between the LSP1 rs3817198 T > C polymorphism and breast cancer risk has been widely investigated, but remains controversial. We therefore undertook a comprehensive meta-analysis to provide a high-quality evaluation of this association. A literature search was performed among Pubmed, EMBASE and Chinese National Knowledge Infrastructure (CNKI) databases prior to July 31, 2016, and the strength of the association between the LSP1 rs3817198 T > C polymorphism and breast cancer risk was assessed based on odds ratio (OR) and 95% confidence interval (95% CI). In total, 12 studies with 50,525 cases and 54,302 controls were included. Pooled risk estimates indicated a significant association between the LSP1 rs3817198 T > C polymorphism and breast cancer risk. Analysis of cases stratified based on ethnicity suggested that the association was significant in both Caucasian and Asian populations. Stratification based on source of controls revealed an association only in population-based studies. These findings indicate the LSP1 rs3817198 T > C polymorphism is associated with increased risk of breast cancer, especially in Caucasian and Asian populations. Large, well-designed studies with different ethnicities are still needed to verify our findings.

Understanding rural-urban differences in risk factors for breast cancer in an Indian population.

Although cancer registry data indicate that there are large differences in breast cancer (BC) rates between rural and urban regions of India, the reasons for these differences are not well understood. We conducted a hospital based case-control study (1,637 breast cancer cases; 1,515 visitor controls) in Mumbai, India, during the years 2009-2013. Extensive questionnaire data, anthropometry measurement and blood samples were collected on all participants. Using logistic regression models, we estimated risk based on odds ratio (OR) and 95 % confidence intervals (CI) for various reproductive and anthropometric measures, stratified by rural-urban status depending upon residence in first 20 years of life. Waist-to-hip ratio of ≥0.95 compared to ratio ≤0.84 was strongly associated with risk of BC in both rural and urban populations (ORurban = 4.10, 95 % CI 3.03-5.56; ORrural = 3.01, 95 % CI 1.85-4.90). First full-term pregnancy after the age of 25 compared to first full-term pregnancy below 20 years of age was associated with risk of BC in both urban and rural women (ORurban = 1.78, 95 % CI 1.32-2.41; ORrural = 2.24, 95 % CI 1.13-4.43). The prevalence of age at first full-term pregnancy was significantly lower in rural (mean age at first full-term pregnancy = 19.39 years) versus urban women (mean age at first full-term pregnancy = 22.62 years), whereas mean waist circumference was much higher in urban women (82.13 cm) compared to rural women (79.26 cm). We did not observe any association between breast feeding and risk of BC. Differences in the prevalence of central adiposity and age at first full-term pregnancy between rural and urban women from India may explain some differences in breast cancer rates between these two populations.

Surgery duration predicts urinary retention after inguinal herniorrhaphy: a single institution review.

Inguinal hernia repair, laparoscopic or open, is one of the most frequently performed operations in general surgery. Postoperative urinary retention (POUR) can occur in 0.2-35% of patients after inguinal hernia repair. The primary objective of this study was to determine the incidence of POUR after inguinal hernia repair. As a secondary goal, we sought to determine whether perioperative and patient factors predicted urinary retention. This study is a retrospective review of patients who underwent inguinal hernia repair with synthetic mesh at the Medical College of Wisconsin from January 2007 to June 2012. Procedures were performed by four surgeons. Clinical information and perioperative outcomes were collected up to hospital discharge. Urinary retention was defined as need for urinary catheterization postoperatively. A total of 192 patients were included in the study (88 bilateral, 46%) and (104 unilateral, 54%). The majority of subjects (76%) underwent laparoscopic repair. The overall POUR rate was 13%, with 25 of 192 patients requiring a Foley catheter prior to discharge. POUR was significantly associated with bilateral hernia repairs (p=0.04), BMI≥35kg/m(2) (p=0.05) and longer operative times (p=0.03). Based on odds ratio (OR) estimates, for every 10-min increase in operative time, an 11% increase in the odds of urinary retention is expected (OR 1.11, CI 1.004-1.223; p=0.04). For every 10-min increase in operative time, an 11% increase in POUR is expected. Bilateral hernia repairs, BMI≥35kg/m(2), and operative time are significant predictors of POUR. These factors are important to determine potential risk to patients and interventions such as strict fluid administration, use of catheters, and potential premedication.

The relationship between body mass index and health-related quality of life in the adult Chinese population: among the healthy and chronic disease subgroups

Objective To investigate the relationship between body mass index (BMI) and health-related quality of life (HRQOL) in the adult Chinese population. Methods Data of 21 108 adults was collected from a cross-sectional survey performed in 9 provinces of China (Jiangsu, Anhui, Gansu, Qinghai, Fujian, Beijing, Jilin, Jiangxi and Henan province). Rank sum test was used to compare HRQOL with different BMI category. Multiple logistic regression analysis was used to assess the impact of different BMI category on HRQOL after adjusted for sex, age, marital, education, physical activity status, and tobacco and alcohol addiction. Results (1) For healthy subjects, the overweight BMI group had the highest HRQOL score in the physical component summary (PCS)(83.69±14.09) and mental component summary(MCS)(80.29±15.41), while the underweight group had the worst HRQOL(81.20±14.05, 74.82±16.41). For subjects with chronic condition, overweight had the highest HRQOL score in the PCS(74.63±18.51), and obese group had the best HRQOL in the MCS(76.75±18.83). The variation among healthy and chronic disease subjects was much greater than the differences among BMI category groups. (2) Compared with normal weight, data on odds ratio(ORs) of impaired HRQOL in PCS(healthy subjects OR=1.23(1.10-1.35), chronic disease subjects OR=1.48(1.20-1.82)) MCS(healthy subjects OR=1.14(1.03-1.26), chronic disease subjects OR=1.37(1.11-1.68)) and multiple dimensions increased among underweight.ORs of impaired HRQOL in PCS and general health dimension, MCS(healthy subjects OR=0.81(0.72-0.91), chronic disease subjects OR=0.80(0.71-0.91)) and multiple dimensions decreased among overweight. ORs of impaired HRQOL in physical functioning dimension (healthy subjects OR=1.91(1.25-2.92), chronic disease subjects OR=1.65(1.21-2.26)) while in MCS and role emotional and mental health dimension decreased among obese. Conclusion Whatever health or chronic disease, the influence of BMI on HRQOL is similar: the HRQOL score for the underweight group is significantly lower than that for other BMI groups in PCS and MCS.Overweight and the obese people has better HRQOL in MCS, and the obese people has poor physical function.The relation above between BMI and HRQOL is more obvious in people with chronic disease. Key words: Body mass index; Health-related quality of life; Chronic disease

Fixed effects modelling for provider mortality outcomes: Analysis of the Australia and New Zealand Intensive Care Society (ANZICS) Adult Patient Data-base.

BackgroundRisk adjusted mortality for intensive care units (ICU) is usually estimated via logistic regression. Random effects (RE) or hierarchical models have been advocated to estimate provider risk-adjusted mortality on the basis that standard estimators increase false outlier classification. The utility of fixed effects (FE) estimators (separate ICU-specific intercepts) has not been fully explored.MethodsUsing a cohort from the Australian and New Zealand Intensive Care Society Adult Patient Database, 2009–2010, the model fit of different logistic estimators (FE, random-intercept and random-coefficient) was characterised: Bayesian Information Criterion (BIC; lower values better), receiver-operator characteristic curve area (AUC) and Hosmer-Lemeshow (H-L) statistic. ICU standardised hospital mortality ratios (SMR) and 95%CI were compared between models. ICU site performance (FE), relative to the grand observation-weighted mean (GO-WM) on odds ratio (OR), risk ratio (RR) and probability scales were assessed using model-based average marginal effects (AME).ResultsThe data set consisted of 145355 patients in 128 ICUs, years 2009 (47.5%) & 2010 (52.5%), with mean(SD) age 60.9(18.8) years, 56% male and ICU and hospital mortalities of 7.0% and 10.9% respectively. The FE model had a BIC = 64058, AUC = 0.90 and an H-L statistic P-value = 0.22. The best-fitting random-intercept model had a BIC = 64457, AUC = 0.90 and H-L statistic P-value = 0.32 and random-coefficient model, BIC = 64556, AUC = 0.90 and H-L statistic P-value = 0.28. Across ICUs and over years no outliers (SMR 95% CI excluding null-value = 1) were identified and no model difference in SMR spread or 95%CI span was demonstrated. Using AME (OR and RR scale), ICU site-specific estimates diverged from the GO-WM, and the effect spread decreased over calendar years. On the probability scale, a majority of ICUs demonstrated calendar year decrease, but in the for-profit sector, this trend was reversed.ConclusionsThe FE estimator had model advantage compared with conventional RE models. Using AME, between and over-year ICU site-effects were easily characterised.

Prevalence and risk factors associated with wheezing in the first year of life

Objectiveto investigate the prevalence and risk factors associated with wheezing in infants in the first year of life. Methodsthis was a cross-sectional study, in which a validated questionnaire (Estudio Internacional de Sibilancias en Lactantes - International Study of Wheezing in Infants - EISL) was applied to parents of infants aged between 12 and 15 months treated in 26 of 85 primary health care units in the period between 2006 and 2007. The dependent variable, wheezing, was defined using the following standards: occasional (up to two episodes of wheezing) and recurrent (three or more episodes of wheezing). The independent variables were shown using frequency distribution to compare the groups. Measures of association were based on odds ratio (OR) with a confidence interval of 95% (95% CI), using bivariate analysis, followed by multivariate analysis (adjusted OR [aOR]). Resultsa total of 1,029 (37.7%) infants had wheezing episodes in the first 12 months of life; of these, 16.2% had recurrent wheezing. Risk factors for wheezing were family history of asthma (OR = 2.12; 95% CI: 1.76-2.54) and six or more episodes of colds (OR = 2.38; 95% CI: 1.91-2.97) and pneumonia (OR = 3.02; 95% CI: 2.43-3.76). For recurrent wheezing, risk factors were: familial asthma (aOR = 1.73; 95%: CI 1.22-2.46); early onset wheezing (aOR = 1.83; 95% CI: 1.75-3.75);nocturnal symptoms (aOR = 2.56; 95% CI: 1.75-3.75), and more than six colds (aOR = 2.07; 95%CI 1.43- .00). Conclusionthe main risk factors associated with wheezing in Fortaleza were respiratory infections and family history of asthma. Knowing the risk factors for this disease should be a priority for public health, in order to develop control and treatment strategies.

Basal Subtype, as Approximated by Triple-Negative Phenotype, is Associated with Locoregional Recurrence in a Case–Control Study of Women with 0–3 Positive Lymph Nodes After Mastectomy

Basal subtype, as approximated by the triple-negative phenotype (ER-PR-Her2-), has correlated with higher LRR in recent studies. Indications for postmastectomy RT (PMRT) in women with 0-3 positive lymph nodes remain unclear. We evaluated the importance of biologic subtype in a cohort of women with LRR after mastectomy. We identified 22 women with 0-3 positive lymph nodes at our institution who were initially treated with mastectomy (without post-mastectomy radiation), suffered LRRs, and had paraffin-embedded tissue blocks from the primary mastectomy specimen available for staining. None of these women received PMRT. We case-control matched these to 29 women with 0-3 positive nodes who had mastectomy (no PMRT) and remained without evidence of disease at last follow-up and had available primary specimens for processing. We matched controls for age (±3years) and follow-up duration (<5year vs. more). Paraffin-embedded specimens were used to construct a triple-redundant tissue microarray. We used conditional logistic regressions to study the association between each predictor and LRR. Results were summarized based on odds ratio (OR). On univariate analysis, ER+, PR+, or the combination was strongly associated with lower odds of LRR. Basal subtype, as approximated by ER-PR-Her2- (TN), was associated with higher LRR (OR 8.5, p=0.048). Use of chemotherapy also was associated with lower LRR (OR 0.126, p=0.0073). Our data are concordant with reports from others demonstrating that TN phenotype is associated with higher LRR and can be considered along with other predictors of LRR when selecting women for PMRT.