Proportional Regression Analysis Research Articles

Predictive value of immunotherapy-induced inflammation indexes: dynamic changes in patients with nasopharyngeal carcinoma receiving immune checkpoint inhibitors

BackgroundImmune checkpoint inhibitors (ICIs) have achieved substantial advancements in clinical care. However, there is no strong evidence for identified biomarkers of ICIs in NPC.MethodsIn this retrospective study, 284 patients were enrolled into a training or validation cohort. Inflammatory indexes based on peripheral blood parameters were evaluated, including the systemic immune-inflammation index (SII), the neutrophil-lymphocyte ratio (NLR), the platelet-lymphocyte ratio (PLR), the lymphocyte-to-C-reactive protein ratio (LCR), and the lymphocyte-monocyte ratio (LMR). The optimum cut-off value for patient stratification was identified using X-tile. The Kaplan-Meier method and Cox’s proportional regression analyses were used to identify prognostic factors.ResultsImmunotherapy significantly changed the levels of SII, NLR, PLR, LCR and LMR in NPC patients. Patients with lower SII, NLR, and PLR, as well as those with higher LCR and LMR, before immunotherapy had superior PFS (all p < 0.05). Moreover, PFS in the decreased SII, reduced NLR and increased LMR group was significantly longer than in the opposite group (all p < 0.05). Both univariate and multivariate analyses validated that baseline SII and LMR, and the immunotherapy-related SII reduction and LMR elevation were independent prognostic factors for PFS in advanced NPC patients receiving ICIs.ConclusionsImmune checkpoint inhibitor treatments significantly changed the levels of SII, NLR, PLR, LCR and LMR in NPC patients treated with immunotherapy. A lower baseline SII and a higher baseline LMR, and a reduction in SII and an elevation in LMR after immunotherapy are favorable factors for predicting survival among advanced NPC patients.

Efficacy and safety of apatinib combined with liposomal doxorubicin or paclitaxel versus liposomal doxorubicin or paclitaxel monotherapy in patients with recurrent platinum-resistant ovarian cancer.

Apatinib is an effective treatment for patients with gynecological cancers. This study aimed to further explore the efficacy and safety of apatinib plus chemotherapy in patients with recurrent platinum-resistant ovarian cancer (PROC). Totally, 105 patients with recurrent PROC receiving apatinib plus chemotherapy (N = 51) and chemotherapy alone (N = 54) were retrospectively enrolled in this cohort study. Objective response rate (37.3% vs. 14.8%) (p = 0.009) and disease control rate (80.4% vs. 61.1%) (p = 0.030) were increased in the apatinib plus chemotherapy group versus the chemotherapy group. The median (95% confidence interval [CI]) progression-free survival (PFS) and overall survival (OS) were 5.5 (3.4-7.6) and 21.4 (16.2-26.6) months in the apatinib plus chemotherapy group, and they were 3.8 (3.0-4.6) and 14.8 (11.9-17.7) months in the chemotherapy group. Meanwhile, the Kaplan-Meier curves revealed that PFS (p = 0.008) and OS (p = 0.012) were prolonged in the apatinib plus chemotherapy group versus the chemotherapy group. This finding was confirmed by multivariate Cox's proportional regression analyses: enter method (hazard ratio [HR] = 0.515, p = 0.007 for PFS; HR = 0.222, p < 0.001 for OS) and step-forward method (HR = 0.608, p = 0.019 for PFS; HR = 0.346, p = 0.001 for OS). Additionally, the incidence of hypertension was increased in the apatinib plus chemotherapy group versus the chemotherapy group (p = 0.038), while others were not different between the two groups (all p > 0.05). Grades 3 and 4 adverse events were neutropenia, hypertension, leukopenia, hand-foot syndrome, nausea and vomiting, fatigue, thrombocytopenia, and anemia in the apatinib plus chemotherapy group. Apatinib combined with chemotherapy is a superior choice over chemotherapy alone for recurrent PROC management.

Association of Mental Health and Physical Activity with All-cause Mortality in Persons with Disability: Based on 14-year Follow-up Data from the Korean Longitudinal Study of Aging

PURPOSE This study investigated the associations between mental health and physical activity with all-cause mortality in persons with disability. METHODS A total of 595 participants (39.3% women) aged 45≥ years, who participated in the Korean longitudinal study of aging (KLoSA) were included in this study. The Korean version of mini-mental state examination (K-MMSE) and the center for epidemiologic studies depression scale (CES-D) were used to assess cognitive impairment and depressive symptoms, respectively. The participants were classified into active and inactive groups based on physical activity of 150 min/week. Cox’s proportional regression analyses were used to determine the hazard ratio (HR) and 95% confidence interval (CI) of mental health and physical activity relating to all-cause mortality. RESULTS During the follow-up period (11.8±4.1 years), a total of 218 (36.6%) deaths occurred from all-causes. Participants in the inactive group had significantly higher cognitive impairment (&lt;i&gt;p&lt;/i&gt; =0.046), depressive symptoms (&lt;i&gt;p&lt;/i&gt; =0.001), and all-cause mortality (&lt;i&gt;p&lt;/i&gt;=0.037) than those in the active group. Compared to participants in the normal (HR=1), cognitive impairment (HR=2.229, 95% CI=1.645-3.020, &lt;i&gt;p&lt;/i&gt;&lt;0.001), and depressive symptoms groups (HR=1.542, 95% CI=1.136-2.091, &lt;i&gt;p&lt;/i&gt;&lt;0.001), those in the inactive group had significantly higher HR related to all-cause mortality. However, in the active group, cognitive function and depressive symptoms were not associated with all-cause mortality. CONCLUSIONS The current finding suggests that the promotion of physical activity may play an important role in preventing premature death from all-causes in persons with disability, especially among those with mental health problems.

Fast-Track Management of Concurrent Percutaneous Coronary Intervention in Patients Scheduled for Endovascular Abdominal Aortic Aneurysm Repair.

To investigate the safety and efficacy of fast-track management of concurrent percutaneous coronary intervention (PCI) in patients with abdominal aortic aneurysm scheduled for endovascular aortic aneurysm repair (EVAR). Eligible patients with abdominal aortic aneurysm who received EVAR from January 2011 to December 2019 were included in this retrospective cohort study. Propensity score (PS)-matched analysis was used to balance the baseline between the fast-track and standard control (EVAR without significant coronary artery disease) groups. Effects of fast-track management on short-term and midterm outcomes were evaluated via Cox proportional hazard regression and logistic regression analyses with corresponding hazard ratio (HR) or odds ratio (OR) and associated 95% confidence intervals (95% CIs), respectively. The study included 669 patients (73 fast-track and 596 standard control). Compared with the standard control group, no significant difference was found regarding major adverse cardiac events (HR 0.78, 95% CI [0.36, 1.68], p=0.519), overall mortality (HR 0.63, 95% CI [0.25, 1.55], p=0.315), and 30-day major hemorrhage events (OR 1.01, 95% CI [0.99, 1.03], p=0.514). The results were consistent in the PS-matched cohorts regarding major adverse cardiac events (HR 0.57, 95% CI [0.25, 1.29], p=0.176), overall mortality (HR 0.43, 95% CI [0.17, 1.11], p=0.820), and 30-day major hemorrhage events (OR 1.00, 95% CI [0.05, 10.61], p=0.999). Similar results were found in the subgroup analyses concerning fast-track management of 2-week intervals and patients with high age-adjusted Charlson comorbidity index. Under appropriate perioperative care, shortening the time interval between PCI and EVAR to 1 month, or even 2 weeks, seemed to be safe and effective. Short-term and midterm cardiovascular and survival outcomes were comparable with patients who underwent standard EVAR without significant coronary artery disease.

Abstract 5280: TERT promoter mutations are an independent predictor of distant metastasis in Middle Eastern papillary thyroid microcarcinoma

Abstract Background: Papillary thyroid microcarcinomas (PTMCs) have been attributed to the recent increased incidence of thyroid cancer. Although indolent, a subset of PTMC could potentially develop distant metastasis (DM). This study aimed to evaluate the clinico-pathological features and molecular characteristics of PTMC and identify the risk factors for DM in PTMC patients from Middle Eastern ethnicity. Methods: We retrospectively analyzed 210 patients with histologically confirmed PTMC. Clinico-pathological associations for DM, BRAF mutation and TERT mutation were analyzed successfully in 184 patients. Multivariate analysis was performed using Cox proportional hazards model and logistic regression analysis. Results: Among the PTMC patients included in this cohort, DM was noted in 6.0%(11/184), whereas tumor relapse occurred in 29/184 (15.8%). Of the 11 cases with DM, lung metastasis occurred in 8 cases, bone metastasis in 2 cases and brain metastasis in 1 case. Presence of extrathyroidal extension and older age were significantly associated with DM. Molecular analysis showed BRAF V600E mutations to be the most frequent, being detected in 45.7% (84/184). TERT promoter mutations were detected in 16 (8.7%) cases and were significantly associated with DM and shorter metastasis-free survival in multivariate analysis. Conclusions: Our study indicates a surprisingly high frequency of TERT promoter mutation in Saudi patients with PTMC. Identifying TERT promoter mutations as an independent predictor of DM in patients with microcarcinoma could explain the inherent aggressive nature of PTMC from Middle Eastern ethnicity and magnify its role in patient risk stratification, which might help in improving therapeutic strategy for these patients. Citation Format: Saeeda Omer Ahmed, Abdul K. Siraj, Sandeep K. Parvathareddy, Kaleem Iqbal, Zeeshan Qadri, Maha Al-Rasheed, Sarah Siraj, Saravanan Thangavel, Roxanne Diaz, Allianah Benito, Ingrid F. Victoria, Khawla S. AlKuraya. TERT promoter mutations are an independent predictor of distant metastasis in Middle Eastern papillary thyroid microcarcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5280.

A Prognostic Model of Differentiated Thyroid Cancer Based on Up-Regulated Glycolysis-Related Genes

ObjectiveThis study aims to identify reliable prognostic biomarkers for differentiated thyroid cancer (DTC) based on glycolysis-related genes (GRGs), and to construct a glycolysis-related gene model for predicting the prognosis of DTC patients.MethodsWe retrospectively analyzed the transcriptomic profiles and clinical parameters of 838 thyroid cancer patients from 6 public datasets. Single factor Cox proportional risk regression analysis and Least Absolute Shrinkage and Selection Operator (LASSO) were applied to screen genes related to prognosis based on 2528 GRGs. Then, an optimal prognostic model was developed as well as evaluated by Kaplan-Meier and ROC curves. In addition, the underlying molecular mechanisms in different risk subgroups were also explored via The Cancer Genome Atlas (TCGA) Pan-Cancer study.ResultsThe glycolysis risk score (GRS) outperformed conventional clinicopathological features for recurrence-free survival prediction. The GRS model identified four candidate genes (ADM, MKI67, CD44 and TYMS), and an accurate predictive model of relapse in DTC patients was established that was highly correlated with prognosis (AUC of 0.767). In vitro assays revealed that high expression of those genes increased DTC cancer cell viability and invasion. Functional enrichment analysis indicated that these signature GRGs are involved in remodelling the tumour microenvironment, which has been demonstrated in pan-cancers. Finally, we generated an integrated decision tree and nomogram based on the GRS model and clinicopathological features to optimize risk stratification (AUC of the composite model was 0.815).ConclusionsThe GRG signature-based predictive model may help clinicians provide a prognosis for DTC patients with a high risk of recurrence after surgery and provide further personalized treatment to decrease the chance of relapse.

Prognostic accuracy of time to sputum culture conversion in predicting cure in extensively drug-resistant tuberculosis patients: a multicentre retrospective observational study

BackgroundThere was a lack of information about prognostic accuracy of time to sputum culture conversion (SCC) in forecasting cure among extensively drug-resistant tuberculosis (XDR-TB) patients. Therefore, this study evaluated the prognostic accuracy of SCC at various time points in forecasting cure among XDR-TB patients.MethodsThis retrospective observational study included 355 eligible pulmonary XDR-TB patients treated at 27 centers in Pakistan between 01-05-2010 and 30-06-2017. The baseline and follow-up information of patients from treatment initiation until the end of treatment were retrieved from electronic nominal recording and reporting system. Time to SCC was analyzed by Kaplan–Meier method, and differences between groups were compared through log-rank test. Predictors of time to SCC and cure were respectively evaluated by multivariate Cox proportional hazards and binary logistic regression analyses. A p-value < 0.05 was considered statistically significant.ResultsA total of 226 (63.6%) and 146 (41.1%) patients respectively achieved SCC and cure. Median time to SCC was significantly shorter in patients who achieved cure, 3 months (95% confidence interval [CI]: 2.47–3.53), than those who did not (median: 10 months, 95% CI: 5.24–14.76) (p-value < 0.001, Log-rank test). Patient’s age > 40 years (hazards ratio [HR] = 0.632, p-value = 0.004), baseline sputum grading of scanty, + 1 (HR = 0.511, p-value = 0.002), + 2, + 3 (HR = 0.523, p-value = 0.001) and use of high dose isoniazid (HR = 0.463, p-value = 0.004) were significantly associated with early SCC. Only SCC at 6 month of treatment had statistically significant association with cure (odds ratio = 15.603, p-value < 0.001). In predicting cure, the sensitivities of SCC at 2, 4 and 6 months were respectively 41.8% (95%CI: 33.7–50.2), 69.9% (95%CI: 61.7–77.2) and 84.9% (95%CI: 78.1–90.3), specificities were respectively, 82.8% (95%CI: 76.9–87.6), 74.6% (95%CI: 68.2–80.4) and 69.4% (95%CI: 62.6–75.5) and prognostic accuracies were respectively 65.9% (95%CI: 60.7–70.8), 72.7% (95%CI: 67.7–77.2) and 75.8% (95%CI: 71.0–80.1).ConclusionIn forecasting cure, SCC at month 6 of treatment performed better than SCC at 2 and 4 months. However, it would be too long for clinicians to wait for 6 months to decide about the regimen efficacy. Therefore, with somewhat comparable prognostic accuracy to that SCC at 6 month, using SCC at 4 month of treatment as a prognostic marker in predicting cure among XDR-TB patients can decrease the clinicians waiting time to decide about the regimen efficacy.

Gradient association between pulmonary tuberculosis and diabetes mellitus among households with a tuberculosis case: a contact tracing-based study

Pulmonary tuberculosis (PTB) and diabetes mellitus (DM) remain high morbidity and mortality, especially when they are comorbid with each other. Screening for diabetes mellitus in tuberculosis is essential as the incidence and mortality of DM in the population with PTB are higher than in the general people. We aimed to examine the gradient association of tuberculosis on developing DM, the additional yield and the number needed to screen (NNS) to find a new diabetes case. A cross-sectional study was conducted on 801 tuberculosis cases and 972 household contacts in Guizhou, China, from April 2019 to October 2020. After screening for PTB among contacts, all participants were screened for DM and interviewed. Kendall’s tau-b test and proportional odds logistic regression analysis were applied to identify the gradient associations. Among the 1773 subjects, the additional yield of screening was 21.8%. The NNSs of the non-PTB group, the sputum-culture negative and positive groups were 50, 60 and 113, respectively. The gradient incremental establishment of DM and PTB were positively correlated. The general trend on the gradient of DM significantly increased with the gradient increase of PTB. Age 35 years and over, excessive edible oil intake and DM family history were identified as significant predictors of diabetes. Integrated screening for DM targeted to different gradients of PTB combined with associated factors is necessitated to achieve a higher additional yield.

Outcomes of patients with small intestine adenocarcinoma (SIA) in a Canadian province: A population-based cohort study.

641 Background: SIA is a rare cancer. Limited data is available about clinicopathological factors and interventions that correlate with its outcomes. The current study aims to determine outcomes of patients with SIA who were diagnosed in a Canadian province. Methods: In this retrospective population-based cohort study patients with biopsy proven SIA diagnosed during 2008-2017 in the province of Saskatchewan were assessed. A Cox Proportional multivariate regression analysis was performed to determine correlation between survival and exploratory factors. Results: 112 eligible patients with median age of 73 yrs and M:W 53: 59 were identified. 75% had a comorbid illness, 34% had a secondary cancer and 45% had WHO performance status (PS) &lt; 2. Of 112 patients, 51 (46%) had early-stage disease and 61 (54%) had advanced-stage disease. Median neutrophil: lymphocyte (NLR) was 4.5. The median overall survival (mOS) in relation to stage of the disease were as follow: stage 1, 59 months, stage 2, 30 months, stage 3, 20 months and stage 4, 3 months (P &lt; 0.001). The patients with early-stage disease had mOS of 36.0 months (95% CI: 8.0-64.0) vs. 3.0 months (1.74-4.26) with advanced disease (P &lt; 0.0001). Of 21 patients with stage 3 disease their median disease-free survival was 26 months (23.1-28.9) with chemotherapy vs. 4 months (0.0-9.1) with no chemotherapy, p = 0.04. Patients with stage 4 disease who had surgery and or chemotherapy had mOS of 18 months (13.70-23.32) vs. 4 months (2.20-5.82) with chemotherapy alone p = 0.03. On univariate analysis age ≥70 yrs, WHO PS &gt; 1, stage 4 disease, low albumin, elevated creatinine, high alkaline phosphatase, duodenal cancer, lack of surgery, and NLR of &gt; 4.50 were significantly correlated with inferior survival. On multivariate analysis stage 4 disease, HR, 3.20 (95%CI:1.84-5.40), WHO PS &gt; 1, HR, 2.22 (1.42-3.45), no surgery, HR, 2.10 (1.25-3.50), and NLR &gt; 4.5, HR, 1.72 (1.10-2.71) were significantly correlated with inferior survival. Conclusions: Most patients with SIA were diagnosed with advanced-stage. In addition to advanced-stage disease and poor PS, lack of surgery and baseline LNR of &gt; 4.5 were significantly correlated with inferior survival.

Cystic Fibrosis Increases Long-Term Revision Rates of Endoscopic Sinus Surgery in Patients With Comorbid Chronic Rhinosinusitis.

Background: Comorbid chronic rhinosinusitis (CRS) of adulthood is increasing among patients with cystic fibrosis (CF) due to improved median survival. However, little is known about the natural history of endoscopic sinus surgery (ESS) in this cohort. The objective of this study was to evaluate the revision rate of ESS and associated risk factors among adults with CRS and CF (CRSwCF). Methods: The Utah Population Database was queried for patients age >18 with CRS who underwent at least one ESS between 1996 and 2018. Demographic information and ESS history were collected and compared for CRSwCF versus CRS without CF (CRSsCF) using chi-square and t-tests. Risk factors for revision were analyzed using Cox proportional hazard models and logistic regression analysis. Results: A total of 34050 patients (33639 CRSsCF and 411 CRSwCF) were included in the final analysis. The mean duration of follow-up was 9.3 and 9.3 years, respectively (P = .98). Adult patients with CF were significantly more likely to undergo revision ESS (18.7%) than those without CF (13.4%; P < .01). Logistic regression analysis indicated that a diagnosis of CF independently elevated the risk for revision ESS in the absence of nasal polyps (odds ratio [OR] 2.18, confidence interval [CI] 1.34-3.54), asthma (OR 1.36, CI 0.94-1.98), and allergies (OR 1.29, CI 0.90-1.73). Conclusion: In the era before highly effective modulator therapies, the mean revision rate of ESS among adults with CRSwCF was 18.7%, significantly greater than that of adults with CRSsCF. CF was an independent risk factor for revision ESS in the absence of nasal polyps, asthma, and allergies.

Pericardial disease in patients treated with immune checkpoint inhibitors

Abstract Background There are limited data on the occurrence, associations and outcomes of pericardial effusions and pericarditis after treatment with immune checkpoint inhibitors (ICIs). Purpose To evaluate incidence of pericardial disease in patients treated with an ICI. Methods This was a retrospective study at a single academic center that compared 2842 consecutive patients who received ICIs with 2699 age- and cancer-type matched patients with metastatic disease who did not receive ICI (design 1). A pericardial event was defined as a composite outcome of pericarditis and new or worsening moderate or large pericardial effusion. The endpoints were obtained through chart review and were blindly adjudicated. To identify risk factors associated with a pericardial event, in a second analysis, we also compared patients who developed an event on an ICI to patients treated with an ICI who did not develop a pericardial event (design 2). Cox proportional hazard model and logistical regression analysis were performed to study the association between ICI use and pericardial disease as well as pericardial disease and mortality. An additional 6-week landmark analysis was performed to account for lead-time bias. Results There were 42 pericardial events in the patients treated with ICI (n=2842) over 193 days (interquartile range 64 to 411) with an incidence rate of 1.57 events per 100 person-years. There was a 4-fold increase in the risk for pericarditis or a pericardial effusion among patients on an ICI compared to controls not treated with ICI after adjusting for potential confounders (hazard ratio [HR] 4.37, 95% confidence interval [CI] 2.09–9.14, p&amp;lt;0.001). Patients who developed pericardial disease while on an ICI had a trend for increased all-cause mortality (HR 1.53, 95% CI 0.99–2.36, p=0.05) compared to those who did not develop pericardial disease. When comparing those who developed pericardial disease after ICI treatment to those who did not, a higher dose of corticosteroid pre-ICI (&amp;gt;0.7 mg/kg prednisone) was associated with increased risk of pericardial disease (HR 2.56, 95% CI 1.00–6.57, p=0.049). Conclusions ICI use was associated with an increased risk for development of pericardial disease among cancer patients and a pericardial event on an ICI was associated with a trend towards increased mortality. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): National Institutes of Health/National Heart, Lung, and Blood Institute; a gift from A. Curt Greer and Pamela Kohlberg

Acute kidney injury and major outcomes in cancer patients with no history of chronic kidney disease (CKD) with coronavirus 2019 (COVID-19) infection.

e18816 Background: Acute Kidney Injury (AKI) in patients with COVID-19 infection is associated with poor clinical outcomes. We examined outcomes (hemodialysis, mechanical ventilation, ICU admission and death) in cancer patients with normal estimated glomerular filtration rate (eGFR) treated in a tertiary referral center with COVID-19 infection, who developed AKI within 30 days of diagnosis. Methods: All patient data — demographics, labs, comorbidities and outcomes — were aggregated and analyzed in the Syntropy platform, Palantir Foundry (“Foundry”), as part of the Data-Driven Determinants of COVID-19 Oncology Discovery Effort (D3CODE) protocol at MD Anderson. The cohort was defined by the following: (1) positive COVID-19 test; (2) baseline eGFR &gt;60 ml/min/1.73m2most temporally proximal lab results within 30 days prior to the patient’s infection. AKI was defined by an absolute change of creatinine ≥0.3 within 30 days after the positive COVID-19 test. Kaplan-Meier analysis was used for survival estimates at specific time periods and multivariate Cox Proportional cause-specific Hazard model regression to determine hazard ratios with 95% confidence intervals for major outcomes. Results: 635 patients with Covid-19 infection had a baseline eGFR &gt;60 ml/min/1.73m2. Of these patients, 124 (19.5%) developed AKI. Patients with AKI were older, mean age of 61+/-13.2 vs 56.9+/- 14.3 years (p=0.002) and more Hypertensive (69.4% vs 56.4%, p=0.011). AKI patients were more likely to have pneumonia (63.7% vs 37%, p&lt;0.001), cardiac arrhythmias (39.5% vs 20.7%, p&lt;0.001) and myocardial infarction (15.3% vs 8.8%, p=0.046). These patients had more hematologic malignancies (35.1% vs 19%, p=0.005), with no difference between non metastatic vs metastatic disease (p=0.284). There was no significant difference in other comorbidities including smoking, diabetes, hypothyroidism and liver disease. AKI patients were more likely to require dialysis (2.4% vs 0.2%, p=0.025), mechanical ventilation (16.1% vs 1.8%, p&lt;0.001), ICU admission (43.5% vs 11.5%, p&lt;0.001) within 30 days, and had a higher mortality at 90 days of admission (20.2% vs 3.7%, p&lt;0.001). Multivariate Cox Proportional cause-specific Hazard model regression analysis identified history of Diabetes Mellitus (HR 10.8, CI 2.42 - 48.4, p=0.001) as an independent risk factor associated with worse outcomes. Mortality was higher in patients with COVID-19 infection that developed AKI compared with those who did not developed AKI (survival estimate 150 days vs 240 days, p=0.0076). Conclusions: In cancer patients treated at a tertiary cancer center with COVID-19 infection and no history of CKD, the presence of AKI is associated with worse outcomes including higher 90 day mortality, ICU stay and mechanical ventilation. Older age and hypertension are major risk factors, where being diabetic was associated with worse clinical outcomes.

Infant and young child feeding practices in Ethiopia: analysis of socioeconomic disparities based on nationally representative data

BackgroundUndernutrition among children is a priority area of public health concern in Ethiopia. The purpose of this study was to examine disparities in Infant and Young Child Feeding (IYCF) practices among children 6–23 months.MethodData were drawn from the 2016 Ethiopian Demographic and Health Surveys (EDHS). A total of 3240 children aged 6–23 months were used for the present analysis. The outcome variable was IYCF practice score (ranging 0–7) which was constructed based on the linear and combined effects of four sets of variables: breastfeeding, avoidance of bottle feeding, diet diversity score and minimum feeding frequency. IYCF practice score was further recoded into three categories. Proportional odds regression was used to assess the determinants of IYCF category.ResultsThe proportional odds regression analysis showed that IYCF scores significantly decreased by 5% (Adjusted Odds Ratio (AOR) = 0.95; 95% CI: 0.93–0.97) for every unit increase in the child’s age. Households with fathers of primary and secondary and above level education were 1.37 times (95% CI: 1.14–1.66) and 1.67 times (95% CI: 1.26–2.23) more likely to be in the high IYCF category than in the poor IYCF category. The likelihood of being in the high IYCF practice category decreased for non-working mothers by 30% (AOR = 0.70; 95% CI: 0.59–0.83) compared to those working in gainful employment. The chance of being in the high IYCF practice category decreased by 29% for households with no access to radio (AOR = 0.71; 95% CI: 0.59–0.85). Those with medium and rich/richer wealth category were 1.54 times (95% CI: 1.22–1.94) and 1.40 times (95% CI: 1.11–1.75) more likely to belong to high IYCF practice category than being in poor IYCF category. For every unit increase in health service utilization, the chance of falling in higher IYCF category increases by 1.15 times (95% CI: 1.08–1.23). The chance of falling in higher IYCF practice category decreases for rural residents by 37% (AOR = 0.63; 95% CI: 0.47–0.84) compared to those residing in urban areas.ConclusionFor a child, the first two years is the time span during which linear faltering of growth is most prevalent and the period when the process of becoming stunted is almost complete. This study recommends improving access to women for gainful employment, provision of economic support to poor rural women, education and promotion of nutrition messages using most accessible media and boosting the positive role of fathers in child feeding practices.

Association of Estimated Cardiorespiratory Fitness with the Incidence of Cognitive Impairment in Middle-Aged and Older Adults: Based on 12 Years Follow-Up Data from the Korean Longitudinal Study of Aging

PURPOSE:This study investigated association of estimated cardiorespiratory fitness (eCRF) with the incidence of cognitive impairment in Korean middle-aged and older adults.METHODS:Total of 4,239 subjects (53% women) aged ≥45 years, who participated in the Korean longitudinal study of aging (KLoSA) were included. Participants were classified into 4 categories from the lowest quartile to the highest quartile based on eCRF distribu¬tions. Korean version of mini-mental status examination (K-MMSE) was used to assessed mild cognitive impairment (MCI) and severe cognitive impairment (SCI). Cox’s proportional regression analyses were used to determine the hazard ratio (HR) and 95% confidence interval (CI) of eCRF categories for having MCI and SCI.RESULTS: During 12-years of follow-up, there were 736 (17.4%) and 272 (6.4%) cases of incidence from MCI and SCI, respectively. In women, compared to the quartile 1 group (reference, HR=1), the quartile 4 group had significantly lower HRs of having incidence of MCI/SCI (HR=0.72, 95% CI=0.55-0.94, p=.015) and MCI (HR=0.73, 95% CI=0.54-0.99, p=.045). However, in men, eCRF was not associated with incidence of cognitive impairment.CONCLUSIONS:The current findings suggest that eCRF may be an independent predictor of cognitive impairment in middle-aged and older women.

Prognostic value of main pulmonary artery diameter to ascending aorta diameter ratio in patients with advanced heart failure

Objectives and background In this study we assessed the prognostic value of main pulmonary artery diameter and its ratio to ascending aorta diameter (P/Ao ratio) in advanced heart failure patients. Methods Patients with advanced heart failure who were candidates for heart transplantation were retrospectively evaluated. The clinical information, cardiac catheterisation results, and computed tomography images were gathered from institutional database system. The observed and predicted probabilities for survival were analysed in a nomogram. Results The P/Ao ratio was found to be a strong predictor for MACE both in traditional multivariable Cox proportional hazard regression modelling (increase in P/Ao ratio per 2 SD, HR:2.72, 95% CI 1.14–6.48, p = 0.024) and ridge regression analysis (increase in P/Ao ratio per 2SD, HR:3.45, 95% CI 1.53–7.74, p = 0.003). Prediction model showed statistically significant correlation between the observed and predicted probabilities for 1-year survival. Conclusion In patients with advanced heart failure, computed tomography derived P/Ao ratio might be a prognostic predictor during follow up.

Impact of KRAS alterations in localized pancreatic cancer (PC).

431 Background: Patients (pts) with localized PC do not routinely undergo comprehensive genomic profiling (CGP) unless they develop recurrent or metastatic disease. KRAS is the most frequently mutated gene in PC, however, the impact of different KRAS mutations in localized PC has not been well characterized. We interrogated our genomic database to analyze the KRAS status in PC pts who presented with localized disease at diagnosis (Dx). Methods: We identified PC pts at our institution who underwent CGP utilizing the Foundation One CDx assay and had localized disease at initial Dx; these pts were categorized into resectable/borderline resectable PC (LPC) and locally advanced PC (LAPC). All pts with LPC and LAPC underwent neoadjuvant chemotherapy and chemoradiation prior to possible surgery (all intended therapy - AIT). Tissue from metastatic sites was used for CGP in pts who developed recurrent/metastatic disease before or after completion of AIT. The primary tumor was used for CGP in pts who completed AIT without subsequent relapse or in the absence of adequate metastatic tissue. Effect of each gene on response and survival outcomes was estimated using proportional odds and Cox regression analysis, respectively, adjusting for stage. Results: 75 pts were identified, median age at Dx was 65 years, 59% were male, 65% had a primary tumor in the pancreatic head. 38 (86%) pts with LPC completed AIT compared to 21 (68%) pts with LAPC (p&lt;0.001). KRAS mutation was detected in 95% (71/75) of pts– 94% (67/71) in codon 12 and 6% (4/71) in codon 61. The various KRAS mutations and their association with completion of AIT is summarized in the table. The likelihood of completing AIT did not differ based on KRAS wildtype (WT) vs mutated status (p =1.00), the mutated codon (codon 12 vs. codon 61; p =1.00) or the individual KRAS point mutations (p = 0.7); however, all patients with G12A (N= 1), G12C (N=1), G12L (N=1) and G12R (N=11) mutations completed AIT. KRAS status (mutated vs. WT) and the individual KRAS mutations were not associated with overall survival (OS) after adjusting for stage (p= 0.13 and p = 0.26 respectively). Median OS for patients with LPC and LAPC, was 39 months (mos) and 29 mos respectively. Conclusions: KRAS status and individual KRAS mutations did not have an impact on completing AIT or mOS; however, these findings need to be interpreted with caution due to the inherent biases involved in such analyses. The clinical significance and functional relevance of KRAS G12A, G12C, G12L and G12R mutations, though relatively rare, needs further characterization as well as mechanistic elucidation. [Table: see text]

Predictive value of prognostic nutritional index in patients with oral squamous cell carcinoma

To determine the prognostic significance of preoperative prognostic nutritional index (PNI) in patients with primary oral squamous cell carcinoma (OSCC) after ablative surgery. A total of 333 patients from two tertiary referral centers were enrolled as training and validation cohorts. The PNI was calculated as 10× serum albumin (g/dL)+0.005×total lymphocyte number (per mm3 ), and its optimal cutoff value for patient stratification was identified by X-tile software. Cox's proportional regression analyses and receiver operating characteristic (ROC) curves were employed to identify prognostic factors and their predictive performance. The optimal cutoff value of PNI was 47.4. Patients with low PNI had significantly shorter overall (OS) and disease-free survival than those with high PNI. Moreover, multivariate regression analyses indicated that PNI was an independent prognostic factor for OS in the training (hazard ratio [HR], 2.267; 95% confidence interval [CI]:1.335-3.849; p=.002) and validation (HR, 2.247; 95% CI: 1.352-3.735; p=.002) cohorts. ROC analyses revealed similar or superior predictive performance of PNI as compared to other prognostic parameters. Our findings reveal that decreased preoperative PNI significantly associates with worse prognosis for patients with OSCC, which serves as a novel prognostic biomarker for OSCC.

MRI Findings Predictive of Shoulder Stiffness in Patients With Full-Thickness Rotator Cuff Tears

OBJECTIVE. The objective of our study was to evaluate the relationship between stiff shoulder in patients with a full-thickness rotator cuff tear and MRI findings, especially joint capsule abnormality. MATERIALS AND METHODS. This study included 106 patients with small to large (≤ 5 cm) full-thickness rotator cuff tears. Joint capsule edema and thickness in the axillary recess, obliteration of the subcoracoid fat triangle, fatty degeneration of the torn rotator cuff muscle, and degree of retraction were assessed by two radiologists. The size and location of tears were determined by MRI findings and operative report. Associations between MRI findings and preoperative passive range of motion (ROM) were assessed by simple and multiple linear regression analyses and proportional odds logistic regression analysis. RESULTS. There was a significant, negative linear correlation between limited ROM at forward elevation and thickness of the joint capsule in the glenoid portion of the axillary recess (p = 0.018), external rotation and joint capsule edema in the humeral portion of the axillary recess (p = 0.011), and internal rotation and joint capsule edema in the glenoid portion of the axillary recess (p = 0.007). Male sex (p = 0.041) and posterosuperior rotator cuff tear (p = 0.030) were independent predictors of shoulder ROM on external rotation. Degree of fatty degeneration (p = 0.003) was another independent predictor of shoulder ROM on internal rotation. CONCLUSION. MRI findings-especially joint capsule edema and thickness at the axillary recess-can be useful in predicting shoulder stiffness in patients with rotator cuff tear.

Impact of CDKN2A/b status in pancreatic cancer (PC).

759 Background: PC is a lethal disease with limited treatment options. We utilized Comprehensive Genomic Profiling (CGP) to identify putative prognostic and/or predictive biomarkers. Methods: We retrospectively reviewed PC patients (pts) at our institution who underwent CGP utilizing the Foundation One assay. CGP was performed on hybrid-capture, adaptor ligation-based libraries for up to 315 genes plus 47 introns from 19 genes frequently rearranged in cancer. PC pts were categorized by clinical stage – localized (resectable and borderline resectable PC; LPC), locally advanced (LAPC) and metastatic (mPC). Effect of gene alterations (GAs) with at least 10% prevalence were analyzed. The marginal effect of each gene on radiographic response and survival outcomes was estimated using proportional odds and multivariate Cox regression analysis, respectively, adjusting for stage. Results: Ninety-three pts were identified - median age was 63, 55% were male, and 50% were smokers. Clinical stage at diagnosis was LPC, LAPC and mPC in 42 (45%), 23 (25%) and 28 (30%) pts, respectively. The most commonly altered genes were KRAS (94%), TP53 (75%), CDKN2A (41.2%) and SMAD4 (32.9%). All patients were microsatellite stable and the median tumor mutational burden was 1.7. 5-FU (52%) or Gemcitabine (46%) based chemotherapy combinations were utilized as the first systemic therapy. Median overall survival for patients with LPC, LAPC and mPC were 30.7, 28.8 and 9.6 months respectively. Thirty-eight (91%) pts with LPC underwent curative intent surgery compared to 15 (65%) pts with LAPC (p = 0.019). Thirty-five (95%) pts with wild type (WT) CDKN2A and 47 (94%) pts with WT CDKN2B underwent curative intent surgery compared to 13 (65%) and 1(14%) pt(s) with GAs in CDKN2A and CDKN2B respectively (p = 0.003 and p &lt; 0.0001 respectively). The response to chemotherapy was statistically significantly higher in pts with WT CDKN2A (53%) and CDKN2B (48%) compared to pts with GAs in CDKN2A (19%) and CDKN2B (12%) (p = 0.03 and p = 0.05, respectively). Conclusions: GAs in CDKN2A/B may have a predictive and possibly a prognostic impact. The clinical validity and biological relevance of these findings need to be further explored in larger studies.

Keeping it within bounds: Regression analysis of proportions in international business

International business researchers commonly estimate proportions, percentages, rates, or fractions – so-called “proportional dependent variables”. In this paper, we posit that two regression strategies are particularly pertinent to the international business field: Tobit and fractional regression. Reviewing recent international business research, we find that, while fractional regression is rarely used, analyses from Tobit regression are often incomplete or erroneously interpreted with consequences for the validity of the reported results. Accordingly, we clarify how researchers should choose between Tobit and fractional regression and interpret their results. We present insights based on simple simulations and data examples with associated Stata code and a decision tree for choosing between types of models for use with proportional dependent variables.