Single Factor Logistic Regression Research Articles

Potential risk factors predicting perioperative mortality in patients with gastric pull-up reconstruction

Objective: To investigate the potential risk factors for the death of patients underwent gastric pull-up reconstruction following total pharyngoesophagectomy during perioperative periods. Methods: A total of 71 patients, including 64 males and 7 females, aged from 35 to 72 years old, with hypopharyngeal or cervical esophageal carcinoma, who underwent gastric pull-up reconstruction after pharyngoesophagectomy between October 2008 and October 2017, were reviewed retrospectively. Seventeen factors which may have potential influence on the mortality of patients during perioperative periods were evaluated by single factor Logistic regression analysis, and then those factors with obvious difference in statistics were further analyzed by multi-factor Logistic regression. Results: The rate of perioperative mortality was 9.9% (7/71). Single factor Logistic regression analysis indicated that the age of patients, abnormal electrocardiogram, TNM stages, alanine aminotransferase and D-Dimer changes, postoperative bleeding were risk factors for the death of patients(P values were 0.023, 0.004, 0.026, 0.021, 0.015 and 0.002, respectively). Multi-factor Logistic regression showed that postoperative bleeding and D-Dimer changes were 2 independent risk factors for perioperative death(P=0.021 and 0.047, respectively). Conclusions: Many potential factors may affect the perioperative mortality of patients underwent gastric pull-up reconstruction following total pharyngoesophagectomy. Postoperative bleeding and significantly elevated D-Dimer level were independent risk factors for the death of patients, indicating poor prognosis.

Assessment of the feasibility of transperineal ultrasound combined with clinical factors in predicting female stress urinary incontinence factors

Objective To investigate the feasibility and accuracy of transperineal real-time three-dimensional ultrasound combined with clinical factors in predicting the risk of female stress urinary incontinence(SUI). Methods Three hundred and forty-eight female patients with SUI diagnosed were selected as the case group, and 102 healthy people in the same period were selected as the control group. All subjects underwent transperineal real-time three-dimensional ultrasound. The ultrasonic parameters of resting state, contraction and Valsalva were measured, and the clinical parameters such as age, height, weight, history of pregnancy and childbirth were collected. According to the time sequence, all the subjcets were divided into derivation cohort and verification cohort inproportion to 2∶1, single factor screening and logistic multiple regression analysis were carried out on 24 factors, and the risk model was established. The cut-off value of the disease probability P was determined by the ROC curve of the subjects, and then the accuracy of the cut-off value in predicting SUI was verified in the verification group. Results Single factor analysis showed that 13 parameters were associated with SUI(all P<0.05). Logit P=2.014+ 1.870×Z1 was established by multivariate logistic regression analysis. The cut-off value of the disease probability P determined by ROC curve was 0.823. The predictive sensitivity of the model was 68.1% (95%CI: 59.6%-76.6%), specificity was 91.2% (95%CI: 86.0%-96.4%), positive predictive value was 64.3% (95%CI: 55.6%-73.0%) and negative predictive value was 92.5% (95%CI: 86.2%-98.8%). Conclusions It is feasible to predict the risk of female stress urinary incontinence by transperineal real-time three-dimensional ultrasound combined with clinical factors. Although, some limitations with the prediction model, it has accuracy in predicting SUI with obvious symptoms. Key words: Ultrasonography, transperineal; Surinary incontinence; Model; Predict; Risk

Occurrence of fall and its influencing factors in elderly patients with knee osteoarthritis

Objective To investigate the occurrence and influencing factors of falls in elderly patients with knee osteoarthritis (KOA) , and provide scientific reference for the prevention of falls in elderly patients with KOA. Methods Using convenience sampling method, 104 elderly patients diagnosed as KOA in orthopaedic wards of four ClassⅢ Grade A hospitals in Hangzhou from November 2017 to August 2018 were selected as subjects. General Information Questionnaire, Morse Fall Scale (MFS) and the Barthel Index (BI) for Activities of Daily Living (ADL) were applied in the investigation. Single factor analysis and multiple factor Logistic regression were used to analyze the influencing factors of falls in elderly KOA patients. Results A total of 104 questionnaires were sent out in this study, and 95 valid questionnaires were recovered, yielding an effective recovery rate of 91.35%. The incidence of falls in elderly KOA patients was 45.26% (43/95) , of which 62.79% (27/43) had fallen twice or more. There were significant differences in knee injury history, staircase climbing and falls among elderly KOA patients (P< 0.05) . There were significant differences in the risk of falls between elderly KOA patients in whether taking drugs , whether using walking , status of self-care ability , and age (P< 0.05) . Logistic regression analysis showed that history of knee injury, frequent staircase climbing and use of walking aids were the influencing factors of falls in elderly KOA patients (OR=4.028, 25.569, 3.191; P< 0.05) . Conclusions In view of the influencing factors of falls in elderly KOA patients, individualized nursing measures should be taken to strengthen falls risk assessment, carry out fall prevention related education and improve patients' social support, which will help to reduce the incidence of falls and further improve patients' quality of life. Key words: Aged; Knee osteoarthritis; Falls; Influencing factors; Questionnaire survey; Morse Fall Scale; Barthel Index for Activities of Daily Living; Prevention

Predictive effect of high density lipoprotein on acute kidney injury after adult heart surgery

Objective To investigate the effect of preoperative serum high-density lipoprotein on acute kidney injury (AKI) after cardiac surgery. Methods A retrospective analysis of 295 cases of adult patients undergoing cardiopulmonary bypass during our hospital from March 2017 to May 2017 was retrospectively analyzed. According to whether AKI was divided into two groups, AKI group(n=40) and non-AKI group(n=255). The clinical data were collected and the risk factors of AKI were analyzed by single factor and multivariate logistic regression. Results Five patients(12.5%) in the AKI group underwent bedside continuous renal replacement therapy (CRRT), 5 died in the AKI group, and 5 patients died in the non-AKI group. Multivariate logistic regression analysis showed that the high-density lipoprotein content was lower than the normal value of 1 mmol/L in patients with age, sex(male), comorbidities (hypertension and diabetes mellitus), cardiopulmonary bypass and preoperative uric acid value>420 μmol/L was also an independent risk factor for AKI after cardiopulmonary bypass. Conclusions AKI is a common complication after cardiopulmonary bypass in adults. Preoperative serum high-density lipoprotein less than 1 mmol / L can increase the probability of occurrence of AKI after surgery. Key words: Acute Kidney Injury; Cardiac Surgical Procedures; Lipoproteins, HDL

Relevance and clinicopathologic relationship of BRAF V600E, TERT and NRAS mutations for papillary thyroid carcinoma patients in Northwest China

BackgroundTo determine the relevance of the single or combination mutations of BRAF V600E, TERT, and NRAS genes and the clinicopathologic relationship in papillary thyroid cancer (PTC).MethodsPatients with PTC were enrolled into the study between February 2018 and April 2019. Based on the number of mutant genes, we classified the participants into single BRAF V600E mutation group, double mutations group and no mutation group. Single factor and multiple logistic regression analyses were applied to explore the independent factors. Review Manager 5.3 was used for meta-analysis to review the clinical efficacy of gene co-mutations.ResultsFinally, 483 patients were enrolled into the study and 419 (86.7%) of them harbored BRAF V600E mutation. TERT or NRAS mutation was likely to coexist with BRAF V600E mutation in PTC. BRAF V600E and NRAS promoter co-mutations was identified in 6 patients, with a prevalence of 1.2%. Prevalence of BRAF V600E and TERT coexistence in PTC was 2.1%. Significant differences were found among age, pathology, multifocality, bilateral lesions, lymph node metastasis, and 131I radiotherapy, P < 0.01. Multiple logistic regression analyses demonstrated that age [odds ratio (OR) = 1.044, 95% confidence interval (CI) = 1.013–1.076; P = 0.006], lymph node metastasis [OR = 0.094, 95% CI = 0.034–0.264; P < 0.001], 131I radiotherapy [OR = 7.628, 95% CI = 2.721–21.378; P < 0.001] were risk factors for BRAF V600E mutation. Besides, age [OR = 1.135, 95% CI = 1.069–1.205; P < 0.001], multiple leisions [OR = 4.128, 95% CI = 1.026–16.614; P = 0.046], pathology [OR = 3.954, 95% CI = 1.235–12.654; P = 0.021] were independent factors for combination mutations. Meta-analysis showed significant association of BRAF V600E+/TERT+ co-mutations with lymph node metastasis, multifocality, distant metastasis, tumor recurrence, extrathyroidal extension, and dead of disease.ConclusionsPrevalence of BRAF V600E mutation in Northwest China was higher than other areas. Age, multiple lesions, and pathology were independent factors for double mutation of BRAF V600E/TERT or BRAF V600E/NRAS. Coexistence of BRAF V600E and TERT promoter mutations was significantly correlated with poor outcome.

CT imaging-based histogram features for prediction of EGFR mutation status of bone metastases in patients with primary lung adenocarcinoma

ObjectiveTo identify imaging markers that reflect the epidermal growth factor receptor (EGFR) mutation status by comparing computed tomography (CT) imaging-based histogram features between bone metastases with and without EGFR mutation in patients with primary lung adenocarcinoma.Materials and methodsThis retrospective study included 57 patients, with pathologically confirmed bone metastasis of primary lung adenocarcinoma. EGFR mutation status of bone metastases was confirmed by gene detection. The CT imaging of the metastatic bone lesions which were obtained between June 2014 and December 2017 were collected and analyzed. A total of 42 CT imaging-based histogram features were automatically extracted. Feature selection was conducted using Student’s t-test, Mann-Whitney U test, single-factor logistic regression analysis and Spearman correlation analysis. A receiver operating characteristic (ROC) curve was plotted to compare the effectiveness of features in distinguishing between EGFR(+) and EGFR(−) groups. DeLong’s test was used to analyze the differences between the area under the curve (AUC) values.ResultsThree histogram features, namely range, skewness, and quantile 0.975 were significantly associated with EGFR mutation status. After combining these three features and combining range and skewness, we obtained the same AUC values, sensitivity and specificity. Meanwhile, the highest AUC value was achieved (AUC 0.783), which also had a higher sensitivity (0.708) and specificity (0.788). The differences between AUC values of the three features and their various combinations were statistically insignificant.ConclusionCT imaging-based histogram features of bone metastases with and without EGFR mutation in patients with primary lung adenocarcinoma were identified, and they may contribute to diagnosis and prediction of EGFR mutation status.

Clinical analysis on risk factors and prognosis of early post-traumatic epilepsy.

To analyze the risk factors and prognosis related to early post-traumatic epilepsy (EPTE). One hundred and eighty-six patients with traumatic brain injury were enrolled. Their full clinical data were collected. Single factor analysis and logistic regression analysis of risk factors related to EPTE were performed. The prognosis of patients was determined. Single factor analysis showed that there were significant differences of age (p = 0.011), epilepsy history (p < 0.001), injury site (p = 0.004), injury type (p < 0.001) and injury degree (p < 0.001) between the EPTE group (40 patients) and non-EPTE group (146 patients). Logistic regression analysis showed that the injury site, injury type and injury degree were the main risk factors for EPTE. The odds ratio values of injury site, injury type and injury degree were 1.977 (1.473-2.679), 2.096 (1.543-2.842) and 2.376 (1.864-3.609), respectively. The logistic regression equation was P = Exp (-1.473 + 0.698 × injury site + 0.717 × injury type + 0.935 × injury degree). The sensitivity and specificity of injury site, injury type and injury degree for predicting EPTE were 79.2% and 80.5%, 78.9% and 85.7% and 84.2% and 81.0%, respectively. The analysis of prognosis showed that the Glasgow Outcome Scale/Activity of Daily Living Scale scores in the EPTE group were significantly lower than those in non-EPTE group (p < 0.05). Injury site, injury type and injury degree are the main risk factors for EPTE. The prognosis of patients with traumatic brain injury can be affected by EPTE.

Proper dosage of primary pegylated G-CSF prophylactic use for breast cancer patients receiving adjuvant or neo-adjuvant chemotherapy.

e18354 Background: Myelosuppression during chemotherapy can lead to life-threatening infections, dose reductions, treatment delays, as well as prolonged hospitalizations, early morbidity, and early mortality. According to NCCN guideline, Pegfilgrastim 6mg per cycle is recommended for breast cancer patients receiving chemotherapy, and dosage modification based on body weight is not required. However, primary PEGylated G-CSF prophylaxis comes with significant extra cost, which has a great impact on health care resources, especially for patients without insurance coverage. Methods: We analyzed clinical data of patients, weighing between 45 and 65 kilogram, received a single subcutaneous PEGylated recombinant human G-CSF injection at fixed doses of either 3 mg or 6 mg per chemotherapy cycle approximately 24 hours after completion of each cycle of chemotherapy. Data for this retrospective study were obtained from Thyroid and Breast Surgical Department of the First Affiliated Hospital of Sun Yat-sen University between July 1, 2017, and October 31, 2017. Results: 41 cycles in 33 patients were included in 3mg PEGylated G-CSF group, and 46 cycles in 39 patients were included in 6mg PEGylated G-CSF group. Among chemotherapy cycles, the incidence of neutropenic event was19.5%and 2.2% in 3mg PEGylated G-CSF group and 6mg PEGylated G-CSF group, respectively. No patients experienced dose reductions or treatment delays in both groups. Using single-factor Logistic Regression Analysis, we found that dose of PEGylated G-CSF(3mg vs 6mg) was significantly associated with occurrence of neutropenic event(p = 0.028). Multi-factor Logistic Regression Analysis also showed that dose of PEGylated G-CSFwas significantly associated with occurrence of neutropenic event (p = 0.031). Conclusions: Our study showed that dose of prophylactic PEGylated G-CSF was significantly associated with occurrence of neutropenic events. So adequate dose of PEGylated G-CSF is important to reduce chemotherapy induced neutropenic events and to guarantee the quality of chemotherapy in patients with breast cancer.

Spiritual health and its influencing factors in primary liver cancer patients

Objective To investigate the status of spiritual health in patients with primary liver cancer and explore its influencing factors, so as to provide basis for formulating intervention measures. Methods From October 2017 to June 2018, a total of 130 patients with primary liver cancer who underwent surgical treatment in a ClassⅢ Grade A hospital were selected by purposive sampling method. Surveys were conducted using a general condition questionnaire, the Functional Assessment of Chronic Illness Therapy (FACIT-Sp) , and a Social Support Rating Scale. The influencing factors of spiritual health were analyzed by single factor analysis and Logistic regression analysis. Results A total of 119 valid questionnaires were collected. There were 67 cases with low FACIT-Sp score, accounting for 56.3%; 32 cases with intermediate grade, accounting for 26.9%; 20 cases with high grade, accounting for 16.8% among the 119 patients. Age, religious beliefs, family monthly income, whether or not receiving radiotherapy and chemotherapy, and social support were the factors affecting patients' spiritual health (P<0.05) . Conclusions The spiritual health of patients with primary liver cancer is mostly at the low-to-medium level. Nursing staff are suggested to provide tailored nursing interventions based on their influencing factors to improve their spiritual health. Key words: Liver neoplasms; Social support; Spiritual health; Influencing factors

Factors associated with the quality of life in women with perimenopausal and postmenopausal status: a cross-sectional questionnaire survey from China

Background: Many factors may influence the quality of life (QOL) of women with perimenopausal and postmenopausal status; however, systematic research is lacking. The purpose of the current study was to determine factors associated with specific dimensions of the QOL for perimenopausal and postmenopausal Chinese women. Materials and Methods: A cross-sectional study was performed and initially included 403 women aged 36-76 years who visited the menopause clinic at Peking University First Hospital between September 2012 and December 2013. Participants completed the modified Kupperman index (mKMI), overactive bladder symptom score (OABSS), and SF-36 (QOL) questionnaires. Single factor logistic regression and multiple binary logistic regression were performed to evaluate the risk factors for low QOL for perimenopausal and postmenopausal women. Results: A total of 320 women were included in the final study sample. The average age was 52.55±5.96 years, average height was 159.99±5.70 cm, the average weight was 61.37±8.47 kg, the average BMI was 23.91±3.14kg/m2, the average total score of QOL was 492.51±145.35, the average score of mKMI was 21.72±9.79, and the average score of OABSS was 2.13±2.313. Multiple logistic regression analysis showed current smoking [OR=10.132, 95%CI (1.142, 89.882), p = 0.038], mKMI [OR=9.151, 95%CI (1.996, 41.957), p = 0.004], passive attitude towards menopause [OR=3.465, 95%CI (1.878, 6.392), p = 0.000], and OABSS (OR=2.410, 95%CI (1.253, 4.636), p = 0.008] showed statistical significance towards total score of QOL. Multiple logistic regression analysis towards different dimension of QOL: factors associated with physical functioning (PF) are age, current smoking, mKMI, and OABSS. Factors associated with physical role (PR) are low frequency of sexual intercourse in the last six months, mKMI, passive attitude towards menopause, dancing, and OABSS. Factors associated with bodily pain (BP) are height, and traditional Chinese medicine (TCM) relieving menopause symptoms. Factors associated with general health (GH) are height, TCM relieving, mKMI, and passive attitude towards menopause. Factors associated with vitality (VT) are living with husband, mKMI, and passive attitude towards menopause. Factors associated with social functioning (SF) are mKMI, passive attitude towards menopause, and OABSS. Factors associated with emotional (ER) are passive smoking, low frequency of sexual intercourse in the last six months, mKMI, passive attitude towards menopause, and OABSS, Factors associated with mental health (MH) are mKMI, passive attitude, and OABSS. Linear-regression showed the different combination of relieving methods of perimenopausal symptoms, complications, relatives, and various exercises have different effects on the each dimension of QOL. Conclusion: Current smoking, mKMI, passive attitude towards menopause, and OABSS are risk factors towards the total QOL score for perimenopausal and postmenopausal Chinese women. Age, low frequency of sexual intercourse in the last six months, using TCM to relieve menopause symptoms, and passive smoking are risk factors towards some dimensions of the QOL for women during this period of life. Dancing, height, and living with husband are protective factors towards some dimensions of the QOL. Fully exploring the factors affecting women during this special period can help make more precise and effective treatments that may improve the QOL.

Risk factors of oral Helicobacter pylori infection among children in two kindergartens in Suzhou and the effects of oral cleaning on reducing oral Helicobacter pylori infection

This work aimed to identify the risk factors ofHelicobacter pylori (H. pylori) infection in preschool children and provide effective measures for the prevention and reduction of the incidence ofH. pyloriinfections. A total of 204 children from two kindergartens in Suzhou city were recruited through a questionnaire survey. Risk factors were selected through the single factor paired data χ² test and multiple factor Logistic regression analysis. Oral and gastricH. pyloriinfections were detected by using H. pylori saliva detection (HPS) and ¹³C-urea breath test (¹³C-UBT). Special toothpaste for H. pylori control was selected for oral cleaning. OralH. pyloriinfection rates at 2 months after special toothpaste treatment were examined by using HPS. The high-risk factors ofH. pyloriinfections among preschool children included poor personal hygiene habits, such as the nibbling of fingers and the avoidance of hand-washing before meals, diet, and parent's history of stomach disease.Among the 204 subjects enrolled in this study, 158 (77.45%), 37 (18.14%), and 28 (13.73%) were HPS positive, ¹³C-UBT positive, and HPS and ¹³C-UBT positive, respectively. The incidence of oralH. pyloriinfections was significantly higher than that of gastric H. pyloriinfections (P<0.01).The positive rate of infections significantly decreased after special toothpaste treatment (P<0.01). This result indicates that the intervention was effective. Children must receive education on good eating habits. Individualized dining habits or the use of public chopsticks must be implemented. H. pyloriinfections must be detected as early as possible. Specific toothpaste for oral cleaning must be selected. These approaches could drastically prevent or reduce theincidence of H. pyloriinfections among preschool children.

Correlation of the electric excitability treated with electroacupuncture at different acupoints and the prognosis of Bell's palsy

To explore the correlation of the electric excitability treated with electroacupuncture (EA) at different acupoints and the prognosis of Bell's palsy, using the Logistic regression analysis. A total of 93 patients of Bell's palsy were collected in the retrospective analysis. Acupuncture was applied to Cuanzu (BL 2), Yangbai (GB 14), Yingxiang (LI 20), Dicang (ST 4), Xiaguan (ST 7) and Qianzheng (Extra point) on the affected side. The electric stimulation was added at the three pairs of points, named Cuanzu (BL 2) and Yangbai (GB 14) (A group), Yingxiang (LI 20) and Dicang (ST 4) (B group) and Qianzheng (Extra point) and Xiaguan (ST 7) (C group), continue wave, 1 Hz at current frequency, for 30 min in one treatment. EA was given once every two days. The endpoint outcome evaluation was conducted when the facial nerve function was recovered completely after treatment or in 16 weeks after onset. On the 8th day of onset, the prognosis-related indexes were collected, such as the electric excitability grade in the A, B and C groups, gender, age, the facial nerve lesion segment and type 2 diabetes mellitus (T2DM). The Logistic regression analysis was conducted on these indexes and the prognosis. The single factor Logistic regression analysis showed that the gender, age and the electric excitability of the C group were negatively correlated with the prognosis statistically (P>0.05). T2DM, the facial nerve lesion segment and the electric excitability of the A and B groups were positively correlated with the prognosis statistically (P<0.05). The multivariate Logistic regression analysis indicated that the electric excitability in the A and B groups was the independent predictor of Bell's palsy prognosis (P<0.05). OR values were 8.410 (1.176-60.113) and 12.589 (1.355-116.922) respectively. The electric excitability of EA at the pairs of Cuanzu (BL 2) and Yangbai (GB 14), and of Yingxiang (LI 20) and Dicang (ST 4) is one of the indexes for the prognosis evaluation of Bell's palsy. It contributes to the early identification of the severity of facial nerve lesion, the regulation of the therapeutic regimen and the improvement of the clinical effects.

Risk factors of early venous thromboembolism based on Caprini model among patients with thoracoscopic lobectomy for lung

Objective To explore the risk factors of early venous thromboembolism (VTE) based on Caprini risk assessment model among patients with thoracoscopic lobectomy for lung. Methods From June 2015 to December 2017, retrospective analysis was used to collect the data of 28 patients with pulmonary embolism one week after thoracoscopic lobectomy for lung of Shanghai Chest Hospital, Shanghai Jiaotong University, in observation group. And we selected 84 patients with the same operation in the same term by convenience sampling in control group according to the ratio of 1: 3. Patients of two groups were scored with the Caprini risk assessment model. Single factor analysis and Logistic regression analysis were used to the risk factors in Caprini risk assessment model and related factors of lung lobectomy. Results The Caprini score of patients group in observation group was higher than that in control group with a significant difference (P<0.01) . The proportion of moderate risk and high risk in patients with VTE was 78.6% in observation group and was 20.2% in control group with a statistical difference in the risk classification (P<0.01) . Logistic regression analysis took patients in case group as dependent variable and 16 risk factors in clinical baseline information as the independent variable showed the body mass index≥25 kg/m2, smoking history, preoperative plasma D-dimer higher than the critical value had positive correlations with the risk of VTE after surgery (OR=13.354, 5.639, 3.084; P<0.05) . Conclusions The Caprini risk assessment model can well determine the risk factors of VTE among patients with thoracoscopic lobectomy for lung. The high risk factors of VTE of these patients may include long-term and heavy smoking, overweight and preoperative plasma D-dimer higher than the critical value. Key words: Venous thrombosis; Pulmonary embolism; Risk factors; Thoracoscopes; Lung lobectomy; Caprini model

Association of nocturnal serum cortisol level with diabetic microvascular complications in overweight/obese type 2 diabetic patients

Objective To explore the association of nocturnal serum cortisol levels with diabetic microvascular complications in overweight or obese patients with type 2 diabetes mellitus. Methods Serum cortisol levels of 316 overweight or obese type 2 diabetic patients were tested at midnight by the method of chemiluminescence. Diabetic microvascular complications were compared among various groups according to nocturnal serum cortisol levels. All the patients with nocturnal serum cortisol level >50 nmol/L were asked to undergo overnight low-dose dexamethasone suppression test to rule out the possibility of subclincal Cushing′s syndrome. The incidences of diabetic nephropathy (DN), diabetic retinopathy (DR), and diabetic peripheral neuropathy (DPN) were examined in all the patients. Results (1)The incidence of DN was gradually increased from 13.3% to 27.7% and 44.2% in patients with low, medium, and high cortisol level groups, showing a statistical difference among 3 groups(P<0.05). The incidences of DR in medium and high cortisol level groups were higher than that in low cortisol level group (40.6% and 47.7% vs 22.7%, both P<0.01). The incidence of DPN in high cortisol level group was higher as compared with low cortisol level group (60.5% vs 38.7%, P<0.01). (2)Nocturnal serum cortisol level in patients with diabetic microvascular complications was higher than that in patients without complications [ (136.87±105.78 vs 97.55±93.48) nmol/L, P<0.01]. Nocturnal serum cortisol level in patients with multiple diabetic microvascular complications was higher than that in patients with single diabetic microvascular complication [ (151.66±114.54 vs 117.69±90.26) nmol/L, P<0.05]. (3)Single factor logistic regression analysis showed that higher nocturnal serum cortisol level was a risk factor for diabetic microvascular complications in addition to female, age, longer diabetic duration, higher fasting plasma glucose (FPG). Multivariate logistic regression analysis showed that higher nocturnal serum cortisol level was still a risk factor for diabetic microvascular complications after adjusted by diabetic duration, FPG, HbA1C, and the use of insulin (P=0.013). Conclusion Nocturnal serum cortisol level seems to be a risk factor for diabetic microvascular complications in overweight or obese patients with type 2 diabetes mellitus. (Chin J Endocrinol Metab, 2018, 34: 834-838) Key words: Overweight; Obese; Diabetes mellitus, type 2; Cortisol; Diabetic microvascular complications

Clinical manifestations and risk factors of poor prognosis of Acinetobacter baumannii intracranial infection

Objective: To investigate the clinical features and risk factors for poor prognosis in patients with intracranial Acinetobacter baumannii infection. Methods: Retrospective analysis of data of patients who were hospitalized in the First Affiliated Hospital of AnHui Medical University between January 2011 and December 2017, and whose cerebral spinal fluid samples were positive for Acinetobacter baumannii and who were clinically demonstrated as intracranial infection during hospitalization was performed. Risk factors for poor prognosis were analyzed using single factor analysis and logistic regression analysis. Results: A total of 50 patients were included, with poor prognosis rate of 58% (29/50).92% of patients had history of craniotomy or operation of site adjacent to brain.Major type of intracranial infection was purulent meningitis.Fever rate was 100%.Multidrug resistant Acinetobacter baumannii accounted for 89.01%. Sensitivity to meropenem was only 9.09%.Shock, multi-drug resistant bacteria and no intrathecal injection were risk factors for poor prognosis of patient.Multi-factor logistic regression analysis showed "no intrathecal injection" was independent risk factor for poor prognosis of patients with intracranial Acinetobacter baumannii infection. Conclusions: Acinetobacter baumannii that induced intracranial infection is mostly highly drug-resistant bacterium, with high risk of post-infection poor prognosis.Clinically, it is essential to take proper peri-operative measures and early identify occurrence of intracranial infection.Reasonable application of anti-infection drug and external ventricle drainage, especially intrathecal injection of aminoglycosides, can be promoted as a kind of safe and effective means.

Public willingness to pay and participate in domestic waste management in rural areas of China

Broad and sustainable public willingness to pay (WTP) and willingness to participate (WTPP) are the basis of successful domestic waste management. Using questionnaires and statistical methods, we investigated the public WTP (73.72%), the public WTPP including willingness to use collection facilities (90.61%), to sort waste (78.70%), to deliver waste (93.28%) and to dispose waste (69.28%), the public willingness to work as a cleaner (62.50%), and their influential socioeconomic factors in rural areas of China, in order to provide more effective and practical policies for the waste management. Results indicated that men and wealthy subjects had greater WTP than women and poor subjects. Demonstration projects and public awareness of waste treatment necessity had significantly positive effects on WTP and WTPP. Villagers who received propaganda were more WTP and WTPP. Perception of environmental pollution could significantly enhance WTP without considering other factors. The older subjects had weaker WTPP compared with the youngest subjects based on single factor logistic regression. Education had a significant positive effect on and high correlation with WTP and WTPP, respectively. Public WTP and willingness to deliver waste decreased exponentially with increases in service fee and delivery distance, respectively. Public willingness to work as a cleaner exhibited logarithmic growth as expected wages increased. In the future, it will be necessary to take effective measures for rural waste management, such as providing demonstration programs, enhancing public awareness of waste treatment necessity, considering influences of service fees, delivery distance and expected wages, and developing sustainable rural economy to increase residents’ incomes.

Clinical characteristics associated with therapeutic nonadherence of the patients with major depressive disorder: A report on the National Survey on Symptomatology of Depression in China.

Nonadherence is one of the leading challenges to treatment of the major depressive disorder (MDD). Few studies have systematically analyzed the relationship between clinical characteristics, especially symptoms of depressive patients and their therapeutic nonadherence over a relatively large sample. This study aimed to investigate factors of nonadherence in a nationwide survey in China. Participants with MDD who met the criteria of Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) were recruited from 32 sites throughout China. Patients were all over 16years old. A doctor-rating questionnaire with 64 symptoms based on DSM-IV was constructed to evaluate depression-related feeling and behavior. Single-factor logistic regression was utilized to screen variables, and multifactor logistic regressive analysis was used to identify which factors were risk or protective for nonadherence. We included 882 patients of poor adherence and 857 patients of good adherence. Recurrence, untreated first episode, tricyclic antidepressant (TCA)-treated first episode, antidepressant-only-treated current episode, decrease or loss of interest, more somatic symptoms, and "atypical" symptoms were risk factors for nonadherence, whereas selective noradrenaline reuptake inhibitor (SNRI)-treated first episode was a protecting factor. Clinical characteristics may play an important role in predicting nonadherence. Doctors may have to pay much attention on patients with these factors and should keep on discussing them with patients.

Establishment of grading model of knee osteoarthritis based on clinical research system

The factors influencing the grade of knee osteoarthritis were screened by ordered Logistic regression analysis. The classification model of knee osteoarthritis was established, which provided tool for the evaluation of clinical classification of knee osteoarthritis. A total of 753 cases of knee osteoarthritis from Wangjing Hospital, China Academy of Chinese Medical Sciences were treated with single factor and multivariate Logistic regression analysis from September 18, 2014 to April 26, 2016. The model formula was constructed and evaluated. In this study, it was found that 13 factors associated with knee osteoarthritis grading. Old age, obesity, long course of disease, recurrence, lower limb deformity, quadriceps muscle atrophy, WOMAC index, TCM syndrome score, VAS score and grading degree were positively correlated. One knee pain, limited pain range, knee activity and grading degree were negatively correlated. The knee osteoarthritis grading model was constructed and the evaluation test was effective(Training set AUC=0.860, test set AUC=0.879). In this study, a classification model of knee osteoarthritis was established which has a good ability to predict the classification of knee osteoarthritis under preliminary evaluation.

Blood pressure level and arterial stiffness parameters role in prediction of the antihypertensive therapy efficacy escape phenomenon

The aim of the study was to evaluate blood pressure (BP) level and vessel wall stiffness parameters role in antihypertensive therapy (AHT) escape phenomena development on the background of primarily effective AHT use. Materials and methods. Data from 102 patients with arterial hypertension level 1-3, stage I-II were analyzed. All patients underwent individual AHT adjustment for 2-3 weeks (adjustment period). At the end of the adjustment period the therapy effectiveness was evaluated with clinical BP measurement (target BP values less than 140/90 mm hg) and 24-hour BP monitoring (target daily BP values less than 130/80 mm hg). The study included only those patients who reached target clinical and daily BP values on the background of 2-3 antihypertensive drugs use at the end of the adjustment period. At the beginning of the observation period after effective AHT was used carotid-femoral pulse wave velocity was evaluated with applanation tonometry. For the purpose of timely escape phenomena diagnosis clinical BP measurement and 24-hour BP monitoring were performed in 1, 3, and 6 months after the trial start in all patients. Results. After 6 months of observation patients were divided in 2 groups: group 1 included 34 patients with AHT escape phenomena, group 2 - 68 patients with stable, controlled AH. In group 1 on the background of effective AHT use at the beginning of observation higher levels of following measures were observed: clinical systolic BP - SBP (125.2±11.3 mm hg vs 119.7±11.7 mm hg, p=0.021), daily SBP (128.0±3.3 mm hg vs 121.2±7.4 mm hg, p=0.000), daily average SBP (131.6±4.9 mm hg vs 125.3±8.5 mm hg, р=0.000), night average SBP (120.4±8.5 mm hg vs 111.8±8.6 mm hg, р=0.000), daily pulse BP 50.2±4.8 mm hg vs 44.2±7.6 mm hg, p=0.000), daily mean brachial artery stiffness index - ASI (161.9±28.3 mm hg vs 142.2±24.5 mm p=0.000), carotid-femoral pulse wave velocity (11.6±2.5 m/s vs 10.5±2.3 m/s, p=0.029). In single-factor logistic regression models all these measures were shown to have predictive value in AHT escape phenomena development. According to multifactor logistic regression analysis that included carotid-femoral pulse wave velocity more than 10.8 m/s, daily mean ASI&gt;137, daily SBP&gt;124 mm hg, and daily pulse BP&gt;46 mm hg, the only independent predictor on the background of effective AHT at the beginning of the observation was daily SBP&gt;124 mm hg (odds ratio 19.1, 95% confidence interval 3.6-101.8; p=0.0004). Conclusion. BP level and artery stiffness index measured on the background of effective AHT at the beginning of the observation are predictors for escape phenomena development and can be used for effectiveness and required frequency of therapy management prognosis.

Predictive value of neurophysiological monitoring in facial nerve function after cerebellopontine angle tumor surgery

Objective To investigate the predictive value of preoperative and intraoperative electrophysiological parameters in facial nerve (FN) function after cerebellopontine angel (CPA) tumor surgery. Methods A total of 58 patients with CPA tumor underwent operations from August 2016 to March 2017 at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University and were enrolled into this retrospective study. Preoperative blink reflex (BR) and FN F wave response were tested in all patients. The R1 component latency and mean F wave latency were determined. Intraoperative facial motor evoked potentials (FMEP) was applied to monitor the FN function and the amplitude ratio of FMEP was documented. According to the House-Brackmann (H-B) grading system, the functional classification of FN was determined preoperatively, at 1 week, 3 months and 6 months postoperatively. Multiple logistic regression analysis was applied to explore the predictor of postoperative FN function. Results A total of 58 cases of CPA tumor underwent microsurgical excisions by retrosigmoid approach. Total and subtotal resections were performed in 55 (94.8%) and 3 cases, respectively. Single factor Logistic regression analysis showed that the results of blink reflex in patients with good FN outcome were better than those in the group with poor outcome at 3 follow-up time points (P<0.05). The results of F wave response in patients with good FN outcome were better than those in poor outcome group at 6 months post operation (P<0.05). At 3 and 6 months post surgery, the maximal tumor diameters in the good outcome group were (31.9±10.2) mm and (31.9±9.3) mm, respectively, which were smaller than those in the poor outcome group [(37.8±9.7) mm and (40.0±10.0) mm, respectively] (both P<0.05). At 1 week, 3 and 6 months post surgery, the FMEP amplitude ratios in the good outcome group were (84.6±21.3)%, (83.0±19.0)% and (81.0±19.1)%, respectively, which were higher than those in the poor outcome group [(66.2±27.0)%, (63.4±29.0)% and (59.6±31, 2)%] (all P<0.05). Multivariate Logistic regression analysis showed that FMEP amplitude ratio was the independent predictor of FN outcome at 1 week, 3 and 6 months post operation (P<0.05). The maximal tumor diameter was the independent predictor of FN outcome at 3 and 6 months post operation (P<0.05). BR classification was the independent predictor of FN outcome at 6 months after operation (P<0.05). ROC (receiver operating characteristic) curve analysis showed that the FMEP amplitude ratio cut-off values of 89.2% [AUC (area under the curve)=0.709], 58.2% (AUC=0.706) and 58.2% (AUC=0.713) predicted good FN function at 1 week, 3 and 6 months after surgery, respectively. Conclusions BR and maximal tumor diameter have certain predictive values for postoperative FN function. The FMEP amplitude ratio is a valuable predictor for postoperative FN function and its value of at least 60% is predictive of favorable long-term postoperative FN function. Key words: Cerebellopontine angle; Brain neoplasms; Facial nerve; Electrophysiology; Forecasting