Univariate Regression Analysis Research Articles

Validation of prognostic scores for predicting acute liver failure and in-hospital death in patients with dengue-induced severe hepatitis

BACKGROUND Acute liver failure (ALF) in dengue is rare but fatal. Early identification of patients who are at risk of ALF is the key strategy to improve survival. AIM To validate prognostic scores for predicting ALF and in-hospital mortality in dengue-induced severe hepatitis (DISH). METHODS We retrospectively reviewed 2532 dengue patients over a period of 16 years (2007-2022). Patients with DISH, defined as transaminases > 10 times the normal reference level and DISH with subsequent ALF, were included. Univariate regression analysis was used to identify factors associated with outcomes. Youden’s index in conjunction with receiver operating characteristic (ROC) analysis was used to determine optimal cut-off values for prognostic scores in predicting ALF and in-hospital death. Area under the ROC (AUROC) curve values were compared using paired data nonparametric ROC curve estimation. RESULTS Of 193 DISH patients, 20 developed ALF (0.79%), with a mortality rate of 60.0%. International normalized ratio, bilirubin, albumin, and creatinine were independent predictors associated with ALF and death. Prognostic scores showed excellent performance: Model for end-stage liver disease (MELD) score ≥ 15 predicted ALF (AUROC 0.917, sensitivity 90.0%, specificity 88.4%) and ≥ 18 predicted death (AUROC 0.823, sensitivity 86.9%, specificity 89.1%); easy albumin-bilirubin (ALBI) score ≥ -30 predicted ALF and death (ALF: AUROC 0.835, sensitivity80.0%, specificity 72.2%; death: AUROC 0.808, sensitivity 76.9%, specificity 69.3%); ALBI score ≥ -2 predicted ALF and death (ALF: AUROC 0.806, sensitivity 80.0%, specificity 77.4%; death: AUROC 0.799, sensitivity 76.9%, specificity 74.3%). Platelet-ALBI score also showed good performance in predicting ALF and death (AUROC = 0.786 and 0.699, respectively). MELD and EZ-ALBI scores had similar performance in predicting ALF (Z = 1.688, P = 0.091) and death (Z = 0.322, P = 0.747). CONCLUSION MELD score is the best predictor of ALF and death in DISH patients. EZ-ALBI score, a simpler yet effective score, shows promise as an alternative prognostic tool in dengue patients.

CMR and adverse clinical outcomes in peripartum cardiomyopathy

BackgroundPeripartum cardiomyopathy (PPCM) is associated with significant morbidity and mortality. Recent studies show recovery of left ventricular ejection fraction (LVEF) can still be associated with longitudinal adverse clinical outcomes. Cardiac MRI (CMR) may yield additional prognostic parameters of serious adverse outcomes (SAE) beyond LVEF. MethodsIndividuals with PPCM and CMR within 3 months of diagnosis were analyzed from the Investigations in Pregnancy Associated Cardiomyopathy (IPAC) trial and our institution from 2010-present. Indexed left ventricular (LV) mass, ventricular volumes, cardiac output, global longitudinal strain (GLS), extracellular cellular volume (ECV) as well as epicardial fat volume (EFV) were analyzed. SAEs included left ventricular assist device (LVAD), heart transplant and death. CMR parameters were compared between SAE and no SAEs groups by non-parametric techniques. ResultsAmong 51 individuals with mean age of 31 years at diagnosis, 6/51 (12 %) experienced 11 adverse outcomes. EF at time of CMR (15.0 vs 37.3 %, p < 0.001), peak GLS (−4.1 % vs −10.0, p = 0.002) and ECV (43.6 vs 28.2, p = 0.02) differed significantly among groups. In univariate regression analysis, worse LVEF, lower peak GLS and higher mean ECV along with greater LVESVi were predictive of adverse outcomes. ConclusionPrior studies found baseline LVEF by echo is a predictor of serious adverse outcomes. CMR identified LVESVi, peak GLS and ECV as additional predictors of adverse outcomes. If confirmed in larger studies, diffuse myocardial fibrosis may represent a therapeutic target in PPCM.

Positive signs from the history as an aid for early diagnosis in functional movement disorders: The prospective TASMAN study.

There has been a concerted move in recent times to shift from an exclusionary to a positive diagnosis of functional movement disorders (FMDs). To date, most of the focus has been on defining positive physical signs. Here the focus was on the diagnostic specificity of specific symptoms and patient characteristics. For this prospective cohort study, newly referred patients in the Netherlands and Australia were recruited before their first neurology appointment. Participants completed questionnaires within 2 months prior to their visit at one of the six different clinics. Directly following the first consultation, physicians received a questionnaire about their diagnostic process. Patients were excluded if the diagnosis was not a movement disorder. Univariate and multivariate regression analyses were conducted to identify predictors of FMDs. Subsequently, a predictive model was constructed and assessed using the area under the receiver operating curve. Between 1 March 2021 and 1 March 2023, 465 patients were eligible for inclusion, of whom 171 (37%) had an FMD and 294 (63%) a non-FMD. Distinguishing factors amongst these groups included age at onset, gender, history or family history of a functional and psychiatric disorder, sudden onset, specific triggers, fluctuation patterns throughout the day and over an extended period, pain, fatigue, depression, anxiety and dissociation. Using these, a predictive model was developed, yielding a discriminative accuracy of 88%. Specific symptoms and patient characteristics have high diagnostic discriminative value between FMDs and non-FMDs, providing an additional tool in positive diagnosis.

Association of adenoid hypertrophy and clinical parameters with preoperative polygraphy in pediatric patients undergoing adenoidectomy.

Adenotonsillar hypertrophy is the most frequent cause for obstructive sleep apnea (OSAS) in children. In patients with small tonsils and where adenoid size cannot be assessed, the indication for adenoidectomy often relies on clinical symptoms. However, data on the association of clinical parameters and adenoid hypertrophy with OSAS severity in children undergoing an adenoidectomy is sparse. To investigate the correlation of patient characteristics, adenoid hypertrophy, and clinical symptoms with OSAS severity in pediatric patients indicated for an adenoidectomy. We performed a retrospective chart review of all pediatric patients at our tertiary referral center between 2018 and 2023 who underwent polygraphy (PG) for OSAS diagnostics. Adenoid hypertrophy was assessed as adenoid-choanal ratio (AC-ratio) via nasal endoscopy and clinical symptom score (CS) via physical examination and parental survey. We included all symptomatic children with mild to severe OSAS (apnea-hypopnea index (AHI) ≥ 1). Exclusion criteria were obesity according to BMI and/or the presence of systemic diseases. The patients were divided according to age in a preschool and school cohort. Patient characteristics and PG data were compared between both groups. Linear regression analysis was used to investigate the association of AC-ratio, CS and BMI with the AHI. A total of 121 patients were identified of which 81 were included in our study, resulting in 42 and 39 patients from 3-5 and 6-14years of age, respectively. We observed a significant correlation between CS and BMI (p = 0.026) and the CS and AC-ratio (p < 0.001). Univariable regression analysis showed significant association of the AC-ratio and CS with AHI-score for the total (p < 0.001), the preschool (p < 0.001), and the school cohort (p < 0.001). In multivariable regression analysis, the significant association of AC-ratio and CS remained in the total (p = 0.014; p < 0.001), and the preschool cohort (p = 0.029; p = 0.002). However, only the CS remained as positive predictor in the school cohort. AC-ratio and clinical symptoms seem to be reliable predictors for OSAS severity in patients between 3-14years of age. Moreover, only clinical symptoms were associated with OSAS severity in schoolchildren. Future investigation should contribute to the validation of our results.

Predictors of lethal COVID-19 in patients of intensive care unit

Goal This study aimed to identify potential independent routine laboratory predictors of lethal COVID-19 in critically ill patients admitted to the ICU from August 1st to October 31st 2021, when the SARS-COV-2 delta variant prevailed in the region. Materials and Methods A retrospective single-center study case-control included 120 patients hospitalized to ICU №2 of the Samara Regional Clinical Hospital named after Seredavin from August 1st to October 31st 2021. The infection with SARS-COV-2 virus was verified with a real-time PCR test of the samples obtained from the nasopharynx. Results The study included 120 patients hospitalized to ICU with a severe form of ARDS caused by COVID-19-associated pneumonia. The results of the comparative analysis showed significant differences between the groups of survived and died patients when they were admitted to ICU. Died patients were older, had lower lymphocyte count, higher levels of glucose, ASAT, CPK, LDH, creatinine, BUN, and potassium, had lower cardiac output, and severe pulmonary lesions. Conclusion The single-center study included 120 patients with a severe form of COVID-19 that required their hospitalization to ICU. Univariate and multivariate regression analysis showed that the levels of LDH, BUN, glucose, ASAT, and lymphocyte count can act as independent predictors of the lethal outcome and have to be taken into account by ICU specialists during the evaluation of the clinical condition of patients for timely indication of the relevant therapy. The obtained data agree with previous studies that aimed to identify predictors of the severe course of COVID-19. However, further multi-center studies on larger cohorts of patients should be conducted for the identification of more precise associations between various predictors of lethality. It will help to reveal patients with a high risk of unfavorable outcomes after admission to ICU.

Prevalence and social determinants of self-reported health status among reproductive age women in Nepal.

The self-reported health status (SRHS) is a subjective evaluation of an individual's health and has been connected to mortality and future health outcomes in numerous studies. However, the determinants of SRHS among women in Nepal remain largely unclear. In Nepal, traditional gender norms often result in women bearing greater responsibilities in terms of household chores, child-rearing, and taking care of elderly family members, all of which may potentially contribute to lower self-perceived health. Therefore, this study aims to identify the factors influencing SRHS among women in Nepal. The study utilized data from 7,442 women aged between 15 and 49 who participated in the Nepal Demographic and Health Survey (NDHS) 2022. Both univariate and multiple linear regression analyses were employed to ascertain the factors influencing self-rated health status (SRHS) among women in Nepal. Women in the age groups 15-24years (AOR: 5.14, 95% CI: 3.07-8.62) and 25-34years (AOR: 2.71, 95% CI: 1.99-3.68) were more likely to report good health status compared to older age groups. Additionally, women who were never married (AOR: 4.89, 95% CI: 3.62-5.32) or currently married (AOR: 1.46, 95% CI: 1.11-2.20) and those from wealthy families (AOR: 1.54, 95% CI: 1.07-2.21), also had a higher likelihood of reporting good health status. Other factors associated with a higher probability of reporting good health included not having a history of terminated pregnancy (AOR: 1.48, 95% CI: 1.11-1.97), having no history of genital discharge (AOR: 1.75, 95% CI: 1.29-2.38), not visiting a health facility in the last 12months (AOR: 2.03, 95% CI: 1.43-2.88), and having no genital ulcers in the previous 12months (AOR: 2.02, 95% CI: 1.24-3.28). Conversely, women with mild to severe depression and anxiety were less likely to report good health status compared to those with no depression or anxiety. This study identified several social determinants of SRHS among Nepalese women. These socioeconomic determinants of health should be included in future research and health policy activities in Nepal and other comparable contexts.

Assessment of forensic medicine education impact on medical students' knowledge and specialisation attitudes: a multicenter analysis from Italian universities.

This study aimed to assess students' knowledge, awareness, and attitudes regarding forensic-medicine concepts taught during a Medicine and Surgery degree program at eight Italian universities. Additionally, the study aimed to evaluate the impact of the course on students' knowledge and attitudes toward choosing medical residency. A cross-sectional study was conducted through an anonymous web-based survey of medical students at eight italian universities. Descriptive, univariate, and logistic regression analyses were performed for the selected questions. The survey was completed by 1022 students. Forensic medicine appears to be important for providing training in the fundamental concepts of forensic medicine, especially professional liability, defensive medicine, and forensic pathology. The descriptive and univariate analyses demonstrate that the course can assist students in choosing their specialisation school. The multivariate analysis highlighted the impact of the forensic medicine course on orienting students' choice of medical residency, increasing it by nine times after attending the course. In the logistic regression analysis of the influence of medical liability on the choice of medical residency, students recognised a doubled effect after attending the course. Finally, the perceived usefulness of the course was significantly higher after attendance. Forensic medicine courses have the task of defining the duties and responsibilities of forensic physicians, providing indispensable tools for future medical practitioners regardless of their future specialisation, and limiting the increasing use of defensive medicine. In conclusion, it is imperative for governments to implement measures directed at diminishing the risk of burnout arising from the ongoing pressure associated with the fear of medicolegal litigation, encompassing both criminal and civil contexts.

Laser-Induced Breakdown Spectroscopy and a Convolutional Neural Network Model for Predicting Total Iron Content in Iron Ores.

Laser-induced breakdown spectroscopy (LIBS) is a rapid method for detecting total iron (TFe) content in iron ores. However, accuracy and measurement error of univariate regression analysis in LIBS are limited due to factors such as laser energy fluctuations and spectral interference. To address this, multiple regression analysis and feature selection/extraction are needed to reduce redundant information, decrease the correlation between variables, and quantify the TFe content of iron ores accurately. Overall, 339 batches of iron ore samples from five countries were obtained from the ports of China during the discharging, and 2034 representative spectra were collected. A convolutional neural network (CNN) model for total iron content prediction in iron ores is established. The performance of variable importance random forest (VI-RF), variable importance back propagation artificial neural network (VI-BP-ANN), and CNN-assisted LIBS in predicting the TFe content of iron ores was compared. Coefficient of determination (R2), root mean square error (RMSE), mean relative error (MRE), and modeling time were selected for model evaluation. The result shows that variable importance significantly enhances the quantitative accuracy and reduces modeling time compared to traditional BP-ANN and RF models. Moreover, the CNN model outperformed manual feature selection methods (VI-BP-ANN and VI-RF), exhibiting the shortest modeling time, highest R2, lowest RMSE, and MRE. CNN model's unique characteristics, such as weight sharing and local connection, make it well suited for analyzing high-dimensional LIBS data in multivariate regression analysis. Our approach demonstrates the effectiveness of machine learning and deep learning approaches in improving the accuracy of LIBS for TFe content prediction in iron ores. CNN-assisted LIBS method holds great potential for practical applications in the mining industry.

Investigating the Relationship between Knowledge Management and Patient Relationship Management and the Mediating Role of Knowledge Sharing

Background: Individuals and their skills in learning and sharing knowledge are regarded as fundamental factors in the competitive success of organizations. Hence, this study aims to investigate the relationship between knowledge management and patient relationship management and the mediating role of knowledge sharing among the staff of Shahid Ayatollah Dastgheib Hospital in Shiraz. Methods: This study employs a descriptive, cross-sectional, and correlational design. The statistical population included all the staff of Shahid Dastgheib Hospital in Shiraz in 2023, totaling 250 individuals. The sample size was determined to be 155 individuals using Morgan table and was selected through stratified random sampling as the final sample, based on quotas. 1-Knowledge Management Questionnaire and Dixon’s Standardized Knowledge Sharing Questionnaire . Data were analyzed via Pearson correlation coefficient and univariate regression analysis using SPSS-25 software. Results: The findings indicated a significant relationship between the mean score of knowledge management and the mean score of patient relationship management (P = 0.001). Knowledge management can positively and significantly predict communication with the patient (P=0.001, β=0.276) and knowledge sharing can positively and significantly predict communication with the patient )P= 0/001, β = 0.255). Conclusion: It appears that enhancing knowledge management, knowledge sharing, and relationships among hospital staff are concepts closely linked to productivity, effectiveness, and performance of personnel and organizations.

Association Between Standard Gait Measures and Anterior Quadriceps Muscle Thickness as Measured by Point of Care Ultrasound (POCUS)

Background: Gait parameters and sarcopenia both predict falls risk among older adults. Our objective was to evaluate whether fast, easy-to-obtain measures of anterior thigh muscle by point of care ultrasound (POCUS) are significantly associated with standard gait measures. Methods: All subjects were referred from ambulatory geriatric medicine clinics at an academic center. Quadriceps muscle thickness was measured by a portable ultrasound device. Gait variables were measured by the patient in comfortable walking shoes walking for six minutes. The primary response variables were gait variables, and the predictor variables were age, biological sex, body mass index, and muscle thickness. Univariate and multivariate regression analyses were performed. Results: A total of 150 participants were recruited from geriatric medicine clinics (65 women, 84 men). Muscle thickness was measured in 149 participants, and the mean (SD) was 1.91 (0.52) (median 1.82 cm, 0.96 to 3.68 cm). Univariate analysis of gait parameters with age showed a statistically significant correlation with gait speed (R2=0.16, P &lt; 0.000), average stride length (R2=0.142, P &lt; 0.000), and average stride velocity (R2=0.182, P &lt; 0.000). Among all the gait variables, average swing time (P = 0.010) and average stance time (P = 0.010) were correlated significantly with muscle thickness. For multivariate analysis with age and gait variables, age was a significant independent variable for all gait variables that were significant in univariate analysis. Conclusion: POCUS showed a significant association with average swing time, average stance time, and step time variability. Although more work needs to be done, POCUS has the potential to be a rapid screening tool for gait assessment.

Association between trandsferrin receptor and urine cobalt: NHANES 2015-2020

Abstract. The transferrin receptor protein 1 (TfR1) is a critical cellular membrane protein. It orchestrates the internal transport and metabolism of iron, a vital process for intracellular functions. Additionally, TfR1 has the capacity to bind with metals beyond iron, including cobalt and manganese; however, the specific mechanisms of this binding and subsequent interactions with other proteins remain elusive. This study delves into the potential correlation between TfR1 levels in humans and the presence of cobalt in urine. Drawing on data from 3,424 participants across three survey cycles spanning two years each, this paper meticulously contrasts the clinical features of individuals across diverse TfR1 and urinary cobalt levels. Through the lens of both univariate and multivariate linear regression analyses, the research uncovers an inverse connection between TfR1 concentrations and urinary cobalt, post exclusion of participants with incomplete biochemical profiles. This inverse relationship could shed light on the complex interplay between TfR1 and metal ions within the body, providing a deeper understanding that may inform future studies and potential clinical applications. In the multivariate linear regression analysis, it is found that with the increasing of TFR1 quartiles, the proportion of obese participants (P&lt;0.01), high level blood manganese, high cobalt level in urine and blood (P&lt;0.01) increased gradually. This association remained significant in sensitivity analysis, while in the stratified analysis, above association was not significant in men with samples aged 65 and over. Transferrin receptor protein levels might be positively associated with urinary cobalt in the general U.S. crowd.

Analysis of intraocular lens tilt and decentration after cataract surgery in eyes with high myopia using the anterior segment optical coherence tomography.

This retrospective study investigated the degree of intraocular lens (IOL) tilt and decentration after cataract surgery in eyes with varying degrees of myopia using the anterior segment optical coherence tomography (AS-OCT). Eyes of 76 patients were analyzed and divided into three groups: mild myopia (emmetropia to - 1.5 diopter [D], Group 1), moderate myopia (- 1.5 D to - 6.0 D, Group 2), and high myopia (over - 6.0 D, Group 3). Postoperative IOL decentration, tilt, and lens diameter were evaluated using swept-source AS-OCT under mesopic conditions without dilation eyedrop. Postoperative parameters revealed no difference in IOL tilt, but IOL decentration was significantly different among the groups, and the degree of decentration was greater in Group 3 (P = 0.007). Univariable regression analysis indicated that age, sex, preoperative uncorrected distant visual acuity, corrected distant visual acuity, intraocular pressure, spherical equivalent, preoperative anterior chamber depth and lens thickness had no influence on postoperative IOL decentration, but axial length (AL) was significantly related to IOL decentration (P = 0.001). This association was confirmed using multivariable regression analysis, establishing a significant correlation between AL and IOL decentration (P = 0.001) on AS-OCT, showing an increase in IOL decentration associated with increasing AL.

Cardiac arrhythmias during and after thoracic irradiation for malignancies.

Cardiac arrhythmia has been reported as a significant complication of thoracic radiotherapy. Both bradyarrhythmias and tachyarrhythmias have been reported, highlighting the arrhythmia-modulating potential of radiation in certain oncologic therapies. This study aimed to analyse the arrhythmic burden in patients with cardiac implantable electrical devices (CIEDs) undergoing thoracic irradiation, examining both immediate effects of radiotherapy and long-term sequelae post-therapy. A retrospective cohort study was conducted involving patients with CIEDs who received thoracic radiotherapy between January 2012 and December 2022. Two distinct analyses were performed involving (1) daily CIED follow-ups during radiotherapy and (2) long-term arrhythmic outcomes post-therapy. For long-term outcomes, Patients were matched in a 1:2 ratio with non-irradiated controls based on age, sex, cardiovascular risk factors, cardiac disease, and beta-blocker use. Statistical analyses included negative binomial regression and propensity score matching. A total of 186 patients underwent daily CIED monitoring during radiotherapy, with 79 receiving thoracic irradiation. Thoracic irradiation was negatively associated with atrial arrhythmia (OR 0.11 [0.02;0.70, 95% CI], adjusted p = 0.0498) and there was a tendency towards less ventricular events (OR 0.14 [0.02;1.41, 95% CI], adjusted p = 0.3572) during radiotherapy in a univariate regression analysis. This association was not significant in the multivariate (OR 0.44 [0.10;1.80, 95%-CI], p = 0.16) model including a history of atrial fibrillation, diabetes and beta-blocker use. Coronary artery disease was associated with an increase in atrial and ventricular arrhythmia. For the long-term analysis, 122 patients were followed up after thoracic (N = 33) and non-thoracic radiation (N = 89) and compared to 244 matched controls drawn from approximately 10.000 CIED-patients. There was no significant increase in arrhythmic events compared to controls over a median follow-up of 6.6months. A previous history of ventricular or atrial arrhythmic events was the strongest predictor for events during the follow-up. Thoracic radiotherapy can be safely administered in patients with CIEDs. However, patients with a history of arrhythmia are more prone to arrhythmic events during and after radiation. These findings highlight the need for personalized arrhythmia management strategies and further research to understand the mechanisms underlying the antiarrhythmic effects of thoracic radiation.

The 5-factor modified frailty index as a prognostic factor for stereotactic radiosurgery in meningioma management.

Meningiomas are the most frequent primary intracranial malignancy. While surgical resection can confer long term tumor control, stereotactic radiosurgery (SRS) is often used for small, asymptomatic tumors in the adjuvant setting. Frailty has been associated with increased rates of peri-operative morbidity but has yet to be defined in the setting of SRS for meningiomas. We therefore sought to examine the relationship between frailty and clinical/radiographic outcomes of patients with meningiomas who have undergone SRS. A single-center, retrospective cohort study classified patients by their 5-factor modified frailty index (mFI-5) score into pre-frail (0-1) and frail (2-5) at the time of SRS treatment. Evaluations of overall survival (OS), progression free survival (PFS), local control (LC), and distant control (DC) were performed using Kaplan-Meier analysis. Cox proportional hazards regression analysis was used to further define factors associated with OS/PFS. 94 patients met inclusion criteria and underwent SRS for meningioma treatment from 2019 to 2023. Analyses compared prefrail (0-1) and frail (2-5) individuals. Kaplan-Meier analysis demonstrated a near significant association between frailty and OS (HR 3.66, 95% CI 0.49-26.8 p = 0.05) with 3-year OS rates of 75.4% in the pre-frail versus 36.6% in the frail group. However, a significant relationship was demonstrated between frailty and PFS (HR: 2.95 95% CI 1.12-7.81, p = 0.02) with 3-year PFS rates of 90.5% in the pre-frail group versus 49.2% in the frail group. Univariable regression analysis demonstrated that frailty, prior surgical excision, and cumulative tumor volume predicted PFS. Frailty, as assessed by the mFI-5, did not independently predict OS but did predict PFS in individuals with meningioma undergoing SRS.

Development and validation of survival nomograms for patients with anaplastic thyroid carcinoma: a SEER program-based study.

We aimed to study the prognostic risk factors affecting patients with anaplastic thyroid carcinoma (ATC), develop a clinical prognostic model, and assess patient survival outcomes. Patients with anaplastic thyroid carcinoma from 2000 to 2019 were selected from the Surveillance, Epidemiology, and End Results (SEER) Program to extract the clinical variables used for analysis. The dataset was divided into training (70%) and validation (30%) sets based on a 7:3 ratio. Univariate and LASSO regression analyses were performed on clinical variables from the training set to identify independent prognostic factors. Independent prognostic factors were determined by Univariate and lasso regression according to the clinical variables of the training set, and a nomogram model was established to construct a prognostic model based on the contribution degree of the predictors. The prognostic model was evaluated and internally verified by C-index, ROC curve and calibration curve. A total of 713 ATC patients were included in the SEER database. LASSO regression results indicated that age, marital status, race, tumor size, whether the primary lesion was limited to the thyroid gland, surgery, radiotherapy and chemotherapy, were associated with overall survival(OS) prognosis of ATC, and were used to construct nomograms. In the training cohort, the OS nomogram's C-index was 0.708 (95% CI 0.672-0.745); in the internal validation cohort, the C-index was 0.677 (95% CI 0.620-0.735). ROC curves demonstrated that the OS nomogram exhibits excellent predictive accuracy and discriminative ability. Calibration curves indicated strong consistency between the OS nomogram's predicted survival rates and actual survival rates. We established a survival prediction model for ATC, which can assist clinicians in assessing patient prognosis and making personalized treatment decisions.

Indexing status of orthodontic research published in presumed predatory journals: a bibliometric study.

To examine the frequency and features of presumed predatory orthodontic publications. We also aimed to assess the presence of these types of publications in established scientific databases. Six electronic databases were searched to identify orthodontic articles published in 2022 in English. Equal numbers of articles from legitimate (n = 159) and suspect or predatory journals (n = 159) were considered. Data regarding journal, article and author characteristics were obtained. The indexing status of the publications in PubMed, Ovid, Embase, Web of Science, Scopus and EBSCOhost was evaluated. The total number of databases that the article was indexed in, level of evidence, origin of first author and research funding were recorded. Univariable ordinal regression analyses were performed to explore potential association between article legitimacy and indexing status. The majority of studies in predatory journals were found in non-specialized journals (79.6%). Scopus was the most porous database, indexing over half of predatory and suspect articles (56%). In Web of Science (Core collection), the distribution of articles across different indexing categories varied (SCIE; 16.4%, ESCI; 30.2%). In contrast, only 8.2% of these articles appeared in Medline. Articles in legitimate journals tended to have higher level of evidence and were indexed in more databases in comparison to predatory/suspect publications (OR=1.5; 95% CI: 1.37-1.64; p<0.01). The origin of the first author was a significant predictor for journal legitimacy (p<0.001). A high proportion of orthodontic publications appear in presumed predatory and suspect journals which are in turn often indexed in trustworthy databases. Medline was the least susceptible to predatory publications, while Web of Science and Scopus were more prone. Predatory and suspect journals are increasingly prevalent with the penetration of these journals into recognized databases. We were able to identify associated trends.

Deterioration in ankle reflex is associated with a reduced estimated glomerular filtration rate in patients with type 2 diabetes: A retrospective observational cohort study.

We investigated the association between the ankle reflex and the estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes. This was a single-center, retrospective, observational cohort study. A total of 1,387 patients who underwent an ankle reflex examination between January 2005 and December 2015 were included in the analysis for the primary outcome. The findings of the ankle reflex examination were classified into three groups: normal, decreased, or absent. The primary outcome was defined as the incidence of a 40% loss of eGFR from baseline. A survival time analysis using the Kaplan-Meier method and a regression analysis using a Cox proportional hazards model were conducted to evaluate the association between the ankle reflex test results and loss of eGFR. The ankle reflex test results were as follows: normal, n = 678 (48.9%); decreased, n = 270 (19.5%); and absent, n = 439 (31.6%) patients. The median follow-up period was 5.6 years in the observational period. In the univariate regression analysis, decreased and absent ankle reflexes were significantly associated with loss of eGFR. Moreover, decreased ankle reflex (hazard ratio: 1.83, 95% confidence interval: 1.16-2.87) and absent ankle reflex (hazard ratio: 2.57, 95% confidence interval: 1.76-3.76) were independently associated with loss of eGFR after adjusting for prognostic risk factors. Decreased and absent ankle reflexes are closely and independently associated with loss of eGFR in patients with type 2 diabetes.

Clinical efficacy of optical coherence tomography parameters to predict the visual field outcome following pituitary adenoma surgery.

To investigate the factors affecting visual field recovery in patients with pituitary adenoma following surgical removal, both eyes of 35 patients with pituitary adenoma who had been followed up for > six months post-surgery were retrospectively analyzed. Pre- and post-operative visual acuity, visual field test, retinal nerve fiber layer (RNFL), and ganglion cell inner plexiform layer (GCIPL) thickness were investigated. The average age of the 35 patients was 58.3 ± 11.5 years. Preoperatively, 30 eyes (mean average RNFL thickness, 99.73 ± 5.89 μm) and 40 eyes (mean average RNFL thickness, 77.55 ± 8.35 μm) were included in the thick (≥ 90 μm) and thin RNFL group (< 90 μm), respectively. In the thick RNFL group, pre- and post-operative mean deviation (MD) and pattern standard deviation (PSD) were favorable (all p < 0.001), and the proportion of eyes of postoperative MD change which were stable or improved was greater than in the thin RNFL group (p = 0.042). Preoperative MD, RNFL (except nasal quadrant) and GCIPL thickness were positively correlated to postoperative MD values (all, p < 0.05). Preoperative MD and temporal RNFL thickness were significantly correlated with postoperative MD change rate (p = 0.03 and 0.04, respectively). Preoperative GC IPL thickness and postoperative MD change rate were not significantly correlated (p = 0.61). Using univariate regression analysis, preoperative best corrected visual acuity (Odds ratio [OR], 0.050; p < 0.001), tumor volume (OR, 1.110, p = 0.002), higher preoperative MD values (OR, 0.858; p < 0.001), lower preoperative PSD values (OR, 1.169, p = 0.002), thick RNFL (OR, 0.215; p = 0.003) and thick GCIPL (OR, 0.305, p = 0.018) were significantly associated with a good visual field outcome following surgery. According to multivariate analysis, any other parameters were not significant. In patients with thick RNFL, postoperative MD values were better than in the thin RNFL group. Eyes with preoperative higher MD and thick temporal RNFL showed more improvement in their visual fields postoperative. Preoperative thick RNFL could be a potential predictor of visual field recovery following TSA-TR, while macular GCIPL thickness does not appear to be a reliable predictor.

Abstract 4124307: Outcome of Obesity in Atrial Fibrillation - Insights from The National Inpatient Sample Database

Background: Obesity is considered a significant risk factor for numerous cardiovascular conditions due to its effects on cardiac structure and function. The prevalence of atrial fibrillation (AF) is elevated among patients with obesity due to the dysregulation of several mechanisms. Weight loss has been shown to reverse cardiac remodeling, leading to a lower recurrence of AF despite the better prognosis in obese patients described as the obesity paradox. Methods: We utilized the National Inpatient Sample 2016-2019 to extract patients ≥18 years of age admitted with AF as the primary diagnosis based on ICD 10 codes. We performed univariate and multivariate regression analysis for known coronary risk factors. We divided patients based on their body mass index (BMI), and our primary outcomes were determining the odds of electrical cardioversion (ECV) and cardiac ablation (CA) due to AF. Results: The analysis included 1,625,809 weighted patients. Patients include underweight (6.66%), normal BMI (4.03), overweight (6.51%), obesity class I (20.65%), obesity class II (21.45%), and obesity class III (40.7). After multivariate regression analysis, patients with obesity class I, II, or III had higher odds of ECV, irrespectively of coronary risk factors (OR 1.3, 95% CI 1.25-1.37, OR 1.3, 95% CI 1.32-1.43, OR 1.3, 95% CI1.29-1.38, respectively, with statistically significant P values). However, underweight or normal BMI patients had fewer odds of ECV (OR 0.5 95%CI 0.49-0.61 and OR 0.6 95%CI 0.58-0.74, respectively, with P values &lt;0.001). Meanwhile, there was no statistical significance between a BMI and the odds of CA. Conclusion: Our study highlights the significant impact of BMI on managing atrial fibrillation, particularly regarding electrical cardioversion (ECV). Patients in higher BMI categories (obesity class I, II, and III) demonstrated increased odds of undergoing ECV, suggesting that obesity may influence treatment approaches and outcomes in AF management. Interestingly, BMI did not affect the likelihood of cardiac ablation (CA), indicating a more complex relationship between body weight and AF treatment modalities that warrants further investigation. These findings underscore the importance of personalized treatment strategies to optimize outcomes, with a focus on weight management.

Abstract 4137424: Circulating Levels of the Pro-Fibrotic Collagen Hormone Endotrophin are Associated with the Risk of Experiencing Major Adverse Cardiovascular Events in Individuals with Type 2 Diabetes – The Thousand&amp;2 Study

Introduction: Cardiovascular disease (CVD) complications are the leading cause of mortality in individuals with type 2 diabetes (T2D). Abnormal extracellular matrix (ECM) remodelling leads to the release of ECM protein fragments into circulation, reflecting these complications. Endotrophin, a pro-fibrotic and -inflammatory hormone, released during collagen type 6 formation, has been linked to adverse outcomes in T2D, but not previously in a long-term perspective. Aim: To assess the 12-year prognostic value of circulating endotrophin levels, measured by PRO-C6, to predict the risk of major adverse cardiovascular events (MACE) in a large cohort of individuals with T2D. Methods: Endotrophin levels were measured with the NordicPRO-C6™ ELISA in 909 serum samples from the Thousand&amp;2 study, which was initiated in 2011 and examined individuals with T2D, with and without known CVD. Clinical data were collected at baseline. Follow-up was 100% complete and performed on the 1 st of May 2024 with the registration of data on MACE from the Danish national registers. The primary outcome was MACE, defined as incident events of hospital admission for ischemic heart disease, heart failure, stroke, or all-cause mortality. PRO-C6 was split into tertiles and examined for survival probability by Kaplan-Meier analysis. Univariate Cox proportional hazard regression analysis was conducted to examine the association between PRO-C6 and the risk of MACE. A multivariable Cox model was additionally conducted, adjusted for age at baseline, sex, systolic blood pressure, duration of diabetes, HbA1c, estimated glomerular filtration rate, use of statins, albuminuria status, and current or prior smoking. Results: The baseline mean (±SD) age of the cohort was 64 (±10) years, 66% were males, mean (±SD) PRO-C6 was 11.9 (±7.01) ng/ml, the median follow-up time was 10.6 years, and number of MACE recorded was 472. The risk of experiencing MACE was significantly higher in the third tertile compared to the first and second tertile (Log-Rank p &lt; 0.001). In the univariate Cox model, the estimated hazard ratio (HR), corresponding to a 2-fold increase of PRO-C6, was HR [95% Confidence Interval(CI)] = 2.1 [1.8-2.4], P &lt;0.001. In the fully adjusted Cox model, PRO-C6 remained significantly associated with the risk of MACE (HR [95% CI] = 1.5 [1.2-1.8], P &lt;0.001). Conclusion: Elevated circulating endotrophin is associated with MACE in T2D, independent of common risk factors.