Objective To analysis correlation factors for preoperative sudden death of patients with type A aortic dissection in order to determine clinical management strategy.?Methods?We retrospectively analyzed clinical data of 52 patients with type A aortic dissection who were admitted in Department of Cardiothoracic Surgery of the Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2003 to January 2010. According to the presence of preoperative death, all the patients were divided into two groups, 9 patients in the preoperative sudden death （PSD）group including 7 males and 2 females with their mean age of 52.0±12.1 years；43 patients in the control group including 31 males and 12 females with their mean age of 51.5±10.9 years. Univariate and multivariate logistic regression analysis were used for analysis of preoperative factors related to sudden death.?Results?Univariate analysis result showed 7 candidate variables：body mass index （BMI, Wald χ2=2.150, P=0.143）, time of onset （Wald χ2=2.711, P= 0.100）, total cholesterol （TC, Wald χ2=1.444, P=0.230）, low density lipoprotein cholesterol （L-C, Wald χ2=1.341, P=0.247）, aortic insufficiency （AI, Wald χ2=2.093, P=0.148）, aortic sinus involvement （Wald χ2=3.386, P=0.066）and false lumen thrombosis （Wald χ2=7.743, P=0.005）. Multivariate logistic regression analysis showed that BMI （Wald χ2=4.215, P=0.040, OR=1.558）and aortic sinus involvement （Wald χ2=4.592, P=0.032, OR=171.166 ）were preoperative risk factors for sudden death, and thrombosed false lumen （Wald χ2=5.097, P=0.024, OR=0.011）was preoperative protective factor for sudden death.?Conclusion?Type A aortic dissection patients with large BMI and/or aortic sinus involvement should receive operation more urgently than others and patients with thrombosed false lumen may have relatively low risk of preoperative sudden death.
ObjectiveTo investigate the risk factor for restenosis of esophageal anastomosis stricture after esophageal cancer operation. MethodsWe retrospectively analyzed the clinical data of 83 patients including 61males and 22 females at age of 58.9(41-81) years with esophageal anastomoic stricture after esophageal cancer operation between January 2002 and December 2013. According to whether the patients developed to restenosis or not, the statistical test and logistic regression was conducted to analyze the risk factors for restenosis. ResultsIn the 83 patients with esophageal anastomoic stricture after esophageal cancer surgery, 35 patients (42.2%) experienced restenosis within the following-up of 1 year. The result of logistic regression analysis indicated that restenosis appeared in 3 months (Wald value=23.3, P < 0.001), the interval between two subsequent sessions of more than 4 weeks at each esophagus dilatation(Wald value=4.8, P=0.029) and the stricture diameter of less than 12 mm after dilation (Wald value=5.8, P=0.016) are the independent risk factors for restenosis in esophageal anastomotic stricture. ConclusionFor the patients with esophageal anastomoic stricture after esophageal cancer operation, we believe that it's conducive to reduce esophageal restenosis if the interval between dilations is within 4 weeks and the diameter of stricture after dilation can reach above 12 mm.
ObjectiveTo investigate the correlative factors for the efficacy of surgical treatment for single segment degenerative lumbar spinal disorders. MethodsFrom October 2008 to November 2010, a prospective non-randomized controlled study was carried out on 179 patients who were diagnosed to have L4-5 degenerative lumbar spinal disorders and underwent surgical treatment. Ninety-seven patients were included in our study, including 64 males and 33 females, aged between 21 and 86 years old, averaging 49.0. The follow up lasted for an average of 18.9 (12-27) months. The correlative factors including age, sex, body mass index, preoperative psychological state and degree of low back pain, surgical methods, combination with adjacent segment degeneration and recurrence state were analyzed. Single and multiple-factor Logistic regression analysis was used to determine the relationship between independent factors and surgical results of lumbar degenerative disease. ResultsAt the last follow-up, Japanese Orthopaedic Association scores were improved to 22.40±3.18 with an improving rate of (68.5±15.7)% compared with the preoperative condition (7.61±3.09), and the difference was significant (t=-33.031, P<0.001). Univariate analysis showed that all factors were variables associated with the surgical results excluding sex and age (P<0.05). Multiple-factor logistic regression analysis showed that the preoperative psychological state, combination with adjacent segment degeneration and surgical methods had important impact on the surgical results (P<0.05). ConclusionSurgical treatment of lumbar degenerative disease is effective. The preoperative psychological state, combination with adjacent segment degeneration and surgical methods are important factors associated with the surgical results.
ObjectivesBased on the historical data of inpatients, a logistic regression model was established. It aimed to identify the influencing factors of patient's admission scheduling decisions and compare them with the actual scheduling rules, so as to discover the differences and deficiencies.MethodsWe extracted data of outpatients and inpatients in Department of Respiration in West China Hospital of Sichuan University from January 1st, 2016 to December 31st, 2016, and standardized the original dataset. We established the binary multivariate logistic regression model through R software and ‘glm’ package.ResultsThe analysis of multi-factor logistic regression showed that the effect of the five variables (type of medical insurance, time of registration, waiting time, type of disease and admission priority) on patient schedule was statistically significant.ConclusionsThe logistic regression model constructed in this study has a good effect on patient planning, which is helpful to provide decision support for admission schedule through identification factors.
Objective To investigate the status of deciduous caries and early childhood caries among 3-5 year-old children of Uyghur and Chinese in Urumqi, and to explore the correlative factors of early childhood caries. Methods According to the criteria recommended by the Third National Oral Health Investigation, and Oral Health Surveys: Basic Methods of World Health Organization, the deciduous caries of 474 Urghur and Chinese children aged from three to five in nine kindergartens were clinically examined. Data were collected by questionnaire from their parents, and the result waw analyzed using Logistic regression analysis. Results The result of logistic regression analysis showed that the variables including nationality, frequency of drinking milk, eating cookie or drinking sweet beverage before sleep, brushing teeth with help, and educational background of the mother were closely related to the incidence of infantile caries. Conclusion The nationality, frequency of drinking milk, eating cookie or drinking sweet beverage before sleep, brushing teeth with help, and educational background of the mother are correlative factors of early childhood caries. Necessary methods for prevention of deciduous caries must be taken into consideration as early as possible, and the bilingual propaganda for preventing and treating caries should be also highly emphasized.
ObjectiveTo explore the selection problem of independent variables and stepwise regression method for multiple logistic regression analysis. MethodsAccording to the data of the case-control investigation for coronary heart disease, age (X1), hypertension history (X2), hypertension family history (X3), smoking (X4), hyperlipidemia history (X5), animal fat intake (X6), weight index (X7), type A personality (X8), and coronary heart disease (CHD, Y) were analyzed by SPSS 18.0 software. The multiple logistic regression analysis was done and the differences of risk factors were compared among 6 kinds stepwise regression variable selection method. ResultsThe univariate analysis showed that no difference was found between CHD group and non-CHD group in age distribution (P=0.116). But the multivariate logistic regression analysis showed that, comparing to population over 65 years old, age was a protective factor on the low age groups (OR< 45=0.100, 0.000 to 0.484, P=0.020; OR45-54=0.051, 0.003 to 0.975, P=0.048). If the age was defined as categorical variable, the risk factors for coronary heart disease were animal fat intake (X6), type A personality (X8), hypertension history (X5) and age (X1), respectively (P < 0.05). If the age was defined as a continuous variable, the effect of age (X1) was not statistically significant (P=0.053). The common risk factors were intake of animal fat (X6) and type a personality (X8) by six kinds method of stepwise variable selection. In addition, the risk factor also included hyperlipidemia history (X5) (forward-condition, forward-LR, forward-wald), hypertension family history (X3), age (X1) (backward-condition, backward-LR) and hypertension history (X2) (backward-wald). ConclusionStepwise regression method should be used to analyze all the variables, including no statistically significant independent variables in univariate analysis. If the categorical variable is regarded as continuous variables, some information may be lost, and even the risk factors may be missed. When the risk factors are not the same by several stepwise regression variable selection method, it should be combined with clinical and epidemiological significance, as well as biological mechanisms and other professional knowledge.
ObjectiveTo investigate the quality of life (QOL) and its influencing factors of patients with human epidermal growth factor receptor 2 (HER2) positive breast cancer returning to social life after treatment.MethodsFunctional assessment of cancer therapy-breast scale (FACT-B Scale) was adopted to investigate the QOL of the HER2 positive breast cancer survivors, who were admitted and treated during January 2015 and October 2019 in Fujian Provincial Hospital. The demographic, social and economic data, as well as the clinical information of the responded survivors were collected. Logistic regression model was adopted to analyze factors associated with the QOL of the responded survivors.ResultsA total of 117 responded survivors were included. The median of the FACT-B scale was 106.0 (91.0, 121.3) points out of 148 points (71.6%). With the control of the demographic, social and economic status of the responded survivors, as well as the time from diagnosis and treatment to responding to the follow-up, we found that "having other chronic conditions" was the risk factor for the HER2 positive breast cancer survivors to have higher QOL in the social life after treatment (OR=4.17, 95%CI 1.33 to 15.37, P=0.01).ConclusionsThe overall QOL of the HER2 positive breast cancer survivors in the social life after treatment was low. "Having other chronic conditions" was the risk factor for the HER2 positive breast cancer survivors to have higher QOL in the social life after treatment.
ObjectivesTo investigate the level of ankle-brachial index (ABI) of health examination population in Chongqing municipality and analyze the risk factors related to the level of ABI, so as to provide basis for effective evaluation of atherosclerotic lesions and their severity, as well as early detection, intervention and treatment of clinical cardiovascular diseases. MethodsA total of 22 886 subjects aged from 20 to 85 undergoing health examination in the medical examination center of First Affiliated Hospital of Chongqing Medical University in Chongqing municipality from January to December in 2016 were retrospectively analyzed. ABI and related physiological and biochemical data were collected. The relationship between ABI and age was analyzed using stepwise logistic regression model combined with restricted cubic splines. ResultsThe detection rate of abnormal ABI was 3.31% in 22 886 subjects undergoing health examination with 2.90% in males and 3.92% in females. The subjects aged below 40 presented the highest detection rate of abnormal ABI (6.17%) with 4.72% in males and 8.66% in females. The subjects were divided into two groups, one with ABI≤0.9 and one with ABI>0.9; the differences in age and levels of body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) between the two groups were statistically significant (allP<0.05). Multivariate stepwise logistic regression combined with restricted cubic splines showed that age, gender and BMI were presented as independent factors affecting ABI, among which the age below 40 (OR=2.885, 95%CI (2.445, 3.404),P<0.0001) was the main risk factor. A curve relating age to probability of abnormal ABI was produced after correcting for the influences of sex and BMI, stratified by gender and BMI into different subgroups, showing a U-shaped curve of decreasing initially and then increasing between the probability of abnormal ABI and age. ConclusionsThe detection rate of abnormal ABI based on individuals undergoing health examination in Chongqing municipality was 3.31%. A U-shaped curve of downward trend followed by an upward one was shown between probability of abnormal ABI and age after correcting for the influences of gender and BMI. The clinical significance of ABI≤0.9 for youth population (20 to 40 years old) without cardiovascular risk factors requires further exploration.
Objective To analyze the substitution mechanism of surrogate endpoints for traditional Chinese medicine (TCM) clinical efficacy evaluation of chronic heart failure (CHF). Methods To obtain data from the occurrence of surrogate endpoints and cardiogenic death of patients with CHF in 7 hospitals. The causal relationship between surrogate endpoints and cardiogenic mortality was inferred by the Bayesian network model, and the interaction among surrogate endpoints was analyzed by non-conditional logistic regression model. Results A total of 2 961 patients with CHF were included. The results of Bayesian network causal inference showed that cardiogenic mortality had a causal relationship with the surrogate endpoints including NYHA classification (P=0.46), amino-terminal pro-B-type natriuretic peptide (NT-proBNP) (P=0.24), left ventricular ejaculation fraction (LVEF) (P=0.19), and hemoglobin (HB) (P=0.11); non-conditional logistic regression analysis showed that NYHA classification had interaction with NT-proBNP, LVEF, and HB prior to and after adjusting confounders. Conclusions The substitution capability of surrogate endpoints for TCM clinical efficacy evaluation of CHF for cardiogenic mortality are NYHA classification, NT-proBNP, LVEF, and HB in turn, and there is a multiplicative interaction between the main surrogate endpoint NYHA classification and the secondary surrogate endpoints including NT-proBNP, LVEF, and HB, suggesting that when the two surrogate endpoints with interaction exist at the same time, it can enhance the substitution capability of surrogate endpoints for cardiogenic mortality.
Early detection of vascular function plays an important role in the prevention and treatment of cardiovascular diseases (CVDs). This paper reports the main studies of the effectiveness of fingertip temperature curve in digital thermal monitoring (DTM) for predicting CVDs, as well as the relationship between parameters from DTM and pulse wave velocity (PWV) detection. A total of 112 subjects [age (42.18±12.28) years, 50% male, 37 with known CVDs] underwent DTM and PWV detection. Results showed that most of parameters related to CVDs were from the declining stage of the digital thermal signal. Binary Logistic regression models were built, and the best one was chosen by ten-fold validation to predict CVDs. Consistency was great between the detection result of PWV and that of the Logistic model of DTM parameters. Parameters from DTM also contained information for early detecting of vascular stiffness. This study indicates that the fingertip temperature curve in DTM has a potential application for predication of CVDs, and it would be used to access vascular function in the initial stage of CVDs.