Trendelenburg Positioning in Large Vessel Ischaemic Stroke: A Pre-Post Observational Study Using Propensity Score Matching

2018 ◽  
Vol 46 (1-2) ◽  
pp. 24-32 ◽  
Author(s):  
Alexandre Gauthier ◽  
Patrick Gérardin ◽  
Pauline Renou ◽  
Sharmila Sagnier ◽  
Sabrina Debruxelles ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Propensity Score ◽  
Ischaemic Stroke ◽  
Multiple Logistic Regression Analysis ◽  
Primary Outcome Measure ◽  
Large Vessel ◽  
Large Artery ◽  
Multiple Logistic Regression ◽  
Nihss Score ◽  
Arterial Blood

Background: Along with pharmacological and mechanical recanalization, improving cerebral perfusion through the recruitment of collateral vessels during the acute phase of ischaemic stroke (IS) is a clinical challenge. Our objective was to assess the effectiveness and safety of Trendelenburg positioning (TP), a procedure intended to increase cerebral blood flow, on the outcome of IS. Methods: Two cohorts of patients with an acute supratentorial IS related to a large artery occlusion were compared. In the first cohort (n = 119), we used standard positioning (0 to +30°); in the second cohort (n = 90), we used TP (0 to –15°). The primary outcome measure was the improvement of National Institutes of Health Stroke Scale (NIHSS) score between admission and day 2. Factors associated with an improvement ≥4 points of NIHSS score were assessed using multiple logistic regression and propensity score (PS) matching analyses. Results: TP was significantly associated with a greater improvement of NIHSS score within 48 h following stroke onset (4.0 ± 5.7 vs. 1.8 ± 5.9, p = 0.011) but also at discharge (p = 0.005). Multiple logistic regression analysis suggested that TP was an independent predictor of early neurological improvement (adjusted OR 1.81, 95% CI 1.00–3.27) in a model controlling recanalization and haemoglobin level. In addition, PS matching analysis confirmed the possible effectiveness of TP (unadjusted OR 1.99, 95% CI 1.04–3.82), especially in male subjects. The effect of TP was more pronounced in patients with admission mean arterial blood pressure ≥100 mm Hg, those exhibiting a good collateral vessel network on admission CT-angiography or experiencing an effective recanalization. Furthermore, TP was not associated with life-threatening complications. Conclusion: TP could be an effective and safe strategy in patients with large IS resulting from the proximal occlusion of a large vessel.

E-cigarette Use and Smoking Cessation Among South Korean Adult Smokers: A Propensity Score–Matching Approach

2017 ◽  
Vol 30 (4) ◽  
pp. 332-341 ◽  
Author(s):  
Baksun Sung
Keyword(s):  
Smoking Cessation ◽  
Logistic Regression ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Multiple Logistic Regression Analysis ◽  
Cigarette Use ◽  
Multiple Logistic Regression ◽  
South Korean ◽  
Health And Nutrition ◽  
Korean Adult

Research on the efficacy of e-cigarette use as a smoking cessation tool has yielded inconclusive results. Hence, the objective of this study was to identify the relationship between e-cigarette use and smoking cessation among South Korean adult smokers. This study used data from the sixth Korea National Health and Nutrition Examination Survey (2013-2015) of 2965 adult smokers aged 19 years and older. As statistical analysis methods, data were analyzed using the χ2 test and multiple logistic regression. Propensity score matching (PSM) was applied to control selection bias, and sociodemographic and smoking-linked factors were used as covariates in PSM. According to the multiple logistic regression analysis, adult smokers who had not used e-cigarettes were more likely to attempt to quit smoking than those who had used e-cigarettes in the prematching (OR = 1.58; 95% CI = 1.18-2.12) and postmatching (OR = 1.62; 95% CI = 1.08-2.44) samples. Thus, this study suggests that e-cigarette use among South Korean adult smokers was not related to smoking cessation.

scholarly journals Deliberate employment of postoperative hypotension for brain arteriovenous malformation surgery and the incidence of delayed postoperative hemorrhage: a prospective cohort study

2017 ◽  
Vol 127 (5) ◽  
pp. 1025-1040 ◽  
Author(s):  
Michael Kerin Morgan ◽  
Markus Karl Hermann Wiedmann ◽  
Nazih N. A. Assaad ◽  
Michael J. A. Parr ◽  
Gillian Z. Heller
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Neurological Deficit ◽  
Multiple Logistic Regression Analysis ◽  
Postoperative Hemorrhage ◽  
Maximum Diameter ◽  
Multiple Logistic Regression ◽  
Arterial Blood ◽  
The Impact

OBJECTIVEThe aim of this study was to examine the impact of deliberate employment of postoperative hypotension on delayed postoperative hemorrhage (DPH) for all Spetzler-Ponce Class (SPC) C brain arteriovenous malformations (bAVMs) and SPC B bAVMs ≥ 3.5 cm in diameter (SPC B 3.5+).METHODSA protocol of deliberate employment of postoperative hypotension was introduced in June 1997 for all SPC C and SPC B 3.5+ bAVMs. The aim was to achieve a maximum mean arterial blood pressure (BP) ≤ 70 mm Hg (with cerebral perfusion pressure > 50 mm Hg) for a minimum of 7 days after resection of bAVMs (BP protocol). The authors compared patients who experienced DPH (defined as brain hemorrhage into the resection bed that resulted in a new neurological deficit or that resulted in reoperation during the hospitalization for microsurgical bAVM resection) between 2 periods (prior to adopting the BP protocol and after introduction of the BP protocol) and 4 bAVM categories (SPC A, SPC B 3.5− [that is, SPC B < 3.5 cm maximum diameter], SPC B 3.5+, and SPC C). Patients excluded from treatment by the BP protocol were managed in the intensive care unit to avoid moderate hypertensive episodes. The pooled cases of all bAVM treated by surgery were analyzed to identify characteristics associated with the risk of DPH. These identified characteristics were then examined by multiple logistic regression analysis in both SPC B 3.5+ and SPC C cases.RESULTSFrom a cohort of 641 bAVMs treated by microsurgery, 32 patients with DPH were identified. Of those, 66% (95% CI 48–80) had a permanent new neurological deficit with a modified Rankin Scale score of 2–6. This included a mortality rate of 13% (95% CI 4.4–29). The BP protocol was used to treat 162 patients with either SPC B 3.5+ or SPC C. For SPC B 3.5+, there was no significant reduction in DPH with the introduction of the BP protocol (p = 0.77). For SPC C, there was a significant (p = 0.035) reduction of DPH from 29% (95% CI 13%–53%) to 8.2% (95% CI 3.2%–18%) associated with the introduction of the BP protocol. Multiple logistic regression analysis found that the absence of the BP protocol (p = 0.011, odds ratio 7.5, 95% CI 1.6–36) remained significant for the development of DPH in patients with SPC C bAVMs.CONCLUSIONSTreating patients with SPC C bAVMs with a protocol that lowers BP immediately after resection seems to reduce the risk of DPH. For SPC A and SPC B 3.5− bAVMs, there is unlikely to be a need to do more than avoid postoperative hypertension. For SPC B 3.5+ bAVMs, a larger number of patients would be required to test the absence of benefit of the BP protocol.

scholarly journals MRCP Combined With CT Promotes the Differentiation of Benign and Malignant Distal Bile Duct Strictures

2021 ◽  
Vol 11 ◽  
Author(s):  
Guang-xian Wang ◽  
Xiao-dong Ge ◽  
Dong Zhang ◽  
Hai-ling Chen ◽  
Qi-chuan Zhang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Diagnostic Accuracy ◽  
Multiple Logistic Regression Analysis ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Threshold Value ◽  
Arterial Phase ◽  
Multiple Logistic Regression ◽  
Scoring Model ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced

ObjectiveTo determine whether contrast-enhanced computed tomography (CT) can promote the identification of malignant and benign distal biliary strictures (DBSs) compared to the use of magnetic resonance cholangiopancreatography (MRCP) alone and to identify imaging findings of malignant DBSs.Materials and MethodsA total of 168 consecutive patients with confirmed DBSs were reviewed. MRCP alone and MRCP combined with CT images were blindly analyzed by two radiologists (e.g., stricture pattern, margins), and malignant or benign DBSs were identified based on surgical findings, endoscopy findings, or follow-up. The diagnostic accuracy of the two reviewers using MRCP alone and MRCP combined with CT were evaluated. MRCP and CT features of malignant and benign DBSs were compared using multiple logistic regression analysis to identify independent malignant risk factors.ResultsMRCP combined with CT examination could improve the diagnostic accuracy, which increased from 70.2% to 81.5% in Doctor A and from 85.1% to 89.3% in Doctor B. The multiple logistic regression model revealed that stricture length [odds ratio (OR) 1.070, P=0.016], angle of the DBS (OR 1.061, P&lt;0.001), double duct sign (OR 4.312, P=0.003) and low density in the arterial phase (OR 0.319, P=0.018) were associated with malignant DBS. A scoring model incorporating these four factors was established; at a threshold value of 1.75, and the sensitivity and specificity for the detection of malignant DBSs were 73.5 and 85.9%, respectively.ConclusionsCompared to the use of MRCP alone, MRCP combined with contrast-enhanced CT can improve the accuracy of DBS diagnosis. The scoring model accurately predicts malignant DBSs and helps make treatment decisions.

scholarly journals Analysis and Factors Associated with Measles in Larut, Matang and Selama Districts, Perak, Malaysia

2020 ◽  
Vol 27 (5) ◽  
pp. 130-140
Author(s):  
Asraf Ahmad Qamruddin ◽  
Reza Qamruddin ◽  
Ayu Malik
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Incidence Rate ◽  
Logistic Regression Analysis ◽  
Protective Factor ◽  
Multiple Logistic Regression Analysis ◽  
Prior History ◽  
Multiple Logistic Regression ◽  
Case Definitions ◽  
Factors Associated

Objectives: To determine the incidence rate of measles and the factors associated with confirmed measles cases in Larut, Matang and Selama districts. Methods: Cross-sectional analysis was carried out looking at all suspected and laboratoryconfirmed measles cases in Larut, Matang and Selama districts between 2015 and 2019. Multiple logistic regression analysis was used to determine the associated factors for laboratory-confirmed measles cases. Results: The incidence rate for suspected measles showed an increasing trend from 2015–2019. For laboratory-confirmed measles cases, the incidence rate showed more variation with an increase to 36.11 per million population in 2017 from 5.67 per million population in 2015. The incidence rate later decreased to 10.99 per million population in 2018 and increased again to 24.47 per million population in 2019. From multiple logistic regression analysis, cases that fulfilled the case definition of measles were more likely to be laboratory-confirmed measles. On the other hand, a prior history of measles immunisation was a protective factor. Conclusion: Measles incidence is increasing in trend. Any suspected measles cases that fulfilled the clinical case definitions need to be further investigated. Immunisation should be promoted as they are effective in preventing and eliminating measles.

scholarly journals SAT-564 Effectiveness of Treatment with Mineralocorticoid Receptor Antagonistsin Primary Aldosteronism

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Yuta Tezuka ◽  
Adina Turcu
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Primary Aldosteronism ◽  
Odds Ratio ◽  
Mineralocorticoid Receptor ◽  
Beta Blockers ◽  
Multiple Logistic Regression Analysis ◽  
Multiple Logistic Regression ◽  
Low Renin Hypertension

Abstract Background: Medical treatment with mineralocorticoid receptor antagonists (MRAs) is preferred for patients with primary aldosteronism (PA) who are not surgical candidates. Adequate mineralocorticoid receptor blockade, as suggested by renin elevation above suppression levels, has been associated with lower rates of cardiovascular and renal complications as compared with PA with sustained renin suppression. Objectives: To assess the timeline and rates of achieving target renin levels in patients with PA and low renin hypertension treated with MRAs. Patients and Methods: We conducted a retrospective cohort study of adult patients with hypertension who were treated with MRAs in an academic center between 2003-2019. Of these, we included patients who had suppressed renin at baseline, and repeated renin measurement(s) during MRAs therapy. Renin suppression was defined as plasma renin activity (PRA) 1.0 ng/mL/h or direct renin concentration (DRC) 8.0 pg/mL. We excluded patients with adrenal cancer, end-stage renal disease, exogenous glucocorticoids, and critically ill. Mann-Whitney test, Wilcoxon signed rank test, Chi-Square test and multiple logistic regression analysis were employed, as appropriate. Results: So far, 89 patients (45 men), median age 56 (range, 19-84), have been included. Of these, 46% had confirmed PA; 25% had positive PA screening, but no confirmatory tests; and 29% had other forms of low-renin hypertension. On average, patients were on 2.9 1.6 antihypertensive agents; 62% of patients were prescribed beta blockers, and 38% were on K+ supplements. Overall, renin (PRA in 69 cases, and DRC in 20 cases) increased after MRA treatment (from 0.40 [0.10, 0.60] ng/mL/h to 1.10 [0.60, 2.23] ng/mL/h; and from 2.1 [2.1, 3.7] pg/mL to 5.7 [2.9, 16.7] pg/mL, respectively, p&lt;0.0001 for both). The cumulative proportions of patients in whom renin reached target levels during MRA treatment were: 25% at 2 weeks; 38.9% at 1 month; 34.2% at 3 months; 39.5% at 6 months; and 47.2% at 1 year. Age, sex, race, blood pressure, use of beta blockers, renal function, serum K+ and aldosterone concentrations were similar between patients with target vs. suppressed renin. Multiple logistic regression analysis suggested that after adjusting for age and sex, higher MRA dose and higher BMI were associated with higher likelihood of achieving target renin during MRA therapy (odds ratio (95%CI): 1.021 (1.001-1.041) and 1.097 (1.008-1.193), respectively, p&lt;0.05 for both); conversely, beta blockers use tended to be less often associated with target renin (odds ratio, 0.37 (0.13-1.008), p=0.052). Conclusion: Although raising renin above suppression levels is important for reducing the cardiovascular risk associated with PA, this goal is achieved in less than half of patients, even after one year of treatment with MRAs, in an academic setting. Strategies for optimizing PA treatment are critically needed.

scholarly journals Prevalence and Associated Metabolic Factors of Gallstone Disease in the Elderly Agricultural and Fishing Population of Taiwan

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Hsi-Che Shen ◽  
Yi-Chun Hu ◽  
Yu-Fen Chen ◽  
Tao-Hsin Tung
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Gallstone Disease ◽  
Multiple Logistic Regression Analysis ◽  
Older Age ◽  
Multiple Logistic Regression ◽  
Metabolic Factors ◽  
Female Sex ◽  
Study Population

Purpose. To evaluate sex-related differences in the prevalence of and cardiovascular risk factors related to gallstone disease (GSD) in an elderly agricultural and fishing population of Taipei, Taiwan.Methods. The study sample consisted of 6511 healthy elderly participants (3971 men and 2540 women) who were voluntarily admitted to a teaching hospital for a physical checkup in 2010. The participants’ blood samples and real-time ultrasound fatty liver results were collected.Results. The prevalence of GSD in the study population was 13.2%, which increased significantly with population age (P<.0001). Women were associated with significantly higher GSD prevalence than men (14.8% versus 12.2%; for the chi-square test,P=.003). In a multiple logistic regression analysis, female sex, older age, and metabolic syndrome (MetS) were significantly associated with GSD. Multiple logistic regression analysis also revealed that obesity (odds ratioOR=1.26, 95% confidence interval (CI): 1.09–1.44) and metabolic factors (one or 2 versus none,OR=1.48, 95% CI: 1.08–1.76) were significantly associated with GSD in women but not in men.Conclusion. In the study population, female sex, older age, and MetS were associated with higher GSD prevalence. The population exhibited other sex-related differences.

Impact of Oral Health Status on Perceived Dental Problems Among Japan Maritime Self-Defense Force Personnel

2021 ◽  
Author(s):  
Chikanobu Sonoda ◽  
Yutaka Sakurai ◽  
Manabu Okoda ◽  
Masato Ebisawa ◽  
Hiroshi Nakashima ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Multiple Logistic Regression Analysis ◽  
Oral Health Status ◽  
Oral Disease ◽  
Multiple Logistic Regression ◽  
Self Defense ◽  
Military Mission ◽  
Stepwise Procedure

ABSTRACT Introduction Dental problems may have a great impact on military mission effectiveness, as such, evidence-based dental classification guidelines are required for minimizing the occurrence of dental problems. The aim of this study is to elucidate the independent contribution of each oral disease to the perception of dental problems among Japan Maritime Self-Defense Force (JMSDF) personnel in order to make the dental classification guidelines more precise for the prediction of future dental problems. Materials and Methods Japan Maritime Self-Defense Force personnel who were examined during the annual dental checkup in 2013 answered questions about the experience of dental problems within the last 12 months in 2014. The associations between the items of a dental checkup and the perception of dental problems were examined using multiple logistic regression analysis with a stepwise procedure to calculate odds ratios (ORs) and 95% CIs. Results The data of a total of 22,441 subjects were included in the analysis. Those who declared to have perceived dental problems within the last 12 months were 5,088 (22.7%). The multiple logistic regression analysis showed that personnel who had decayed teeth had a higher chance of experiencing dental problems than those who had no dental caries. Personnel whose periodontal disease was judged to be more severe in a dental examination had a greater OR for the perception of dental problems. Conclusion These results may become recommendations for operations in the JMSDF dental classification system.

Sign in / Sign up

Export Citation Format

Share Document