Timing of Free Flaps for Traumatic Wounds of the Lower Extremity: Have Advances in Perioperative Care Changed the Treatment Algorithm?

2019 ◽  
Vol 35 (08) ◽  
pp. 616-621 ◽  
Author(s):  
Charles W. Patterson ◽  
Mark W. Stalder ◽  
William Richardson ◽  
Thomas Steele ◽  
M. Whitten Wise ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Lower Extremity ◽  
Perioperative Care ◽  
Wound Care ◽  
Treatment Algorithm ◽  
Adverse Outcomes ◽  
Recipient Site ◽  
Independent Variables ◽  
Flap Loss ◽  
Injury Classification

Abstract Background Despite the landmark study by Godina 30 years ago, opinions still vary within the literature about the management of complex traumatic wounds in the lower extremity. We present a large series of lower extremity reconstructions with vascularized free tissue and examine the perioperative factors that influenced the success of these cases. Methods We reviewed 88 patients with free flap reconstruction of traumatic lower extremity wounds over 8 years. Primary outcomes were flap infections, flap loss, total flap-specific complications, and total recipient site complications. Independent variables specific to perioperative care including time to flap coverage, injury classification, exposed or infected hardware, prior osteomyelitis, use of wound vacuum-assisted closure (VAC) therapy, and concurrent polytrauma were investigated to establish their influence on primary outcomes. Each independent variable was assessed using Chi-square or Fisher's exact test and was included in a logistic regression analysis to establish significance. Results Of the 88 patients, 8 had flap loss, 8 had flap infections, and a total of 23 had primary adverse outcomes. Timing of the reconstruction, VAC use, injury classification, prior hardware or wound status, or presence of polytrauma had no statistically significant impact on the primary outcomes. Injury classification/severity on total recipient site complications (p = 0.051) and flap-specific complications (p = 0.073) trended toward significance; however, subgroup analysis did not achieve significance. Logistic regression of any recipient site complication including all independent variables similarly showed no significance. Conclusion Although the original study by Godina suggests early coverage is critical to optimize outcomes, in the modern era of advanced wound care, our study adds to a growing body of evidence that supports the de-emphasis of the 72-hour reconstruction interval. Our current management is focused on more effectively coordinating efficient peritraumatic and perioperative care on an individualized basis in the often very complicated polytrauma patient.

scholarly journals Comparison of laparoscopic and hand-assisted laparoscopic nephrectomy for inflammatory renal disease: which is the preferred approach?

2021 ◽  
Vol 13 ◽  
pp. 175628722098404
Author(s):  
Xudong Guo ◽  
Hanbo Wang ◽  
Yuzhu Xiang ◽  
Xunbo Jin ◽  
Shaobo Jiang
Keyword(s):  
Logistic Regression ◽  
Renal Disease ◽  
Complication Rate ◽  
Adverse Outcomes ◽  
Laparoscopic Nephrectomy ◽  
Multivariable Logistic Regression Analysis ◽  
Invasive Approach ◽  
Intraoperative Complication ◽  
Multivariable Logistic Regression ◽  
Significant Difference

Aims: Management of inflammatory renal disease (IRD) can still be technically challenging for laparoscopic procedures. The aim of the present study was to compare the safety and feasibility of laparoscopic and hand-assisted laparoscopic nephrectomy in patients with IRD. Patients and methods: We retrospectively analyzed the data of 107 patients who underwent laparoscopic nephrectomy (LN) and hand-assisted laparoscopic nephrectomy (HALN) for IRD from January 2008 to March 2020, including pyonephrosis, renal tuberculosis, hydronephrosis, and xanthogranulomatous pyelonephritis. Patient demographics, operative outcomes, and postoperative recovery and complications were compared between the LN and HALN groups. Multivariable logistic regression analysis was conducted to identify the independent predictors of adverse outcomes. Results: Fifty-five subjects in the LN group and 52 subjects in the HALN group were enrolled in this study. In the LN group, laparoscopic nephrectomy was successfully performed in 50 patients (90.9%), while four (7.3%) patients were converted to HALN and one (1.8%) case was converted to open procedure. In HALN group, operations were completed in 51 (98.1%) patients and conversion to open surgery was necessary in one patient (1.9%). The LN group had a shorter median incision length (5 cm versus 7 cm, p < 0.01) but a longer median operative duration (140 min versus 105 min, p < 0.01) than the HALN group. There was no significant difference in blood loss, intraoperative complication rate, postoperative complication rate, recovery of bowel function, and hospital stay between the two groups. Multivariable logistic regression revealed that severe perinephric adhesions was an independent predictor of adverse outcomes. Conclusion: Both LN and HALN appear to be safe and feasible for IRD. As a still minimally invasive approach, HALN provided an alternative to IRD or when conversion was needed in LN.

scholarly journals Low Serum Uric Acid Predicts Risk of a Composite Disease Endpoint

Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 361
Author(s):  
Fatma Özpamuk-Karadeniz ◽  
Yusuf Karadeniz ◽  
Adnan Kaya ◽  
Servet Altay ◽  
Günay Can ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Uric Acid ◽  
Serum Uric Acid ◽  
Density Lipoprotein ◽  
Positive Association ◽  
Composite Endpoint ◽  
Adverse Outcomes ◽  
Inverse Association ◽  
Adjusted Logistic Regression ◽  
Low Serum

Background and objectives: Mortality may increase in hypouricemia as well as inhyperuricemia. We assessed the predictive value of low serum uric acid (SUA) levels on the risk of overall mortality or a composite endpoint of death and nonfatal events. Materials and Methods: In 1013 community-based middle-aged adults, free of uncontrolled diabetes and coronary heart disease at baseline, the association of sex-specific SUA tertiles with defined outcomes was evaluated prospectively by logistic regression, stratified to gender and presence of type-2 diabetes, using recent criteria. Results: Totally, 43 deaths and additional incident nonfatal events in 157 cases were recorded at a median 3.4 years’ follow-up. Multivariable linear regression disclosed SUA to be significantly associated among non-diabetic individuals positively with creatinine, triglycerides, and body mass index in women further with fasted glucose. In multivariable-adjusted logistic regression analysis, sex-specifically dichotomized baseline uric acid (<5.1 and <4.1 mg/dL vs. higher values) significantly predicted the non-fatal events in the whole sample (relative risk (RR) 1.51 [95% confidence interval (CI) 1.02; 2.26]), as well as in men, while composite endpoint in the whole sample tended to rise (RR 1.38). Compared with the intermediate one, the top and bottom SUA tertiles combined tended to confer mortality risk (RR 2.40 [95% CI 0.89; 6.51]). Adverse outcomes in diabetic women were predicted by tertiles 2 and 3. Conclusions: Inverse association of SUA with adverse outcomes, especially in men, is consistent with the involvement of uric acid mass in autoimmune activation. The positive association of uric acid with adverse outcomes in diabetic women is likely mediated by concomitant high-density lipoprotein dysfunction.

scholarly journals Association between insulin resistance and left ventricular hypertrophy in asymptomatic, Black, sub-Saharan African, hypertensive patients: a case–control study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bernard Kianu Phanzu ◽  
Aliocha Nkodila Natuhoyila ◽  
Eleuthère Kintoki Vita ◽  
Jean-René M’Buyamba Kabangu ◽  
Benjamin Longo-Mbenza
Keyword(s):  
Insulin Resistance ◽  
Logistic Regression ◽  
Ventricular Hypertrophy ◽  
Case Control Study ◽  
Case Control ◽  
Left Ventricular ◽  
Hypertensive Patients ◽  
Independent Variables ◽  
Sub Saharan ◽  
Control Study

Abstract Background Conflicting information exists regarding the association between insulin resistance (IR) and left ventricular hypertrophy (LVH). We described the associations between obesity, fasting insulinemia, homeostasis model assessment of insulin resistance (HOMA-IR), and LVH in Black patients with essential hypertension. Methods A case–control study was conducted at the Centre Médical de Kinshasa (CMK), the Democratic Republic of the Congo, between January and December 2019. Cases and controls were hypertensive patients with and without LVH, respectively. The relationships between obesity indices, physical inactivity, glucose metabolism and lipid disorder parameters, and LVH were assessed using linear and logistic regression analyses in simple and univariate exploratory analyses, respectively. When differences were observed between LVH and independent variables, the effects of potential confounders were studied through the use of multiple linear regression and in conditional logistic regression in multivariate analyses. The coefficients of determination (R2), adjusted odds ratios (aORs), and their 95% confidence intervals (95% CIs) were calculated to determine associations between LVH and the independent variables. Results Eighty-eight LVH cases (52 men) were compared against 132 controls (81 men). Variation in left ventricular mass (LVM) could be predicted by the following variables: age (19%), duration of hypertension (31.3%), body mass index (BMI, 44.4%), waist circumference (WC, 42.5%), glycemia (20%), insulinemia (44.8%), and HOMA-IR (43.7%). Hypertension duration, BMI, insulinemia, and HOMA-IR explained 68.3% of LVM variability in the multiple linear regression analysis. In the logistic regression model, obesity increased the risk of LVH by threefold [aOR 2.8; 95% CI (1.06–7.4); p = 0.038], and IR increased the risk of LVH by eightfold [aOR 8.4; 95 (3.7–15.7); p < 0.001]. Conclusion Obesity and IR appear to be the primary predictors of LVH in Black sub-Saharan African hypertensive patients. The comprehensive management of cardiovascular risk factors should be emphasized, with particular attention paid to obesity and IR. A prospective population-based study of Black sub-Saharan individuals that includes the use of serial imaging remains essential to better understand subclinical LV deterioration over time and to confirm the role played by IR in Black sub-Saharan individuals with hypertension.

Hyperoxia is associated with adverse outcomes in the cardiac intensive care unit: insights from the Medical Information Mart for Intensive Care (MIMI-III) database

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.Y Lui ◽  
L Garber ◽  
M Vincent ◽  
L Celi ◽  
J Masip ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Logistic Regression ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Adverse Outcomes ◽  
Rank Test ◽  
Positive Pressure ◽  
Cardiac Intensive Care Unit ◽  
Multivariable Logistic Regression ◽  
Cardiac Intensive Care

Abstract Background Hyperoxia produces reactive oxygen species, apoptosis, and vasoconstriction, and is associated with adverse outcomes in patients with heart failure and cardiac arrest. Our aim was to evaluate the association between hyperoxia and mortality in patients (pts) receiving positive pressure ventilation (PPV) in the cardiac intensive care unit (CICU). Methods Patients admitted to our medical center CICU who received any PPV (invasive or non-invasive) from 2001 through 2012 were included. Hyperoxia was defined as time-weighted mean of PaO2 &gt;120mmHg and non-hyperoxia as PaO2 ≤120mmHg during CICU admission. Primary outcome was in-hospital mortality. Multivariable logistic regression was used to assess the association between hyperoxia and in-hospital mortality adjusted for age, female sex, Oxford Acute Severity of Illness Score, creatinine, lactate, pH, PaO2/FiO2 ratio, PCO2, PEEP, and estimated time spent on PEEP. Results Among 1493 patients, hyperoxia (median PaO2 147mmHg) during the CICU admission was observed in 702 (47.0%) pts. In-hospital mortality was 29.7% in the non-hyperoxia group and 33.9% in the hyperoxia group ((log rank test, p=0.0282, see figure). Using multivariable logistic regression, hyperoxia was independently associated with in-hospital mortality (OR 1.507, 95% CI 1.311–2.001, p=0.00508). Post-hoc analysis with PaO2 as a continuous variable was consistent with the primary analysis (OR 1.053 per 10mmHg increase in PaO2, 95% CI 1.024–1.082, p=0.0002). Conclusions In a large CICU cohort, hyperoxia was associated with increased mortality. Trials of titration of supplemental oxygen across the full spectrum of critically ill cardiac patients are warranted. Funding Acknowledgement Type of funding source: None

scholarly journals Sonographic Cervical Shortening after Labor Induction is a Predictor of Vaginal Delivery

2016 ◽  
Vol 38 (12) ◽  
pp. 585-588 ◽  
Author(s):  
Ugo Indraccolo ◽  
Gennaro Scutiero ◽  
Pantaleo Greco
Keyword(s):  
Logistic Regression ◽  
Vaginal Delivery ◽  
Regression Models ◽  
Operating Characteristic ◽  
Roc Curves ◽  
Cervical Length ◽  
Labor Induction ◽  
Logistic Regression Models ◽  
Independent Variables ◽  
Sonographic Evaluation

Objective Analyzing if the sonographic evaluation of the cervix (cervical shortening) is a prognostic marker for vaginal delivery. Methods Women who underwent labor induction by using dinoprostone were enrolled. Before the induction and three hours after it, the cervical length was measured by ultrasonography to obtain the cervical shortening. The cervical shortening was introduced in logistic regression models among independent variables and for calculating receiver operating characteristic (ROC) curves. Results Each centimeter in the cervical shortening increases the odds of vaginal delivery in 24.4% within 6 hours; in 16.1% within 24 hours; and in 10.5% within 48 hours. The best predictions for vaginal delivery are achieved for births within 6 and 24 hours, while the cervical shortening poorly predicts vaginal delivery within 48 hours. Conclusion The greater the cervical shortening 3 hours after labor induction, the higher the likelihood of vaginal delivery within 6, 24 and 48 hours.

Third-Party Reimbursement for Lower-Extremity Wound Care

2002 ◽  
Vol 92 (1) ◽  
pp. 54-58
Author(s):  
Harry Goldsmith ◽  
Matthew G. Garoufalis
Keyword(s):  
Lower Extremity ◽  
Wound Care ◽  
Standard Of Care ◽  
Third Party ◽  
Foot And Ankle ◽  
Lower Extremity Wound ◽  
Third Party Reimbursement

This article describes the treatment of lower-extremity wounds, specifically foot and ankle ulcerations, in the context of reimbursement for treatments rendered. Therefore, such issues as standard of care, documentation, classification of foot wounds, coding, and reimbursement are discussed. (J Am Podiatr Med Assoc 92(1): 54-58, 2002)

Correlation between Restless Leg Syndrome and Superficial Venous Reflux

2021 ◽  
Author(s):  
Aaron R. Dezube ◽  
Jake Rauh ◽  
Michael Dezube ◽  
Mark Iafrati ◽  
JoAnn Rigo ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Family History ◽  
Lower Extremity ◽  
Symptom Improvement ◽  
Venous Disease ◽  
Restless Leg Syndrome ◽  
Venous Reflux ◽  
Common Cause ◽  
History Of ◽  
Prospective Trials

AbstractRestless leg syndrome (RLS) is a common cause of lower extremity discomfort. We hypothesized that patients with RLS symptoms have higher rates of deep and superficial venous reflux (SVR). Retrospective review of patients ≥18 years of age evaluated in a venous center from December 2018 to February 2019. Differences in rates of RLS symptoms, demographics, comorbidities, and clinical and radiologic presence of venous disease were analyzed. Overall, 207 patients were analyzed; 140 (67.6%) reported RLS symptoms (n = 25 with prior RLS diagnosis). RLS symptoms were more common with superficial or combined superficial and deep venous reflux (DVR) compared with those without reflux (p < 0.001). Patients with RLS symptoms as opposed to those without had similar demographics and comorbidities (all p > 0.05) but increased rates of venous pain, phlebitis, family history of venous disease, lower extremity swelling and SVR, and combined SVR and DVR (all p < 0.05). Our multivariable logistic regression found presence of SVR, and family history of venous reflux was associated with RLS symptomatology (all p < 0.001). Ninety-nine patients with RLS underwent ablation; of them, 93 had duplex-proven reflux resolution of which 81 (87%) reported RLS symptom improvement. This included 13 of 16 (81.3%) with prior RLS diagnosis. SVR is associated with increased rates of RLS symptoms in a vein center population. Therefore, RLS symptoms should trigger a targeted venous evaluation. Our results suggest that venous ablation may lead to resolution of RLS symptoms in patients with SVR, but randomized prospective trials with strict RLS definition criteria are warranted to confirm these outcomes.

scholarly journals Prediksi Not Operational Transaction Menggunakan Logistic Regression pada Bank XYZ di Kota Kupang

AITI ◽  
2020 ◽  
Vol 17 (1) ◽  
pp. 42-55
Author(s):  
Radius Tanone ◽  
Arnold B Emmanuel
Keyword(s):  
Machine Learning ◽  
Logistic Regression ◽  
Regression Method ◽  
Learning Approach ◽  
Know How ◽  
Independent Variables ◽  
Machine Learning Approach ◽  
Logistic Regression Method ◽  
Python Programming

Bank XYZ is one of the banks in Kupang City, East Nusa Tenggara Province which has several ATM machines and is placed in several merchant locations. The existing ATM machine is one of the goals of customers and non-customers in conducting transactions at the ATM machine. The placement of the ATM machines sometimes makes the machine not used optimally by the customer to transact, causing the disposal of machine resources and a condition called Not Operational Transaction (NOP). With the data consisting of several independent variables with numeric types, it is necessary to know how the classification of the dependent variable is NOP. Machine learning approach with Logistic Regression method is the solution in doing this classification. Some research steps are carried out by collecting data, analyzing using machine learning using python programming and writing reports. The results obtained with this machine learning approach is the resulting prediction value of 0.507 for its classification. This means that in the future XYZ Bank can classify NOP conditions based on the behavior of customers or non-customers in making transactions using Bank XYZ ATM machines.  

scholarly journals Clinical efficacy of Thumari gel in the management of superficial non healing leg ulcers- A rare case report.

2017 ◽  
Vol 1 (1) ◽  
pp. 1-5
Author(s):  
Naresh Kumar Ghodela ◽  
Tukaram Dudhamal
Keyword(s):  
Lower Extremity ◽  
Venous Insufficiency ◽  
Treatment Approach ◽  
Wound Care ◽  
Multidisciplinary Treatment ◽  
Local Application ◽  
Rare Case Report ◽  
Arterial Insufficiency ◽  
Underlying Pathophysiology

Ulcers in lower extremity are generally caused by venous insufficiency, arterial insufficiency, and diabetic neuropathy. Inflammatory ulcers are also difficult to diagnose because of underlying pathophysiology rests on inflammation and immunologic phenomena. Definitive diagnosis and multidisciplinary treatment approach are needed to manage lower extremity ulcers. These ulcers may hamper the quality of life of patient. Here we reported a new case of post fracture of shaft of right tibia bone, presented with painful, hypertrophied, irregular shaped ulcer on anterior aspect of tibia gradually developing since 3 months. A male patient of 45 years old consulted to OPD with above complaint that was unable to bear weight on the effected leg (right limb). This case was managed with a local application of Thumari Gel and ulcers were almost healed within 6 weeks of wound care along with internal use of Ayurveda medicines. This case concluded that regular local application of Thumari Gel helpful in healing of chronic ulcer.

scholarly journals Analysis of Financial Ratios for Predicting Bankruptcy in SMEs Listed on PEFINDO25

2020 ◽  
Vol 19 (2) ◽  
Author(s):  
Vitalia Fina Carla Rettobjaan
Keyword(s):  
Logistic Regression ◽  
Data Analysis ◽  
Activity Ratio ◽  
Significant Positive Effect ◽  
Debt Structure ◽  
Financial Ratio ◽  
Independent Variables ◽  
Negative Effect ◽  
And Control ◽  
Positive Effect

This study aims to analyze the Financial Ratio for Predicting Bankruptcy. The sample used in this study are SMEs according PEFINDO25 period 2013 to 2017. The independent variables in this study is liquidity, profitability, debt structure, solvency and activity ratio; and control variables is size and age, as well as the dependent variable is bankruptcy. The amount of sample in this study 32 companies PEFINDO25 by using purposive sampling. The method of data analysis is done by using logistic regression with SPSS version 23. The result of this research showed that liquidity, profitability and age has significant negative effect on bankruptcy. Debt structure has significant positive effect on bankruptcy. While solvency, activity ratio and size does not significantly effect on bankruptcy

Sign in / Sign up

Export Citation Format

Share Document