Abstract 3734: Presurgical fMRI and Morbidity Outcomes in Patients with Vascular Lesions

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Andrew C Radtke ◽  
Joshua Pankratz ◽  
Ryan Holdsworth ◽  
Dovile Baniulis ◽  
Nicole Kornder ◽  
...  

Background fMRI is being increasingly used as an adjunct imaging technique for preoperative planning for patients with various brain lesions. The proximity of the lesion to eloquent cortex is a major factor in guiding surgical planning. Our group has previously reported significant association between the distance between brain tumor periphery and area of fMRI activation (Lesion-Activation Distance; LAD) and morbidity and mortality outcomes. This study investigated the relationship between vascular lesion LAD and morbidity. Methods This study was a retrospective analysis of data from patients with vascular lesions [arteriovenous malformations (AVMs) (n=49), and cavernomas (n=57)], who had received fMRI as part of their preoperative planning. The preoperative fMRI included motor mapping (n=87) and/or language mapping (n=102). The fMRI paradigms were chosen based on observed preoperative weakness (aphasia, paresis) and anticipated functional areas of the brain that may be affected by treatment. Results Multiple logistic regression analyses showed that a model that combines Age and Language LAD was a significant predictor of postoperative deficits (p= 0.04). Broca’s LAD(1-2 cm) X Age was a significant predictor of postoperative deficits (change in odds ratio (OR) =0.82, CI:0.68-0.98). The relationship between Brocas’s LAD and postoperative aphasia and Broca’s LAD and pre and postoperative aphasia trended towards significance (p = .08 and p =.07 respectively). Wernicke’s LAD, independently or combined with Age, was not a significant predictor of postoperative deficits. Binary logistic regression analysis for SMC LAD and postop deficits did not reach significance (p =.10). There were no significant differences in postoperative language or motor deficits as a function of gender or handedness. Conclusions These results suggest that both age and the proximity of a vascular lesion to language LAD are factors that can help predict postoperative outcomes, especially for Broca’s LAD. The lack of similar results when investigating the relationship between Wernicke’s LAD and postoperative deficits suggests potential brain reorganization and/or robustness of this brain region. These results have implications for the potential use of fMRI as a presurgical tool for language mapping in patients with vascular lesions.

2013 ◽  
Vol 34 (4) ◽  
pp. E7 ◽  
Author(s):  
Jed Voss ◽  
Timothy B. Meier ◽  
Robert Freidel ◽  
Bornali Kundu ◽  
Veena A. Nair ◽  
...  

Object Functional MRI (fMRI) is commonly used by neurosurgeons preoperatively to identify brain regions associated with essential behaviors, such as language and motor abilities. In this study the authors investigated the relationship between patient morbidity and mortality and the distance from the tumor border area to functional activations in secondary motor and language cortices. Methods Patients with primary or metastatic brain tumors who underwent preoperative fMRI motor and language mapping were selected from a large database of patients with tumors. The lesion-to-activation distance (LAD) was measured in each patient relative to the supplementary motor area (SMA) for motor tasks and the presupplementary motor area (pSMA) for language tasks. The association between LAD and the incidence of deficits was investigated using the Fisher exact tests of significance. The impact of other variables, including age, handedness, sex, and tumor grade, was also investigated. In a subset of patients, logistic regression was performed to identify the likelihood of deficits based on the LAD to primary and secondary regions. Finally, Mantel-Cox log-rank tests were performed to determine whether survival time was significantly related to the LAD to secondary motor and language areas. Results A significant association was observed between the LAD to the SMA and the incidence of motor deficits, with the percentage of patients with deficits dropping for those in the LAD > 2 cm group. The relationship between the LAD to the pSMA and the incidence of language deficits was not significant. Logistic regression demonstrated that the LAD to primary sensorimotor cortex does affect the incidence of motor deficits, but that the LAD to SMA does not. Finally, the authors observed no relationship between the LAD to secondary regions and patient mortality rates. Conclusions These results demonstrate that the LAD to SMA structures does affect morbidity, although not to the extent of LAD to primary structures. In addition, motor deficits are significantly associated with LAD to secondary structures, but language deficits are not. This should be considered by neurosurgeons for patient consultation and preoperative planning.


2021 ◽  
Vol 7 (1) ◽  
pp. 52
Author(s):  
Putricia Synthesa

Gender equality which has become one of the national development goals is often described by the degree of women's autonomy. The absence of the RPJMN target in terms of fertility rates in Indonesia could be due to the current low autonomy of women. The purpose of this study is to determine the spatial analysis of the relationship between women's autonomy and fertility at the provincial level and to determine the effect of women's autonomy on fertility in Indonesia. The analysis method used in this research is the spatial analysis and binary logistic regression analysis. The spatial analysis will describe spatially the relationship between women's autonomy and fertility based on 34 provinces in Indonesia. Meanwhile, the logistic regression analysis will look at the influence of the female autonomy variable on fertility in Indonesia. The results of the spatial analysis show that most provinces in Indonesia still have high fertility rates and this pattern is followed by low women's autonomy. Meanwhile, the results of binary logistic regression analysis showed that 7 out of 11 independent variables consisting of female autonomy variables and other control variables significantly affected fertility. Where the independent variables that describe women's autonomy affect on fertility in Indonesia. So that increasing women's autonomy needs to be built in terms of supporting population control.


2013 ◽  
Vol 34 (4) ◽  
pp. E8 ◽  
Author(s):  
Thomas A. Gallagher ◽  
Veena A. Nair ◽  
Michael F. Regner ◽  
Brittany M. Young ◽  
Andrew Radtke ◽  
...  

Object Functional MRI (fMRI) has proven to be an effective component of pretreatment planning in patients harboring a variety of different brain lesions. The authors have recently reported significant relationships concerning distances between brain tumor borders and areas of functional activation (lesion-to-activation distance; LAD) with regard to patient morbidity and mortality. This study further examines the relationship between LAD, focusing on a host of vascular lesions and pre- and posttreatment morbidity. Methods This study included a sample population of patients with vascular lesions (n = 106), primarily arteriovenous malformations (AVMs) and cavernomas. These patients underwent pretreatment fMRI-based motor mapping (n = 72) or language mapping (n = 84). The impact of LAD and other variables derived from the patient medical record were analyzed with respect to functional deficits in terms of morbidity (weakness and/or aphasia). Results In patients with no pretreatment deficits, there was trend for a significant relationship between the Wernicke area LAD and posttreatment language deficits. In patients with or without pretreatment deficits, a trend toward significance was observed between sensorimotor LAD and posttreatment motor deficits. Additionally, lesion type (AVMs or cavernomas) affected posttreatment deficits, with more patients with cavernomas showing posttreatment language deficits than patients with AVMs. However, this difference was not observed for posttreatment motor deficits. Conclusions These findings suggest that the proximity of a vascular lesion to sensorimotor and language areas is a relevant parameter in estimating patient prognosis in the perioperative period. Additionally, vascular lesion type and existence of pretreatment deficits play a significant role in outcomes.


Author(s):  
Sneha Sharma ◽  
Raman Tandon

Abstract Background Prediction of outcome for burn patients allows appropriate allocation of resources and prognostication. There is a paucity of simple to use burn-specific mortality prediction models which consider both endogenous and exogenous factors. Our objective was to create such a model. Methods A prospective observational study was performed on consecutive eligible consenting burns patients. Demographic data, total burn surface area (TBSA), results of complete blood count, kidney function test, and arterial blood gas analysis were collected. The quantitative variables were compared using the unpaired student t-test/nonparametric Mann Whitney U-test. Qualitative variables were compared using the ⊠2-test/Fischer exact test. Binary logistic regression analysis was done and a logit score was derived and simplified. The discrimination of these models was tested using the receiver operating characteristic curve; calibration was checked using the Hosmer—Lemeshow goodness of fit statistic, and the probability of death calculated. Validation was done using the bootstrapping technique in 5,000 samples. A p-value of <0.05 was considered significant. Results On univariate analysis TBSA (p <0.001) and Acute Physiology and Chronic Health Evaluation II (APACHE II) score (p = 0.004) were found to be independent predictors of mortality. TBSA (odds ratio [OR] 1.094, 95% confidence interval [CI] 1.037–1.155, p = 0.001) and APACHE II (OR 1.166, 95% CI 1.034–1.313, p = 0.012) retained significance on binary logistic regression analysis. The prediction model devised performed well (area under the receiver operating characteristic 0.778, 95% CI 0.681–0.875). Conclusion The prediction of mortality can be done accurately at the bedside using TBSA and APACHE II score.


2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Weerakit Naweera ◽  
Thapat Wannarong

Abstract Background and Aims Snakebite is a common animal bite injury in tropical countries. Acute kidney injury (AKI) is an important complication in snakebite patients. This study aimed to comprehensively investigate the clinical profiles and outcomes of patients following hematotoxin-related snakebite associated with kidney impairment. Method We conducted a hospital-based, cross-sectional study of 238 patients with hematotoxin-related snakebite injuries. Data were retrieved from the King Narai Hospital Registry from October 2014 to August 2020. The prevalence of complications associated with snakebite injuries, including acute kidney injury (AKI) and its severity, was determined. Univariate and Multivariate predictors of AKI diagnosis were evaluated using binary logistic regression analysis Results A total of 238 patients, with 63.4% men, median (IQR) age 49.8 (39-61) years and median duration from injury to a hospital arrival of 1 hour (0.5-2) hours, were injured by Green pit viper (85.7%), Russell’s viper (12.6%) and Malayan pit viper (1.7%). AKI mostly occurred in Russell’s viper group 66.7%. An AKI was reported in thirty (12.6%, 95% CI: 8.7 % - 17.5%) patients, with the severity of 66.7% stage one, 6.7% stage two, 26.6% stage three by KDIGO classifications, and 13.3% requiring hemodialysis. Complete renal recovery was seen in twenty-two patients (73.3%), while partial renal recovery was 23.3%. Other complications included 84.4 % limb cellulitis, 4.6% significantly bleeding, 2.5% hypotension, 25.6% prolonged venous clotting time (VCT), 46.7% prolonged prothrombin time (PT), and 14.3% prolonged partial thromboplastin time (PTT). Of total patients, 60.1% were treated with anti-venom. Mortality was relatively low (0.4%). In multivariable logistic regression analyses, AKI was significantly associated with time to hospital arrival more than 3 hours (p = 0.04), Russell’s viper bitten (p = 0.01), clinical bleeding (p = 0.01), and prolonged PT (p &lt; 0.01). Conclusion The prevalence of AKI in patients bitten by hematotoxin snakes was 12.6%, mostly from Russell’s viper. Factors associated with AKI outcomes were time to hospital arrival more than 3 hours, Russell’s viper bitten, clinical bleeding, and prolonged PT. Besides, one-fourth of AKI patients turned to chronic kidney disease.


Author(s):  
Askalech Feyisa Jobira ◽  
Abdulnasir Abdulmelike Mohammed

AbstractMotivation is one of the most researched yet crucial topics in academia from various perspectives. Despite this, researches show mixed results about the effect of extrinsic motivation on intrinsic motivation and organizational performance. Studies in Ethiopia also lack causal analysis and theoretical underpinning that made contributions from academia very little. Hence, this research is important to assess the effect of extrinsic motivation on intrinsic motivation and organizational performance from a cognitive evaluation theory perspective. The researchers adopted an explanatory research design with a quantitative approach. The entire 119 employees of the Oromia Seed Enterprise, Bale branch were included in the study to collect primary data through a close-ended questionnaire. The collected data was processed by SPSS software version 20. The relationship analysis was addressed by correlation and binary logistic regression analysis. Seen from extrinsic and intrinsic motivation aspects, the findings of the study showed that Oromia Seed Enterprise had a moderate level of organizational performance and a moderate level of employees’ motivation. The correlation analysis result indicated that employees’ extrinsic and intrinsic motivation had a positive relationship with organizational performance. The binary logistic regression analysis also indicated that extrinsic and intrinsic motivation had a positive and significant influence on organizational performance. However, the interaction effect of intrinsic and extrinsic motivation on organizational performance was not significant, implying the absence of influence when both intrinsic and extrinsic motivations happen at the same time. Finally, the study results have a theoretical contribution for compensating the lack of actual experience in the Ethiopian organization’s context. Equally, the understanding of the moderated relationship among the study variables may encourage Oromia Seed Enterprise and its managers to develop a practical motivation system, which entertains the complex interaction of motivation variables to improve organizational performance. In addition, studies of this nature can inform policymakers to strengthen an incentive system as well as other motivation veins in the Ethiopian public organizations.


2020 ◽  
Author(s):  
Shouxing Yang ◽  
Jinwei Zhong ◽  
Mengsi Ye ◽  
Lei Miao ◽  
Guangrong Lu ◽  
...  

Abstract Background: The non-HDL-cholesterol to HDL-cholesterol (NHDLC/HDLC) ratio is closely related to a variety of dyslipidemia-related diseases. This study aimed to inspect the relationship between the NHDLC/HDLC ratio and non-alcoholic fatty liver (NAFLD) in children and adolescents.Methods: In this cross-sectional survey, a total of 7,759 eligible Chinese children and adolescents (5,692 boys and 2,067 girls) received routine medical examinations. The anthropometric and laboratory data of the subjects were collected. NAFLD was diagnosed by liver ultrasonography. Binary logistic regression analysis was performed on the NHDLC/HDLC ratio, NHDLC, HDLC and NAFLD. Receiver operating characteristic (ROC) curve analysis was exploited to compare the diagnostic significance of the above parameters for NAFLD.Results: The total prevalence of NAFLD was 4.36%, and the prevalence in boys was higher than that in girls (5.61% vs. 1.9%, P < 0.001). The prevalence of NAFLD was positively correlated with the NHDLC/HDLC ratio (P < 0.001). The binary logistic regression analysis demonstrated that the OR was 8.61 (95% CI, 5.90-12.57, P < 0.001) in tertile 3 (highest NHDLC/HDLC ratio) compared with tertile 1 (lowest NHDLC/HDLC ratio). After adjustment for age, sex, body mass index (BMI), alanine aminotransferase (ALT), uric acid (UA), total bilirubin (TB), fasting plasma glucose (FPG) and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), the OR for tertile 3 (OR=1.83, 95% CI, 1.04-3.22, P = 0.035) was still significantly higher than that of tertile 1. The area under the curve (AUC) of the NHDLC/HDLC ratio of boys was 0.787, which was significantly greater than that of NHDLC and HDLC (0.719 and 0.726, P < 0.001). For girls, the AUC of the NHDLC/HDLC ratio was 0.763, which was also significantly greater than that of NHDLC (0.661, P < 0.001). Furthermore, the cutoff point of the NHDLC/HDLC ratio was 2.475 in boys and 2.695 in girls. In addition, the AUC of the NHDLC/HDLC ratio was 0.761 in subjects with normal ALT levels (ALT ≤ 40 U/L), which was significantly higher than that of NHDLC (0.680, P < 0.001) and HDLC (0.724, P = 0.007). For subjects with elevated ALT levels (ALT > 40 U/L), the AUC of the NHDLC/HDLC ratio (0.746) was also significantly greater than that of NHDLC (0.646, P < 0.001)Conclusions: The NHDLC/HDLC ratio was positively correlated with NAFLD in Chinese children and adolescents. It may serve as an effective indicator to help identify NAFLD in children and adolescents.


2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Setyaningsih SU ◽  
Edi Wibowo

This study aims to analyze the effect of the needs of achievement and personal characteristics (education, age, experience, training) on business performance. This research is census research, using 63 respondents of women entrepreneurs to Toga farmers in Jumantono District, Karanganyar Regency. Data analysis technique using binary logistic regression analysis. The conclusions from the results of this study indicate that the needs of achievement and personal characteristics of business experience have a significant effect on business performance, while the variables of education, age, and entrepreneurship training have no significant effect on business performance. Based on the results of this study, the odds/probabilities of the performance of women's entrepreneurial business in Toga farmers in Jumantono District, Karanganyar Regency can be predicted by the needs of achievement and business experience. The implication of this finding is that to achieve high business performance, Toga farmers in Jumantono District, Karanganyar Regency need to increase their needs for achievement and business experience.Keywords: needs of achievement, education, age, experience, training, business performance


2022 ◽  
Vol 6 (1) ◽  
pp. e384
Author(s):  
Rubén Molina-Sánchez ◽  
Domingo García-Pérez-de-Lema ◽  
Alejandra López-Salazar ◽  
Roberto Godínez-López

This work empirically analyzes the competitive factors that help make micro, small, and medium enterprises (MSMEs) successful. To do this, an empirical study with a sample of 614 companies in Guanajuato, Mexico, has been carried out. The results of the binary logistic regression analysis show that quality, technology, and innovation are the main variables that determine a company’s success. These findings could provide guidelines to help MSMEs improve their competitiveness, and they could help public administrations better support MSME growth.


Author(s):  
Sendi Nugraha Nurdiansah ◽  
Laelatul Khikmah

The phenomenon of poverty is a serious problem faced by almost every country in the world. This is because poverty can affect various aspects of people's lives. One of the causes of poverty is due to lack of income and assets to meet basic needs such as food, clothing, housing, health level and acceptable education. In addition, poverty occurs because of the powerlessness of society to get out of the problems it faces. The Central Java regional government incorporated poverty issues into the Regional Medium-Term Development Plan (RPJMD) because Central Java has a high number of poor people. This was done as an effort by the Central Java government to reduce poverty. Therefore, research is needed to find out the variables that most influence poverty in order to assist the government in developing the RPJMD. To find out what factors influence poverty in Central Java with the dichotomous categorical response variable, binary logistic regression analysis was used. The results showed that based on the analysis conducted did not obtain a logistic regression equation model because there were no significant parameters because there were no variables that had a sig value <0.05. Existing variables are Number of Population, Female Head of Household, Number of Children not in School, Number of Disabled Individuals, Number of Chronic Disease Individuals, Unemployment, Non-Electricity Lighting Sources, Unprotected Drinking Water Sources, Kerosene and Wood Cooking Fuels, Location Facilities Defecation (BAB) Not Available, so there are no variables that affect the level of poverty in Central Java Province.


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