Neuraxial analgesia is not associated with an increased risk of post-partum           relapses in MS

Background: Obstetrical analgesia remains a matter of controversy because of the fear of neurotoxicity of local anesthetics on demyelinated fibers or their potential relationship with subsequent relapses. Objective: To assess the impact of neuraxial analgesia on the risk of relapse during the first 3 months post-partum, with a focus on women who experienced relapses during pregnancy. Methods: We analyzed data of women followed-up prospectively during their pregnancies and at least 3 months post-partum, collected in the Pregnancy in Multiple Sclerosis (PRIMS) and Prevention of Post-Partum Relapses with Progestin and Estradiol in Multiple Sclerosis (POPARTMUS) studies between 1992–1995 and 2005–2012, respectively. The association of neuraxial analgesia with the occurrence of a post-partum relapse was estimated by logistic regression analysis. Results: A total of 389 women were included, 215 from PRIMS and 174 from POPARTMUS. In total, 156 women (40%) had neuraxial analgesia. Overall, 24% experienced a relapse during pregnancy and 25% in the 3 months post-partum. Women with a pregnancy relapse were more likely to have a post-partum relapse (odds ratio (OR) = 1.83, p = 0.02), independently of the use of neuraxial analgesia. There was no association between neuraxial analgesia and post-partum relapse (OR = 1.08, p = 0.78). Conclusion: Neuraxial analgesia was not associated with an increased risk of post-partum relapses, whatever multiple sclerosis (MS) activity during pregnancy.

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The Association between TREM2 Gene and Late-Onset Alzheimer’s Disease in Chinese Han Population

Gerontology ◽

10.1159/000517284 ◽

2021 ◽

pp. 1-7

Author(s):

Yan Sun ◽

Yun-Ke Zhang ◽

Hai Chen ◽

Ren-Shou Chen

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Logistic Regression ◽

Regression Analysis ◽

Environmental Factors ◽

Logistic Regression Analysis ◽

Late Onset ◽

Increased Risk ◽

The Impact ◽

Load Risk

Objective: : The objective of this study was to evaluate the impact of single nucleotide polymorphisms (SNPs) in triggering receptor expressed on the myeloid cells 2 protein (TREM2) gene and their interaction with environmental factors and haplotypes on late-onset Alzheimer’s disease (LOAD). Methods: DNA was extracted from the whole blood of the participants and genotyped using PCR and followed by restriction fragment length polymorphism. The Hardy-Weinberg equilibrium test was used in the control group. Multivariate logistic regression analysis was used to determine the relationship between the 4 SNPs of the TREM2 gene and the risk of LOAD. Generalized multifactor dimensionality reduction was used to test the best interaction combination between SNPs and environmental factors. Results: Logistic regression analysis showed that the T allele of rs75932628 and the T allele of rs2234253 were independently associated with increased risk of LOAD, and adjusted odds ratios (ORs) were 1.81 (1.271–2.35) and 1.59 (1.15–2.03), respectively. However, there was no significant association with LOAD for rs142232675 and rs143332484. We found a best model significantly associated with LOAD risk that consisted of rs75932628 and smoking, which scored 10/10 for both the sign test and cross-validation consistency (p = 0.012). Stratified analysis indicated that current smokers with rs75932628-CT/TT genotype have the highest LOAD risk compared to never smokers with rs75932628 – CC genotype, OR (95% confidence interval) = 2.73 (1.72–3.79). Haplotypes of rs75932628 and rs2234253 were analyzed using the SHEsis online software. However, no haplotype was found to be significantly associated with the risk of LOAD. Conclusions: The T allele of rs75932628 and the T allele of rs2234253 and interaction between rs75932628 and smoking were all correlated with increased risk of LOAD.

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Exposure to passive smoking during adolescence is associated with an increased risk of developing multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458520912500 ◽

2020 ◽

pp. 135245852091250 ◽

Cited By ~ 1

Author(s):

Ditte Bang Oturai ◽

Helle Bach Søndergaard ◽

Nils Koch-Henriksen ◽

Christina Andersen ◽

Julie Hejgaard Laursen ◽

...

Keyword(s):

Multiple Sclerosis ◽

Logistic Regression ◽

Environmental Factors ◽

Passive Smoking ◽

Odds Ratio ◽

Blood Donors ◽

Propensity Scores ◽

Increased Risk ◽

Female Case ◽

Never Smokers

Background: Environmental factors are associated with acquiring multiple sclerosis (MS) particularly in adolescence. Objective: To test for association between MS and exposure to passive smoking at the age of 10–19. Methods: A total of 919 patients from the Danish MS Registry and Biobank and 3419 healthy blood donors who had not smoked before the age of 19 were targeted. We analyzed separately for each sex and for those never-smokers (cohort 1) and active smokers above the age of 19 (cohort 2). All participants completed standardized questionnaires about smoking and lifestyle. We matched cases and controls in the ratio of 1:2 by propensity scores discarding unmatchable individuals and used logistic regression adjusted for all covariates and interactions. Results: After matching, we included 110/213 male cases/controls and 232/377 female case/controls in cohort 1. In cohort 2, the numbers were 160/320 and 417/760, respectively. Among women in cohort 1, the odds ratio (OR) for MS by passive smoking at the age of 10–19 was 1.432 ( p = 0.037) but in men it was 1.232 ( p = 0.39). Among men in cohort 2, OR was 1.593 ( p = 0.022) but among women it was only 1.102 ( p = 0.44). Conclusion: Among never smokers, female MS cases were more often than female controls reported with passive smoking between the age of 10 and 19, and among smokers above the age of 19, male MS patients were more often than male controls reported with passive smoking.

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Bisphosphonates after Denosumab withdrawal reduce the vertebral fractures incidence

Acta Endocrinologica ◽

10.1530/eje-21-0157 ◽

2021 ◽

Author(s):

Giorgia Grassi ◽

Iacopo Chiodini ◽

Serena Palmieri ◽

Elisa Cairoli ◽

Maura Arosio ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Vertebral Fracture ◽

Confidence Interval ◽

Odds Ratio ◽

Treated Group ◽

Single Infusion ◽

Risk Increase ◽

Increased Risk ◽

Frax Score

Objective: Several studies showed the occurrence of vertebral fracture (VFx) in patients discontinuing denosumab (Dmab), suggesting the need of bisphosphonate (BPs) therapy to mitigate this VFx risk increase. However, the morphometric VFx (morphoVFx) incidence after Dmab discontinuation and the BPs effect on VFx risk in this setting are still a matter of debate. Design: Retrospective, monocentric study. Methods: In 120 patients (111 females) discontinuing Dmab, 19 have not been treated (Not-treated Group, 16 females, age 63.5±15.0 years) and 101 patients have been treated (Treated Group, 95 females, age 70.0±10.6 years) with BPs (28 alendronate, ALN; 73 zoledronate, ZOL, single infusion), respectively. We evaluated the incidence of both clinical VFx and morphoVFx in Treated Group and Non-treated Group. Results: Patients in Treated Group showed a 5.5% VFx incidence (n=6, 3 clinical, 3 morpho VFx), which was anyway lower than Not-treated Group patients (n=4, 21.1%, 4 clinical, 3 multiple, p=0.029), despite a comparable FRAX score at the time of Dmab initiation. The logistic regression analysis showed that the VFx incidence was independently associated with the lack of BPs treatment (odds ratio 13.9, 95% confidence interval 1.7-111.1, p=0.014), but not with the number of Dmab injections, age, duration of BPs before Dmab initiation, the BMD at Dmab withdrawal and the prevalence of VFx at Dmab withdrawal. Conclusions: The Dmab withdrawal is associated with an increased risk of clinical but not morphometric VFx. Therapy with ALN or with a single ZOL treatment are partially effective in reducing the increased VFx risk after Dmab withdrawal.

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Chronic Pain After Breast Surgery: Incidence, Associated Factors and Impact on Quality of Life, an Observational Prospective Study

10.21203/rs.3.rs-53287/v1 ◽

2020 ◽

Author(s):

Gianluca Villa ◽

Raffaele Mandarano ◽

Caterina Scirè Calabrisotto ◽

Valeria Rizzelli ◽

Martina Del Duca ◽

...

Keyword(s):

Risk Factors ◽

Chronic Pain ◽

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Breast Surgery ◽

Persistent Pain ◽

Axillary Surgery ◽

Increased Risk ◽

The Impact

Abstract Background. Chronic pain after breast surgery (CPBS) has a disabling impact on postoperative health conditions. Mainly because of the lack of a clear definition, inconsistency does exist in the literature concerning both the actual incidence of and the risk factors for CPBS. The aim of this prospective, observational study is to describe incidence of and risk factors for CPBS, defined in accordance with the IASP taskforce. The impact of CPBS on patients’ daily functions is also described. Methods. Adult female patients scheduled for oncological or reconstructive breast surgery at the Breast Unit of Careggi Hospital (Florence, Italy) were prospectively observed. Persistent postoperative pain was evaluated at 2 months (“pain becoming chronic”) and at 3 months (CPBS) after surgery. Preoperative, intraoperative, and postoperative factors were compared in CPBS and No-CPBS groups through multivariate logistic regression analysis. Results. Among the 307 patients considered in this study, the incidence of “pain becoming chronic” was 25.4% [95%CI 20.6%-30.7%], while that of CPBS was 28% [95%CI 23.1%-33.4%]. The presence of persistent pain at 2 months concords with the presence of CPBS at 3 months (Cohen k coefficient 0.63, IC95% 0.54-0.73). Results from the logistic regression analysis suggest that axillary surgery (OR [95%CI], 2.99 [1.13-7.87], p=0.03), preoperative use of pain medications (OR [95%CI], 2.04 [1.20-3.46], p=0.01), and dynamic NRS values at 6 hours postoperatively (OR [95%CI], 1.28 [1.05-1.55], p=0.01) were all independent predictors for CPBS. Conclusions. Chronic pain after breast surgery is a frequent complication. The presence of an earlier form of persistent pain at 2 months after surgery concords with the occurrence of CPBS. The possibility to early detect persistent pain, particularly in those patients at high risk for CPBS, might help physicians to more effectively prevent pain chronicization. In our cohort, long-term use of analgesics for preexisting chronic pain, axillary surgery, and higher dynamic NRS values at 6 hours postoperatively were all factors associated with increased risk of developing CPBS. Trial registration: clinicalTrials.gov registration NCT04309929

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Major malformations in offspring of women with epilepsy

Neurology ◽

10.1212/01.wnl.0000044157.28073.dc ◽

2003 ◽

Vol 60 (4) ◽

pp. 575-579 ◽

Cited By ~ 130

Author(s):

Erja Kaaja ◽

Risto Kaaja ◽

Vilho Hiilesmaa

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

First Trimester ◽

Serum Folate ◽

Contributing Factors ◽

Level Of Education ◽

Increased Risk ◽

The Impact ◽

Low Serum

Background: The offspring of women with epilepsy are at an increased risk of major congenital malformations, but the impact of the various contributing factors remains unresolved.Method: In 1980 through 1998, the authors prospectively followed up 970 pregnancies in women with epilepsy at a single maternity clinic. Of their 979 offspring, 740 were exposed to maternal antiepileptic drugs (AED) during the first trimester of pregnancy and 239 were not exposed. Maternal AED levels and serum folate concentrations were measured at the end of the first trimester. Logistic regression analysis was applied to identify factors associated with the occurrence of major malformations in the fetuses and newborns.Results: Major malformations were detected in 28 fetuses (3.8%) exposed to maternal AED and in 2 (0.8%) not exposed (p = 0.02). After logistic regression analysis, the occurrence of major malformations was independently associated with use of carbamazepine (adjusted OR 2.5; 95% CI 1.0 to 6.0), use of valproate (4.1; 1.6 to 11), use of oxcarbazepine (10.8; 1.1 to 106), low serum folate concentration (5.8; 1.3 to 27), and low maternal level of education (3.0; 1.3 to 6.8). Major malformations were not associated with seizures during the first trimester (0.6; 0.1 to 2.9).Conclusions: Major malformations in the offspring of mothers with epilepsy are associated with use of AED during early pregnancy, and also with low serum folate concentrations and a low level of education.

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Smoking as a risk factor for multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458512470862 ◽

2012 ◽

Vol 19 (8) ◽

pp. 1022-1027 ◽

Cited By ~ 34

Author(s):

Jonatan Salzer ◽

Göran Hallmans ◽

Maria Nyström ◽

Hans Stenlund ◽

Göran Wadell ◽

...

Keyword(s):

Multiple Sclerosis ◽

Logistic Regression ◽

Risk Factor ◽

Confidence Interval ◽

Tobacco Use ◽

Odds Ratio ◽

Disease Onset ◽

Recall Bias ◽

Blood Samples ◽

Increased Risk

Background: Smoking has been associated with an increased risk for multiple sclerosis, but no studies have measured levels of the nicotine metabolite cotinine in prospectively collected samples to assess exposure. Objective: To investigate the effects of laboratory defined tobacco use on the risk for multiple sclerosis using prospectively collected biobank blood samples. Methods: Levels of cotinine were measured in n=192 cases, and n=384 matched controls, using an immunoassay. The risk for multiple sclerosis was estimated using matched logistic regression. Results: Elevated cotinine levels (≥10 ng/ml) were associated with a significantly increased risk for multiple sclerosis, (odds ratio, OR 1.5, 95% confidence interval, CI 1.0–2.1). This association was only present in young individuals (below median age at blood sampling, <26.4 years), (OR 2.2, 95% CI 1.3–3.8). Conclusions: This study confirms that smoking is a risk factor for multiple sclerosis. It has the advantage of using analyses of cotinine levels in samples that were collected several years before disease onset, thus excluding any risk for recall bias and minimising the risk for reversed causation. Our results also suggest that the smoking related immunological events that contribute to the development of multiple sclerosis occur early in life.

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TNFAIP8L1 and FLT1 polymorphisms alter the susceptibility to cervical cancer amongst uyghur females in China

Bioscience Reports ◽

10.1042/bsr20191155 ◽

2019 ◽

Vol 39 (7) ◽

Author(s):

Lili Han ◽

Sulaiya Husaiyin ◽

Chunhua Ma ◽

Lin Wang ◽

Mayinuer Niyazi

Keyword(s):

Cervical Cancer ◽

Logistic Regression ◽

Regression Analysis ◽

Odds Ratio ◽

Linkage Disequilibrium Block ◽

Nucleotide Polymorphisms ◽

Single Nucleotide ◽

Cervical Cancer Risk ◽

Increased Risk ◽

Stratified Analysis

Abstract TNFAIP8L1 and FLT1 play critical roles in the occurrence and development of tumors, but no in-depth studies have been carried out in cervical cancer. The present study aims to research the correlation between polymorphisms of these two genes and the risk of cervical cancer in the Uygur women. The study involved 342 cervical cancer patients and 498 healthy women. Five single nucleotide polymorphisms (SNPs) from the TNFAIP8L1 gene and the FLT1 gene were selected and genotyped. Odds ratio and 95% CIs were calculated by logistic regression analysis to evaluate the correlation between SNPs and cervical cancer risk. The alleles rs9917028-A (P=0.032), rs10426502-A (P=0.007), and rs1060555-G (P=0.026) of TNFAIP8L1 were associated with a decreased risk of cervical cancer. In the multiple genetic models, these three SNPs were also associated with the risk of cervical cancer. The stratified analysis showed that TNFAIP8L1-rs10426502, -rs1060555, and FLT1-rs9513111 were associated with a decreased risk of cervical cancer amongst people older than 43 years. Moreover, the haplotypes AG (P=0.007) and GC (P=0.026) of linkage disequilibrium block rs10426502|rs1060555 in TNFAIP8L1 were significantly associated with an increased risk of cervical cancer. Our results suggested that the relationships between TNFAIP8L1 and FLT1 polymorphisms and the risk of cervical cancer amongst Uyghur females.

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Prior Admissions as a Risk Factor for Readmission in Patients Surgically Treated for Femur Fractures: Implications for a Potential Hip Fracture Bundle

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459321996169 ◽

2021 ◽

Vol 12 ◽

pp. 215145932199616

Author(s):

Robert Erlichman ◽

Nicholas Kolodychuk ◽

Joseph N. Gabra ◽

Harshitha Dudipala ◽

Brook Maxhimer ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Hip Fracture ◽

Logistic Regression Analysis ◽

Hip Fractures ◽

Surgical Procedure ◽

Hospital Admissions ◽

Fracture Care ◽

Increased Risk ◽

Payment Models

Introduction: Hip fractures are a significant economic burden to our healthcare system. As there have been efforts made to create an alternative payment model for hip fracture care, it will be imperative to risk-stratify reimbursement for these medically comorbid patients. We hypothesized that patients readmitted to the hospital within 90 days would be more likely to have a recent previous hospital admission, prior to their injury. Patients with a recent prior admission could therefore be considered higher risk for readmission and increased cost. Methods: A retrospective chart review identified 598 patients who underwent surgical fixation of a hip or femur fracture. Data on readmissions within 90 days of surgical procedure and previous admissions in the year prior to injury resulting in surgical procedure were collected. Logistic regression analysis was used to determine if recent prior admission had increased risk of 90-day readmission. A subgroup analysis of geriatric hip fractures and of readmitted patients were also performed. Results: Having a prior admission within one year was significantly associated (p < 0.0001) for 90-day readmission. Specifically, logistic regression analysis revealed that a prior admission was significantly associated with 90-day readmission with an odds ratio of 7.2 (95% CI: 4.8-10.9). Discussion: This patient population has a high rate of prior hospital admissions, and these prior admissions were predictive of 90-day readmission. Alternative payment models that include penalties for readmissions or fail to apply robust risk stratification may unjustly penalize hospital systems which care for more medically complex patients. Conclusions: Hip fracture patients with a recent prior admission to the hospital are at an increased risk for 90-day readmission. This information should be considered as alternative payment models are developed for hip fracture care.

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Impact of Rehabilitation Dose on Nutritional Status at Discharge from a Convalescent Rehabilitation Ward in Malnourished Patients with Hip Fracture

Healthcare ◽

10.3390/healthcare9060722 ◽

2021 ◽

Vol 9 (6) ◽

pp. 722

Author(s):

Yusuke Ito ◽

Hidetaka Wakabayashi ◽

Shinta Nishioka ◽

Shin Nomura ◽

Ryo Momosaki

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Hip Fracture ◽

Nutritional Status ◽

Logistic Regression Analysis ◽

Short Form ◽

Mini Nutritional Assessment ◽

Functional Independence ◽

Rehabilitation Ward ◽

The Impact

The object of this study is to determine the impact of the rehabilitation dose on the nutritional status at discharge from a convalescent rehabilitation ward in malnourished patients with hip fracture. This retrospective case-control study involved malnourished patients with hip fracture aged 65 years or older who had been admitted to a convalescent rehabilitation ward and whose data were registered in the Japan Rehabilitation Nutrition Database. The primary outcome was nutritional status at discharge. Patients were classified according to whether nutritional status was improved or not at discharge, according to the Mini Nutritional Assessment-Short Form® (MNA-SF) score. The association between improved nutritional status and rehabilitation dose was assessed by a logistic regression analysis. Data were available for 145 patients (27 men, 118 women; mean age 85.1 ± 7.9 years). Daily rehabilitation dose was 109.5 (median 94.6–116.2) min and the MNA-SF score at admission was 5 (median 4–6). Nutritional status was improved in 97 patients and not improved in 48. Logistic regression analysis showed the following factors to be independently associated with nutritional status at discharge: Functional Independence Measure score (OR 1.042, 95% CI 1.016–1.068), energy intake (OR 1.002 CI 1.000–1.004), daily rehabilitation dose (OR 1.023, 95% CI 1.002–1.045), and length of hospital stay (OR 1.026, 95% CI 1.003–1.049). The daily rehabilitation dose in malnourished patients with hip fracture may positively impact nutritional status at discharge.

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Rural Barriers to Surgical Care for Children With Sleep-Disordered Breathing

Otolaryngology ◽

10.1177/0194599821993383 ◽

2021 ◽

pp. 019459982199338

Author(s):

Flora Yan ◽

Dylan A. Levy ◽

Chun-Che Wen ◽

Cathy L. Melvin ◽

Marvella E. Ford ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Sleep Disordered Breathing ◽

Healthy Children ◽

Loss To Follow Up ◽

Cox Regression Analysis ◽

Obstructive Sleep ◽

The Impact ◽

Disordered Breathing

Objective To assess the impact of rural-urban residence on children with obstructive sleep-disordered breathing (SDB) who were candidates for tonsillectomy with or without adenoidectomy (TA). Study Design Retrospective cohort study. Setting Tertiary children’s hospital. Methods A cohort of otherwise healthy children aged 2 to 18 years with a diagnosis of obstructive SDB between April 2016 and December 2018 who were recommended TA were included. Rural-urban designation was defined by ZIP code approximation of rural-urban commuting area codes. The main outcome was association of rurality with time to TA and loss to follow-up using Cox and logistic regression analyses. Results In total, 213 patients were included (mean age 6 ± 2.9 years, 117 [55%] male, 69 [32%] rural dwelling). Rural-dwelling children were more often insured by Medicaid than private insurance ( P < .001) and had a median driving distance of 74.8 vs 16.8 miles ( P < .001) compared to urban-dwelling patients. The majority (94.9%) eventually underwent recommended TA once evaluated by an otolaryngologist. Multivariable logistic regression analysis did not reveal any significant predictors for loss to follow-up in receiving TA. Cox regression analysis that adjusted for age, sex, insurance, and race showed that rural-dwelling patients had a 30% reduction in receipt of TA over time as compared to urban-dwelling patients (hazard ratio, 0.7; 95% CI, 0.50-0.99). Conclusion Rural-dwelling patients experienced longer wait times and driving distance to TA. This study suggests that rurality should be considered a potential barrier to surgical intervention and highlights the need to further investigate geographic access as an important determinant of care in pediatric SDB.

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