scholarly journals Comparison of peripheral nerve block with local infiltration analgesia regarding walking ability after total knee replacement: A retrospective, propensity-score matched-pair cohort study

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902093165
Author(s):  
Taeko Fukuda ◽  
Shinobu Imai ◽  
Shunji Simoda ◽  
Masaya Nakdera ◽  
Hiromasa Horiguchi
Keyword(s):  
Regression Analysis ◽  
Propensity Score ◽  
Total Knee Replacement ◽  
Multivariate Regression ◽  
Peripheral Nerve Block ◽  
Multivariate Regression Analysis ◽  
Walking Ability ◽  
Local Infiltration ◽  
Significant Difference ◽  
Total Knee

Purpose: It is unclear whether perioperative analgesic techniques affect the functional outcome of total knee replacement (TKR). We investigated the effects of peripheral nerve block (PNB) and local infiltration (LI) on walking ability after TKR. Methods: The medical records of 7143 patients who underwent TKR using general anesthesia with PNB or LI techniques were reviewed. Factors affecting independence and/or improvement of walking after surgery were investigated using multivariate regression analysis. To adjust for baseline differences and minimize selection bias for the chosen analgesic technique, patients were matched by propensity scores. Results: The multivariate regression analysis showed that PNB was associated with independence and/or improvement of walking. Of the 7143 patients, 2755 (39%) received PNB analgesia and 4388 (61%) LI analgesia. After the propensity score matching, the analgesic types were not associated with walking ability. Independence reflected by the total score of daily living activities was higher in the PNB group than in the LI group. The PNB group started rehabilitation later but performed rehabilitation for longer in the initial period than the LI group. Consumption levels of fentanyl, pentazocine, and antiemetics were lower in the PNB group than in the LI group. The PNB group had fewer hypertensive episodes during surgery than the LI group. There was no significant difference in total hospitalization costs between the two groups. Conclusions: No significant difference in postoperative walking ability was found between PNB and LI groups. However, PNB offered some advantages over LI. Future detailed investigations to improve TKR surgery are needed.

scholarly journals Association of ABO Blood Types and Clinicopathological Features of Prostate Cancer

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Fang-Ming Wang ◽  
Yan Zhang ◽  
Gui-Ming Zhang ◽  
Ya-Nan Liu ◽  
Li-Jiang Sun ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Regression Analysis ◽  
High Risk ◽  
Gleason Score ◽  
Multivariate Regression ◽  
Multivariate Regression Analysis ◽  
High Risk Group ◽  
Blood Type ◽  
Blood Types ◽  
Significant Difference

Purpose. To investigate the association between ABO blood types and clinicopathological characteristics in patients with prostate cancer (PC). Methods. A total of 237 pathologically diagnosed PC patients were enrolled. All patients were classified as low–middle or high-risk group. The correlation of ABO blood types with high-risk PC was determined by univariate and multivariate regression analysis. Results. Data indicated 144 (85.7%) patients were stratified as high risk in the non-O group, while 50 (72.5%) patients in the O group (p=0.025). However, there was no significant difference regarding PSA, Gleason score, stage, or metastasis between O and non-O group (p>0.05). Univariate logistic regression analyses revealed PSA, Gleason score, and blood type non-O were all correlated with high-risk PC (OR = 1.139, p<0.001; OR = 9.465, p<0.001; OR = 2.280, p=0.018, resp.). In the stepwise multivariate regression analysis, the association between blood type non-O and high-risk PC remained significant (OR = 33.066, 95% CI 2.391–457.323, and p=0.009) after adjusting for confounding factors as well as PSA and Gleason score. Conclusion. The present study firstly demonstrated that non-O blood type was at higher risk of aggressive PC compared with O type, suggesting that PC patients with non-O blood type should receive more attention in clinical practice.

scholarly journals Effect of hypoproteinemia on the mortality of sepsis patients in the ICU: a retrospective cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jing Hu ◽  
Chenwei Lv ◽  
Xingxing Hu ◽  
Jiangyun Liu
Keyword(s):  
Mechanical Ventilation ◽  
Regression Analysis ◽  
Cohort Study ◽  
Mortality Rate ◽  
Multivariate Regression ◽  
Retrospective Cohort ◽  
Multivariate Regression Analysis ◽  
Albumin Level ◽  
Normal Group ◽  
Significant Difference

AbstractThe objective of the study was to evaluate the effect of hypoproteinemia on the prognosis of sepsis patients and the effectiveness of exogenous albumin supplementation. A retrospective cohort study was conducted in adult ICUs. The subjects were 1055 sepsis patients in MIMIC III database from June 2001 to October 2012. There were no interventions. A total of 1055 sepsis patients were enrolled and allocated into two groups based on the lowest in-hospital albumin level: 924 patients were in the hypoproteinemia group (the lowest in-hospital albumin ≤ 3.1 g/dL) and 131 patients were in the normal group (the lowest in-hospital albumin > 3.1 g/dL). A total of 378 patients [331 (35.8%) were in the hypoproteinemia group, and 47 (35.9%) were in the normal group] died at 28 days, and no statistically significant difference was found between the two groups (P = 0.99). The survival analysis of the 28-day mortality rate was performed using the Cox proportional risk model and it was found that the lowest in-hospital albumin level showed no significant effect on the 28-day mortality rate (P = 0.18, 95%CI). Patients in the hypoproteinemia group exhibited a longer length of stay in ICU and hospital and more complications with AKI than those in the normal group. However, multivariate regression analysis found that there was no statistical significance between the two groups. In addition, multivariate regression analysis showed that patients in the hypoproteinemia group had a shorter time without vasoactive drugs and time without mechanical ventilation than those in the normal group (P < 0.01). In the subgroup analysis, univariate analysis and multivariate regression analysis showed that there was no significant difference in the 28-day mortality rate (39.6% vs 37.5%, P = 0.80), the proportion of mechanical ventilation time (P = 0.57), and vasoactive drug time (P = 0.89) between patients with and without albumin supplementation. However, patients in the albumin supplementation group had a longer length of ICU stay and hospital stay than those in the non-supplementation group (P < 0.01). Albumin level may be an indicator of sepsis severity, but hypoproteinemia has no significant effect on the mortality of sepsis patients. Despite various physiological effects of albumin, the benefits of albumin supplementation in sepsis patients need to be evaluated with caution.

scholarly journals Ceftazidime-avibactam use for KPC-Kp infections: a retrospective observational multicenter study

2021 ◽  
Author(s):  
Mario Tumbarello ◽  
Francesca Raffaelli ◽  
Maddalena Giannella ◽  
Elisabetta Mantengoli ◽  
Alessandra Mularoni ◽  
...  
Keyword(s):  
Propensity Score ◽  
Multivariate Regression ◽  
Bloodstream Infections ◽  
Multivariate Regression Analysis ◽  
Carbapenem Resistant ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Propensity Score Adjustment ◽  
Combination Regimens ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background A growing body of observational evidence supports the value of ceftazidime-avibactam (CAZ-AVI) in managing infections caused by carbapenem-resistant Enterobacteriaceae (CRE). Methods We retrospectively analyzed observational data on the use and outcomes of CAZ-AVI therapy for infections caused by KPC-producing K. pneumoniae (KPC-Kp) strains. Multivariate regression analysis was used to identify variables independently associated with 30-day mortality. Results were adjusted for propensity score for receipt of CAZ-AVI combination regimens vs. CAZ-AVI monotherapy. Results The cohort comprised 577 adults with bloodstream infections (BSIs) (n=391) or non-bacteremic infections (nBSIs) involving mainly the urinary tract, lower respiratory tract, intra-abdominal structures. All received treatment with CAZ-AVI alone (n=165) or with one or more other active antimicrobials (n=412). The all-cause mortality rate 30 days after infection onset was 25% (146/577). There was no statistically significant difference in mortality between patients managed with CAZ-AVI alone and those treated with combination regimens (26.1% vs. 25.0%, P=0.79). In multivariate analysis, mortality was positively associated with the presence at infection onset of septic shock (P=0.002), neutropenia (P &lt;0.001), or an INCREMENT score &gt;8 (P=0.01); with LRTI (P=0.04); and with CAZ-AVI dose adjustment for renal function (P=0.01). Mortality was negatively associated with CAZ-AVI administration by prolonged infusion (P=0.006). All associations remained significant after propensity score adjustment. Conclusions CAZ-AVI is an important option for treating serious KPC-Kp infections, even when used alone. Further study is needed to explore the drug’s seemingly more limited efficacy in LRTIs and the potential survival benefits of prolonging CAZ-AVI infusions to 3 hours or more.

scholarly journals The Diagnosis and Treatment of Low T3 Syndrome in Neurocritical Patients

2019 ◽  
Author(s):  
Yihao Chen ◽  
Jianbo Chang ◽  
Rui Yin ◽  
Junxian Wen ◽  
Baitao Ma ◽  
...  
Keyword(s):  
Overall Survival ◽  
Regression Analysis ◽  
Mortality Risk ◽  
Multivariate Regression ◽  
Multivariate Regression Analysis ◽  
Low T3 Syndrome ◽  
Low T3 ◽  
Significant Difference ◽  
Serum T3

Abstract Background Low serum T3 level is considered as a strong predictor of mortalities and poor prognosis in critical care patients. Few reports, however, focus on neurocritical patients. The application of hormone replacement therapy (HRT) in neurocritical patients with low T3 syndrome also remains controversial. We studied the role of low T3 state as a predictor in neurocritical patients and presented our experience of HRT from a single-center perspective.Methods From January 2012 to October 2018, a total of 32 neurocritical patients with low T3 syndrome were admitted to the neuro-intensive care unit (NICU) of Peking Union Medical College Hospital. Among them, 18 (56.25%) patients received HRT (HRT group) since the diagnosis of low T3 syndrome, while the other 14 (43.75%) patients did not (non-HRT group). We collected the clinical baseline and laboratory data of all the patients and conducted follow-up from 3 to 72 months. Overall survival was assessed by the Kaplan-Meier curve and compared by the log-rank test. Univariate and multivariate regression analysis was applied to estimate the prognostic power of HRT for mortality. We also performed the Mann-Whitney U test or t-test to assess the influence of HRT on the final neurological function.Results The cohort consists of 32 patients, with an average Glasgow Coma Scale (GCS) of 6.41 (HRT=6.44±3.14, non-HRT=6.36±2.06). The neurocritical events include postoperative complications (n=18), traumatic brain injury (n=8), and spontaneous intracerebral hemorrhage (n=6). A total of 15 (46.87%) deaths were recorded (HRT=7, non-HRT=8). In the HRT group, the low T3 situation in 5 patients (33.3%) was corrected and 10 (66.7%) were not. It turns out that the overall survival rate of the non-HRT group was significantly lower than that of the HRT group (P=0.034, 16.445 vs. 47.470 months). The non-HRT group has 3.322 times the mortality risk of the HRT group, according to univariate regression analysis, while the multivariate regression analysis showed no significant difference in mortality risk between the two groups (P=0.087, HR=0.340 95%CI 0.099-1.172). There was no significant difference in the short and long-term effects of HRT on neurological function (short-term GCS P=0.587, long-term GCS P=0.419, long-term GOS P=0.419).Conclusion Low T3 syndrome can significantly influence the prognosis of neurocritical patients. Therefore much attention should be paid to the changes in serum T3 level during treatment. Although it is unclear to what extent can HRT improve the short or long-term outcome of neurological function, it can significantly benefit the survival of neurocritical patients.

scholarly journals Preoperative and intraoperative factors contributing to patient satisfaction after bi-cruciate stabilized total knee arthroplasty

2021 ◽  
Vol 29 (3) ◽  
pp. 230949902110340
Author(s):  
Hiroshi Inui ◽  
Shuji Taketomi ◽  
Ryota Yamagami ◽  
Kenichi Kono ◽  
Kohei Kawaguchi ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Regression Analysis ◽  
Patient Satisfaction ◽  
Knee Arthroplasty ◽  
Multivariate Regression ◽  
Multivariate Regression Analysis ◽  
Joint Laxity ◽  
Satisfaction Score ◽  
Patient Reported ◽  
Total Knee

Background: One of the causes of dissatisfaction following total knee arthroplasty (TKA) is abnormal knee kinematics. A newly designed bi-cruciate stabilized (BCS) TKA system has been developed to produce close-to-normal kinematics because of its anatomic tibiofemoral articular geometry and cam-post mechanism. Although BCS TKA is expected to improve patient satisfaction, no reports have described the appropriate technique or soft tissue handling required to achieve excellent satisfaction with BCS TKA. This study is to identify preoperative and intraoperative predictors of patient satisfaction after BCS TKA. Methods: Altogether, we studied 113 knees with primary varus knee osteoarthritis that underwent BCS TKA with a navigation system. Preoperative parameters including Knee Society Score and patient-reported scores [the Knee injury and Osteoarthritis Outcome Score (KOOS)] and intraoperative parameters including coronal, sagittal and axial alignment and joint laxity in each compartment that affected patient satisfaction was evaluated. Satisfaction score was evaluated with use of the 2011 Knee Society Scoring system. The multivariate regression analysis included age and preoperative and intraoperative parameters that correlated with satisfaction scores in the univariate analysis ( P < 0.05). Results: The mean satisfaction score was 28.2 ± 6.1. Multivariate regression analysis showed that the predictors of patient satisfaction were a preoperative high KOOS score for activities of daily living ( P < 0.001), male sex ( P = 0.005), older age ( P = 0.027), and minimal medial joint laxity during flexion ( P = 0.031). Conclusion: When performing BCS TKA, surgeons should pay attention to maintaining proper stability of the medial compartment, especially during flexion.

scholarly journals 1574. Multivariate Regression Analysis to Determine Independent Predictors of Treatment Outcomes in the RESTORE-IMI 2 Trial

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S785-S786
Author(s):  
Robert Tipping ◽  
Jiejun Du ◽  
Maria C Losada ◽  
Michelle L Brown ◽  
Katherine Young ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Clinical Response ◽  
Treatment Outcomes ◽  
Multivariate Regression ◽  
Multivariate Regression Analysis ◽  
Apache Ii Score ◽  
Double Blind ◽  
Mitt Population ◽  
Study Results ◽  
All Cause Mortality

Abstract Background In the RESTORE-IMI 2 trial, imipenem/cilastatin/relebactam (IMI/REL) was non-inferior to PIP/TAZ for treating hospital-acquired/ventilator-associated bacterial pneumonia (HABP/VABP) in the primary endpoint of Day 28 all-cause mortality (D28 ACM) and the key secondary endpoint of clinical response (CR) at early follow-up (EFU; 7-14 d after end of therapy). We performed a multivariate regression analysis to determine independent predictors of treatment outcomes in this trial. Methods Randomized, controlled, double-blind, phase 3, non-inferiority trial comparing IMI/REL 500 mg/250 mg vs PIP/TAZ 4 g/500 mg, every 6 h for 7-14 d, in adult patients (pts) with HABP/VABP. Stepwise-selection logistic regression modeling was used to determine independent predictors of D28 ACM and favorable CR at EFU, in the MITT population (randomized pts with ≥1 dose of study drug, except pts with only gram-positive cocci at baseline). Baseline variables (n=19) were pre-selected as candidates for inclusion (Table 1), based on clinical relevance. Variables were added to the model if significant (p &lt; 0.05) and removed if their significance was reduced (p &gt; 0.1) by addition of other variables. Results Baseline variables that met criteria for significant independent predictors of D28 ACM and CR at EFU in the final selected regression model are in Fig 1 and Fig 2, respectively. As expected, APACHE II score, renal impairment, elderly age, and mechanical ventilation were significant predictors for both outcomes. Bacteremia and P. aeruginosa as a causative pathogen were predictors of unfavorable CR, but not of D28 ACM. Geographic region and the hospital service unit a patient was admitted to were found to be significant predictors, likely explained by their collinearity with other variables. Treatment allocation (IMI/REL vs PIP/TAZ) was not a significant predictor for ACM or CR; this was not unexpected, since the trial showed non-inferiority of the two HABP/VABP therapies. No interactions between the significant predictors and treatment arm were observed. Conclusion This analysis validated known predictors for mortality and clinical outcomes in pts with HABP/VABP and supports the main study results by showing no interactions between predictors and treatment arm. Table 1. Candidate baseline variables pre-selected for inclusion Figure 1. Independent predictors of greater Day 28 all-cause mortality (MITT population; N=531) Figure 2. Independent predictors of favorable clinical response at EFU (MITT population; N=531) Disclosures Robert Tipping, MS, Merck & Co., Inc. (Employee, Shareholder) Jiejun Du, PhD, Merck & Co., Inc. (Employee, Shareholder) Maria C. Losada, BA, Merck & Co., Inc. (Employee, Shareholder) Michelle L. Brown, BS, Merck & Co., Inc. (Employee, Shareholder) Katherine Young, MS, Merck & Co., Inc. (Employee, Shareholder)Merck & Co., Inc. (Employee, Shareholder) Joan R. Butterton, MD, Merck & Co., Inc. (Employee, Shareholder) Amanda Paschke, MD MSCE, Merck & Co., Inc. (Employee, Shareholder) Luke F. Chen, MBBS MPH MBA FRACP FSHEA FIDSA, Merck & Co., Inc. (Employee, Shareholder)Merck & Co., Inc. (Employee, Shareholder)

Epicardial fat thickness as arterial hypertension predictor in normotensive patients with abdominal obesity

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Kuznetsova ◽  
M Druzhilov
Keyword(s):  
Blood Pressure ◽  
Regression Analysis ◽  
Blood Glucose ◽  
Waist Circumference ◽  
Arterial Hypertension ◽  
Multivariate Regression ◽  
Fasting Blood Glucose ◽  
Multivariate Regression Analysis ◽  
Epicardial Fat Thickness ◽  
Fat Thickness

Abstract Objective Arterial hypertension (HTN) is one of the most common diseases associated with obesity. Visceral obesity (VO) with dysfunctional visceral adipose tissue plays the main role in obesity induced HTN. Direct criteria of VO including echocardiographic epicardial fat thickness (EFT) may become an additional predictor of HTN. Purpose The aim was to assess the role of echocardiographic EFT (EEFT) as a predictor of HTN in normotensive patients with abdominal obesity (AO). Methods 526 normotensive men (according to ambulatory blood pressure monitoring (ABPM) without therapy) with AO (waist circumference (WC) &gt;94 cm) and SCORE &lt;5%, without cardiovascular diseases and diabetes mellitus were examined (age 45.1±5.0 years). The lipid and glucose profiles, creatinine, uric acid and C-reactive protein blood levels, albuminuria evaluation, echocardiography, carotid ultrasound, bifunctional ABPM were performed. The values of EEFT ≥75 percentile for persons 35–45 years and 46–55 years were 4.8 mm and 5.8 mm respectively. These values used as epicardial VO criteria. Patients with subclinical carotid atherosclerosis due to the lipid-lowering therapy administration (n=98) were excluded from the follow-up. Re-examination with ABPM was conducted on average through 46.3±5.1 months. Data were summarized as mean ± standard error, statistical analysis conducted with paired two-tailed t-tests, Pearson χ2 criterion and multivariate regression analysis. Results Data of 406 persons were available for analysis. HTN as average daily blood pressure ≥130/80 mm Hg was detected in 157 (38.7%) patients. These patients were characterized by initially higher values of age (45.9±4.6 years vs 44.3±4.9 years, p&lt;0.001), waist circumference (106.9±7.3 cm vs 104.2±7.3 cm, p&lt;0.001), body mass index (BMI) (32.0±3.3 kg/m2 vs 30.9±3.2 kg/m2, p&lt;0.001), average daily systolic and diastolic blood pressure (120.7/74.5±4.6/3.4 mm Hg vs 118.2/73.2±5.5/3.9 mm Hg, p&lt;0.001), EEFT (5.2±0.7 mm vs 4.4±1.0 mm, p&lt;0.001). The epicardial VO was initially detected in 95 (23.3%) patients. In patients with HTN the initial prevalence of epicardial VO was greater (58.0% vs 23.3%, p&lt;0.001). As predictors for the multivariate regression analysis the clinical and laboratory examinations data and EEFT were evaluated. According to the results a mathematical model for estimating the probability HTN was obtained: 0.696*fasting blood glucose + 0.198*systolic BP + 2.844*EFT – 40.166 (constant). Among these predictors EEFT was characterized by the highest standardized regression coefficient (0.302, p&lt;0.001) (0.295, p&lt;0.01 for fasting blood glucose, 0.035, p&lt;0.001 for systolic BP). The Hosmer-Lemeshow test value was 0.863, the total percentage of correct classifications was 86%, the area under the ROC-curve was 0.913. Conclusions EEFT (4.8 mm for persons 35–45 years and 5.8 mm for persons 46–55 years) may be an additional predictor of HTN in normotensive patients with AO. Funding Acknowledgement Type of funding source: None

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