scholarly journals Analysis of Risk Factors Associated With Preterm Delivery After Fetoscopic Laser Surgery for TTTS

Author(s):  
Genxia Li ◽  
Shuhui Chu ◽  
Shihong Cui ◽  
Yajuan Xu ◽  
Hezhou Li ◽  
...  

Abstract Objective Fetoscopic laser surgery (FLS) is currently the standard treatment for twin to twin transfusion syndrome (TTTS). This study aims to improve the perinatal outcomes of TTTS patients by analyzing the risk factors associated with preterm delivery after FLS for TTTS. Methods A prospective cohort study was conducted in 97 cases of patients with TTTS who underwent FLS at the Third Affiliated Hospital of Zhengzhou University from May 2018 to December 2020. A multivariate logistic regression model was used to determine the risk factors associated with preterm delivery. Finally, ROC curve was utilized to analyze the diagnostic value of related risk factors. Results A total of 90 TTTS patients were included in the study. There were 37 cases in group A and 53 cases in group B. Through multivariate logistic regression model analysis, three risk factors related to the gestational age of childbirth <32 weeks were identified: preoperative CL < 27.5 mm (OR, 10.9; P <0.001), PPROM (OR, 4.0; P=0.024), placental abruption (OR, 17.6; P=0.018). ROC curve analysis suggested that the AUC of the combined diagnosis of the three factors was 0.799 (P<0.001), which has a high value for predicting preterm delivery at low gestational age. Conclusion Multivariate logistic regression analysis demonstrated that CL < 27.5 mm, PPROM and placental abruption were connected with preterm delivery before 32 weeks of pregnancy. Identifying and intervening the corresponding risk factors can improve the pregnancy and neonatal outcomes after fetoscopic surgery, and promote the improvement of fetoscopic surgery techniques.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1127-1127
Author(s):  
Chi Lin ◽  
Kyle A. Denniston ◽  
Mary E. Charlton

1127 Background: The objective of this study was to evaluate the effect of external beam radiation therapy (RT) on late cardiac death (CD) in patients with left breast cancer. Methods: A total of 529,246 patients who were diagnosed with adenocarcinoma of the breast between 1983 and 2004 and survived ≥ 5 years were identified from the SEER database. After excluding patients who were male, had right breast cancer, received brachytherapy or had missing data, 163,894 patients remained. Examined risk factors for CD include age (≤49/50-59/60-69/70-100), race (white/non-white), stage (In situ/local/regional/distant), breast subsite (nipple and areola/inner quadrant/outer quadrant), diagnosis year (1983-1993/1994-2004), surgery status (none/less than mastectomy/mastectomy) and RT. Time to CD was evaluated using the Kaplan-Meier method. A multivariate logistic regression model was used to evaluate factors associated with the use of RT and the Cox Proportional Hazards model was used to evaluate risk factors for CD. Results: A multivariate logistic regression model revealed that patients who received RT tended to be younger, white, more recently diagnosed, have inner quadrant and more advanced disease and undergo less than mastectomy. Median overall survival for patients with RT was significantly longer than those without RT (263 vs. 226 months, Log-Rank p < .0001). RT group had a lower risk of CD than no-RT group (Log-Rank p < .0001). Median time to CD was not reached in either group. The probability of CD was increased with increasing age and stage, and decreased with more recent diagnosis year and after mastectomy. Cox model found RT to be associated with lower probability of CD (HR 0.66, 95% CI 0.62-0.70), after adjusting for age, stage, surgery status and diagnosis year. Race and breast subsite were not associated with CD. Conclusions: Patients with left breast cancer who survived ≥ 5 years and received RT had a lower risk of cardiac death than those who did not. The cause of this difference is unclear but suggests influence from an uninvestigated factor, potentially the increased use of cardiotoxic chemotherapy or other cardiovascular comorbidity in those patients not receiving RT. Continued study, accounting for such factors, is warranted.


2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S246-S247
Author(s):  
Sherif Khattab ◽  
Souad AlMuthree ◽  
Mohamed Bakry ◽  
Noha Ibraheem ◽  
Omar Alghamdi ◽  
...  

Abstract Background The first case of COVID-19 in the Kingdom of Saudi Arabia (KSA) was reported in March 2020. This study aims to describe the overall mortality in the ICU during the COVID-19 pandemic and to determine independent risk factors for overall survival & 29 days mortality. Methods This is a retrospective single-center study; data for adult patients admitted to the ICU with COVID-19 between 1st March 2020 to 31st December 2020 were extracted and reviewed. Overall survival was described using Kaplan-Meier curves with reporting of median overall survival and 29 days survival estimates. Multivariate analysis was performed using Cox proportional hazards model and multivariate logistic regression model. Figure 1. Study flow chart Table 1. Demographic characteristics categorized by Gender Results Eligible subjects were 209 (Figure 1) and subjects demographics are summarized in (Table1). Observed death events were 82 (39.2% of the total cohort), 61% of deaths reached at 2 weeks of ICU stay (n.= 50), median overall survival (OS) was reached at day 23, as shown in (Figure 2). The multivariate Cox proportional hazard regression analysis (Figure 3) showed elevated SOFA score [aHR= 1.10, P &lt; 0.001] and Vasopressors [aHR= 3.23, P= 0.002] as independent risk factors for overall ICU mortality. Independent protective factors were: Systemic corticosteroids use (P= 0.019), Insulin use (P= 0.026) and Liposomal Amphotericin B (LAMB) use (P= 0.019). For mortality at day 29, the multivariate logistic regression model (Figure. 4) showed elevated SOFA score (P= 0.005), any need for ventilation escalation after ICU admission (P= 0.014), Ribavirin use (P=0.016) and Vasopressors use ( P&lt; 0.001) as independent risk factors. Angiotensin-Converting Enzyme inhibitors (ACEi) use was a protective factor (P=0.025). Figure 2. Overall Survival (OS) for patients admitted to the ICU due to COVID-19 - Kaplan Meier (KM) Figure 3. Multivariate Cox proportional hazard regression model for factors associated with overall mortality in patients admitted to the ICU due to COVID-19 Figure 4. Multivariate logistic regression model for factors associated with 29 days mortality in patients admitted to the ICU due to COVID-19 Conclusion SOFA score and vasopressors are independent predictors for overall survival and 29-day mortality in the ICU. The need for ventilation escalation after ICU admission appeared to lead to poor prognosis in regard to 29-day mortality only. Systemic corticosteroids are lifesaving, further studies are required to confirm the observed clinical benefits with insulin, LAMB and ACEi use in the ICU and to investigate any hazardous impact of ribavirin on COVID-19 outcomes. Study limitations Residual confounding of other measured and/or unobserved factors cannot be ruled out. Disclosures Sherif Khattab, BPharm, Gilead Sciences (Employee, Shareholder) Mohamed Bakry, MBBCh, Gilead Sciences (Employee)Roche Pharma (Employee)


2020 ◽  
Author(s):  
Abdilahi Yousuf ◽  
Ramli Musa ◽  
Muhammad Lokman Md. Isa ◽  
Siti Roshaidai Mohd Arifin

AbstractIntroductionIntegration of related health services, such as screening of depression in HIV care is crucial for improving the quality of care and enhancing the use of scarce resources in developing countries. However, commonly these interrelated health services are commonly provided separately and there are many missed opportunities. Little is known about the client-related non-implementation issues. This study aims at examining the acceptability of anxiety and depression screening among women living with HIV.Material and methodsThis was a facility based cross-sectional study which included women living with HIV attending two hospitals in Jijiga town, Ethiopia. The study participants were identified using systematic random sampling method. An exit interview was conducted with the use of a pretested questionnaire. The gathered data was analysed using SPSS version 23 and multivariate logistic regression model was used to determine factors associated with the factors associated with the acceptance of anxiety and depression screening.ResultsA total of 409 women participated in this study. Though, only 115 (28.1%) were aware about the existence of anxiety and depression screening, 357 (87.3%) accepted to receive the screening for anxiety and depression. Requisite of partner approval was the most common reason for not accepting the screening of anxiety and depression 21 (40.4%). When used multivariate logistic regression model; holding college level education, divorced and were living without partner, being self employed by occupation, aware of the existing screening service, source of information from health care providers and history of previous screening were significantly associated with acceptance of depression screening.ConclusionThis research has shown that women participant living with HIV were willing to undergo the screening for depression, hence future interventions should focus on the integration of mental health screening in HIV clinical setup.


1970 ◽  
Vol 29 (6) ◽  
Author(s):  
Gutema Wako ◽  
Henok Teshome ◽  
Engida Abebe

BACKGROUND: Anastomotic leakage is a morbid and potentially fatal complication of colorectal surgery. Determination of perioperative risk factors for colorectal anastomosis leak helps to identify patients requiring increased postoperative surveillance.METHODS: Institution based retrospective study was done to determine colorectal anastomosis leak rate and risk factors associated with it at a teaching hospital in Addis Ababa Ethiopia. Patients operated from January 2013 to December 2017 G.C were included. Univariate analysis followed by a multivariate logistic regression model was used to determine the influence of patient factors and operative events on postoperative anastomotic leakage.RESULTS: Inclusion criteria were met by 221 patients. Mean age of patients was 46.44(SD=19.1) with range of 1 to 85 years. Male accounted to 166 (74.8%) of the patients. Anastomotic leakage occurred in 12 (5.2%) of the patients. Mean time to diagnosis was 9.55 days (95% CI, 7.2-11.8) after surgery. Univariate analyses showed high preoperative level of creatinine, ASA score III and IV, emergency operation, operative time more than three hours, and malignant diseases were associated with colorectal anastomosisleak. Multivariate logistic regression model failed to show an association. Colorectal anastomosis leak increased the inpatient mortality rate by 50%. Median length of hospitalization in colorectal anastomosis leak group was 27.5 days, versus 7 days in patients without leak.CONCLUSION: Colorectal anastomosis leak remains common problem after colorectal surgery resulting significant post-operative mortality and morbidity. 


2020 ◽  
Author(s):  
Haohai Tong ◽  
Qingfeng Hao ◽  
Zijin Wang ◽  
Yue Wang ◽  
Rui Li ◽  
...  

Abstract Backgrounds: Aniso-astigmatism may hinder normal visual development in preschool children. Knowing its prevalence, biometric parameters and risk factors is fundamental to children eye care. The purpose of this study was to determine the biometric components of aniso-astigmatism and associated maternal risk factors in Chinese preschool children. Methods: In the population-based, prospective cohort Nanjing Eye Study, children were measured for noncycloplegic refractive error using an autorefractor and for biometric parameters using an optical low-coherent reflectometry. The difference of total astigmatism (TA) between both eyes was calculated using cylinder power (non-vectorial aniso-TA was defined as ≥1.00 Dioptre Cylinder [DC] between both eyes) and by vector analysis (vectorial aniso-TA was defined as a difference of ≥0.5 in J0 or J45 between both eyes which is equivalent to 1.00 DC). The prevalence of aniso-TA was presented. Interocular biometric parameters were compared between with vs. without aniso-astigmatism group. In addition, risk factors were determined using multivariate logistic regression model. Results: Of 1131 children (66.90±3.38 months, 53.31% male), the prevalence of non-vectorial aniso-TA was 1.95% (95% Confidence Interval (CI)=1.14%-2.75%), while the prevalence of vectorial aniso-TA was twice as common as non-vectorial aniso-TA, neither varying with sex or age. With aniso-TA eyes were more asymmetric in axial length and corneal curvature radius than without aniso-TA eyes. In multivariate logistic regression model, 5-min Apgar score less than 7 was significantly associated with higher risk of aniso-TA (vectorial aniso-TA: Odds Ratio (OR)=6.42, 95%CI=2.63-15.69, P<0.001; non-vectorial aniso-TA: OR=4.99, 95%CI=1.41-17.68, P=0.01). Being twin or triple was significantly associated with higher risk of vectorial aniso-CA (OR=2.43, 95%CI=1.05-5.60, P=0.04). Pre-term delivery (OR=2.60, 95%CI=1.09-6.15, P=0.03) and post-term delivery (OR=3.61, 95%CI=1.31-9.96, P=0.01) were significantly associated with higher risk of vectorial aniso-CA. Conclusions: Both corneal curvature radius and axial length asymmetry were correlated with aniso-TA. Children with 5-min Apgar score<7 were more likely to have aniso-TA, while twin or triple, pre-term or post-term delivery were more likely to have vectorial aniso-CA.


2021 ◽  
Vol 11 ◽  
Author(s):  
Hao-ran Zhang ◽  
Ming-you Xu ◽  
Xiong-gang Yang ◽  
Feng Wang ◽  
Hao Zhang ◽  
...  

IntroductionVenous thromboembolism can be divided into deep vein thrombosis and pulmonary embolism. These diseases are a major factor affecting the clinical prognosis of patients and can lead to the death of these patients. Unfortunately, the literature on the risk factors of venous thromboembolism after surgery for spine metastatic bone lesions are rare, and no predictive model has been established.MethodsWe retrospectively analyzed 411 cancer patients who underwent metastatic spinal tumor surgery at our institution between 2009 and 2019. The outcome variable of the current study is venous thromboembolism that occurred within 90 days of surgery. In order to identify the risk factors for venous thromboembolism, a univariate logistic regression analysis was performed first, and then variables significant at the P value less than 0.2 were included in a multivariate logistic regression analysis. Finally, a nomogram model was established using the independent risk factors.ResultsIn the multivariate logistic regression model, four independent risk factors for venous thromboembolism were further screened out, including preoperative Frankel score (OR=2.68, 95% CI 1.78-4.04, P=0.001), blood transfusion (OR=3.11, 95% CI 1.61-6.02, P=0.041), Charlson comorbidity index (OR=2.01, 95% CI 1.27-3.17, P=0.013; OR=2.29, 95% CI 1.25-4.20, P=0.017), and operative time (OR=1.36, 95% CI 1.14-1.63, P=0.001). On the basis of the four independent influencing factors screened out by multivariate logistic regression model, a nomogram prediction model was established. Both training sample and validation sample showed that the predicted probability of the nomogram had a strong correlation with the actual situation.ConclusionThe prediction model for postoperative VTE developed by our team provides clinicians with a simple method that can be used to calculate the VTE risk of patients at the bedside, and can help clinicians make evidence-based judgments on when to use intervention measures. In clinical practice, the simplicity of this predictive model has great practical value.


2017 ◽  
Vol 36 (2) ◽  
pp. 113-117 ◽  
Author(s):  
Shigeo Banno ◽  
Motohiko Kato ◽  
Yukie Sunata ◽  
Yuichiro Hirai ◽  
Yoko Kubosawa ◽  
...  

Background: Sedatives or analgesics are widely used to relieve a patient’s discomfort during colonoscopy (CS). Although cardiopulmonary adverse events are sometimes experienced during the examination, the risk factors for vital signs fluctuation (VSF) have not been fully elucidated. This study thus aimed to identify the risk factors for VSF during the examination, as well as to evaluate the frequency and the degree of VSF. Summary: A total of 755 consecutive subjects who received CS under endoscopist-administrated sedation using midazolam, meperidine, or combination of both were retrospectively analyzed. We assessed the distribution of vital signs during the procedure and frequency of VSF. To identify independent risk factors, we analyzed the association between VSF and subjects’ characteristics and procedure information using the multivariate logistic regression model. Consequently, VSF was observed in 17% of all; hypotension and oxygen desaturation was observed in 13 and 5%, respectively. However, we could achieve the purpose of all procedure and, no one required hospitalization or extension of hospital stay. Multivariate analysis revealed that age (OR 1.05 [95% CI 1.04–1.07]), being female (OR 1.78 [95% CI 1.19–2.70]), and use of midazolam (OR 5.06 [95% CI 3.18–8.08]) were independent risk factors for VSF.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Haohai Tong ◽  
Qingfeng Hao ◽  
Zijin Wang ◽  
Yue Wang ◽  
Rui Li ◽  
...  

Abstract Backgrounds Aniso-astigmatism may hinder normal visual development in preschool children. Knowing its prevalence, biometric parameters and risk factors is fundamental to children eye care. The purpose of this study was to determine the biometric components of aniso-astigmatism and associated maternal risk factors in Chinese preschool children. Methods In the population-based, prospective cohort Nanjing Eye Study, children were measured for noncycloplegic refractive error using an autorefractor and for biometric parameters using an optical low-coherent reflectometry. The difference of total astigmatism (TA) between both eyes was calculated using cylinder power (non-vectorial aniso-TA was defined as ≥1.00 Dioptre Cylinder [DC] between both eyes) and by vector analysis (vectorial aniso-TA was defined as a difference of ≥0.5 in J0 or J45 between both eyes which is equivalent to 1.00 DC). The prevalence of aniso-TA was presented. Interocular biometric parameters were compared between with vs. without aniso-astigmatism group. In addition, risk factors were determined using multivariate logistic regression model. Results Of 1131 children (66.90 ± 3.38 months, 53.31% male), the prevalence of non-vectorial aniso-TA was 1.95% (95% Confidence Interval (CI) = 1.14–2.75%), while the prevalence of vectorial aniso-TA was twice as common as non-vectorial aniso-TA, neither varying with sex or age. With aniso-TA eyes were more asymmetric in axial length and corneal curvature radius than without aniso-TA eyes. In multivariate logistic regression model, 5-min Apgar score less than 7 was significantly associated with higher risk of aniso-TA (vectorial aniso-TA: Odds Ratio (OR) = 6.42, 95%CI = 2.63–15.69, P < 0.001; non-vectorial aniso-TA: OR = 4.99, 95%CI = 1.41–17.68, P = 0.01). Being twin or triple was significantly associated with higher risk of vectorial aniso-CA (OR = 2.43, 95%CI = 1.05–5.60, P = 0.04). Pre-term delivery (OR = 2.60, 95%CI = 1.09–6.15, P = 0.03) and post-term delivery (OR = 3.61, 95%CI = 1.31–9.96, P = 0.01) were significantly associated with higher risk of vectorial aniso-CA. Conclusions Both corneal curvature radius and axial length asymmetry were correlated with aniso-TA. Children with 5-min Apgar score < 7 were more likely to have aniso-TA, while twin or triple, pre-term or post-term delivery were more likely to have vectorial aniso-CA.


2020 ◽  
Author(s):  
Haohai Tong ◽  
Qingfeng Hao ◽  
Zijin Wang ◽  
Yue Wang ◽  
Rui Li ◽  
...  

Abstract Backgrounds: Aniso-astigmatism may hinder normal visual development in preschool children. Knowing its prevalence, biometric parameters and risk factors is fundamental to children eye care. The purpose of this study was to determine the biometric components of aniso-astigmatism and associated maternal risk factors in Chinese preschool children.Methods: In the population-based, prospective cohort Nanjing Eye Study, children were measured for noncycloplegic refractive error using an autorefractor and for biometric parameters using an optical low-coherent reflectometry. The difference of total astigmatism (TA) between both eyes was calculated using cylinder power (non-vectorial aniso-TA was defined as ≥1.00 Dioptre Cylinder [DC] between both eyes) and by vector analysis (vectorial aniso-TA was defined as a difference of ≥0.5 in J0 or J45 between both eyes which is equivalent to 1.00 DC). The prevalence of aniso-TA was presented. Interocular biometric parameters were compared between with vs. without aniso-astigmatism group. In addition, risk factors were determined using multivariate logistic regression model.Results: Of 1131 children (66.90±3.38 months, 53.31% male), the prevalence of non-vectorial aniso-TA was 1.95% (95% Confidence Interval (CI)=1.14%-2.75%), while the prevalence of vectorial aniso-TA was twice as common as non-vectorial aniso-TA, neither varying with sex or age. With aniso-TA eyes were more asymmetric in axial length and corneal curvature radius than without aniso-TA eyes. In multivariate logistic regression model, 5-min Apgar score less than 7 was significantly associated with higher risk of aniso-TA (vectorial aniso-TA: Odds Ratio (OR)=6.42, 95%CI=2.63-15.69, P<0.001; non-vectorial aniso-TA: OR=4.99, 95%CI=1.41-17.68, P=0.01). Being twin or triple was significantly associated with higher risk of vectorial aniso-CA (OR=2.43, 95%CI=1.05-5.60, P=0.04). Pre-term delivery (OR=2.60, 95%CI=1.09-6.15, P=0.03) and post-term delivery (OR=3.61, 95%CI=1.31-9.96, P=0.01) were significantly associated with higher risk of vectorial aniso-CA.Conclusions: Both corneal curvature radius and axial length asymmetry were correlated with aniso-TA. Children with 5-min Apgar score<7 were more likely to have aniso-TA, while twin or triple, pre-term or post-term delivery were more likely to have vectorial aniso-CA.


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