Objective To analyze and screen the risk factors of both immunohistochemistry and pathology for lung cancer lymphatic metastasis, and to build a mathematical model for preliminary evaluation. Methods By conducting retrospective studies, the information of lung cancer patients in the General Hospital of Air Force from 2009 to 2011 were collected. Both single and multiple unconditional logistic regression analyses were applied to screen total 27 possible factors for lymphatic metastasis. After the factors with statistical significance were selected, the relevant mathematical model was built and then evaluated by means of receiver operating characteristic (ROC) analysis. Results A total of 216 patients were included. The single analyses on 27 possible factors showed significant differences in the following 10 factors: pathological grade (P=0.00), age (P=0.00), tumor types (P=0.01), nm23 (P=0.00), GSTII (P=0.01), TTF1 (P=0.01), MRP (P=0.01), CK14 (P=0.02), CD56 (P=0.02), and EGFR (P=0.03). The multiple factors unconditional logistic regression analyses on those 10 risk factors screened 4 relevant factors as follows: pathological grade (OR=2.34), age (OR=1.02), nm23 (OR=1.66), and EGFR (OR=1.47). Then a mathematical diagnostic model was established based on those 4 identified risk factors, and the result of ROC analysis showed it could improve the diagnostic sensitivity and specificity compared with the single factor mathematical diagnostic model. Conclusion Pathological grade, age, nm23, and EGFR are related with lung cancer lymphatic metastasis, and all of them are the risk factors which have higher adjuvant diagnostic value for lung cancer lymphatic metastasis.
Objective To analysis correlation factors for preoperative sudden death of patients with type A aortic dissection in order to determine clinical management strategy.?Methods?We retrospectively analyzed clinical data of 52 patients with type A aortic dissection who were admitted in Department of Cardiothoracic Surgery of the Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2003 to January 2010. According to the presence of preoperative death, all the patients were divided into two groups, 9 patients in the preoperative sudden death （PSD）group including 7 males and 2 females with their mean age of 52.0±12.1 years；43 patients in the control group including 31 males and 12 females with their mean age of 51.5±10.9 years. Univariate and multivariate logistic regression analysis were used for analysis of preoperative factors related to sudden death.?Results?Univariate analysis result showed 7 candidate variables：body mass index （BMI, Wald χ2=2.150, P=0.143）, time of onset （Wald χ2=2.711, P= 0.100）, total cholesterol （TC, Wald χ2=1.444, P=0.230）, low density lipoprotein cholesterol （L-C, Wald χ2=1.341, P=0.247）, aortic insufficiency （AI, Wald χ2=2.093, P=0.148）, aortic sinus involvement （Wald χ2=3.386, P=0.066）and false lumen thrombosis （Wald χ2=7.743, P=0.005）. Multivariate logistic regression analysis showed that BMI （Wald χ2=4.215, P=0.040, OR=1.558）and aortic sinus involvement （Wald χ2=4.592, P=0.032, OR=171.166 ）were preoperative risk factors for sudden death, and thrombosed false lumen （Wald χ2=5.097, P=0.024, OR=0.011）was preoperative protective factor for sudden death.?Conclusion?Type A aortic dissection patients with large BMI and/or aortic sinus involvement should receive operation more urgently than others and patients with thrombosed false lumen may have relatively low risk of preoperative sudden death.
Objective To investigate the prognostic factors of esophageal squamous cell carcinoma（ESCC） by multivariate analysis of clinicopathologic features of ESCC between long-term and short-term survivals after esophagectomy. Methods The clinicopathologic features of randomly selected 126 cases with ESCC were analyzed with binary logistic regression, 48 cases of which was divided into long-term survival group（≥5 years） and 78 cases into short-term survival group（≤1 year） according to the follow-up. Results Under univariate analysis, the differences between two groups on tumor pathologic grading, metastasis to lymph node, depth of tumor invasion and length of tumor were significant （Plt;0.01）, however, that on age, gender, location of tumor and status of residues were not （Pgt;0. 05）. Multivariate analysis showed that tumor pathologic grading, metastasis to lymph node, depth of tumor invasion and length of tumor correlated with the prognosis of ESCC （Plt;0. 05）. Their risk coefficient were 2. 943, 2. 641, 2. 126 and 1. 728, respectively. Age, gender, location of tumor and status of residues did not correlated with the prognosis of ESCC （Pgt;0. 05）. Correlation analysis indicated that depth of tumor invasion was positively related to the length of tumor （r=0. 488, Plt;0. 001）, metastasis to lymph node was positively related with depth of tumor invasion and tumor pathologic grading （r=0. 216, P=0. 014; r=0. 238, P=0. 007）. Conclusions The main prognostic factors of ESCC are tumor pathologic grading, metastasis to lymph nodes, depth of tumor invasion and length of tumor,Tumor pathologic grading is high risk factor for prognosis of ESCC,while length of tumor is low risk factor. Age and gender of patients, location of tumor and status of esophageal residues are non-risk factors.
Objective To investigate the status of deciduous caries and early childhood caries among 3-5 year-old children of Uyghur and Chinese in Urumqi, and to explore the correlative factors of early childhood caries. Methods According to the criteria recommended by the Third National Oral Health Investigation, and Oral Health Surveys: Basic Methods of World Health Organization, the deciduous caries of 474 Urghur and Chinese children aged from three to five in nine kindergartens were clinically examined. Data were collected by questionnaire from their parents, and the result waw analyzed using Logistic regression analysis. Results The result of logistic regression analysis showed that the variables including nationality, frequency of drinking milk, eating cookie or drinking sweet beverage before sleep, brushing teeth with help, and educational background of the mother were closely related to the incidence of infantile caries. Conclusion The nationality, frequency of drinking milk, eating cookie or drinking sweet beverage before sleep, brushing teeth with help, and educational background of the mother are correlative factors of early childhood caries. Necessary methods for prevention of deciduous caries must be taken into consideration as early as possible, and the bilingual propaganda for preventing and treating caries should be also highly emphasized.
Objective To approach the convenient prediction methods about surgical indications of adhesive ileus. Methods Two thousand and thirtyfour patients with adhesive ileus were analyzed retrospectively between January 1996 and January 2010 in the Department of General Surgery, The First Affiliated Hospital of Anhui Medical University， and 1 992 patients were included into this model. Seventeen factors which could influence the surgical decisions, including period of intestinal obstruction (X1), frequency of attack (X2), history of operation on abdominal region (X3), continuous and severe abdominal pain (X4), severe or frequent vomiting (X5), severe abdominal distention (X6), hemafecia (X7), fever (X8), heart rate (X9), shock or hypotension (X10), touching a swell ansa intestinalis (X11), hypoactive bowel sound (X12), peritonitis (X13), white blood cell (WBC) count of peripheral blood (X14), obstruction ansa interstinalis fixation and a severe expansion by abdominal erect position plain film (X15), peritoneal cavity free air (X16), and seroperitoneum whether or not by B ultrasonic examination (X17) were analyzed by binary logistic regression. Then prediction schedule whether patients with adhesive ileus needed emergency operation was gained by the theory of logistic regression analysis. Results Eight items were included in the prediction model by the method of forward stepwise which were X1, X2, X4, X9, X13, X14, X15, and X17, respectively. The probability of operation could be calculated by the following formula: logit(P)=expZ/（1+expZ）, where, Z={-7.813+〔-1.942×X1(1)/2.290×X1(2)/2.765×X1(3)〕+2.801×X2+2.692×X4+10.610×X9(1)/13.279×X9(2)+3.422×X13+〔-3.048×X14(1)/16.992×X14(2)〕+6.113×X15+2×X17}， which X1（1）, X1（2）, and X1（3） were periods of intestinal obstruction 3－5 d, 5－7 d, and ≥7 d, respectively. X9(1) and X9(2) were heart rates of 60－100/min and ≥100/min, respectively. X14(1) and X14(2) were WBC counts of peripheral blood of (10-20)×109/L and ≥20×109/L， respectively. The patient had to accept surgical procedure when the value of P was more than 0.5. The coincidence was 99.00%, sensitivity was 96.17%, specificity was 99.53% in 1 992 patients. The coincidence was 96.20%, sensitivity was 90.00%, specificity was 96.84% in 105 patients between January 2010 and April 2010 in this hospital. Conclusion The prediction schedule is a good useful value, but the coefficients is corrected following the cases increasing.
Objective To investigate the prognostic factors related to in-hospital mortality in patients with acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) . Methods A prospective cohort study was carried out in AECOPD patients admitted in three district general hospitals of Jiangyou city, Sichuan province from February 2007 to February 2008. The clinical and epidemiological data at admission and all-cause death in hospital were recorded. The in-hospital mortality rate and potential determinants of mortality of AECOPD were analyzed using Logistic regression method. Results 257 AECOPD inpatients with AECOPD were recruited into the cohort study. The in-hospital mortality rate was 5.84% (15/257) . Univariate analysis showed in-hospital mortality was significantly associated with age, FEV1% pred, arterial oxygen tension ( PaO2 ) , arterial oxygen saturation ( SaO2 ) , pH, and Charlson’s complication index. Multivariate logistic regression model showed that lower arterial oxygen tension ( OR 4.775;95%CI 1.545 ～14.757; P =0.007) and higher Charlson’s complication index ( OR 4. 608; 95% CI 1. 330 ～15. 966; P =0. 016) were significantly associated with in-hospital mortality after adjustment by age. Conclusion For in-patients with AECOPD, PaO2 and Charlson’s complication index are independent risk factors associated with in-hospital mortality.
ObjectiveTo establish logistic regression analysis model to evaluate the diagnostic efficacy of breast imaging report and data system (BI-RADS) ultrasound signs in forecasting malignant risk of breast lesions. MethodUltrasound graphic materials of 1 660 breast lesions diagnosed during January to September 2011 were retrospectively studied and standardized by BI-RADS. Pathology results were regarded as gold standard reference. Ultrasound signs with significant efficacy after single-factor logistic regression were evaluated in multi-factor logistic regression model to predict the malignant risk of breast lesions. ResultsEighteen ultrasound signs of breast lesions on BI-RADS were included in the final regression model. Among them, Cooper ligaments stretch, echogenic halo, skin thickening, axillary lymph node abnormalities, structural distortions and speculation had high OR values of 30 or more and had higher specificity than 90%. The diagnosis values of regressions model were high, with a sensitivity of 84.5%, specificity 95.5% and accuracy 91.4%. The area under ROC curve was 0.964 and prediction accuracy was 91.0%. ConclusionsThe logistic regression model based on BI-RADS ultrasound signs of breast lesions has high diagnostic values in detecting breast cancer.
ObjectiveTo investigate the correlative factors for the efficacy of surgical treatment for single segment degenerative lumbar spinal disorders. MethodsFrom October 2008 to November 2010, a prospective non-randomized controlled study was carried out on 179 patients who were diagnosed to have L4-5 degenerative lumbar spinal disorders and underwent surgical treatment. Ninety-seven patients were included in our study, including 64 males and 33 females, aged between 21 and 86 years old, averaging 49.0. The follow up lasted for an average of 18.9 (12-27) months. The correlative factors including age, sex, body mass index, preoperative psychological state and degree of low back pain, surgical methods, combination with adjacent segment degeneration and recurrence state were analyzed. Single and multiple-factor Logistic regression analysis was used to determine the relationship between independent factors and surgical results of lumbar degenerative disease. ResultsAt the last follow-up, Japanese Orthopaedic Association scores were improved to 22.40±3.18 with an improving rate of (68.5±15.7)% compared with the preoperative condition (7.61±3.09), and the difference was significant (t=-33.031, P<0.001). Univariate analysis showed that all factors were variables associated with the surgical results excluding sex and age (P<0.05). Multiple-factor logistic regression analysis showed that the preoperative psychological state, combination with adjacent segment degeneration and surgical methods had important impact on the surgical results (P<0.05). ConclusionSurgical treatment of lumbar degenerative disease is effective. The preoperative psychological state, combination with adjacent segment degeneration and surgical methods are important factors associated with the surgical results.
ObjectiveTo learn the outcomes of hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) cases after artificial liver support system (ALSS) treatment and the relevant factors correlated with the clinical outcomes. MethodsIn the period from January 2011 to June 2014, 321 patients with HBV-ACLF were admitted to West China Hospital. The clinical data at baseline, before and after treatment were analyzed by univariate and multivariate logistic regressions to identify the independent risk factors correlated with 30-day outcomes. ResultsOf all the 321 patients, 233 survived and 88 died by the end of a 30-day observation. The univariate analysis identified that the incidences of cirrhosis, hepatorenal syndrome and peritonitis in the death group were significantly higher (P<0.05). The model for end-stage liver disease values, white blood cells (WBC), blood ammonia, creatinine and total bilirubin (TBIL) at different stages in the death group were significantly higher than those in the survival group (P<0.05). In the death group, the HBV-DNA, TBIL decrease after triple ALSS treatments, baseline prothrombin time activity (PTA) and PTA level after triple ALSS treatments were significantly lower (P<0.05). The multivariate logistic regression indicated that WBC (OR=2.337, P<0.001) and TBIL level after triple ALSS treatments (OR=4.935, P<0.001) were independent predicting factors for death within 30 days after ALSS treatment; HBV-DNA (OR=0.403, P<0.001), the decrease of TBIL after triple ALSS treatments (OR=0.447, P<0.001) and PTA level after triple ALSS treatments (OR=0.332, P<0.001) were protecting factors for the 30-day prognosis. ConclusionThese five factors including WBC, HBV-DNA, PTA, TBIL and TBIL decrease after triple ALSS treatments influence the short-term prognosis for HBV-ACLF patients, which are valuable for decision making in clinical practices.
Objective To study the influence factors of surgical site infection (SSI) after hepatobiliary and pancreatic surgery. Methods Fifty patients suffered from SSI after hepatobiliary and pancreatic surgery who treated in Feng,nan District Hospital of Tangshan City from April 2010 and April 2015 were retrospectively collected as observation group, and 102 patients who didn’t suffered from SSI after hepatobiliary and pancreatic surgery at the same time period were retrospectively collected as control group. Then logistic regression was performed to explore the influence factors of SSI. Results Results of univariate analysis showed that, the ratios of patients older than 60 years, combined with cardiovascular and cerebrovascular diseases, had abdominal surgery history, had smoking history, suffered from the increased level of preoperative blood glucose , suffered from preoperative infection, operative time was longer than 180 minutes, American Societyof Anesthesiologists (ASA) score were 3-5, indwelled drainage tube, without dressing changes within 48 hours after surgery, and new injury severity score (NISS) were 2-3 were higher in observation group (P＜0.05). Results of logistic regression analysis showed that, patients had history of abdominal surgery (OR=1.92), without dressing changes within 48 hours after surgery (OR=2.07), and NISS were 2-3 (OR=2.27) had higher incidence of SSI (P＜0.05). Conclusion We should pay more attention on the patient with abdominal surgery history and with NISS of 2-3, and give dressing changes within 48 hours after surgery, to reduce the incidence of SSI.