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Conservative treatment for cervical spondylotic myelopathy. prediction of treatment effects by multivariate analysis.

BACKGROUND CONTEXT: Many studies have suggested only slight effects of conservative treatment on cervical spondylotic myelopathy (CSM), whereas a few reports describe conservative treatment as being effective. This suggested the influence of various factors on treatment outcomes. PURPOSE: We investigated symptomatic changes after conservative treatment in patients based on a clear understanding of the effects and limitations of conservative treatment. STUDY DESIGN: We have encountered cases that showed symptomatic improvement with conservative treatment and became interested in the effectiveness of conservative treatment for CSM and whether other factors affect the results of conservative treatment. PATIENT SAMPLE: We have analyzed the results of conservative treatment for CSM in 69 cases, derived from a population of 101 CSM cases. OUTCOME MEASURES: Symptoms at the time of the first examination were compared with those at the final examination, and the patients were classified into three groups showing improvement, no change or exacerbation. METHODS: Improvement or exacerbation of the symptoms was used as dependent variables and the collected factors as independent variables, and logistic regression was performed on these variables. RESULTS: Multivariate analysis showed significant correlation between clinical outcome and the disease duration and the presence of rigorous conservative treatment. CONCLUSIONS: Conservative treatment for CSM is considered to be effective if it is performed intensively in selected patients. In treating CSM, the therapeutic approach must be selected first in consideration of the patient's disease duration. Conservative treatment must be carried out intensively after sufficient explanation to the patients. Timely surgical intervention is considered to be important if the symptoms show no change or exacerbation with conservative treatment.

Adult↗

PubMed2006

Margin distance and other clinico-pathologic prognostic factors in vulvar carcinoma: a multivariate analysis.

OBJECTIVES: To determine the importance of margin status and other prognostic factors associated with the recurrence and survival of patients with squamous cell vulvar carcinoma. METHODS: Data were analyzed using Kaplan-Meier methods and Cox proportional hazards regression. All slides were re-reviewed by two gynecologic pathologists. RESULTS: Ninety patients (median age: 69) were treated for vulvar carcinoma from 1984 to 2002, including 28 FIGO stage I, 20 stage II, 26 stage III and 16 with stage IV disease. Sixty-three (70%) patients underwent complete radical vulvectomies and 27 (30%) had modified radical vulvectomies. Nineteen (20%) patients received adjuvant radiotherapy. Five-year disease-specific survival rates were 100%, 100%, 86% and 29% for stages I-IV, respectively. None of the 30 patients with a pathologic margin distance >8 mm had local recurrence. Of the 53 women with tumor-free pathologic margin of <8 mm, 12 (23%) had a local recurrence. Moreover, women with >2 positive groin nodes had significantly higher recurrence risk compared to those with <2 metastatic groin nodes (p<0.001). On multivariate analysis, positive groin nodes and margin distance were important prognostic factors for recurrence. Moreover, stage, tumor size, margin distance, and depth of invasion were significant independent predictors for disease-specific survival. The median follow-up was 58 months (range: 2-188). CONCLUSIONS: Pathologic margin distance is an important predictor of local vulvar recurrence. Our data suggest that a > or =8-mm pathologic margin clearance leads to a high rate of loco-regional control.

Adult↗

PubMed1997

Predictors of response to subsequent chemotherapy in platinum pretreated ovarian cancer: a multivariate analysis of 704 patients [seecomments].

BACKGROUND: The probability of response to chemotherapy following platinum based treatment in ovarian cancer has usually been related to the 'platinum-free interval'. However, in a recent European-Canadian trial of paclitaxel, serous histology, tumor bulk, and hemoglobin, but not treatment free interval, were predictors of response. To determine if these observations were unique to this study (or this drug), data from other active agents given as second- or third-line treatment in ovarian cancer were obtained and analyzed. METHODS: In the first part of the study, results of trials in 1185 platinum pretreated ovarian cancer patients were obtained on six agents: paclitaxel, epirubicin, docetaxel, carboplatin, irinotecan, and gemcitabine. Response results according to histology, baseline hemoglobin, tumor size and time from last chemotherapy were determined for each agent and the Cochran-Mantel-Haenszel procedure was used to obtain an overall assessment of significance for each factor. In the second part of the study, individual data from 704 patients in four studies (three agents: paclitaxel, docetaxel and epirubicin) were pooled for univariate and multivariate analysis of factors predictive of response. RESULTS: In the analysis of results of individual agents all factors examined were significant predictors of response: serous histology (P = 0.001), tumor size < or = 5 cm (P = 0.02), normal baseline hemoglobin (P = 0.003), and > or = 6 mo since last treatment (P = 0.001). While these results were interesting, they did not supply definitive answers regarding independent response predictors. Therefore a multifactor analysis was undertaken on the 704 patients for whom individual data were available. Of the 11 factors examined in a univariate analysis, 10 met the criteria for inclusion in a stepwise logistic regression. In the final model only 3 factors remained as significant independent predictors of response: serous histology (P = 0.009), no. disease sites (P = 0.003), and tumor size (P = 0.001). Time from last treatment, when evaluated as a continuous variable, was not in the final model and was highly correlated with tumor size (P = 0.0005). CONCLUSIONS: On the basis of this analysis, we conclude that tumor burden (as assessed by size of the largest lesion and number of disease sites) and histology are factors of importance in response to subsequent chemotherapy in relapsed ovarian cancer. Time from last treatment was correlated with tumor size in this data set and its effect on response was dependent on whether it was examined as a categorical or continuous variable, so we conclude it is not the sole critical factor of biologic importance. We recommend description of these factors in reports of phase II studies, confirmation of these findings in other data sets and further investigation of the mechanism of sensitivity of serous tumors.

Female↗

PubMed1996

Effects of sensory aids on the quality of life and mortality of elderly people: a multivariate analysis.

The present study aimed at clarifying the relationships between the use of sensory aids and the quality of life (QOL) and mortality of elderly people suffering from sensory deprivation. We carried out a cross-sectional survey on the QOL and the sensory status of an elderly cohort and a 6-year longitudinal follow-up of mortality rates among 1192 non-institutionalized people aged 70-75 years in a North Italian town. We classified respondents into three groups: those with functionally adequate visual and hearing acuity (n = 275); those with sensory impairment, corrected by the use of sensory aids (n = 680), and those with uncorrected sensory impairment (n = 245). In the whole sample, multiple logistic regression analyses showed that an uncorrected sensory deprivation was associated with a significant and independent impairment of mood, self-sufficiency in instrumental activities of daily living and social relationships. Such impairments were not apparent in the subjects with sensory impairments who were using sensory aids. In men with uncorrected sensory impairment the unadjusted 6-year mortality rate was almost twice that of the other two groups, which did not differ from each other. No corresponding differences were detected in women. Multivariate analysis showed that the effect of the sensory aid status on mortality was indirect and mediated through the global physical health status and the social relationships. We conclude that our cross-sectional data demonstrate an association between uncorrected sensory deprivation and a low QOL; such an association was not present in subjects with corrected sensory deprivation.

Activities of Daily Living↗

PubMed1995

Delayed graft function, acute rejection, and outcome after cadaver renal transplantation. The multivariate analysis.

The impact of delayed graft function on outcome after cadaver renal transplantation has been controversial, but most authors fail to control their analyses for the presence or absence of rejection. We studied 457 adult recipients of primary cadaver allografts at a single institution during the cyclosporine era. All patients received sequential immunosuppression. The incidence of delayed graft function (defined as dialysis being required during the first week after transplant) was 23%. There was a significant association between delayed graft function and cold ischemia time > 24 hr (P = 0.0001) and between delayed graft function and the occurrence of at least one biopsy-proven rejection episode (P = 0.004). Actuarial graft survival was not significantly different when comparing delayed graft function versus no delayed graft function for patients without rejection (P = 0.02). However, it was significantly worse for patients with both delayed graft function and rejection versus those with delayed graft function but no rejection (P = 0.005), as well as for grafts preserved > 24 hr versus < or = 24 hr (P = 0.007). By multivariate analysis, delayed graft function per se was not a significant risk factor for decreased graft survival for patients without rejection (P = 0.42). In contrast, rejection significantly decreased graft survival for grafts with immediate function (relative risk = 2.3, P = 0.0002), particularly in combination with delayed graft function (relative risk = 4.2, P < 0.0001). While cold ischemia time > 24 hr was also a significant risk factor (relative risk = 1.9, P = 0.02), other variables (preservation mode, 0 HLA Ag mismatch, age at transplantation, gender, diabetic status, and panel-reactive antibody at transplantation) had no impact on graft survival. Patient survival was significantly affected by the combination of delayed graft function and rejection (relative risk = 3.1, P < 0.0001), age at transplantation > 50 years (relative risk = 2.6, P < 0.0001), and diabetes (relative risk = 1.8, P = 0.006). Further studies are necessary to elucidate the mechanisms linking delayed graft function and rejection, which, in combination, lead to poor allograft outcome.

Adult↗

PubMed2005

Multivariate analysis of paired watershed data to evaluate agricultural best management practice effects on stream water phosphorus.

Quantification of the effects of management programs on water quality is critical to agencies responsible for water resource protection. This research documents reductions in stream water phosphorus (P) loads resulting from agricultural best management practices (BMPs) implemented as part of an effort to control eutrophication of Cannonsville Reservoir, a drinking water supply for New York City. Dairy farms in the upstate New York reservoir basin were the target of BMPs designed to reduce P losses. A paired watershed study was established on one of these farms in 1993 to evaluate changes in P loading attributable to implementation of BMPs that included manure management, rotational grazing, and improved infrastructure. Intensive stream water monitoring provided data to calculate P loads from the 160-ha farm watershed for all runoff events during a two-year pre-treatment period and a four-year post-treatment period. Statistical control for inter-annual climatic variability was provided by matched P loads from a nearby 86-ha forested watershed, and by several event flow variables measured at the farm. A sophisticated multivariate analysis of covariance (ANCOVA) provided estimates of both seasonal and overall load reductions. Statistical power and the minimum detectable treatment effect (MDTE) were also calculated. The results demonstrated overall event load reductions of 43% for total dissolved phosphorus (TDP) and 29% for particulate phosphorus (PP). Changes in farm management practices and physical infrastructure clearly produced decreases in event P losses measurable at the small watershed scale.

Agriculture↗

PubMed1992

Relative effect of steroid hormone receptors on the prognosis of patients with operable breast cancer. A univariate and multivariate analysis of 3089 Japanese patients with breast cancer from the Study Group for the Japanese Breast Cancer Society on Hormone Receptors and Prognosis in Breast Cancer.

In a retrospective multicenter study to investigate the correlation between estrogen (ER) and/or progesterone receptors (PgR) in primary breast cancer with patient prognosis, 3118 patients with operable breast cancer (International Union Against Cancer Stages I, II, and III) were investigated from ten hospitals in Japan who underwent surgery from October 1972 to December 1982; 3089 were evaluable. The ER-positive and PgR-positive cancers were found in 56% and 34% of patients, respectively. The positivities decreased as the tumor size increased but were independent on lymph node metastasis. There were no significant differences in relapse-free survival (RFS) in relation to receptor status (median follow-up, 89 months [ER], 84 months [PgR]). However, in patients with four or more positive nodes, those with PgR-positive cancer had a longer RFS. The patients with ER-positive cancer survived significantly longer than ER-negative ones, with the greatest difference seen in those with four or more positive nodes. There was a significantly longer postrelapse survival (PRS) for patients with ER-positive cancer because of the different distribution of the major metastasis and better responses to first-line and subsequent treatments. Cox's multivariate analysis showed that overall survival but not PRS was affected by ER (and more weakly by PgR) because of the longer PRS in patients with ER-positive cancer.

Adult↗

PubMed2003

Multivariate analysis of risk factors for hemorrhagic cystitis after hematopoietic stem cell transplantation.

To establish the most appropriate prophylactic therapy and risk factors for predicting hemorrhagic cystitis (HC) after stem cell transplantation (SCT), we retrospectively analyzed the clinical records of 450 transplant patients treated from 1982 to 2002. In all, 81 patients developed early- and/or late-onset HC (early=29, late=48, both=4). For the incidence of early-onset HC, administration of cyclophosphamide (CY) (p=0.0079, odds ratio (OD)=5.109, 95% confidence interval (CI)=1.533-17.030), busulfan (BU) (p=0.0015, OD=3.336, 95% CI=1.584-7.027), BU+CY (p=0.0001, OD=4.369, 95% CI=2.055-9.292), antithymocyte globulin (p=0.0009, OD=3.368, 95% CI=1.642-6.911), nonradiation (p=0.0163, OD=2.564, 95% CI=0.181-0.841), 2-mercaptoethane sodium sulfonate (Mesna) (p=0.0001, OD=7.519, 95% CI=2.847-19.858), and bladder irrigation (p=0.0001, OD=4.950, 95% CI=2.328-10.523) were risk factors. By Fisher's exact test, the combination of BU and Mesna was a more significant risk factor (P<0.001) than Mesna alone (p=0.008) compared to the administration of neither agent. By multivariate analysis, prophylactic administration of Mesna (p=0.0105, OD=5.301, 95% CI=1.477-19.026) and bladder irrigation (p=0.0001, OD=9.469, 95% CI=3.872-23.156) were significant risk factors of early-onset HC. We conclude that (i). high-dose BU as well as CY is a cause of HC, (ii). protective bladder irrigation has an opposite effect, and (iii). Mesna possibly has a toxic effect on bladder mucosa.

Adolescent↗

PubMed2005

Multivariate analysis of antibody induction therapy and their associated outcomes in deceased donor transplants.

AIMS: The aims of this study were to describe factors associated with the use of overall induction, classes of induction agents, and to evaluate the incidence of acute rejection, short-term graft survival, and patient survival. METHODS: Of 24,901 transplants reported to the United Network for Organ Sharing (UNOS) between 1999 and 2001, 51% received induction therapy including Thymoglobulin (T; n = 3090), Simulect (S; n = 6063), or Zenapax (Z; n = 3755). Propensity scores (PS) were calculated to indicate factors associated with use of induction and for each induction agent. Outcome parameters included graft survival (GS), hazard ratio (HR) for graft loss (GL), and odds ratio (OR) for first-year acute rejection (AR). RESULTS: Pediatric (PS = 1.29; 95% confidence interval [CI] 1.12-1.49, vs adults) and retransplanted recipients (PS = 1.36; 1.23-1.49, vs first) were more likely to receive induction. One-year GS (90.1 vs 88.0%; P < .001), GL = 0.92% (0.86-0.98; P = .01), and AR free = 0.74 (P < .001) were superior in patients receiving induction. Using multivariate analysis, the odds of rejection 0.73 (0.68-0.78), GL 0.91 (0.85-0.97), and death 0.90 (0.82-0.98) were lower in those receiving induction. Among patients given induction, those receiving T were more likely sensitized (PS = 1.50%; 1.31-1.71), retransplanted (PS = 1.51; 1.31-1.75), or had delayed graft function (PS = 1.75; 1.58-1.93). T decreased the odds of rejection compared with S or Z (OR = 0.74; 0.69-0.79), but the type of induction agent did not have an impact on graft outcome HR for T = 1.07 (0.96-1.19). CONCLUSIONS: The use of antibody induction was associated with lower risk of rejection and better GS. There were no differences in GS among individual regimens. Comparative safety data were not analyzed but should be taken into consideration when choosing antibody preparations.

Adult↗

PubMed2006

Prognostic factors of primary small bowel adenocarcinoma: univariate and multivariate analysis.

BACKGROUND: Adenocarcinoma of the small bowel is relatively less common than malignancies of the esophagus, stomach, and colorectum. In small bowel adenocarcinoma, various prognostic factors influence the disease-free status and overall survival rates. MATERIALS AND METHODS: Eighty patients who were diagnosed with small bowel adenocarcinoma and treated at our institute between 1983 and 2003 were retrospectively reviewed. RESULTS: The patients included 40 men and 40 women with an age range of 15 to 93 years (median: 62 years). Only 51.3% of patients were accurately proved preoperatively to have a malignancy by endoscopic biopsy. Sixty patients underwent surgical treatment, and 45 of those patients had curative resection. The follow-up period ranged from 2.5 to 229.7 months, with a median of 9.1 months. The cumulative 1-, 3-, and 5-year survival rates for all patients (excluding 3 patients who died in the immediate postoperative period) were 43.6%, 22.8%, and 17.5%, respectively. The cumulative 1-, 3-, and 5-year disease-free survival rate for all 43 patients with curative resection (excluding 2 patients who died in the immediate postoperative period) was 54.9%, 30.5%, and 27.4%, respectively. Meanwhile, multivariate analysis with Cox proportional hazards analysis demonstrated that earlier tumor stages (stages I and II) and curative resection were two independent factors influencing favorable overall survival. Lymph node metastasis was the only independent factor predicting poor disease-free survival in patients undergoing curative resection. CONCLUSIONS: Poor prognosis of small bowel adenocarcinoma may be related to a delay in the diagnosis and treatment of the disease. Curative resection is the aim of surgical treatment for small bowel adenocarcinoma. Lymph node metastasis at presentation of the disease predicts tumor recurrence and distant metastasis after curative surgical treatment.

Adenocarcinoma↗

PubMed1997

Functional vision is improved in the majority of patients treated with external-beam radiotherapy for choroid metastases: a multivariate analysis of 188 patients.

PURPOSE: Metastatic deposits are the most common intraocular malignancies. We evaluated the efficacy of external-beam radiotherapy (EBRT) in the palliation of posterior uveal metastases in terms of clinically relevant outcomes: functional vision, tumor control, and globe preservation. PATIENTS AND METHODS: Four hundred eighty-three consecutive patients (578 eyes) were diagnosed with intraocular metastatic disease from solid tumors between 1972 and 1995. Of these, 233 eyes (188 patients) had lesions of the posterior uveal tract and received EBRT. Best-corrected visual acuity (VA) was documented pre- and post-EBRT. Visual function was considered excellent if VA < or = 20/50, navigational if 20/60 to 20/200, and legally blind if > or = 20/400. Most patients received 30 to 40 Gy in 2- to 3-Gy fractions to the posterior or entire globe. RESULTS: Fifty-seven percent of all assessable eyes had improved visual function or maintained at least navigational vision following EBRT. Thirty-six percent of legally blind eyes regained useful vision. Ninety-three percent experienced no clinical evidence of tumor progression and the globe preservation rate was 98%. The following characteristics independently predicted improvement to or maintenance of excellent vision on multivariate analysis: excellent vision pre-EBRT (P = .001), age less than 55 years (P = .004), white race (v black/Hispanic) (P = .003), and tumor base diameter less than 15 mm (P < .001). CONCLUSION: EBRT effectively restores and maintains useful vision in patients with choroid metastases, with a globe preservation rate of 98%. Patients less than 55 years with pretreatment VA better than 20/60 and tumor diameter less than 15 mm are most likely to benefit from this therapeutic intervention.

Adult↗

PubMed2005

Prognostic factors responsible for survival in sex cord stromal tumors of the ovary--a multivariate analysis.

OBJECTIVE: To evaluate prognostic factors that impacts the survival of women with sex cord stromal tumors of the ovary (SCST). METHODS: Cases were identified from tumor registry databases at three academic institutions between 1975 and 2003. Patient characteristics, surgical treatment, adjuvant therapy, pathologic and follow-up information were collected from hospital charts and clinic records. Kaplan-Meier and Cox proportional hazards analyses were used to identify predictors of outcome. RESULTS: Eighty-three women (median age: 49 years) with SCST of the ovary, including 73 with granulosa and 10 with Sertoli-Leydig cell tumors were identified. Fifty-one were stage I, 8 stage II, 10 stage III, 3 stage IV, and 11 patients were unstaged. The median and 5-year disease-specific survival of women with stage I-II vs. III-IV was 180 months and 85% compared to 58 months and 48%, respectively (P = 0.012). Furthermore, age <50 (P = 0.003), premenopausal status (P = 0.013), tumor size < 10 cm (P = 0.003), lack of lymph node invasion (P < 0.0005), and absence of residual disease (P = 0.002) were all significant predictors for improved survival. Of the patients who received adjuvant treatment, chemotherapy did not impact survival (P = 0.11). Twelve of 51 stage I patients underwent fertility-sparing surgery with three recurrences. In multivariate analysis, age <50, smaller tumor size, and absence of residual disease remained as independent prognostic factors. The median follow up was 58 months (range: 1-310). CONCLUSIONS: Age <50, smaller tumor size, and absence of residual disease are important predictors for improved survival in patients with SCST of the ovary.

Adolescent↗

PubMed2001

Prognostic implications of aberrations in p16/pRb pathway in urothelial bladder carcinomas: a multivariate analysis including p53 expression and proliferation markers.

OBJECTIVE: To assess the prognostic value of the expression of two negative regulators of the cell cycle, namely CDKN2/INK4a gene product (p16) and retinoblastoma gene product (pRb), in urinary bladder cancer in relation to clinicopathological parameters, proliferative fraction and p53 protein accumulation. METHODS: Paraffin sections from 139 patients with urothelial carcinomas were stained immunohistochemically with antibodies to p16 (F12), pRb (PMG3-245), p53 (DO1), PCNA (PC10) and Ki-67 (MIB-1). RESULTS: Diminished p16 and pRb expression occurred in 29 and 74% of cases, respectively, being associated with advanced stage but not with histological grade, papillary status or proliferation rate. In most cases (53%) with some fault in the p16/pRb pathway, only one gene was affected. A double-negative p16/pRb phenotype was comparatively uncommon (25%) and was usually seen in T3-T4 tumours. In survival analysis (either univariate or multivariate) aberrant p16 expression was an adverse prognostic parameter only in T3-T4 tumours. In contrast, the abnormal p16/pRb and p53/p16 phenotypes were linked to a diminished overall and disease-free survival (univariate analysis); p53/p16 abnormal expression was also found to be an independent predictor of reduced survival in muscle-invasive tumours, while proliferation markers were the only parameters with independent significance in superficial (Ta-T1) tumours. CONCLUSION: Our results suggest that lack of p16 immunoexpression, when combined with p53 accumulation, plays an important role in determining the clinical outcome in muscle-invasive urothelial carcinomas.

Adult↗

PubMed1996

Prognostic factors of colorectal cancer. Results of multivariate analysis of curative resection cases with or without adjuvant chemotherapy.

One thousand two hundred fifty-four cases (610 colonic and 644 rectal cancers resected during 2 years from 1984 and followed up for more than 5 years) were entered from 140 institutions in Japan and analyzed by means of Cox's proportional hazards model. The analyzed pathologic variables were the size and depth of invasion, Dukes' stage, venous invasion, lymphatic permeation, and other clinical features, such as the sex and age of the patient and location of the tumor. The extent of dissection, serum carcinoembryonic antigen (CEA) level, and the presence or absence of adjuvant chemotherapy were also analyzed. Adjuvant chemotherapy consisted of three arms for both colonic and rectal cancers. For colonic cancer, arm I was a combination of i.p. (intraportal) and i.v. mitomycin C (MMC) + p.o. 5-fluorouracil (5-FU); arm II was i.v. MMC + p.o. 5-FU; and arm III was surgery only. For rectal cancer, arm IV was a combination of i.a. (inferior mesenteric artery) and i.v. MMC + p.o. 5-FU; arm V was i.v. MMC + p.o. 5-FU; and arm VI was surgery only. As for the factors affecting the disease-free survival of the patient, multivariate analysis disclosed nodal involvement, venous invasion, an elevated CEA level, and the lower part of the rectum. The effect of adjuvant chemotherapy on the patient's survival was proven for rectal cancer but not for colonic cancer. We conclude that these factors should be considered in setting the stage of tumor pre- and postoperatively.

Aged↗

PubMed2002

Influence of hepatitis C virus subtype on hepatocellular carcinogenesis: a multivariate analysis of a retrospective cohort of 593 patients with cirrhosis.

OBJECTIVE: The influence of hepatitis C virus (HCV) subtypes on hepatocellular carcinogenesis was prospectively investigated. METHODS: A total of 593 patients with HCV-related cirrhosis were recruited and their HCV subtype was determined. RESULTS: The carcinogenesis rates in the patients with HCV group 1 (genotype 1a +1b, n = 442) and group 2 (genotype 2a +2b, n = 136) were 32.0 and 26.6% at the end of the 5th year, 57.4 and 48.1% at the end of the 10th year and 71.8 and 71.0% at the end of the 15th year, respectively (p = 0.10). As to those patients without a history of regular drinking (i.e. less than 200 kg on a pure alcohol basis), the carcinogenesis rates in group 1 (n = 277) and group 2 (n = 90) were 30.8 and 16.3% at the end of the 5th year, 52.8 and 34.4% at the end of the 10th year and 70.6 and 67.1% at the end of the 15th year, respectively (p = 0.025). Although HCV subtype did not influence carcinogenesis in patients with a drinking history of 200 kg or more (p = 0.62), it significantly affected the carcinogenesis rate in patients without a history of regular drinking. Multivariate analysis showed that HCV subtype group 1 significantly increased the carcinogenesis in the group without a history of regular drinking after adjustment for age and gender (hazard ratio = 2.57, p = 0.0085). CONCLUSION: The interaction between HCV subtype and drinking history should be considered in the prediction of carcinogenesis using a multiplicative proportional hazard model.

Adolescent↗

PubMed2000

Multivariate analysis of associations of 42 genes in ADHD, ODD and conduct disorder.

In a previous study (Comings DE et al. Comparison of the role of dopamine, serotonin, and noradrenergic genes in ADHD, ODD and conduct disorder. Multivariate regression analysis of 20 genes. Clin Genet 2000: 57: 178-196) we examined the role of 20 dopamine, serotonin and norepinephrine genes in attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD), using a multivariate analysis of associations (MAA) technique. We have now brought the total number of genes examined to 42 by adding an additional 22 candidate genes. These results indicate that even with the inclusion of these additional genes the noradrenergic genes still played a greater role in ADHD than any other group. Six other neurotransmitter genes were included in the regression equation - cholinergic, nicotinic, alpha 4 receptor (CHNRA4), adenosine A2A receptor (ADOA2A), nitric oxide synthase (NOS3), NMDAR1, GRIN2B, and GABRB3. In contrast to ADHD and ODD, CD preferentially utilized hormone and neuropeptide genes These included CCK, CYP19 (aromatase cytochrome P-450), ESR1, and INS (p = 0.005). This is consistent with our prior studies indicating a role of the androgen receptor (AR) gene in a range of externalizing behavors. We propose that the MAA technique, by focusing on the additive effect of multiple genes and on the cummulative effect of functionally related groups of genes, provides a powerful approach to the dissection of the genetic basis of polygenic disorders.

Adolescent↗

PubMed2002

Relationship between serum parathyroid hormone, serum calcium and arterial blood pressure in patients with primary hyperparathyroidism: results of a multivariate analysis.

OBJECTIVE: To evaluate the possible relationship between serum calcium, serum parathyroid hormone (PTH) levels and arterial blood pressure (BP) in patients with primary hyperparathyroidism (HPT). DESIGN: A retrospective population-based study. METHODS: Charts of 194 patients with proven primary HPT were reviewed, and the main clinical and biochemical parameters were recorded. There were 48 men (24.7%) and 146 women (75.3%), with a median age of 59 years (range 23-82 years). Patients who used antihypertensive drugs or hormone replacement therapy had been previously excluded. All patients underwent successful parathyroidectomy, and were cured of their disease. RESULTS: There were no differences (P=NS) between men and women in systolic (143.3+/-19.1 vs 145.4+/-17.1 mmHg) and diastolic (87.1+/-12.3 vs 88.4+/-9.9 mmHg) BP, and in the main biochemical parameters. A significant (P<0.01) correlation was found between (i) serum calcium and serum PTH levels (r=0.39, F=88.36), (ii) age and BP, both systolic (r=0.61, F=118.16) and diastolic (r=0.48, F=64.5), and (iii) body mass index (BMI) and BP (r=0.45 and 0.36 respectively). There was no significant association of serum calcium levels with systolic (r=0.0974, t=1.3422, P=0.18) or diastolic (r=0.1117, t=1.5409, P=0.12) BP, and of serum PTH levels with systolic (r=-0.0349, t=-0.4783, P=0.63) or diastolic (r=-0.0793, t=-1.0913, P=0.28) BP. Multivariate analysis confirmed that none of the independent biochemical parameters significantly correlated with BP, both systolic and diastolic. CONCLUSIONS: In patients with primary HPT there is no relationship between PTH, calcium and BP. Thus, in hyperparathyroid patients, BP should be considered as an independent variable, mainly related to age and BMI.

Aged↗

PubMed1997

[Nosocomial infection at an intensive care unit: multivariate analysis of risk factors].

BACKGROUND: Nosocomial infections, especially in the intensive care unit, are a very important problem due to their frequency and important consequences (morbility and mortality). On the other hand there are some risk factors and some preventive measures which are involved in the appearance of the nosocomial infections. The purpose of this work was to recognize these risk factors and to identify the preventive measures which are effective, and also to quantify the participation of each risk factors/preventive measures in the development of the nosocomial infections. PATIENTS AND METHODS: Follow-up of a cohort of patients admitted to the intensive care unit of the General Hospital of La Paz (Madrid, Spain) during a year and with a stay of at least 48 hours. RESULTS: We have found a cummulative incidence of patients with nosocomial infection of 32.8%. More than 80% of the patients received antibiotic treatment during their stay in the intensive care unit. The stay of the patients no infected was 4 days while the stay of infected patients was 20 days. We have found a mortality of 29.5%, which was greater in the patients who were infected (42%). In the multivariate analysis we have developed an equation to predict the development of the nosocomial infection. The following variables were identified: six or more instrumentations (OR, 4.75; 95% CI, 2.75-8.19), more of ten days of hospitalization previous to the appearance of the first nosocomial infection (OR, 4.17; 95% CI, 2.60-6.70), administration of muscle relaxing drugs (OR, 2.25; 95% CI, 1.43-3.55), nasogastric tube (OR, 2.19; 95% CI, 1.25-3.84), and altered consciousness (OR, 2.19; 95% CI, 1.25-3.84). Therefore, those patients who present some of these characteristics should be monitored in a special way due to their high risk of development of a nosocomial infection. CONCLUSIONS: Several factors play an important role in the development of a nosocomial infection in the intensive care unit; these are not only intrinsec (especially the altered consciousness) but also extrinsec (instrumentations and drugs), as well as the stay at the hospital previous to the appearance of the first nosocomial infection.

Adult↗