Percussion Entropy Analysis of Synchronized ECG and PPG Signals as a Prognostic Indicator for Future Peripheral Neuropathy in Type 2 Diabetic Subjects.

Diabetic peripheral neuropathy (DPN) is one of the most common chronic complications of diabetes. It has become an essential public health crisis, especially for care in the home. Synchronized electrocardiogram (ECG) and photoplethysmography (PPG) signals were obtained from healthy non-diabetic (n = 37) and diabetic (n = 85) subjects without peripheral neuropathy, recruited from the diabetic outpatient clinic. The conventional parameters, including low-/high-frequency power ratio (LHR), small-scale multiscale entropy index (MEISS), large-scale multiscale entropy index (MEILS), electrocardiogram-based pulse wave velocity (PWVmean), and percussion entropy index (PEI), were computed as baseline and were then followed for six years after the initial PEI measurement. Three new diabetic subgroups with different PEI values were identified for the goodness-of-fit test and Cox proportional Hazards model for relative risks analysis. Finally, Cox regression analysis showed that the PEI value was significantly and independently associated with the risk of developing DPN after adjustment for some traditional risk factors for diabetes (relative risks = 4.77, 95% confidence interval = 1.87 to 6.31, p = 0.015). These findings suggest that the PEI is an important risk parameter for new-onset DPN as a result of a chronic complication of diabetes and, thus, a smaller PEI value can provide valid information that may help identify type 2 diabetic patients at a greater risk of future DPN.

Fasting serum glucose, thyroid-stimulating hormone, and thyroid hormones and risk of papillary thyroid cancer: A case-control study.

BACKGROUND: This study was to investigate the association of fasting serum glucose (FSG), thyroid-stimulating hormone (TSH), and thyroid hormones with papillary thyroid cancer (PTC). METHODS: A total of 649 participants were included in this case-control study. The associations of FSG, TSH, free triiodothyronine (FT3) and free thyroxine (FT4) with PTC were estimated using an unconditional logistic regression. RESULTS: Compared with the lowest quintile of TSH levels, odds ratios (ORs) and 95% confidence intervals (CIs) for association between PTC risk and highest quintile of TSH levels were 1.67 (95% CI, 0.99-2.83). However, this risk correlation was more significant in PTC cases with ≤1.0 cm tumor size (adjusted OR, 1.95; 95% CI, 1.08-3.54; adjusted P-trend, 0.05). The PTC risk was also inversely associated with the serum FT3 level in all participants (adjusted P-trend, 0.001), but positively associated with the serum FT4 (adjusted P-trend, 0.001) and FSG (adjusted P-trend, 0.01) levels. Among the participants without diabetes, the individuals with high FSG levels and abnormal TSH concentration had an increased PTC risk (adjusted OR, 3.38; 95% CI, 1.78-6.42). CONCLUSION: The current study provides evidence for the association of FSG, TSH, and thyroid hormones (FT3 and FT4) with PTC risk. However, larger relative studies are needed.

[Efficacy of modified radical operation of preserving nipple-areolar complex on early stage breast cancer].

BACKGROUND AND OBJECTIVE: Modified radical mastectomy of preserving nipple-areolar complex (NAC) is an important surgical therapy for stage I-IIa breast cancer, but the oncological risk is controversial. This study was to compare the efficacy of NAC-preserving modified radical operation and conventional modified radical operation on early stage breast cancer. METHODS: The patients who received NAC-preserving modified radical operation (42 patients) or conventional modified radical operation (84 patients) from January 1998 to December 2003 in the First Affiliated Hospital of Bengbu Medical College were matched with a ratio of 1:2 by age at diagnosis, axillary lymph node status, sexual hormone receptor status, tumor size and Her-2/neu expression for retrospective analysis. The loco-regional recurrence, distant metastasis, 5-year disease-free survival (DFS) and 5-year overall survival (OS) between the two groups were compared. RESULTS: Median follow-up time was 48 months in NAC-preserving operation group and 44 months in conventional operation group. The 5-year occurrence rate of loco-regional recurrence was 2.44% in NAC-preserving operation group and 3.21% in conventional operation group (P=0.771). The 5-year occurrence rate of distant metastasis was 5.64% in NAC-preserving operation group and 4.30% in conventional operation group (P=0.654). The 5-year OS rates were 96.00% in NAC-preserving operation group and 98.18% in conventional operation group (P=0.694). The 5-year DFS rates were 91.67% in NAC-preserving operation group and 92.26% in conventional operation group (P=0.597). CONCLUSION: Modified NAC-preserving radical operation results in the same effect on early stage breast cancer as conventional modified radical operation based on careful consideration of the indications, and results in better cosmetic appearance after restitution and better quality of life.

[A clinic study of cervical lymph node metastasis in well-differentiated thyroid carcinoma].

OBJECTIVE: To study the distribution of cervical lymph nodes metastasis and explore the surgical treating modality of cervical lymph nodes in the patients with differentiated thyroid carcinoma. METHODS: The clinic and pathological data of 104 patients with differentiated thyroid carcinoma who had undergone neck lymph nodes dissection from January 2003 to June 2007 were analyzed retrospectively. There were 29 male and 75 female patients. The age of the patients was 12 to 79 years old with a median of 39 years old. Patients were divided into clinic cervical lymph nodes metastasis (cN+) group and clinic no cervical lymph nodes metastasis (cN0) group according the condition of physical examination and image analysis preoperatively and compared respectively with pathological data postoperatively. RESULTS: In the cN+ group 91.3% (63/69) patients were pN+ while in the cN0 group 52.1% (25/48) patients were pN+. The distribution of metastasized lymph nodes: level VI 64.1%, level II 31.6%, level III 44.4%, level IV 40.2%, level V 12.0%, level I 3.2%. In the cN+ group 86.7% (54/63) patients with lymph nodes metastasis had multi-levels lymph nodes metastasis while in the cN0 group 64.0% (16/25) patients had single-level lymph nodes metastasis. CONCLUSIONS: Cervical lymph nodes metastasis in the patients with differentiated thyroid carcinoma mainly localize in level II, level III, level IV, level VI, especially level VI. Patients with lymph nodes metastasis had multi-levels lymph nodes metastasis in the cN+ group but single-level in the cN0 group. The surgical treating modality of cervical lymph nodes should also be different in the two group patients.

[Clinicopathologic analysis of the nipple-areolar complex occult involvement in early stage breast carcinoma].

OBJECTIVE: The aim of this study was to investigate the incidence of nipple-areola complex (NAG) involvement in stage I - II a breast cancer patients who underwent skin-sparing mastectomy and to determine the associated risk factors, to provide a theoretical basis for modified radical mastectomy preserving NAC and breast reconstruction in early stage breast cancer patients. METHODS: A total of 68 women with primary breast cancer were included in this study. The following associated risk factors of NAC involvement were assessed and compared with those of non-involvement: the distance from the tumor site to the edge of areola (D), axillary lymph node status, over-expression of HER-2/neu, location of tumor, TNM stage, abnormal nipple (nipple indentation, erosion, discharge), tumor size, age, histological type, as well as status of estrogen receptor (ER) and progesterone receptor (PR), by Chi-square test. RESULTS: The positive rate of NAG involvement was 13.2%. It decreased with an increase in the distance from the tumor site to the edge of the areola (D) (chi2 = 10.68, P <0.01)), and higher incidence of NAG involvement was found in patients with axillary lymph node metastasis (chi2 = 14. 61, P < 0.01) and over-expression of HER-2/neu (chi2 =6.83, P <0.01). Location of tumor (P <0.01), TNM stage (chi2 =3.85, P <0.05), abnormal nipple (chi2 = 11.65, P<0.01), and tumor size (chi2 =4.13, P <0.05) also had influence on the NAG involvement. No significant correlation between NAC involvement and age (P > 0.05)), histological type (chi2 = 0.07, P > 0.05)), as well as status of estrogen receptor (ER) (chi2 = 0.06, P > 0.05) and progesterone receptor (PR) (chi2 = 0.04, P > 0.05) was found. Most of the NAG involvement was caused by ductal infiltration. CONCLUSION: In the stage I - II a breast cancer patients, location of tumor, TNM stage, the distance from the tumor site to the edge of areola (D), abnormal nipple, over-expression of HER-2 and metastases in axillary lymph nodes are the primary influential factors of NAG involvement.

[Modified radical operation for early breast cancer for preserving nipple-areolar complex and breast reconstruction using transverse rectus abdominis myocutaneous (TRAM) flap].

BACKGROUND & OBJECTIVE: Modified radical mastectomy (MRM) operation has become an important surgical therapy for early stage breast cancer, but how to reconstruct breast and preserve nipple-areolar complex (NAC) is controversial. In this study, we applied a modified radical mastectomy for early stage breast cancer for preserving NAC and breast reconstruction using transverse rectus abdominis myocutaneous (TRAM) flap. METHODS: During operation we performed the subcutaneous glandular excision and axillary dissection, and reconstructed the breast using TRAM flap in 10 patients with early stage breast cancer; meanwhile, maximam extent of breast skin and NAC were preserved. RESULTS: The appearance of the reconstructed breast was better preserved after operation. No local recurrence and distant metastasis occurred in the patients during the follow up time (range 24-48 months). No skin flap necrosis, atrophy, and scleroses surround the NAC were observed; and no abdominal wall hernia occurred at the donor site. The nipple sensation was recovered half a year after surgery. CONCLUSION: Modified radical operation for preserving NAC and breast reconstruction using TRAM flap may be a better way for breast cancer patients in early stage who request well preserving of breast. More samples are needed for proving the effects of this operation.