An improved nomogram including elastography for the prediction of non-sentinel lymph node metastasis in breast cancer patients with 1 or 2 sentinel lymph node metastases.

Background: The rate of breast-conserving surgery is very low in China, compared with that in developed countries; most breast cancer patients receive mastectomy. It is great important to explore the possibility of omitting axillary lymph node dissection (ALND) in early-stage breast cancer patients with 1 or 2 positive sentinel lymph nodes (SLNs) in China. The aim of this study was to develop a nomogram based on elastography for the prediction of the risk of non-SLN (NSLN) metastasis in early-stage breast cancer patients with 1 or 2 positive SLNs. Methods: A total of 601 breast cancer patients were initially recruited. According to the inclusion and exclusion criteria, 118 early-stage breast cancer patients with 1 or 2 positive SLNs were finally enrolled and were assigned to the training cohort (n=82) and the validation cohort (n=36), respectively. In the training cohort, the independent predictors were screened by logistic regression analysis and then were used to conducted the nomogram for the prediction of NSLN metastasis in early-stage breast cancer patients with 1 or 2 positive SLNs. The calibration curves, concordance index (C-index), the area under the receiver operating characteristic (ROC) curve (AUC), and Decision curve analysis (DCA) were used to verified the performance of the nomogram. Results: The multivariable analysis showed that the enrolled patients with positive HER2 expression (OR=6.179, P=0.013), Ki67≥14% (OR=8.976, P=0.015), larger lesion size (OR=1.038, P=0.045), and higher Emean (OR=2.237, P=0.006) were observed to be the independent factors of NSLN metastasis. Based on the above four independent predictors, a nomogram was conducted to predict the risk of the NSLN metastasis in early-stage breast cancer patients with 1 or 2 positive SLNs. The nomogram showed good discrimination in the prediction of NSLN metastasis, with bias-corrected C-index of 0.855 (95% CI, 0.754-0.956) and 0.853 (95% CI, 0.724-0.983) in the training and validation cohorts, respectively. Furthermore, the AUC was 0.877 (95%CI: 0.776- 0.978) and 0.861 (95%CI: 0.732-0.991), respectively, indicating a good performance of the nomogram. The calibration curve suggested a satisfactory agreement between the predictive and actual risk in both the training (χ2 = 11.484, P=0.176, HL test) and validation (χ2 = 6.247, p = 0.620, HL test) cohorts, and the obvious clinical nets were revealed by DCA. Conclusions: We conducted a satisfactory nomogram model to evaluate the risk of NSLN metastasis in early-stage breast cancer patients with 1 or 2 SLN metastases. This model could be considered as an ancillary tool to help such patients to be selectively exempted from ALND.

Association Between Blood Heavy Metal Concentrations and Dyslipidemia in the Elderly.

Our objective was to evaluate the relationship of blood metal levels including strontium, cadmium, lead, vanadium, aluminum, cobalt, and manganese with dyslipidemia in the elderly Chinese population. In this study, stratified cluster sampling was adopted in the elderly in two communities of Lu'an City from June to September 2016, and 1013 participants were finally included. The inductively coupled plasma mass spectrometry (ICP-MS) was used to measure the metals' concentrations in whole blood. After multivariable adjustment, the odds ratios (95% confidence interval [CI]) of dyslipidemia associated with the highest quartile of metal concentrations were 1.32 (0.89 ~ 1.96), 1.28 (0.83 ~ 1.97), 1.86 (1.23 ~ 2.80), 0.80 (0.55 ~ 1.16), 0.76 (0.51 ~ 1.13), 0.76 (0.53 ~ 1.11), and 1.14 (0.78 ~ 1.67) for strontium, cadmium, lead, vanadium, aluminum, cobalt, and manganese, respectively, compared with the lowest quartile. After reducing the dimensionality of metal elements by principal component analysis, we found that the combined exposure of aluminum, cobalt, and vanadium was the protective factor of non-dyslipidemia, while the combined exposure of cadmium, strontium, and lead was the risk factor of dyslipidemia.

Dietary patterns, dietary intakes and the risk of type 2 diabetes: results from the Hefei Nutrition and Health Study.

A total of 1776 Chinese adults, aged 40-60 years, had been recruited to participate in the Hefei Nutrition and Health Study started in 2012. Three major dietary patterns were identified, "High-salt and high-fat", "Traditional Chinese" and "Western" dietary patterns. After adjusting for potential confounders, there is no significant difference in the effect of different dietary pattern quintiles on the risk of type 2 diabetes (T2D). However, compared with lowest quintile intakes, the adjusted odds ratio of T2D for highest quintile intakes of bread and noodle, rice noodle and coarse grain were 2.45 (95% CI: 1.17, 5.12), 0.34 (95% CI: 0.17, 0.92), 0.27 (95% CI: 0.14, 0.51), with corresponding p trend being .002, .375, .003, respectively. Our study suggests that high intakes of bread and noodle are significantly associated with increased risk of T2D, while high intakes of rice noodle and coarse grain are remarkably correlated with decreased risk of T2D.

The effect of Chinese famine exposure in early life on dietary patterns and chronic diseases of adults.

OBJECTIVE: To assess the effect of famine exposure during early life on dietary patterns, chronic diseases, and the interaction effect between famine exposure and dietary patterns on chronic diseases in adulthood. DESIGN: Cross-sectional study. Dietary patterns were derived by factor analysis. Multivariate quantile regression and log-binomial regression were used to evaluate the impact of famine exposure on dietary patterns, chronic diseases and the interaction effect between famine exposure and dietary patterns on chronic diseases, respectively. SETTING: Hefei, China. PARTICIPANTS: Adults aged 45-60 years (n 939). RESULTS: 'Healthy', 'high-fat and high-salt', 'Western' and 'traditional Chinese' dietary patterns were identified. Early-childhood and mid-childhood famine exposure were remarkably correlated with high intake of the traditional Chinese dietary pattern. Compared with the non-exposed group (prevalence ratio (PR); 95 % CI), early-childhood (3·13; 1·43, 6·84) and mid-childhood (2·37; 1·05, 5·36) exposed groups showed an increased PR for diabetes, and the early-childhood (2·07; 1·01, 4·25) exposed group showed an increased PR for hypercholesterolaemia. Additionally, relative to the combination of non-exposed group and low-dichotomous high-fat and high-salt dietary pattern, the combination of famine exposure in early life and high-dichotomous high-fat and high-salt dietary pattern in adulthood had higher PR for diabetes (4·95; 1·66, 9·05) and hypercholesterolaemia (3·71; 1·73, 7·60), and significant additive interactions were observed. CONCLUSIONS: Having suffered the Chinese famine in childhood might affect an individual's dietary habits and health status, and the joint effect between famine and harmful dietary pattern could have serious consequences on later-life health outcomes.

Association between serum amyloid A levels and cancers: a systematic review and meta-analysis.

OBJECTIVE: Increased serum amyloid A (SAA) levels have been investigated in various human malignancies, but a consistent perspective has not been established to date. This study systematically reviewed the association between SAA levels and cancers. METHODS: Cochrane Library, PubMed and Embase were carefully searched for available studies. The following keywords were used in database searches: 'serum amyloid A', 'SAA', 'cancer', 'tumour', 'carcinoma', 'nubble', 'knurl' and 'lump'. Pooled standard mean differences (SMDs) with corresponding 95% CIs were calculated using random-effects model analysis. RESULTS: Twenty studies, which contained 3682 cancer cases and 2424 healthy controls, were identified in this systematic review and meta-analysis. Our study suggested that the average SAA concentrations in the case groups were significantly higher than those in control groups (SMD 0.77, 95% CI 0.55 to 1.00, p<0.001). Subgroup analysis revealed that continent, age and cancer location were associated with SAA level differences between case groups and control groups. Sensitivity analyses showed the robustness and credibility of our results. In addition, we further stratified analyses for cancer stages and found that the concentrations of SAA increased gradually with the aggravation of cancer stages. CONCLUSION: High circulating SAA levels were markedly associated with the developing risks of cancer, especially for participants from Asia, Oceania and Europe, or subject age more than 50, or locations in oesophageal squamous cell, ovarian, breast, lung, renal and gastric cancers. In addition, our study found that the concentrations of SAA increased with the severity of cancer stages.