Characteristics of glucose change in diabetes mellitus generalized through continuous wavelet transform processing:A preliminary study

BACKGROUND The continuous glucose monitoring(CGM)system has become a popular evaluation tool for glucose fluctuation,providing a detailed description of glucose change patterns.We hypothesized that glucose fluctuations may contain specific information on differences in glucose change between type 1 diabetes mellitus(T1DM)and type 2 diabetes mellitus(T2DM),despite similarities in change patterns,because of different etiologies.Unlike Fourier transform,continuous wavelet transform(CWT)is able to simultaneously analyze the time and frequency domains of oscillating data.AIM To investigate whether CWT can detect glucose fluctuations in T1DM.METHODS The 60-d and 296-d glucose fluctuation data of patients with T1DM(n=5)and T2DM(n=25)were evaluated respectively.Glucose data obtained every 15 min for 356 d were analyzed.Data were assessed by CWT with Morlet form(n=7)as the mother wavelet.This methodology was employed to search for limited frequency glucose fluctuation in the daily glucose change.The frequency and enclosed area(0.02625 scalogram value)of 18 emerged signals were compared.The specificity for T1DM was evaluated through multiple regression analysis using items that demonstrated significant differences between them as explanatory variables.RESULTS The high frequency at midnight(median:75 Hz,cycle time:19 min)and middle frequency at noon(median:45.5 Hz,cycle time:32 min)were higher in T1DM vs T2DM(median:73 and 44 Hz;P=0.006 and 0.005,respectively).The area of the>100 Hz zone at midnight to forenoon was more frequent and larger in T1DM vs T2DM.In a day,the lower frequency zone(15-35 Hz)was more frequent and the area was larger in T2DM than in T1DM.The threedimensional scatter diagrams,which consist of the time of day,frequency,and area of each signal after CWT,revealed that high frequency signals belonging to T1DM at midnight had a loose distribution of wave cycles that were 17-24 min.Multivariate analysis revealed that the high frequency signal at midnight could characterize T1DM(odds ratio:1.33,95%confidence interval:1.08-1.62;P=0.006).CONCLUSION CWT might be a novel tool for differentiate glucose fluctuation of each type of diabetes mellitus using CGM data.

Predictive factors for body weight loss and its impact on quality of life following gastrectomy

AIM To determine the predictive factors and impact of body weight loss on postgastrectomy quality of life(QOL). METHODS We applied the newly developed integrated questionnaire postgastrectomy syndrome assessment scale-45, which consists of 45 items including those from the Short Form-8 and Gastrointestinal Symptom Rating Scale instruments, in addition to 22 newly selected items. Between July 2009 and December 2010, completed questionnaires were received from 2520 patients with curative resection at 1 year or more after having undergone one of six types of gastrectomy for Stage Ⅰ gastric cancer at one of 52 participating institutions. Of those, we analyzed 1777 eligible questionnaires from patients who underwent total gastrectomy with Roux-en-Y procedure(TGRY) or distal gastrectomy with Billroth-I(DGBI) or Roux-en-Y(DGRY) procedures. RESULTS A total of 393, 475 and 909 patients underwent TGRY, DGRY, and DGBI, respectively. The mean age of patients was 62.1 ± 9.2 years. The mean time interval between surgery and retrieval of the questionnaires was 37.0 ± 26.8 mo. On multiple regression analysis, higher preoperative body mass index, total gastrectomy, and female sex, in that order, were independent predictors of greater body weight loss after gastrectomy. There was a significant difference in the degree of weight loss(P < 0.001) among groups stratified according to preoperative body mass index(< 18.5, 18.5-25 and > 25 kg/m2). Multiple linear regression analysis identified lower postoperative body mass index, rather than greater body weight loss postoperatively, as a certain factor for worse QOL(P < 0.0001) after gastrectomy, but the influence of both such factors on QOL was relatively small(R2, 0.028-0.080).CONCLUSION While it is certainly important to maintain adequate body weight after gastrectomy, the impact of body weight loss on QOL is unexpectedly small.

Left testicular artery arching over the ipsilateral renal vein

Aim： To report two cases of the left testicular artery arching over the left renal vein （LRV） before running downward to the testis. Methods： The subjects were obtained from two Japanese cadavers. During the student course of gross-anatomical dissection, the anatomical relationship between the testicular vessels and the renal vein was specifically observed. Results： The arching left testicular artery arose from the aorta below the LRV and made a loop around the LRV, which appeared to be mildly compressed between the arching artery and the psoas major muscle. Conclusion： Clinically, compression of the LRV between the abdominal aorta and the superior mesenteric artery occasionally induces LRV hypertension, resulting in varicocele, orthostatic protenuria and hematuria. Considering that the incidence of a left arching testicular artery is higher than that of a right one, an arching left artery could be an additional cause of LRV hypertension. （Asian J Androl 2006 Jan; 8： 107-110）

A new diagnostic feasibility for cardiomyopathy utilizing acoustic microscopy

Aims: Dilated cardiomyopathy often shows left ventricular systolic dysfunction, although histologically it always exhibits non-specific abnormality. We hypothesized that myocyte sound speed might be altered due to incomplete protein accumulation in cells. Methods and Results: Ninety eight biopsied samples were obtained from 49 patients comprising 43 with clinical dilated cardiomyopathy and 6 with hypertrophic cardiomyopathy. Sound speed was evaluated in deparaffinized 10 μm thick sections using an acoustic microscope (frequency range: 50 - 105 MHz). Conventional histology revealed 7 cases of persistent myocarditis derived from clinical dilated cardio- myopathy samples. Histology of the remaining dilated cardiomyopathy patients indicated non-specific abnormality. All hypertrophic cardiomyopathy cases exhibited myocardial disarray. Ten normal autopsied hearts were compared as controls. The sound speed of controls was 1627 ± 30m/sec. The sound speed in dilated cardiomyopathy samples (1700 ±51m/sec) was 1.045-fold faster compared to controls. The sound speed in hypertrophic cardiomyopathy samples (1734 ±51m/sec, 1.066-fold compared to controls) was faster than that of the myocarditis group (1672 ±30m/sec, 1.028-fold) (P = 0.0218). Furtheremore, desmin expression was evaluated as extent of emergence (grading 0 - 4). The desmin expression score in hypertrophic cardiomyopathy samples (2.7 ± 0.8) was significantly higher than in other groups (dilated 2.0 ± 1.4, myocarditis 1.6 ± 1.5 vs., controls 0, P ≤ 0.0001, 0.0001, 0.0129, respectively). Conclusion: Cardio-myopathy enhanced the sound speed, which correlated with the elasticity of myocytes, following the impaired compliance of left ventricle, despite the absence of histological changes. The elevation of sound speed of myocytes may be linked to cytoskeletal changes. Myocyte sound speed may be a new diagnostic tool for diagnosis of idiopathic cardiomyopathy independently of conventional histological diagnosis.

Echo-guided pin-point compression can effectively repair pseudoaneurysms associated with catheter procedure

Background: Catheter intervention is occasionally complicated by a pseudoaneurysm at the puncture site. Although the feasibility of echo-guided repair of a pseudoaneurysm has been reported, this method does not always repair the pseudoaneurysm. We hypothesized that if the communication to the artery could be effectively closed by pin-point compression, the clot that forms in the residual lumen would effectively cover the communication. We studied the safety and efficacy of the echo-guided pinpoint compression procedure for repairing a pseudoaneurysm. Methods: Ten consecutive patients with a pseudoaneurysm were enrolled. We determined the site of communication by echography with a high-frequency linear probe. We performed pin-point compression on the communication point with the right index finger, and we confirmed closure of the communication by color Doppler. During compression, we monitored echo images to confirm clot formation. Results: A pseudoaneurysm was located on the femoral artery in 6 patients and on the brachial artery in 4 patients. The sizes of the pseudoaneurysms ranged from 13 to 40 mm in diameter. We successfully closed the communication with one-finger compression in all patients. During the compression, we observed clot formation in the residual lumen of the pseudoaneurysm in all patients by echography. The duration of compression ranged from 5 to 40 minutes (mean, 18 minutes). We succeeded in repairing the pseudoaneurysm in all patients using this method. The success of the procedure was also confirmed 24 hours later in all patients. Conclusions: Echo-guided pin-point compression of the communication might be an effective technique for repairing a pseudoaneurysm at the puncture site, and echography is useful for confirming the success of the procedure.