•Diagnosis of gestational diabetes (GDM) consists of clinical risk stratification followed by OGTT•Reports suggests that maternal serum YKL-40 levels may be associated with GDM•We show a pooled ...association between maternal serum YKL-40 at gestational age >12 weeks with GDM•Serum YKL-40 may have a role as a simple blood test investigation in GDM risk stratification
Current clinical risk stratification of gestational diabetes mellitus (GDM) is imprecise and definitive diagnosis requires administration of an oral glucose tolerance test (OGTT). A systematic review and meta-analysis study was conducted to determine the association between maternal serum YKL-40 and GDM, and its potential role in risk stratification and diagnosis.
A literature search in Pubmed, Embase and Web of Science was conducted to identify studies examining the association between maternal serum YKL-40 in the context of GDM. We included studies reporting serum YKL-40 levels in GDM participants compared to a referent healthy control group. Studies not reporting serum YKL-40 levels in both cases and controls, or which failed to report mean or median levels with a measure of variability were excluded. Weighted mean differences in serum YKL-40 levels comparing GDM cases to healthy controls were pooled using a random effects model.
Four observational studies met the inclusion criteria. Pooled analysis showed an association between serum YKL-40 levels at gestational age >12 weeks among GDM cases compared to controls (WMD=17.58 ng/mL, 95% CI: 3.63-31.53, p=0.014). This finding persisted across several sensitivity analyses. Only a single study investigated serum YKL-40 levels at gestational age <12 weeks and post-partum respectively, reporting null association.
Maternal serum YKL-40 levels measured after the first trimester (>12 weeks gestational age) may have a potential role in future risk stratification and diagnosis of GDM. Our findings are presented with an overall moderate confidence level, driven primarily by risk of bias in the body of evidence. Given the small number of studies, we did not formally assess for publication bias and cannot exclude this risk impacting our reported findings.
To date, diagnosis of Primary Ciliary Dyskinesia (PCD) remains difficult and challenging. We systematically evaluated the diagnostic performance of nasal Nitric Oxide (nNO) measurement for the ...detection of PCD, using either velum-closure (VC) or non-velum-closure (non-VC) techniques.
All major electronic databases were searched from inception until March 2015 using appropriate terms. The sensitivity and specificity of nNO measurement was calculated in PCD patients diagnosed by transmission electron microscopy, high speed video-microscopy or genetic testing. Summary receiver operating characteristic (HSROC) curves were drawn using the parameters of the fitted models.
Twelve studies provided data for 13 different populations, including nine case-control (n = 793) and four prospective cohorts (n = 392). The overall sensitivity of nNO measured by VC techniques was 0.95 (95 % CI 0.91-0.97), while specificity was 0.94 (95 % CI 0.88-0.97). The positive likelihood ratio (LR+) of the test was 15.8 (95 % CI 8.1-30.6), whereas the negative likelihood ratio (LR-) was 0.06 (95 % CI 0.04-0.09). For non-VC techniques, the overall sensitivity of nNO measurement was 0.93 (95 % CI 0.89-0.96) whereas specificity was 0.95 (95 % CI 0.82-0.99). The LR+ of the test was 18.5 (95 % CI 4.6-73.8) whereas the LR- was 0.07 (95 % CI 0.04-0.12).
Diagnostic accuracy of nNO measurement both with VC and non-VC maneuvers is high and can be effectively employed in the clinical setting to detect PCD even in young children, thus potentiating early diagnosis. Measurement of nNO merits to be part of a revised diagnostic algorithm with the most efficacious combination of tests to achieve PCD diagnosis.
Few studies have examined the potentially therapeutic effect of increasing the production of endogenous nitric oxide (NO) in Primary Ciliary Dyskinesia (PCD) and other chronic respiratory conditions. ...Nasal NO is low in PCD and has been found to correlate with compromised Ciliary Beat Frequency (CBF). In this study we assessed the effect of increasing l-Arginine, as the substrate of NO synthases, on CBF in biopsies of human respiratory ciliated epithelium.
A total of 28 suspect cases with chronic respiratory manifestations referred for PCD diagnostic testing and 8 healthy controls underwent nasal brushing. Obtained epithelial cells were divided between three culture medium 199 solutions, containing different levels of l-Arginine (0.33 mM as baseline, 1 mM and 10 Mm as increased levels). CBF measurements were obtained at 37 °C and 25 °C at 1, 3 and 24 h after sample acquisition.
Among a total of 36 recruited subjects, 8 had PCD confirmed (PCD n = 8), 20 had PCD excluded (non-PCD n = 20) and 8 were healthy controls (Healthy Controls = 8). Among PCD subjects, ciliary motility was characterized by rotational (n = 5) or dyskinetic (n = 3) beating. At 37 °C, compared to baseline, higher levels of l-Arginine resulted in up to 9% CBF increase at 1 h (p = 0.007), up to 9% CBF increase at 3 h (p < 0.001) and up to 12% CBF increase at 24 h (p = 0.002). Similar although smaller scale increases were recorded at 25 °C. The effect of l-Arginine was time dependent (interaction p = 0.002) and was similar in PCD patients, non-PCD chronic respiratory patients and healthy controls (interaction p = 0.800).
l-Arginine increases CBF and merits to be evaluated as a potential stimulator of mucociliary clearance in chronic respiratory conditions and congenital ciliary disorders with residual motility. Larger human studies are needed to confirm these findings.
Abstract Objectives Meta-analyses of biomarkers often present spurious significant results and large effects. We applied sensitivity analyses with the use of credibility ceilings to assess whether ...and how the results of meta-analyses of biomarkers and cancer risk would change. Study Design and Setting We evaluated 98 meta-analyses, 43 (44%) of which had nominally statistically significant results. We assumed that any single study cannot give more than a maximum certainty 100 − c % ( c , credibility ceiling) that the effect estimate odds ratio (OR) exceeds 1 (null) or 1.2. Results Nominal statistical significance was maintained for 21 (21%) meta-analyses, for c = 10% and OR >1, and these proportions changed to 7%, 3%, and 6% with ceilings of 20%, 30%, and 40%, respectively. For ceilings for OR >1.2, the respective proportions were 37%, 21%, 7%, and 3%. Seven meta-analyses on infectious agents retained statistical significance even with a high ceiling of c = 20% for OR >1.00. Meta-analyses without other hints of bias (large between-study heterogeneity, small-study effects, excess significance) were more likely to retain statistical significance than those that had such hints of bias. Conclusion Credibility ceilings may be helpful in meta-analyses of biomarkers to understand the robustness of the results to different levels of uncertainty.
Cyprus is a typical eastern Mediterranean country that suffers from local emissions, transported anthropogenic pollution, and dust storms all year round. Therefore, exposures to PM in ambient and ...residential micro-environments are of great public health concern. Our study collected indoor and outdoor PM
2.5
and PM
10
samples simultaneously in 22 houses in Nicosia, Cyprus, during warm seasons and cold seasons from February 2019 to May 2021. Samples were analyzed for mass and constituents’ concentrations. To determine indoor and outdoor sources of PM in residential environments, we used the EPA positive matrix factorization (PMF) model to conduct source apportionment analyses for both indoor and outdoor PM
2.5
and PM
10
particles. Generally, six types of residential-level PM sources were resolved: biomass burning, traffic, local or regional secondary sulfate pollution, Ca-rich particles, sea salt, and soil dust. In the source apportionment of PM
2.5
, the main contribution to outdoor levels (33.1%) was associated with sulfate-rich transported pollution. The predominant contribution to indoor levels (48.0%) was attributed to secondary sulfate pollution as a mixture of local- and regional-scale pollutants. Biomass burning and traffic sources constituted the main outdoor sources of indoor PM
2.5
, while the Ca-rich particles were identified to almost originate from indoors. By contrast, the largest fraction (29.3%) of the ambient PM
10
and a smaller proportion (10.2%) of indoor PM
10
were attributed to Ca-rich particles. Indoor PM
10
was associated mainly with outdoor sources, except for the soil dust which originated from indoor activities.
Objective
The safety of minimally invasive mitral valve surgery (MIMVS) in elderly patients is still debated. Our objective was to perform a systematic review and meta-analysis of studies comparing ...MIMVS with conventional sternotomy (CS) in elderly patients (≥65 years old).
Methods
We searched PubMed, EMBASE, Web of Science, clinicaltrials.gov, and Cochrane Central Register of Controlled Trials for trials and observational studies comparing MIMVS with CS in patients ≥65 years old presenting for mitral valve surgery. We performed a random-effects meta-analysis of all outcomes.
Results
The MIMVS group had lower odds of acute renal failure (odds ratio OR 0.27; 95% CI 0.10 to 0.78), prolonged intubation (>48 h; OR 0.47; 95% CI 0.31 to 0.70), less blood product transfusion (weighted mean difference WMD −0.82 units; 95% CI −1.29 to −0.34 units), shorter ICU length of stay (LOS; WMD −2.57 days; 95% CI −3.24 to −1.90 days) and hospital LOS (WMD −4.06 days; 95% CI −5.19 to −2.94 days). There were no significant differences in the odds of mortality, stroke, respiratory infection, reoperation for bleeding, and postoperative atrial fibrillation. MIMVS was associated with longer cross-clamp (WMD 11.8 min; 95% CI 3.5 to 20.1 min) and cardiopulmonary bypass times (WMD 23.0 min; 95% CI 10.4 to 35.6 min).
Conclusions
MIMVS in elderly patients is associated with lower postoperative complications, blood transfusion, shorter ICU, and hospital LOS, and longer cross-clamp and bypass times.
The aim of this systematic review and meta-analysis is to evaluate the effect of mindfulness-based interventions (MBIs) on post-surgical pain in patients undergoing a total hip replacement (THR) or ...total knee replacement (TKR).
We performed a systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A search of multiple databases, including PubMed and EMBASE, was performed for studies from database inception through March 2nd, 2022. Data were extracted, and pooled estimates of standardized mean differences in pain scores were calculated using a random effects model and inverse probability weighting.
Two randomized control trials were eligible for inclusion (299 patients). The average ages of participants in each study were similar at 65.5 and 64.8 years, and both studies were predominantly female at 72.4% and 61.9%. The mindfulness intervention ranged from an eight-week program to a 20-minute session. Both individual studies reported statistically significant reductions in postoperative pain for MBI groups. The pooled standardized mean difference in pain scores for the MBI groups compared to the control groups was -1.94 (-3.39; -0.48).
There exists preliminary evidence for the beneficial effect of MBIs on reducing the postoperative pain experience in this patient population. Given the significant consequences of postoperative pain and the necessity for non-opioid forms of analgesia, this topic represents a promising area of research that warrants future randomized control trials to better understand the role of MBIs for postoperative analgesia.
Abstract Objective To examine trends in and determinants of the number of authors in clinical studies. Study Design and Setting We analyzed determinants of the number of authors in 633 articles of ...randomized trials and 313 articles of nonrandomized studies included in large meta-analyses (seven and six topics, respectively). Analyses were adjusted for topic. We also evaluated 310 randomly sampled case reports that had an abstract and described a single case. Results After adjusting for topic and other determinants, for both randomized trials and nonrandomized studies, the number of authors increased by 0.8 per decade ( P < 0.001). Topic was a strong determinant of the number of authors; other independent factors included journal impact factor, multinational authorship, and (for randomized trials) article length and sample size. Trials from South Europe (+1.1 authors) and North America (+0.9) and nonrandomized studies from South Europe (+1.8) had more authors than studies from North Europe ( P < 0.001). For case reports, only geographic location and article length were significantly related with author numbers. Conclusion The number of authors in articles of randomized and nonrandomized studies has increased over time, even after adjusting for the topic, size, and visibility of a study. The academic coinage of authorship may be suffering from inflation.
Abstract Exposure to extreme temperatures can trigger a cascade of adverse cardiovascular and respiratory events. However, in Cyprus, a hotspot of climate change in the Eastern Mediterranean region, ...little is known about the temperature-related cardiorespiratory morbidity risks. We analyzed daily counts of hospital admissions for cardiovascular and respiratory diseases from four general hospitals in three districts in Cyprus from 2000 through 2019. For each district, we fitted time-series quasi-Poisson regression with distributed lag non-linear models to analyze the associations between daily mean temperature (lag 0–21 d) and hospital admissions for cardiorespiratory, cardiovascular, and respiratory diseases. A random-effects meta-analytical model was then applied to pool the district-specific estimates and obtain the national average associations. We analyzed 20 years of cause-specific hospitalization data with a total of 179 988 cardiovascular and respiratory events. The relationships between cardiorespiratory morbidity and temperature were overall U-shaped. During extreme temperature days, 15.85% (95% empirical CI eCI: 8.24, 22.40%) excess cardiovascular hospitalizations and 9.59% (95% eCI: −0.66, 18.69%) excess respiratory hospitalizations were attributable to extreme cold days (below the 2.5th percentile). Extreme hot days (above the 97.5th percentile) accounted for 0.17% (95% eCI: 0.03, 0.29%) excess cardiovascular hospitalizations and 0.23% (95% eCI: 0.07, 0.35%) excess respiratory hospitalizations. We found evidence of increased cardiovascular morbidity risk associated with extreme temperatures in Cyprus. Our study highlights the necessity to implement public health interventions and adaptive measures to mitigate the related temperature effects in an understudied region.
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