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Journal of Orthopaedics Oct 2024Nutritional assessment is important for optimization of patients undergoing elective total joint arthroplasty (TJA). Preoperative nutritional intervention is a... (Review)
Review
BACKGROUND
Nutritional assessment is important for optimization of patients undergoing elective total joint arthroplasty (TJA). Preoperative nutritional intervention is a potentially modifiable optimization target, but the outcomes of such intervention are not well-studied. The purpose of this study is to assess the impact of nutritional interventions on elective TJA outcomes.
METHODS
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilized to perform a systematic review of the Ovid Medline, Embase, and Cochrane Library systems. Included studies were comprised of patients greater than 18 years of age undergoing a primary unilateral TJA who received a perioperative dietitian-led intervention. Data analyzed included nutritional intervention protocol, patient demographics, length of stay (LOS), postoperative labs and complications, among others.
RESULTS
Our initial search identified a total of 1766 articles. Four studies representing 5006 patients met inclusion criteria. The studies utilized a protein-dominant diet, with or without a carbohydrate solution accompanied by dietitian assessment or education. The 4 studies found that the intervention group had significantly decreased LOS, fewer albumin infusions, less wound drainage, lower rates of hypocalcemia and hypokalemia, reduced C-reactive protein (CRP) values, improved time out of bed, and decreased overall costs.
CONCLUSION
The findings support the potential benefits of perioperative dietitian-led intervention on key outcomes for patients undergoing primary TJA. Surgeons should consider nutritional intervention in their preoperative optimization protocols. Future studies could help elucidate the optimum nutritional regimens and monitoring for idealized intervention and surgical timing.
PROSPERO REGISTRATION NUMBER
CRD4202338494.
PubMed: 38737733
DOI: 10.1016/j.jor.2024.04.021 -
Nutrition, Metabolism, and... Jun 2024The impact of the loss-of-function (LOF) genetic variant PCSK9 R46L on glucose homeostasis and cardiovascular disease (CVD) remains uncertain, despite its established... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND AIM
The impact of the loss-of-function (LOF) genetic variant PCSK9 R46L on glucose homeostasis and cardiovascular disease (CVD) remains uncertain, despite its established correlation with diminished blood cholesterol levels. This meta-analysis aimed at exploring the effect of the PCSK9 R46L genetic variant on plasma insulin and glucose levels, risk of diabetes mellitus and CVD.
METHODS AND RESULTS
PubMed, Embase, and the Cochrane Library were searched for cohort and case-control studies published until October 1, 2023. The studies should report the association of the PCSK9 R46L genetic variant with one of the following: fasting plasma insulin, blood glucose levels, diabetes mellitus, and CVD risk. A dominant model of the PCSK9 R46L genetic variant was employed to statistical analysis. The meta-analyses were performed for continuous variables with standard mean difference (SMD), categorical variables with odds ratio (OR) using a random-effects model. A total of 17 articles with 20 studies engaging 1,186,861 population were identified and mobilized for these analyses. The overall results indicated that, compared with non-carriers of the PCSK9 R46L genetic variant, carriers of the PCSK9 R46L genetic variant did not increase or decrease the levels of fasting plasma insulin (3 studies with 7277 population; SMD, 0.08; 95% CI, -0.04 to 0.19; P = 0.270), and the levels of fasting plasma glucose (7 studies with 9331 population; SMD, 0.03; 95% CI, -0.08 to 0.13; P = 0.610). However, carriers of the PCSK9 R46L genetic variant indeed had 17% reduction in the risk of CVD (11 studies with 558,263 population; OR, 0.83; 95% CI, 0.71 to 0.98; P = 0.030), and 9% increase in the risk of diabetes mellitus (10 studies with 744,466 population; OR, 1.09; 95% CI, 1.04 to 1.14; P < 0.01). Meta-regression analyses indicated that the increased risk of diabetes mellitus and the reduced risk of CVD were positively correlated with reduction in LDL-C (P = 0.004 and 0.033, respectively).
CONCLUSIONS
PCSK9 R46L genetic variant exhibited an elevated susceptibility to diabetes mellitus alongside a reduced vulnerability to CVD.
Topics: Humans; Proprotein Convertase 9; Cardiovascular Diseases; Blood Glucose; Genetic Predisposition to Disease; Insulin; Risk Assessment; Biomarkers; Diabetes Mellitus; Female; Male; Middle Aged; Phenotype; Adult; Aged; Loss of Function Mutation; Risk Factors; Young Adult; Heart Disease Risk Factors
PubMed: 38734541
DOI: 10.1016/j.numecd.2024.04.007 -
The Laryngoscope May 2024Microbiome research has predominantly focused on the oral cavity and oropharynx's role in disease, while the upper airway, specifically the larynx and trachea, has been... (Review)
Review
INTRODUCTION
Microbiome research has predominantly focused on the oral cavity and oropharynx's role in disease, while the upper airway, specifically the larynx and trachea, has been relatively overlooked. Examining the microbial communities in these regions can shed light on how dysbiosis influences diseases and their management. This review evaluates laryngotracheal microbial compositions in both healthy and diseased patients.
METHODS
We conducted a systematic review in EMBASE, MEDLINE, and Cochrane Central databases, yielding 1383 studies in the initial search. Inclusion criteria involved participants aged over 18 years and the use of next-generation 16s ribosomal sequencing methods.
RESULTS
We included 10 studies-seven focused on larynx sequencing and four on trachea sequencing (one investigated both sites). In a healthy larynx, diverse species such as Streptococcus, Cloacibacterium, Prevotella, and Helicobacter were found. Benign laryngeal diseases exhibited reduced microbial diversity, mainly dominated by Streptococcus. Subglottic stenosis patients showed diminished diversity in both idiopathic and iatrogenic scars. Laryngeal squamous cell carcinoma displayed increased diversity, primarily featuring Fusobacterium. Among non-respiratory-compromised surgery patients, the tracheal microbiome was more diverse in diabetics and those later developing lower respiratory infections. Pneumonia patients exhibited an abundance of Prevotella and Streptococcus, linked to an increased 28-day survival rate, while Streptococcus and Haemophilus abundance correlated with successful extubation.
CONCLUSIONS
The laryngotracheal region hosts a unique microbial community influenced by both benign and malignant conditions. Many lesions remain unexplored, underscoring the need for future studies encompassing diverse laryngotracheal conditions. Clinical trials assessing microbiome modifications may unveil novel therapeutic avenues.
LEVEL OF EVIDENCE
NA Laryngoscope, 2024.
PubMed: 38727532
DOI: 10.1002/lary.31453 -
Gut Microbes 2024Interactions between diet and gastrointestinal microbiota influence health status and outcomes. Evaluating these relationships requires accurate quantification of...
Interactions between diet and gastrointestinal microbiota influence health status and outcomes. Evaluating these relationships requires accurate quantification of dietary variables relevant to microbial metabolism, however current dietary assessment methods focus on dietary components relevant to human digestion only. The aim of this study was to synthesize research on foods and nutrients that influence human gut microbiota and thereby identify knowledge gaps to inform dietary assessment advancements toward better understanding of diet-microbiota interactions. Thirty-eight systematic reviews and 106 primary studies reported on human diet-microbiota associations. Dietary factors altering colonic microbiota included dietary patterns, macronutrients, micronutrients, bioactive compounds, and food additives. Reported diet-microbiota associations were dominated by routinely analyzed nutrients, which are absorbed from the small intestine but analyzed for correlation to stool microbiota. Dietary derived microbiota-relevant nutrients are more challenging to quantify and underrepresented in included studies. This evidence synthesis highlights advancements needed, including opportunities for expansion of food composition databases to include microbiota-relevant data, particularly for human intervention studies. These advances in dietary assessment methodology will facilitate translation of microbiota-specific nutrition therapy to practice.
Topics: Humans; Diet; Gastrointestinal Microbiome; Gastrointestinal Tract; Nutrients
PubMed: 38725230
DOI: 10.1080/19490976.2024.2350785 -
Comprehensive Reviews in Food Science... May 2024Fermentation is a traditional method utilized for vegetable preservation, with microorganisms playing a crucial role in the process. Nowadays, traditional spontaneous...
Fermentation is a traditional method utilized for vegetable preservation, with microorganisms playing a crucial role in the process. Nowadays, traditional spontaneous fermentation methods are widely employed, which excessively depend on the microorganisms attached to the surface of raw materials, resulting in great difficulties in ideal control over the fermentation process. To achieve standardized production and improve product quality, it is essential to promote inoculated fermentation. In this way, starter cultures can dominate the fermentation processes successfully. Unfortunately, inoculated fermentation has not been thoroughly studied and applied. Therefore, this paper provides a systematic review of the potential upgrading strategy of vegetable fermentation technology. First, we disclose the microbial community structures and succession rules in some typical spontaneously fermented vegetables to comprehend the microbial fermentation processes well. Then, internal and external factors affecting microorganisms are explored to provide references for the selection of fermented materials and conditions. Besides, we widely summarize the potential starter candidates with various characteristics isolated from spontaneously fermented products. Subsequently, we exhibited the inoculated fermentation strategies with those isolations. To optimize the product quality, not only lactic acid bacteria that lead the fermentation, but also yeasts that contribute to aroma formation should be combined for inoculation. The inoculation order of the starter cultures also affects the microbial fermentation. It is equally important to choose a proper processing method to guarantee the activity and convenience of starter cultures. Only in this way can we achieve the transition from traditional spontaneous fermentation to modern inoculated fermentation.
Topics: Bacteria; Fermentation; Fermented Foods; Food Microbiology; Microbiota; Vegetables; Yeasts
PubMed: 38720585
DOI: 10.1111/1541-4337.13362 -
The Science of the Total Environment Jun 2024Water is a defining element for cities and their inhabitants. Throughout urban systems, water is either produced or received, used, and finally disposed of as... (Review)
Review
Water is a defining element for cities and their inhabitants. Throughout urban systems, water is either produced or received, used, and finally disposed of as wastewater. As Latin American urbanization accelerates, problems related to wastewater are increasing due to its inclusion as the main source of river pollution, as well as the high cost of infrastructure development and maintenance. The consequences of wastewater disposal are particularly relevant in areas frequently associated with urban expansion, like peripheries whose growth follows constant transitions between rural, peri-urban, and urban areas. Such consequences are often related to heterogeneity, lack of urban services and sanitation infrastructure, water pollution and health risks, as well as the development of informal compensatory systems. A systematic literature review was conducted to broaden research panorama and identify spatial, temporal, and thematic trends and challenges present in wastewater assessments of Latin American urban peripheries, this using the SALSA (search, appraisal, synthesis, and analysis) protocol in a search through international databases Scopus and Web of Science Scielo, in English, Spanish, French, and Portuguese. In these databases, 228 papers satisfied selection criteria and show a growing trend of publications about urban wastewater since 1988. Most case studies are from Brazil (58 %), Mexico (14 %), and Argentina (9 %). Their main approaches are quantitative research (82 %) in urban contexts (57 %). Most studies were found to be operationalized using environmental geochemistry methodologies, suggesting a dominance of technical, reductionist approaches. Integrated and mixed perspectives including actors and other societal elements are suggested as a central research challenge. Without an integrated view, it will be unfeasible to enhance decision-making processes and governance in the pursuit of sustainable water management.
PubMed: 38719034
DOI: 10.1016/j.scitotenv.2024.173019 -
Journal of Occupational Medicine and... May 2024Hip osteoarthritis (HOA) is a leading cause of disability increasing with age and is more prevalent in women and in various physically demanding occupations. This...
BACKGROUND
Hip osteoarthritis (HOA) is a leading cause of disability increasing with age and is more prevalent in women and in various physically demanding occupations. This systematic review identifies and summarises occupational exposures for women in physically demanding occupations and discusses sex differences and consequences.
METHODS
In this systematic review, we searched various electronic databases for reports published between date of database inception and October 2022. We included cohort studies and case-control studies that assessed the association between exposure to physically demanding occupations and the development of HOA. We then assessed the methodological quality of selected studies, extracted relative effects, compared the risk for women and men and meta-analytically reviewed the effects of physically demanding occupations. All steps were based on a study protocol published in PROSPERO (CRD42015016894).
RESULTS
We included six cohort studies and two case-control studies in this systematic review. These studies showed a considerably increased risk of developing HOA in both sexes. Women working in traditionally female-dominated occupations such as cleaning, sales, catering, childcare and hairdressing that are physically demanding, have a higher risk of developing HOA than men in similarly physically demanding occupations. Conversely, in traditionally male-dominated occupations with a high heterogeneity of work activities, such as agriculture, crafts, construction, as well as in low-skilled occupations, the risk was higher for men. One exception are health occupations, which are grouped together with a wide range of other technical occupations, making it difficult to draw conclusions.
CONCLUSIONS
Existing studies indicate an association between various occupations with a high physical workload and an increased risk of developing HOA. Occupational prevention and individual health promotion strategies should focus on reducing the effects of heavy physical workloads at work. The aforementioned as well as early detection should be specifically offered to women in female-dominated occupations and to people working in elementary occupations.
PubMed: 38711071
DOI: 10.1186/s12995-024-00415-8 -
Prenatal Diagnosis Jun 2024To determine the incremental yield of prenatal exome sequencing (PES) over standard testing in fetuses with an isolated congenital heart abnormality (CHA), CHA... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To determine the incremental yield of prenatal exome sequencing (PES) over standard testing in fetuses with an isolated congenital heart abnormality (CHA), CHA associated with extra-cardiac malformations (ECMs) and CHA dependent upon anatomical subclassification.
METHODS
A systematic review of the literature was performed using MEDLINE, EMBASE, Web of Science and grey literature January 2010-February 2023. Studies were selected if they included greater than 20 cases of prenatally diagnosed CHA when standard testing (QF-PCR/chromosome microarray/karyotype) was negative. Pooled incremental yield was determined. PROSPERO CRD 42022364747.
RESULTS
Overall, 21 studies, incorporating 1957 cases were included. The incremental yield of PES (causative pathogenic and likely pathogenic variants) over standard testing was 17.4% (95% CI, 13.5%-21.6%), 9.3% (95% CI, 6.6%-12.3%) and 35.9% (95% CI, 21.0%-52.3%) for all CHAs, isolated CHAs and CHAs associated with ECMs. The subgroup with the greatest yield was complex lesions/heterotaxy; 35.2% (95% CI 9.7%-65.3%). The most common syndrome was Kabuki syndrome (31/256, 12.1%) and most pathogenic variants occurred de novo and in autosomal dominant (monoallelic) disease causing genes (114/224, 50.9%).
CONCLUSION
The likelihood of a monogenic aetiology in fetuses with multi-system CHAs is high. Clinicians must consider the clinical utility of offering PES in selected isolated cardiac lesions.
Topics: Humans; Heart Defects, Congenital; Female; Pregnancy; Exome Sequencing; Prenatal Diagnosis
PubMed: 38708840
DOI: 10.1002/pd.6581 -
Clinical and Translational Science May 2024No systematic review of trial designs in patients with relapsing multiple sclerosis (RMS) was reported. This systematic review was conducted on the trial designs and... (Review)
Review
No systematic review of trial designs in patients with relapsing multiple sclerosis (RMS) was reported. This systematic review was conducted on the trial designs and primary end points (PEs) of phase II and III trials intended to modify the natural course of the disease in patients with RMS. The purpose of the study is to explore trends/topics and discussion points in clinical trial design and PE, comparing them to regulatory guidelines and expert recommendations. Three trial registration systems, ClinicalTrials.gov, the EU Clinical Trials Register, and the Japan Registry of Clinical Trials, were used and 60 trials were evaluated. The dominant clinical trial design was a randomized controlled parallel-arms trial and other details were as follows: in adult phase III confirmatory trials (n = 32), active-controlled double-blind trial (DBT) (53%) and active-controlled open-label assessor-masking trial (16%); in adult phase II dose-finding trials (n = 9), placebo- and active-controlled DBT (44%), placebo-controlled DBT (22%), and placebo-controlled add-on DBT (22%); and in pediatric phase III confirmatory trials (n = 8), active-controlled DBT (38%) and active-controlled open-label non-masking trial (25%). The most common PEs were as follows: in adult confirmatory trials, annual relapse rate (ARR) (56%) and no evidence of disease activity-3 (NEDA-3) (13%); in adult dose-finding trials, the cumulative number of T1 gadolinium-enhancing lesions (56%), combined unique active lesions (22%), and overall disability response score (22%); and in pediatric confirmatory trials, ARR (38%) and time to first relapse (25%). It was suggested that some parts of the regulatory guidelines and expert recommendations need to be revised.
Topics: Humans; Clinical Trials, Phase III as Topic; Clinical Trials, Phase II as Topic; Adult; Multiple Sclerosis, Relapsing-Remitting; Child; Research Design; Endpoint Determination; Randomized Controlled Trials as Topic
PubMed: 38708586
DOI: 10.1111/cts.13794 -
Water Environment Research : a Research... May 2024Microplastics (MPs) pollution has wreaked havoc on biodiversity and food safety globally. The false ingestion of MPs causes harmful effects on organisms, resulting in a... (Review)
Review
A systematic review on microplastic contamination in marine Crustacea and Mollusca of Asia: Current scenario, concentration, characterization, polymeric risk assessment, and future Prospectives.
Microplastics (MPs) pollution has wreaked havoc on biodiversity and food safety globally. The false ingestion of MPs causes harmful effects on organisms, resulting in a decline in biodiversity. The present review comprehended the current knowledge of MP contamination in Crustacea and Mollusca from 75 peer-reviewed articles published in Asia between 2015 and 2023. A total of 79 species (27 Crustacea and 52 Mollusca) have been recorded to be contaminated with MPs. Out of the total 27 species of Crustacea, Metopograpsus quadridentatus (327.56 MPs/individual) and Balanus albicostatus (0.42 MPs/individual) showed the highest and lowest contamination, respectively. Out of the total 52 species of Mollusca, Dolabella auricularia (2325 MPs/individual) and Crassostrea gigas and Mytilus edulis (0.2 MPs/individual) showed the highest and lowest contamination, respectively. In terms of country-wise MP contamination, China has the highest number of contaminated species in both phylums among Asia. Findings of pollution indices revealed a very high risk of MP contamination in all the countries. Fiber was reported predominantly in both groups. Blue and black-colored MPs having <500 μm and <500 μm-1 mm size were found dominantly in Crustacea and Mollusca, respectively. Polypropylene was recorded as the dominant plastic polymer in both Crustacea and Mollusca. In essence, this review has provided a comprehensive insight into MP concentration in Crustacea and Mollusca of Asia, highlighting variations among species and geographic locations. This understanding is crucial for tackling urgent environmental challenges, safeguarding human health, and promoting global sustainability initiatives amid the escalating issue of plastic pollution. PRACTITIONER POINTS: Microplastic pollution has created havoc on biodiversity and food safety. A total of 27 and 52 species of crustaceans and Mollusca have been recorded to be contaminated with MPs. Metopograpsus quadridentate and Dolabella auricularia have shown higher MPs contamination. Polypropylene was recorded as the dominant plastic polymer in both crustacean and Mollusca. Findings of pollution indices revealed a very high risk of MP contamination in all the countries.
Topics: Animals; Mollusca; Water Pollutants, Chemical; Risk Assessment; Asia; Microplastics; Crustacea; Environmental Monitoring
PubMed: 38708452
DOI: 10.1002/wer.11029