Low-Grade Inflammation in Gestational Diabetes Mellitus and Its Correlation with Maternal Insulin Resistance and Fetal Growth Indices

Kien Xuan Nguyen,1,&ast; Tien Bui Minh,2,&ast; Hoa Trung Dinh,3,4 Tien Viet Tran,5 Tuan Dinh Le,5,&ast; Nga Phi Thi Nguyen,6 Thi Thanh Hoa Tran,3 Trinh Hien Vu,3 Lan Ho Thi Nguyen,3 Kien Trung Nguyen,2 Nguyen Huy Thong,6 Khanh Do,6 Trung Kien Nguyen,7 Hung Nguyen Dao,8 Son Tien Nguyen6,&ast; 1Department of Military Medical Command and Organization, Vietnam Medical Military University, Ha Noi, Vietnam; 2Department of Obstetrics and Gynecology, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam; 3Department of Requested Treatment, National Hospital of Endocrinology, Ha Noi, Vietnam; 4National Hospital of Endocrinology, Ha Noi, Vietnam; 5Department of Infectious Diseases, Military Hospital 103, Vietnam Medical Military University, Hanoi, Vietnam; 6Department of Rheumatology and Endocrinology, Military Hospital 103, Vietnam Military Medical University, Ha Noi, Vietnam; 7Hematology and Blood Transfusion Center, Military Hospital 103, Vietnam Military Medical University, Ha Noi, Vietnam; 8Department of Obstetrics and Gynecology, Military Hospital 103, Vietnam Military Medical University, Ha Noi, Vietnam&ast;These authors contributed equally to this workCorrespondence: Son Tien Nguyen, Department of Rheumatology and Endocrinology, Military Hospital 103, Vietnam Military Medical University, 160 Phung Hung Street, Phuc La Ward, Ha Dong District, Hanoi City, Vietnam, Email [email protected]: Chronic low-grade inflammation (LGI) plays a role in the pathogenesis of gestational diabetes mellitus (GDM). LGI, on the one hand, promotes insulin resistance and at the same time, affects fetal development. The study aimed to use clinically feasible means to evaluate the association between maternal LGI and maternal insulin resistance and fetal growth indices by ultrasound in the third trimester.Methods: A crossectional and descriptive study on 248 first-time diagnosed GDM in Vietnam.Results: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte (PLR) indices were significantly higher in GDM than in normal glucose-tolerant pregnancies (p = 0.048 and 0.016, respectively). GDM with LGI witnessed significantly higher systolic blood pressure, BMI, HbA1c, and significantly lower quantitative Insulin Sensitivity Check Index (QUICKI) than those without LGI. After adjusting for maternal BMI, fasting plasma glucose (FPG), age, and parity, C-reactive protein (CRP) was positively correlated with HOMA2-IR (B=0.13, p< 0.01) and Mathews index (B=0.29, p< 0.01). Regarding fetal characteristics, LGI was associated with fetal growth indices in the third trimester of GDM. NLR was negatively correlated with estimated fetal weight (EFW) (B=− 64.4, p< 0.05) after adjusting for maternal BMI and FPG. After adjusting for maternal BMI, FPG, age, and parity, PLR was negatively correlated with biparietal diameter (B=− 0.02, p< 0.01) and abdominal circumference (AC) (B=− 0.16, p< 0.05), and EFW (B=− 1.1, p< 0.01), and head circumference (HC) (B=− 0.06, p< 0.01); CRP was negatively correlated with AC (B=− 0.16, p< 0.001), EFW (B=− 85.3, p< 0.001), and HC (B=− 5.0, p< 0.001).Conclusion: In the third trimester, LGI was associated with maternal glucose and insulin resistance in GDM. Moreover, LGI was associated with fetal characteristics in ultrasonic images. There were negative correlations between LGI and fetal developmental characteristics.Keywords: gestational diabetes mellitus, low-grade inflammation, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, fetal ultrasound parameter

A taxonomic review of Rhinolophus coelophyllus Peters 1867 and R. shameli Tate 1943 (Chiroptera: Rhinolophidae) in continental Southeast Asia

Recent field studies have provided new data for a review of the taxonomy, acoustic characters, distribution, and ecology of two often confused rhinolophid species, which have essentially parapatric distributions in continental Southeast Asia. Rhinolophus coelophyllus is widespread ranging from northern Myanmar to northern Malaysia, eastern Thailand and provisionally western Lao PDR. R. shameli is restricted to eastern Thailand, Cambodia, Lao PDR, and central and southern Vietnam. There are well defined differences in skull morphology, size, and echolocation call frequency, which discriminate between the two taxa

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

Background Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. Methods We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). Findings In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683–0·717]). Interpretation In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. Funding British Journal of Surgery Society