First Trimester Potential Biochemical Predictive Tests for Gestational Diabetes Mellitus: A Systematic Review

Objective: Gestational diabetes mellitus (GDM) is the most common metabolic complication during pregnancy. So, a large number of studies have evaluated the usefulness of different screening tests. The aim of this study was focused on the potential of only first-trimester screening used in the prediction of GDM. Materials and Methods: In this systematic review, we searched PubMed, EMBASE, and Scopus (between 2010 and 2020) and also searched the reference lists of the relevant articles manually. After performing a thorough evaluation of the 242 potentially eligible papers, only 60 papers were selected in terms of the inclusion criteria. Search key terms were combining ‘Gestational diabetes’ or ‘GD’ “gestational diabetes mellitus” or” GDM” or pregnancy-induced diabetes’ with at least one of the following terms: “screening test”, “first-trimester”, “prediction”, “marker predictor”, “serum marker”. Results: A total of 161954 pregnant women were evaluated in these reviewed studies. Moreover, many tests were assessed in the first trimester of pregnancy to predict GDM. This review showed that hs-CRP, FPG, TG, and LDL-C along with maternal BMI in the first trimester were related to the increased risk of developing GDM. Other tests were used in only one or two studies. Conclusion: This review showed that hs-CRP, FPG, TG, and LDL-C along with maternal BMI in the first trimester were linked to an increased risk of developing GDM. It is recommended that further well-designed studies by considering the cost-effective advantages of these predictive tests, should be performed.

An osteochondral bio-engineered model to in vitro mimicking osteoarthritis

To date, treatments of Osteoarthritis are not able to provide the pathology regression. In vitro models are therefore necessary to: i) investigate the mechanisms involved in the disease evolution, ii) identify pharmacological targets, and iii) perform predictive tests for new drug delivery strategies.

Minireview: Utilidad de las pruebas predictivas para parto pretérmino utilizadas en la práctica clínica

Preterm labor, defined as delivery before 37 weeks of gestation, is a serious obstetric condition that accounts for 11% of pregnancies worldwide. Predictive tests for preterm birth are important, given the personal, economic, and health impact of preterm birth. This review explores the utility of both, the current predictive tests used in clinical practice (maternal characteristics, cervical length and biochemical markers), as well as the new emerging tests. An electronic search was carried out in the scientific health databases: PUBMED, COCHRANE, SCIELO, national universities virtual repositories were also reviewed, using the following search items and their combinations: preterm delivery, cervical length, cervical shortening, cervicometry, fetal fibronectin, risk factors, and maternal characteristics. We included papers in English and Spanish published from 2006 to 2020, which responded to the aim of the review: the utility of predictive test for preterm delivery. A total of 30 articles were included in this review. There are multiple scientific criteria on the different current techniques to identify patients at risk and achieve adequate prevention of preterm birth. Measurement of cervical length by transvaginal ultrasound is the most cost-effective method in women with a history of preterm labor or symptoms of preterm labor; the current evidence allows us to affirm that it is also essential to perform routine cervicometry in all patients, even with low risk. There are promising ultrasound predictive methods such as cervical elastography and cervical consistency index, but there are limitations in their technical implementation, it is proposed that they could be a possible alternative in the future, that can be combined with cervical length measurement. Also, adding cervical length easurement to biochemical tests appears to improve predictive accuracy.

Ethical Implications of Alzheimer’s Disease Prediction in Asymptomatic Individuals Through Artificial Intelligence

Biomarker-based predictive tests for subjectively asymptomatic Alzheimer’s disease (AD) are utilized in research today. Novel applications of artificial intelligence (AI) promise to predict the onset of AD several years in advance without determining biomarker thresholds. Until now, little attention has been paid to the new ethical challenges that AI brings to the early diagnosis in asymptomatic individuals, beyond contributing to research purposes, when we still lack adequate treatment. The aim of this paper is to explore the ethical arguments put forward for AI aided AD prediction in subjectively asymptomatic individuals and their ethical implications. The ethical assessment is based on a systematic literature search. Thematic analysis was conducted inductively of 18 included publications. The ethical framework includes the principles of autonomy, beneficence, non-maleficence, and justice. Reasons for offering predictive tests to asymptomatic individuals are the right to know, a positive balance of the risk-benefit assessment, and the opportunity for future planning. Reasons against are the lack of disease modifying treatment, the accuracy and explicability of AI aided prediction, the right not to know, and threats to social rights. We conclude that there are serious ethical concerns in offering early diagnosis to asymptomatic individuals and the issues raised by the application of AI add to the already known issues. Nevertheless, pre-symptomatic testing should only be offered on request to avoid inflicted harm. We recommend developing training for physicians in communicating AI aided prediction.

Prevention in the age of personal responsibility: epigenetic risk-predictive screening for female cancers as a case study

Epigenetic markers could potentially be used for risk assessment in risk-stratified population-based cancer screening programmes. Whereas current screening programmes generally aim to detect existing cancer, epigenetic markers could be used to provide risk estimates for not-yet-existing cancers. Epigenetic risk-predictive tests may thus allow for new opportunities for risk assessment for developing cancer in the future. Since epigenetic changes are presumed to be modifiable, preventive measures, such as lifestyle modification, could be used to reduce the risk of cancer. Moreover, epigenetic markers might be used to monitor the response to risk-reducing interventions. In this article, we address ethical concerns related to personal responsibility raised by epigenetic risk-predictive tests in cancer population screening. Will individuals increasingly be held responsible for their health, that is, will they be held accountable for bad health outcomes? Will they be blamed or subject to moral sanctions? We will illustrate these ethical concerns by means of a Europe-wide research programme that develops an epigenetic risk-predictive test for female cancers. Subsequently, we investigate when we can hold someone responsible for her actions. We argue that the standard conception of personal responsibility does not provide an appropriate framework to address these concerns. A different, prospective account of responsibility meets part of our concerns, that is, concerns about inequality of opportunities, but does not meet all our concerns about personal responsibility. We argue that even if someone is responsible on grounds of a negative and/or prospective account of responsibility, there may be moral and practical reasons to abstain from moral sanctions.

Are there predictive tests that determine the difficulty in LMA insertion?

Objective: To determine the predictive tests for difficulty in laryngeal mask airway insertion, and to observe the success rate of insertion in the first attempt. Methods: The prospective, observational study was conducted at Bülent Ecevit University Hospital, Turkey, from September 2013 to 2014, and comprised patients of American Society of Anesthesiologists grade I to IV adult patients who underwent elective surgery under general anaesthesia. The supraglottic airway device was randomly selected for each patient, and the laryngeal mask airway was used as per the decision of an anaesthesiologist who was not part of the study. Patients were divided into three groups according to laryngeal mask airway types as classic group A, i-gel group B and suprema group C. These were inserted by anaesthesia residents with the same seniority when bispectral index value reached 40-60. Data was noted and analysed using SPSS 24. Results: Of the 120 patients, 40(33.33%) were in group A, 38(31.66%) in group B, and 42(35%) in group C. There was no significant difference among the groups in terms of demographics (p>0.05). Apart from the height/thyromental distance ratio (p=0.046), no predictive test was statistically significant in identifying the difficulty in laryngeal mask airway insertion (p>0.05). There was no significant difference involving number of attempts, difficulty in insertion, and patient response (p>0.05). Placement success rate at first attempt was similar among the groups (p>0.05). Conclusion: Higher height/thyromental distance ratio values were associated with difficulty in laryngeal mask airway insertion, Continuous...