Background. Investigations regarding serum and plasma vascular endothelial growth factor (VEGF) levels in patients with diabetic retinopathy (DR) are conflicting. This meta-analysis is aimed at determining whether serum and plasma VEGF levels are associated with DR and its severity in diabetic patients. Methods. PubMed and EMBASE were used to search for published studies, and serum and plasma VEGF levels were compared among DR, nonproliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), and nondiabetic retinopathy (NDR) patients. Standardized mean differences (SMD) and 95% confidence interval (CI) were pooled using a random effects model. Results. A total of 29 studies comprising 1805 DR (or NPDR or PDR) patients and 1699 NDR patients were included. ELISA was used to evaluate serum or plasma VEGF levels in all except for two studies included in this meta-analysis. Overall, serum VEGF levels were significantly higher in DR patients (SMD: 0.74, 95% CI: 0.44-1.03) than those in NDR patients, while plasma VEGF levels were not in the comparison (SMD: 0.40, 95% CI: −0.13-0.92). Similarly, NPDR (SMD: 0.51, 95% CI: 0.22-0.80) and PDR (SMD: 1.32, 95% CI: 0.79-1.85) patients had higher serum VEGF levels compared with NDR patients, but the difference was not significant in plasma samples (SMD: 0.24, 95% CI: −0.47-0.95; SMD: 0.37, 95% CI: −0.30-1.05). In addition, serum VEGF levels were higher in PDR patients than those in NPDR patients (SMD: 0.87, 95% CI: 0.41-1.33), but plasma VEGF levels were not (SMD: −0.00, 95% CI: −0.31-0.31). The subgroup and metaregression analysis revealed that the study location, study design, and publication year of a study have certain influence on heterogeneity between studies in serum or plasma samples. Conclusions. VEGF levels in the serum instead of those in the plasma correlate to the presence and severity of DR in diabetic patients. Further large-scale studies are required to confirm these findings.

BackgroundChemerin is a novel adipokine which is associated with metabolic syndrome and type 2 diabetes mellitus. However, recent investigations regarding circulating chemerin levels in gestational diabetes mellitus (GDM) are conflicting. This meta-analysis is to evaluate and determine their associations.MethodsA systematic literature search was performed in PubMed, EMBASE and Web of Science up to 13 December 2017. Pooled standardized mean differences (SMD) and 95% confidence interval (CI) were calculated using a random-effect model.ResultsEleven studies comprising 742 GDM patients and 840 normal pregnant women were included. Circulating chemerin levels were increased in GDM patients compared with healthy pregnant women (SMD: 1.16; 95% CI: 0.29, 2.04; P = 0.009). Subgroup analyses revealed such difference was especially available in the groups of the second trimester (SMD: 1.47; 95% CI: 0.28, 2.67) and mean age < 30 years (SMD: 2.30; 95% CI: 0.69, 3.91) of GDM patients. There was significant heterogeneity among studies (I2 = 98.0%, P < 0.001); however, heterogeneity disappeared or markedly decreased in the subgroups of European populations (I2 = 0.0%, P = 0.531), age ≥ 30 years (I2 = 28.2%, P = 0.223) and WHO diagnostic criteria (I2 = 0.0%, P = 0.490) when stratifying by study location, trimester of chemerin measurement and the diagnostic criteria of GDM.ConclusionsThe elevated levels of circulating chemerin were associated with GDM, which suggests it might play an important role in the pathogenetic mechanism of GDM.

Aim To evaluate the association between mean platelet volume (MPV) and gestational diabetes mellitus (GDM). Methods A systematic literature search was performed in PubMed, EMBASE, Web of Science, and The Cochrane Library up to 4 September 2017. Pooled standardized mean differences (SMD) and 95% confidence interval (CI) were calculated using a random-effect model. Results Nineteen studies comprising 1361 GDM patients and 1911 normal pregnant women were included. MPV was increased in GDM patients when compared with healthy pregnant women (SMD: 0.79; 95% CI: 0.43–1.16; P < 0.001). Subgroup analyses revealed that such trend was consistent in the third-trimester (SMD: 1.35; 95% CI: 0.72–1.98), Turkish (SMD: 0.81; 95% CI: 0.43–1.19), and Italian (SMD: 2.78; 95% CI: 2.22–3.34) patients with GDM and the patients diagnosed based on Carpenter and Coustan criteria (SMD: 1.04; 95% CI: 0.42–1.65). Significantly higher MPV also were observed within cross-sectional studies (SMD: 0.99; 95% CI: 0.49–1.49). Remarkable between-study heterogeneity and potential publication bias were observed in this meta-analysis; however, sensitivity analysis indicated that the results were not unduly influenced by any single study. Conclusions GDM patients are accompanied by increased MPV, strengthening the clinical evidence that MPV may be a predictive marker for GDM.

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Objective. To compare the clinical value of serum microRNA21 (miR21) and other tumor markers in early diagnosis of non-small cell lung cancer (NSCLC). Methods. Serums carcinoembryonic antigen (CEA), cytokeratin 19 fragment (CYFRA21-1), neuron-specific enolase (NSE), and miR21 were detected in 50 NSCLC cases and 60 healthy control individuals. Results. Average serums miR21, CEA, NSE, and CYFRA21-1 levels were significantly higher in the case group than in control group (P < 0.01). Analysis of areas under the receiver operating characteristic (ROC) curve (AUC) revealed that CEA had the highest diagnostic efficiency for NSCLC. Serums miR21 and CYFRA21-1 levels were significantly lower at TNM stages I-II than stages III-IV (P < 0.05). Further, logistic multivariate regression analysis showed that the incidence of early NSCLC (TNM stages I-II) was correlated with serums CYFRA21-1 (OR = 1.076) and miR21 (OR = 2.473) levels (P < 0.05). By AUC analysis, miR21 had the highest diagnostic efficiency for early NSCLC, and single or combined detection of serums CYFRA21-1 and miR21 levels showed improved diagnostic efficiency for joint detection of both markers. Conclusions. Serum miR21 could serve as an important marker for auxiliary diagnosis of early NSCLC, while joint detection of serums miR21 and CYFRA21-1 levels could improve diagnostic efficiency.

BackgroundRetinol binding protein 4 (RBP4) is implicated in obesity, insulin resistance and type 2 diabetes mellitus that are closely associated with nonalcoholic fatty liver disease (NAFLD). However, recent investigations regarding circulating RBP4 levels in NAFLD are conflicting. This meta-analysis is to determine whether NAFLD, non-alcoholic steatohepatitis (NASH) and simple steatosis (SS) patients have altered RBP4 levels.MethodsWe performed a systematic search in PubMed, EMBASE and The Cochrane Library up until 18 March 2017, and 12 studies comprising a total of 4247 participants (2271 NAFLD patients and 1976 controls) were included in the meta-analysis.ResultsThere were no significant differences of circulating RBP4 levels in the following comparisons: (1) NAFLD patients vs controls (standardized mean differences [SMD]: 0.08; 95% CI: −0.21, 0.38); (2) NASH patients vs controls (SMD: −0.49; 95% CI: −1.09, 0.12); (3) SS patients vs controls (SMD: −0.72; 95% CI: −1.64, 0.20) and (4) NASH vs SS patients (SMD: −0.04; 95% CI: −0.32, 0.24). The results remained essentially unchanged in the comparisons between NAFLD patients and controls after excluding single individual study or bariatric studies (n = 2). No significant publication bias was detected. However, there was significant heterogeneity among studies and the subgroup and meta-regression analyses did not find the potential sources.ConclusionsCirculating RBP4 levels may not be associated with NAFLD. Further prospective cohort studies are required to confirm these findings.Electronic supplementary materialThe online version of this article (10.1186/s12944-017-0566-7) contains supplementary material, which is available to authorized users.

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Background: Investigations on the association of circulating fetuin-A with all-cause mortality risk in patients with chronic kidney disease (CKD) are conflicting. This meta-analysis aimed to provide a comprehensive estimation of the relationship between fetuin-A and all-cause mortality in CKD patients. Methods: A systematic literature search was performed in PubMed, EMBASE, and The Cochrane Library up until 12 December 2018. Hazard risk (HR) and 95% confidence interval (CI) were pooled using random-effect or fixed-effect model models. Results: A total of 13 studies comprising 5,169 CKD patients were included in the meta-analysis. In a comparison of individuals in the bottom third vs. the top third of baseline fetuin-A levels, the pooled multivariate-adjusted HR for the risk of all-cause mortality was 1.92 (95% CI 1.31–2.80), and the significant association was observed only in dialysis patients, but not non-dialysis patients. When fetuin-A was treated as continuous variables, per 0.1 g/L increase of fetuin-A levels was associated with a 8% lower mortality risk in dialysis patients (HR 0.92, 95% CI 0.87–0.97, p = 0.001), but per 0.01 g/L was not. Sensitivity analysis indicated the association was not adjusted by diabetes and inflammation. Conclusion: Lower fetuin-A levels are associated with an increased risk of all-cause mortality independent of diabetes and inflammation in dialysis patients, and there may be a dose-response relationship between them.