Health-related physical fitness in women with polycystic ovary syndrome versus controls: a systematic review and meta-analysis

INTRODUCTION

Polycystic ovary syndrome (PCOS) is a common endocrinopathy associated with cardiometabolic dysfunction.

PURPOSE

(1) To compare HRPF indices, including cardiorespiratory fitness (CRF), muscle strength, and muscle endurance, between women with and without PCOS (i.e., controls). (2) To explore the impact of moderating factors, i.e., insulin sensitivity, androgen levels, physical activity levels, and body mass index, on these indices.

METHODS

Articles comparing HRPF between PCOS and control groups were identified until February 27th, 2022. Random-effects meta-analyses were conducted and moderating factors were explored with subgroup and meta-regression analyses.

RESULTS

Twenty studies were included. Compared to controls, CRF was lower in women with PCOS (n = 15, - 0.70 [- 1.35, - 0.05], P = 0.03, I2 = 95%). Meta-regression analyses demonstrated that fasting insulin (P = 0.004) and homeostatic model assessment of insulin resistance (P = 0.006) were negatively associated with CRF, while sex-hormone binding globulin levels (P = 0.003) were positively associated. Absolute muscle strength was not different between PCOS and controls (n = 7, 0.17 [- 0.10, 0.45], P = 0.22, I2 = 37%). One study evaluated muscle endurance and reported lower core endurance in PCOS subjects compared to controls.

CONCLUSION

These data suggest that PCOS may be associated with impaired CRF. It remains unclear whether muscle strength and endurance differ between women with PCOS and controls. As this data set was limited by a small sample size, potential for bias, and inconsistent findings, additional studies accounting for the heterogeneous presentation of PCOS as well as improved matching between PCOS and controls for characteristics known to affect HRPF would help elucidate the impact of PCOS on indices of HRPF.

PROSPERO REGISTRATION NUMBER

CRD42020196380.

Improving patient waiting time of centralized front office service in a regional hub hospital using the discrete event simulation model

BACKGROUND

Today, hospital rankings are based not only on basic clinical indicators, but even on quality service indicators such as patient waiting times. Improving these indicators is a very important issue for hospital management, so finding a solution to achieve it in a simple and effective way is one of the greatest goals.

OBJECTIVES

The aim of this article is to evaluate the use of a discrete event simulation model to improve healthcare processes and reduce waiting time of patients and hospital costs.

METHODS

The case study proposed in this paper is the reorganization of non-clinical front office operation for the patients (i.e. booking of exams, delivering medical reports, etc.) of the Careggi University Hospital of Florence, to optimize the utilization of the human resources and to improve performances of the process.

RESULTS

The development and validation of the model was made according to an analysis of real processes and data, pre and post implementation of model outcomes. The new organization shows a decrease of waiting times from an average value of 10 minutes and 37 seconds to 5 minutes and 57 seconds (-44%).

CONCLUSIONS

This paper shows that discrete event simulation could be a precise, cost-limited tool to optimize hospital processes and performance.

Device-guided slow breathing reduces blood pressure and sympathetic activity in young normotensive individuals of both sexes

Slow breathing (SLOWB) is recommended for use as an adjuvant treatment for hypertension. However, the extent to which blood pressure (BP) responses to SLOWB differ between men and women are not well-established. Therefore, we tested the hypothesis that an acute bout of SLOWB would induce larger decreases in BP in males than in females, given that males typically have higher resting BP. We also examined autonomic contributors to reduced BP during SLOWB; that is, muscle sympathetic nerve activity and spontaneous cardiovagal (sequence method) and vascular sympathetic baroreflex sensitivity. We tested normotensive females ( n = 10, age: 22 ± 2 y, body mass index: 22 ± 2 kg/m2) and males ( n = 12, age: 23 ± 3 y, body mass index: 26 ± 4 kg/m2). Subjects were tested at baseline and during the last 5 min of a 15-min RESPeRATE-guided SLOWB session. Overall, SLOWB reduced systolic BP by 3.2 ± 0.8 mmHg (main effect, P < 0.01). Females had lower systolic BP (main effect, P = 0.02); we observed no interaction between sex and SLOWB. SLOWB also reduced muscle sympathetic nerve activity burst incidence by −5.0 ± 1.4 bursts/100 heartbeats (main effect, P < 0.01). Although females tended to have lower burst incidence (main effect, P = 0.1), there was no interaction between sex and SLOWB. Cardiovagal baroreflex sensitivity improved during SLOWB (21.0 vs. 36.0 ms/mmHg, P = 0.03) with no effect of sex. Despite lower overall BP in females, our data support a lack of basement effect on SLOWB-induced reductions in BP, as SLOWB was equally effective in reducing BP in males and females. Our findings support the efficacy of the RESPeRATE device for reducing BP in both sexes, even in young, normotensive individuals.

NEW & NOTEWORTHY We provide support for the effectiveness of device-guided slow breathing for blood pressure reduction in young normotensive women and men. Despite having lower baseline blood pressure and sympathetic nerve activity, women experienced equivalent reductions in both measures in response to RESPeRATE-guided slow breathing as men. Thus, slow breathing appears to be effective in young healthy normotensive individuals of both sexes and may be an ideal preventative therapy against future hypertension.

Optical Coherence Tomography Imaging of Surgical Resolution of Bilateral Vitreomacular Traction Syndrome Related to Incomplete Posterior Vitreoschisis: A Case Report

Purpose

To report a case of surgical resolution of bilateral vitreomacular traction syndrome related to incomplete posterior vitreoschisis as documented by optical coherence tomography (Stratus OCT, Carl Zeiss Meditec, Dublin, CA).

Case Report

In both eyes of a 72-year-old man with bilateral blurred vision, OCT examination disclosed a relevant increase in mean foveal thickness (right eye = 714 μm; left eye = 757 μm) due to a vitreomacular traction syndrome. At the edges of the most highly elevated area of vitreo-macular traction, OCT scans showed a characteristic splitting of the hyperreflective signal in both eyes, usually identified as posterior vitreous cortex. Both eyes underwent vitrectomy with epiretinal membrane peeling. Postoperative OCT examination showed vitreomacular traction resolution in both eyes with an evident decrease in mean foveal thickness (right eye = 364 μm; left eye = 335 μm). Right visual acuity improved from 20/200 to 20/50; left visual acuity changed from 20/150 to 20/40.

Conclusions

OCT was a useful tool in identifying an unusual case of bilateral vitreomacular traction syndrome linked to incomplete posterior vitreoschisis and following a favorable course after surgical management.

Optical Coherence Tomography and Fundus Microperimetry Imaging of Spontaneous Closure of Traumatic Macular Hole: A Case Report

PURPOSE

To report a case of spontaneous closure of traumatic macular hole in a young patient followed using optical coherence tomography (OCT) and fundus microperimetry.

METHODS/RESULTS

In the right eye of a 10-year-old child, a traumatic macular hole was observed to spontaneously resolve 18 weeks after blunt trauma. Initially, visual acuity in the right eye was 20/200 and OCT examination showed a 200 microm-diameter full-thickness macular hole with perifoveal edema. Fundus microperimetry examination showed an evident decrease in retinal sensitivity within the macular hole and in the upper macular region where an area of commotio retinae was clearly visible. During follow-up OCT demonstrated the appearance of a band of tissue linking the inferior edge of the hole to the foveal retinal pigment epithelium and at the bottom of the hole the presence of hyperreflective (glial) material. Eighteen weeks after trauma right eye visual acuity had improved to 20/25, OCT examination showed a restored foveal depression, and fundus microperimetry demonstrated an increase in foveal sensitivity.

CONCLUSIONS

Both OCT and fundus microperimetry were useful tools for following the favorable course in a case of spontaneous closure of traumatic macular hole in a young patient. During follow-up OCT examinations were able to demonstrate the course of macular hole closure.

Custom measurement of retinal nerve fiber layer thickness using STRATUS OCT in normal eyes

PURPOSE

To evaluate variability of retinal nerve fiber layer (RNFL) thickness measurements in normal eyes and their correlation with optic disc diameter by using two different scan options of the ultimate commercial optical coherence tomography (OCT) unit (STRATUS OCT, Carl Zeiss Meditec, Inc., Dublin, CA).

METHODS

In this observational case series and instrument validation study 30 eyes of 30 normal subjects were enrolled. Each eye underwent optic disc vertical diameter measurement by means of both stereoscopic photography and planimetry and OCT; RNFL thickness measurements were performed using OCT. Three repetitions of two series of scans were performed. Each eye was scanned at two different options (RNFL thickness 3.4 and Nerve Head Circle). For each option descriptive statistics, analysis of variance, intraclass correlation coefficients (ICCs), and coefficients of variation (COVs) were calculated. To verify the correlation between the two methods of optic disc diameter assessment and to study the influence of optic disc diameter on RNFL measurement using the two different OCT options, Pearson's correlation coefficients were calculated.

RESULTS

Optic disc diameter length ranged from 1.47 to 2.04 mm (mean 1.709 mm, SD +/- 0.147) with stereoscopic photographs, and from 1.47 to 2.02 mm (mean 1.703 mm, SD +/- 0.143) with OCT (Pearson correlation coefficient 0.999, p<0.001). Mean RNFL thickness was 89.29 mm (SD +/- 10.80 mm) using the RNFL thickness 3.4 scanning option and 89.88 mm (SD +/- 1.72 mm) using the Nerve Head Circle protocol (Pearson correlation coefficient 0.065, p=0.734). The intersubject variance is higher using the RNFL thickness 3.4 option than using the NHC protocol (sum of square: 1,014,760 vs. 25,741) (p<0.001); the intrasubject variance is very similar in the two groups (2,372 vs 2,360) (p=NS). The ICC is 99.89% when using the RNFL thickness 3.4 option, 95.62% with the NHC protocol (p=NS). COVs were 12.10% and 1.91% by using RNFL thickness 3.4 and Nerve Head Circle option, respectively. Pearson's correlation coefficient was 0.988 (p<0.001) when comparing optic disc diameter and RNFL thickness by using the RNFL thickness 3.4 option and -0.016 (p=0.932) when comparing optic disc diameter and RNFL thickness by using the Nerve Head Circle option.

CONCLUSIONS

These results suggest that both scan options give good RNFL thickness measurement reproducibility; the use of the Nerve Head Circle option leads to less interindividual variability and can minimize the effect of differences in optic disc diameter on RNFL thickness measurements in normal subjects.

Low level potentiation of the brain stem laryngeal reflex

Trains of electrical stimuli were applied to the superior laryngeal nerve (SLN) innervating the upper respiratory tract while evoked potentials were recorded from the recurrent nerve (RN) which innervates the intrinsic laryngeal muscles. Responses of this brain stem reflex (central delay 3.5-5.0 msec) were compared to the post-tetanic potentiation (PTP) of the polysynaptic ventral root response (L6-S1) with trains of stimuli applied to the dorsal root of adult cats. Stimulation of the SLN with a train of pulses varying from 10-45/sec evokes an initial depression of the polysynaptic potential from the RN followed by a low but sustained increase in the amplitude of the integrated signal (1.2-1.6x) lasting 45-130 msec and lacking the early maximum amplitude as seen in the PTP of the polysynaptic spinal reflex. Both the early and late components of the superior laryngeal-recurrent nerve reflex (SLN-RN) demonstrate potentiation whereas the shortest latency components of the spinal reflex account for most of the PTP. Systemic administration of strychnine sulfate (dosage: 0.03-0.45 mg/kg) does not alter the normalized PTP of the SLN-RN reflex despite enhancement of both early and late components of the reflex following control stimuli at 1/sec.