Retinol-binding protein 4 (RBP4) circulating levels and gestational diabetes mellitus: a systematic review and meta-analysis.

Background: Gestational diabetes mellitus (GDM) is a prevalent condition where diabetes is diagnosed during pregnancy, affecting both maternal and fetal outcomes. Retinol-binding protein 4 (RBP4) is a circulating adipokine which belongs to the lipocalin family and acts as a specific carrier protein that delivers retinol (vitamin A) from the liver to the peripheral tissues. Growing data indicate that circulating RBP4 levels may positively correlate with GDM. Thus, this systematic review and meta-analysis aimed to investigate the potential relationship between circulating RBP4 levels and GDM when measured at various stages of pregnancy. Methods: MEDLINE, CINAHL, EMCARE, EMBASE, Scopus, and Web of Science databases were searched to identify studies comparing pregnant women with and without GDM, whose circulating RBP4 levels were measured in at least one pregnancy trimester. Findings were reported using standardized mean difference (SMD) and random-effects models were used to account for variability among studies. Furthermore, the risk of bias was assessed using the RoBANS tool. Results: Out of the 34 studies identified, 32 were included in the meta-analysis (seven with circulating RBP4 levels measured in the first trimester, 19 at 24-28 weeks, and 14 at >28 weeks of pregnancy). RBP4 levels were statistically higher in the GDM group than in controls when measured during all these pregnancy stages, with the noted RBP4 SMD being 0.322 in the first trimester (95% CI: 0.126-0.517; p < 0.001; 946 GDM cases vs. 1701 non-GDM controls); 0.628 at 24-28 weeks of gestation (95% CI: 0.290-0.966; p < 0.001; 1776 GDM cases vs. 1942 controls); and 0.875 at >28 weeks of gestation (95% CI: 0.252-1.498; p = 0.006; 870 GDM cases vs. 1942 non-GDM controls). Significant study heterogeneity was noted for all three pregnancy timepoints. Conclusion: The present findings indicate consistently higher circulating RBP4 levels in GDM cases compared to non-GDM controls, suggesting the potential relevance of RBP4 as a biomarker for GDM. However, the documented substantial study heterogeneity, alongside imprecision in effect estimates, underscores the need for further research and standardization of measurement methods to elucidate whether RBP4 can be utilized in clinical practice as a potential GDM biomarker. Systematic review registration: PROSPERO (CRD42022340097: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022340097).

Inconsistency of decision-making, the Achilles heel of referees.

This study assessed whether decisions made by six qualified referees were consistent when watching the live 2016 televised Champions League Final. Referees were paired off into three separate rooms. Two referees watched the game with no supporters present. Two watched the game surrounded by Real Madrid supporters, and the remaining two watched the game surrounded by Athletic Madrid supporters. Referees were asked to decide whether each decision made by the on-field referee was either correct or incorrect. Results identified two types of refereeing inconsistency. The first type was a systematic tendency of the supporting crowds (both rooms) to influence the adjudicating referees to make fewer incorrect (disagree with the on-field referee) decisions (8 and 5) than referees in the "no supporters" room (19) (χ2 = 11.22 [df = 2], P = 0.004). The second type of inconsistency was the home advantage "bias", where the surrounding crowd influenced the adjudicating referees to favour their team, by disagreeing with the decision made by the on-field referee (χ2 = 6.0 [df = 2], P = 0.0498). One explanation for these inconsistencies is that referees adopt a coping strategy of "avoidance", i.e., when faced with difficult decisions, referees simply avoid making unpopular decisions by waving "play on".