Translating HbA1c measurements into estimated average glucose values in pregnant women with diabetes

Aims/hypothesis This study aimed to examine the relationship between average glucose levels, assessed by continuous glucose monitoring (CGM), and HbA1c levels in pregnant women with diabetes to determine whether calculations of standard estimated average glucose (eAG) levels from HbA1c measurements are applicable to pregnant women with diabetes. Methods CGM data from 117 pregnant women (89 women with type 1 diabetes; 28 women with type 2 diabetes) were analysed. Average glucose levels were calculated from 5–7 day CGM profiles (mean 1275 glucose values per profile) and paired with a corresponding (±1 week) HbA1c measure. In total, 688 average glucose–HbA1c pairs were obtained across pregnancy (mean six pairs per participant). Average glucose level was used as the dependent variable in a regression model. Covariates were gestational week, study centre and HbA1c. Results There was a strong association between HbA1c and average glucose values in pregnancy (coefficient 0.67 [95% CI 0.57, 0.78]), i.e. a 1% (11 mmol/mol) difference in HbA1c corresponded to a 0.67 mmol/l difference in average glucose. The random effects model that included gestational week as a curvilinear (quadratic) covariate fitted best, allowing calculation of a pregnancy-specific eAG (PeAG). This showed that an HbA1c of 8.0% (64 mmol/mol) gave a PeAG of 7.4–7.7 mmol/l (depending on gestational week), compared with a standard eAG of 10.2 mmol/l. The PeAG associated with maintaining an HbA1c level of 6.0% (42 mmol/mol) during pregnancy was between 6.4 and 6.7 mmol/l, depending on gestational week. Conclusions/interpretation The HbA1c–average glucose relationship is altered by pregnancy. Routinely generated standard eAG values do not account for this difference between pregnant and non-pregnant individuals and, thus, should not be used during pregnancy. Instead, the PeAG values deduced in the current study are recommended for antenatal clinical care

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Red and near-infrared luminescent materials for biological imaging

Fluorescence imaging is a critical tool for visualizing cellular structures and complex biological processes; however, background autofluorescence from molecules and structures within the cell can severely reduce the signal-to-noise ratio (SNR) and imaging quality. Time-resolved imaging (TRI) and two-photon excited fluorescence (2PEF) microscopy are two techniques that can be used to remove background autofluorescence and improve SNR. Imaging probes with long lifetime emission are required to utilize TRI techniques. Purely organic materials with properties such as thermally activated delayed fluorescence (TADF) exhibit long lifetime photoluminescence. Additionally, to image living samples, luminescent imaging probes should ideally absorb and emit within the biological transparency window (650–1350 nm), but efficient TADF emission within this range is rare. Work described in this thesis uses materials exhibiting TADF or 2PEF to develop biological imaging probes with emission within the biological transparency window. These materials were synthesized as small molecules or polymerized with a semiconductor host and formed into polymer nanoparticles called polymer dots (Pdots) that retain the photophysical properties required for TRI or 2PEF microscopy. New deep-red/near-infrared (NIR) emissive TADF monomers were synthesized and the mechanism behind TADF was explored using density functional theory (DFT). Pdots with a cell-penetrating peptide mimic shell were demonstrated to efficiently enter multiple cell lines in under 30 minutes while retaining high cell viability. Proof-of-concept experiments for the use of these Pdots in TRI demonstrated that the TADF emission can be separated from background fluorescence. This work represents some of the first demonstrations of Pdots containing red to NIR emissive TADF polymers for cellular imaging. For materials exhibiting 2PEF, it was shown that the electron donor moieties effect on planarity directly correlates to the relative strength of 2PEF within a series. Additionally, in the closely related field of semiconductor polymers, reactive semifluorinated polymers were investigated for the efficient synthesis of a series of polymers based on p-type and n-type semiconductor motifs commonly found in organic light-emitting diodes (OLEDs), organic thin-film transistors (OTFTs), and organic photovoltaics (OPVs). Experiments demonstrating that semifluorinated polymers can provide a useful building block in the synthesis of organic electronic materials were conducted.Science, Faculty ofChemistry, Department ofGraduat

Aspectos epidemiológicos da Febre do Oeste do Nilo Epidemiological aspects of West Nile Fever

Desde sua introdução na América do Norte em 1999, mais de 27.500 casos humanos da infecção por West Nile virus (WNV) foram reportados nos Estados Unidos da América (EUA), resultando em mais de 1000 casos fatais. Recentemente, a disseminação do vírus para o hemisfério sul foi confirmada com a detecção de animais infectados pelo WNV em território sul-americano. A soropositividade para WNV em eqüídeos na Colômbia e Venezuela e o isolamento do vírus nestes animais na Argentina, reiteram a necessidade da manutenção do sistema de vigilância enzoótica para WNV em território brasileiro. Aspectos pertinentes à infecção, patogenia e epidemiologia do WNV são discutidos neste artigo.<br>Since the West Nile virus (WNV) was introduced in North America in 1999, more than 27,500 cases were reported among humans in the US, resulting in more than 1,000 casualties. Recently, the dissemination of the WNV to the Southern Hemisphere was confirmed through the detection of seropositive animals. Positively-infected horses for WNV in Colombia, Venezuela and viral isolation in Argentina uphold the need to maintain the enzootic surveillance system in the Brazilian territory. Aspects related to infection, diagnosis and epidemiology of WNV are discussed in this article