CGM use may be beneficial in insulin-treated GDM because it improves HbA compared with usual antenatal care without increasing severe hypoglycaemia. (Clinical Trials Registry No.: NCT02204657).

While adenosine exerts its predominant modulation of infarct size during reperfusion, the cardioprotection mediated by A1 receptor mechanisms is modest and exerted principally during the ischaemic time period.

Background: Obstetric airway guidelines recommend preoxygenation in preparation for general anaesthesia to achieve end-tidal oxygen concentrations (etO 2) of !90%, and mention the potential use of high-flow humidified nasal oxygen (HFNO). We investigated the new HFNO technique (Optiflow™) in term pregnant women. Methods: Seventy-three term participants underwent a 3 min HFNO protocol (30 L min À1 for 30 s, and then 50 L min À1 for 150 s). The etO 2 was assessed for the first four breaths after simulated preoxygenation. The primary outcome was the proportion who achieved etO 2 !90% for the first expired breath. The secondary outcomes were the proportion who achieved etO 2 !80%; fetal heart rate before and after the test; the association of body mass index (BMI) to etO 2 achieved with preoxygenation; and comfort levels of, and preference for, nasal and face mask preoxygenation. Results: The proportion with first expired breath etO 2 !90% was 60% [95% confidence interval (CI): 54e66%] and etO 2 !80% was 84% (95% CI: 80e88%). There was no change in fetal heart rate from before to after the test (P¼0.34). There was a negative association of BMI to etO 2 achieved with preoxygenation (Pearson correlation: e0.26; P¼0.027). There was no difference in comfort scores between nasal cannula and face mask (P¼0.40). Forty-one (56%; 95% CI: 35e47%) women preferred the nasal cannula to the face mask. Conclusions: HFNO using this protocol is inadequate to preoxygenate term pregnant women. Despite encouraging results in the literature reporting results in non-pregnant women, further work is required before justifying its use in pregnant women. Clinical trial registration: ACTRN 12616000531415p.

No abstract

Beta-thalassemia is the most-common genetic disorder of hemoglobin synthesis in Malaysia, and about 4.5% of the population are heterozygous carriers of the disorder. Prenatal diagnosis was performed for 96 couples using the Amplification Refractory Mutation System and Gap-Polymerase Chain Reaction. We identified 17 beta-globin defects-initiation codon for translation (T-G), -29 (A-G), -28 (A-G), CAP +1 (A-C), CD 8/9 (+G), CD 15 (G-A), CD 17 (A-T), CD 19 (A-G), Hb E (G-A), IVS1-1 (G-T), IVS1-5 (G-C), CD 41/42 (-CTTT), CD 71-72 (+A), IVS2-654 (CT), poly A(A-G), 100-kb Ggamma(Agammadeltabeta) degrees and 45-kb Filipino deletions. The 192 beta-alleles studied comprised Chinese (151 patients), Malay (21), Orang Asli from East Malaysia (15), Filipino (1), Indian (1), Indonesian Chinese (2), and Thai (1). In the Chinese, 2 beta-globin defects at CD 41/42 and IVS2-654 were responsible for 74% of beta-thalassemia. beta-mutations at CD 19, IVS1-1 (G-T), IVS1-5, poly A, and hemoglobin E caused 76% of the hemoglobin disorders in the Malays. The Filipino 45-kb deletion caused 73.3% of bthalassemia in the Orang Asli. Using genomic sequencing, the rare Chinese beta-mutation at CD 43 (G-T) was confirmed in 2 Chinese, and the Mediterranean mutation IVS1-1 (G-A) was observed in a Malay beta-thalassemia carrier. The beta-globin mutations confirmed in this prenatal diagnosis study were heterogenous and 65 (68%) couples showed a different globin defect from each other. The use of specific molecular protocols has allowed rapid and successful prenatal diagnosis of beta-thalassemia in Malaysia.

High hCG but not estradiol is associated with more severe HG.

Background: Though increasing evidence supports association between gaseous air pollution and stroke, it remains unclear whether the effects differ in season, sex and age. The aim of this study was to examine the associations of gaseous air pollution with stroke admissions in Beijing, 2013–2014 in different subgroups. Methods: Case-crossover design and conditional logistic regression were used to perform the analyses. We examined the exposure-response relationship between air pollution and stroke. Stratified analyses were performed in different seasons, sex, and age groups. Results: There were 147,624 stroke admissions during the study period. In the whole study period, percent changes of stroke admissions were 0.82% (95% CI: 0.52% to 1.13%) and 0.73% (95% CI: 0.44% to 1.03%) per 10 μg/m3 increase in the same day conentration of nitrogen dioxide (NO2) and sulfur dioxide (SO2). The positive associations were higher in warm seasons and with patients >65 years (p < 0.05). Contrary effects of carbon monoxide (CO) and ozone on stroke admissions were observed in different seasons. Conclusions: NO2 and SO2 were positively associated with stroke admissions, with stronger effects in warm seasons and with patients >65 years. The associations of CO and ozone with stroke admissions differed across seasons.

Failed airway management in the obstetric patient undergoing general anaesthesia is associated with major sequelae for the mother and/or fetus. Effective and adequate pre-oxygenation is an important safety strategy and a recommendation in all current major airway guidelines. Pre-oxygenation practice in the obstetric population may be suboptimal based on current literature. Recently, clinical applications for high flow nasal oxygen, also known as transnasal humidified rapid insufflation ventilatory exchange or THRIVE, are expanding in the non-obstetric population and may have theoretical benefits if used for pre-oxygenation and apnoeic oxygenation in the obstetric population. We review the current literature surrounding high flow nasal oxygen relevant to the pregnant woman. We also propose a basis for potential advantages and complications for its use in this context.