Maternal Outcomes Among Pregnant Women With Congenital Heart Disease-Associated Pulmonary Hypertension.

BACKGROUND: Studies focused on pregnant women with congenital heart disease (CHD)-associated pulmonary hypertension (PH) are scarce and limited by small sample sizes and single-center design. This study sought to describe the pregnancy outcomes in women with CHD with and without PH. METHODS: Outcomes for pregnant women with CHD were evaluated retrospectively from 1993 to 2016 and prospectively from 2017 to 2019 from 7 tertiary hospitals. PH was diagnosed on the basis of echocardiogram or catheterization. The incidence of maternal death, cardiac complications, and obstetric and offspring complications was compared for women with CHD and no PH, mild, and moderate-to-severe PH. RESULTS: A total of 2220 pregnant women with CHD had completed pregnancies. PH associated with CHD was identified in 729 women, including 398 with mild PH (right ventricle to right atrium gradient 30-50 mm Hg) and 331 with moderate-to-severe PH (right ventricle to right atrium gradient >50 mm Hg). Maternal mortality occurred in 1 (0.1%), 0, and 19 (5.7%) women with CHD and no, mild, or moderate-to-severe PH, respectively. Of the 729 patients with PH, 619 (85%) had CHD-associated pulmonary arterial hypertension, and 110 (15%) had other forms of PH. Overall, patients with mild PH had better maternal outcomes than those with moderate-to-severe PH, including the incidence of maternal mortality or heart failure (7.8% versus 39.6%; P<0.001), other cardiac complications (9.0% versus 32.3%; P<0.001), and obstetric complications (5.3% versus 15.7%; P<0.001). Brain natriuretic peptide >100 ng/L (odds ratio, 1.9 [95% CI, 1.0-3.4], P=0.04) and New York Heart Association class III to IV (odds ratio, 2.9 [95% CI, 1.6-5.3], P<0.001) were independently associated with adverse maternal cardiac events in pregnancy with PH, whereas follow-up with a multidisciplinary team (odds ratio, 0.4 [95% CI, 0.2-0.6], P<0.001) and strict antenatal supervision (odds ratio, 0.5 [95% CI, 0.3-0.7], P=0.001) were protective. CONCLUSIONS: Women with CHD-associated mild PH appear to have better outcomes compared with women with CHD-associated moderate-to-severe PH, and with event rates similar for most outcomes with women with CHD and no PH. Multimodality risk assessment, including PH severity, brain natriuretic peptide level, and New York Heart Association class, may be useful in risk stratification in pregnancy with PH. Follow-up with a multidisciplinary team and strict antenatal supervision during pregnancy may also help to mitigate the risk of adverse maternal cardiac events.

CircRHBDD1 promotes immune escape via IGF2BP2/PD-L1 signaling and acts as a nanotherapeutic target in gastric cancer.

BACKGROUND: Circular RNAs (circRNAs) have been implicated in the development and progression of gastric cancer (GC). However, it remains unclear whether dysregulated circRNA affects immune escape and the efficacy of immunotherapy in GC. Our aim is to investigate the molecular mechanism of circRNA affecting GC immunotherapy and identify effective molecular therapeutic targets. METHODS: The differential expression profile of circRNAs was established through circRNA sequencing, comparing three paired GC tissues with their adjacent non-cancerous gastric tissues. The expression level of circRHBDD1 in GC tissues was then assessed using quantitative reverse transcription polymerase chain reaction (qRT-PCR). The biological characteristics of circRHBDD1 were verified through a series of experiments, including agarose gel electrophoresis assays, RNase R treatment, and actinomycin D experiments. The prognostic value of circRHBDD1 in GC was evaluated by conducting both univariate and multivariate survival analyses. Furthermore, loss- and gain-of-function approaches were utilized to investigate the impact of circRHBDD1 on GC immune escape. RNA-sequencing, immunoprecipitation, flow cytometry, and methylated RNA immunoprecipitation (meRIP) analysis were performed to elucidate the underlying molecular mechanisms. RESULTS: We discovered that circRHBDD1 exhibited remarkably high expression levels in GC tissues and cell lines. Notably, the high expression of circRHBDD1 was significantly correlated with poor overall survival and disease-free survival among GC patients. Both in vitro and in vivo experiments revealed that circRHBDD1 upregulated the expression of PD-L1 and impeded the infiltration of CD8+ T cells. Further, we found that circRHBDD1 binds to IGF2BP2, disrupting the interaction between E3 ligase TRIM25 and IGF2BP2, and ultimately inhibiting IGF2BP2 ubiquitination and degradation. Intriguingly, IGF2BP2 enhances PD-L1 mRNA stability through m6A modification. Additionally, we developed Poly (lactide-co-glycolic acid) (PLGA)-Polyethylene glycol (PEG)-based nanoparticles loaded with circRHBDD1 siRNA. In vivo experiments validated that the combination of PLGA-PEG(si-circRHBDD1) and anti-PD-1 offers a safe and efficacious nano-drug regimen for cancer immunotherapy. CONCLUSION: Our results demonstrated that circRHBDD1 promoted GC immune escape by upregulating the expression of PD-L1 and reprogramming T cell-mediated immune response. Inhibition of circRHBDD1 expression could potentially enhance the response of GC patients to immunotherapy, thus improving treatment outcomes. Additionally, the development of a nanodrug delivery system provides a feasible approach for future clinical applications.

Integrated transcriptomics and epigenomics reveal chamber-specific and species-specific characteristics of human and mouse hearts.

DNA methylation, chromatin accessibility, and gene expression represent different levels information in biological process, but a comprehensive multiomics analysis of the mammalian heart is lacking. Here, we applied nucleosome occupancy and methylome sequencing, which detected DNA methylation and chromatin accessibility simultaneously, as well as RNA-seq, for multiomics analysis of the 4 chambers of adult and fetal human hearts, and adult mouse hearts. Our results showed conserved region-specific patterns in the mammalian heart at transcriptome and DNA methylation level. Adult and fetal human hearts showed distinct features in DNA methylome, chromatin accessibility, and transcriptome. Novel long noncoding RNAs were identified in the human heart, and the gene expression profiles of major cardiovascular diseases associated genes were displayed. Furthermore, cross-species comparisons revealed human-specific and mouse-specific differentially expressed genes between the atria and ventricles. We also reported the relationship among multiomics and found there was a bell-shaped relationship between gene-body methylation and expression in the human heart. In general, our study provided comprehensive spatiotemporal and evolutionary insights into the regulation of gene expression in the heart.

Constructing a Titanium Silicon Molecular Sieve-Based Z-Scheme Heterojunction with Enhanced Photocatalytic Activity.

Titanium silicon molecular sieve (TS-1) is an oxidation catalyst that possesses a long lifetime of charge transfer excited state, high Ti utilization efficiency, large specific surface area, and good adsorption property; therefore, TS-1 acts as a Ti-based photocatalyst candidate. In this work, TS-1 coupled Bi2MoO6 (TS-1/BMO) photocatalysts were fabricated via a facile hydrothermal route. Interestingly, the optimized TS-1/BMO-1.0 catalyst exhibited a decent photodegradation property toward tetracycline hydrochloride (85.49% in 120 min) under the irradiation of full spectrum light, which were 4.38 and 1.76 times compared to TS-1 and BMO, respectively. The enhanced photodegradation property of the TS-1/BMO-1.0 catalyst could be attributed to the reinforced light-harvesting capacity of the photocatalyst, high charge mobility, and suitable band structure for tetracycline hydrochloride degradation. In addition, the mechanism of photocatalytic degradation of tetracycline hydrochloride by the TS-1/BMO-1.0 catalyst was reasonably proposed based on the band structure, trapping, and ESR tests. This research provided feasible ideas for the design and construction of high-efficiency photocatalysts for contaminant degradation.

Circ_0008315 promotes tumorigenesis and cisplatin resistance and acts as a nanotherapeutic target in gastric cancer.

INTRODUCTION: Cisplatin-based chemotherapy is one of the fundamental therapeutic modalities for gastric cancer (GC). Chemoresistance to cisplatin is a great clinical challenge, and its underlying mechanisms remain poorly understood. Circular RNAs (circRNAs) are involved in the pathophysiology of multiple human malignancies. METHODS: High-throughput sequencing was performed to determine the differentially expressed profile of circRNA in GC tissues and cisplatin-resistant GC cells. Quantitative real-time polymerase chain reaction and Fluorescence in situ hybridization was utilized to confirm the dysregulation of circ_0008315 in GC tissues. To evaluate the prognostic significance of circ_0008315 in GC, we used Kaplan-Meier plot. The self-renewal ability of drug-resistant GC cell was verified through tumor sphere formation assay. GC organoids were constructed to simulate the tumor microenvironment and verified the function of circ_0008315 in cisplatin resistance of gastric cancer. In vivo evaluation was conducted using patient-derived xenograft models. Dual-luciferase reporter gene, RNA immunoprecipitation and miRNA pull-down assays were employed to investigate the molecular mechanisms of circ_0008315 in GC. RESULTS: We revealed that a novel circRNA hsa_circ_0008315 was upregulated in GC and cisplatin-resistant GC cells. Elevated circ_0008315 was also observed in cisplatin-resistant GC organoid model. High circ_0008315 expression predicted unfavorable survival outcome in GC patients. Downregulation of circ_0008315 expression inhibited proliferation, mobility, and epithelial-mesenchymal transition of GC cells in vitro and in vivo. Reducing circ_0008315 expression in cisplatin-resistant GC organoid model reversed cisplatin resistance. Mechanistically, circ_0008315 modulated the stem cell properties of GC through the miR-3666/CPEB4 signaling pathway, thereby promoting cisplatin resistance and GC malignant progression. Furthermore, we developed PLGA-PEG nanoparticles targeting circ_0008315, and the nanoparticles could effectively inhibit GC proliferation and cisplatin resistance. CONCLUSION: Circ_0008315 exacerbates GC progression and cisplatin resistance, and can be used as a prognostic predictor. Circ_0008315 may function as a promising nanotherapeutic target for GC treatment.

Outcomes of pregnancy in women with different types of pulmonary hypertension.

BACKGROUND: Pulmonary hypertension (PH) is considered to increase maternal and fetal risk, and we attempt to explore pregnancy outcomes in women with different types of PH. METHODS: We retrospectively analyzed the clinical data of pregnant women with PH who were admitted to Anzhen Hospital from January 2010 to December 2019, and followed up on these parturients and their offspring. RESULTS: Three hundred and sixty-six pregnant women with PH were collected, including 265 pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD), 65 PH caused by left heart disease, 12 idiopathic PH, and 24 PH associated with other diseases. Maternal mean age was 28.4 ± 4.4 years and 72.1% were nulliparous. The estimated systolic pulmonary artery pressure was < 50 mmHg in 40.2% of patients, 50-70 mmHg in 23.2%, and > 70 mmHg in 36.6%. In more than 94% of women, a diagnosis of PH was made before pregnancy. During pregnancy, heart failure occurred in 15% of patients. Cesarean section was performed in 90.5% (20.4% emergency). Complications included fetal mortality (0.5%), preterm delivery (40.4%), and low birth weight (37.7%). A total of 20 mothers died (5.5%). The highest mortality rate was found in patients with idiopathic PH (4/12, 33.3%). A total of 12 children died (3.3%), 5 (1.4%) of them after discharge from the hospital, and 7 (1.9%) were in hospital. CONCLUSIONS: Although most of these women are fertile, PH does increase maternal and fetal risk. Women with idiopathic PH and Eisenmenger syndrome are not recommended to have children.

TH-302-loaded nanodrug reshapes the hypoxic tumour microenvironment and enhances PD-1 blockade efficacy in gastric cancer.

BACKGROUND: Hypoxia, a common characteristic of the tumour microenvironment, is involved in tumour progression and immune evasion. Targeting the hypoxic microenvironment has been implicated as a promising antitumour therapeutic strategy. TH-302 can be selectively activated under hypoxic conditions. However, the effectiveness of TH-302 in gastric cancer combined immunotherapy remains unclear. METHODS: We designed mPEG-PLGA-encapsulated TH-302 (TH-302 NPs) to target the hypoxic area of tumour tissues. A particle size analyzer was used to measure the average size and zeta potential of TH-302 NPs. The morphology was observed by transmission electron microscopy and scanning electron microscopy. The hypoxic area of tumour tissues was examined by immunofluorescence assays using pimonidazole. Flow cytometry analysis was performed to measure the levels of TNF-α, IFN-γ, and granzyme B. The synergistic antitumour activity of the combination of TH-302 NPs with anti-PD-1 (α-PD-1) therapy was assessed in vitro and in vivo. Haematoxylin and eosin staining of major organs and biochemical indicator detection were performed to investigate the biological safety of TH-302 NPs in vivo. RESULTS: TH-302 NPs inhibited the proliferation and promoted the apoptosis of gastric cancer cells under hypoxic conditions. In vitro and in vivo experiments confirmed that TH-302 NPs could effectively alleviate tumour hypoxia. TH-302 NPs exhibited high bioavailability, effective tumour-targeting ability and satisfactory biosafety. Moreover, the combination of TH-302 NPs with α-PD-1 significantly improved immunotherapeutic efficacy in vivo. Mechanistically, TH-302 NPs reduced the expression of HIF-1α and PD-L1, facilitated the infiltration of CD8+ T cells and increased the levels of TNF-α, IFN-γ, and granzyme B in tumours, thereby enhancing the efficacy of α-PD-1 therapy. CONCLUSION: TH-302 NPs alleviated the hypoxic tumour microenvironment and enhanced the efficacy of PD-1 blockade. Our results provide evidence that TH-302 NPs can be used as a safe and effective nanodrug for combined immunotherapy in gastric cancer treatment.

Surgery Before Pregnancy in Women with Congenital Heart Disease: A Retrospective Study.

BACKGROUND: This study aimed to investigate if surgery before pregnancy would result in better maternal and fetal outcomes in patients with congenital heart disease. METHODS: A retrospective study was conducted using data collected from the medical records of pregnant patients with congenital heart disease, who were seen at Beijing Anzhen Hospital between 2010 and 2019. The patients were divided into surgical and non-surgical groups, and the differences in outcomes were compared. RESULTS: A total of 999 patients with congenital heart disease (mean age, 28.7±4.3 years) were enrolled, with 403 (40.0%) and 596 (60.0%) in the surgical and non-surgical groups, respectively. The percentages of almost all adverse events were higher in the non-surgical group than in the surgical group. The adverse events included preterm delivery (9.9 vs. 17.1%), low birth weight (6.5 vs. 11.6%), heart failure (2.7 vs. 6.7%), cesarean section (75.7 vs. 85.9%), pulmonary hypertension (13.6 vs. 36.2%), and death (0.5 vs. 2.3%) (all P < 0.05). A total of 16 (1.6%) patients died, including 14 and two in the non-surgical and surgical groups, respectively. Regardless of the type of congenital heart disease, preterm delivery and low birth weight were more common in the non-surgical group compared with the surgical group, and there were no statistical between group differences in the other remaining events. CONCLUSIONS: In the non-surgical group, the results were similar regardless of the type of congenital heart disease, except for preterm delivery and low birth weight. The overall outcome of the surgical group was better than that of the non-surgical group, and surgery before pregnancy reduced maternal and infant risk.

FT-like paralogs are repressed by an SVP protein during the floral transition in Phalaenopsis orchid.

KEY MESSAGE: An SVP protein, PhSVP, bound to the CArG-boxes in the promoter regions of FT-like paralogs and repressed their expression, thus affecting the floral transition in Phalaenopsis orchid. Phalaenopsis is an important ornamental flower native to tropical rain forests. It usually reaches vegetative maturity after 4-5 leaves and, after a juvenile stage, forms a flower spike (inflorescence) from the axillary buds. The PEBP gene family encodes a phosphatidyl-ethanolamine-binding protein (PEBP) domain involved in regulating flowering and other aspects of plant development. Here, we identified eight PEBP family genes in Phalaenopsis and detected the expression patterns of seven of them in various organs. Among them, PhFT1 (Phalaenopsis hybrid FLOWERING LOCUS T1), PhFT3, PhFT5, and PhMFT (Phalaenopsis hybrid MOTHER OF FT AND TFL1) promoted flowering in transgenic Arabidopsis, while PhFT6 inhibited flowering. PhSVP (Phalaenopsis hybrid SHORT VEGETATIVE PHASE), an SVP protein that repressed flowering in Arabidopsis, bound to the CArG-boxes in the promoter regions of PhFT3, PhFT6, and PhMFT in a yeast one-hybrid assay. Additionally, dual-luciferase and transient expression assays showed that PhSVP significantly inhibits the expression of both PhFT3 and PhFT6. Together, our work provides a comprehensive understanding of the PhFT-like genes that can promote or repress flowering, and it suggests strategies for regulating the floral transition in Phalaenopsis that exploit the evolutionary versatility of PhFTs to respond to various signals stimuli.

[Analysis of GJB2, SLC26A4, GJB3 and 12S rRNA gene mutations among patients with nonsyndromic hearing loss from eastern Shandong].

OBJECTIVE: To explore the characteristics of mutations of four common pathogenic genes (GJB2, SLC26A4, GJB3 and 12S rRNA) among patients with nonsyndromic hearing loss (NSHL) from eastern Shandong. METHODS: Peripheral blood samples of 420 NSHL patients were collected, and a hereditary-deafness-gene microarray was used to detect GJB2 c.235delC, c.299-300delAT, c.35delG and c.176del16 mutations, GJB3 c.538C>T mutation, SLC26A4 c.2168A>G and c.IVS7-2A>G mutations, and 12S rRNA c.1555A>C and c.1494C>T mutations. For patients carrying single heterozygous mutations, the coding regions of the above genes were analyzed with Sanger sequencing. RESULTS: The results of the microarray assay and Sanger sequencing showed that 84 patients (20.00%) carried GJB2 mutations, with c.235delC (16.43%) and c.299-300delAT (7.86%) being most common. Seventy-five patients (17.86%) carried SLC26A4 mutations, for which c.IVS7-2A>G accounted for 15.71%. In addition, 5.95% of patients carried 12S rRNA mutations. Only one patient was found to carried GJB3 mutation (c.538C>T). CONCLUSION: Common pathogenic mutations for NSHL in eastern Shandong included GJB2 c.235delC and SLC26A4 c.IVS7-2A>G. Of note, 5.95% of patients were due to 12S rRNA m.1555A>G mutation, which gave a frequency greater than other regions of China.

Hyper- and hybrid nonlocality.

The controlled generation and identification of quantum correlations, usually encoded in either qubits or continuous degrees of freedom, builds the foundation of quantum information science. Recently, more sophisticated approaches, involving a combination of two distinct degrees of freedom, have been proposed to improve on the traditional strategies. Hyperentanglement describes simultaneous entanglement in more than one distinct degree of freedom, whereas hybrid entanglement refers to entanglement shared between a discrete and a continuous degree of freedom. In this work we propose a scheme that allows us to combine the two approaches, and to extend them to the strongest form of quantum correlations. Specifically, we show how two identical, initially separated particles can be manipulated to produce Bell nonlocality among their spins, among their momenta, as well as across their spins and momenta. We discuss possible experimental realizations with atomic and photonic systems.

Perioperative Management of Pregnant Women With Idiopathic Pulmonary Arterial Hypertension: An Observational Case Series Study From China.

OBJECTIVES: The mortality of pregnant women with idiopathic pulmonary arterial hypertension (PAH) is very high. There are limited data on the management of idiopathic PAH during pregnancy. The authors aimed to examine systematically the characteristics of parturient women with idiopathic PAH, to explore the adverse effects of idiopathic PAH on pregnancy outcomes, and to report the multidisciplinary perioperative management strategy from the largest comprehensive cardiac hospital in China. DESIGN: Observational case series study. SETTING: Tertiary referral acute care hospital in Beijing, China. PARTICIPANTS: The cases of 17 consecutive pregnant idiopathic PAH patients undergoing abortion or parturition at Anzhen Hospital were reviewed retrospectively. INTERVENTIONS: Preoperative characteristics, anesthesia method, intensive care management, PAH-specific therapy, and maternal and neonatal outcomes were analyzed in this case series study. MEASURES AND MAIN RESULTS: Maternal and neonatal outcomes were the main measures. The mean ages of the 17 parturient women with idiopathic PAH were 28.3 ± 5.4 years, and the mean systolic pulmonary arterial pressure was 97.9 ± 18.6 mmHg. Fifteen patients (88.2%) received PAH-specific therapy before delivery, including sildenafil, iloprost, and treprostinil. All except 1 parturient received epidural anesthesia for surgery due to an emergency Caesarean section. Three patients experienced pulmonary hypertension crisis that necessitated conversion to general anesthesia. Ten parturients underwent Caesarean delivery at a median gestational age of 31 weeks. Three patients developed acute pulmonary hypertensive crisis intraoperatively. Two patients underwent cardiopulmonary resuscitation and extracorporeal membrane oxygenation support. The maternal mortality was 17.6% (3/17). Of the 10 delivered neonates, 9 (90.0%) survived. CONCLUSIONS: The maternal mortality of the idiopathic PAH parturient was high in this case series from China. The authors applied epidural anesthesia, early management with multidisciplinary approaches, PAH-specific therapy, avoidance of oxytocin, and timely delivery or pregnancy termination to improve maternal and neonatal outcomes.

Clinical analysis: 13 cases of pregnancy complicated with Takayasu arteritis.

OBJECTIVES: To investigate the clinical features, disposition, and effect of pregnancy complicated with Takayasu arteritis (P-TA) on maternal and fetal outcomes. MATERIAL AND METHODS: The clinical data (diagnosis and treatment, peri-pregnancy monitoring, and pregnancy outcomes) of patients with P-TA treated in our hospital between September 2007 and April 2016 were analyzed retrospectively. RESULTS: Among the 13 P-TA cases, seven were diagnosed before pregnancy, and six were diagnosed during pregnancy; six cases were diagnosed as the generalized type, and seven cases were diagnosed as the cephalic-brachial type; six cases were in the stable stage, and seven cases were in the active stage. All the cases in the active stage underwent glucocorticoid therapy. Four cases developed complications, including cardiac dysfunction combined with preeclampsia in two cases, preeclampsia in one case, and stroke in one case. Eleven patients successfully delivered (nine cases of full-term delivery and two cases of premature delivery); one patient had late miscarriage; one patient had missed abortion. All the parturients survived and delivered 11 neonates (nine full-term neonates and two premature neonates) and one low-birth-weight neonate; no neonatal asphyxia or death occurred. CONCLUSIONS: Patients with P-TA can have better maternal and child outcomes through timely diagnosis and treatment, dynamic monitoring, or timely pregnancy termination.

The association of perioperative autologous blood transfusion with the early postoperative cognitive dysfunction in aged patients following lumbar surgery.

PURPOSE: Intraoperation autologous blood transfusion is an effective method that is used in surgeries with an important blood loss. Several studies suggest that massive blood transfusion is one of the independent risks for postoperative cognitive dysfunction (POCD). Whether the autologous blood is one of the risk factor for POCD or not, we retrospectively examined the incidence of POCD and the probable risk factors in patients undergoing lumbar surgery in our hospital, with the same aged non-POCD patients as controls. METHODS: Eighty-one patients who underwent lumbar surgery were included. Perioperative data were examined for association with POCD on the 7 postoperative days by a Mini-Mental State Test. Multivariable logistic regression analysis was conducted to determine the probable risks associated with POCD. RESULTS: POCD was found in 21 patients. Participants who developed POCD were more likely to had a lower eduction level, more likely to had more blood loss, higher incidence of preoperative anemia, and perioperative allogeneic blood transfusion of more than 3 units as independent risk factors for POCD 7 d postoperatively (P < 0.05). Otherwise, there is no significant difference of the patients received autologous blood or not (P > 0.05). CONCLUSION: Autologous blood transfusion is not a risk factor for POCD in aged patients following lumbar surgery. Autologous blood is likely to be a better method of intraoperative blood transfusion during lumbar spine surgery.

[The application of peripartum use of pulmonary artery catheter in pregnant patients with pulmonary hypertension].

OBJECTIVE: To investigate the application and value of pulmonary artery catheterization (PAC) in pregnant patients with pulmonary hypertension (PH). METHODS: The clinical data of pregnant patients with PH who were treated between 2006 and 2014 in surgical intensive care unit (SICU) at Capital Medical University affiliated Beijing Anzhen Hospital were retrospectively analysed. The differences of the clinical characteristics and outcome between PAC inserted patients and PAC not inserted patients were compared. RESULTS: The systolic pulmonary artery pressure (sPAP) measured by preoperative echocardiography has no significant difference between the PAC inserted patients [(103.0 ± 24.1) mmHg (1 mmHg = 0.133 kPa)] and PAC not inserted patients [(96.4 ± 27.3) mmHg; P = 0.175]. SPAP may be overestimated or underestimated by echocardiography compared with PAC with a gap from -38.4 mmHg to 49.5 mmHg. The rates of idiopathic pulmonary arterial hypertension (20.0% vs 3.2%) and continuous use of epidural anesthesia (89.1% vs 65.1%) were higher in PAC inserted patients compared with PAC not inserted patients. Norepinephrine, dobutamine, sildenafil, alprostadil, iloprost and low molecular weight heparin were more widely used in PAC inserted patients. The mortality rate and the rates of low birth weight (63.9% vs 30.6%) and very low birth weight infants (19.4% vs 13.9%) were all higher in PAC inserted patients, while the rate of induced abortion was lower in this group (5.5% vs 17.5%). The length of stay in surgical intensive care unit [6.0 (5.0) d vs 1.0 (3.0) d], postoperative length of stay [8.0 (6.0) d vs 8.0 (4.0) d] and total hospital costs [43 999.22 (38 267.27) RMB vs 14 878.24 (10 564.47) RMB] were all higher in PAC inserted patients. The incidence rate of PAC related complications was 7.3%. CONCLUSIONS: In moderate or severe PH pregnant patients with severe clinical symptoms, perioperative insertion of PAC helps to monitor the perinatal pulmonary arterial pressure(PAP) and guide treatment, potentially improving clinical outcomes and lowering the short term mortality. PAC can't be replaced by echocardiography in measuring PAP.

[Maternal and fetal outcomes with aortic dissection in pregnant patients with Marfan syndrome].

OBJECTIVE: To evaluate the clinical characteristics of aortic dissection in pregnant patients with Marfan syndrome and the maternal and fetal outcomes in cardiovascular surgery. METHODS: Seven pregnant women with Marfan syndrome with aortic dissection were identified, who were treated in Beijing Anzhen Hospital Affiliated to Capital Medical University between January 2012 and September 2014. Patient charts were reviewed for cardiovascular surgery, occurrence of complications, clinical features and the maternal and fetal outcomes. RESULTS: (1) Among 7 patients, 4 cases were diagnosed as type A aortic dissection and 3 were cases diagnosed as type B aortic dissection. The diagnosis mainly depends on CT angiography. New York Heart Association (NYHA) classify into 5 of level II, 1 of level III, 1 of leveI IV. Except for 1 patient with cardiac tamponade lead to heart failure, the remaining 6 cases had no complications. (2) Three patients underwent heart surgery with cardiopulmonary bypass in second trimester and two patients underwent heart surgery in third trimester. Two patients terminated pregnancy before heart surgery (one of whom underwent artificial abortion, one of whom underwent cesarean section in second trimester). (3) The methods of cardiovascular surgeries were as follow: 3 of Bentall+Sun', 1 of Bentall+Sun'+ right coronary artery bypass grafting, 1 of Bentall, 1 of the whole chest aorta replacement surgery, and 1 of femoral artery catheter chest aorta with membrane mesh stent implantation. The diameter of aortic roots measured during operation were 5 cm in 2 cases, 7 cm in 2 cases and 10 cm in 2 cases respectively. Among the 7 cases, 3 were conducted cesarean sections during cardiovascular surgery, 1 was terminated pregnancy due to intrauterine fetal death after cardiovascular surgery, and 1 was conducted cesarean section due to severe early-onset preeclampsia at 30 weeks of pregnancy after cardiovascular surgery. (4) Among the 7 cases, 3 were conducted cesarean sections during cardiovascular surgery, the order of which was implemented cesarean section under general anesthesia firstly and then operated cardiovascular surgery with cardiopulmonary bypass and heparinization. Two were conducted cardiovascular surgery after termination of pregnancy by early artificial abortion operation or hysterotomy. 1 was conducted Bentall surgery at 18 weeks of pregnancy, after that the patient was receiving warfarin until the fetal brain hemorrhage was examined by ultrasound at 31 weeks of pregnancy; the patient was conducted cesarean section due to intrauterine fetal death. 1 was conducted heart surgery at 24 weeks of pregnancy and continue the pregnancy to 30 weeks, was conducted cesarean section due to severe early-onset preeclampsia at 30 weeks of pregnancy. (5) Among 7 patients, three patients underwent heart surgery with cardiopulmonary bypass combined with cesarean section. Two patients terminated pregnancy after heart surgery. Two patients terminated pregnancy before heart surgery. Six patients were alive and one patient died of multiple organ failure. (6) 3 cases of newborn with birth body mass between 1 080 to 1 490 g.1 case of birth died after 14 d. 2 cases for newborns were alive without exception. CONCLUSION: Aortic dissection poses serious risk for pregnant women with Marfan syndrome and the fetus, and the mortality rates for both the mother and the fetus are high. Early diagnosis and appropriate treatment should be based on maternal and fetal conditions (such as aortic dissection, gestational age). When fetus is mature, cardiovascular surgery should be carried out with cesarean section. A multi-disciplinary team between obstetric and cardiovascular surgery is crucial to the outcome of these critical patients.

Strain gauge using Si-based optical microring resonator.

This paper presents a strain gauge using the mechanical-optical coupling method. The Si-based optical microring resonator was employed as the sensing element, which was embedded on the microcantilevers. The experimental results show that applying external strain triggers a clear redshift of the output resonant spectrum of the structure. The sensitivity of 93.72 pm/MPa was achieved, which also was verified using theoretical simulations. This paper provides what we believe is a new method to develop micro-opto-electromechanical system (MOEMS) sensors.

[Severe idiopathic pulmonary arterial hypertension in pregnancy: a review of 10 cases].

OBJECTIVE: To study the impact of severe idiopathic pulmonary arterial hypertension (IPAH) on pregnancy outcome and to investigate the effect of multidisciplinary approach during pregnancy on the pregnancy outcome in pregnant woman with severe IPAH. METHODS: Between March 2007 and November 2013, 10 pregnant women with severe IPAH undergoing treatment in Beijing Anzhen Hospital were studied retrospectively.Hemodynamic measurements, medical therapy, manner of delivery, anesthetic administration, multidisciplinary management and outcomes were assessed. RESULTS: All 10 cases were first diagnosed at the mean of (24 ± 3) weeks during the pregnancy. The systolic pulmonary artery pressure (sPAP) estimated by transthoracic echocardiography was (95.6 ± 1.3) mmHg (1 mmHg = 0.133 kPa) .Seven cases of class III and 3 cases of class IV were recorded by World Health Organization functional class.One patient underwent pregnancy termination at gestational age of 21 weeks with no maternal death or complications, nine patients continued pregnancy and all the patients underwent cesarean section. The mean pregnancy length was (31 ± 5) weeks.Nine had cesarean deliveries during continuous epidural anesthesia, and one during general anesthesia. There were three maternal deaths in hospital (5, 2, 3 days postpartum), and seven patients were alive, and the average hospitalization days was (8 ± 4) days.One fetus lost with cesarean section. Two were term delivery, and seven cases were premature delivery. The average weight is (1 948 ± 731) g and nine were alive and no malformation. CONCLUSIONS: Because of maternal mortality in patients with severe IPAH remains prohibitively high, patients should continue to be counseled to avoid pregnancy.Women with severe IPAH who become pregnancy should be followed by multidisciplinary approach, and cesarean deliveries during continuous epidural anesthesia are a relatively safe way for pregnancy termination in patients with severe IPAH.

[Maternal and fetal outcomes in pregnant patients undergoing cardiac surgery with cardiopulmonary bypass].

OBJECTIVE: To evaluate the optimal management of cardiac surgery during pregnancy, and the maternal and fetal outcomes in pregnant patients undergoing cardiac surgery with the use of cardiopulmonary bypass. METHODS: Nine pregnant women with heart diseases were identified, who underwent cardiac surgery with cardiopulmonary bypass between January 2002 and March 2013. Patient charts were reviewed for pregnant age, types of heart diseases, surgical indication, parameters of cardiopulmonary bypass, and maternal and fetal outcomes. RESULTS: Among 9 patients, there were 4 cases of valvular heart disease (two of rheumatic heart disease complicated with subacute bacterial endocarditis and heart failure, one of mechanical prosthetic valves flap after mitral replacement, one of severe aortic stenosis), one case of aortic dissection, three cases with atrial myxoma, and one case with tetralogy of Fallot. The New York Heart Association (NYHA) functional classification: there were three cases with class I, two with class II, two with class III, and two with class IV. Heart surgeries were performed from 9 to 39 weeks gestation. Five patients underwent heart surgery with cardiopulmonary bypass combined with cesarean section. The other 4 patients terminated pregnancies after heart surgeries, two of whom underwent uterine curettage in first trimester, one induction of labor in second trimester, and one continued to be pregnant until 37 weeks' gestation. Seven patients were alive. Nine fetal outcomes were included two with artificial abortion, one with induction of labor and one with cesarean section in second trimester, two of premature labor and three of full-term labor with cesarean section in third trimester. Five newborns were no malformation, four of whom were alive. CONCLUSION: Cardiopulmonary bypass can be used safely with satisfactory maternal and fetal outcomes in pregnant patients with heart disease undergoing cardiac surgery.

Mediating role of body mass index on the relationship between physical activity and physical fitness among junior high school students in Shanghai.

Objectives: This study explored the relationship between physical activity (PA), body mass index (BMI), and physical fitness among junior high school students in Shanghai. Methods: A nationwide offline survey was conducted in Shanghai between August and December 2023, using a purposive sampling design. A total of 403 questionnaires were administered to 10 ninth-grade classes in 10 schools in Shanghai and 372 responses were included in the final analysis. Smart-PLS 4.0, structural equation modeling techniques were employed to analyze the collected data. Results: Light physical activity (LPA) had no influence on BMI, 800/1000 m (800/1000 M), sitting forward bend (FB), standing long jump (SLJ), 50 m (50 M), or vital capacity (VC). The results of part hypothesis supported the hypothetical model and explained that BMI had a negatively influence on 50 M, 800/1000 M and SLJ, BMI had a positively influence on VC. Moderate physical activity (MPA) had a negatively influence on BMI, but vigorous physical activity (VPA) had a positively influence on BMI, they both had influence on 50 M and FB, but had no influence on 800/1000 M, SLJ, and VC. Conclusions: BMI, MPA and VPA were found as pivotal factors influencing physical fitness, MPA and VPA were found to have divergent effects on BMI. This study highlighted the multifaceted nature of the relationship between PA, BMI, and physical fitness in junior high school students in Shanghai.