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.

Model Predictive Control for Speed-Dependent Active Suspension System with Road Preview Information.

This paper proposes a model predictive control (MPC) scheme based on linear parameter variation to enhance the damping control of speed-dependent active suspensions. The controller is developed by introducing a speed-dependent term, specifically front- and rear-wheel time delays, to the half-car model using the Padé approximation. Subsequently, the model is augmented with time-varying parameter dependence. An adaptive Kalman filter based on variance matching is employed to estimate system states affected by imprecise sensor measurement noise. Finally, a set of explicit control laws incorporating road preview information and available vehicle speed are determined offline using multi-parameter linear programming (mp-LP), simplifying online implementation to searching for optimal solutions in a lookup table. Simulation results demonstrate a significant improvement in active suspension control under changing vehicle speeds compared to passive control.

Association between triglyceride glucose-body mass and one-year all-cause mortality of patients with heart failure: a retrospective study utilizing the MIMIC-IV database.

BACKGROUND: The triglyceride glucose-body mass (TyG-BMI) index is acknowledged as both a reliable indicator of the risk of cardiovascular disease and an accurate surrogate biomarker for evaluating insulin resistance (IR). The importance of the TyG-BMI index among people with heart failure (HF), however, requires more investigation. The objective of this study was to inquire about the relationship between HF patients' TyG-BMI index and their risk of 360-day mortality. METHODS: The Medical Information Mart for Intensive Care (MIMIC-IV) database provided the study's patient data, which were divided into quartiles according to their TyG-BMI index. The endpoint was mortality from all causes within 360 days. Kaplan-Meier analysis was used to compare this primary endpoint amongst the four groups indicated above. The association between the TyG-BMI index and the endpoint was investigated using restricted cubic splines and Cox proportional hazards analysis. RESULTS: The study enrolled a total of 423 patients with HF (59.2% male), of whom 70 patients (16.9%) died within 360 days. Patients with higher TyG-BMI indexes had significantly lower mortality risks, according to the Kaplan-Meier analysis (log-rank P = 0.003). Furthermore, the restricted cubic spline analysis illustrated a decrease in the risk of all-cause mortality with an increasing TyG-BMI index. Additionally, multivariable Cox proportional hazards analyses showed that the risk of 360-day death from all causes was considerably higher in the lowest quartile of TyG-BMI. In comparison to the lowest TyG-BMI group, the fully adjusted Cox model yielded a hazard ratio (HR) of 0.24 (95% CI: 0.10, 0.59; p = 0.002) for 360-day mortality. CONCLUSIONS: In patients diagnosed with HF, a lower TyG-BMI index is strongly related to a higher risk of 360-day mortality. This index can be employed to categorize the risk levels of patients with HF and predict their one-year all-cause mortality .

Three-dimensional multiphysics coupling numerical simulation of a proton conductor solid oxide fuel cell based on multi-defect transport.

The conductivity of the electrolyte of a proton conductor solid oxide fuel cell is not only related to temperature, but also related to the humidity and oxygen partial pressure of the cathode and anode. The gas partial pressure and temperature of the cell have significant inhomogeneity in three-dimensional space, so it is extremely important to develop a multi-field coupled three-dimensional model to explore the electrochemical performance of the cell. In this study, a model is constructed that takes into account macroscopic heat and mass transfer, microscopic defect transport, and the reaction kinetics of defects. The results show that for thin cathodes, the ribs significantly affect the oxygen partial pressure and the concentration of defects on the cathode side. On both sides of the electrolyte membrane, the concentration of hydroxide ions increases with increasing gas humidity. The hydroxide ion concentration increases along the flow direction, but the concentration of O-site small polarons increases on the anode side and decreases on the cathode side. The conductivity of hydroxide ions is more sensitive to the humidity of the anode side, while the conductivity of O-site small polarons is more sensitive to the humidity of the cathode side. Increasing the humidity of the cathode side results in a significant decrease in the conductivity of the O-site small polarons. The contribution of the conductivity of oxygen vacancies to the total conductivity is negligible. The total conductivity on the cathode side is greater than that on the anode side; it is dominated by hydroxide ions on the anode side, and co-dominated by hydroxide ions and O-site small polarons on the cathode side. Increasing temperature significantly increases both partial and total conductivity. When hydrogen depletion occurs, the partial conductivities and the total conductivity exhibit a sharp increase downstream of the cell.

Exploring RNA methylation as a promising biomarker for assessing sublethal effects of fipronil on honeybees (Apis mellifera L.).

Honeybees play a crucial role as pollinators for crops and are regarded as sensitive bioindicators of environmental health. The widespread use of pesticides poses a severe threat to honeybee survival. However, there is limited information available on the specific risks associated with fipronil exposure in honeybees, particularly concerning the impact on RNA methylation throughout their lifespan. This study aimed to evaluate the effects of sublethal concentrations of fipronil on RNA m6A and m5C methylations, along with the associated genes in honeybee larvae and newly emerged adults. LC-MS/MS analysis revealed a notable hypomethylation of m5C in larvae, while hypermethylation of m6A was observed in the adult brain. Significant changes in the expression of genes such as AmWTAP, AmYTHDF, AmALKBH4, AmALKBH6, AmALKBH8, AmNSUN5, AmNOP2, AmTET1, and AmYBX1 were observed in the adult brain, whereas alterations in the expression of AmNSUN2, AmMETTL14, AmALKBH1, AmALKBH4, AmALKBH6 AmALYREF, AmTET1, and AmYBX1 were observed in the larvae. Notably, the expression of AmALKBH1 was not detected in any fipronil-treated larvae, suggesting its potential as an early risk indicator for honeybee larvae in future assessments. This pioneering study provides insights into the effects of fipronil on RNA methylations in honeybees and explores the possibility of employing RNA methylation as a tool for assessing pesticide risks in this important pollinator species. These findings offer new perspectives on honeybee protection and the development of toxicity evaluation systems for pesticides.

Exercise training improves cardiac function and regulates myocardial mitophagy differently in ischaemic and pressure-overload heart failure mice.

NEW FINDINGS: What is the central question of this study? What are the cardioprotective effects of different aerobic exercises on chronic heart failure with different aetiologies, and is mitophagy involved? What is the main finding and its importance? Moderate-intensity continuous training may be the 'optimum' modality for improving cardiac structure and function in ischaemic heart failure, while both moderate-intensity continuous training and high-intensity interval training were suitable for pressure-overload heart failure. Various mitophagy pathways, especially parkin-dependent pathways, participated in the protective effects of exercise on heart failure. ABSTRACT: The cardioprotective effects of different aerobic exercises on chronic heart failure with different aetiologies and whether mitophagy is involved remain elusive. In the current research, left anterior descending ligation and transverse aortic constriction surgeries were used to establish mouse models of heart failure, followed by 8 weeks of moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT). The results showed that for ischaemic heart failure MICT significantly improved ejection fraction (P < 0.05) and fractional shortening (P < 0.05), mitigated left ventricular end-systolic dimension (P < 0.01), decreased brain natriuretic peptide (P < 0.0001) and mitigated fibrosis (P < 0.0001), while HIIT only decreased brain natriuretic peptide (P < 0.0001) and fibrosis (P < 0.0001). For pressure-overload heart failure, both MICT and HIIT significantly increased ejection fraction (P < 0.0001) and fractional shortening (MICT: P < 0.001, HIIT: P < 0.0001), and reduced left ventricular end-diastolic and end-systolic dimensions, brain natriuretic peptide (P < 0.0001), and fibrosis (MICT: P < 0.01, HIIT: P < 0.0001); HIIT was even better in reducing brain natriuretic peptide. Myocardial autophagy and mitophagy were compromised in heart failure, and the exercises improved myocardial autophagic flux and mitophagy inconsistently in heart failure with different aetiologies. Significant correlations were found between multiple mitophagy pathways and the cardioprotection of the exercises. Collectively, MICT may be the 'optimum' modality for ischaemic heart failure, while both MICT and HIIT (especially HIIT) were suitable for pressure-overload heart failure. Exercises differently improved myocardial autophagy/mitophagy, and multiple mitophagy-related pathways were closely implicated in cardioprotection of exercises for chronic heart failure.

Crushed/chewed administration of potent P2Y12 inhibitors in ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: Systematic review and meta-analysis.

Crushed or chewed potent P2Y12 inhibitors are commonly used in the hope of bridging the gap of platelet inhibition in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). The study aimed to investigate the efficacy and safety of this alternative oral administration strategy by performing a meta-analysis of available randomized clinical trials (RCTs). PubMed, Embase, the Cochrane Library and Web of Science medical literature databases were searched for RCTs comparing crushed/chewed vs. integral administration of loading dose potent P2Y12 inhibitors in patients with STEMI undergoing pPCI with no language restrictions from inception to January 20th, 2021. The primary efficacy endpoints of high on treatment platelet reactivity (HPR) and P2Y12 reaction units (PRU) at 1 hour together with safety and additional clinical endpoints were evaluated by pooled odds ratio (OR) or mean differences (MD) with 95% confidence intervals (95% CI). A total of 973 patents in six RCTs were eligible for analysis, while 876 patients present baseline and procedural characteristics. HPR and PRU at 1 hour were significantly reduced in the group receiving crushed/chewed P2Y12 inhibitors compared with integral tablets (OR 0.28, 95% CI 0.16 to 0.49, P < .0001; MD -60.62, 95% CI -97.06 to -24.19, P = .001, respectively). Safety endpoints of major bleeding (OR 0.54, 95% CI 0.11 to 2.73, P = .46) and any bleeding (OR 0.84, 95% CI 0.43 to 1.64, P = .61), as well as additional clinical endpoints of cardiovascular death, myocardial infarction, and stroke were not affected by the oral administration strategy. In STEMI patients undergoing pPCI, crushed or chewed administration of potent P2Y12 inhibitors are associated with enhanced early platelet inhibition and appear to be safe. The clinical profile transformed from this pharmacodynamic benefit need to be determined by further researches.

Diazapentabenzocorannulenium: A Hydrophilic/Biophilic Cationic Buckybowl.

Polycyclic aromatic molecules are promising functional materials for a wide range of applications, especially in organic electronics. However, their largely hydrophobic nature has impeded further applications. As such, imparting high solubility/hydrophilicity to polycyclic aromatic molecules leads to a breakthrough in this research field. Herein, we report the synthesis of diazapentabenzocorannulenium, a cationic nitrogen-embedded buckybowl bearing a central imidazolium core, by a bottom-up strategy from polycyclic aromatic azomethine ylide. X-ray crystallography analyses have revealed a bowl-shaped molecular structure that is capable of forming charge-segregated one-dimensional columns by bowl-in-bowl packing. In addition to its fluorescence capabilities and high dispersibility in water, the molecule was found to selectively localize in the mitochondria of various tumor cells, showing potential as viable mitochondria-selective fluorescent probes.

Metal Microfibers Delivered Eddy Current Heating for Efficient Synthesis and Regeneration of Metal-Organic Framework Monoliths.

On the basis of stainless-steel fiber (SSF)-delivered localized Eddy current heating (LECH) in response to an alternating magnetic field, a novel LECH-driven framework synthesis (LIFS) strategy has been developed for highly efficient metal-organic framework (MOF) synthesis, resulting in the production of a set of SSF/MOF composites consisting of MOF-coated SSF (SSF@MOF) fibers and free MOF crystals. Detailed studies on the LIFS reaction kinetics indicate that the use of LIFS can greatly promote MOF production in comparison to the conventional solvothermal reactions. To facilitate the practical applications, the resulting powder SSF/UiO-66-NH2 composites, as a typical example, are further processed into well-shaped SSF/UiO-66-NH2 monoliths (SUS) with varied MOF loadings. In SUSs, the embedded SSFs exhibit well-controlled LECH capacities depending on the applied magnetic field strength. Driven by LECH, SUS monoliths can be uniformly heated and fully regenerated, demonstrating a LECH-triggered framework regeneration (LIFR) process for highly efficient regenerating MOF monoliths. As LECH is delivered by the low-cost commercial SSFs and remotely triggered by an external magnetic field, our currently developed LIFS and LIFR processes provide a novel, low-cost, and energy-efficient way to highly efficiently synthesize and regenerate MOF materials.

Assessing the emission sources and reduction potential of atmospheric ammonia at an urban site in Northeast China.

Atmospheric ammonium and ammonia have brought negative environmental impacts and adverse health effects. However, ammonia emissions are generally less regulated worldwide. This study analyzed ammonium pollution character, quantified the dominant ammonia emission sources, and assessed ammonia reduction potential in urban Harbin (China). The results showed that ammonium recorded low concentration in the non-heating season (1.34 ± 1.57 µg/m3), and recorded sharply increased concentration (6.50 ± 7.02 µg/m3) and relative abundance in the heating season. It was closely correlated with vehicle-related pollutants (CO) in non-heating season, while with biomass burning-related pollutants (K+, Cl-) in the heating season. Bayesian Mixing Model emphasized the increasing contribution of biomass burning and decreasing contribution of fertilizer as the pollution levels escalate. The results from the thermodynamic equilibrium model showed that a 50%-60% ammonium decrease could bring marketable decrements of the aerosol pH, aerosol water content, ammonium nitrate concentration, and inorganic ion mass. The results of this study would provide scientific bases for ammonia emission reduction and haze pollution control in urban Harbin.

On-Surface Synthesis of a π-Extended Diaza[8]circulene.

Heterocyclic [8]circulenes are an important class of polycyclic aromatic hydrocarbon molecules because of their unique structural properties and promising applications. However, the synthesis of heterocyclic [8]circulenes is still limited and thus is an important synthetic challenge. Here we describe the first example of a π-extended diaza[8]circulene surrounded by and fused with six hexagons and two pentagons, which was successfully synthesized only by a combined in-solution and on-surface synthetic strategy. State-of-the-art scanning tunneling microscopy with a CO-functionalized tip and density functional theory calculations revealed its planar conformation and unique electronic structure.

MiR-16, as a potential NF-κB-related miRNA, exerts anti-inflammatory effects on LPS-induced myocarditis via mediating CD40 expression: A preliminary study.

The purpose of this study was to investigate the biological effect of miR-16 on myocarditis and the underlying molecular mechanism. H9c2 cells were treated with 10 µg/mL lipopolysaccharide (LPS) for 12 hours to form a myocarditis injury model. We observed that LPS treatment distinctly decreased the level of miR-16 in H9c2 cells. Upregulation of miR-16 increased cell proliferation and reduced cell apoptosis. Then, CD40 was predicted and verified as a target gene of miR-16 by TargetScan and luciferase reporter assay, respectively. Furthermore, the messenger RNA and protein expression of CD40 are negatively regulated by miR-16. The relative expression of inflammatory factors was dramatically decreased by the miR-16 mimic. Cells cotransfected with miR-16 mimic and si-CD40 could significantly abolish the injury of cardiomyocytes caused by myocarditis. Our study illustrated that the upregulation of miR-16 has a protective effect on LPS-damaged H9c2 cells, which may be achieved by regulating CD40 and the nuclear factor kappa B pathway.

Perioperative predictors of prolonged length of hospital stay following total knee arthroplasty: a retrospective study from a single center in China.

BACKGROUND: Decreasing the length of hospital stay is an ideal course of action to appropriately allocate medical resources. The aim of this retrospective study was to identify perioperative factors that may decrease the length of hospital stay (LOS). METHODS: In this study, we collected the data on 1112 patients who underwent primary total knee arthroplasty surgery (TKAs) at our institution from Jan 1, 2011 to Nov 31, 2017. Based on the published literature, 16 potential factors (12 preoperative variables, 1 intraoperative variable, and 3 postoperative variables) were investigated. The patients requiring a hospital stay longer than the mean LOS (8 days) were defined as patients with a prolonged LOS. The factors with a P value less than 0.1 in the univariate analysis were further analysed in a multivariate model. An ordinal regression was used to determine independent risk factors for a prolonged LOS. RESULTS: The mean LOS was 8.3 days (±4.3), with a range of 2 to 30 days. Sixteen variables were analysed by univariate analysis, and 11 of them had p < 0.1 and were included in the multivariable model. Finally, 9 factors were found to be associated with a prolonged LOS. Among the 9 variables, 2 were surgery-related factors (operative time and intraoperative blood loss), and 3 were patient-related factors (age, ASA classification and neurological comorbidities). CONCLUSION: In this study, we found that the clinical protocol, complications, the patient's age, the ASA classification, neurological comorbidities, the operative time, the ward, intraoperative blood loss and the surgeon were all factors contributing to a prolonged LOS. In clinical practice, these factors provide important information for the surgeon and are useful for identifying patients with a high risk of a prolonged LOS.

Hazards of ventricular pre-excitation to left ventricular systolic function and ventricular wall motion in children: analysis of 25 cases.

AimThe aim was to attach importance to the hazards of ventricular pre-excitation on left ventricular systolic function and size. METHOD: We analysed the clinical, electrophysiological, and echocardiographic characteristics of the 25 cases with abnormal ventricular wall motion, left ventricular systolic dysfunction, or dilation with co-existing right-sided overt accessary pathways before and after ablation or medication during March 2011 and June 2017. Moreover, we compared the therapy effect between patients with ventricular pre-excitation-induced dilated cardiomyopathy and idiopathic dilated cardiomyopathy without ventricular pre-excitation.ResultAbnormal ventricular wall motion was demonstrated using M-mode echocardiography in 23 cases. The basal segments of the interventricular septum became thin and moved similarly to an aneurysm with typical bulging during end-systole, which was observed in 16 cases. Dilated cardiomyopathy was diagnosed in 14 cases. A total of 23 patients underwent successful ablations and received medications, and the other two patients received only oral medications because of young age. The prognosis of pre-excitation-induced dilated cardiomyopathy is better than idiopathic dilated cardiomyopathy. All the cases with abnormal ventricular wall motion demonstrated recovery of normal left ventricular ejection fraction and decreased left ventricular end-diastolic diameter through ablation. CONCLUSION: Ventricular pre-excitation caused by right-sided accessory pathways may result in abnormal ventricular wall motion, left ventricular systolic dysfunction, dilation, and even dilated cardiomyopathy. In some cases with dilated cardiomyopathy, ventricular pre-excitation may not be the cause of disease but a harmful factor which hampered the recovering of left ventricular systolic function. These conditions are indications for ablation with good prognosis.

Direct Wittig Olefination of Alcohols.

A base-promoted transition metal-free approach to substituted alkenes using alcohols under aerobic conditions using air as the inexpensive and clean oxidant is described. Aldehydes are relatively difficult to handle compared to corresponding alcohols due to their volatility and penchant to polymerize and autoxidize. Wittig ylides are easily oxidized to aldehydes and consequently form homo-olefination products. By the strategy of simultaneously in situ generation of ylides and aldehydes, for the first time, alcohols are directly transferred to olefins with no need of prepreparation of either aldehydes or ylides. Thus, the di/monocontrollable olefination of diols is accomplished. This synthetically practical method has been applied in the gram-scale synthesis of pharmaceuticals, such as DMU-212 and resveratrol from alcohols.

Knockdown of Ggps1 in chondrocyte expedites fracture healing by accelerating the progression of endochondral ossification in mice.

Bone fracture healing is achieved through the proliferation and differentiation of stem cells, while bone marrow stem cells (BMSCs) contribute to endochondral ossification. During fracture healing, mesenchymal progenitor cells first form a cartilaginous blastema that becomes vascularized to recruit precursor cells of osteoblasts through the bone morphogenetic protein 2 (Bmp2)/Smad-dependent Runx2 pathway. Statins deplete geranylgeranyl diphosphate (GGPP), which participates in the regulation of BMSCs differentiation, through the inhibition of 3-hydroxy-3-methylglutaryl (HMG)-CoA reductase, leading to impaired protein geranylgeranylation, which strongly impacts the bone synthesis induced by Bmp2. Accordingly, we would like to investigate the role of geranylgeranyl diphosphate synthase 1 (Ggps1) in bone fracture via endochondral ossification in mice. We used a Cre-loxP system, namely the tamoxifen-inducible Collagen 2-CreERT2 Ggps1 fl/fl, to eliminate specifically the Ggps1 activity in chondrocytes of 8-10-week-old mice. We found that the endochondral bone formation, calcification and vasculogenesis of the bony callus were accelerated in fractures in Ggps1-/-mice. Together, the results of this study confirm that the specific deletion of Ggps1, using the Collagen 2-CreERT2 mice, will accelerate the fracture healing process by activating the Bmp2/Smad-dependent Runx2 pathway. In addition, we managed to improve the fracture healing process by inhibiting the Ggps1 activity and its related products with statin drugs.

Different patterns of myopia prevalence and progression between internal migrant and local resident school children in Shanghai, China: a 2-year cohort study.

BACKGROUND: In 2010, there were ~ 36 million migrant children under 18 y old in China. This study compared patterns of myopia prevalence and progression between migrant and resident children. METHODS: Eight hundred forty-two migrant children from 2 migrant schools and 1081 from 2 local schools in Baoshan District, Shanghai, were randomly chosen. Baseline measurements were taken on children in grades one through four, and children in grades one and two were followed for 2 y. The children underwent comprehensive ophthalmic examinations, including cycloplegic refraction and axial length. The average time per week spent on homework and outdoor activities were investigated. RESULTS: Migrant children in grades one and two showed a lower myopia prevalence than resident children; however, from grades three to four, the prevalence accelerated and exceeded that of residents. In the follow-up, the myopia incidence did not significantly change from grades one to two in resident children but was significantly higher in grade two in migrant children. Correspondingly, for migrant children, increased progression of refraction and axial length was observed; however, it decreased in resident children. The average time spent on homework increased from grades two to three in parallel with the acceleration of myopia prevalence for migrant children; however, the time spent outdoors did not correspondingly change. CONCLUSION: The patterns of myopia prevalence and progression are different between migrant and non-migrant children. The acceleration of myopia in migrant children might be a result of a change in their environment, such as intensive education pressure.

Cohort study with 4-year follow-up of myopia and refractive parameters in primary schoolchildren in Baoshan District, Shanghai.

IMPORTANCE: Cohort studies could not only reveal associations between change of refractive components and onset/progression of myopia, but also risk factors, which is important for understanding mechanism and providing strategies. BACKGROUND: Prevalence of myopia is high in Shanghai, being reported to be 52.2% in children aged 10 years old. DESIGN: Cohort study. PARTICIPANTS: A total of 1856 students from six randomly selected primary schools in Baoshan District, Shanghai. METHODS: Children underwent comprehensive ocular measurement, including axial length (AL), corneal curvature radius and cycloplegic auto-refraction. Questionnaires about eye usage time were collected. Grade 1 students were followed for 4 years, and grade 2 and 3 students for 2 years. MAIN OUTCOME MEASURES: (i) Change of spherical equivalent (SE) and AL and (ii) risk factors for progression and incidence of myopia. RESULTS: The average 2-year progress of SE was 0.91D, 0.91D and 1.11D for grade 1, 2 and 3, respectively, and the average elongation of AL was 0.70 mm, 0.64 mm and 0.71 mm, respectively. Only parental myopia, but not near work time, near work diopter time, outdoor activity time or attending tutoring classes, was associated with myopia incidence and progression in the present population. Using baseline SE could be a simple and effective indicator for myopia prediction. CONCLUSIONS AND RELEVANCE: Incidence and progression of myopia is relatively high in schoolchildren in Shanghai compared with children of Western countries, East Asia and other parts of China. Effective strategies to control myopia prevalence are in urgent need.

Acute Effect of Inhaled Iloprost in Children with Pulmonary Arterial Hypertension Associated with Simple Congenital Heart Defects.

Inhaled prostacyclin analogue iloprost is currently utilized in adult patients with pulmonary arterial hypertension (PAH), but little information is available on its use in the pediatric population. This study evaluated the safety and acute haemodynamic effects of inhaled iloprost in children with PAH associated with congenital heart disease (CHD). Children with PAH-CHD who underwent cardiac catheterization and iloprost administration in our catheter laboratory between June 2007 and October 2015 were included. Iloprost was administered by atomization inhalation and changes in hemodynamic parameters were recorded. In total, 100 children with PAH-CHD were enrolled. Median age was 13 [1.5-18.0] years and 34% were male. A ventricular septal defect was present in 84%, a patent duct in 12%, a complete atrioventricular septal defect in 2%, and an isolated atrial septal defect in 2%. Pulmonary vascular resistance indexed (PVRI) was above 8 WU m2 in 96% and was above a third systemic (Rp/Rs > 0.33) in 97%. Iloprost was well tolerated in all patients. Following iloprost inhalation, mean pulmonary arterial pressure decreased from 78.4 ± 9.2 to 72.8 ± 10.8 mmHg (p < 0.01) and pulmonary-to-systemic blood flow ratio (Qp/Qs) increased from 1.12 ± 0.48 to 1.37 ± 0.63 (p < 0.01), with no change in cardiac index (Qs). PVRI decreased from 21.0 ± 9.0 to 16.9 ± 8.0 WU m2 (p < 0.01) following inhalation but 92% patients still had a PVRI > 8 WU m2 and 93% an Rp/Rs > 0.33. Acute inhalation of iloprost in children with PAH associated with CHD resulted in a significant improvement in hemodynamic parameters. Despite this, few patients achieve strict criteria of operability, underscoring the importance of early screening and timely repair of CHD.