Rationale and design of the SPRING trail: effectivity and safety of Pfo closuRe vs medIcine in alleviatiNg migraine, a multicenter, randomized and open-label trail.

BACKGROUND: Migraine is a leading cause of disability worldwide. Several retrospective studies have suggested that the closure of the Patent Foramen Ovale (PFO) may provide relief from migraines. However, three randomized controlled trials did not meet their primary endpoints regarding migraine cessation, reduction in monthly migraine days, and responder rates. METHODS: The SPRING study is a multicenter, prospective, randomized, and open-label trial designed to compare the effectiveness and safety of PFO closure versus medication in the relief of migraines. The primary endpoint is the total cessation of migraines, as recorded in patient headache diaries during the follow-up period. Additional diagnostic tools include echocardiography with agitated saline contrast, transcranial Doppler, and routine laboratory measurements. CONCLUSION: The SPRING trial aims to assess the effectiveness and safety of PFO closure versus medication in mitigating migraines in real-world settings. (Clinical Trails ID: NCT04946734).

ACE2 gene polymorphisms are associated with elevated pulmonary artery pressure in congenital heart diseases.

BACKGROUNDS: Angiotensin converting enzyme 2 (ACE2) polymorphisms are related to the occurrence and prognosis of cardiovascular disease. However, whether ACE2 polymorphisms also affect pulmonary circulation in congenital heart disease (CHD) remains unclear. Thus, we investigated the relationship between ACE2 single nucleotide polymorphism (SNPs) and pulmonary circulation in CHD patients of Chinese Han ethnicity. METHODS: Enrolled CHD patients (n = 367) underwent gene sequencing of ACE2 SNPs rs2074192, rs2285666, and rs2106809. Patients with pulmonary hypertension were further examined for detailed hemodynamics. RESULTS: Female heterozygous patients had worse pulmonary circulation hemodynamic parameters compared to those of homozygotes. Female CHD patients with the CCA (OR = 0.53, 95% CI: 0.32-0.88) or CCG (OR = 0.59, 95% CI: 0.35-0.99) haplotype had a lower risk of elevated pulmonary artery pressure. CONCLUSION: In female CHD patients, ACE2 SNPs are related to pulmonary circulation hemodynamics. Female CHD patients with the CCA and CCG haplotype had a lower risk of pulmonary hypertension.

Screening for scoliosis and associated factors among primary and middle school students in Shanghai / 中国学校卫生

Objective@#To understand the prevalence and influencing factors of scoliosis among primary and middle school students in Shanghai, so as to provide reference for the prevention and control strategies of scoliosis in children and adolescents.@*Methods@#From September to December 2021, a total of 4 531 students from grade four of primary school to grade three of junior high school from 16 primary and middle schools in 4 districts of Shanghai were selected by multi stage stratified cluster sampling to carry out scoliosis screening and questionnaire survey. Independent sample t-test, Chi-squared test, Fisher s exact probability method and nonparametric Mann Whitney U-test were used for statistical analysis, and multivariate Logistic regression was used to analyze the influencing factors of scoliosis.@*Results@#The on the spot detection rate of scoliosis abnormality was 7.4% and the prevalence was 2.2%, mainly for thoracolumbar scoliosis (60.4%) and the scoliosis angle of 10° -<20°(88.1%). The results showed that the detection rate of scoliosis in boys was 1.6% and in girls was 3.3%, with a statistically significant difference ( χ 2=11.84, P < 0.01). There were significant differences in weight and BMI between scoliosis students and students with negative initial screening( t = -3.77, -5.30, P <0.01). And there was a statistically significant difference in the detection rate of scoliosis with different frequency of classroom seating arrangements ( Z =2.02, P <0.05). The results of multivariate Logistic regression showed that the risk of scoliosis in girls was higher than that in boys ( OR =1.87, 95% CI =1.21-2.88). BMI ( OR =0.89, 95% CI =0.83-0.95) and frequency of classroom seating arrangements ( OR =0.49, 95% CI =0.25-0.93) were correlated with lower rate of scoliosis. After stratification by sex, the frequency of classroom seating arrangements ( OR =0.26, 95% CI =0.10-0.67) in boys and the educational stage ( OR =2.35, 95% CI =1.26-4.41) in girls ( P <0.05) was correlated with higher rate of scoliosis, while BMI ( OR =0.86, 95% CI =0.79-0.94) in girls were correlated with lower rate of scoliosis.@*Conclusion@#Regular screening of scoliosis is an effective method for early detection of scoliosis. Girls in junior high school and low BMI should be paid close attention to. According to the occurrence and influencing factors of scoliosis, comprehensive prevention and control based on family, school, society, and other aspects can be carried out.

Model for screening adult congenital heart disease surgery eligibility with echocardiography parameters.

OBJECTIVES: This study aimed to screen for the eligibility of correction in cases of adult congenital heart disease (CHD). Pulmonary to systemic flow ratios (Qp/Qs) > 1.5 and pulmonary to systemic vascular resistance ratios (Rp/Rs) < 1/3, acquired by right heart catheterization (RHC), are two essential parameters. Nonetheless, performing RHC at every follow-up is impractical and even harmful. Thus, it is important to establish a model to predict Qp/Qs and Rp/Rs status before a RHC confirmation, using echocardiography parameters. METHODS: A total of 1,785 patients with adult CHD were enrolled and randomly assigned to the derivation or validation groups. Echocardiogram parameters of the 974 patients in the derivation group were considered candidate predictors for surgery eligibility (Qp/Qs > 1.5 and Rp/Rs < 1/3). Binary logistic regression analyses were performed to identify the independent predictors and establish a scoring system. The scoring system was further examined in the validation group using a receiver operating characteristic (ROC) analysis. RESULTS: Estimated pulmonary artery systolic pressure, velocity through the pulmonary valve, and diameters of the left and right atria were identified as independent predictors. The area under the ROC curve of the predictive value in the validation group and its pre- and post-tricuspid valve malformation subgroups were 0.87 (95% confidence interval [CI]: 0.84-0.90, p < 0.01), 0.86 (95% CI: 0.82-0.91, p < 0.01), and 0.85 (95% CI: 0.79-0.90, p < 0.01), respectively. CONCLUSIONS: This scoring system could augment flexibility and convenience for pre-screening CHD patients' eligibility for surgery, before RHC.

Associations of habitual fish oil use with risk of SARS-CoV-2 infection and COVID-19-related outcomes in UK: national population based cohort study

ObjectivesTo prospectively investigate the associations of habitual fish oil use with Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, hospital admission, or mortality with Corona Virus Disease-19 (COVID-19) in a large-scale cohort. DesignProspective population-based cohort study. SettingUK Biobank. ParticipantsA total of 110 440 participants aged 37 -73 years who completed a questionnaire on supplement use, which included fish oil at baseline were enrolled between 2006 and 2010 and followed up until 2022. Main exposureAll participants filled out questionnaires about the habitual use of supplements, including fish oil. Main outcome measuresSARS-CoV-2 infection, COVID-19 hospital admission and COVID-19 mortality. ResultsAt baseline, 29 424 (26.6%) of the 110 440 participants reported habitual use of fish oil supplements. The multivariable adjusted hazard ratios for habitual users of fish oil versus non-users were 0.95 (0.93 to 0.98) for SARS-CoV-2 infection among participants with follow-up time less than 12.1 years but no significant associations were observed for participants with follow-up time more than 12.1 years. For COVID-19-related outcomes, the hazard ratios were 0.79 (95% confidence interval 0.71 to 0.88) for COVID-19 hospital admission and 0.72 (0.60 to 0.87) for COVID-19 mortality. For COVID-19-related outcomes, the association seemed to be stronger among those with longstanding illness. The Cox proportional hazard analysis after propensity-score matching yielded consistent results. ConclusionsHabitual fish oil supplement is associated with a lower risk of hospital admission and mortality with COVID-19, but not associated with SARS-CoV-2 infection in the population with more than 12.1 years of follow-up.

Associations of habitual glucosamine use with SARS-CoV-2 infection and hospital admission and death with COVID-19: Evidence from a large population based cohort study

ObjectivesTo assess the association of habitual glucosamine use with coronavirus 2 (SARS-CoV-2) infection, hospital admission, or mortality with Corona Virus Disease-19 (COVID-19) in a large population based cohort. DesignPopulation based, prospective cohort study. SettingUK Biobank. ParticipantsParticipants with complete information on habitual glucosamine use and SARS-CoV-2 infection or COVID-19-related outcomes were included. These participants were registered from 2006 to 2010, followed up until 2022 and participated in SARS-CoV-2 tests between 2020 and 2022. Main outcome measuresSARS-CoV-2 infection, COVID-19 hospital admission, and COVID-19 mortality. ResultsAt baseline, 20,118 (15.9%) of the 126,518 participants reported as habitual glucosamine users. During the median follow-up 12.16 years, there were 53,682 cases of SARS-CoV-2 infection, 2,120 cases of COVID-19 hospital admission and 548 cases of COVID-19 mortality. The multivariate adjusted hazard ratios of habitual glucosamine users to non-users were 1.02 (95% confidence interval [CI] 0.99 to 1.05) for SARS-CoV-2 infection, 0.73 (95% CI 0.63 to 0.85) for COVID-19 hospital admission, and 0.74 (95% CI 0.56 to 0.98) for COVID-19 mortality. The Cox proportional hazard analysis after propensity-score matching yielded consistent results. ConclusionsHabitual glucosamine use seems to be associated with a lower risk of hospital admission and mortality with COVID-19, but not the risk of SARS-CoV-2 infection.

Associations of proton pump inhibitors with susceptibility to pneumonia, influenza, and COVID-19: evidence from a large population based cohort study

ObjectiveConcerns have been raised about the widespread use of proton pump inhibitors (PPIs), and current findings linking the regular use of PPIs to respiratory infections remain inconsistent. Our study aims to evaluate whether PPI use increases the risk of pneumonia, influenza, and COVID-19. MethodThe presented study included 160,923 eligible participants from the UK Biobank (mean age 56.5 years, 53% women). Cox proportional hazards regression and propensity score-matching analyses were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). Effect modifications by stratifications, including indications and CYP2C19 phenotypes were tested. ResultsThe regular use of PPIs was associated with increased risks of developing pneumonia (hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.26-1.59) and influenza (HR 1.31, 95% CI 1.11-1.55). However, the risk of COVID-19 infection among regular PPI users was not significantly increased (HR 1.05, 95% CI 0.95-1.16). The burden was more notably observed in patients without indications of PPI use (HR 1.52, 95% CI 1.33-1.73 for pneumonia; HR 1.36, 95% CI 1.12-1.64 for influenza). The risk for pneumonia was higher among the CYP2C19 rapid and ultrarapid metabolizers (HR 1.45, 95% CI 1.22-1.73, P for interaction < 0.001). The propensity score-matching analyses yielded similar trends. ConclusionsThe regular use of PPIs is associated with increased susceptibility to pneumonia and influenza, but not COVID-19 infection. The risks are even higher among recipients without main indications. Our study highlights the appropriate use and de-prescribing of PPIs according to indications and CYP2C19 phenotypes for patients and clinical practitioners. What is already known on this topicO_LIProton pump inhibitors (PPIs) have been extensively used in clinical practice, while emerging studies suggest the adverse effects associated with their long-term use. C_LIO_LIThe linkage between PPIs and respiratory infections has been indicated, whereas controversy remains. C_LI What this study addsO_LIIn the large cohort involving 160,923 individuals, regular use of PPIs was associated with 42% and 31% increased risks of pneumonia and influenza, respectively, but not COVID-19 infection. C_LIO_LIThe burdens were more evident among PPI users without main indications, and CYP2C19 rapid and ultrarapid metabolizers. C_LI How this study might affect research, practice or policyO_LIConsidering the potential risk of respiratory infections, appropriate use following indications and metabolic phenotypes, as well as de-prescribing of PPIs are highlighted. C_LI

Trends of smoking and drinking behaviors among adolescents in Shanghai from 2004 to 2019 / 中国学校卫生

Objective@#To analyze the trends of smoking and drinking behaviors among adolescents in Shanghai from 2004 to 2019, and to provide theoretical evidence for effective tobacco and alcohol interventions among adolescents.@*Methods@#Data regarding smoking and drinking behaviors from adolescent health risk behavior surveillance program in Shanghai from 2004 to 2019 were collected, and the prevalence of ever smoking, current smoking, ever drinking and current drinking were comparatively analyzed.@*Results@#The prevalence of ever smoking, current smoking, ever drinking and current drinking among boys were significantly higher than those among girls in 2004 to 2019( χ 2=58.20-347.44, P <0.01). Except the prevalence of ever drinking in 2012, the prevalence of ever smoking, current smoking, ever drinking and current drinking in vocational school students were the highest in each survey( χ 2=111.19-1 196.61, P <0.01). From 2004 to 2019, the standardized rates of smoking and drinking of boys and girls showed a downward trend ( APC =-6.20--1.80, P <0.05). The standardized ever smoking rate and the standardized ever drinking rate of both boys and girls declined significantly from 2004 to 2019（ APC=-5.00, -1.80, P ＜0.05）. The overall standardized rate of ever smoking decreased from 21.02% in 2004 to 12.23% in 2019, and that of ever drinking decreased from 60.52% in 2004 to 47.17 % in 2019）. However, the overall standardized rates of current smoking and current drinking did not reach statistically significance（ P >0.05）.@*Conclusion@#From 2014 to 2019,the prevalence of ever smoking and ever drinking among adolescents in Shanghai over the observed period showed a declining trend by years, but there was no significant change in current smoking and current drinking among adolescents. Specific interventions targeting on smoking and drinking behaviors among adolescents need to be strengthened.

Trends in the prevalence of Internet addiction among adolescents from 2004 to 2019 in Shanghai / 中国学校卫生

Objective@#To analyze the trends of Internet addiction among adolescents in Shanghai, so as to provide theoretical evidence for the prevention and control of Internet addiction in adolescents.@*Methods@#A multistage stratified cluster random sampling method was conducted, and 92 171 junior and senior high school students in Shanghai were selected for questionnaire survey in 2004-2019. Evaluation of Internet addiction, loneliness, academic pressure and depression among middle school students.@*Results@#In 2004-2019, the rate of Internet addiction among middle school students in Shanghai was 4.3%, which without significant differences by year( t =1.8, P >0.05). The detection rate of Internet addiction in boys (5.3%) was higher than that in girls (3.4%) ( χ 2=186.8, P <0.01), and was highest in secondary vocational school (7.7%), followed by senior high school (4.6%) and junior middle school students (2.8%) ( χ 2=746.5, P <0.01). The prevalence of Internet addiction in girls, senior high school students, secondary vocational school students, students aged 16-20, students with loneliness or high academic pressure showed an increasing trend in 2004-2019, with the average annual increase rate ( APC ) of 6.62%, 5.45%, 2.13%, 3.36%, 4.09% and 3.60% respectively ( P <0.05).@*Conclusion@#Internet addiction among adolescents in Shanghai showed an increasing trend in some groups from 2004-2019, but without significant differences by year in the overall groups. Comprehensive prevention and control programs are needed for adolescent Internet addiction, especially for those with mental health problems.

Carcinoembryonic antigen levels are increased with pulmonary output in pulmonary hypertension due to congenital heart disease.

OBJECTIVE: Pulmonary artery hypertension (PAH) is a severe complication of congenital heart disease (CHD). Monitoring of pulmonary arterial pressure (PAP) and pulmonary vascular resistance (PVR) is essential during follow-up. This retrospective study aimed to examine carcinoembryonic antigen (CEA) as an additional marker for evaluation by investigating the correlation between CEA levels and hemodynamics in CHD-PAH. METHODS: Seventy-six patients with CHD-PAH (mean PAP [mPAP] >25 mmHg and PVR >3 Wood units, group A), 71 patients with CHD and pulmonary hypertension (CHD-PH, mPAP >25 mmHg and PVR ≤3 Wood units, group B), and 102 patients with CHD without PH (mPAP ≤25 mmHg, group C) were enrolled. Serum CEA levels and the relationships between CEA levels and hemodynamic data were assessed. RESULTS: Mean serum CEA levels were 1.99±1.61, 2.44±1.82, and 1.58±1.07 ng/mL, mPAP was 58.66±20.21, 30.2±4.83, and 17.31±4.51 mmHg, and PVR was 10.12±7.01, 2.19±0.56, and 2.2±1.1 Wood units in groups A, B, and C, respectively. Mean pulmonary output (PO) was 7.24±3.07, 15.79±5.49, 10.18±4.72 L/minute, respectively. CEA levels were positively correlated with PO and negatively correlated with PVR in all of the patients. CONCLUSION: CEA levels are increased with PO and decreased with PVR in CHD-PH.

Serum uric acid is associated with disease severity and an important predictor for clinical outcome in patients with pulmonary hypertension / 中华心血管病杂志

Objective@#The growing body of literature showed a link between uric acid and pulmonary hypertension (PH), but the impact of hyperuremia on outcome of patients with PH has not been well defined. Therefore, the present study was performed to analyze the impact of uric acid on outcome of PH patients.@*Methods@#One hundred seventy-three PH patients (112 females, mean age 38 years old), who were hospitalized in our department between January 2010 and December 2015, were included in our study, the PH diagnosis was made based on right heart catheterization examination result (mean pulmonary artery pressure≥25 mmHg(1 mmHg=0.133 kPa)). PH patients were divided into mild to moderate PH group (Rp/Rs≤0.6, n=97) and severe PH group (Rp/Rs>0.6, n=76). Fifty-one patients (33 females, mean age 45 years old) without PH based on right heart catheterization were included as control subjects. All participants were followed up for a median of 24 months(6-71 months). Clinical endpoints were defined as cardiogenic death or heart-and-lung transplantation.@*Results@#Uric acid was positively correlated with pulmonary vascular resistance(r=0.398, P<0.01), systemic vascular resistance(r=0.244, P<0.01) and mean right atrial pressure (r=0.26, P<0.01), and was negatively correlated with cardiac index(r=-0.278, P<0.01)and mixed venous oxygen saturation (r=-0.322, P<0.01)in PH patients. Serum uric acid level was significantly higher in patients with severe PH than in patients with mild-to-moderate PH and the control subjects (both P<0.05). According to the receiver operating characteristic curve (ROC), 425.5 μmol/L was found to be the best cut-off value of serum uric acid level to predict the outcome of PH patients (sensitivity 50%, specificity 72%). During follow-up, patients with higher level of uric acid (>425.5 μmol/L) were linked with poorer clinical outcome compared to patients with uric acid <425.5 μmol/L(P=0.027).@*Conclusion@#Our findings suggests that uric acid is associated with the severity of PH and higher uric acid level serves as an important predictor for poor clinical outcome of PH patients.