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SummaryBackground: Pregnancy is associated with marked alteration in cardiovascular hemodynamics. Recent reports have characterized the effects on cardiac systolic function. Little has been written on the influences of loading conditions on Doppler measures of diastolic function during pregnancy.Hypothesis: Stage of pregnancy has an impact on Doppler indices of diastolic function independent of loading conditions, systolic function, and heart rate.Method: Thirty healthy women were prospectively evaluated by serial echocardiography and Doppler examinations at six time periods: 10-12, 18-20, 28-30, 36-38 weeks gestation, 2-4 and 12-14 weeks postpartum. The related effects on indices of diastolic function and its interaction with load, heart rate, mass, and systolic function were determined.Results: Compared with the nonpregnant state, early (E) velocity increased (0.7 ± 0.1-0.9 ± 0.1 m/s, p = 0.0001), peaking at 18 weeks and returning to normal levels during late pregnancy. Atrial phase (A) velocity peaked at 18 weeks (0.48 ± 0.12-0.60 ± 0.13 m/s, p = 0.0001), remaining high throughout the rest of pregnancy. Consequently, the E/A ratio fell significantly during late pregnancy, from 1.9 ± 0.4 to 1.4 ± 0.3 (p = 0.02). In addition, mean acceleration was significantly increased in early pregnancy with a peak at 18 weeks (7.4 ± 1.3 m/s 2 ), returning to nonpregnant level at term (5.7 ± 1.4 m/s 2 , p = 0.0001). Generalized estimating equation using multivariate regression analysis demonstrated that rising heart rate and stroke volume index had an independent effect on A velocity, and that contractility and preload had an independent effect

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Retaining subjects from disadvantaged populations in long-term studies is necessary to obtain high-quality data. This article presents cumulative retention rates from a 5-year prospective cohort study, the Pediatric Pulmonary and Cardiovascular Complications of Vertically Transmitted HIV Infection study. It also presents results of a cross-sectional qualitative survey about factors that induced caregivers to stay in the study. Although the repeated study visits were long and uncomfortable, cumulative retention among the 298 HIV-infected children was 80%. Incentives considered important by the caregivers included phone contact with nurse coordinators, nurse coordinators accompanying the caregiver and child during visits, phone reminders for appointments, help with scheduling, meals and transportation, access to health care, and relationships with staff. Thus, the high follow-up rate was in part due to nurses' efforts to reduce the study's burden on the families, provide tangible and intangible incentives, and establish personal relationships with families.

<b>Objective: </b>Type 2 diabetes (T2D) is a leading cause of end stage kidney disease (ESKD) worldwide. Recent studies suggest a more aggressive clinical course of diabetic kidney disease (DKD) in youth-onset than adult-onset T2D. We compared kidney structural lesions in youth- and adult-onset T2D to determine if youth-onset was associated with greater early tissue injury.<b></b> <p><b> </b></p> <p><b>Methods: </b>Quantitative microscopy was performed on kidney tissue obtained from research kidney biopsies in 161 Pima Indians (117 women, 44 men) with T2D. Onset of T2D was established by serial oral glucose tolerance testing and participants were stratified as youth-onset (<25 years) or adult-onset (≥25 years). Associations between clinical and morphometric parameters and age of onset were tested using linear models.<b></b></p> <p><b> </b></p> <p><b>Results: </b>At biopsy, the 52 participants with youth-onset T2D were younger than the 109 with adult-onset T2D (39.1±9.9 <i>vs.</i> 51.4±10.2 years, <i>p</i><0.0001), but their diabetes duration was similar (19.3±8.1 <i>vs.</i> 17.0±7.8 years, <i>p</i>=0.09). Median urine albumin-to-creatinine ratio was higher in the youth-onset group (58 [25^th-75^th percentile, 17-470] <i>vs.</i> 27 [13-73] mg/g, <i>p</i>=0.02). Youth-onset participants had greater glomerular basement membrane (GBM) width (552±128 nm <i>vs.</i> 490±114nm, <i>p</i>=0.002) and mesangial fractional volume (0.31±0.10 <i>vs</i>. 0.27±0.08, <i>p</i>=0.001) than adult-onset participants. Percentage glomerular sclerosis, glomerular volume, mesangial fractional volume, and GBM width were also inversely associated with age of diabetes onset as a continuous variable.<b></b></p> <p><b> </b></p> <p><b>Conclusion: </b>Younger age of T2D onset strongly associates with more severe kidney structural lesions. Studies are underway to elucidate the pathways underlying these associations.</p>

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The P 2 C 2 HIV Study is a prospective natural history study initiated by the National Heart, Lung, and Blood Institute in order to describe the types and incidence of cardiovascular and pulmonary disorders that occur in children with vertically transmitted HIV infection (i.e., transmitted from mother to child in utero or perinatally). This article describes the study design and methods. Patients were recruited from five clinical centers in the United States. The cohort is composed of 205 infants and children enrolled after 28 days of age (Group I) and 612 fetuses and infants of HIV-infected mothers, enrolled prenatally (73%) or postnatally at age <28 days (Group II). The maternal-to-infant transmission rate in Group II was 17%. The HIV-negative infants in Group II (Group IIb) serves as a control group for the HIV-infected children (Group IIa). The cohort is followed at specified intervals for clinical examination, cardiac, pulmonary, immunologic, and infectious studies and for intercurrent illnesses. In Group IIa, the cumulative loss-to-follow-up rate at 3 years was 10.5%, and the 3-year cumulative mortality rate was 24.9%. The findings will be relevant to clinical and epidemiologic aspects of HIV infection in children.