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Extracorporeal membrane oxygenation (ECMO) has salvaged many people's life during global pandemics. However, ECMO is associated with a high incidence of hemostatic complications. This study aims to explore the effects of the ECMO system on the coagulation system in the healthy ovine ECMO model.Ten healthy male sheep were included. Five received the veno-arterial ECMO and five received the veno-venous ECMO. Heparin was infused for systemic anticoagulation and was adjusted according to the activated clotting time. Blood routine tests, coagulation factors, anticoagulation proteins, and fibrinolysis markers were tested at the baseline and every 24 h. After weaning, the pump heads were dissected to explore thrombosis.Platelets decreased in the first 72 h and returned to the baseline at the 120th hour. The neutrophils increased in the first 24 h and returned to the baseline at the 48th hour. Factors II, VII, and X decreased in the first 24 h and gradually increased, while factors VIII, IX, XI, and XII decreased in the first 24 h and remained at a low level. The baseline antithrombin was 73.2 ± 14.4% and reduced to 42.6 ± 9.9% at the 168th hour. Pathology showed seven sheep developed thrombus, but no clinically relevant bleeding or thrombosis events occurred.The study explored hemostatic alterations during ECMO in healthy animal models, which eliminated the confounding under critically ill conditions. The study may provide insights into ECMO hemostatic disorders and aid the design of optimal therapeutic strategies.

Due to the abundant underground water source, the structure of the valve pool, the non installation of water stop flange in the crossing pipeline and other problems, the leakage disease rate of the valve pool in Tahe oilfield reaches more than 80%. If it is not treated in time, the valves, pipe fittings and other facilities will be rusted, which will affect the normal operation and daily maintenance of the valves and cause serious potential safety hazards. According to the characteristics of the valve pool in Tahe oilfield, XinJiang, the performance and construction technology of different kinds of anti-corrosion materials are studied, and the best anti-corrosion materials are optimized. Through comparative research, it is found that the multi-layer petrolatum coating technology has excellent anti-corrosion performance and simple construction technology, which can completely solve the corrosion problem of the pipe fittings inside the valve pool.

Introduction: Postoperative thrombocytopenia is common in cardiac surgery with cardiopulmonary bypass, and its risk factors are unclear. Methods: This retrospective study enrolled 3,175 adult patients undergoing valve surgeries with cardiopulmonary bypass from January 1, 2017 to December 30, 2018 in our institute. Postoperative thrombocytopenia was defined as the first postoperative platelet count below the 10th quantile in all the enrolled patients. Outcomes between patients with and without postoperative thrombocytopenia were compared. The primary outcome was in-hospital mortality. Risk factors of postoperative thrombocytopenia were assessed by logistic regression analysis. Results: The 10th quantile of all enrolled patients (75×109/L) was defined as the threshold for postoperative thrombocytopenia. In-hospital mortality was comparable between thrombocytopenia and non-thrombocytopenia groups (0.9% vs. 0.6%, P=0.434). Patients in the thrombocytopenia group had higher rate of postoperative blood transfusion (5.9% vs. 3.2%, P=0.014), more chest drainage volume (735 [550-1080] vs. 560 [430-730] ml, P 60 years (odds ratio [OR] 2.25, 95% confidence interval [CI] 1.345-3.765, P=0.002], preoperative thrombocytopenia (OR 18.671, 95% CI 13.649-25.542, P 60 years, small BSA, preoperative thrombocytopenia, and cardiopulmonary bypass time. BSA and isolated mitral valve surgery were negative predictors.

Introduction Patients undergoing total aortic arch replacement (TAAR) usually require blood products perioperatively. This cohort study aimed to investigate the impact of a comprehensive blood conservation program on the major complications in these patients. Methods Patients with traditional or comprehensive blood management intraoperatively from January 2017 to December 2018 were included. We compared the rates of major complications (cerebral vascular accident, acute kidney injury, or mortality) between the two groups after propensity score matching (PSM). The association between blood management and outcomes was assessed by logistic regression. Restricted cubic splines (RCS) were built to evaluate the impact of fresh frozen plasma (FFP) on complications. Patients were stratified by the ratio of FFP/RBC (red blood cell) to investigate the effect of the ratio on complications. Results After 1:1 PSM, 200 patients were selected. 35% (35/100) of patients suffered major complications in the traditional group, while it decreased to 22% (22/100) in the comprehensive management group (OR = 0.524, p = 0.043). Multivariable logistic regression showed that FFP was a risk factor (OR = 1.186, p = 0.014). RCS results indicated that with the increase of FFP, the risk of complications gradually increases. The cut-off value was 402 mL. Patients in the group of ratio = 0 ∼ 0.5 had a higher chance than those without transfusion (OR = 7.487, p < 0.001). Conclusions Comprehensive blood conservation program in patients undergoing TAAR is safe and can reduce the incidence of major complications, which are associated with FFP volume and the ratio of FFP/RBC.

Objectives This study was performed to internally derive and then validate risk score systems using preoperative and intraoperative variables to predict the occurrence of any-stage (stage 1, 2, 3) and stage-3 acute kidney injury (AKI) within seven days of cardiac surgery. Design Single-center, retrospective, observational study. Setting Single, large, tertiary care center. Participants Adult patients undergoing open cardiac surgery between January 1, 2012, and January 1, 2019. Measurements and Main Results The clinical data were divided into the following two groups: a derivation cohort (n = 43,799) and a validation cohort (n = 14,600). AKI was defined using the Kidney Disease: Improving Global Outcomes criteria. Multivariate logistic regression analysis was used to develop the prediction models. The overall prevalence of any-stage AKI and stage-3 AKI after cardiac surgery were 34.3% and 1.7%, respectively. The discriminatory ability of the any-stage AKI prediction model measured with the area under the curve (AUC) was acceptable (AUC = 0.69, 95% confidence interval 0.68-0.69), and the calibration measured with the Hosmer-Lemeshow test was good (p = 0.95). The AUC for the stage-3 AKI prediction model was 0.84 (95% confidence interval 0.83-0.85), and the Hosmer-Lemeshow test also indicated a good calibration (p = 0.73). Conclusions This research study, which used preoperative and intraoperative variables, derived and internally validated two predictive scoring systems for any-stage AKI and stage-3 AKI as defined by modified Kidney Disease: Improving Global Outcomes criteria using a very large cohort of Chinese cardiac surgical patients.

BACKGROUND: To investigate the optimal monoenergetic level of spectral reconstructions in coronary computed tomography angiography (coronary CTA) on a dual-layer spectral detector computed tomography (SDCT) with half-dose contrast media. METHODS: Two hundred patients with suspected coronary artery disease (CAD) were enrolled in this prospective coronary CTA study and randomly divided into a routine-dose contrast media group and a half-dose contrast media group (each n=100). Coronary CTA was performed using SDCT with prospective electrocardiogram (ECG)-gated mode. A tube voltage of 120 kVp was used, along with an automated tube current modulation. A dose of iodixanol 270 mgI/mL of 0.8 and 0.4 mL/kg was administered to the routine and half-dose groups, respectively. For the routine-dose group, 120 kVp polychromatic images with a model-based iterative reconstruction (IMR) (Group A) were reconstructed. For the half-dose group, three monoenergetic levels of images were reconstructed (Group B, 45 keV; Group C, 50 keV; and Group D, 55 keV). Objective indicators [mean CT values; noise; signal-to-noise ratio (SNR); and contrast-to-noise ratio (CNR)] and subjective indicators (contrast, sharpness, subjective noise, and acceptability) in each group were compared. RESULTS: There were no significant differences in demographics or radiation dose (1.83±0.51 vs. 1.80±0.53 mSv, P=0.78) between the routine- and half-dose groups. The average iodine loads were 15.33±2.26 and 7.48±1.14 g, respectively. Mean CT values, SNR, CNR, and subjective contrast in Group C were higher than those in Group A (P0.05). The objective and subjective noise in Group B were worse than those in Group A (P

OBJECTIVES The intestinal injury during deep hypothermic circulatory arrest (DHCA) is harmful to clinical outcomes. Cold-inducible RNA-binding protein (CIRBP) plays a protective role in hypothermia. The aim of this study was to explore the effects of CIRBP on intestinal barrier during DHCA. METHODS Sprague-Dawley (wild type, n = 13) and knockout of Cirbp (Cirbp−/−, n = 8) rats were used in the model of DHCA. The histomorphology of the epithelial barrier was evaluated by haematoxylin–eosin, Chiu’s scores, Gram's stain and Ki67. The function of the intestinal barrier was evaluated by serum intestinal fatty acid-binding protein, diamine oxidase and d-lactate. The structure of the epithelial barrier, phosphocreatine-creatine kinase system and adenosine triphosphate were assessed in the intestine. RESULTS The expression of CIRBP significantly increased in the intestine during DHCA. Cirbp−/− rats showed obvious destruction of intestinal barrier after DHCA. Chiu’s scores, intestinal fatty acid-binding protein, diamine oxidase and d-lactate significantly increased in the Cirbp−/− group. Ki67 showed that cell proliferation decreased in the Cirbp−/− rats. In the Cirbp−/− group, zonula occludens-1, E-cadherin and occludin levels were significantly decreased, and these proteins either disappeared or redistributed in the monolayer. Besides, Cirbp−/− resulted in decreased levels of creatine kinase B, glycine amidinotransferase, adenosine triphosphate and creatine contents in the intestine, affecting energy metabolism and balance, which is associated with the maintenance of epithelial barrier during acute injury. CONCLUSIONS CIRBP is related to the maintenance of the intestinal epithelial barrier during DHCA, which is expected to be a new target for the prevention of intestinal injury.

Introduction Red blood cell (RBC) transfusion is associated with adverse outcomes, but there are few studies on the RBC volume. This study aimed to evaluate the relationship between intraoperative RBC volume and postoperative adverse outcomes for on-pump cardiac surgery. Methods Adult patients undergoing on-pump cardiac surgery from 1 January 2017 to 31 December 2018 were included. Those transfused with more than 6 units of RBC were excluded. The clinical characteristics of four groups with various RBC volume were compared. We analyzed the relationship between RBC volume and adverse outcomes through multivariable logistic regression. Results 12,143 patients were analyzed, of which 3353 (27.6%) were transfused with 1–6U RBC intraoperatively. The incidence of death, overall morbidity, acute kidney injury and prolonged mechanical ventilation were increased stepwise along with incremental RBC volume. After adjusting for possible confounders, patients transfused with 1–2U were associated with a 1.42-fold risk of death (99% CI, 1.21–2.34, p = 0.01) compared with patients without RBC, patients with 3–4U were associated with a 1.57-fold risk (99% CI, 1.32–2.80, p = 0.005) and patients with 5–6U had a 2.26-fold risk of death (99% CI, 1.65–3.88, p < 0.001). Similarly, the incidence of overall morbidity, acute kidney injury and prolonged mechanical ventilation increased several folds as the RBC numbers increased. Conclusions There was a significant dose-dependent influence of incremental intraoperative RBC volume on increased risk of adverse outcomes for on-pump cardiac surgery patients. Patient blood management practice should aim to reduce not only transfusion rate but also the volume of blood use.

Background Glucocorticoids (GC)were applied in total aortic arch replacement (TAAR) at various dosages in many centers, but with limited evidence. Methods The retrospective study was aimed to evaluate whether methylprednisolone was associated with better postoperative outcomes in patients undergoing TAAR. Patients undergoing TAAR with moderate hypothermia and selective cerebral perfusion between 2017.1 to 2018.12 in Fuwai hospital were classified into three groups according to doses of methylprednisolone given in the surgery: large-GC group (1500–3000 mg); medium-GC group (500–1000 mg) and no-GC group (0 mg). Postoperative outcomes were compared among three groups. Multivariable analysis was performed to identify the association of methylprednisolone with outcomes. Results Three hundred twenty-eight patients were enrolled. Two hundred twenty-eight were in the large-GC group, 34 were in the medium-GC group, and 66 were in the no-GC group. The incidences of major adverse outcomes in large-GC, medium-GC and no-GC groups were 22.8%, 17.6% and 18.2%, respectively, with no statistical difference. A significant difference was observed in post-cardiopulmonary bypass (CPB) fresh frozen plasma (FFP) transfusion ( p < .001) and chest drainage volume ( p < .001). Multivariable analysis demonstrated that methylprednisolone was not associated with better outcomes ( p = .455), while large doses of methylprednisolone were significantly associated with excessive chest drainage (over 2000 mL) [OR (99% CI) 4.282 (1.66–11.044), p < .001] and excessive post-CPB FFP transfusion (over 400 mL) [OR (99% CI) 2.208 (1.027–4.747), p = .008]. Conclusions Large doses of methylprednisolone (1500–3000 mg) did not show a protective effect in TAAR with moderate hypothermia arrest plus selective cerebral perfusion and might increase postoperative bleeding and FFP transfusion.

Background: Extracorporeal membrane oxygenation (ECMO) is rapidly becoming a mainstream technology for lung or heart/lung support especially during the COVID-19 pandemic. “Awake ECMO”is frequently used to indicate an alternative approach of using ECMO without invasive mechanical ventilation, and it has the unique advantages of application. In this study, we explored the feasibility and stability of the establishment method and management strategy of long-term awake ECMO model in healthy sheep. As the sheep are healthy, according to the histopathological analysis , we explored the effect of ECMO circuit itself on organs and tissues. As a preclinical study in large animals, our study aims to provide clues for further research on application expansion, management strategy optimization, pathophysiology exploration, equipment development and subsequent establishment of the disease animal model.Methods: Ten healthy sheep were treated with awake veno-arterial (V-A) or veno-venous (V-V) ECMO for 7 days. They were transferred into the monitoring cages after operation and were ambulatory after anesthesia recovery. ECMO configurations, hemodynamic and hematologic parameters were measured every day. Necropsy was conducted at the endpoint of the experiment to visualize the cannula position in vivo and to examine cannulation related injury and thrombus formation in blood vessels and major organs. Main organs and blood vessels were harvested for pathological investigation.Results: All sheep survived to the end of the experiment (the 7th day). In the whole process of the experiment, the vital signs of which were stable, and no serious bleeding and coagulation events occurred. Hemoglobin concentration and platelet count were in normal reference range, plasma free hemoglobin concentration was maintained at a low level. ECMO flow was stable, and oxygenation performance of oxygenator was satisfied. There was no major adverse pathological injury occurred.Conclusions: Long term awake extracorporeal membrane oxygenation model in large animal is feasible and stable. Perioperative management is the key to the success of this model. As a basic research, it can also provide an alternative strategy for mechanical circulatory support in patients with awake ECMO indications.

Introduction: Extracorporeal membrane oxygenation (ECMO) is an imperative short-term cardiopulmonary support device now. We aimed to provide a single-center experience of veno-arterial (V-A) ECMO management and identify the risk factors of in-hospital mortality. Methods: We conducted a retrospective review of adult patients who received V-A ECMO between 2009 and 2019 in a cardiovascular disease center. The risk factor analysis of in-hospital mortality was conducted. Results: The study reviewed 236 patients, with an overall survival rate of 68.2%. The survivors’ blood lactate concentration is significantly lower than non-survivors [7.4 (7.8) vs 11.1 (9.7), p = 0.002]. Patients who received heart transplantation were with higher in-hospital survival rate. Survivors developed less hepatic dysfunction, acute kidney injury and myocardial damage [23 (14.3%) vs 19 (25.3%), p = 0.039; 81 (50.3%) vs 51 (68%), p = 0.011; 24 (14.9%) vs 22 (29.3%), p = 0.009, respectively], with higher rate of continuous renal replacement therapy (CRRT) [56 (34.8%) vs 53 (70.7%), p Conclusions: By providing a general description of V-A ECMO practice at a single-center in China. Post-heart transplant graft failure was associated with numerically, the greatest survival in our practice. Furthermore, female sex, pre-ECMO blood lactate concentration, hyperlipidemia, CRRT, and high blood loss in chest drains are predictors of mortality in patients who undergo V-A ECMO.

Background Prevention, screening, and early treatment are the mainstays of postoperative delirium management. Score system is an objective and effective tool to stratify potential delirium risk for patients undergoing cardiac surgery Methods Patients undergoing cardiac surgery from January 1, 2012, to January 1, 2019, were enrolled in our retrospective study. The patients were divided into a derivation cohort (n = 45,744) and a validation cohort (n = 11,436). The agitated delirium (AD) predictive systems were formulated using multivariate logistic regression analysis at three time points: preoperation, ICU admittance, and 24 hours after ICU admittance. Results The prevalence of AD after cardiac surgery in the whole cohort was 3.6% (2,085/57,180). The dynamic scoring system included preoperative LVEF ≤ 45%, serum creatinine > 100 umol/L, emergency surgery, coronary artery disease, hemorrhage volume > 600 mL, intraoperative platelet or plasma use, and postoperative LVEF ≤ 45%. The area under the receiver operating characteristic curve (AUC) values for AD prediction of 0.68 (preoperative), 0.74 (on the day of ICU admission), and 0.75 (postoperative). The Hosmer-Lemeshow test indicated that the calibration of the preoperative prediction model was poor (P = 0.01), whereas that of the pre- and intraoperative prediction model (P = 0.49) and the pre-, intra- and postoperative prediction model (P = 0.35) was good. Conclusions Using perioperative data, we developed a dynamic scoring system for predicting the risk of AD following cardiac surgery. The dynamic scoring system may improve early recognition of and interventions for AD.

Red blood cell transfusion is common and associated with adverse outcomes for cardiac surgery, while present blood conservation guidelines have not been fully implemented until now. This study evaluated our comprehensive blood conservation program after quality management and explored its impact on blood transfusion and outcomes in patients undergoing cardiopulmonary bypass (CPB).We retrospectively compared blood transfusions and outcomes of patients from 2 different periods, before and after initiation of the quality management of the comprehensive blood conservation program. The comprehensive program included restrictive transfusion protocols, conventional ultrafiltration, cell salvage, residual pump blood ultrafiltration, and a modified minimal extracorporeal circulation system. A 1:1 propensity score matching and subgroup analysis were conducted.There were 3977 pairs. A significant decrease of red blood cell transfusion was observed before vs after the comprehensive blood conservation program during CPB (28.4% vs 18.6%, P.001), in the operation (40.7% vs 34.3%, P.001), and after the operation (6.2% vs 4.3%, P.001). Also reduced were 30-day mortality and some major complications. Subgroup analysis showed that the comprehensive blood conservation program was more beneficial for patients aged60 years, male, and with a medium-risk European System for Cardiac Operative Risk Evaluation (EuroSCORE) of score 3 to 5.The comprehensive blood conservation program during CPB is safe and effective in adult cardiac operations, reducing blood use, with no adverse outcomes. For patients who are older, male, and have a EuroSCORE of 3 to 5, blood transfusion should be more cautious.

OBJECTIVES Conventional cardiopulmonary bypass with gravity drainage leads inevitably to haemodilution. Vacuum-assisted venous drainage (VAVD) utilizes negative pressure in the venous reservoir, allowing active drainage with a shortened venous line to reduce the priming volume. The goal of this study was to analyse the efficacy and safety of VAVD. METHODS Data on 19 687 patients (18 681 with gravity drainage and 1006 with VAVD) who underwent cardiac operations between 1 January 2015 and 31 January 2018 were retrospectively collected from a single centre. Propensity matching identified 1002 matched patient pairs with VAVD and gravity drainage for comparison of blood product transfusion rate, major morbidities and in-hospital mortality rates. RESULTS The blood transfusion rate of the VAVD group was lower than that of the gravity drainage group (28.1% vs 35% for red blood cells, 13% vs 18% for fresh frozen plasma and 0.1% vs 1.8% for platelets; P = 0.0009, 0.0020 and CONCLUSIONS VAVD was associated with a reduction in blood product transfusions, and an increase in the risk of major morbidities and in-hospital deaths of the VAVD group was not observed.

Background Neuroinflammation acts as a contributor to neurologic deficits after deep hypothermic circulatory arrest. However, the molecular mechanism remains unclear. This study postulates that cold-inducible RNA-binding protein can promote deep hypothermic circulatory arrest–induced neuroinflammation. Methods Rats were randomly assigned into 3 groups (n = 5, each group): sham group, deep hypothermic circulatory arrest group, and deep hypothermic circulatory arrest + Cirp−/− group (Cirp−/− group). Murine microglial BV2 cells were administered by adeno-associated viral vectors containing cold-inducible RNA-binding protein small interference RNA or negative control small interference RNA at 2 days before 4-hour oxygen–glucose deprivation at 18°C. Microglial activation, cell death, neuroinflammation, and related protein expression were assessed in tissue samples and cell cultures. Results Cold-inducible RNA-binding protein was elevated along with evident neuroinflammation and neuronal damage in rats exposed to deep hypothermic circulatory arrest. In Cirp−/− rats, histologic injury (3.00 [interquartile range, 2.00-3.00] vs 1.00 [interquartile range, 1.00-1.50] neuropathological score, P Conclusions Enhanced cold-inducible RNA-binding protein in microglia aggravates neuronal injury by promoting the release of proinflammatory cytokines, which might be mediated through Brd2-NF-κB signals during deep hypothermic circulatory arrest.

An intra-aortic balloon pump (IABP) concomitant with venoarterial extracorporeal membrane oxygenation (VA-ECMO) is frequently used to support patients with refractory cardiogenic shock (CS). Because of the lack of evidence of the adjunctive benefit, the goal of the study was to compare the effect of VA-ECMO plus IABP with that of VA-ECMO alone. Systematic searches were conducted to identify studies using PubMed, Embase, the Cochrane Library and the International Clinical Trials Registry Platform. Studies reporting on patients with adult CS treated with VA-ECMO plus IABP or VA-ECMO alone were identified and included. The primary outcome was in-hospital death. The secondary outcomes included neurological, gastrointestinal and limb-related complications. The study protocol was registered at PROSPERO (CRD42017069259). A total of 29 studies comprising 4576 patients were included. The pooled in-hospital deaths of patients on VA-ECMO were 1441/2285 (63.1%) compared with 1339/2291 (58.4%) for patients with adjunctive IABP. VA-ECMO plus IABP was associated with decreased in-hospital deaths [risk ratio (RR) 0.90; 95% confidence interval (CI) 0.85-0.95; P < 0.0001]. Moreover, IABP was related to decreased in-hospital deaths of patients with extracorporeal cardiopulmonary resuscitation, postcardiotomy CS and ischaemic heart disease (RR 0.78; 95% CI 0.64-0.95; P = 0.01; RR 0.91; 95% CI: 0.85-0.98; P = 0.008; RR 0.83; 95% CI 0.73-0.96, P = 0.009). Neurological, gastrointestinal and limb-related complications did not differ significantly between patients on ECMO with and without concurrent IABP. VA-ECMO plus IABP was associated with decreased in-hospital deaths in patients with CS.

The drug resistance of Helicobacter pylori is gradually becoming a serious problem. Biofilm formation is an important factor that leads to multidrug resistance (MDR) in bacteria., The drug resistance of Helicobacter pylori is gradually becoming a serious problem. Biofilm formation is an important factor that leads to multidrug resistance (MDR) in bacteria. The ability of H. pylori to form biofilms on the gastric mucosa is known. However, there are few studies on the regulatory mechanisms of H. pylori biofilm formation and multidrug resistance. Guanosine 3′-diphosphate 5′-triphosphate and guanosine 3′,5′-bispyrophosphate [(p)ppGpp] are global regulatory factors and are synthesized in H. pylori by the bifunctional enzyme SpoT. It has been reported that (p)ppGpp is involved in the biofilm formation and multidrug resistance of various bacteria. In this study, we found that SpoT also plays an important role in H. pylori biofilm formation and multidrug resistance. Therefore, it was necessary to carry out some further studies regarding its regulatory mechanism. Considering that efflux pumps are of great importance in the biofilm formation and multidrug resistance of bacteria, we tried to determine whether efflux pumps controlled by SpoT participate in these activities. We found that Hp1174 (glucose/galactose transporter [gluP]), an efflux pump of the major facilitator superfamily (MFS), is highly expressed in biofilm-forming and multidrug-resistant (MDR) H. pylori strains and is upregulated by SpoT. Through further research, we determined that gluP is involved in H. pylori biofilm formation and multidrug resistance. Furthermore, the average expression level of gluP in the clinical MDR strains (C-MDR) was considerably higher than that in the clinical drug-sensitive strains (C-DSS). Taken together, our results revealed a novel molecular mechanism of H. pylori resistance to multidrug exposure.

We read with great interest the paper by Russo et al. [(1)][1] published in a recent issue of the Journal . The effect of retrograde flow in the aorta toward the left ventricle (LV) in venoarterial extracorporeal membrane oxygenation (VA-ECMO) therapy, which may impact LV function. Russo et al

Clarithromycin (CLA) is a commonly recommended drug for Helicobacter pylori eradication. However, the prevalence of CLA-resistant H. pylori is increasing. Although point mutations in the 23S rRNA are key factors for CLA resistance, other factors, including efflux pumps and regulation genes, are also involved in the resistance of H. pylori to CLA. Guanosine 3′-diphosphate 5′-triphosphate and guanosine 3′,5′-bispyrophosphate [(p)ppGpp)], which are synthesized by the bifunctional enzyme SpoT in H. pylori , play an important role for some bacteria to adapt to antibiotic pressure. Nevertheless, no related research involving H. pylori has been reported. In addition, transporters have been found to be related to bacterial drug resistance. Therefore, this study investigated the function of SpoT in H. pylori resistance to CLA by examining the shifts in the expression of transporters and explored the role of transporters in the CLA resistance of H. pylori . A Δ spoT strain was constructed in this study, and it was shown that SpoT is involved in H. pylori tolerance of CLA by upregulating the transporters HP0939, HP1017, HP0497, and HP0471. This was assessed using a series of molecular and biochemical experiments and a cDNA microarray. Additionally, the knockout of genes hp0939 , hp0471 , and hp0497 in the resistant strains caused a reduction or loss (the latter in the Δ hp0497 strain) of resistance to CLA. Furthermore, the average expression levels of these four transporters in clinical CLA-resistant strains were considerably higher than those in clinical CLA-sensitive strains. Taken together, our results revealed a novel molecular mechanism of H. pylori adaption to CLA stress.

Few previous studies noticed the three bony structures that formed the acetabulum in developmental dysplasia of the hip (DDH). This study aimed at investigating the spatial changes of the peri-acetabular pelvis in developmental dysplasia of the hip through radiological evaluation of the patients and experimental observations in rat models. 115 unilateral DDH patients were studied through 3D-CT. In reconstruction workstation, the iliopubic inner plate angle, ilioischial inner plate angle and ischialpubic inner plate angle were measured and compared. 58 neonatal Wistar rats were divided into two groups and the rats in experiment group were swaddled to establish DDH models. The hips were sectioned, stained. The same three angles were measured and compared. The ilioischial inner plate angle of the affected hip decreased while the ischialpubic inner plate angle increased compared to those of the contralateral side. The iliopubic inner plate angle showed no difference between the affected and unaffected hips. In animal models we observed the same pathological pattern. The three angles measured on the sections showed similar tendency as those in the patients with DDH. The ischium rotates up and forwardly around the posterior and vertical limbs of the triradiate cartilage complex in DDH, just as a lifted piece of Pizza.