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Helicobacter pylori (H. pylori) infection is the major cause of chronic active gastritis and peptic ulcer disease. Upregulation of IL-17A is associated with H. pylori infection in the gastric mucosa; however, the factors involved in the regulation of interleukin (IL)-17A-induced inflammatory responses in H. pylori-associated gastritis remain unknown. MicroRNAs (miRNAs) serve as key post-transcriptional regulators of gene expression and are associated with the H. pylori infection. The present study aimed to analyze the effects of IL-17A on the expression of miR-146a upon infection with H. pylori, as well as to identify the possible impact of miR-146a dysregulation on the inflammatory response in vivo and in vitro. Reverse transcription-quantitative polymerase chain reaction analysis was used to determine the expression levels of miR-146a in gastric epithelial cells upon IL-17A stimulation. The effects of miR-146a mimics on IL-17A-induced inflammatory responses in SGC-7901 cells were evaluated. The effects of miR-146a mimics on the expression levels of IL-1 receptor-associated kinase 1 (IRAK1) and tumor necrosis factor receptor-associated factor 6 (TRAF6) upon IL-17A treatment were analyzed, and the IL-17A-stimulated inflammation following the silencing of IRAK1 and TRAF6 was observed. In addition, the correlation between miR-146a and IL-17A in human gastric mucosa with H. pylori was examined. The results indicated that IL-17A-induced miR-146a may regulate the inflammatory response during the infection of H. pylori in a nuclear factor-κB-dependent manner. Furthermore, the expression of miR-146a and IL-17A are positively correlated in human gastric mucosa infected with H. pylori. These data suggested that miR-146a may serve as a biomarker or therapeutic target in gastritis therapy.

ObjectiveTo explore the clinical value of low-dose prospectively electrocardiogram-gated axial dual-source CT angiography (low-dose PGA scanning, CTA) in patients with pulsatile bilateral bidirectional Glenn shunt (bBDG) as an alternative noninvasive method for postoperative morphological estimation.MethodsTwenty patients with pulsatile bBDG (mean age 4.2±1.6 years) underwent both low-dose PGA scanning and conventional cardiac angiography (CCA) for the morphological changes. The morphological evaluation included the anatomy of superior vena cava (SVC) and pulmonary artery (PA), the anastomotic location, thrombosis, aorto-pulmonary collateral circulation, pulmonary arteriovenous malformations, etc. Objective and subjective image quality was assessed. Bland–Altman analysis and linear regression analyses were used to evaluate the correlation on measurements between CTA and CCA. Effective radiation dose of both modalities was calculated.ResultsThe CT attenuation value of bilateral SVC and PA was higher than 300 HU. The average subjective image quality score was 4.05±0.69. The morphology of bilateral SVC and PA was displayed completely and intuitively by CTA images. There were 24 SVC above PA and 15 SVC beside PA. Thrombosis was found in 1 patient. Collateral vessels were detected in 13 patients. No pulmonary arteriovenous malformation was found in our study. A strong correlation (R2>0.8, P<0.001) was observed between the measurements on CTA images and on CCA images. Bland–Altman analysis demonstrated a systematic overestimation of the measurements by CTA (the mean value of bias>0).The mean effective dose of CTA and CCA was 0.50±0.17 mSv and 4.85±1.34 mSv respectively.ConclusionCT angiography with a low-dose PGA scanning is an accurate and reliable noninvasive examination in the assessment of morphological changes in patients with pulsatile bBDG.

To accurately assess the hemolysis risk of the ventricular assist device, this paper proposed a cell destruction model and the corresponding evaluation parameters based on multiphase flow. The single-phase flow and multiphase flow in two patient-specific total cavopulmonary connection structures assisted by a rotationally symmetric blood pump (pump-TCPC) were simulated. Then, single-phase and multiphase cell destruction models were used to evaluate the hemolysis risk. The results of both cell destruction models indicated that the hemolysis risk in the straight pump-TCPC model was lower than that in the curved pump-TCPC model. However, the average and maximum values of the multiphase flow blood damage index (mBDI) were smaller than those of the single-phase flow blood damage index (BDI), but the average and maximum values of the multiphase flow particle residence time (mPRT) were larger than those of the single-phase flow particle residence time (PRT). This study proved that the multiphase flow method can be used to simulate the mechanical behavior of red blood cells (RBCs) and white blood cells (WBCs) in a complex flow field and the multiphase flow cell destruction model had smaller estimates of the impact shear stress.

The effect of additional pulmonary blood flow (APBF) on the hemodynamics of bilateral bidirectional Glenn (BBDG) connection was marginally discussed in previous studies. This study assessed this effect using patient-specific numerical simulation. A 15-year-old female patient who underwent BBDG was enrolled in this study. Patient-specific anatomy, flow waveforms, and pressure tracings were obtained using computed tomography, Doppler ultrasound technology, and catheterization, respectively. Computational fluid dynamic simulations were performed to assess flow field and derived hemodynamic metrics of the BBDG connection with various APBF. APBF showed noticeable effects on the hemodynamics of the BBDG connection. It suppressed flow mixing in the connection, which resulted in a more antegrade flow structure. Also, as the APBF rate increases, both power loss and reflux in superior venae cavae (SVCs) monotonically increases while the flow ratio of the right to the left pulmonary artery (RPA/LPA) monotonically decreases. However, a non-monotonic relationship was observed between the APBF rate and indexed power loss. A high APBF rate may result in a good flow ratio of RPA/LPA but with the side effect of bad power loss and remarkable reflux in SVCs, and vice versa. A moderate APBF rate could be favourable because it leads to an optimal indexed power loss and achieves the acceptable flow ratio of RPA/LPA without causing severe power loss and reflux in SVCs. These findings suggest that patient-specific numerical simulation should be used to assist clinicians in determining an appropriate APBF rate based on desired outcomes on a patient-specific basis.

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Objective Several authors have detailed their experiences with small cohorts of patients in light of expanding interest in using minimally invasive surgery (MIS) to treat tetralogy of Fallot (ToF). The goal of this study was to review an innovative MIS technique that results in a small tube-free surgical field. The technique clinical outcomes were examined in the largest cohort to date of patients with ToF treated with an MIS technique. Methods We reviewed all patients who underwent MIS at a single center between 2013 and 2017. The MIS procedure (including establishment of cavopulmonary bypass) is described. The inter-, peri- and postoperative data are reported and compared with those in the contemporary literature on ToF MIS. Results A total of 105 patients with ToF were identified. All patients, including 2 under 6 months of age, had good postoperative oxygen saturation (99% [98-100]). The incision size was 3 mm for patients younger than 3 years and 3-5 mm for older patients. No conversions to sternotomy or reinterventions were needed. Postoperative complications occurred in 14 patients (13.3%), including 1 death in the intensive care unit, which was not felt to be cardiac in origin. The primary hospital course metrics were comparable to previously published data. Conclusions The MIS technique with a tube-free surgical field has been successfully performed in 105 patients. The overall outcomes are favorable, including those for 2 patients younger than 6 months. This innovative MIS could be a promising approach for facilitating ToF repair in patients of all ages.

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