Objective: To explore the value of metagenomic next-generation sequencing (mNGS) and culture in microbial diagnosis of patients with acute infection. Methods: We retrospectively analyzed 206 specimens from 163 patients who were admitted to the emergency department of The First Affiliated Hospital of Sun Yat-sen University between July 2020, and July 2021. We evaluated the diagnostic efficacy of mNGS and in-hospital traditional culture. Results: The total positive rate of mNGS was significantly higher than that culture methods (71.4 % vs 40.8 %, p < 0.001), while the sensitivity and accuracy of mNGS were found to be 92.9 % and 88.2 % respectively. However, culture exhibited superior specificity with a value of 92.6 % compared to 75.9 % for mNGS. The detection efficiency of mNGS and culture for fungi was comparable, but mNGS showed superior performance for bacterial detection. In the analysis of sepsis samples, mNGS outperformed traditional culture methods in diagnosing various types of samples, especially for sputum and bronchoalveolar lavage fluid. Among the identified infections, bacterial infections were the most common single infection (37.5 %). Additionally, bacterialfungal infections represented the most prevalent form of mixed infection (77.3 %). Candida albicans and Staphylococcus aureus were identified as the predominant pathogens in the survival and death groups, respectively. No significant differences in microbial diversity were observed. Conclusion: Compared to culture methods, mNGS demonstrates superior positive rates, sensitivity, and accuracy in the rapid detection of acute infections, particularly in critically ill patients such as those with sepsis. This capability establishes a foundation for the swift and precise identification of pathogens, allowing for the analysis of clinical indicators and patient prognosis based on the extensive data generated from mNGS.

Abstract AIM Acute lung injury in sepsis is a life-threatening clinical problem with high mortality and few treatment options, posing a significant challenge for clinicians. Powerful anti-inflammatory anthraquinone derivative dialcerhein (DIA) has numerous targets. The objective of this investigation is to ascertain whether DIA and potential molecular targets can protect mice against sepsis-induced deteriorate of the pulmonary vascular endothelial barrier. METHODS Cecal ligation and puncture (CLP) was used to induce sepsis in mice, followed by DIA administration. Survival rate, serum biochemical indicators and advanced glycation end products (AGEs), pulmonary vascular endothelial barrier function, glucose tolerance, and protein expression in lung tissue were all studied using molecular and biochemical approaches. RESULTS In septic mice lung tissue, DIA therapy normalized CLP-induced survival rate, vascular hyperpermeability, pulmonary vascular endothelial barrier dysfunction, inflammatory response, insulin tolerance test, AGEs level, and VE-cadherin phosphorylation level. Furthermore, AGEs and Scr interventions could greatly impair the therapeutic efficacy of DIA. CONCLUSION In this study, DIA alleviated pulmonary vascular endothelial barrier dysfunction in septic mice by regulating inflammation and lowering insulin resistance through AGEs inhibition. These findings showed that DIA could be a potential therapeutic for sepsis patients.

Left bundle branch pacing (LBBP) has emerged as a novel physiological pacing method to produce narrower QRS duration, but whether it could restore mechanical synchrony and improve myocardial work still lacks sufficient evidence. Therefore, the goal of this study was to evaluate mechanical synchrony and myocardial work in LBBP. We collected 20 patients with LBBP due to symptomatic bradycardia and another 29 age-matched patients with right ventricular pacing (RVP). For LBBP patients, cardiac electro-mechanical synchrony and myocardial work were measured at baseline and 7 days after implantation and compared with the RVP patients. In the LBBP group, paced QRS duration and mechanical synchrony were not significantly different from baseline(all P > 0.05), but significantly smaller than that in the RVP group (all P<0.05). Meanwhile, global longitudinal strain (GLS) in LBBP was greater than that in the RVP group (17.7 ± 3.5

Trichinella spiralis represents an effective treatment for autoimmune and inflammatory diseases. The effects of recombinant T. spiralis (TS) 53-kDa protein (rTsP53) on acute lung injury (ALI) remain unclear. Here, mice were divided randomly into a control group, LPS group, and rTsP53 + LPS group. ALI was induced in BALB/c mice by LPS (10 mg/kg) injected via the tail vein. rTsP53 (200 µl; 0.4 μg/μl) was injected subcutaneously three times at an interval of 5 d before inducing ALI in the rTsP53+LPS group. Lung pathological score, the ratio and markers of classic activated macrophages (M1) and alternatively activated macrophages (M2), cytokine profiles in alveolar lavage fluid, and pyroptosis protein expression in lung tissue were investigated. RTsP53 decreased lung pathological score. Furthermore, rTsP53 suppressed inflammation by increasing IL-4, IL-10, and IL-13. There was an increase in alveolar M2 macrophage numbers, with an increase in CD206 and arginase-1-positive cells and a decrease in alveolar M1 markers such as CD197 and iNOS. In addition, the polarization of M2 macrophages induced by rTsP53 treatment could alleviate ALI by suppressing lung pyroptosis. RTsP53 was identified as a potential agent for treating LPS-induced ALI via alleviating lung pyroptosis by promoting M2 macrophage polarization.

BACKGROUND:To investigate the clinical characteristics and risk factors of human immunodeficiency virus (HIV)-negative patients with Talaromyces marneffei (T. marneffei) infection.METHODS:We retrospectively collected the clinical information of HIV-negative patients with T. marneffei infection from January 1, 2010 to June 30, 2019, and analyzed the related risk factors of poor prognosis.RESULTS:Twenty-five cases aging 22 to 79 years were included. Manifestations of T. marneffei infection included fever, cough, dyspnea, chest pain or distress, lymphadenopathy, ear, nose, and throat (ENT) and/or skin lesions, bone or joint pain, edema and pain in the lower extremities, digestive symptoms, icterus, malaise, and hoarseness. Two cases had no comorbidity, while 23 cases suffered from autoimmune disease, pulmonary disease, cancer, and other chronic diseases. Sixteen cases had a medication history of glucocorticoids, chemotherapy or immunosuppressors. Pulmonary lesions included interstitial infiltration, nodules, atelectasis, cavitary lesions, pleural effusion or hydropneumothorax, bronchiectasis, pulmonary fibrosis, pulmonary edema, and consolidation. The incidence of osteolytic lesions was 20%. Eight patients received antifungal monotherapy, and 11 patients received combined antifungal agents. Fifteen patients survived and ten patients were dead. The Cox regression analysis showed that reduced eosinophil counts, higher levels of blood urea nitrogen (BUN), alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactic dehydrogenase (LDH), myoglobin (Mb), procalcitonin (PCT), and galactomannan were related to poor prognosis (hazard ratio [HR]>1, P<0.05).CONCLUSIONS:Bone destruction is common in HIV-negative patients with T. marneffei infection. Defective cell-mediated immunity, active infection, multiple system, and organ damage can be the risk factors of poor prognosis.

目的 观察内皮祖细胞(EPC)在阿尔茨海默病(AD)外周血中的数量及功能,探讨AD潜在的血管机制.方法 选择58例AD患者分为轻度痴呆组19例、中度痴呆组21例和重度痴呆组18例,并以18名无痴呆者作为对照组,采集外周血,分离及培养EPC,采用荧光标记方法评估体外培养EPC数量,同时检测EPC的迁移和黏附功能,分别进行组间EPC数量、迁移和黏附功能的对比.结果 4组外周血EPC数量比较差异无统计学意义(P>0.05).中度痴呆组和重度痴呆组的外周血EPC的迁移和黏附功能均低于轻度痴呆组和无痴呆组(P均<0.05).结论 AD患者的EPC功能下降,导致内皮细胞修复功能降低,这可能与AD的发生发展有关.

目的 探讨经鼻高流量鼻导管湿化氧疗(HFNC)治疗急性呼吸衰竭的临床疗效.方法 收集40例急性呼吸衰竭患者的临床资料,按其氧疗方式分为HFNC组(20例)和鼻导管常规氧疗组(对照组,20例).比较治疗前和治疗24 h时2组患者的心率、呼吸频率、pH值、PaCO2、氧合指数,评价2组的湿化满意率.结果 治疗前,HFNC组和对照组间的心率、呼吸频率、pH值、PaCO2和氧合指数比较差异均无统计学意义(P均>0.05).治疗24 h时,HFNC组患者的心率、呼吸频率、pH值、PaCO2、氧合指数均较治疗前改善,对照组患者的心率、呼吸频率、氧合指数均比治疗前改善(P均<0.05);HFNC组的心率、呼吸频率、pH值、氧合指数均优于对照组(P均<0.05).HFNC组的湿化满意率为90％,高于对照组的25％(χ2=17.289,P<0.001).结论 急性呼吸衰竭患者使用HFNC的效果优于鼻导管常规氧疗.