Acute respiratory distress syndrome following multiple wasp stings treated with extracorporeal membrane oxygenation: A case report.

BACKGROUND: It is necessary for clinicians to be aware of a rare but possible acute respiratory distress syndrome (ARDS) complication caused by multiple wasp stings. Severe ARDS has a high mortality rate but no specific pharmacotherapies have been identified to date. This case study presents the first case of severe ARDS caused by multiple wasp stings, treated successfully with extracorporeal membrane oxygenation (ECMO). It also emphasizes the effectiveness of early ECMO treatment for severe ARDS with persistent hypoxemia. CASE SUMMARY: A 24-year-old woman was admitted to the emergency department after being stung by more than 10 wasps within a 30-min period, with clinical symptoms of multiple rashes, dizziness, chest tightness, nausea, and vomiting. On the 2nd day of admission, the patient developed progressive dyspnea. The patient was diagnosed with ARDS based on clinical manifestations and lung computed tomography (CT) scan. Because of the progressive dyspnea, the intensive care unit physician performed endotracheal intubation and continued to provide ventilator support, but the patient's respiratory distress worsened, as indicated by the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen. Veno-venous ECMO was initiated for 6 d. On day 7 of admission, ECMO was stopped. On the 11th day of admission, CT scan of the lungs revealed significant reduction of ground-glass opacities and consolidations. After about 2 wk, the patient recovered completely from ARDS and was discharged to home. At the 2-mo follow-up, the patient was in good health with no recurrence of dyspnea nor chest tightness. CONCLUSION: ARDS complication caused by multiple wasp stings may be fatal when mechanical ventilation becomes dangerous due to persistent hypoxemia and despite optimization of ARDS management. We propose that the early implementation of ECMO is a relatively effective treatment, although the evidence is relatively limited.

The diagnostic value of next-generation sequencing technology in sepsis.

Objective: This study aims to assess the clinical utility of next-generation sequencing (NGS) in sepsis diagnosis. Methods: A prospective study was conducted on patients with a high suspicion of sepsis by unknown pathogens from January 2017 to December 2021. Blood samples were taken from patients to perform NGS, blood culture (BC), leucocyte (WBC), procalcitonin (PCT), creatinine (CREA), Albumin (ALB) and C-reactive protein (CRP) tests. Results: The feedback time for BC was 3~5 days for bacteria and 5~7 days for fungi, while the turnover time for NGS was only 24 h. The clinical diagnosis was considered the "gold standard". 83 patients passed our inclusion criteria and were separated into two groups by clinical diagnosis. 62 met the clinical diagnosis criteria for sepsis and 21 were non-sepsis. The data from the two groups were retrospectively compared and analyzed. Of 62 sepsis in 83 patients, 8(9.64%) were diagnosed by both BC and NGS, 51 (61.45%) by NGS only, 1(1.20%) by BC and 2 (2.41%) by conventional testing only; PCT, CREA, CRP levels and the detection rate of NGS and BC were higher in the sepsis group than in the non-sepsis group, while ALB levels were lower (p<0.05). The logistic regression results in our study revealed that NGS and ALB were independent prediction factors for sepsis (p<0.05), the area under the receiver operating characteristic curve (AUC), sensitivity and specificity of NGS for diagnosing sepsis was 0.857, 95.16% and 76.19%, while ALB was 0.728, 58.06%, 80.95%, respectively. The combination's sensitivity, specificity and AUC of NGS and ALB were 93.55%, 85.71% and 0.935, greater than that of Albumin or NGS only (both p<0.05). Conclusion: NGS can effectively and quickly identify pathogens, thereby emerges as a promising technology for sepsis diagnosis. Combination of NGS and ALB can be used for early screening and is more powerful than NGS or ALB only.

Study of a High-Temperature and High-Density Water-Based Drilling Fluid System Based on Non-sulfonated Plant Polymers.

The environment-friendly water-based drilling fluid system developed for the petroleum development industry cannot successfully withstand temperatures up to 180 °C, and most high temperature-resistant additives with sulfonic acid groups that have been successfully applied to water-based drilling fluid are not good for environmental protection. In order to solve the above technical problems, a non-sulfonated filtrate reducer and viscosity reducer with resistance to high temperature were prepared by using humic acid, lignin and a multifunctional monomer as raw materials. In laboratory experiments, the molecular weights of the FLO-H filtrate reducer and the VR-H viscosity reducer were 5.45 × 105 g/mol and 8.51 × 103 g/mol, respectively, and all of them showed good high-temperature resistance. The API filtration loss of the bentonite-base slurry with 3.0 wt% FLO-H was only 6.2 mL, which indicated that FLO-H had a prominent reduction in filtration loss after aging at high temperature. When the dosage of VR-H was 1.0 wt%, the plastic viscosity of the water-based drilling fluid after aging at 200 °C decreased from 71 mPa·s to 55 mPa·s, which provided excellent dispersion and dilution. The high-temperature and high-density water-based drilling fluid containing the FLO-H filtrate reducer and the VR-H viscosity reducer had good suspension stability and low filtration performance at the high temperature of 200 °C, which can meet the requirements of high-temperature deep well drilling.

Case Report: A Candida Meningitis in an Immunocompetent Patient Detected Through the Next-Generation Sequencing.

Background: Fungal infections of the central nervous system (CNS) are not commonly seen clinically. Clinical diagnosis of fungal infections often depend on the pathogen culture and the clinical features. This method is time-consuming and insensitive, which can lead to misdiagnosis. The authors introduce an adult patient with fungal infections diagnosed by next-generation sequencing (NGS). Case: The patient was a 60-year-old male Chinese who had both hypermyotonia of the lower extremities and fever. The auxiliary examinations such as MRI, CT, and cerebrospinal fluid (CSF) analysis showed obvious abnormalities. Because of the difficulties in diagnosis, it was hard to determine the treatment plan. The NGS detected specific sequences of Candida albicans in 3 days. The patient was then treated with liposomal amphotericin B and fluconazole. About 3 weeks later, the symptoms of the patient improved significantly and he was discharged from the hospital. Conclusion: Compared with the routine cultural method, NGS has made a huge advancement in infection diagnosis and targeting antimicrobial therapy for CNS infection.

[A study of the clinical features and the effect of therapy on acute respiratory distress syndrome patients as a result of severe triphosgene poisoning].

OBJECTIVE: To investigate the clinical features and treatment strategy for acute respiratory distress syndrome (ARDS) caused by phosgene. METHODS: Individualized therapy was carried out in 17 cases of severe phosgene poison patients. Blood routine, electrolytes, blood gas analysis, hepatic and renal function tests and cardiac enzymes were examined before and after treatment. RESULTS: Vital signs, fluid, electrolytes and acid-base disturbances were improved after treatment. As compared to that of pre-treatment period, white blood cells [WBC, ×10(9)/L: 12.18 ± 4.76 vs. 21.93 ± 6.21], neutrophil percentage (0.87 ± 0.05 vs. 0.92 ± 0.03), hemoglobin (Hb, g/L: 128.12 ± 25.65 vs. 173.71 ± 23.53), blood platelet count [PLT,×10(9)/L:165.12 ± 31.70 vs. 254.47 ± 70.80], alanine transaminase (ALT, U/L: 70.71 ± 46.70 vs. 212.71 ± 141.34), aspartate aminotransferase (AST, U/L: 52.47 ± 34.68 vs. 82.41 ± 34.60), blood urea nitrogen (BUN, mmol/L: 5.83 ± 4.09 vs. 7.89 ± 5.96), serum creatinine (SCr, µmol/L: 48.13 ± 14.97 vs. 67.25 ± 24.29), lactate dehydrogenase (LDH, U/L: 280.10 ± 81.77 vs. 586.35 ± 186.71), creatine kinase (CK, U/L: 199.12 ± 106.75 vs. 683.00 ± 323.21), MB isoenzyme of creatine kinase (CK-MB, U/L: 26.94 ± 9.13 vs. 45.59 ± 11.21), serum chlorine anion [Cl(-), mmol/L: 95.88 ± 6.06 vs. 102.29 ± 7.28], respiratory rate (RR, beats/min: 20.88 ± 4.30 vs. 30.06 ± 5.78), heart rate (HR, beats/min: 82.76 ± 17.16 vs. 113.35 ± 16.90), blood pH value (7.34 ± 0.44 vs. 7.39 ± 0.03) were all decreased (P < 0.05 or P < 0.01). Serum sodium ion [Na(+),mmol/L:140.61 ± 6.69 vs. 134.06 ± 4.80], arterial partial pressure of oxygen [PO(2), mm Hg, 1 mm Hg = 0.133 kPa: 84.41 ± 30.58 vs. 59.88 ± 15.19] and pulse oxygen saturation [SpO(2): 0.91 ± 0.08 vs. 0.78 ± 0.15] were increased (P < 0.05 or P < 0.01). Sixteen patients totally recovered, 1 patient died, and the cure rate was 94.12%. CONCLUSIONS: Respiratory system could be mainly injured as the result of exposure to phosgene and leading to ARDS. Early initial combination therapies with corticosteroids and respiratory support should be addressed.

[Effect of Xuebijing injection on T helper 17 and CD4+ CD25+ regulatory T cells in patients with sepsis].

OBJECTIVE: To study the level and significance of T helper 17 (Th17) and CD4(+) CD25(+) regulatory T cells (Treg) in peripheral blood of patients with sepsis and to evaluate the effects of Xuebijing injection on them. METHODS: ¹ Sixty-four patients with sepsis in intensive care unit (ICU) of Anhui Provincial Hospital were divided into three groups: sepsis group (n=26), severe sepsis group (n=21), and septic shock group (n=17). Eighteen healthy individuals served as controls. The comparison in the expression of Th17 and CD4(+)CD25(+) Treg within groups and the correlation between their levels and the severity of sepsis was made. ² Sixty-four patients were also randomly divided into two groups: routine group (n=25, received routine bundle treatment) and Xuebijing treatment group (n=39, received bundle treatment + Xuebijing treatment). Patients in Xuebijing treated group were given 50 ml Xuebijing injection two times per day in addition to routine bundle treatment. Seven days constituted one course of treatment. The expressions of Th17 and CD4(+) CD25(+) Treg of 64 patients on the 1 day and 7 days after treatment were detected by flow cytometry. The effects of Xuebijing injection on the patients were evaluated. RESULTS: ¹ The expression rate of Th17 and CD4(+)CD25(+) Treg was (0.84 ± 0.29)% and (0.43 ± 0.20)% respectively in control group, and they were lower than that of patients with sepsis (P<0.05). The expression rate of Th17 was higher in severe sepsis group [(3.18 ± 0.84)%] than that of other two groups (P <0.05). Moreover , The expression rate of CD4(+)CD25(+) Treg was highest [(3.28 ± 0.76)%] in septic shock group (P<0.05) , and it was positive correlated with acute physiology and chronic health evaluation II (APACHEII) score and blood lactate (r(1)=0.519, r(2)=0.451, both P =0.01) in all 64 patients. ² Compared with routine group, our study indicated that Xuebijing injection could reduce the abnormal expression of Th17 [(1.72 ± 0.69)% vs. (2.35 ± 0.81)%,P<0.05] and CD4(+)CD25(+) Treg [(1.78 ± 1.00)% vs. (2.30 ± 0.85)%,P<0.05] and decrease length of stay in ICU [(4.7 ± 2.6) days vs. (7.5 ± 4.3) days,P=0.002]. It also lowered 28-day mortality of patients with sepsis, but the difference between two groups was not significant (20.5% vs. 28.0%,P>0.05). CONCLUSION: The expression of Th17 and CD4(+)CD25(+) Treg was increased in sepsis patients and was positively correlated with severity of sepsis, suggesting that they may play an important role in pathogenesis of sepsis. Xuebijing injection could decrease the abnormal expression of Th17 and CD4(+) CD25(+) Treg and tend to decrease the fatality rate of sepsis.

[Effects of hyperbaric oxygen on T lymphocyte subpopulation and its electron microscopic changes in rats with acute pancreatitis].

OBJECTIVE: To investigate the effect of hyperbaric oxygen (HBO) therapy on T lymphocyte subpopulations in rats with acute pancreatitis (AP). METHODS: According to random number table, 56 Sprague Dawley (SD) rats were divided into three groups: the sham group, model group, and HBO therapy group. The rats of model and HBO groups underwent pancreatic duct ligation to induce pancreatitis, then they were divided into three subgroups of 8 rats each. The HBO group was treated with a daily exposure to HBO [2.5 atm (1 atm=101.325 kPa)]. The rats in each subgroup were euthanased on days 1, 3, 7, and the subpopulations of T lymphocytes in peripheral blood were detected respectively using flow cytometry. The nuclei, mitochondrion, rough and smooth endoplasmic reticulum of the pancreatic cells were examined using electron microscopy. RESULTS: The serum level of amylase on day 1 in model and HBO groups was significantly lower than that in sham group. In the model group the CD4(+)CD8(+) cells and the CD4(+)/CD8(+) ratio in AP rats was significantly decreased, indicating the presence of immune suppression. After 7 days of HBO therapy, compared with the model group, the CD4(+) lymphocytes in the HBO group were markedly increased on day 3 and day 7 [(27.92±2.10)% vs. (20.79±2.80)%, (26.58±4.50)% vs. (17.76±4.40)%]. The number of CD8(+) lymphocytes were also increased to a certain extent on day 7 [(25.32±3.70)% vs. (22.46±3.10)%]. The CD4(+)/CD8(+) ratio was obviously increased on day 3 and day 7 (1.07±0.14 vs. 0.86±0.15, 1.04±0.11 vs. 0.79±0.12, P<0.05 or P <0.01). Also beneficial effects as evaluated on the nuclei, mitochondrion, rough and smooth endoplasmic reticulum were found in the HBO group (10.8±1.6 vs. 17.9±1.7, 22.1±1.6 vs. 27.5±1.3, 16.8±1.0 vs. 29.3±0.8, 21.2±1.4 vs. 28.7±1.2, all P <0.01). CONCLUSION: This study shows that 7-day HBO therapy can promote a more balanced profile of T lymphocyte subpopulations, resulting in improvement of cellular immune function, and it can ameliorate pathological changes as shown by electron microscopic examination.

[Effects of hyperbaric oxygen on the acute lung injury induced by oleic acid in rats].

OBJECTIVE: To explore the effect of hyperbaric oxygen (HBO) on acute lung injury (ALI) induced by oleic acid (OA) in rats. METHODS: Eighty healthy Sprague-Dawley (SD) rats were randomly divided into four groups. In OA group (n=30), ALI was produced by injection of OA 0.15 ml/kg through tail vein. Ten rats were randomly selected and sacrificed after injection of OA at the time of 4 hours, 3 days, and 7 days, respectively. In OA plus HBO group (n=20), rats received HBO intervention in a special box with oxygen of 2.5 atm (1 atm=101.325 kPa) for 90 minutes. Ten rats were randomly respectively sacrificed at 3 days and 7 days. In simple HBO group, 20 rats were sacrificed at 3 days and 7 days of HBO intervention, respectively. Other 10 rats were assigned as control group. Blood, lung specimens were collected after sacrifice. Serum contents of tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1 beta) and IL-6 were measured. Gross changes and pathological findings of the left lung were recorded. The wet to the dry weigh (W/D) of the right lung was determined. RESULTS: Partial pressure of oxygen in arterial blood (PaO2, mm Hg, 1 mm Hg=0.133 kPa) fell from 107.70+/-5.37 to 57.40+/-2.63 in OA group. Congestion, bleeding and edema could be seen grossly. They could also be found under microscope with disappearance of normal structure, and accumulation of fluid in interstitium with inflammatory cell infiltration and hyaline membrane formation were also found. Lung W/D ratio was increased as compared with the control group (6.94+/-0.44 vs. 4.59+/-0.44, P<0.05). A marked increase was found in serum TNF-alpha, IL-1 beta, IL-6 levels [TNF-alpha (microg/L): 18.52+/-1.20 vs. 5.27+/-0.61, IL-1 beta (microg/L): 13.73+/-1.37 vs. 6.13+/-1.51, IL-6 (microg/L): 14.51+/-1.21 vs. 11.14+/-0.89]. After HBO therapy for 3 days and 7 days, PaO2 (mm Hg, 3 days: 79.20+/-1.68 vs. 59.00+/-2.70, 7 days: 94.30+/-3.77 vs. 74.00+/-3.85) and lung W/D (3 day: 7.43+/-0.73 vs. 9.82+/-0.99, 7 days : 6.75+/-1.14 vs. 8.77+/-1.60) of HBO group were ameliorated to varying degrees compared with OA model group (P<0.05 or P<0.01). HBO therapy for 3 days could lower levels of IL-1 beta (microg/L) in the serum (6.46+/-1.99 vs. 9.09+/-1.09, P<0.05). CONCLUSION: It is suggested that HBO treatment for ALI in rats had effects of improving arterial blood gases and the lung water transport, and inhibiting inflammatory mediators production.

[A study on the active efflux system in methicillin-resistant Staphylococcus aureus].

OBJECTIVE: To explore the status of methicillin-resistant Staphylococcus aureus (MRSA) infection in an intensive care unit (ICU), and investigate the active efflux mechanism of MRSA. METHODS: Eighty isolates were identified as MRSA among 102 strains of Staphylococcus aureus collected, and then the minimal inhibitory concentration (MIC) were determined. The 4 primers of active efflux gene were designed to amplify the 80 clinical isolates respectively by polymerase chain reaction (PCR). The PCR products were analyzed by electrophoresis in order to grasp the situation of the existence of the four genes (norA, qacA, qacB and qacJ). Omeprazole inhibition test was used to observe the changes in the susceptibility of MRSA to antibiotics. RESULTS: The detection rate of MRSA was 78.4%. The sensitivity rate of MRSA to both vancomycin and teicoplanin was 100.0%, while to other antibiotics (oxacillin, benzylpenicillin, cefuroxime, cefotaxime, ceftazidime, ceftiaxone, cefepime, cefoxitin, imipenem, piperacillin and tazobactam, azithromycin, erythromycin, chloramphenicol, clindamycin, amikacin, gentamicin, levofloxacin, gatifloxacin, ciprofloxacin) MRSA was multi-drug resistant. The detection rates of norA, qacA, qacB and qacJ were 67.5% (54/80), 15.0% (12/80), 21.2% (17/80) and 11.2% (9/80), respectively. Combined use of omeprazole and levofloxacin could lower MIC value. CONCLUSION: The infection of MRSA in ICU is serious. MRSA is multi-drug resistant and possesses active efflux genes norA, qacA, qacB and qacJ. Omeprazole can inhibit the activity of the active efflux genes.

[Individualized and comprehensive therapy for severe acute pancreatitis in early stage: analysis of 110 cases].

OBJECTIVE: To investigate the risk factors of exacerbation of severe acute pancreatitis (SAP) in early stage, in order to formulate therapeutic strategies including minimally invasive intervention and organ support, and to finalize an individualized and comprehensive therapy for the SAP in early stage to decrease the mortality. METHODS: Fifty-three patients with SAP admitted from 1995 to 1999 was categorized as group 1, and 57 patients admitted from 2000 to 2005 as group 2, were analyzed retrospectively. Ranson's score, acute physiological and chronic health evaluation II (APACHE II) score, Balthazar CT grade, presence or absence of biliary tract obstruction, hypoxia, lung infection, shock, abdomen compartment syndrome (ACS), hyperlipemia, pleural effusion were analysed logistically. Mortality following different treatments and incidence rate of complications were also evaluated. RESULTS: In the two groups, 13 patients of the group 1 and 14 of group 2 were complicated with multiple organ dysfunction syndrome (MODS) in the early stage. There was difference in Ranson's score, APACHE II, Balthazar CT grade, between the groups with and without MODS (all P<0.05). Higher incidences of shock, biliary tract obstruction, ACS, hyperlipemia, pleural effusion were seen in group with MODS (P<0.01). Mortality of group 2 patients was lowered after receiving a comprehensive therapy including bedside hemodialysis (CBP) and artificial liver support (P<0.01). CONCLUSION: Development of MODS in SAP and its mortality are related to strategies of treatment, and adoption of an individualized and comprehensive therapy for the SAP in early stage can decrease the complications and the mortality.