The microbiological diagnostic performance of metagenomic next-generation sequencing in patients with sepsis.

BACKGROUND: In this study, we aimed to perform a comprehensive analysis on the metagenomic next-generation sequencing for the etiological diagnosis of septic patients, and further to establish optimal read values for detecting common pathogens. METHODS: In this single-center retrospective study, septic patients who underwent pathogen detection by both microbial culture and metagenomic next-generation sequencing in the intensive care unit of the Second People's Hospital of Shenzhen from June 24, 2015, to October 20, 2019, were included. RESULTS: A total of 193 patients with 305 detected specimens were included in the final analysis. The results of metagenomic next-generation sequencing showed significantly higher positive rates in samples from disparate loci, including blood, bronchoalveolar lavage fluid, and cerebrospinal fluid, as well as in the determination of various pathogens. The optimal diagnostic reads were 2893, 1825.5, and 892.5 for Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae, respectively. CONCLUSIONS: The metagenomic next-generation sequencing is capable of identifying multiple pathogens in specimens from septic patients, and shows significantly higher positive rates than culture-based diagnostics. The optimal diagnostic reads for frequently detected microbes might be useful for the clinical application of metagenomic next-generation sequencing in terms of timely and accurately determining etiological pathogens for suspected and confirmed cases of sepsis due to well-performed data interpretation.

Management of COVID-19 patients in Fangcang shelter hospital: clinical practice and effectiveness analysis.

Fangcang shelter (Cabin) hospitals were set up in order to cope with the rapid growth of confirmed cases of coronavirus disease 2019 (COVID-19) in Wuhan, China at a time when there were insufficient beds in designated hospitals. This paper describes the layout and functioning of a typical Fangcang shelter hospital, Wuhan Dongxihu Fangcang shelter Hospital, where the author has worked, the working mechanism, experience and effectiveness. A set of patient management protocols was employed for daily practice, which included preset criteria and procedure for admission, examination, medication treatment, referral and discharge. WeChat platform with different groups was used for communication, ward round, test appointments and patient data communication. All these procedures and mechanisms of working enabled the effective management of a larger number of patients with relatively few doctors. As a result, 442 mild or moderate COVID-19 patients in Hall C were successfully managed by a team of 40 doctors, with 246 (56%) patients were cured and discharged from the Fangcang shelter hospital while the remaining 196 (44%) patients were referred on to designated hospitals for further treatment. The reasons for referral included poor resolution in computerized tomography (CT) scan (59%), persistently positive severe acute respiratory syndrome coronavirus 2 by PCR after 9 days of admission (16%), deterioration in CT image (4%), development of dyspnoea (1%) and other (4%) or unclear reasons (16%) due to no record of reasons for referral on the document. There were no deaths and no complaints from the patients in Hall C. In summary, the Fangcang shelter hospital could be run successfully with a set of patient management protocols under conditions of limited facilities and medical staff. It was effective and safe in isolating patients, providing basic medical care and early identification of potential severe cases. This experience may provide a successful example of a working mechanism for the prevention and control of the COVID-19 pandemic worldwide.

[Effect of Sini decoction on function of hypothalamic-pituitary-adrenal axis in patients with sepsis].

OBJECTIVE: To investigate the effects of Sini decoction on function of hypothalamic-pituitary-adrenal axis in patients with sepsis. METHODS: A prospective single-blind randomized controlled trial was conducted. 60 septic patients were divided into three groups with the method of random number table, 20 cases in the control group, 20 in the Chinese herb group, and 20 in corticoid group. All of them received routine treatment. Patients in Chinese herb group were given Sini decoction in addition (decoction of monkshood 15 g, dried ginger 15 g, honey-fried licorice 10 g) 100 mL/d orally or by nasal feeding, while patients in corticoid group were given hydrocortisone 200 mg/d intravenously instead, both for 7 days. Before the treatment, 3 days and 14 days after treatment, blood was collected to determine the levels of adrenocorticotropic hormone (ACTH) and cortisol, and the result of ACTH stimulating test was observed. At the same time, acute physiology and chronic health evaluation II (APACHEII) score was recorded, and 3-day shock recovery rate and 28-day death rate were also compared among these groups. RESULTS: None of the three groups showed different result in ACTH stimulating test (χ(2)=1.101, P=0.605). ACTH in three groups was gradually decreased. Compared with that before treatment, ACTH in Chinese herb group and corticoid groups began to decrease obviously on day 3 (29.90±3.31 ng/L vs. 33.10±3.31 ng/L, 28.20±2.45 ng/L vs. 33.30±3.84 ng/L, both P<0.01), while in control group declined ACTH appeared later (on day 14) compared with before treatment (29.40±5.63 ng/L vs. 33.50±4.89 ng/L, P<0.05). No obvious difference in ACTH level was showed between the Chinese herb group and the cortical group (both P>0.05). Cortisol level in both Chinese herb and cortical groups showed a raise-fall biphase trend while there was no change in the control. The cortical levels on day 3 in Chinese herb and cortical groups were much higher than that before treatment (343.04±31.20 µg/L vs. 294.70±42.10 µg/L, 331.25±42.80 µg/L vs. 280.36±38.10 µg/L, both P<0.01) and that of control group (291.61±41.50 µg/L, both P<0.01), though no significant statistical difference was observed between two groups (both P>0.05). APACHEII score on day 14 in control, Chinese herb and cortical groups was significantly lower than that before treatment (16.8±5.1 vs. 20.1±4.3, 13.4±3.2 vs. 18.3±3.8,15.1±2.5 vs. 19.5±4.0, all P<0.01), and the score was much lower in Chinese herb group comparing with that of control group (P<0.05). No statistical difference was observed among control, Chinese herb and cortical groups in lowering 28-day death rate [35.0% (7/20), 25.0% (5/20), 20.0% (4/20)] and improving 3-day shock recovery rate [40.0% (8/20), 70.0% (14/20), 60.0% (12/20), all P>0.05]. CONCLUSIONS: Sini decoction could elevate cortisol while lower ACTH at the early stage of sepsis. Sini decoction could also effectively improve symptoms and hypothalamic-pituitary-adrenal axis function in septic patients without affecting death rate.

[Rational control on postoperative blood glucose levels in infants with congenital heart disease].

OBJECTIVE: To investigate optimal level of post-operation blood glucose control in infants with congenital heart disease (CHD). METHODS: One hundred and two infants ≤1 year old undergoing open-heart surgery were randomly divided into three groups: intensive blood glucose control group (group A, n = 35), active blood glucose control group (group B, n = 38), and common glucose control group (group C, n = 29). Insulin injection would be intravenously administrated when blood glucose levels up to 8.3, 15.0, and 18.0 mmol/L in group A, B, and C, respectively. Blood white blood count (WBC), C-reactive protein (CRP), lactic acid, alanine aminotransferase (ALT), creatinine (Cr), incidence of pulmonary infection, the length of intensive care unit (ICU) stay, incidence of hypoglycemia and mortality were compared at 72 hours after operation among three groups. RESULTS: WBC [×10(9)/L], CRP (mg/L) and incidence of pulmonary infection in group C were significantly higher than those in group A and group B (WBC: 18.2 ± 8.7 vs. 13.2 ± 5.1, 14.5 ± 5.7; CRP: 32.9 ± 10.9 vs. 20.8 ± 9.8, 18.6 ± 8.5; incidence of pulmonary infection: 27.6% vs. 8.6%, 10.5%, all P < 0.05), but there were no statistical differences between group A and group B. ALT (U/L) in group B was significantly lower than that in group A and group C (49.0 ± 17.8 vs. 68.4 ± 16.9, 69.9 ± 13.8, both P < 0.05), but there was no statistical difference between group A and group C. Incidence of hypoglycemia in group A was significantly higher than that in group B and group C (20.0% vs. 2.6%, 3.4%, both P < 0.05), but there was no statistical difference between group B and group C. There were no statistical differences in lactic acid (mmol/L), Cr (µmol/L) and the length of ICU stay (days) among group A, B, and C (lactic acid: 2.1 ± 0.8, 2.3 ± 0.5, 2.2 ± 0.7; Cr: 55.1 ± 13.4, 49.4 ± 15.7, 57.3 ± 11.6; the length of ICU stay: 3.5 ± 1.8, 3.2 ± 1.1, 3.6 ± 1.6, all P>0.05). There was no infant death in three groups. CONCLUSIONS: Severe hyperglycemia after open heart operation was associated with increasing WBC count, CRP level and incidence of pulmonary infection during the post operative period. However, it also demonstrated that intensive blood glucose control be link to increase risks of hypoglycemia and liver dysfunction.

[Clinical study on value of severity of patient with coronary artery disease evaluated with the thrombosis in myocardial infarction risk score].

OBJECTIVE: To explore the value of severity evaluating and outcome predicting on coronary artery disease (CAD) patients scored with the thrombosis in myocardial infarction (TIMI) risk score. METHODS: All of 126 patients with CAD were enrolled in study. TIMI risk score and coronary artery angiographic in them were performed respectively. Correlativity between TIMI risk score and clinical type of CAD, narrow severity, pathological changes limits and character of coronary artery were analyzed. Difference of scores of TIMI, narrow severity, pathological changes limits and character of coronary artery were compared among stable angina (SA), unstable angina (UA), un-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI) respectively. RESULTS: TIMI risk score significantly correlated with clinical type of CAD score, narrow severity score, pathological changes limits and character scores of coronary artery respectively (r=0.607 for narrow severity score, 0.569 for pathological changes limits score, 0.367 for pathological changes character score, all P<0.05). TIMI risk score increased company with severity of coronary artery pathological changes advancing. Significantly differences were found when TIMI risk scores were compared between SA and UA, NSTEMI and STEMI respectively as well as narrow severity scores (all P<0.05). Same RESULTS: were found between UA and NSTEMI, STEMI respectively (all P<0.05). There had no significantly difference among pathological changes limits scores of SA, UA, NSTEMI, STEMI (all P>0.05). Significantly difference was found when pathological changes character scores were compared between SA and UA, NSTEMI, STEMI respectively as well as narrow severity scores (P<0.05), but contrary RESULTS: were found between UA and NSTEMI, STEMI respectively (P>0.05). CONCLUSION: TIMI risk score not only could be used to predict the possibility of heart accident, but also could be used to evaluate clinical type of CAD, narrow severity, pathological changes limits and character of coronary artery in CAD patient.

[Study of acute physiology and chronic health evaluation III and multiple organ dysfunction syndrome score in evaluating severity of intensive care units patient].

OBJECTIVE: To evaluate the value of acute physiology and chronic health evaluation(APACHE)III and multiple organ dysfunction syndrome(MODS) score introduced to evaluate the severity of intensive care unit(ICU) patient. METHODS: Seventy of ICU patients were scored by APACHE III and MODS scoring system respectively after admission for 24 hours. Area under of the receiver operating characteristic curve(ROC) was used to scale the ability of APACHE III and MODS scoring systems evaluating severity and predicting outcomes of ICU patient. The areas were compared among APACHE III, MODS and the score of APACHE III adding MODS. Discriminant was built between the scores and outcomes of patient, and coefficients were compared among the three scoring systems. RESULTS: The areas under of the ROC of APACHE III, MODS and the score of APACHE III adding MODS were 0.765, 0.643 and 0.753 respectively; coefficients of discriminant of them were 0.998, 0.892 and 0.568 respectively. CONCLUSION: APACHE III is superior to MODS scoring system in evaluating severity of ICU patient, and APACHE III add MODS score can't increase the evaluating effectiveness compared to APACHE III and MODS score respectively in evaluating severity of ICU patient.

Multiple organ dysfunction syndrome due to ingestion of fish gall bladder.

OBJECTIVE: To investigate changes in renal function, urine N-acetyl-beta-D-glucosaminidase enzyme (N-AG),liver function, myocardial enzymes, the pathology of renal damage and the mechanism of acute renal failure (ARF) associated with fish gall bladder poisoning. METHODS: Eleven patients with acute fish gall bladder poisoning were consecutively admitted to our hospital from September 1997 to October 1999. Renal function, urine N-AG enzyme, liver function, and myocardial enzymes were assayed before and after treatment. One patient consented to a kidney biopsy and the pathology of renal damage was observed under light and electron microscopes. RESULTS: All patients had multiple organ dysfunction syndrome (MODS) and 11 patients suffered from ARF. Ten patients had liver dysfunction, ten patients had poisonous myocarditis, and 8 patients had gastrointestinal dysfunction. Renal function, urine N-AG enzyme, liver function, and myocardial enzymes were significantly improved after treatment compared with those of before treatment (P < 0.05). Kidney biopsy showed that the main damage site was the proximal renal tubule. All eleven patients recovered and were discharged from the hospital. CONCLUSIONS: Ingestion of fish gall bladder leads to kidney damage, as well as liver, heart and gastrointestinal tract injury. The mechanism of acute renal function failure is the serious tubular damage, confirming the location of kidney damage. Necrosis of the proximal tubules plays an important role in the development of ARF. Immediate hemodialysis is the most effective treatment.