Diagnostic performance of pancreatic fluid aspiration through metagenomic next-generation sequencing for suspected infected pancreatic necrosis.

AIMS: This study aimed to evaluate the diagnostic performance of metagenomic next-generation sequencing (mNGS) with pancreatic fluid aspiration for the detection of infected pancreatic necrosis (IPN). METHODS: This retrospective observational study included 66 patients with suspected IPN. The participants simultaneously underwent pancreatic fluid aspiration mNGS, and microbial and blood culture. We compared the diagnostic performance of mNGS with that of culture in the detection of pathogens associated with IPN. RESULTS: Of the 66 patients, 45 (68.2 %) were confirmed to have IPN. Pancreatic fluid aspiration mNGS yielded positive results in 32 of these patients (71.1 %), significantly outperforming microbial culture results (25 patients, 55.6 %; P = 0.039); however, both methods exhibited similar specificity (95.2% vs. 100 %). The results of pancreatic fluid aspiration mNGS and microbial culture matched in 73.3 % (33/45) of patients with IPN. The turnaround time for the mNGS results was significantly shorter than that for the microbial culture method (P < 0.001). In addition, survival analysis demonstrated that a positive mNGS result was not associated with increased mortality (hazard ratio, 0.652; 95 % confidence interval 0.157-2.699, P = 0.555). CONCLUSIONS: Our study highlights the potential of mNGS for diagnosing IPN, with implications for improving patient care by facilitating early and accurate diagnosis, guiding appropriate interventions, and possibly improving patient outcomes.

Revealing Prdx4 as a potential diagnostic and therapeutic target for acute pancreatitis based on machine learning analysis.

Acute pancreatitis (AP) is a common systemic inflammatory disease resulting from the activation of trypsinogen by various incentives in ICU. The annual incidence rate is approximately 30 out of 100,000. Some patients may progress to severe acute pancreatitis, with a mortality rate of up to 40%. Therefore, the goal of this article is to explore the key genes for effective diagnosis and treatment of AP. The analysis data for this study were merged from two GEO datasets. 1357 DEGs were used for functional enrichment and cMAP analysis, aiming to reveal the pathogenic genes and potential mechanisms of AP, as well as potential drugs for treating AP. Importantly, the study used LASSO and SVM-RFE machine learning to screen the most likely AP occurrence biomarker for Prdx4 among numerous candidate genes. A receiver operating characteristic of Prdx4 was used to estimate the incidence of AP. The ssGSEA algorithm was employed to investigate immune cell infiltration in AP. The biomarker Prdx4 gene exhibited significant associations with a majority of immune cells and was identified as being expressed in NKT cells, macrophages, granulocytes, and B cells based on single-cell transcriptome data. Finally, we found an increase in Prdx4 expression in the pancreatic tissue of AP mice through immunohistochemistry. After treatment with recombinant Prdx4, the pathological damage to the pancreatic tissue of AP mice was relieved. In conclusion, our study identified Prdx4 as a potential AP hub gene, providing a new target for treatment.

Successful treatment of invasive liver abscess syndrome caused by Klebsiella variicola with intracranial infection and septic shock: A case report.

BACKGROUND: Klebsiella variicola (K. variicola) is a member of the Klebsiella genus and is often misidentified as Klebsiella pneumoniae. In this report, we present a rare case of invasive liver abscess caused by K. variicola. CASE SUMMARY: We report a rare case of liver abscess due to K. variicola. A 57-year-old female patient presented with back pain for a month. She developed a high-grade fever associated with chills, and went into a coma and developed shock. The clinical examinations and tests after admission confirmed a diagnosis of primary liver abscess caused by K. variicola complicated by intracranial infection and septic shock. The patient successfully recovered following early percutaneous drainage of the abscess, prompt appropriate antibiotic administration, and timely open surgical drainage. CONCLUSION: This is a case of successful treatment of invasive liver abscess syndrome caused by K. variicola, which has rarely been reported. The findings of this report point to the need for further study of this disease.

A case of acute pancreatitis secondary to spinal cord injury. Case Report.

Acute pancreatitis (AP) is a frequent and potentially life-threatening disease with high morbidity and mortality. The overall mortality of AP is approximately 5%. Alcohol consumption and gallstones are the main etiology of AP. Hypertriglyceridemia, idiosyncratic reactions to drugs, anatomic alterations and ascaris lumbricoides can also give rise to AP. Although spinal cord injury (SCI) can cause AP, however, the case of induced by cervical spine surgery has not been reported. A 61-year-old man with quadriplegic and respiratory distress received cervical spine surgery for spinal cervical spondylosis and multi-stage longitudinal ligament. He was admitted to intensive care unit (ICU) after tracheotomy for progressive dyspnea, one day after the cervical spine surgery. The patient was diagnosed with AP, in the absence of any identifiable causes of pancreatitis. He was treated with intravenous fluids, no oral feeding, enteral and parenteral nutrition, antibiotic and mechanical ventilation. The patient's condition gradually improved after the treatment. This case describes a case of postoperative cervical spondylosis that led to AP. In this report, we highlight the importance of early diagnosis and subsequent appropriate treatment. We conclude that the outcome can be favorable, if the treatment is appropriate.

A new reversed-phase/strong anion-exchange mixed-mode stationary phase based on polar-copolymerized approach and its application in the enrichment of aristolochic acids.

A novel silica-based reversed-phase/strong anion-exchange mixed-mode stationary phase named C18SAX was synthesized based on the polar-copolymerized approach. C18SAX stationary phase showed excellent compatibility with 100% aqueous mobile phase and comparable performance with commercial SunFire™ C18 column in terms of column efficiency and methylene selectivity. And the results indicated that hydrophobic interaction and anion-exchange mechanism dominate the separation process of aristolochic acids. The utility of C18SAX material-based SPE was demonstrated for the enrichment of aristolochic acids extracted from Caulis Aristochiae Manshuriensis. The SPE method was developed rapidly and simply by HPLC evaluation. Under the optimized SPE conditions, the average recoveries of aristolochic acid I and aristolochic acid II in crude sample were 72.36% and 105.59%, with RSDs of 5.77% and 1.13%, respectively. The complexity of sample matrices was significantly simplified after the SPE procedure and further preparation and purification of target compounds was performed on a preparative C18TDE column. Four aristolochic acids, including aristolochic acid I (31.8 mg), II (8.9 mg), IIIa (6.1 mg) and IVa (4.3 mg) were purified with HPLC purities all above 93%. The results proved that the aristolochic acids could be efficiently enriched by C18SAX material and easily eluted in acidic conditions, indicating its great potential in the enrichment of acidic compounds from complex matrices.