1.Application value of metagenomic next-generation sequencing in pathogenic diagnosis of sus-pected infected severe acute pancreatitis
Xiaoyue HONG ; Jiayan LIN ; Jiarong LI ; Caihong NING ; Zefang SUN ; Baiqi LIU ; Lu CHEN ; Shuai ZHU ; Gengwen HUANG ; Dingcheng SHEN
Chinese Journal of Digestive Surgery 2024;23(5):720-725
Objective:To investigate the application value of metagenomic next-genera-tion sequencing (mNGS) in pathogenic diagnosis of suspected infected severe acute pancreatitis (SAP).Methods:The prospective study was conducted. The clinical data of 25 patients with suspected infected SAP who were admitted to the Xiangya Hospital of Central South University from May to September 2023 were collected. Upper limb venous blood samples of all the patients were collected for both of mNGS and routine pathogen microbial culture. Observation indicators: (1) grouping situations of the enrolled patients; (2) comparison of the diagnostic efficiency of mNGS and routine pathogen microbial culture; (3) results of peripheral blood pathogen microbial testing and peri-pancreatic effusion microbial culture; (4) testing time and cost. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3). Count data were expressed as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Results:(1) Grouping situations of the enrolled patients. A total of 25 patients were selected for eligibility. There were 18 males and 7 females, aged 48(40,59)years. The duration of hospital stay of 25 patients was 30(20,50)days. The etiologies of 25 patients included 14 cases of hyperlipidemic pancreatitis, 8 cases of biliary pancreatitis, 1 case of alcohol-induced acute pancreatitis, and 2 cases of pancreatitis caused by other causes. Of the 25 patients, there were 17 cases with infected pancreatic necrosis (IPN) including 7 cases of death, and 8 cases with sterile pancreatic necrosis including no death. (2) Comparison of the diagnostic efficiency of mNGS and routine pathogen microbial culture. The positive rates of mNGS and routine pathogen microbial culture in diagnosis of suspected infected SAP were 72.0%(18/25) and 32.0%(8/25), respectively, showing a significant difference between them ( χ2=8.01, P<0.05). The sensitivity and negative predic-tive value of mNGS and routine pathogen microbial culture in diagnosis of IPN were 94.1%(16/17), 35.3%(6/17) and 85.7%(6/7), 35.3%(6/17), showing significant differences between them ( χ2=12.88, 5.04, P<0.05). The specificity and positive predictive value of mNGS and routine pathogen microbial culture in diagnosis of IPN were 75.0%(6/8), 75.0%(6/8) and 88.9%(16/18), 75.0%(6/8), showing no significant difference between them ( χ2=0, 0.82, P>0.05). (3) Results of peripheral blood pathogen microbial testing and peripancreatic effusion microbial culture. Of the 17 patients with IPN, 36 strains of pathogenic bacteria were detected by mNGS, and 6 strains were detected by routine pathogen microbial culture. There were 16 of 17 patients with IPN showing positive mNGS pathogenic testing, of which 13 cases were consistent with the pathogenic testing results of peri-pancreatic effusion microbial culture, showing a consistency rate of 76.5%(13/17). There were 6 pati-ents with IPN showing positive routine pathogen microbial culture, with a consistency rate of 35.3%(6/17) to peripancreatic effusion microbial culture. (4) Testing time and cost. Testing time of mNGS and routine pathogen microbial culture were (43±17)hours and (111±36)hours, showing a signifi-cant difference between them ( t=9.31, P<0.05). Testing cost of mNGS was (2 267±0)yuan/case, accoun-ting for 1.7% of the hospitalization expenses of (133 759±120 744)yuan/case. Testing cost of routine pathogen microbial culture was (240±0)yuan/case, accounting of 0.2% of the hospitalization expenses. Conclusion:mNGS has important value for early pathogenic diagnosis of suspected infected SAP, and has a high timeliness.
2.Early diagnosis of peripancreatic infection secondary to acute pancreatitis
Dingcheng SHEN ; Gengwen HUANG
Chinese Journal of Pancreatology 2024;24(3):186-189
Peripancreatic infection secondary to acute pancreatitis, also known as infected pancreatic necrosis (IPN), is one of the most serious complications of acute pancreatitis. In recent years, with the continuous advancement of endoscopic and surgical therapeutic concepts and technologies, the complication rate and mortality of IPN have significantly decreased and entered a plateau period. Early diagnosis of IPN and targeted interventions are expected to become a breakthrough for further improving its prognosis.
3.Advances in early precision diagnosis and treatment of severe acute pancreatitis
Chinese Journal of General Surgery 2024;33(9):1398-1405
Severe acute pancreatitis(SAP)is a rapid onset and complex acute digestive system emergency,often accompanied by severe local and systemic complications,leading to a high mortality rate.In recent years,with the continuous update of treatment concepts,especially the advancement of endoscopic and minimally invasive surgical techniques,the prognosis of SAP patients has significantly improved.However,in clinical practice,particularly in the early stages of the disease,there are still widespread issues of non-standard and imprecise diagnostic and therapeutic practices,which are important factors contributing to the occurrence of severe complications in the later stages of the disease and a major reason for the poor prognosis of SAP patients.In light of this,this article systematically reviews high-quality literature from recent years and combines the latest clinical research findings from the authors'team to summarize advancements in early precise diagnosis and treatment of SAP,providing new evidence for standardized treatment of SAP,which will undoubtedly help further improve the overall treatment outcomes for SAP.
4.The clinical application value of next-generation sequencing technology based on metagenomics capture for identifying pathogens in infected pancreatic necrosis
Baiqi LIU ; Jiarong LI ; Xiaoyue HONG ; Jiayan LIN ; Caihong NING ; Zefang SUN ; Shuai ZHU ; Lu CHEN ; Dingcheng SHEN ; Yan YU ; Gengwen HUANG
Chinese Journal of General Surgery 2024;33(9):1481-1487
Background and Aims:Accurate early pathogen diagnosis is a breakthrough for improving the prognosis of infectious pancreatic necrosis(IPN)patients.However,there is currently a lack of efficient methods for early identification of IPN in clinical settings.This study was performed to assess the application value of next-generation sequencing technology based on metagenomic capture(MetaCAP)in the pathogen diagnosis of IPN. Methods:A prospective study was conducted on 29 patients suspected of having acute necrotizing pancreatitis at Xiangya Hospital of Central South University between January and July 2024.Blood samples were tested using MetaCAP and conventional pathogen culture.The results of peritoneal fluid pathogen culture were used as the gold standard to compare the diagnostic efficacy of the two methods. Results:Due to three cases lacking peritoneal fluid culture results,a total of 26 cases were included in the final analysis.The overall mortality rate was 23.1%(6/26).During hospitalization,9 cases(34.6%)were diagnosed with IPN.The sensitivity and negative predictive value of MetaCAP for diagnosing IPN were significantly higher than those of conventional pathogen culture(77.8%vs.11.1%,P=0.031;86.7%vs.65.2%,P=0.032),while the differences in specificity(76.5%vs.88.2%,P=0.689)and positive predictive value(63.6%vs.33.3%,P=0.347)between the two methods were not statistically significant.The average detection time for MetaCAP was 33(20-49)h,while microbial culture took 125(45-142)h,with a significant difference(P<0.001).The average cost for blood MetaCAP testing was 2 500 yuan per case,but it accounted for only 1.19%of the average hospitalization cost. Conclusion:MetaCAP has significant value in the early pathogen diagnosis of IPN,with a shorter detection time,good testing efficacy,and health-economic value,demonstrating a promising clinical application prospect.
5.Strategies for stoma reversal based on hernia surgery principles
Chinese Journal of General Surgery 2024;33(10):1594-1599
Stoma reversal surgery is usually performed 3 to 6 months after a temporary stoma creation to restore intestinal continuity.The high incidence of stoma site incisional hernia(SSIH)after stoma closure is a significant concern,as the development of SSIH not only increases psychological and financial burdens on patients but also significantly raises medical risks and societal costs.Therefore,reducing the incidence of SSIH is of great practical importance.The fundamental strategy is to accurately identify high-risk patients based on known risk factors,which include:female sex,age ≥ 68 years,colostomy,BMI ≥ 25 kg/m2,malignancy,emergency surgery,existing parastomal hernia,concurrent midline incisional hernia,and postoperative wound complications,and to implement preventive measures in advance.Given that the abdominal wall defect caused by the stoma resembles the condition of bowel herniation in incisional hernias,applying the principles of incisional hernia repair during stoma reversal surgery-particularly for high-risk patients-can be beneficial.This involves the prophylactic use of a mesh during abdominal closure to reinforce the abdominal wall,which may help prevent the occurrence of incisional hernia without increasing the risk of surgical site infections or other adverse events.However,there is still debate over the optimal type of mesh to use during stoma reversal.In summary,stoma reversal incisions differ from standard abdominal incisions,and employing hernia repair principles for their closure may be a crucial strategy in preventing the development of SSIH.
6.Comparative analysis of performance evaluation indexes of public medical institutions in China
Lei YUAN ; Zongfeng DING ; Gengwen HUANG
Chinese Journal of Hospital Administration 2021;37(7):534-537
The reform of public medical institutions is a critical and difficult breakthrough in furthering the healthcare system reform in China, for which the performance appraisal of public hospitals can serve an important role. The performance policy documents of tertiary public hospitals, secondary public hospitals and primary medical and health institutions in China since 2019 were compared and analyzed, to systematically identify the similarities and differences and development rules of the three evaluation index systems. The study analyzed the impacts of the three systems on the management of medical institutions and provided reference suggestions for improving their performance evaluation. It was found that all the three systems aim at guiding tertiary public hospitals to evolve from the pattern centering on scale expansion to that on quality and benefits, guiding secondary ones to improve their capacity of medical services, and guiding primary medical institutions to focus on basic medical and public health services. However, these systems lack indexes on hierarchical diagnosis and treatment for secondary hospitals and application of examination results, while national surveillance indexes on primary ones accounted for only 23.8% of all. It is recommended to dynamically adjust both the performance evaluation index system and the surveillance methods, and to enhance the application of examination results and development of supporting policies as well.
7.Operative strategy and short-term efficacy of recurrent groin hernia.
Xitao WANG ; Gengwen HUANG ; Dingcheng SHEN ; Jiayan LIN ; Caihong NING ; Xintong CAO ; Liandong JI ; Yebin LU ; Wei WEI
Chinese Journal of Gastrointestinal Surgery 2018;21(7):761-765
OBJECTIVETo explore the appropriate operative strategy in recurrent groin hernia repair.
METHODSClinical and follow-up data of 82 patients with recurrent groin hernia undergoing operation at Department of Pancreatobiliary Surgery, Xiangya Hospital of Central South University from April 2010 to April 2017 were analyzed retrospectively. The operative approaches included laparoscopic transabdominal preperitoneal (TAPP) hernia repair, Lichtenstein repair and hybrid repair. Surgical method selection was based on the basis of European Hernia Society guidelines, combined with hernia histories, preoperative examination results and intra-operative results: (1) When an anterior approach (Lichtenstein, Bassini or Shouldice surgery) was adopted in the previous operation, TAPP was preferred for the recurrent groin hernia. (2) When the previous operation was an posterior approach [TAPP or total extraperitoneal hernioplasty (TEP)], Lichtenstein method was preferred. Moreover, Lichtenstein surgery with local anesthesia or nerve block was also selected when the patient could not tolerate general anesthesia. (3) When extensive preperitoneal adhesions were found in patients with previous anterior approach repair during laparoscopic exploration, especially in patients who had relapsed after multiple operations or had previous biochemical glues injection, hybrid surgery was preferred.
RESULTSAll 82 patients completed operations smoothly. TAPP, Lichtenstein and hybrid operation were applied in 74, 4 and 4 patients, respectively, with median operative time of 70 minutes (40-130 minutes) in TAPP, 60 minutes (40-90 minutes) in Lichtenstein and 120 minutes (70-150 minutes) in hybrid operation, respectively. The median numerical rating scales (NRS) score was 2 (0-6) on postoperative day 1. The incidences of postoperative seroma, pain and urinary retention were 4.9% (4/82), 2.4% (2/82) and 1.2% (1/82) respectively. The median postoperative hospital stay was 2 days (1-6 days). Seventy-two patients were followed-up from 11 to 87 months. The median follow-up period was 27 months. The median inguinal pain questionnaire (IPQ) score was 2 (0-8) month after operation. One recurrent case was reported 1 year after operation. No incision or mesh infection and long-term inguinal chronic pain were observed.
CONCLUSIONSFor recurrent patients with previous open anterior approach, TEP and TAPP repair are equivalent surgical techniques, and the choice should be tailored to the surgeon's expertise. For those with previous TAPP or TEP repair, Lichtenstein technique is recommended. For those with adhesions both in anterior transverse fascia and pre-peritoneum, hybrid operation may be the preferable choice according to adhesion conditions.
Groin ; Hernia, Inguinal ; surgery ; Herniorrhaphy ; Humans ; Laparoscopy ; Recurrence ; Retrospective Studies ; Surgical Mesh ; Treatment Outcome
8.The trends in surgical treatment and the outcomes of critical acute pancreatitis
Chiayen LIN ; Dingcheng SHEN ; Gengwen HUANG ; Xintong CAO ; Caihong NING ; Shuyi ZHOU ; Liandong JI ; Wei WEI ; Zhiyong LIU
Chinese Journal of Hepatobiliary Surgery 2018;24(9):622-624
Objective To study the trends in surgical treatment and the outcomes of critical acute pancreatitis (CAP).Methods The clinical data of 76 patients with CAP who were treated in the Department of Biliopancreatic Surgery of the Xiangya Hospital,Central South University from January 2010 to December 2017 were retrospectively reviewed.Data which included demographics,micro-organisms,surgical interventions and mortality were compared between the time periods of 2010 to 2013 and 2014 to 2017.Results Before 2014,19 patients with CAP were treated in the Department of Biliopancreatic Surgery of the Xiangya Hospital,Central South University.The percentage of multidrug resistant organisms (MDRO) in pancreatic drainage was 5.3% (1/19).In the latter 4 years,57 patients with CAP were treated.The percentage of MDRO was 50.9% (29/57),which was significandy higher than the initial 4 years (P<0.001).For surgical treatment,the proportion of minimally invasive surgery in the latter 4 years was significantly higher than that in the initial 4 years.The percentage of percutaneous catheter drainage (PCD) increased from 63.2% in the initial 4 years to 86.0% in the latter 4 years.The proportion of minimal access retroperitoneal pancreatic necrosectomy (MARPN) increased from zero in the initial 4 years to 59.6%,while the proportion of open pancreatic necrosectomy (OPN) decreased from 68.4% in the initial 4 years to 24.6%.The mortality rate of patients with CAP dropped from 52.6% (10/19) in the initial 4 years to 24.6% (14/57) in the latter four years.Conclusions In the center which specializes in treating pancreatitis,although the problem of bacterial resistance had become increasingly prominent,the mortality rate of CAP had shown a significant downward trend due to the development of various minimally invasive techniques.
9.Prognosis and related factors of infectious pancreatic necrosis caused by multidrug-resistant organisms
Dingcheng SHEN ; Gengwen HUANG ; Wenmao ZOU ; Hao KANG ; Shuyi ZHOU
Chinese Journal of Infection Control 2017;16(3):203-206
Objective To investigate prognosis and related factors of infectious pancreatic necrosis(IPN) caused by multidrug-resistant organisms(MDROs).Methods Clinical data of 53 IPN patients admitted to a hospital between October 2010 and March 2016 were analyzed retrospectively,patients were divided into MDRO infection group and common bacterial infection group according to antimicrobial resistance of pathogens isolated from peripancreatic drainge fluid,prognosis and related factors of two groups were compared.Results Among 53 IPN patients with confirmed evidence for pathogenicity,33(62.3%)were in MDRO infection group,and 20(37.7%)were in common bacterial infection group,the most common MDROs isolated from peripancreatic drainage was multidrug-resistant Acinetobacter baumannii (MDRO-AB) (37.5%,18/48).The mortality of IPN patients was 30.2% (16/53),mortality of MDRO infection group was higher than common bacterial infection group(39.4% [13/33] vs 15.0% [3/ 20],P<0.05);the severity score,length of intensive care unit (ICU) stay,and hospitalization expenses in MDRO infection group were all higher than common bacterial infection group(all P<0.05).The mortality of IPN patients were closely associated with MDRO infection and severity score of acute pancreatitis (all P < 0.05).Conclusion Prognosis of patients with MDRO infection is poor,treatment is difficult,MDRO infection has become one of the most important challenge to the treatment of severe acute pancreatitis.
10.Clinical efficacy and prognostic factors analysis of hilar cholangiocarcinoma in 322 patients
Xinlei SUI ; Huihuan TANG ; Guangfa XIAO ; Yebin LU ; Qun HE ; Jun ZHOU ; Wei WEI ; Shuai LIANG ; Gengwen HUANG ; Weijia SUN ; Yixiong LI ; Xuejun GONG
Chinese Journal of Digestive Surgery 2017;16(4):391-397
Objective To investigate clinical efficacy and prognostic factors of hilar cholangiocarcinoma.Methods The retrospective case-control study was conducted.The clinicopathological data of 322 patients with hilar cholangiocarcinoma who were admitted to the Xiangya Hospital of Central South University between December 2005 and November 2015 were collected.Preoperative staging and classification of tumor and treatment planning were carried out according to the results of laboratory and imaging examinations.Observation indexes:(1) clinical features and results of assisted examinations;(2) treatments and results of pathological examination;(3) followup and survival;(4) prognostic factors analysis:gender,age,preoperative highest total bilirubin (TBil),preoperative carcinoembryonic antigen (CEA),preoperative CA19-9,preoperative CA242,preoperative CA125,treatment methods and TNM staging.The follow-up of outpatient examination and telephone interview was perfornmed to detect patients' survival up to November 2016.Survival curve was drawn using the Kaplan-Meier method.Survival and univariate analyses were done using the Log-rank test,and multivariate analysis was done using the Cox proportional hazard model.Results (1) Clinical features and results of assisted examinations:among the 322 patients,there were 301 patients with a chief complaint of jaundice.Of the 322 patients,the preoperative highest levels of TBil,DBil,ALT and AST in 322 patients were 3.9-785.2 μmol/L,1.6-410.2 μ mol/L,14.8-484.5 U/L and 21.4-539.8 U/L,respectively.Levels of ALP and GGT in 272 patients were 93.8-1 890.0 U/L and 2.0-1 832.8 U/L,respectively.Seventy-seven of 292 patients had an elevated CEA level,272 of 298 patients had an elevated CA19-9 level,153 of 260 patients had an elevated CA242 level and 86 of 260 patients had an elevated CA125 level.According to Bismuth-Corlette type,24 patients were detected in type Ⅰ,115 in type Ⅱ,55 in type Ⅲa,63 in type Ⅲb and 65 in type Ⅳ.(2) Treatments and results of pathological examination:Of the 322 patients,104 patients underwent radical resection,including 79 with hilar bile duct resection (9 combined with vascular resection and reconstruction) and 25 with extended hepatic lobectomy (16 combined with caudate lobectomy),and 218 patients underwent palliative treatments,including 134 with external biliary drainage and 84 with internal biliary drainage.Five patients were dead in the perioperative period,of which 2 died of acute liver failure,1 died of systemic infection and multiple organ failure,1 died of acute renal failure and 1 died of acute suppurative cholangitis,septic shock and disseminated intravascular coagulation.Of 263 patients receiving pathological examination,adenocarcinoma was detected in 253 patients (12 with high-differentiated adenocarcinoma,85 with moderate-differentiated adenocarcinoma,33 with low-differentiated adenocarcinoma and 123 with indefinite differentiation),mucinous adenocarcinoma in 5 patients,cholangiocarcinoma in 3 patients and neuroendocrine carcinoma in 2 patients.TNM staging of 322 patients:stage Ⅰ was detected in 8 patients,stage Ⅱ in 53 patients,stage Ⅲ in 132 patients,stage Ⅳ in 96 patients and indefinite stage in 33 patients.(3) Follow up and survival:among the 322 patients,296 were followed up for 12-132 months,with a median follow-up time of 65 months,including 94 with radical resection and 202 with palliative treatments.Among the 296 patients,the median survival time and 1-,3-,5-year survival rates were 10 months,47.1%,20.2% and 9.5%,respectively.0f296 patients with follow-up,median survival time and 1-,3-,5-year survival rates were 31 months,84.0%,46.2%,25.0% in 94 patients receiving radical resection and 7 months,29.9%,8.1% and 2.3% in 202 patients receiving palliative treatment,respectively,with a statistically significant difference between the 2 groups (x2=78.777,P< 0.05).Among the 94 patients receiving follow-up and radical resection,the median survival time and 1-,3-,5-year survival rates were 31 months,82.1%,45.1%,25.7% in 73 patients undergoing hilar bile duct resection and 35 months,90.5%,49.8%,22.1% in 21 patients undergoing hepatic lobectomy,respectively,with no statistically significant difference (x2=0.186,P>0.05).Among the 73 patients undergoing hilar bile duct resection,median survival time and 1-,3-,5-year survival rates were 16 months,57.1%,0,0 in 7 patients combined with vascular resection and reconstruction and 34 months,84.6%,49.5%,27.5% in 66 patients undergoing simplex hilar bile duct resection,respectively,showing a statistically significant difference (x2 =11.977,P< 0.05).(4) Prognostic factors analysis:results of univariate analysis showed that preoperative highest TBil,preoperative CEA,preoperative CA242,preoperative CA125,treatment methods and TNM staging were related factors affecting prognosis of patients with hilar cholangiocarcinoma (x2=25.009,18.671,9.359,33.628,94.729,77.136,P<0.05).Multivariate analysis showed that preoperative highest TBil ≥ 342.0 μmol/L,preoperative CEA ≥ 5.00 μg/L,palliative treatments,TNM stage Ⅲ and Ⅳ were the independent risk factors affecting the poor prognosis of patients with hilar cholangiocarcinoma (HR =2.270,2.147,3.166,2.351,95% confidence interval:1.587-3.247,1.446-3.188,2.117-4.734,1.489-3.712,P<0.05).Conclusions Prognosis of hilar cholangiocarcinoma is still unsatisfactory.The R0 resection is the key in radical surgery.Preoperative highest TBil≥342.0 μmol/L,preoperative CEA ≥ 5.00 μg/L,palliative treatments,TNM stage Ⅲ-Ⅳ are independent risk factors affecting the poor prognosis of patients with hilar cholangiocarcinoma.

Result Analysis
Print
Save
E-mail