BACKGROUND Inappropriate antibiotic treatment for patients with viral infections has led to a surge in antimicrobial resistance, increasing mortality and healthcare costs. Viral and bacterial infections are often difficult to distinguish. Myxovirus resistance protein A (MxA), an essential antiviral factor induced by interferon after viral infection, holds promise for distinguishing between viral and bacterial infections. This study aimed to determine the ability of MxA to distinguish viral from bacterial infections. METHODS: We quantified MxA in 121 infected patients via dry immunofluorescence chromatography. The Kruskal-Wallis test and receiver operating characteristic (ROC) curve analysis were used to determine the diagnostic value of MxA, either alone or in combination with C-reactive protein (CRP) or procalcitonin (PCT), in patients with viral, bacterial, or co-infections. RESULTS: The value of MxA (ng/mL) was significantly higher in patients with viral infections than in those with bacterial and co-infections (82.3 [24.5-182.9] vs. 16.4 [10.8-26.5], P<0.0001) (82.3 [24.5-182.9] vs. 28.5 [10.2-106.8], P=0.0237). The area under the curve (AUC) of the ROC curve for distinguishing between viral and bacterial infections was 0.799 (95% confidence interval [95% CI] 0.696-0.903), with a sensitivity of 68.9% (95% CI54.3%-80.5%) and specificity of 90.0% (95% CI 74.4%-96.5%) at the threshold of 50.3 ng/mL. Combining the MxA level with the CRP or PCT level improved its ability. MxA expression was low in cytomegalovirus (15.8 [9.6-47.6] ng/mL) and Epstein-Barr virus (12.9 [8.5-21.0] ng/mL) infections. CONCLUSION: Our study showed the diagnostic efficacy of MxA in distinguishing between viral and bacterial infections, with further enhancement when it was combined with CRP or PCT. Moreover, Epstein-Barr virus and human cytomegalovirus infections did not elicit elevated MxA expression.

Objective:To evaluate the clinical value of nanopore targeted sequencing (NTS) in pathogens detection in urinary tract by comparing the results of different tests performed on the same urine sample.Methods:The results of NTS and urine culture test collected from 326 patients in the Department of Urology of People's Hospital of Wuhan University from July 2020 to June 2021 were retrospectively analyzed. There were 224 males and 102 females. The average age was (56.88 ± 14.58)years old. χ 2 test and Student’s test and Wilcoxon's sign rank test were used to analyze the differences of the pathogen detection rate, pathogen types results and detection time consuming between NTS and urine culture. The clinical value of the NTS in rapid detection of urinary pathogens was evaluated. Results:Among 326 hospitalized patients, the urinary tract microbes’ detecting rate of NTS was significantly higher than that of urine culture[67.80%(221/326)vs. 23.93%(78/326), χ2=130.25, P<0.01]. The uropathogens detecting rate of NTS was significantly higher than that of urine culture[54.29%(177/326)vs. 23.31%(76/326), χ2=38.95, P<0.01]. The number of urinary tract microbes detected by NTS was significantly higher than that of urine culture ( Z=11.49, P<0.01), the number of uropathogens was significantly higher than that of urine culture ( Z=9.67, P<0.01). The detection time of NTS and urine culture positive samples was (24.29±2.65) h and (49.28±11.30) h, the difference was statistically significant ( t =39.48, P<0.01). The results obtained by using NTS and urine culture were consistent in 135 (41.41%) samples. In 150 (46.01%) samples, NTS could detect the urinary tract microbes while urine culture cannot find, of which 112 cases (34.36%) were uropathogenic. In 27 cases (8.28%), more pathogens were detected by NTS except those from urine culture. In 6 cases (1.84%) re-detecting NTS after antibiotic therapy, the number of reads of primary uropathogen decreased gradually with the growth of colonizing bacteria or opportunistic pathogens appeared in the end. Re-examinations of urine culture could verify the results of NTS detection on admission in 5 cases (1.53%). NTS in 2 cases (0.61%) could cover the uropathogens of subsequent several urine cultures. Conclusions:NTS has the advantages of rapid, sensitive and comprehensive detection of urinary tract infection pathogens. When urine culture is not yet reported or even negative, NTS already has a certain clinical reference value and can be used as an effective supplement to urine culture, which is conducive to the comprehensive judgment of the patient's condition.

Objective    To investigate the predictive value of volatile organic compounds (VOCs) on pulmonary nodules in people aged less than 50 years. Methods    The 147 patients with pulmonary nodules and aged less than 50 years who were treated in the Department of Thoracic Surgery of Sichuan Cancer Hospital from August 1, 2019 to January 15, 2020 were divided into a lung cancer group and a lung benign disease group. The lung cancer group included 36 males and 68 females, with the age of 27-49 (43.54±5.73) years. The benign lung disease group included 23 males and 20 females, with the age of 22-49 (42.49±6.83) years. Clinical data and exhaled breath samples were collected prospectively from the two groups. Exhaled breath VOCs were analyzed by gas chromatography mass spectrometry. Binary logistic regression analysis was used to select variables and establish a prediction model. The sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve of the prediction model were calculated. Results    There were statistically significant differences in sex (P=0.034), smoking history (P=0.047), cyclopentane (P=0.002), 3-methyl pentane (P=0.043) and ethylbenzene (P=0.009) between the two groups. The sensitivity, specificity and area under the ROC curve of the prediction model with gender, cyclopentane, 3-methyl pentane, ethylbenzene and N,N-dimethylformamide as variables were 80.8%, 60.5% and 0.781, respectively. Conclusion    The combination of VOCs and clinical characteristics has a certain predictive value for the benign and malignant pulmonary nodules in people aged less than 50 years.

BACKGROUND: Bronchial pleural fistula (BPF) is a common complication after thoracic surgery for lung resection. Clinical treatment is complex and the effect is poor. The treatment of BPF after lung resection has plagued thoracic surgeons. We reviewed retrospectively the clinical and follow-up data of 6 patients in our hospital who underwent the omentum transplantation in thorax to cover bronchial stump as treatment of BPF after pulmonary resection to analyze why BPF occurs and describe this treatment method. We intend to discuss and evaluate the feasibility, safety and small sample success rate ofthis treatment method. METHODS: During August 2016 to February 2018, six patients in our hospital underwent remedial open thoracotomy and omentum transplantation in pleura space to cover bronchial stump as treatment of bronchopleural fistula after pulmonary resection. Four patients had undergone a prior pneumonectomy and two patients had undergone a prior lobectomy (the residual lungs were resected with the main bronchus cut by endoscopic stapler during the reoperation). The bronchial stumps were sutured by 4-0 string with needle and covered by omentums, which were transplanted in pleura space from the cardiophrenic angle. Postoperatively, the pleura space was irrigated and drained. Summarize the clinical effect and technique learning points. RESULTS: The patients were all males, aged 61 to 73 years (median age: 66). BPF occurred from postoperative day 10 to 45 (median postoperative day 25). The reoperation was finished in 80 mins-150 mins (median 110 mins). Total blood loss was 200 mL-1,000 mL (median 450 mL). These patients were discharged on postoperative day 12-17 (median 14 days), and there was no more complications associated with bronchopleural fistula. All six patients' bronchial stumps were well closed (100%) and have recovered well during the follow-up period, which lasted 1 month-18 months. CONCLUSIONS Remedial operation should be performed as soon as possible when BPF after pulmonary resection diagnosed. Excellent prognoses can be achieved by omentum which is easy to get transplanted in thorax to cover bronchial stump as treatment in patients with BPF after pulmonary resection those who can tolerate reoperation.
Aged ; Bronchi ; surgery ; Bronchial Fistula ; etiology ; surgery ; Female ; Humans ; Lung ; surgery ; Lung Neoplasms ; complications ; surgery ; Male ; Middle Aged ; Omentum ; transplantation ; Pleura ; surgery ; Pleural Diseases ; etiology ; surgery ; Pneumonectomy ; adverse effects ; Postoperative Complications ; etiology ; surgery ; Retrospective Studies ; Thoracotomy

OBJECTIVEThoracoscopic esophagectomy has gained worldwide popularity. This study compared the perioperative outcomes and lymphadenectomy after thoracoscopic esophagectomy in semi prone position and open esophagectomy.

METHODSSixty-two consecutive patients after thoracoscopic esophagectomy were compared with 62 patients who underwent open esophagectomy. Outcomes included surgical time, blood loss, length of hospital stay, 30-day mortality, complications and gained lymph nodes.

RESULTSThe mean length of hospital stay of the thoracoscopic group was 12.4 ± 7.4 days, and 13.6 ± 6.7 days in the open esophagectomy group (P > 0.05). The median total operation time and median thoracic operation time were 270 and 130 min, the median total blood loss and median thoracic blood loss were 300 and 180 ml in the thoracoscopic group, while the results in open esophagectomy group were 290, 150 min and 300, 180 ml. The median total operation time and median thoracic operation time were of statistically significant difference (P < 0.01). But there were no significant differences between the two groups in total blood loss and thoracic blood loss (P > 0.05) . The numbers of obtained lymph nodes in the thoracoscopic group and open esophagectomy group were 20.5 and 16.9 (P < 0.01). Among them, the median numbers of mediastinal lymph nodes in the thoracoscopic group and open esophagectomy group were 12.4 and 8.8, the left recurrent laryngeal nerve lymph nodes were 1.8 and 1.0, and the right recurrent laryngeal nerve lymph nodes were 2.9 and 1.2 (P < 0.01 for all). There were 8 positive recurrent laryngeal nerve lymph nodes (12.9%) in the thoracoscopic group, while 5 in the open esophagectomy group (8.1%, P > 0.05). There were no peri-operative period death, heavy bleeding, or thoracic gastric fistula in both groups.

CONCLUSIONSThoracoscopic esophagectomy in semi prone position may achieve good surgical field exposure, therefore, to make esophagectomy, lymph node dissection and digestive tract reconstruction possible. These findings suggest that with further technical refinement, thoracoscopic esophagectomy may have the upper hand on reducing postoperative complications and performing mediastinal lymph node dissection.

Esophageal Neoplasms ; surgery ; Esophagectomy ; Humans ; Length of Stay ; Lymph Node Excision ; Lymph Nodes ; surgery ; Mediastinum ; Operative Time ; Postoperative Complications ; Prone Position ; Recurrent Laryngeal Nerve ; Thoracoscopy

Objective To investigate the morphology change of transplants of adrenocortical cells using poly-? -hybroxybutyric acid (PHB) as a cell carrier. Methods Adrenocortical cells were seeded on PHB and then implanted into rats bearing bilateral adrenalectomy. Histological changes and CD3 expression by using immunohistochemical staining were observed in local area of transplants on the postoperative week 2, 4, 8. Results Histological study showed inflaming cells were decreased as time passed, fibrous tissue disappeared step by step, PHB degraded gradually and adrenocortical cells tended to be organized; Ultrastratural observation revealed these cells maintained identical secreting function; Immunohistochemical assay indicated the expression of CD3 in the transplanted was similar to that in the normal adrenal cells. Conclusion The transplanted cells seeded in PHB can not only be survival, but also organized to the same tissue structure and ultrastructure as normal adrenal tissue.