Objective To evaluate the diagnostic efficacy of metagenomic next-generation sequencing(mNGS)in detecting pathogens causing secondary infections in maintenance hemodialysis(MHD)patients,providing evidence for clinical implementation.Methods Sixty-five MHD patients with suspected secondary infections admitted to the blood purification treatment center of Tianjin University Tianjin Hospital from October 2022 to March 2024 were selected as the research subjects.All enrolled patients underwent routine laboratory examinations and imaging tests,the peripheral blood,sputum,bronchoalveolar lavage fluid(BALF),urine,feces,pleural effusion,and peritoneal effusion were collected for mNGS and traditional isolation and culture respectively.The infection status of MHD patients was analyzed.Compare the sensitivity,specificity,diagnostic accuracy,positive predictive value,negative predictive value,pathogen detection rate,and detection cycle across the two etiological diagnostic methods.Results Among the enrolled patients,11 were excluded from infection after comprehensive analysis and diagnostic treatment,and 54 were definitively diagnosed with MHD-associated secondary infections,including 20 cases of respiratory system infection(accounting for 37.04%),18 cases of bloodstream infection(33.33%),13 cases of urinary system infection(24.07%),2 cases of pleurisy(3.71%),and 1 case of peritonitis(1.85%).Among these infected cases,there were 12 cases of single bacterial infection,6 cases of single fungal infection,3 cases of atypical pathogen infection,and 33 cases of overlapping infections detected.The most common pathogens in respiratory infections,bloodstream infections,and urinary tract infections were Klebsiella pneumoniae,Staphylococcus aureus,and Escherichia coli respectively.Through mNGS,6 additional cases of Pneumocystispneumonia,3 cases of pulmonary Aspergillosis,3 cases of pulmonary tuberculosis,and 1 case of fungal pleurisy were successfully detected.A total of 25 patients had their medication adjusted based on the mNGS results,among whom 18 were discharged after improvement with treatment.The most common pattern of mixed infection was bacteria+fungi(16 cases),followed by bacteria+bacteria(9 cases),bacteria+fungi+atypical pathogens(4 cases),bacteria+atypical pathogens(3 cases),and fungi+fungi(1 case)in overlapping infections.The positive detection rate of overlapping infections by mNGS was significantly higher than that by traditional isolation and culture[78.79%(26/33)vs.12.12%(4/33),P<0.05].The sensitivity of mNGS in diagnosing pathogenic infections was significantly higher than that of traditional isolation and culture(overall diagnostic efficacy:96.30%vs.59.26%,precise diagnostic efficacy:95.35%vs.35.29%,both P<0.05).However,the specificity of the overall diagnostic efficacy of traditional isolation and culture was significantly higher than that of mNGS(100.00%vs.81.82%,P<0.05),the diagnostic coincidence rate,accuracy rate of single pathogen detection,and accuracy rate of overlapping pathogen detection of mNGS were all significantly higher than those of traditional isolation and culture(diagnostic coincidence rate of overall diagnostic efficacy:93.85%vs.66.15%,diagnostic coincidence rate of precise diagnostic efficacy:76.92%vs.35.38%,accuracy rate of single pathogen detection:80.95%vs.52.38%,accuracy rate of overlapping pathogen detection:66.67%vs.0,all P<0.05).The detection cycle of mNGS was significantly shorter than that of traditional isolation and culture[hours:27(26,29)vs.70(28,114),P<0.05].Conclusion mNGS can provide accurate and rapid etiological diagnosis for secondary infections in MHD patients,bringing benefits to precise diagnosis and targeted drug therapy.

Objective To evaluate the diagnostic efficacy of metagenomic next-generation sequencing(mNGS)in detecting pathogens causing secondary infections in maintenance hemodialysis(MHD)patients,providing evidence for clinical implementation.Methods Sixty-five MHD patients with suspected secondary infections admitted to the blood purification treatment center of Tianjin University Tianjin Hospital from October 2022 to March 2024 were selected as the research subjects.All enrolled patients underwent routine laboratory examinations and imaging tests,the peripheral blood,sputum,bronchoalveolar lavage fluid(BALF),urine,feces,pleural effusion,and peritoneal effusion were collected for mNGS and traditional isolation and culture respectively.The infection status of MHD patients was analyzed.Compare the sensitivity,specificity,diagnostic accuracy,positive predictive value,negative predictive value,pathogen detection rate,and detection cycle across the two etiological diagnostic methods.Results Among the enrolled patients,11 were excluded from infection after comprehensive analysis and diagnostic treatment,and 54 were definitively diagnosed with MHD-associated secondary infections,including 20 cases of respiratory system infection(accounting for 37.04%),18 cases of bloodstream infection(33.33%),13 cases of urinary system infection(24.07%),2 cases of pleurisy(3.71%),and 1 case of peritonitis(1.85%).Among these infected cases,there were 12 cases of single bacterial infection,6 cases of single fungal infection,3 cases of atypical pathogen infection,and 33 cases of overlapping infections detected.The most common pathogens in respiratory infections,bloodstream infections,and urinary tract infections were Klebsiella pneumoniae,Staphylococcus aureus,and Escherichia coli respectively.Through mNGS,6 additional cases of Pneumocystispneumonia,3 cases of pulmonary Aspergillosis,3 cases of pulmonary tuberculosis,and 1 case of fungal pleurisy were successfully detected.A total of 25 patients had their medication adjusted based on the mNGS results,among whom 18 were discharged after improvement with treatment.The most common pattern of mixed infection was bacteria+fungi(16 cases),followed by bacteria+bacteria(9 cases),bacteria+fungi+atypical pathogens(4 cases),bacteria+atypical pathogens(3 cases),and fungi+fungi(1 case)in overlapping infections.The positive detection rate of overlapping infections by mNGS was significantly higher than that by traditional isolation and culture[78.79%(26/33)vs.12.12%(4/33),P<0.05].The sensitivity of mNGS in diagnosing pathogenic infections was significantly higher than that of traditional isolation and culture(overall diagnostic efficacy:96.30%vs.59.26%,precise diagnostic efficacy:95.35%vs.35.29%,both P<0.05).However,the specificity of the overall diagnostic efficacy of traditional isolation and culture was significantly higher than that of mNGS(100.00%vs.81.82%,P<0.05),the diagnostic coincidence rate,accuracy rate of single pathogen detection,and accuracy rate of overlapping pathogen detection of mNGS were all significantly higher than those of traditional isolation and culture(diagnostic coincidence rate of overall diagnostic efficacy:93.85%vs.66.15%,diagnostic coincidence rate of precise diagnostic efficacy:76.92%vs.35.38%,accuracy rate of single pathogen detection:80.95%vs.52.38%,accuracy rate of overlapping pathogen detection:66.67%vs.0,all P<0.05).The detection cycle of mNGS was significantly shorter than that of traditional isolation and culture[hours:27(26,29)vs.70(28,114),P<0.05].Conclusion mNGS can provide accurate and rapid etiological diagnosis for secondary infections in MHD patients,bringing benefits to precise diagnosis and targeted drug therapy.

BACKGROUND:Mitochondrial reactive oxygen bursts have been shown to play a key role in skeletal muscle ischemia-reperfusion injury.3-Nitro-N-methylsalicylamide(3-NNMS)can effectively reduce the electron transport rate and has a potential protective effect on limb ischemia-reperfusion injury,but there is no clear research and clinical application. OBJECTIVE:To investigate the protective effect of 3-NNMS on the skeletal muscle after limb ischemia-reperfusion injury in rats and its mechanism. METHODS:Forty healthy 8-week-old Sprague-Dawley rats were randomly divided into control group,0,25 and 125 μg/mL 3-NNMS groups,with 10 rats in each group.Animal models of limb ischemia-reperfusion injury were prepared in the latter three groups.3-NNMS was injected into the injury site 30 minutes before reperfusion.The animals were sacrificed 2 hours after reperfusion.Blood from the apical part of the heart,and the tissue of the rectus femoris muscle of the right lower limb were taken for testing.The pathological morphology of the rectus femoris muscle was detected by hematoxylin-eosin staining.Serum levels of creatine kinase found in the skeletal muscle(CK-MM),lactate dehydrogenase,and myeloperoxidase were detected using ELISA;the levels of nuclear factor κB,tumor necrosis factor α,interleukin 1β,cyclooxygenase 2,malondialdehyde,reactive oxygen species,superoxide dismutase,catalase and glutathione peroxidase in the rectus femoris muscle were measured;and adenosine triphosphate(ATP)level,ATPase activity,and mitochondrial respiratory control rate were tested. RESULTS AND CONCLUSION:Compared with the control group,the model rats with ischemia-reperfusion injury had increased serum levels of CK-MM,lactate dehydrogenase,and myeloperoxidase,increased levels of nuclear factor κB,tumor necrosis factor α,interleukin 1β,cyclooxygenase 2,malondialdehyde and reactive oxygen species in the rectus femoris muscle,decreased levels of catalase and glutathione peroxidase in the rectus femoris muscle,and reduced ATPase activity and mitochondrial respiratory control rate.Moreover,cell morphology was irregular,inflammatory cell infiltration was obvious,and the cells were swollen in rats after ischemia-reperfusion injury.Compared with the 0 μg/mL group,the serum CK-MM and lactate dehydrogenase levels decreased,the levels of nuclear factor κB and cyclooxygenase 2 in the rectus femoris muscle decreased,reactive oxygen species level decreased,and superoxide dismutase activity increased in the 25 μg/mL group;cell morphology was more regular,inflammatory cell infiltration was lighter,and cell swelling was alleviated.Compared with the 0 μg/mL group,the 125 μg/mL group had a reduction in the serum levels of CK-MM,lactate dehydrogenase,and myeloperoxidase and the levels of nuclear factor κB,tumor necrosis factor α,cyclooxygenase 2,malondialdehyde and reactive oxygen species in the rectus femoris muscle,as well as an increase in the levels of superoxide dismutase and glutathione peroxidase in the rectus femoris muscle,and mitochondrial respiratory control rate.Moreover,the cells were arranged neatly,the outline was clear and complete,and the inflammatory cell infiltration was light.To conclude,3-NNMS can alleviate the functional impairment of the skeletal muscle caused by limb ischemia-reperfusion,and its mechanism of action may be through improving mitochondrial function,reducing reactive oxygen species production,decreasing oxidative stress and inflammatory response,and thus reducing tissue damage and repairing skeletal muscle function.

Objective:To investigate the clinical features of neonatal testicular torsion and to evaluate the effect and necessity of early intervention.Methods:A retrospective analysis was performed on 11 neonates admitted to the Second Hospital of Shandong University with neonatal testicular torsion from June 2017 to June 2022. Clinical data of these cases including clinical manifestations, ultrasonography findings, surgical management and outcomes were reviewed and analyzed with descriptive statistical methods.Results:The median age of the 11 patients on admission was 2.6 d (1-5 d). The median time from finding abnormal scrotum to admission was 12 h (1-120 h). Various degrees of scrotal swelling or scleroma were found in the patients. Among them, seven patients presented with acute inflammatory signs of cyano sis or skin redness, and testis-like tissue induration could be touched. Ultrasound scan showed abnormal blood flow in the affected testicle in all cases. Emergency scrotal exploration under general anesthesia was performed successfully in all cases and ten of them underwent orchiectomy of the affected testicle plus contralateral orchiopexy. The rest one who was admitted within 1 h after birth only underwent orchiopexy of the affected testicle as the parents refused contralateral testicular exploration. During the operation, 12 twisted testis were observed, including seven with extravaginal torsion, three with intravaginal torsion and two adhering to the surrounding tissue without normal testicular tissue or distinguishable torsion direction or degree. In this study, ten patients had unilateral testicular torsion, which affected the left side in seven cases and the right side in three cases, and one had bilateral testicular torsion, which was diagnosed as left testicle torsion before surgery. During scrotal exploration, the left testicle of this bilateral case was resected due to necrosis, while the right testicle twisted about 180 degrees with good blood flow and was subjected to orchidopexy after reduction. In one case, the unaffected testicle was unfixed and dysplastic during contralateral exploration, which was also subjected to orchidopexy. In the 12 testis with torsion, one testicle of the patient admitted within 1 h after birth and the right testicle of the bilateral case were preserved with a salvage rate of 2/12. Pathological examination showed necrosis in the ten excised testis, and fibrosis and calcification foci in two of them. None of the patients had any perioperative complications and the scrotal incision healed well in all neonates. The patients were followed up for 6-12 months with regular ultrasound. The two preserved testis and the contralateral testis subjected to orchidopexy were located in the scrotum with good blood supply, and no torsion, atrophy or other abnormalities occurred.Conclusions:Neonatal testicular torsion is rarely seen in clinical practice and has no specific manifestations. It has a high excision rate due to testicular necrosis. Early diagnosis and bilateral scrotal exploration are crucial to the prognosis and the keys to save the affected testis and avoid anorchidism.

Acute kidney injury (AKI) is a clinical syndrome characterized by a rapid decline of renal function in a short period of time. In recent years, the incidence of AKI has been increasing gradually. Once the AKI occurs in a patient whose mortality in hospital may be increased significantly, the length of stay in hospital will be prolonged and the hospitalization costs increased in a short term, the long-term consequences include AKI recurrence, development into chronic kidney disease (CKD) or end-stage kidney disease (ESRD), cardiovascular events and death, etc. Ischemia/reperfusion (I/R) injury and contrast agents are common causes of AKI. The nephropathy induced by I/R and contrast agent is associated with intracellular calcium overload caused by Na+-Ca2+ exchanger (NCX). In this article, a systematic review of the relationship between NCX and AKI was conducted, aiming to provide a reference for further recognizing the prevention, treatment and prognosis of AKI.

Submandibular gland excision was performed on two patients using trans-oral robotic surgery (TORS). Complications such as the injury of marginal mandibular branch of facial nerve, ranula in the floor of the mouth, and postoperative hemorrhage were not observed. Visible cervical scar can be avoided and esthetic outcome can be expected by using this surgical modality.

Objective To explore the effect of 5M1E quality analysis tool-based hand hygiene(HH) comprehensive intervention measures on pediatric healthcare-associated infection(HAI).Methods HH status of 29 health care workers(HCWs) in the pediatric department of a hospital was monitored, April-June 2015 was baseline survey stage, 5M1E quality analysis tool was adopted to analyze various factors affecting the compliance rate of pediatric HH, intervention measures began to be taken in June 2015, and compared with HH in July 2015-March 2016.The occurrence of HAI between July 2014-March 2015 and July 2015-March 2016 was compared.Results HH compliance rate of HCWs increased from 30.86% in April-June 2015 to 81.94% in January-March 2016;HH correct rate increased from 68.14% to 93.75%;HH compliance rate and correct rate of HCWs gradually increased(X2=2 608.626, 630.798,respectively, both P<0.001).Qualified rate of detection of HCWs' HH sampling increased from 20.69% in April-June 2015 to 89.66% in January-March 2016(X2=31.957,P<0.001).Incidence of HAI decreased from 7.74% in July 2014-March 2015 to 3.62% in July 2015-March 2016(X2=46.717,P<0.001).Conclusion Application of 5M1E quality analysis tool in the investigation, analysis, and comprehensive intervention in HCWs' HH in pediatric department has greatly enhanced HCWs' HH compliance rate, and reduced the incidence of HAI in pediatric patients.

Objective To explore the effects of an aerobic exercise of different durations on the binding capacity of NF-E2-related factor 2(Nrf2)/Kelch-like ECH-associated protein-1(Keap1) in skeletal muscle of mice.Methods Thirty C57BL/6J mice were divided into a control(0h) group,an acute exercise for 3 hours (3h) group and an acute exercise for 6 hours(6h) group.The mice ran on treadmill at the speed of 15 m/min for different durations.The mice were sacrificed immediately after exercise and collected skeletal muscles of legs.The high quality fluorescence assay was done to detect the reactive oxygen species(ROS) level in the skeletal muscles of mice.The binding capacity of Nrf2/Keap1 was detected using co-immunoprecipitation.The expression of Nrf2 and Keap1 was analyzed using the Western blotting.Result Compared with group 0h,the Nrf2/Keap1 binding capacity in skeletal muscles of group 3h and 6h decreased significantly(P＜0.05),but the total Nrf2 in skeletal muscles increased significantly(P＜0.05).No significant differences were observed in the expression of total Keapl.The expression of Nrf2 protein of group 3h and 6h increased significantly compared with 0h,with that of group 6h significantly higher than group 3h(P＜0.05).The ROS level in skeletal muscles of group 6h increased significantly compared with group 0h(P＜0.05).Conclusion The effect of acute aerobic exercise on Nrf2/Keap1 binding capacity in skeletal muscle of mice depends on its duration.

Purpose To study the MRI manifestations of hippocampus with acute injury in children with epilepsy, and to explore its causes and outcomes for a better understanding of the changes of hippocampal structure with acute injury.Materials and Methods The clinical and imaging data of 8 children with epilepsy whose hippocampus showed hyperintensity in DWI were retrospectively analyzed. The bilateral hippocampal volume and ADC values were measured; changes of hippocampal volume and T2WI signal and ADC value were also analyzed.Results Eight patients were clinically diagnosed as epilepsy, 7 cases had recurrent history of seizures. MRI was performed from 1 to 5 days after the onset of epilepsy. All the 8 patients had increased unilateral hippocampal volume, 6 of whom were on the left side and the other 2 were on the right side. The affected ipsilateral hippocampal volume was significantly higher than that on the contralateral side [(2.096±0.570) cm3 and (1.768±0.447) cm3, respectively,t=-4.763,P<0.01]. The signals increased on T2WI and FLAIR; DWI showed hyperintensity with increase by approximately 25.52%. The affected ipsilateral ADC value was significantly lower than the contralateral one [(0.763±0.049)×10-3 mm2/s and (0.859±0.054)×10-3 mm2/s, respectively, t=9.598,P<0.01]. No abnormalities were found in bilateral hippocampus when 3 patients underwent MRI due to febrile convulsions and seizures before the onset of epilepsy. The affected ipsilateral hippocampal volume reduced in 3 patients after 3 to 5 months;signal was still high on T2WI and FLAIR; ADC values increased by 15.6%, the imaging results indicated hippocampal sclerosis.Conclusion Epilepsy can cause acute injury in hippocampus which demonstrates hippocampus swelling, signal increase on T2WI, and reduced ADC value and may lead to hippocampal sclerosis.

Purpose To investigate the correlation between the brain white matter changes of MR diffusion tensor imaging (DTI) and cognitive function in the patients with mild cognitive impairment. Materials and Methods The patients (40 cases) were classified into two groups:group A (20 patients with ischemic foci in the deep white matter ) and group B (20 patients without ischemic foci in the deep white matter), and 20 normal controls was enrolled. Conventional MRI, DTI, mini-mental state examination (MMSE) and montreal cognitive assessment (MoCA) were applied, then fractional anisotropy (FA) value and apparent diffusion coefficient (ADC) value were compared among three groups. The scores of MoCA was analyzed between the patient groups. Results The decreased FA value, increased ADC value and decreased MoCA scores was demonstrate in group A, and showed significant difference compared with group B (t=-4.229,-3.251,-7.533,-2.702,-2.660;P<0.05). The increased ADC value and decreased FA value in the frontal and hippocampus region were detected in group B compared with normal controls (t=-7.790,-2.785,-4.415,-5.164;P<0.05). Conclusion The early and special structural changes can be detected using DTI compared with conventional MRI. The severe white matter lesions can be demonstrated in the patients with ischemic foci in the deep white matter, who is prone to dementia.