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.

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.

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.