Objective: Intrathyroid thymic carcinoma（ITTC） is a rare thyroid tumor that lacks typical clinical manifestations and imaging features, making preoperative diagnosis challenging.The primary treatment for ITTC is radical surgery; however, the effectiveness of adjuvant radiotherapy and chemotherapy post-surgery is not well-established. This paper presents a case of ITTC , analyzing the clinical data and correlating it with the literature to explore the clinical manifestations, diagnostic approach, treatment, and prognosis of ITTC.
Humans ; Prognosis ; Thymoma ; Thymus Neoplasms/diagnosis* ; Thyroid Neoplasms/pathology*

Objective·To explore the diagnostic,therapeutic,and prognostic value of metagenomics next-generation sequencing(mNGS)in patients with pneumonia-induced sepsis.Methods·This study consisted of a multicenter,prospective,non-randomized controlled trial and a diagnostic test.Patients with pneumonia-induced sepsis who were hospitalized in four hospitals across China were enrolled between March 2020 and October 2021.All patients met the Sepsis-3 criteria issued by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine,as well as the clinical diagnostic standard of pneumonia.Enrolled patients were assigned based on their preference to either the conventional test-only group[receiving only conventional test(CMT)]or the combined mNGS test group(receiving CMT and mNGS concurrently).The primary outcome was the 7-day all-cause mortality rate,and secondary outcomes included the changes in SOFA and APACHE Ⅱ scores from baseline to day 7,28-day all-cause mortality rate,the composite endpoint of mechanical ventilation or death within 28 d,28 d ventilation-free days,28 d hospital-free days,and the average daily hospitalization cost.Propensity score matching was used to balance covariates between the two groups.Kaplan-Meier curves were plotted and Cox proportional hazards models were built to compare the risk of death between the two groups.Pathogen detection results from infection site samples in the combined mNGS test group were used for the diagnostic test.The clinically-adjudicated causative pathogens was used as the reference standard.The results of traditional pathogen detection and mNGS detection were compared respectively with the reference standard.The positive percent agreement,negative percent agreement,positive predictive value,and negative predictive value between the two methods and the reference standard were calculated.McNemar's χ2 test was used to evaluate the causative pathogen detection capabilities of the two methods.Results·A total of 533 patients were enrolled,of whom 311 opted for additional mNGS testing,while 222 received only conventional pathogenetic testing.In the non-randomized controlled trial,after propensity score matching to balance covariates,the 7-day all-cause mortality was lower in the combined mNGS test group compared to the conventional test-only group[4.8%vs 8.6%,HR 0.37(95%CI 0.15?0.91),P=0.031].Additionally,the 28-day ventilation-free days were increased in the combined mNGS test group(19.9 d vs 18.4 d,P=0.041).No significant difference was observed between the two groups in terms of 28-day all-cause mortality or the average daily hospitalization costs.In the diagnostic test,compared to the reference standard,the positive percent agreement of mNGS with the clinical composite judgment for causative pathogens was higher than that of CMT[91.9%(95%CI 87.7%?95.0%)vs 56.1%(95%CI 49.7%?62.4%),P<0.001].Conversely,the negative percent agreement of mNGS was lower than that of CMT[29.2%(95%CI 18.6%?41.8%)vs 69.2%95%CI 56.6%?80.1%),P<0.001].The negative predictive value of nNGS was higher than that of CMT[48.7%(95%CI 32.4%?65.2%)vs 29.4%(95%CI 22.3%?37.3%),P=0.001].Conclusion·In patients with pneumonia-induced sepsis,mNGS of infection site samples demonstrated a higher detection rate of causative pathogen compared to CMT.Furthermore,the combination of mNGS with CMT may help reduce the 7-day all-cause mortality,suggesting that mNGS has clinical value and potential for application in the management of sepsis caused by pulmonary infections.

Objective·To explore the diagnostic,therapeutic,and prognostic value of metagenomics next-generation sequencing(mNGS)in patients with pneumonia-induced sepsis.Methods·This study consisted of a multicenter,prospective,non-randomized controlled trial and a diagnostic test.Patients with pneumonia-induced sepsis who were hospitalized in four hospitals across China were enrolled between March 2020 and October 2021.All patients met the Sepsis-3 criteria issued by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine,as well as the clinical diagnostic standard of pneumonia.Enrolled patients were assigned based on their preference to either the conventional test-only group[receiving only conventional test(CMT)]or the combined mNGS test group(receiving CMT and mNGS concurrently).The primary outcome was the 7-day all-cause mortality rate,and secondary outcomes included the changes in SOFA and APACHE Ⅱ scores from baseline to day 7,28-day all-cause mortality rate,the composite endpoint of mechanical ventilation or death within 28 d,28 d ventilation-free days,28 d hospital-free days,and the average daily hospitalization cost.Propensity score matching was used to balance covariates between the two groups.Kaplan-Meier curves were plotted and Cox proportional hazards models were built to compare the risk of death between the two groups.Pathogen detection results from infection site samples in the combined mNGS test group were used for the diagnostic test.The clinically-adjudicated causative pathogens was used as the reference standard.The results of traditional pathogen detection and mNGS detection were compared respectively with the reference standard.The positive percent agreement,negative percent agreement,positive predictive value,and negative predictive value between the two methods and the reference standard were calculated.McNemar's χ2 test was used to evaluate the causative pathogen detection capabilities of the two methods.Results·A total of 533 patients were enrolled,of whom 311 opted for additional mNGS testing,while 222 received only conventional pathogenetic testing.In the non-randomized controlled trial,after propensity score matching to balance covariates,the 7-day all-cause mortality was lower in the combined mNGS test group compared to the conventional test-only group[4.8%vs 8.6%,HR 0.37(95%CI 0.15?0.91),P=0.031].Additionally,the 28-day ventilation-free days were increased in the combined mNGS test group(19.9 d vs 18.4 d,P=0.041).No significant difference was observed between the two groups in terms of 28-day all-cause mortality or the average daily hospitalization costs.In the diagnostic test,compared to the reference standard,the positive percent agreement of mNGS with the clinical composite judgment for causative pathogens was higher than that of CMT[91.9%(95%CI 87.7%?95.0%)vs 56.1%(95%CI 49.7%?62.4%),P<0.001].Conversely,the negative percent agreement of mNGS was lower than that of CMT[29.2%(95%CI 18.6%?41.8%)vs 69.2%95%CI 56.6%?80.1%),P<0.001].The negative predictive value of nNGS was higher than that of CMT[48.7%(95%CI 32.4%?65.2%)vs 29.4%(95%CI 22.3%?37.3%),P=0.001].Conclusion·In patients with pneumonia-induced sepsis,mNGS of infection site samples demonstrated a higher detection rate of causative pathogen compared to CMT.Furthermore,the combination of mNGS with CMT may help reduce the 7-day all-cause mortality,suggesting that mNGS has clinical value and potential for application in the management of sepsis caused by pulmonary infections.

Objective:To analyze the clinical features of patients with pyogenic liver abscess (PLA) and the application of mNGS in PLA, thus to provide reference for clinical diagnosis and treatment.Methods:The demographic and clinical data of 549 patients with liver abscess admitted to Zhongshan Hospital Affiliated to Fudan University from December 2015 to June 2020 were analyzed retrospectively. According to the detection of Klebsiella pneumoniae in 246 patients with positive etiological test results, the patients were divided into two groups: KPLA group and nKPLA group, and clinical characteristics of the two groups were compared. At the same time, the application value of mNGS in PLA was analyzed.Results:Among the 549 patients, the main clinical symptom of PLA was fever ( n= 503, 91.6%) and other clinical symptoms included chills and abdominal pain. Most patients had a single abscess ( n= 464, 84.5%) located in the right lobe ( n = 368, 67.0%), with a size between 5 and 10 cm ( n= 341, 62.1%). A total of 246 patients had positive etiological test results, including 202 KPLA patients which was the main pathogen of liver abscess. The prevalence of diabetes and fatty liver was higher in KPLA patients ( P < 0.05), but there were more culture of liver positive factors in nKPLA patients ( P < 0.001). Among the 109 patients with traditional microbiological results, 92 patients were suspected to KPLA (Klebsiella pneumoniae), of which 14 patients (15.2%) were multidrug resistant (MDR) infection; 17 patients were suspected to nKPLA, of which 10 patients (58.8%) were MDR infection; the incidence of MDR infection in patients with nKPLA was significantly higher than that in patients with KPLA ( P < 0.05). The positive rate of mNGS in plasma was 85.2%, the positive rate of traditional microbial culture in plasma was 14.8%, the positive rate of mNGS in pus was 96.2% and traditional microbial culture in pus was 65.4%. The positive rate of traditional culture was significantly lower than that of mNGS ( P < 0.05). Conclusions:PLA is usually manifested as fever, single and at the right lobe of the liver. Klebsiella pneumoniae is the most common pathogenic bacteria of PLA, which is more common in patients with diabetes and fatty liver, while non-Klebsiella pneumoniae is relatively more common in patients with culture of liver positive factors. The positive detection rate of mNGS is high, which has a unique advantage in pathogen detection.

Objective:To explore the value of metagenomic next-generation sequencing (mNGS) in the pathogen diagnosis of liver abscess.Methods:A perspective study was performed in 35 hospitalized patients with liver abscess in Department of Emergency Medicine, Zhongshan Hospital, Fudan University from February 2020 to April 2021. Blood samples and abscess drainage fluid samples were detected by routine microbial culture and mNGS. Patients were divided into two groups according to whether they had septic shock or not. SPSS 25.0 was used for statistical analysis.Results:The overall positive rate of mNGS in blood samples and drainage fluid samples was significantly higher than that of routine microbial culture methods (blood: 67.6% vs. 15.2%, P<0.05; Drainage fluid: 100% vs. 55.2%, P<0.05). In 35 patients with liver abscess, 71.4% of the pathogens were Klebsiella pneumoniae. The sequence number of pathogenic pathogens detected by mNGS in abscess drainage fluid samples of patients in the shock group was significantly higher than that in the non-shock group ( P<0.05). Conclusions:The mNGS can quickly and accurately detect the pathogen of liver abscess, which can provide important etiological diagnostic for clinical treatment.

Objective To investigate the effect of hyperbaric oxygen (HBO) coupled with cisplatin on the apoptosis of human hypopharyngeal cancer Fadu cells in vitro and also to observe the effect of HBO exposure at different time points on the efficacy of cisplatin.Methods Human hypopharyngeal cancer Fadu cells for culture were bought from the Tumor Research Institute,Shanghai Jiaotong University.MTT assay was applied to observe the effect of different concentrations of cisplatin on the proliferation inhibition of Fadu cells in vitro.In accordance with different treatment,Fadu cells were divided into 6 groups:group C (the control group),group HBO (the HBO group),group CHT (the chemotherapy group),group HBO + CHT (the HBO + chemotherapy group),group CHT + HBO (the chemotherapy + HBO group and group IC (the HBO immediately combined with chemotherapy group).Cells of various groups were detected by flow cytometry 48 hours after experiment to observe changes in apoptosis,and adenosine triphosphate (ATP) changes in the cells of various groups were measured by ATP kit.Results Apoptosis rates of group C,HBO,CHT,HBO + CHT,CT + HBO and IC were respectively(2.00 ±0.17)％,(2.07 ±0.22)％,(8.73 ±0.74)％,(11.9 ±0.68)％,(9.92 ±0.27)％ and(10.4 ±0.72)％.No statistical significance could be noticed in the apoptosis rates of group C and HBO(P ＞0.05).The apoptosis rates of group CHT,HBO + CHT,CHT + HBO and IC were all higher that those of group C and HBO,and statistical significance could be noted when comparisons were made between them(P ＜0.01).Experiments showed that the apoptosis rate of group HBO + CHT was higher than those of the other groups,with statistical significance(P ＜ 0.05).Suppose the ATP level of group C was 100％,the ATP levels of other groups were respectively 98.7％,83.9％,61.3％,78.5％ and 77.1％.There was statistical significance in the ATP levels of group C and HBO(P ＞0.05).However,the ATP levels of group CHT,HBO + CHT,CHT + HBO and IC were all lower than those of group C and HBO,also with statistical significance (P ＜0.01).The ATP level of group HBO + CHT was significantly lower than those of the other groups,also with statistical significance(P ＜ 0.05).Conclusions Single HBO exposure had no effect on the apoptosis of hypopharyngeal cancer Fadu cells.HBO coupled with cisplatin could enhance the therapeutic efficacy of cisplatin,promote apoptosis,and the efficacy might be associated with the time points of the combined treatment of HBO.

Objective To investigate the effect of hyperbaric oxygen (HBO) coupled with cisplatin on the apoptosis of human hypopharyngeal cancer Fadu cells in vitro and also to observe the effect of HBO exposure at different time points on the efficacy of cisplatin.Methods Human hypopharyngeal cancer Fadu cells for culture were bought from the Tumor Research Institute,Shanghai Jiaotong University.MTT assay was applied to observe the effect of different concentrations of cisplatin on the proliferation inhibition of Fadu cells in vitro.In accordance with different treatment,Fadu cells were divided into 6 groups:group C (the control group),group HBO (the HBO group),group CHT (the chemotherapy group),group HBO + CHT (the HBO + chemotherapy group),group CHT + HBO (the chemotherapy + HBO group and group IC (the HBO immediately combined with chemotherapy group).Cells of various groups were detected by flow cytometry 48 hours after experiment to observe changes in apoptosis,and adenosine triphosphate (ATP) changes in the cells of various groups were measured by ATP kit.Results Apoptosis rates of group C,HBO,CHT,HBO + CHT,CT + HBO and IC were respectively(2.00 ±0.17)％,(2.07 ±0.22)％,(8.73 ±0.74)％,(11.9 ±0.68)％,(9.92 ±0.27)％ and(10.4 ±0.72)％.No statistical significance could be noticed in the apoptosis rates of group C and HBO(P ＞0.05).The apoptosis rates of group CHT,HBO + CHT,CHT + HBO and IC were all higher that those of group C and HBO,and statistical significance could be noted when comparisons were made between them(P ＜0.01).Experiments showed that the apoptosis rate of group HBO + CHT was higher than those of the other groups,with statistical significance(P ＜ 0.05).Suppose the ATP level of group C was 100％,the ATP levels of other groups were respectively 98.7％,83.9％,61.3％,78.5％ and 77.1％.There was statistical significance in the ATP levels of group C and HBO(P ＞0.05).However,the ATP levels of group CHT,HBO + CHT,CHT + HBO and IC were all lower than those of group C and HBO,also with statistical significance (P ＜0.01).The ATP level of group HBO + CHT was significantly lower than those of the other groups,also with statistical significance(P ＜ 0.05).Conclusions Single HBO exposure had no effect on the apoptosis of hypopharyngeal cancer Fadu cells.HBO coupled with cisplatin could enhance the therapeutic efficacy of cisplatin,promote apoptosis,and the efficacy might be associated with the time points of the combined treatment of HBO.