ObjectiveTo analyze the clinical characteristics, risk factors, and drug resistance of pathogenic bacteria in patients with blood stream infections (BSI) after orthopedic surgery, so as to provide reference and basis for clinical diagnosis and treatment.MethodsA retrospective analysis was made on the clinical data of 6 348 orthopedic patients admitted for surgery between January 2017 and December 2019. There were 3 598 males and 2 750 females. Their age ranged from 18 to 98 years, with an average of 66 years. The data of patients were collected, and the risk factors of BSI were analyzed by univariate analysis and logistic regression analysis. The distribution of BSI pathogenic bacteria, the results of drug sensitivity test, the incidence of BSI in patients after orthopedic surgery in different years, and the common sites of BSI secondary infection were summarized.ResultsBSI occurred in 106 (1.67%) of 6 348 patients after orthopedic surgery. There were 71 cases (66.98%) of secondary infection. The mortality of postoperative BSI patients was 1.89%, and the difference was significant when compared with that of non-postoperative BSI patients (0.24%) (χ2=5.313, P=0.021). The incidences of BSI in 2017, 2018, and 2019 were 1.18%, 1.53%, and 2.17%, respectively, showing an increasing trend year by year (trend χ2=6.610, P=0.037). Statistical analysis showed that the independent risk factors for BSI after orthopedic surgery (P<0.05) included the trauma, length of hospital stay≥14 days, emergency surgery, postoperative leukocyte counting<4×109/L, level of hemoglobin≤90 g/L, albumin≤30 g/L, the time of indwelling ureter>24 hours, use of deep vein catheter insertion, and merging other site infection. Blood culture showed 56 strains (52.83%) of Gram-positive bacteria, 47 strains (44.34%) of Gram-negative bacteria, and 3 strains (2.83%) of fungi. The top three pathogenic bacteria were coagulase negative Staphylococci (CNS; 36 strains, 33.96%), Escherichia coli (16 strains, 15.09%), and Staphylococcus aureus (15 strains, 14.15%). The detection rates of extended-spectum β-lactamases producing strains of Escherichia coli and Klebsiella pneumoniae were 56.25% (9/16) and 44.44% (4/9), respectively. The detection rates of methicillin-resistant strains in Staphylococcus aureus and CNS were 46.67% (7/15) and 72.22% (26/36), respectively.ConclusionPostoperative BSI in orthopedic patients is caused by multiple factors. Preventive measures should be taken according to related risk factors and perioperative risk assessment should be strengthened. Staphylococcus and Escherichia coli are the most common pathogenic bacteria in BSI after orthopedic surgery. The infection rate and drug-resistant bacteria are increasing year by year. Therefore, drug resistance monitoring should be strengthened.
ObjectiveTo review the research progress on etiology and pathogenesis of spina bifida. MethodsBy consulting relevant domestic and foreign research literature on spina bifida, the classification, epidemic trend, pathogenesis, etiology, prevention and treatment of it were analyzed and summarized. ResultsSpina bifida, a common phenotype of neural tube defects, is classified based on the degree and pattern of malformation associated with neuroectodermal involvement and is due to the disturbance of neural tube closure 28 days before embryonic development. The prevalence of spina bifida varies greatly among different ethnic groups and regions, and its etiology is complex. Currently, some spina bifida patients can be prevented by folic acid supplements, and with the improvement of treatment technology, the short-term and long-term survival rate of children with spina bifida has improved. ConclusionThe research on the pathogenesis of spina bifida will be based on the refined individual information on exposure, genetics, and complex phenotype, and will provide a theoretical basis for improving prevention and treatment strategies through multidisciplinary cooperation.
Myasthenia gravis is an autoimmune neuromuscular junction disorder primarily mediated by autoantibodies against the acetylcholine receptor (AChR). It is now widely recognized that the total titer of anti-AChR antibodies does not correlate directly with clinical severity and shows significant interindividual variability. This review focuses on the structure of the AChR, the three major pathogenic mechanisms mediated by anti-AChR antibodies, the pathogenic differences associated with distinct antigenic epitopes, the characteristics of various immunoglobulin subclasses, and the limitations of current antibody detection methods. It further explores future directions in antibody profiling and functional assessment. By systematically analyzing the complexity and heterogeneity of anti-AChR antibodies, this article underscores the critical role of precision medicine in the management of myasthenia gravis.
Objective To analyze the clinical pathogenic characteristics of children with co-infected pneumonia, and to provide reference for clinical diagnosis and treatment. Methods Children with co-infected pneumonia treated in the pediatrics department of the First Affiliated Hospital of Chengdu Medical College between June 2023 and May 2024 were selected. According to age, the children were divided into goups of infants, toddlers, preschoolers, school-aged children, and adolescents. The clinical pathogenic characteristics of children with pneumonia were analyzed. ResultsA total of 358 pediatric patients were included. Among them, there were 189 males (52.79%) and 169 females (47.21%); 71 (19.83%) were infants, 74 (20.67%) were toddlers, 113 (31.56%) were preschoolers, 75 (20.95%) were school-aged children, and 25 (6.98%) were adolescents. There was no statistically significant difference in the composition of males and females among different age groups or types of pneumonia (P>0.05). The bacteria detected were mainly Haemophilus influenzae, Staphylococcus aureus, Moraxella catarrhalis and Streptococcus pneumoniae. Viruses in the pathogen mainly included adenovirus, influenza A and B stream, human rhinovirus and respiratory syncytial virus. The main atypical pathogen detected was Mycoplasma pneumoniae (240 cases). Except for atypical pathogens (P>0.05), the detection rates of bacteria and viruses among different age groups showed statistically significant differences (P<0.05). The compositions of bacterial co-infections, viral co-infections, bacterial+viral infections, and co-infections involving atypical pathogens were compared among different age groups, and the difference was statistically significant (P<0.05). The proportions of different types of pathogens detected in winter were the highest. Conclusions Children with co-infected pneumonia are mainly aged 0-6 years old. The incidence of co-infected pneumonia in children is the highest in winter. Mycoplasma is the main pathogen in dual infections or co-infections. Co-infections in early childhood are mainly caused by bacterial infections, and the incidence of viral infections increases with age.
Objective To compare the infection characteristics and pathogen resistance between dialysis and non-dialysis patients with chronic kidney disease (CKD) in West China Hospital of Sichuan University, and provide a reference for clinical diagnosis and treatment. Methods The clinical data of CKD patients with non-repeated etiological evidence admitted to West China Hospital of Sichuan University between January 2010 and December 2021 were retrospectively analyzed. The patients were divided into dialysis group and non-dialysis group according to treatment methods. The infection characteristics and pathogen resistance of the two groups were analyzed by WHONET 5.6 and SPSS 23 softwares. Results A total of 1387 patients with CKD with positive etiology were included, excluding coagulase-negative Staphylococcus, which was common contamination pathogens of bloodstream infections. There were 527 patients in the dialysis group and 860 patients in the non-dialysis group in this study. There was no significant difference in gender between the two groups (P>0.05). There were significant differences in age, disease stage and specimen type between the two groups (P<0.01). The pathogenic bacteria samples of dialysis patients were mainly blood (25.81%) and dialysate (44.02%), and Staphylococcus aureus was the main pathogenic bacteria. In the non-dialysis group, sputum (49.88%) and urine (35.47%) were the main contents. In main Gram-positive pathogens, there were high resistance rates to penicillin and cephalosporin, and high sensitive rates to vancomycin and linezolid. In Gram-negative pathogenic bacteria, there were high resistance rates to penicillins, the first generation cephalosporins and the third generation cephalosporins, and high sensitive rates to β-lactamase inhibitor compound preparation, the fourth generation cephalosporins and other antibiotics. Conclusions CKD patients are easy to be complicated with infections. In clinical practice, it is necessary to pay attention to pathogen culture results, and selectively use antibiotics based on drug sensitivity results. At the same time, medical staff in hemodialysis centers should pay attention to aseptic operation and hand hygiene to reduce the risk of concurrent infection in dialysis patients.
Antimicrobial resistance is a rigorous health issue around the world. Because of the short turn-around-time and broad pathogen spectrum, culture-independent metagenomic next-generation sequencing (mNGS) is a powerful and highly efficient tool for clinical pathogen detection. The increasing question is whether mNGS is practical in the prediction of antimicrobial susceptibility. This review summarizes the current mNGS-based antimicrobial susceptibility testing technologies. The critical determinants of mNGS-based antibacterial resistance prediction have been comprehensively analyzed, including antimicrobial resistance databases, sequence alignment tools, detection tools for genomic antimicrobial resistance determinants, as well as resistance prediction models. The clinical challenges for mNGS-based antibacterial resistance prediction have also been reviewed and discussed.
Objective To explore clinical effect of failure mode and effect analysis in improving the submission rate of pathogen examination in counterpart supported high-altitude county hospitals, and formulate practical measures and methods suitable for high-altitude county hospitals to improve the submission rate of pathogen examination. Methods Patients admitted to the People’s Hospital of Ganzi County between January and December 2024 were selected. The data of hospitalized patients between January and June 2024 were as the control group, and the data of hospitalized patients between July and December 2024 were as the intervention group. The study analyzed and compared the submission rate of pathogen testing and the pass rate of microbiological test specimens before antimicrobial treatment between the two groups. Results A total of 3 984 patients were included. Among them, there were 1 748 cases in the control group and 2 236 cases in the intervention group. A total of 10 risk factors and 2 high-risk points were identified. There were statistically significant differences in the submission rate of pathogen specimens before antibiotic treatment [36.21% (633/1 748) vs. 49.33% (1 103/2 236); χ2=68.646, P<0.001] and the qualified rate of microbiological test specimens [26.75% (122/456) vs. 36.45% (261/716); χ2=11.910, P=0.001] between the control group and the intervention group. Conclusions Failure mode and effect analysis can effectively find out the weak points in low pathogen examination submission rate in high-altitude county hospitals. According to the high-risk points to guide the formulation of relevant measures, the pathogen submission rate in the region can be effectively improved.
Objective To study effects of Helicobacter pylori on oncogenesis and progression of pancreatic cancer. Method The current literatures on the relationship between the Helicobacter pylori and the pancreatic cancer were collected and reviewed. Results The Helicobacter pylori infection might play a role in the development of the pancreatic cancer. The infection rate of the Helicobacter pylori in the patients with pancreatic cancer is higher than that of the healthy controls; furthermore, in the patients with Helicobacter pylori antibody positive, the infection rate of the Helicobacter pylori in the cytotoxin-associated gene A-negative strains of Helicobacter pylori is significantly higher than that of the healthy controls. Conclusions Helicobacter pylori infection is related to occurrence and development of pancreatic cancer. Specific mechanism is still not clarified and further research is need to study.
Mitochondrial DNA (mtDNA) is the circulating genome in mitochondria, and it is easy to accumulate oxidative damage, causing mitochondrial dysfunction, and then cell dysfunction, and even tissue and body pathological changes, leading to diseases. As a pro-inflammatory, inflammatory, and even predictive factor, mtDNA is directly involved in the inflammatory response and the pathogenesis of many diseases. This article aims to review the current pathogenesis of mtDNA damage and its pathogenic role in various human diseases.
Most immune-related adverse event (irAE) associated with immune checkpoint inhibitors (ICIs) resulted from excessive immune response against normal organs. The severity, timing, and organs affected by these events were often unpredictable. Adverse reactions could cause treatment delays or interruptions, in rare cases, pose a life-threatening risk. The mechanisms underlying irAE involved immune cell dysregulation, imbalances in inflammatory factor expression, alterations in autoantibodies and complement activation, even dysbiosis of intestinal microorganisms. However, the mechanisms of irAE occurrence might differ slightly among organs due to variations in their structures and the functions of resident immune cells. Future research should focus on the development of targeted drugs for the prevention or treatment of irAE based on the mechanisms by which irAE occurs in different organs. A deeper understanding of the mechanisms underlying irAE occurrence would aid clinicians in effectively utilizing ICIs and provide valuable guidance for their clinical application.