Advantages and challenges of metagenomic sequencing for the diagnosis of pulmonary infectious diseases

ObjectiveWe aim to familiarize the application status of metagenomic sequencing in diagnosing pulmonary infections, to compare metagenomic sequencing with traditional diagnostic methods, to conclude the advantages and limitations of metagenomic sequencing, and to provide some advice for clinical practice and some inspiration for associated researches.Data SourcesThe data were obtained from peer‐reviewed literature, white papers, and meeting reports.ResultsThis review focused on the applications of untargeted metagenomic sequencing in lungs infected by bacteria, viruses, fungi, chlamydia pneumoniae, Mycoplasma pneumoniae , parasites, and other pathogens. Compared with conventional diagnostic methods, metagenomic sequencing is better in detecting novel, rare, and unexpected pathogens and being applied in co‐infections. Meanwhile, it can also provide more comprehensive information about pathogens. However, metagenomic sequencing still has limitations. Also, the situations that should be applied in and how the results should be interpreted are discussed in this review.ConclusionMetagenomic sequencing improves efficiency to identify pathogens compared with traditional diagnostic methods and can be applied in clinical diagnosis. However, the technology of metagenomic sequencing still needs to be improved. Also, clinicians should learn more about when to use metagenomic sequencing and how to interpret its results.     

Effects of Surgeon Handedness on the Outcomes of Unicompartmental Knee Arthroplasty: A Single Center's Experience

ObjectiveSurgeon handedness has been widely discussed in operative surgery, and could cause clinical discrepancy. However, few studies have reported the effect of handedness on unicompartmental knee arthroplasty (UKA). Based on our clinical observation and case analysis, we aimed to find out the effects of surgeon handedness on UKA.MethodsWe retrospectively studied 94 UKA procedures performed by one right‐handed surgeon from January 2017 to December 2018 at a single medical center. The cases were divided into two groups by operation side (49 L‐UKAs and 45 R‐UKAs). Preoperative demographic data were collected. Imaging parameters (femorotibial and hip‐knee‐ankle angles and tibial‐plateau retroversion) and joint function scores (Knee Society Score [KSS] and Oxford Knee Score [OKS]) were recorded. Patients were followed up regularly and Forgotten Joint Score (FJS) was calculated at the last follow‐up. All data were compared between the two groups with independent‐samples t‐test, and paired t‐test was used for intragroup comparisons.ResultsThe average follow‐up was 26.7 ± 3.2 months. The average patient age was 63.5 ± 9.0 years and the average body mass index was 26.89 ± 3.43 kg/m². There was no significant group difference in any preoperative characteristic. Both the KSS and OKS improved significantly after surgery (p < 0.05). No significant group difference was found between the KSS or OKS at any follow‐up visit. The varus or valgus of tibial component was 3.57 ± 1.42° on the left side and 3.19 ± 1.56° on the right side (p = 0.45). The varus or valgus of femoral component was 7.81 ± 2.43° in patients undergoing L‐UKA and 7.05 ± 2.90° in those undergoing R‐UKA (p = 0.04). No statistical differences were found in outliers of component orientation on both sides. The femorotibial and hip‐knee‐ankle angles improved significantly in both groups, and there was no significant group difference in either lower limb alignment or tibial‐plateau retroversion. The complication rate was 8.16% (4/49) in the L‐UKA group and 6.67% (3/45) in the R‐UKA group. There was no correlation between prosthesis orientation and early joint function score.ConclusionsSurgeon handedness may cause a worse prosthetic orientation on femoral side during surgeon''s non‐dominant UKA, and surgeons should be cautious of bone resection and prosthesis implantation. However, radiographic difference did not bring variations on short‐term clinical outcomes or lower limb alignment.     

Epidemiological Trends of Pediatric Inflammatory Bowel Disease in Korea: A Multicenter Study of the Last 3 Years Including the COVID-19 Era

BackgroundStudies on how the coronavirus pandemic has affected pediatric inflammatory bowel disease (PIBD) are lacking. We aimed to investigate the trends in epidemiology, characteristics, initial management, and short-term outcomes of PIBD in South Korea over the recent three years including the era of coronavirus disease 2019 (COVID-19).MethodsThis multicenter study retrospectively investigated temporal trends in the epidemiology of PIBD in Korea. Annual occurrences, disease phenotypes, and initial management at diagnosis were analyzed from January 2018 to June 2021.ResultsA total of 486 patients from 17 institutions were included in this epidemiological evaluation. Analysis of the occurrence trend confirmed a significant increase in PIBD, regardless of the COVID-19 pandemic. In Crohn’s disease, patients with post-coronavirus outbreaks had significantly higher fecal calprotectin levels than those with previous onset (1,339.4 ± 717.04 vs. 1,595.5 ± 703.94, P = 0.001). Patients with post-coronavirus-onset ulcerative colitis had significantly higher Pediatric Ulcerative Colitis Activity Index scores than those with previous outbreaks (48 ± 17 vs. 36 ± 15, P = 0.004). In the initial treatment of Crohn’s disease, the use of 5-aminosalicylic acid (5-ASA) and steroids significantly decreased (P = 0.006 and 0.001, respectively), and enteral nutrition and the use of infliximab increased significantly (P = 0.045 and 0.009, respectively). There was a significant increase in azathioprine use during the initial treatment of ulcerative colitis (P = 0.020).ConclusionRegardless of the COVID-19 pandemic, the number of patients with PIBD is increasing significantly annually in Korea. The initial management trends for PIBD have also changed. More research is needed to establish appropriate treatment guidelines considering the epidemiological and clinical characteristics of Korean PIBD.     

Nationwide Survey for Pediatric Gastrostomy Tube Placement in Korea

BackgroundVarious methods have been implemented for pediatric gastrostomy tube placement. We aimed to investigate the performance status of pediatric gastrostomy in South Korea and to present indications and appropriate methods for domestic situations.MethodsA survey was conducted among pediatric endoscopists who performed upper gastrointestinal endoscopy in Korea. The questionnaire consisted of 16 questions on gastrostomy performance status.ResultsAmong the 48 institutions where the survey was applied, 36 (75%) responded. Of the 36 institutions, gastrostomy was performed in 31 (86.1%). The departments in which gastrostomy was performed were pediatrics at 26 institutions (81.3%), surgery at 24 institutions (75.0%), internal medicine at 9 institutions (28.1%), and radiology at 7 institutions (21.9%). There were 18 institutions (66.7%) using the pull method for percutaneous endoscopic gastrostomy (PEG) and nine institutions (33.3%) using the push method. When performing gastrostomies, fundoplication procedures were performed in 19 institutions (61.3%), if deemed necessary. However, 12 institutions (38.7%) answered that gastrostomy was always implemented alone. Complications after gastrostomy included buried bumper syndrome, wound infection, leakage, tube migration, and incorrect opening site in the stomach, but the number of cases with complications was very small.ConclusionIn Korea, a pediatric gastrostomy is implemented in various ways depending on the institution. Clinicians are concerned about choosing the most effective methods with fewer complications after the procedure. In our study, we reported only a few complications. Korea has good accessibility for pediatric gastrointestinal endoscopy, and this survey showed that it is a safe procedure that can be considered initially in pediatric gastrostomy. This study is expected to help to create optimal pediatric PEG guidelines in Korea.     

中国不同地区三棱的化学特征比较

Objective: To compare the chemical characters of Sparganii Rhizoma from different areas via chromatographic analysis and to establish a sensitive LC/MS method for quality assessment of Sparganii Rhizoma.Methods: Under the optimised HPLC-PDA chromatographic conditions,twenty batches of Sparganii Rhizoma were analyzed by HPLC fingerprints.Principal component analysis(PCA),orthogonal projections to latent structures discriminant analysis(OPLS-DA)and hierarchical cluster analysis(HCA)were performed based on all peak areas of Sparganii Rhizoma fingerprints.Meanwhile,part of common peaks were subsequently quantified by UFLC-QTRAP-MS.Results: The similarity values of HPLC fingerprints fluctuated in a wide range of 0.511–0.973,which showed variable differences of chemical characters among Sparganii Rhizoma from twenty habitats.PCA,OPLS-DA and HCA indicated that samples could be divided into five groups with different chemical characters,which generally corresponded with their geographical distributions.A total of 31 peaks in HPLC fingerprints were marked,and eight of them were identified and quantified.The quantitative result was generally in agreement with the classifications based on HPLC fingerprints,which indicated that Sparganii Rhizoma samples from eastern China mostly contained more contents including phenolic acids and flavonoids.Conclusion: This study not only proved that there were relationships between geographic distributions and internal chemical compositions of plants,which could provide evidence to the traditional Chinese medicine concept "geo-authentic",but also supplied a sensitive and rapid simultaneous quantitive method for the quality estimation of Sparganii Rhizoma.     

《黄帝内经》经脉理论与络脉理论是各自独立的理论

经脉理论与络脉理论是各自不同的理论,不能合并起来研究,经络研究就是因为选择了经脉和络脉不分的经络概念为研究对象,并误解为经络系统研究,实际是以经络取代经脉,以穴位连结线取代经脉循行线进行检测,抛弃经脉理论研究而陷入找经络系统形态结构及相关物质的研究误区,所以无法取得科学的结论。     

扶正颗粒抗菌作用的实验研究

目的：探讨扶正颗粒的抗菌作用。方法：观察扶正颗粒对正常小鼠及氢化可的松、环磷酰胺所致免疫抑制小鼠对克雷伯杆菌、肺炎双球菌、金黄色葡萄球菌、溶血性链球菌死亡率的影响；观察扶正颗粒对双黄连颗粒抗免疫抑制小鼠上述细菌感染的协同作用。结果：扶正颗粒可显著延长正常及免疫抑制小鼠在被克雷伯杆菌、肺炎双球菌、金黄色葡萄球菌、溶血性链球菌感染时的存活时间，并有一定的降低死亡率的作用；扶正颗粒与双黄连颗粒联合用药，可显著降低免疫抑制小鼠上述细菌感染的死亡率，作用呈量效关系，在相同的双黄连颗粒剂量下，联合用药组优于单用双黄连颗粒组。结论：扶正颗粒具有抗菌作用。