Etiological diagnostic value of metagenomic next-generation sequencing in peritoneal dialysis-related peritonitis / 中华肝脏病杂志

Objective: To explore the etiological diagnostic value of metagenomic next-generation sequencing (mNGS) in peritoneal dialysis (PD)-related peritonitis. Methods: The study was a retrospective cohort study. The clinical data of patients with PD-related peritonitis who were treated and underwent microbial cultivation and mNGS test at the same time from June 2020 to July 2021 in the Affiliated Drum Tower Hospital, Medical School of Nanjing University were analyzed. The positive rate, detection time and consistency between mNGS test and traditional microbial culture were compared. Results: A total of 18 patients with age of (50.4±15.4) years old and median dialysis time of 34.0 (12.4, 62.0) months were enrolled in the study, including 11 males and 7 females. Pathogenic microorganisms were isolated in 17 patients by mNGS test, with a positive rate of 17/18, which was higher than 13/18 of microbial culture, but the difference was not statistically significant (P=0.219). Both mNGS test and microbial culture isolated positive pathogenic bacteria in 12 patients, and mNGS test isolated the same types of pathogenic bacteria as microbial cultivation did in 11 patients. In five patients with negative microbial culture, mNGS test also isolated pathogenic microorganisms, including 3 cases of Staphylococcus epidermidis, 1 case of Mycobacterium tuberculosis and 1 case of Ureaplasma urealyticum. In 1 patient, microbial culture isolated pathogenic bacteria (Escherichia coli) whereas mNGS test did not. The detection time of mNGS was 25.0 (24.0, 27.0) h, which was significantly shorter than 89.0 (72.8, 122.0) h of microbial culture (Z=3.726, P<0.001). Conclusions: mNGS test can improve the detection rate of pathogenic microorganisms in PD-related peritonitis and greatly shorten the detection time, and has good consistency with microbial culture. mNGS may provide a new approach for pathogen identification of PD-related peritonitis, especially refractory peritonitis.

An Angiotensin Receptor Blocker Prevents Arrhythmogenic Left Atrial Remodeling in a Rat Post Myocardial Infarction Induced Heart Failure Model

This study investigated the role of angiotensin II receptor blocker in atrial remodeling in rats with atrial fibrillation (AF) induced by a myocardial infarction (MI). MIs were induced by a ligation of the left anterior descending coronary artery. Two days after, the rats in the losartan group were given losartan (10 mg/kg/day for 10 weeks). Ten weeks later, echocardiography and AF induction studies were conducted. Ejection fraction was significantly lower in the MI rats. Fibrosis analysis revealed much increased left atrial fibrosis in the MI group than sham (2.22 +/- 0.66% vs 0.25 +/- 0.08%, P = 0.001) and suppression in the losartan group (0.90 +/- 0.27%, P 0.001) compared with the MI group. AF inducibility was higher in the MI group than sham (39.4 +/- 43.0% vs 2.0 +/- 6.3%, P = 0.005) and significantly lower in losartan group (12.0 +/- 31.6%, P = 0.029) compared with the MI. The left atrial endothelial nitric oxide synthase (NOS) and sarco/endoplasmic reticulum Ca(2+)-ATPase levels were lower in the MI group and higher in the losartan group significantly. The atrial inducible NOS and sodium-calcium exchanger levels were higher in the MI and lower in the losartan group significantly. Losartan disrupts collagen fiber formation and prevents the alteration of the tissue eNOS and iNOS levels, which prevent subsequent AF induction.

Ingestion--associated adverse events necessitating pediatric ICU admissions.

OBJECTIVE: To review the pattern of food-associated pediatric intensive care unit (PICU) admissions. METHODS: A retrospective chart review was conducted to analyse the pattern of food-associated PICU admissions at a teaching hospital between January 2004 and May 2007. RESULTS: Ten cases (7 boys and 3 girls, aged 9 month to 11.7 year) were identified. One girl developed progressive generalized urticarial rash and anaphylactic shock following consumption of bird nest drink. A boy presented with the classic triads of acute onset altered mental state, respiratory depression and small pupils following consumption of a bottle of presumed "green tea", which was subsequently found to contain methadone. In the remaining 8 cases, dried mango, peanut, peanut-shell, fishmeat ball, pork chop, bread and bone were the culprits, impacting in the airway or oesophagus. All but one patient had short ICU stay (<or=3 days). Ingestion-associated adverse events can be protean and may necessitate PICU admissions. All age groups can be affected. Solids are usually associated with symptoms from local obstruction or suffocation, while fluids may be associated with systemic manifestations. CONCLUSION: Presentations were generally acute, dramatic and unmistaken. The majority of patients made prompt and uneventful recovery and had short PICU stay.

Experiences of Accreditation of Medical Education in Taiwan / 보건의료교육평가

This review aims to introduce the Taiwanese Medical Accreditation System: its history, role and future goals. In 1999, the Ministry of Education, Taiwanese Government commissioned the non-profit National Health Research Institutes (NHRI) to develop a new medical accreditation system. According to that policy, the Taiwan Medical Accreditation Council (TMAC) was established in the same year. The council serves a similar function to that of the Liaison Committee on Medical Education (LCME) of the United States and the Australian Medical Council (AMC). The accreditation process consists of a self-assessment plus a four-day site visit by a team of eight medical educators that are headed by one of the council members of the TMAC. The first cycle of initial visits was completed from 2001 to 2004. Subsequent follow-up visits were arranged according to the results of the survey with smaller-sized teams and shorter periods. There is evidence to suggest that the majority (seven of eleven) of the medical schools in Taiwan have made good progress. TMAC's next step will be to monitor the progress and raise the standard of medical education in individual schools with a homogenous, superior standard of medical education.

Epilepsy research priorities in Asia: Psycho-social and cultural Issues

Since the Asia and Oceania region has tremendous variety in cultural and religious background, the author would like to propose the formation of a research committee with representatives from different countries under the Commission on Asian & Oceanean Affairs to study the psychosocial and cultural aspects of epilepsy. A uniform study protocol can be designed to collect data on “public awareness, understanding and attitudes toward epilepsy” and “patients’ perception of having epilepsy.” The survey can be done among the general population, patients with epilepsy, family members, health providers, or school teachers.