Application of metagenomic next-generation sequencing in the diagnosis of infectious diseases of the central nervous system after empirical treatment.

BACKGROUND: The diagnostic value of metagenomic next-generation sequencing (mNGS) in central nervous system (CNS) infectious diseases after empirical treatment has not been reported. AIM: To investigate the diagnostic value of mNGS of cerebrospinal fluid (CSF) in the empirically treated CNS infectious diseases. METHODS: A total of 262 CSF samples from patients with suspected CNS infections were collected between August 2020 and December 2021. Both mNGS and conventional methods were used for testing. The conventional methods included microbial culture, smear, polymerase chain reaction, etc. RESULTS: Among 262 suspected cases, 183 cases (69.84%) were diagnosed as CNS infection, including 86 cases of virus infection (47.00%), 70 cases of bacterial infection (38.25%) and 27 cases of fungal infection (14.76%). The sensitivity and specificity of mNGS were 65.6% (95%CI: 58.2%-72.3%) and 89.6% (95%CI: 79.1%-95.3%), respectively. The PPV of mNGS was 94.5% (95%CI: 88.6%-97.6%), and the NPV was 48.8% (95%CI: 39.7%-57.9%). The pathogen detective sensitivity and accuracy of mNGS were higher than those of conventional methods (Sensitivity: 65.6% vs 37.2%; P < 0.001; Accuracy: 72.0% vs 50%, P < 0.001). The results showed that compared with conventional methods, mNGS technology was a more sensitive method for the diagnosis of CNS infection after empirical treatment. CONCLUSION: mNGS can be a better method applied in the diagnosis of CNS infection after empirical treatment.

Coinfection of Streptococcus suis and Nocardia asiatica in the human central nervous system: A case report.

BACKGROUND: Streptococcus suis (S. suis) is an anthropozoonotic pathogen that shows clinical manifestations of meningitis, septicemia, and arthritis in infected humans. Nocardia is another type of anthropozoonotic bacteria, with clinical manifestations of skin, lung, and brain abscesses in infected humans. Few intracranial infections caused by S. suis or Nocardia have been reported. To the best of our knowledge, no study has reported a patient with simultaneous intracranial infection by S. suis and Nocardia. CASE SUMMARY: A 66-year-old male presented at Liaocheng People's Hospital (Liaocheng, Shandong Province, China) reporting dizziness with nausea and vomiting. Metagenomic next-generation sequencing (mNGS) was performed on cerebrospinal fluid for examination, and the patient was diagnosed with suppurative meningitis caused by S. suis infection. He received anti-infection treatment with penicillin sodium and ceftriaxone. The patient's condition initially improved but then deteriorated. Further mNGS of cerebrospinal fluid revealed both S. suis and Nocardia. Imaging examination revealed a brain abscess. Furthermore, a mixed infection of S. suis and Nocardia was detected in the patient's central nervous system. The patient was treated with antibiotics and sulfamethoxazole. He was discharged after his condition improved. CONCLUSION: This case shows that the disease can be recurrent in patients with intracranial infection of a rare pathogen. The possibility of mixed infection should also be considered, especially in patients treated with immunosuppressive agents. mNGS of cerebrospinal fluid is a supplement to conventional microbial pathogen identification methods. Patients with unknown pathogen diagnosis, early extensive use of antibiotics and infection with rare pathogens can be diagnosed by the combination of conventional methods and mNGS of cerebrospinal fluid.

Diagnostic utility of GDF15 in neurodegenerative diseases: A systematic review and meta-analysis.

INTRODUCTION: GDF15 may be a potential biomarker for neurodegenerative diseases. In this analysis, we aimed to quantitative analysis the levels of GDF15 in patients with neurological diseases and in health control, and then to determine its potential diagnostic utility. METHODS: Two researchers separately conducted a systematic search of the relevant studies up to January 2021 in Embase, PubMed, and Web of Science. Effect sizes were estimated to use the standardized mean difference (SMD) with 95% confidence interval (CI). Sensitivity and specificity were calculated by the summary receiver operating characteristics curve (SROC) method. The sensitivity analysis was performed by the "one-in/one-out" approach. Considering the considerable heterogeneity among studies, random-effects model was used for the meta-analysis investigation. RESULTS: A total of eight articles were included in this meta-analysis and systematic review. The pooled results of the random effect model indicated GDF15 levels were significantly higher in patients with neurodegenerative disease than healthy people (SMD = 0.92, 95% CI: 0.44-1.40, Z = 3.75, p < 0.001). Sensitivity and specificity of biomarker of GDF15 were 0.90 (95% CI: 0.75-0.97), 0.77 (95% CI: 0.67-0.65), and AUC = 0.87 (95% CI: 0.84-0.90), respectively. CONCLUSIONS: GDF15 levels were higher in patients with neurodegenerative disease than healthy people. And serum levels of GDF15 were a better marker for diagnostic utility of neurodegenerative disease.

Effects of different anesthesia methods on cognitive dysfunction after hip replacement operation in elder patients.

There are many risk factors for the cause of postoperative cognitive dysfunction (POCD), however, the anesthesia selection always trigger controversy for the POCD occurrence. This study aims to explore the relationship between the anesthesia and the occurrence of POCD in elder patients, and also investigate the mechanism of the POCD. One hundred elder patients with hip replacement were included in this study, which were divided into general anesthesia (GA) and epidural analgesia (EA) group. Minimum mental state examination (MMSE) method was employed to assess the nervous and mental function (POCD) in both analgesia group patients. Aß and tau protein levels in blood were detected by using the ELISA assay. The correlation between MMSE in POCD patients and Aß or tau was analyzed by employing the Spearman rank correlation method. The results indicated that epidural analgesia decreases the MMSE scoring compared to general analgesia (P < 0.05). General analgesia enhanced the Aß and tau level compared to epidural analgesia (P < 0.05). Aß and tau level were increased in the patients with POCD. The POCD occurrence rate in GA group was significantly higher compared to EA group (P < 0.05). MMSE scores of POCD patients positively correlated with Aß or tau level (P < 0.05). In conclusion, the epidural analgesia method was better than general analgesia method for the hip replacement in elder patients. The mechanism of the POCD may be caused by the enhancement of Aß and Tau protein.

[Risk factors on the recurrence of ischemic stroke and the establishment of a Cox's regression model].

OBJECTIVE: To investigate the risk factors and establish the Cox's regression model on the recurrence of ischemic stroke. METHODS: We retrospectively reviewed consecutive patients with ischemic stroke admitted to the Neurology Department of the Hebei United University Affiliated Hospital between January 1, 2008 and December 31, 2009. Cases had been followed since the onset of ischemic stroke. The follow-up program was finished in June 30, 2010. Kaplan-Meier methods were used to describe the recurrence rate. Monovariant and multivariate Cox's proportional hazard regression model were used to analyze the risk factors associated to the episodes of recurrence. And then, a recurrence model was set up. RESULTS: During the period of follow-up program, 79 cases were relapsed, with the recurrence rates as 12.75% in one year and 18.87% in two years. Monovariant and multivariate Cox's proportional hazard regression model showed that the independent risk factors that were associated with the recurrence appeared to be age (X1) (RR = 1.025, 95%CI: 1.003 - 1.048), history of hypertension (X2) (RR = 1.976, 95%CI: 1.014 - 3.851), history of family strokes (X3) (RR = 2.647, 95%CI: 1.175 - 5.961), total cholesterol amount (X4) (RR = 1.485, 95%CI: 1.214 - 1.817), ESRS total scores (X5) (RR = 1.327, 95%CI: 1.057 - 1.666) and progression of the disease (X6) (RR = 1.889, 95%CI: 1.123 - 3.178). Personal prognosis index (PI) of the recurrence model was as follows: PI = 0.025X1 + 0.681X2 + 0.973X3 + 0.395X4 + 0.283X5 + 0.636X6. The smaller the personal prognosis index was, the lower the recurrence risk appeared, while the bigger the personal prognosis index was, the higher the recurrence risk appeared. CONCLUSION: Age, history of hypertension, total cholesterol amount, total scores of ESRS, together with the disease progression were the independent risk factors associated with the recurrence episodes of ischemic stroke. Both recurrence model and the personal prognosis index equation were successful constructed.