Metagenomic Next-Generation Sequencing as an Effective Diagnostic Tool for Talaromycosis in HIV-Negative Patients.

The diagnosis of Talaromyces marneffei infection in HIV-negative patients remains challenging. There is an urgent need for rapid and convenient methods to diagnose this complicated disease. The aim of this study was to evaluate the diagnostic efficiency of metagenomic next-generation sequencing (mNGS) for talaromycosis in non-HIV-infected patients by comparing mNGS with traditional microbial culture. In total, 66 samples from 57 patients were analyzed via both mNGS and microbial culture. The ROC curve showed a sensitivity for mNGS of 97.22%, which was greater than that of microbial culture (61.11%). Samples from the respiratory tract, infectious skin lesions, and lymph nodes are recommended as routine samples for talaromycosis detection via mNGS. Furthermore, mNGS significantly reduced the diagnostic time compared to microbial culture. Overall, our study demonstrated that mNGS is a promising tool for rapid and accurate pathogenic detection in HIV-negative patients with talaromycosis.

Palliative treatment of malignant colorectal obstruction caused by advanced malignancy: a self-expanding metallic stent or surgery? A system review and meta-analysis.

We conducted a meta-analysis to compare the outcomes of a self-expanding metallic stent (SEMS) vs. surgery for the palliative treatment of colorectal obstruction caused by advanced colorectal malignancy. The databases of MEDLINE, EMBASE, Cochrane controlled trials registry and the Chinese Wanfang were retrieved (updated to 31 August 2011) to identify eligible studies. We calculated the odds ratio or weighted mean difference and its corresponding 95 % confidence interval. In total, nine primary studies were included in this analysis. The success rate of SEMS placement was 93.9 %, with short-term and long-term complication rates of 26.2 and 16.1 %, respectively. Combined analyses revealed that the SEMS group had a similar risk of short-term complications as the surgical group (P = 0.22). Moreover, SEMS was not associated with a higher mortality risk than surgical intervention (P = 0.22) and it required a significantly shorter hospitalization time (P < 0.01); however, SEMS patients had a higher risk of long-term complications (P = 0.03). Because of great heterogeneities between patients and chemoradiotherapy, we did not analyze the survival times of the two groups. These results support the feasibility of SEMS as a palliative treatment for malignant colorectal obstruction caused by incurable malignancy, as it requires shorter hospitalization and is followed by quick recovery. However, the risk of long-term complications such as perforation and stent migration should be borne in mind.

[Necessity of defunctioning stoma in low anterior resection for rectal cancer: a meta-analysis].

OBJECTIVE: To evaluate the necessity of defunctioning stoma in low anterior resection for rectal cancer below peritoneal reflection. METHODS: The databases of Medline, Embase, Cochrane Library, Wanfang and CNKI were searched. The eligible studies were identified for pooled analyses. RESULTS: Six randomized controlled trials with 648 cases(332 patients with defunctioning stoma and 316 without stoma) and 25 retrospective controlled trials with 10,722 cases(4,470 patients with defunctioning stoma and 6,252 without stoma) were included. Combined analyses showed that defunctioning stoma was effective for decreasing risk of postoperative anastomotic leakage (RR=0.33 and 95% CI:0.21-0.53 for RCTs, OR=0.60 and 95% CI:0.42-0.85 for retrospective studies), reoperation (RR=0.30, 95% CI:0.16-0.53 for RCTs, OR=0.26 and 95% CI:0.21-0.32 for retrospective studies) and mortality(OR=0.41, 95% CI:0.27-0.62 for retrospective studies). CONCLUSION: Defunctioning stoma should be routinely performed in low anterior resection for high-risk patients.