Lemierre Syndrome: Report of a Case with an Innovative Diagnostic Method and Literature Review.

Objective: To understand the clinical features, diagnosis and treatment of Lemierre syndrome (LS), a high-risk and low-prevalence infectious disease. Methods: We present the severe LS case that was diagnosed using metagenomic next-generation sequencing (mNGS) in our hospital, and systematically summarized the diagnosis and treatment strategies of patients that reported LS from 2006 to 2022. Results: The 24-year-old patient in our hospital suffered from cranial nerve paralysis, a neurological complication rarely seen in LS cases. The causative agent (Fusobacterium necrophorum, Fn) of this patient was only detected by mNGS tests, and the reads number of Fn detected by plasma mNGS tests was decrease as the patients gradually improved, indicating plasma mNGS is valuable in monitoring treatment efficacy. Although most of the cases retrieved from the literature showed typical symptoms, such as a history of sore throat, septic emboli, and internal jugular vein thrombosis, clinical manifestations were still relatively heterogeneous (eg, diversity of predisposing factors and pathogens, differences in pulmonary imaging features). Conclusion: We summarized the clinical presentation, diagnosis, treatment, and regression of 17 symptomatic cases reported LS to provide clinicians with knowledge about this rare but fatal disease. mNGS assays should be considered as early as possible to identify the responsible pathogens for acute and critically ill patients with suspected infections in order to implement accurate and effective treatment.

Re-Designing Cellulosic Core-Shell Composite Fibers for Advanced Photothermal and Thermal-Regulating Performance.

Flexible fibers and textiles featuring photothermal conversion and storage capacities are ideal platforms for solar-energy utilization and wearable thermal management. Other than using fossil-fuel-based synthetic fibers, re-designing natural fibers with nanotechnology is a sustainable but challenging option. Herein, advanced core-shell structure fibers based on plant-based nanocelluloses are obtained using a facile co-axial wet-spinning process, which has superior photothermal and thermal-regulating performances. Besides serving as the continuous matrix, nanocelluloses also have two other important roles: dispersing agent when exfoliating molybdenum disulfide (MoS2), and stabilizer for phase change materials (PCM) in the form of Pickering emulsion. Consequently, the shell layer contains well-oriented nanocelluloses and MoS2, and the core layer contains a high content of PCM in a leak-proof encapsulated manner. Such a hierarchical cellulosic supportive structure leads to high mechanical strength (139 MPa), favorable flexibility, and large latent heat (92.0 J g-1), surpassing most previous studies. Furthermore, the corresponding woven cloth demonstrates satisfactory thermal-regulating performance, high solar-thermal conversion and storage efficiency (78.4-84.3%), and excellent long-term performance. In all, this work paves a new way to build advanced structures by assembling nanoparticles and polymers for functional composite fibers in advanced solar-energy-related applications.

ddPCR provides a sensitive test compared with GeneXpert MTB/RIF and mNGS for suspected Mycobacterium tuberculosis infection.

Introduction: The Metagenomics next-generation sequencing (mNGS) and GeneXpert MTB/RIF assay (Xpert) exhibited a sensitivity for tuberculosis (TB) diagnostic performance. Research that directly compared the clinical performance of ddPCR analysis, mNGS, and Xpert in mycobacterium tuberculosis complex (MTB) infection has not been conducted. Methods: The study aimed to evaluate the diagnostic performance of ddPCR compared to mNGS and Xpert for the detection of MTB in multiple types of clinical samples. The final clinical diagnosis was used as the reference standard. Results: Out of 236 patients with suspected active TB infection, 217 underwent synchronous testing for tuberculosis using ddPCR, Xpert, and mNGS on direct clinical samples. During follow-up, 100 out of 217 participants were diagnosed with MTB infection. Compared to the clinical final diagnosis, ddPCR produced the highest sensitivity of 99% compared with mNGS (86%) and Xpert (64%) for all active MTB cases. Discussion: Twenty-two Xpert-negative samples were positive in mNGS tests, which confirmed the clinical diagnosis results from ddPCR and clinical manifestation, radiologic findings. Thirteen mNGS-negative samples were positive in ddPCR assays, which confirmed the clinical final diagnosis.ddPCR provides a higher sensitive compared to Xpert and mNGS for MTB diagnosis, as defined by the high concordance between ddPCR assay and clinical final diagnosis.

Secondary Infection Surveillance with Metagenomic Next-Generation Sequencing in COVID-19 Patients: A Cross-Sectional Study.

Background: Metagenomic next-generation sequencing (mNGS) is a promising tool for improving antimicrobial therapy and infection control decision-making in complex infections. Secondary infection surveillance using mNGS in COVID-19 patients has rarely been reported. Methods: Respiratory pathogen and antibiotic resistance prediction were evaluated by BALF mNGS for 192 hospitalized COVID-19 patients between December 2022 and February 2023. Results: Secondary infection was confirmed in 83.3% (160/192) of the COVID-19 patients, with bacterial infections (45%, 72/160) predominating, followed by mixed bacterial and fungal infections (20%, 32/160), and fungal infections (17.5%, 28/160). The incidence of bacterial or viral secondary infection was significantly higher in patients who were admitted to the ICU, received mechanical ventilation, or developed severe pneumonia (all p<0.05). Klebsiella pneumoniae (n=30, 8.4%) was the most prevalent pathogen associated with secondary infection followed by Acinetobacter baumannii (n=29, 8.1%), Candida albicans (n=29, 8.1%), Aspergillus fumigatus (n=27, 7.6%), human herpes simplex virus type 1 (n=23, 6.4%), Staphylococcus aureus (n=20, 5.6%) and Pneumocystis jiroveci (n=14, 3.9%). The overall concordance between the resistance genes detected by mNGS and the reported phenotypic resistance in 69 samples containing five clinically important pathogens (ie, K. pneumoniae, A. baumannii, S. aureus, P. aeruginosa and E. coli) that caused secondary infection was 85.5% (59/69). Conclusion: mNGS can detect pathogens causing secondary infection and predict antimicrobial resistance for COVID19 patients. This is crucial for initiating targeted treatment and rapidly detect unsuspected spread of multidrug-resistant pathogens.

The Real-World Clinical Impact of Plasma mNGS Testing: an Observational Study.

Plasma metagenomic next-generation sequencing (mNGS) testing is a promising diagnostic modality for infectious diseases, but its real-world clinical impact is poorly understood. We reviewed patients who had undergone plasma mNGS at a general hospital to evaluate the clinical utility of plasma mNGS testing. A total of 76.9% (113/147) of plasma mNGS tests had a positive result. A total of 196 microorganisms (58) were identified and reported, of which 75.6% (148/196) were clinically relevant. The median stringent mapped read number (SMRN) of clinically relevant organisms was 88 versus 22 for irrelevant organisms (P = 0.04). Based on the clinically adjudicated diagnosis, the positive and negative percent agreements of plasma mNGS testing for identifying a clinically defined infection were 95.2% and 67.4%, respectively. The plasma mNGS results led to a positive impact in 83 (57.1%) patients by diagnosing or ruling out infection and initiating targeted therapy. However, only 32.4% (11/34) of negative mNGS tests showed a positive impact, suggesting that plasma mNGS testing alone may not be a powerful tool to rule out infection in clinical practice. In the subset of 37 patients positive for both plasma mNGS and conventional testing, mNGS identified the pathogen(s) 2 days (IQR = 0.75 to 4.25) earlier than conventional testing. mNGS enables pathogen identification within 24 h, but given that the detection of clinically irrelevant organisms and nearly half of the tests result in no or a negative clinical impact, more clinical practice and studies are required to better understand who and when to test and how to optimally integrate mNGS into the infectious disease diagnostic workup. IMPORTANCE In this study, we show that although plasma mNGS testing significantly improved the detection rate of tested samples, nearly one in four (24.5%, 48/196) mNGS tests reported organisms were not clinically relevant, emphasizing the importance of cautious interpretation and infectious disease consultation. Moreover, based on clinical adjudication, plasma mNGS testing resulted in no or a negative impact in nearly half (43.5%, 64/147) of patients in the current study, indicating that how best to integrate this advanced method into current infectious disease diagnostic frameworks to maximize its clinical utility in real-world practice is an important question. Therefore, recommending plasma mNGS testing as a routine supplement to first-line diagnostic tests for infectious diseases faces great challenges. The decision to conduct mNGS testing should take into account the diagnostic performance, turnaround time and cost-effectiveness of mNGS, as well as the availability of conventional tests.

Synthesis, Curing Behaviors and Properties of a Bio-Based Trifunctional Epoxy Silicone Modified Epoxy Thermosets.

Tremendous effort has been focused on improving the toughness of epoxy, but the common approaches diminish the mechanical properties. In this work, a new silicone-modified trifunctional epoxy monomer SITEUP is synthesized from the hydrosilylation transformation of eugenol epoxy (EPEU) and tris-(dimethylsiloxy)phenylsilane. The chemical structures and curing kinetics of SITEUP are investigated based on 1H-NMR, 13C-NMR, MADLI-TOF-MS, and DSC analyses. SITEUP is introduced into DGEBA/IPDA systems as a functional modifier in varied loadings for toughening the resulting epoxy thermosets. The impact strength of the modified epoxy thermosets containing 20% SITEUP is 84% higher than that of the pristine epoxy thermoset and also maintains high flexural strength. Further morphology study reveals that the plastic deformation caused by siloxane segments is the key factor accounting for the enhanced toughness of the finalized epoxy thermosets. Si-O-Si segments incorporated into the thermosetting network could absorb more energy by increasing the mobility of polymer chains under external stress and led to improved thermal stability and damping characteristics. In addition, SITEUP is able to decrease the surface tension and increase the hydrophobic properties of the resultant epoxy materials.

Facile fabrication of self-roughened surfaces for superhydrophobic coatings via polarity-induced phase separation strategy.

Rough structures have gained increasing attention since they are essential for surfaces with special wettability, which can be used for various applications. It is still a challenge to find a low-cost and simple way to fabricate rough surfaces despite extensive efforts. Herein, we report a facile strategy to fabricate self-roughened surfaces based on polarity-induced phase separation. The strategy relies on the migration of flexible chains of the nonpolar polysiloxane to airside, driven by surface tension and polarity difference with the polar crosslinker, which forms a self-roughened surface with numerous protrusions. It is worth noting that this strategy does not require strict control of procedures, since it is insensitive to environmental changes unlike other phase separation methods, as shown by the results of systematic studies on several key parameters. Modified fabrics and coatings exhibit excellent superhydrophobicity with a water contact angle higher than 160°. Moreover, due to the strong hydrogen bonds formed by the polar urea groups of the crosslinker with substrates, the abrasion resistance of the coating is significantly enhanced. It is believed that the proposed novel and facile strategy will be a promising candidate for industrial manufacturing.

Modification of Cellulose Nanocrystals With 2-Carboxyethyl Acrylate in the Presence of Epoxy Resin for Enhancing its Adhesive Properties.

Cellulose nanocrystals (CNCs) have unparalleled advantages in the preparation of nanocomposites for various applications. However, a major challenge associated with CNCs in nanocomposite preparation is the lack of compatibility with hydrophobic polymers. The hydrophobic modification of CNCs has attracted increasing interest in the modern era standing with long challenges and being environmentally friendly. Here, we synthesized CNCs by using cotton as raw material and then modified them with 2-carboxyethyl acrylate to improve their corresponding mechanical, adhesive, contact angle, and thermal properties. Different concentrations (1-5 wt%) of CNCs were used as modifiers to improve the interfacial adhesion between the reinforced CNCs and E-51 (Bisphenol A diglycidyl ether) epoxy resin system. CNCs offered a better modulus of elasticity, a lower coefficient of energy, and thermal expansion. Compared with the standard sample, the modified CNCs (MCNCs) showed high shear stress, high toughness, efficient degradation, thermal stability, and recycling due to the combined effect of the hyperbranched topological structure of epoxy with good compatibility. The native CNCs lost their hydrophilicity after modification with epoxy, and MCNCs showed good hydrophobic behavior (CA = 105 ± 2°). The findings of this study indicate that modification of CNCs with 2-carboxyethyl acrylate in the presence of epoxy resin and the enhancement of the features would further expand their applications to different sectors.

[Chinese version of the reflux symptom index was evaluated for reliability and validity].

OBJECTIVE: To discuss the Chinese version of reflux symptom index (RSI) scale's reliability, validity and clinical value. METHODS: Using the Chinese version of RSI scale on the ENT outpatients. There are one hundred and seven patients, included thirty-five patients with common throat (non-suspected) and seventy-two patients with clinically suspected throat reflux. 107 patients are to complete the two scales before and after one week. Thirteen patients with common throat(non-suspected) diseases and forty-one with suspected throat reflux also received RSI testing. Among the thirty-four confirmed acid reflux disease patients, thirty patients received pharmaceutical treatments and self-performed post-RSI testing after three months. RESULTS: The RSI Scale internal reliability consistency included the test-retest reliability (0.750 - 0.971), discriminant validity and construct validity. RSI total targeting percentage of 66.7%, targeting percentage is 80.8%, discriminant validity using 2 independent samples Wilcoxon test, RSI total score compared to Z = -3.266, P = 0.001. The before and after treatment self-control chi-square test (P < 0.05), difference was statistically significant. CONCLUSIONS: RSI Simplified Chinese version has good reliability and validity, and can be used for laryngopharyngeal reflux disease (LPRD) diagnostic screening along with the efficacy for the treatment of patients with appropriate LPRD aids.