Metagenomic Next-Generation Sequencing In Febrile Neutropaenia of Children Hematological And Malignant Diseases

Objective: To evaluate the diagnostic value of metagenomic next-generation sequencing in febrile neutropaenia of Hematological and malignant tumor children. Methods: We retrospectively studied the diagnostic value of metagenomic next-generation sequencing in febrile neutropaenia of Hematological and malignant tumor children in the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University from July 2018 to December 2019. Children with neutropenia and fever for more than 72 hours were sent for mNGS analysis together with traditional pathogen detection tests. The positive rate of pathogen detection and the following change of clinical treatment strategy was analyzed. Furthermore the duration of fever was compared between patients receiving both mNGS and traditional tests and those only had pathogen detected by traditionally methods. Results: The positive rate of mNGS was 75.6% (28/37cases), and that of the two methods combined was 86.4% (32/37cases). In these patients with long duration of fever, the detection positivity for bacteria, fungi, and viruse detection was high, and mycoplasma and rickettsias were also found. Among all the cases reported, clinical treatment strategies were changed in 9 cases due to the pathogen detection. The duration of fever of patients receiving mNGS together with traditional tests was shorter than those only had traditional ones (7.84d±0.17 vs. 8.39d±0.25, respectively, P<0.001) .Conclusion: Due to high positive rate of mNGS in pathogen detection, active treatment can be taken in time, infections can be controlled earlier. It has a positive effect on the outcome of febrile neutropaenia patients.

Severe Acute Respiratory Syndrome Coronavirus-2 Antibody Responses in Hospitalized Patients with Coronavirus Disease 2019 in Daegu, Korea

Background: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) started to spread in Daegu from the end of February 2020. IgG and IgM antibodies against SARS-CoV-2 were measured in hospitalized patients with COVID-19 with moderate to severe symptoms to improve the understanding of antibody responses.Methods: We enrolled 312 patients with COVID-19 admitted to seven hospitals located in Daegu. Using serum (or plasma) samples from patients with polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infections, both IgG and IgM antibodies were measured using commercial enzyme-linked immunosorbent assay (R-FIND COVID-19 ELISA, SG medical, Seoul, Korea). Results: The median value from the initial diagnosis by confirming SARS-CoV-2 PCR to the sampling date was 24 days (day -1 to 88). The total positive rate of IgG was 93.9% and the positive IgM rate was 39.4%, without considering the elapsed period after diagnosis. Positive IgG and IgM rates were highest at 100.0% and 59.0% in 3 weeks (15–21 days), respectively. IgG showed a high positive rate of 79.3% even within 7 days after the initial diagnosis of the disease and maintained a positive rate of 97.8% until after 8 weeks. Conclusions: Among hospitalized patients with COVID-19, IgG was detected from the beginning of the diagnosis and persisted for an extended time period.

WED 222 Hawkes sign: a novel test for carpal tunnel syndrome

BackgroundIn carpal tunnel syndrome (CTS) patients often report symptoms when elevating the arms, as in driving or phoning.In Hawkes test both forearms are squeezed firmly about 50 mm (2 inches) proximal to the patient’s wrist while simultaneously elevating the subject’s hands just above shoulder height. When positive there is tingling in a median nerve distribution within a few seconds.MethodsFifteen patients with suspected CTS were evaluated by a) Tinel’s, Phalen’s and Hawkes’ manoeuvres b) routine nerve conduction tests (NCT) then graded positive or negative and compared with NCT.ResultsPositive signs were present for Tinel in 14/15; Phalen in 8/10 and Hawkes in 15/15. NCT supported CTS in 9/15. Where NCT were abnormal Tinel and Hawkes signs were always positive but Phalen was negative in 2/7. Where NCT was normal (6/15) the negative/positive rates were: Tinel 1/5; Phalen 3/3; Hawkes 0/6.ConclusionAll three procedures, particularly Tinel and Hawkes had a high positive rate for CTS, but confirmed by NCT in only 6/15. However, NCT may be falsely negative especially in mild cases. The proposed arm elevation/compression test permits useful initial assessment of CTS although the false positive rate is probably high.

Cell-Free Circulating Methylated SEPT9 for Noninvasive Diagnosis and Monitoring of Colorectal Cancer

Identification of early-stage tumor and monitoring therapeutic efficacy and recurrence or metastasis of colorectal cancer (CRC) are urgently warranted for improving the outcome of CRC patients and reducing the disease-related mortality. In this study, we evaluated the diagnostic value of cell-free circulating methylated SEPT9 (mSEPT9) for CRC and beyond CRC and examined the potentiality of mSEPT9 in assessing therapeutic efficacy and monitoring recurrence of CRC. Our results confirmed the favorable diagnostic value of plasma mSEPT9 for CRC, with a sensitivity of 61.22% (95% confidence interval (CI): 51.33%–70.27%) and specificity of 93.7% (95% CI: 91.09%–95.57%) using 2/3 algorithm. The positive rate of mSEPT9 in CRC was correlated with tumor size, histological grade, and general histological type (P<0.05). Beyond CRC, gastric cancer patients also presented a high positive rate of plasma mSEPT9 (70%). The conversions between preoperative and postoperative plasma mSEPT9 reflected the therapeutic efficacy of curatively intended surgery for CRC patients. The persistent positivity of plasma mSEPT9 after surgery (within 7–14 days) was highly associated with impending recurrences or metastases (within one year), with a sensitivity of 100%. Postoperative mSEPT9 status during follow-up also provided valuable indication for CRC recurrence or metastases, with a good consistency (kappa = 0.818, P=0.001). Our results verified the reliability of plasma mSEPT9 as a biomarker for noninvasive diagnosis of CRC. More significantly, we revealed its valuable role in appraising CRC therapeutic efficacy and monitoring CRC recurrences or metastases. Further studies with larger sample sizes are needed to verify and elucidate the clinical utility of the promising findings.