The choice of initial anti-infection empirical therapy is the key to the successful treatment of community-acquired pneumonia in adults.This review is aimed at interpretation of the 2016 edition of Guidelines for the Initial Anti-infection Empiric Therapy Management of Chinese Adult Patients with Community-Acquired Pneumonia based on the different characteristics of antimicrobial agents.It may be useful for clinical physicians and pharmacists understand and master the guidance theoretically and practically,and also help thegn to select the empirical anti-infection treatment of adult patients with community-acquired pneumonia in combining regional epidemiological characteristics reasonably.

AIM: To investigate the effect of hypoxia on the invasion and migration of lung carcinoma cells. METHODS: Lung carcinoma cell H128 was exposed to normoxia (air, 5% CO 2), hypoxia (5% O 2,5% CO 2,90% N 2) or anoxia (95% N 2,5% CO 2) conditions for 48 hours. The migration ability of the cells was assayed by wound healing methods. The invasiveness ability was determined with HABM-HEM model. The cells exposed to hypoxia were inoculated under skin in nude mice, and then the growth of the tumor and the rate of metastasis to lymph node or lung were observed. The expression of E-cadherin and ?1-integrin on the cells were also assayed by flow cytometry. RESULTS: Compared with normoxic group, the invasiveness and migration in hypoxic group were increased. The rates of tumorgenesis and metastasis to lung in anoxic group were evidently decreased. The expression of E-cadherin was decreased, and the expression of ?1-integrin was increased in hypoxic group. In anoxia group, the invasiveness, migration, the expression of E-cadherin and ?1-integrin were all decreased. CONCLUSIONS: Moderate hypoxia down-regulated the expression of E-cadherin, up-regulated the expression of ?1-integrin, and increased the invasiveness and metastasis of carcinoma cells. Serious hypoxia decreased the expression of adhesive molecules, and the proliferation, invasiveness and migration were also decreased.

Objective To study the expression of neural cell adhesion molecule CD 56 in the human lung cancer and its pathological significance. Methods 59 paraffin imbedded specimens of lung cancers were collected and human small cell lung cancer H128 cell line was cultured.The CD 56 expression in the lung cancer tissues and H128 cells was detected by immunohistochemical method. Results The expression of CD 56 was positive in 35 of 43 NSLC specimens, and the other specimens showed weakly positive staining. All 19 cases of the SCLC specimens showed CD 56 positive staining, 12 specimens of which were strongly positive. There was a significant difference in CD 56 expression between the SCLC and NSCLC. CD 56 was extensively expressed in H128 cells. Conclusion CD 56 might be an ideal tumour marker for SCLC.

Objective To explore the clinical features and treatment measures of the severe pneumonia in renal transplantation patients. Methods The clinical data of 27 patients with severe pneumonia following renal transplantation was retrospectively analyzed. Results The severe pneumonia in renal transplantation patients had the features such as earlier occurrence, speedy development and mixed infection of multi-bacteria. Twenty-two cases out of 27 patients (81.5%) were rescued successfully, and five cases died. Conclusion The patients with severe pneumonia following renal transplantation should be intensively observed and actively treated. The reasonable application of broad-spectrum antibiotics, breathing sustain and combined measures are the key points of successful treatment.

Objective:To study the blocking effects of anti-sense peptide of C5a on the adhesion between pulmonary vascular endothelial cell(PVEC) and neutrophil resulting from C5a anaphylatoxin.Methods:It was determined by Flowcytometry that the change of adhesion molecule expression on PVEC and the activity of MPO in PMN was determined after adhesion.Results:In response to C5a after interactions with several concentrations of anti-sense peptide R4, the expression of P-Selectin on PVEC decreased significantly and reached the minimum at the concentration of 5 000 ng/ml, and the activity of MPO in PMN reduced by 40% at the concentration of 5 000 ng/ml of anti-sense peptide R4.Conclusion:The results suggested that anti-sense peptide of C5a has significant blocking effects on C5a anaphylatoxin.

Objective To explore the effect of hypoxia on the in vitro invasion of lung carcinoma cells and its molecular basis. Methods Small cell lung carcinoma cells(H128) were exposed to hypoxia(5%O 2,5%CO 2,90%N 2) or anoxia(95%N 2,5%CO 2)condition for 48 hours. The invasive ability of the cancer cells was assayed with HABM-HEM model. The expression of E-cadherin and ? 1-integrin on the cells was also assayed by flow cytometry. Results Compared with normoxia group, the invasive ability of the cancer cells increased, the expression of E-cadherin decreased, and the expression of ? 1-integrin increased in hypoxia group. In anoxia group, the invasive ability and the expression of E-cadherin and ? 1-integrin all decreased compared with normoxia group. Conclusions Moderate hypoxia can down-regulate the expression of E-cadherin, up-regulate the expression of ? 1-integrin, and increase the invasion of carcinoma cells. But serious hypoxia can decrease the expression of adhesive molecules and the invasion of the cancer cells.

Objective To investigate the effect and mechanism of compound glycyrrhizin on airway inflammation in asthmatic rats. Methods Forty wistar rats were randomly divided into health group (group Ⅰ), asthma group(group Ⅱ), treating group (group Ⅲ) and treating control group (group Ⅳ) (n=10 in each group). Group Ⅱ, group Ⅲ and group Ⅳ received intraperitoneal injection of ovalbumin (OVA) and aluminum hydroxide gel for sensitization and OVA aerosol by ultrasonic nebulization for challenge, in addition, group Ⅲ re-ceived intraperioneal injection of 200 μg of compound glycyrrhizin 1 hour before OVA aerosol challenging every time, and group Ⅳ were in-jected with normal saline instead of compound glycyrrhizin. Group Ⅰ were injected and nebulizated with normal saline instead of OVA and alu-minlum hydroxide. All rats were sacrificed at the 6th hour after the last challenging, venous blood and bronchoalveolar lavage fluid(BALF) were collected, the IgE in venous blood were determined and the concentration of IL-4, IL-5, IL-13 and IFN-γ in BALF were detected, the cells in BALF were counted and detached. Results The concentration of IgE, IL-4, IL-5, IL-13 and the count of neutrophilic granulocytcs, lymphocytes, cosinophils in group Ⅱ were significantly higher than those in group Ⅰ and group Ⅲ(P<0.01), and the concentration of IFN-γ in group Ⅰ and group Ⅳ were significantly lower than those in group Ⅰ and group Ⅲ(P <0.01). There was no significant difference be-tween group Ⅱ and group Ⅳ(P >0. 05). The concentration of IgE, IL-4, IL-5, IL-13 and the count of neutrophilic granulocytes, lympho-cytes, cosinophils in group Ⅲ were higher than those in group Ⅰ, and the concentration of IFN-γ and the count of mononucleat macroplile cells in group Ⅲ were lower than those in group Ⅰ, but there were no significant difference(P>0.05). Conclusion Compound giycyrrhiz-in alleviated the airway inflammation and reduced the airway hyperresponsiveness in asthmatic rats, which mechanism may be related to regu-lating the balance of Th1/Th2 cytokines, suppressing the immune ability of Th2 and promoting the immune ability of Th1.

Objective To realize the effect of hypoxia on the growth and angiogenesis of non small cell lung carcinoma. Methods Non small cell lung carcinoma cell (A549) were exposed to hypoxia(1%O 2,5%CO 2,90%N 2) or anoxia(95%N 2,5%CO 2) condition for 48 hours. The cells exposed to hypoxia were subcutaneously planted in nude mice, observed the volume per 5days. After 25 days, the weight and volume were measured, and the microvessel density (MLD) were observed by immunohistochemistry method for CD34, the level of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) were assayed by ELISA. Results Comparing with normoxia group, the volume and weight of subcutaneous tumor of nude mice were increased in hypoxic group, the MLD and the level of VEGF and bFGF in hypoxic group were higher than that in normoxia group. The volume, weighty, MLD and the level of VEGF and bFGF in anoxic groups decreased contrasted to normoxic group. Conclusion Moderate hypoxia can up regulate the expression of VEGF and bFGF, and increase the angiogenesis and growth of non small cell lung carcinoma. But serious hypoxia can decrease the expression of VEGF and bFGF, and inhibit the angiogenesis and growth of the carcinoma.

Objective To observe the effect of treating generalized anxiety disorder with clearing heart and relieving rstlessness acupuncture combined with western medicine. Methods 87 patients with generalized anxiety disorder were randomly recruited into a control group and a treatment group. Both groups received conventional western medical treatment. On this basis, the control group was given conventional acupuncture therapy, while the treatment was given clearing heart and relieving restlessness acupuncture. The efficacies were evaluated with Hamailton anxiety (HAMA)scale and clinical global impression scale (CGI). The adverse reaction was evaluated with treatment emergent symptoms scale (TESS). Results One week after treatment, the efficacies and adverse reaction in the treatment group markedly decreased comparing with those before the treatment(P<0.05). Two weeks after treatment, the efficacies and adverse reaction of both groups decreased comparing with those before the treatment(P<0.01). Besides, the decrease continues with time passing by. One week after treatment, the HAMA score in the control group markedly decreased comparing with that of the control group (P<0.05), and the CGI score in the treatment group had no significant difference comparing with that of the control group(P<0.05). Conclusion The treatment of clearing heart and relieving restlessness acupuncture on generalized anxiety disorder has rapid effect and good compliance.

Abstract: Objective To compare the application value of metagenomic next generation sequencing (mNGS) with traditional culture in diagnosis of pulmonary infection pathogens. Methods　The clinical documents of 310 patients with suspected pulmonary infection admitted to the General Hospital of Center Theater Command from February 2021 to September 2022 were retrospectively analyzed. The results of mNGS and traditional culture were analyzed, followed by comparison on the positive rate, sensitivity, specificity, accuracy (ACC), positive predictive value (PPV) and negative predictive value (NPV) between the two methods. Results　 The study revealed that mNGS can simultaneously detect multiple pathogens, with the highest efficiency of detection for bacteria and the lowest for fungi. And the sequencing numbers of bacteria, fungi and viruses shown by mNGS were significantly different (H=70.361, P<0.001). In comparison, mNGS displayed a higher positive detection rate (88.40%) than traditional culture (29.70%) (χ2=162.373, P<0.001), but the consistency between the two methods was not significant (Kappa = -0.003, P=0.902). The sensitivity, specificity, ACC, PPV and NPV of mNGS were 91.29%, 28.26%, 81.94%, 87.96%, and 36.11% respectively, compared to corresponding 30.30%, 73.91%, 36.77%, 86.96% and 15.60% of traditional culture respectively. Through analysis, it is confirmed that the sensitivity and specificity between the two methods were statistically significant (91.29% vs 30.30%, χ2=148.120, P<0.001 and 28.26% vs 73.91, χ2=13.793, P<0.001). Conclusions　mNGS can significantly improve the detection rate of pathogens in pulmonary infections and provide a complementary tool besides to traditional culture method for accurate anti-infection therapy. Furthermore, both traditional culture and mNGS pathogen detection methods are highly dependent on sample quality and detection quality control. mNGS requires the correct interpretation of comprehensive, non-destructive pathogenic genetic information to accurately identify pathogens.