OBJECTIVE To compare the efficacy and safety of different classes of antibacterial agents in hospitalized adult patients with community-acquired pneumonia （CAP）.METHODS PubMed， Embase，the Cochrane Library，Web of Science，CNKI，and Wanfang data were searched from inception to January 1，2026，to identify randomized controlled trials that evaluated different classes of antibacterial agents in hospitalized adults with CAP.After screening the literature， extracting the data， and evaluating the quality of the literature， a network meta-analysis was performed using Stata 18.0.RESULTS A total of 25 studies were included，involving 7 863 patients. In terms of efficacy，compared with carbapenems，penicillins，cephalosporins，macrolides，and pleuromutilins were associated with significantly higher treatment failure rates （ P ＜0.05），carbapenems and traditional tetracyclines were ranked as the top two by the surface under the cumulative ranking curve area （SUCRA）. No statistically significant differences were observed in mortality among the interventions （ P ＞0.05），carbapenems and other quinolones were ranked as the top two by SUCRA. In terms of safety，no statistically significant differences were observed among the interventions in the incidence of adverse events or discontinuation rates （ P ＞0.05）；traditional tetracyclines and novel tetracyclines were ranked as the top two by SUCRA for the incidence of adverse events，while novel tetracyclines and pleuromutilins were ranked as the top two by SUCRA for discontinuation rates.CONCLUSIONS Carbapenems significantly reduced the treatment failure rate in hospitalized adults with CAP. The safety profiles of all antibacterial agents were comparable， with novel tetracyclines showing a more favorable safety profile.

Objective:To analyze the clinical characteristics and treatment of eosinophilic angiocentric fibrosis (EAF) involving the orbit.Methods:We described a case and review the literature of EAF involving the orbit.Results:The literature review has shown 34 similar cases. Nineteen patients combined with other site involvement (17 cases had nasal involvement), whereas 15 had primary orbital involvement. Ocular swelling (18 cases) and epiphora (4 cases) were the most common initial presenting symptoms. The typical histopathologic findings include a perivascular, eosinophil-rich infiltrate and a "onion-skin" type of fibrosis concentrated around small vessels and all cases in this group conformed the above typical characteristics. In this series, 20 patients provided immunohistochemical results for IgG4, among them, 16 cases were positive while 4 cases were negative. No manifestations of obliterative phlebitis and storiform fibrosis were observed. The age, gender, and lesion locations (single or multiple) of the IgG4 staining positive group and the negative group were analyzed. There was no statistically significant difference in the age of onset, gender ratio and lesion the two groups ( P>0.05). Conclusion:For patients presented with ocular swelling, epiphora, with or without nasal lesions, EAF should be considered. The diagnosis of EAF is based largely on histopathologic findings. Although some cases were positive for IgG4 by immunohistochemistry, storiform fibrosis and obliterative phlebitis is not seen in our series, which aid in distinguishing EAF from IgG4-related disease.

Lung cancer is one of the most prevalent malignant tumors,which incidence and mortality rates increasing annually.Development of drug resistance is a primary factor contributing to treatment failure.Tumor-associated macrophages(TAMs),as key immune cells within tumor microenvironment(TME),play a significant role in the emergence and progression of drug resistance in tu-mors.TAMs can polarize into two distinct subtypes,M1 and M2,in response to diverse signaling stimuli.Research indicates that M2 TAMs are closely associated with poor prognoses in lung cancer,facilitating drug resistance through mechanisms such as promoting angiogenesis,enabling immune evasion,inducing stem cell-like characteristics in tumors,modulating relevant signaling pathways,and secreting cytokines.Traditional Chinese medicine(TCM)is characterized by its multi-target approach and minimal toxic side effects,it has been shown to enhance tumor sensitivity to drugs,slow malignant progression,and extend patient survival.This paper reviews the relationship between TAMs and lung cancer drug resistance while summarizing current research on TCM and their active components that regulate TAM activity to mitigate drug resistance in lung cancer,aiming to provide new insights for targeting TAMs in this context.

Objective:To investigate the relationship between carotid intraplaque hemorrhage (IPH) in CT angiography(CTA) and perivascular fat density (PFD).Methods:This study retrospectively analyzed 103 patients with carotid atherosclerosis, including 209 carotid plaques, who received carotid CTA and high-resolution magnetic resonance angiography in Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 2018 to July 2023. According to the evaluation of IPH by MRI, the plaques were divided into IPH group ( n=85) and non IPH group ( n=124). CTA was used to evaluate the plaque characteristics (calcification, lumen stenosis, maximum plaque thickness and plaque density) and PFD. Univariate and multivariate logistic analysis was used to evaluate the relationship between PFD and IPH. The diagnostic efficacy of multiple features was performed by receiver operating characteristic curve analysis. Results:Finally, 103 patients with 209 carotid plaques were collected. Multivariate logistic regression analysis showed that PFD ( OR=1.183, 95% CI 1.104-1.267, P<0.001) still showed a significant association with IPH after adjusting for age, hyperlipidemia, degree of luminal stenosis, plaque calcification, maximum plaque thickness, and plaque density. The area under the curve values, sensitivity, specificity, and accuracy of combined PFD, maximum plaque thickness, and plaque density were 0.980, 88.24%, 98.39%, and 94.26%, respectively. Conclusion:The changes of PFD in the carotid artery are closely related to the presence of carotid IPH in MRI and may become a new imaging indicator for high-risk plaque identification and cerebrovascular risk assessment.

Objective:In carbon ion treatment planning of water phantom, establish a conversion factor calculation system and conversion factor curves for organs at risk (OAR) for microdosimetric kinetic models (MKM) and local effect models (LEM), and validate them in clinical patient planning.Methods:Using a uniform spherical water phantom as the research object, relative biological effectiveness-weighted doses (RWD) for the LEM were re-calculated based on the physical dose of RayStation-MKM. The median dose within the planning target volume (PTV) of LEM and MKM was regarded as the conversion factor. The impacts of single-fraction target prescription dose, spread-out Bragg peak (SOBP) width and depth, shape, and irradiation mode on the conversion factor were assessed, and a conversion factor calculation system was established. Additionally, the accuracy of the conversion factor calculation system was validated using both water phantoms and clinical patient cases. The conversion factor curves for OAR were computed based on clinical patient treatment plans.Results:The primary influencing factors for the conversion factors were the single-fraction prescription dose, target SOBP width and depth. The conversion factors were increased with the increase of SOBP width and target depth, whereas decreased with the increase of the single-fraction prescription dose. Under single-field irradiation, a conversion factor calculation system was established based on above 3 parameters. For the plans of 9 patients, the average difference between the calculated results and the conversion factor calculation system was 0.340% ± 0.203%, and the average difference in the conversion curves for OAR was 2.650% ± 2.399%.Conclusion:A dose conversion factor calculation system and conversion factor curves for OAR for carbon ion radiotherapy are established for MKM and LEM, and their accuracy meets the requirements for use in clinical patient treatment plans.

Lung cancer is one of the most prevalent malignant tumors,which incidence and mortality rates increasing annually.Development of drug resistance is a primary factor contributing to treatment failure.Tumor-associated macrophages(TAMs),as key immune cells within tumor microenvironment(TME),play a significant role in the emergence and progression of drug resistance in tu-mors.TAMs can polarize into two distinct subtypes,M1 and M2,in response to diverse signaling stimuli.Research indicates that M2 TAMs are closely associated with poor prognoses in lung cancer,facilitating drug resistance through mechanisms such as promoting angiogenesis,enabling immune evasion,inducing stem cell-like characteristics in tumors,modulating relevant signaling pathways,and secreting cytokines.Traditional Chinese medicine(TCM)is characterized by its multi-target approach and minimal toxic side effects,it has been shown to enhance tumor sensitivity to drugs,slow malignant progression,and extend patient survival.This paper reviews the relationship between TAMs and lung cancer drug resistance while summarizing current research on TCM and their active components that regulate TAM activity to mitigate drug resistance in lung cancer,aiming to provide new insights for targeting TAMs in this context.

Objective:To analyze the clinical characteristics and treatment of eosinophilic angiocentric fibrosis (EAF) involving the orbit.Methods:We described a case and review the literature of EAF involving the orbit.Results:The literature review has shown 34 similar cases. Nineteen patients combined with other site involvement (17 cases had nasal involvement), whereas 15 had primary orbital involvement. Ocular swelling (18 cases) and epiphora (4 cases) were the most common initial presenting symptoms. The typical histopathologic findings include a perivascular, eosinophil-rich infiltrate and a "onion-skin" type of fibrosis concentrated around small vessels and all cases in this group conformed the above typical characteristics. In this series, 20 patients provided immunohistochemical results for IgG4, among them, 16 cases were positive while 4 cases were negative. No manifestations of obliterative phlebitis and storiform fibrosis were observed. The age, gender, and lesion locations (single or multiple) of the IgG4 staining positive group and the negative group were analyzed. There was no statistically significant difference in the age of onset, gender ratio and lesion the two groups ( P>0.05). Conclusion:For patients presented with ocular swelling, epiphora, with or without nasal lesions, EAF should be considered. The diagnosis of EAF is based largely on histopathologic findings. Although some cases were positive for IgG4 by immunohistochemistry, storiform fibrosis and obliterative phlebitis is not seen in our series, which aid in distinguishing EAF from IgG4-related disease.

Objective:To investigate the relationship between carotid intraplaque hemorrhage (IPH) in CT angiography(CTA) and perivascular fat density (PFD).Methods:This study retrospectively analyzed 103 patients with carotid atherosclerosis, including 209 carotid plaques, who received carotid CTA and high-resolution magnetic resonance angiography in Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 2018 to July 2023. According to the evaluation of IPH by MRI, the plaques were divided into IPH group ( n=85) and non IPH group ( n=124). CTA was used to evaluate the plaque characteristics (calcification, lumen stenosis, maximum plaque thickness and plaque density) and PFD. Univariate and multivariate logistic analysis was used to evaluate the relationship between PFD and IPH. The diagnostic efficacy of multiple features was performed by receiver operating characteristic curve analysis. Results:Finally, 103 patients with 209 carotid plaques were collected. Multivariate logistic regression analysis showed that PFD ( OR=1.183, 95% CI 1.104-1.267, P<0.001) still showed a significant association with IPH after adjusting for age, hyperlipidemia, degree of luminal stenosis, plaque calcification, maximum plaque thickness, and plaque density. The area under the curve values, sensitivity, specificity, and accuracy of combined PFD, maximum plaque thickness, and plaque density were 0.980, 88.24%, 98.39%, and 94.26%, respectively. Conclusion:The changes of PFD in the carotid artery are closely related to the presence of carotid IPH in MRI and may become a new imaging indicator for high-risk plaque identification and cerebrovascular risk assessment.

Objective:In carbon ion treatment planning of water phantom, establish a conversion factor calculation system and conversion factor curves for organs at risk (OAR) for microdosimetric kinetic models (MKM) and local effect models (LEM), and validate them in clinical patient planning.Methods:Using a uniform spherical water phantom as the research object, relative biological effectiveness-weighted doses (RWD) for the LEM were re-calculated based on the physical dose of RayStation-MKM. The median dose within the planning target volume (PTV) of LEM and MKM was regarded as the conversion factor. The impacts of single-fraction target prescription dose, spread-out Bragg peak (SOBP) width and depth, shape, and irradiation mode on the conversion factor were assessed, and a conversion factor calculation system was established. Additionally, the accuracy of the conversion factor calculation system was validated using both water phantoms and clinical patient cases. The conversion factor curves for OAR were computed based on clinical patient treatment plans.Results:The primary influencing factors for the conversion factors were the single-fraction prescription dose, target SOBP width and depth. The conversion factors were increased with the increase of SOBP width and target depth, whereas decreased with the increase of the single-fraction prescription dose. Under single-field irradiation, a conversion factor calculation system was established based on above 3 parameters. For the plans of 9 patients, the average difference between the calculated results and the conversion factor calculation system was 0.340% ± 0.203%, and the average difference in the conversion curves for OAR was 2.650% ± 2.399%.Conclusion:A dose conversion factor calculation system and conversion factor curves for OAR for carbon ion radiotherapy are established for MKM and LEM, and their accuracy meets the requirements for use in clinical patient treatment plans.

Familial adenomatous polyposis and Lynch syndrome represent two different molecular pathways of colorectal carcinogenesis that are commonly considered mutually exclusive: chromosomal instability and microsatellite instability. Here, we report a rare case of familial adenomatous polyposis in an adult male with Lynch-like syndrome. A 46-year-old male patient was found to have hundreds of adenomatous polyps throughout the whole intestine, and irregular masses in rectum, sigmoid and transverse colon. Genetic test showed that the patient carried pathogenic germline APC (c.423-1G>A) variant and two variants of uncertain significance in MLH1 (p.R725H) and PTCH1 (p.S438N), combined with tumor characteristics of somatic AKT1/PIK3CA/KRAS co-mutations, microsatellite instability and high tumor mutation burden. The patient underwent laparoscopic total colectomy with abdominoperineal resection and end ileostomy, then received 4 cycles adjuvant chemotherapy of oxaliplatin with capecitabine. This patient was followed up to April 2024 and performed well without abnormalities in serum cancer biomarkers and radiological examinations.