OBJECTIVE: To explore whether hydrocortisone can improve the prognosis of patients with severe community-acquired pneumonia (sCAP) by Meta-analysis. METHODS: Randomized controlled trial (RCT) on hydrocortisone in the treatment of sCAP were extracted from the database including PubMed, Cochrane library, Web of Science, and Embase, and the search time was up to April 29, 2023. The patients in the standard treatment group received standard treatment such as antibiotics and supportive care, while those in the hydrocortisone group received hydrocortisone treatment on the basis of standard treatment. Meta-analysis was used to compare the mortality, duration of mechanical ventilation, mechanical ventilation rate and incidence of adverse reactions (hyperglycemia, gastrointestinal bleeding, secondary infection) between the two groups. The risk of literature bias was assessed. The studies that might have publication bias were corrected by the subtraction and complementation method. At the same time, trial sequential analysis (TSA) was conducted. RESULTS: A total of 5 RCTs involving 1 031 patients were finally enrolled, including 494 patients in the standard treatment group and 537 patients in the hydrocortisone group. Among the 5 studies, the research site of 2 studies was in the mixed ward. Considering the inclusion characteristics of the study population, there was doubt whether its research object was sCAP patients, which might have a certain impact on the results and introduce potential bias. Meta-analysis showed that the mortality in the hydrocortisone group was significantly lower than that in the standard treatment group [6.0% vs. 14.0%; odds ratio (OR) = 0.38, 95% confidence interval (95%CI) was 0.25-0.59, P < 0.01; I² = 9%]. The studies that were asymmetric were corrected by the reduction and supplementation method. Even after filling the missing studies, hydrocortisone could still reduce the death risk of the patient (OR = 0.49, 95%CI was 0.32-0.73, P < 0.01; I² = 31%). TSA showed that the average mortality of the standard treatment group was about 14.0%, and that of the hydrocortisone group was about 6.0%, with a relative risk reduction (RRR) = 57%. The calculated sample size was 699 cases, and the actual sample size was 1 031 cases. The actual sample size exceeded the required sample size, and the Z-curve crossed the O'Brien-Fleming boundary and the curve corresponding to P = 0.05, it meant that hydrocortisone could effectively reduce the mortality of sCAP. Compared with the standard treatment group, no statistical difference in the duration of mechanical ventilation was found in the hydrocortisone group [mean difference (MD) = -3.26, 95%CI was -6.72-0.21, P = 0.07; I² = 0%], but the 8-day mechanical ventilation rate was significantly lowered (19.5% vs. 55.4%; OR = 0.24, 95%CI was 0.12-0.45, P < 0.01; I² = 0%), and also no significantly difference was found in the incidence of hyperglycemia (54.3% vs. 44.6%, OR = 1.26, 95%CI was 0.56-2.84, P = 0.58; I² = 61%), gastrointestinal bleeding (2.5% vs. 3.6%; OR = 0.70, 95%CI was 0.34-1.46, P = 0.34; I² = 0%) and secondary infection (9.2% vs. 11.5%; OR = 0.46, 95%CI was 0.06-3.35, P = 0.45; I² = 53%). CONCLUSION Hydrocortisone can reduce the mortality rate of sCAP patients, decrease their need for mechanical ventilation, and does not increase the risk of hyperglycemia, gastrointestinal bleeding, or secondary infections.
Humans ; Hydrocortisone/therapeutic use* ; Community-Acquired Infections/drug therapy* ; Pneumonia/drug therapy* ; Randomized Controlled Trials as Topic ; Respiration, Artificial ; Community-Acquired Pneumonia

Objective:To sort out medical device related policies in Anhui Province,to analyze the distribution of content in each policy text to provide reference for policy optimization in the later stage.Methods:The official websites of the People's Government of Anhui Province and the Anhui Provincial Drug Administration were searched by using the keywords of"medical devices","medical device enterprises",and"medical consumables"to search for medical device related policy documents released from January 2011 to December 2022.The 21 medical device-related policy documents retrieved shall be coded using the content analysis method in the sequence of"policy code-chapter number-unit number-sentence number".A two-dimensional analytical framework of"Basic Policy Instruments-Involved Subjects"was constructed to quantitatively analyze the medical device policy text from the two dimensions of policy instruments-involved subjects.Results:A total of 338 items were codes,including 107 supply-based policy tools(accounting for 31.66%),40 demand-based policy tools(accounting for 11.83%),and 191 environmental policy tools(accounting for 56.51%).The 338 codes involved entities including 202 government departments(accounting for 59.76%),62 operating enterprises(accounting for 18.34%),59 production enterprises(accounting for 17.46%),9 medical institutions(accounting for 2.66%),and 6 industry associations(accounting for 1.78%).Conclusion:The medical device policy in Anhui Province is mainly based on environmental policy tools,and demand-based policy tools are rarely used.The rationality of the distribution of internal items and participating entities in policy tools needs to be improved.There are certain differences in the interaction between each entity and policy tools.Therefore,it is necessary to strengthen the balance of policy tool use,increase the participation of multiple entities,and optimize the synergy between entities and policy tools.

177Lu-prostate specific membrane antigen(PSMA)radio-ligand therapy has been approved abroad for advanced prostate cancer and has been in several clinical trials in China.Based on domestic clinical practice and experimental data and referred to international experience and viewpoints,the expert group forms a consensus on the clinical application of 177Lu-PSMA radio-ligand therapy in prostate cancer to guide clinical practice.

Objective:To establish ulcerative colitis(UC)rat model of spleen deficiency and dampness,and to explore effect of Jianpi-Huazhu pill and its different deconditions on TLR-4/MyD88/NF-κB pathway.Methods:A total of 64 Wistar rats were ran-domly divided into normal control group(n=8)and model group(n=56).UC rat model was established by traditional Chinese medi-cine syndrome combined with ethanol-2,4,6-trinitrobenzene sulfonic acid enema method.After successfully modeling,rats were ran-domly divided into model group(M),Mesalazine group(A),Jianpi-Huazhi pill group(B),Jianpi-Qinghua decoction group(C),Jianpi-Qinghua-Huoxue decoction group(D),Jianpi-Qinghua-Daozhi decoction group(E)and Qinghua-Daozhi-Huoxue decoction group(F),with 8 rats in each group,given corresponding drugs by gavage for 4 weeks.At end of course of treatment,all rats were sacrificed and samples were taken.Changes of body weight,disease activity and pathological changes of colon were observed.TNF-α expression in colon tissue was detected by ELISA and immunohistochemistry.RT-PCR and Western blot were used to detect mRNA and protein expressions of TLR-4,MyD88 and NF-κB in rat colon tissue.Results:Rats weight in Jianpi-Huazhi pill group,Jianpi-Qinghua decoction group,Jianpi-Qinghua-Huoxue decoction group and Jianpi-Qinghua-Daozhi decoction group were obviously higher than that of model group(P<0.01),all treatment groups could obviously improve UC model rat pathological damage and disease activity index in colon tissue,and Jianpi-Huazhi pill group and Jianpi-Qinghua-Huoxue group showed better efficacy.All treatment groups could inhibit mRNA and protein expressions of TLR-4,MyD88 and NF-κB in colon tissue(P<0.001).Mesalazine group,Jianpi-Huazhi pill group,Jianpi-Qinghua-Daozhi group and Qinghua-Daozhi-Huoxue group were significantly better than Jianpi-Qinghua group and Jianpi-Qinghua-Huoxue group in reducing NF-κB mRNA and protein expressions(P<0.05).All groups could reduce expres-sion of TNF-α in colon tissue(P<0.001),and there was no significant difference between groups(P>0.05).Conclusion:Jianpi-Huazhi pill and its various deconditions may play roles through TLR-4/MyD88/NF-κB pathway.Among them,Coptid-Rhizoma coptifo-lia,stews woody incense,Fengwei herb and gung ginger may be core drugs of this recipe,which has certain guiding significance for clinical practice.

Objective:To systematically review and integrate the caring experience of caregivers of lung transplant patients.Methods:Qualitative studies on the caregiving experience of caregivers of lung transplant patients were searched by computer from PubMed, Web of Science, Embase, Cochrane Library, China Biology Medicine disc, China National Knowledge Infrastructure and Wanfang data, and the search period was from establishment of the databases to April 30, 2023. The qualitative research quality evaluation criteria (2016 edition) of the Joanna Briggs Institute Evidence Based Health Care Center in Australia were used to evaluate the quality of the included literature, and the Meta-synthesis was used to integrate the literature results.Results:A total of ten articles were included, and 33 clear research results were extracted, which were summarized into eight new categories, and finally summarized into four integrated results, such as heavy burden experience, strong demand, positive experience and satisfaction with the medical service system.Conclusions:Medical workers should attach importance to and pay attention to the burden and needs of caregivers of lung transplant patients, provide professional and emotional support to caregivers, improve their caring ability and quality, and ultimately improve the quality of life of lung transplant patients.

Purpose To investigate the clinicopathological features and prognosis of alpha-fetoprotein-producing colorectal carcinoma(AFPCRC).Methods 42 cases of AFPCRC from 2 012 colorectal carcinomas of preoperative serum AFP detected and surgically resected were identified.The clinicopathological data of AFPCRC and other 42 cases of conventional colorectal carcinoma exactly matched for age,gender,stage were also col-lected.Immunohistochemical EnVision method was performed to detect the expression of HER2,MMR,p53,AFP,Glypican3,and SALL4.Cases presenting HER2 2+were further analyzed by fluorescence in situ hybridization.Elastic staining was per-formed in cases with ambiguous extramural venous invasion.The clinicopathlogical features and prognosis between two groups were compared.Cases with AFPCRC were divided into high-AFP group and low-AFP group.The clinicopathological features and prognosis of the two groups were compared.Results AF-PCRC accounted for 2.1％(42/2 012)of colorectal carcinoma in the same period.The frequency of extramural vascular inva-sion and moderate/high grade of tumor budding of AFPCRC was 35.7％and 61.9％,while that of control group was 14.3％and 40.5％respectively.The 5-year survival rate of AFPCRC and control group was 66.8％and 85.1％respectively.The differ-ence of aforementioned clinicopathological features between 2 groups was significant(P＜0.05).The proportion of tumor in rectum in the high-AFP group was significantly higher than that in the low-AFP group(61.9％vs 23.8％,P＜0.05).Conclu-sion AFPCRC is a rare subset of colorectal carcinoma,which has a propensity for extramural vessel invasion,moderate-or high-grade of tumor budding and poor prognosis.

Objective To investigate the effect of radiation on cardiomyocyte apoptosis and its related mechanism.Methods Rat H9C2 cardiomyocytes were divided into blank control group,X-ray irradiation group(X-ray group),X-ray irradiation+microRNA(miRNA)-134-5p inhibitor group(X-inhibitor group)and X-ray irradiation+miRNA-134-5p inhibitor negative control group(X-NC group).H9C2 cardiomyocytes were irradiated with 6 Gy X-ray,and the changes of various indexes were detected 48 h after irradiation.Cell viability was detected by cell counting kit 8 assay.The apoptosis rate was detected by flow cytometry and Hoechst 33342 staining.The level of reactive oxygen species(ROS)in cells was detected by DCFH-DA fluorescence probe.The mitochondrial membrane potential was detected by JC-1 method.The activity of superoxide dismutase(SOD)and the level of malondialdehyde(MDA)in cells were measured by kits.The expression of miRNA-134-5p was detected by quantitative polymerase chain reaction.The protein expression of brain-derived neurotrophic factor(BDNF),protein kinase B(Akt),phosphorylated Akt(p-Akt),Bcl2 and Bax was detected by Western blotting.Results Compared with the blank control group,in the X-ray group the levels of ROS and MDA were significantly increased,the activity of SOD was significantly decreased,the decreased percentage in mitochondrial membrane potential was significantly increased,the number of micronuclei of DNA damage was significantly increased,and the apoptosis rate was significantly increased(all P＜0.01).Compared with the X-ray group,all the indexes of the X-inhibitor group were reversed(P＜0.05 or P＜0.01),while there was no significant difference in the above parameters in the X-NC group(all P＞0.05).Compared with the blank control group,the X-ray group had a significant increase in the miRNA-134-5p level and significant reductions in the protein level of BDNF,Bcl2/Bax ratio,and p-Akt/Akt ratio(all P＜0.01).Compared with the X-ray group,the X-inhibitor group had a significant reduction in the level of miRNA-134-5p and significant increases in the protein level of BDNF,Bcl2/Bax ratio,and p-Akt/Akt ratio(all P＜0.01),and there was no significant difference in all parameters in the X-NC group(all P＞0.05).Conclusion X-ray irradiation can induce oxidative stress,mitochondrial damage,and DNA damage,eventually leading to apoptosis in rat cardiomyocytes,and the mechanism may involve miRNA-134-5p/BDNF/Akt signaling pathway.

Prepubertal-type testicular neuroendocrine tumor is a rare neoplasm of low malignant potential, which is classified as germ cell tumors unrelated to germ cell neoplasia in situ, and needs to be differentiated from metastatic neuroendocrine tumor, postpubertal-type testicular neuroendocrine tumor, and testicular seminoma. The clinicopathological and molecular features of a case of prepubertal-type testicular neuroendocrine tumor were reported. The tumour cells were uniform in size and arranged in nested and insular pattern. The tumor was positive for CgA and Syn, and the Ki-67 index was less than 2% by immunostaining. Next-generation sequencing identified no variants of pathogenicity, potential pathogenicity or uncertain significance. The patient was followed without evidence of recurrence and metastasis 56 months after surgery.

Hypertension heightens the risk of cardiovascular and renal complications in individuals with type 2 diabetes mellitus. Optimal blood pressure (BP) management is crucial for preventing these complications. This review consolidates evidence from clinical trials and major BP management guidelines to shed light on key aspects of hypertension management in diabetes. It addresses BP thresholds to initiate antihypertensive treatment, optimal BP control targets, recommended first-line antihypertensive edications, and BP monitoring plan for the prevention of chronic complications in type 2 diabetes.

A 9-year-old male child presented with red plaques on the left upper limb for more than 5 years without obvious subjective symptoms. Topical glucocorticoids and calcineurin inhibitors did not markedly improve his condition. Skin examination showed dark red map-like plaques with clear borders on the extensor side of the left upper limb, with a few white scales attached to the surface and satellite lesions at the edge. There were no obvious abnormalities in routine blood and urine tests or immunological examinations. Histopathological examination revealed dense infiltration of abundant lymphocytes and plasma cells in the upper and middle dermis, with some inflammatory cells infiltrating the fat septa and focal formation of lymphoid follicles; immunohistochemical study showed positive staining for CD3 in interfollicular regions, CD20 in the follicular center, and CD38 in plasma cells, as well as for IgG Kappa chain and IgG Lambda chain; periodic acid-Schiff staining and acid-fast staining both showed negative results. A diagnosis of childhood benign lymphoplasmacytic plaque was made. The patient was treated with topical halometasone cream once a day in the morning, topical tacrolimus ointment once a night, and oral traditional Chinese medicine for promoting blood circulation and removing blood stasis. After 6 months of follow-up, the skin lesions became slightly flat, slightly lighter in color, and no new lesions occurred. Treatment and follow-up were ongoing.