Oral vs. parenteral antibiotic therapy in adult patients with community-acquired pneumonia: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVES: Antibiotic therapy is widely used for patients with community-acquired pneumonia (CAP), and yet whether the efficacy of antibiotics differs based on the treatment mode remains unclear. This study aimed to summarize the evidence regarding the efficacy and safety of oral vs. parenteral administration of antibiotic therapy for the treatment of patients with CAP. METHODS: The databases of PubMed, EmBase, and the Cochrane Central Register of Controlled Trials were systematically searched for eligible randomized controlled trials (RCTs) from inception until 11 December 2021. The effectiveness of oral vs. parenteral administration of antibiotic therapy was estimated using a random-effects model. Additional sensitivity, subgroup, and publication bias analyses were performed. RESULTS: Of 912 identified articles, 12 RCTs involving 2158 patients with CAP were included in our pooled analysis. This mostly included trials with low certainty and some concerns regarding risk of bias, including lack of allocation concealment and blinding of participants and personnel. Overall, oral antibiotic therapy did not affect the incidence of clinical success at the end of treatment (relative risk [RR], 1.01; 95% confidence interval [CI], 0.98-1.05; P = 0.417), clinical success at follow-up (RR, 1.02; 95% CI, 0.98-1.06; P = 0.301), or adverse events (RR, 0.87; 95% CI, 0.56-1.35; P = 0.527). Moreover, oral antibiotic therapy had a beneficial effect on the risk of all-cause mortality (RR, 0.58; 95% CI, 0.35-0.96; P = 0.034). CONCLUSIONS: Oral administration of antibiotics is associated with a reduced risk of all-cause mortality compared with parenteral therapy based on RCTs with low to moderate quality. This finding should be verified in further large-scale RCTs.

[Application of detecting bronchoalveolar lavage fluid Aspergillus galactomannan antigen in the diagnosis of pulmonary aspergillosis].

OBJECTIVE: To prospectively evaluate the utility of detecting bronchoalveolar lavage fluid (BALF) Aspergillus galactomannan antigen (GM) in the diagnosis of pulmonary aspergillosis. METHODS: From August 2008 to April 2012, 121 patients suspected of pulmonary aspergillosis were recruited and classified into pulmonary aspergillosis group (n = 57) and non-pulmonary disease group (n = 64) according to the 2008 diagnostic criteria and classification of European Organization for Research and Treatment of Cancer/National Institute of Mycoses Study Group(EORTC/MSG). The absorbency (A) and I value of GM in the patients' serum and BALF were detected by enzyme-linked immunosorbent assay (ELISA). And their values were compared and analyzed. RESULTS: Twenty cases were confirmed by pathological examinations and 37 cases by clinical diagnosis in the pulmonary aspergillosis group. The mean rank of GM's I value in the serum and BALF samples was 88.21 and 86.49. And they significantly increased compared with the non-pulmonary aspergillosis group (36.77, 38.30) (P < 0.01). At a different serum GM threshold I = 0.5, 0.8, 1.0, the sensitivities were 0.842, 0.649 and 0.228; the specificities 0.906, 0.938, 0.929; the positive predictive values 0.889, 0.902, 0.984 and the negative predictive values 0.866, 0.750, 0.589 respectively. And at a different BALF GM threshold I = 0.5, 0.8, 1.0, the sensitivities were 0.930, 0.657, 0.561; the specificities 0.766, 0.922, 0.969; the positive predictive values 0.779, 0.884, 0.941 and the negative predictive values 0.925, 0.756, 0.713 respectively. CONCLUSION: The detection of GM in BALF may be employed for the clinical diagnosis of pulmonary aspergillosis.

Mechanism insights into CO oxidation over transition metal modified V2O5/TiO2 catalysts: A theoretical study.

The V2O5/TiO2 based selective catalytic reduction (SCR) catalysts possess not only promising capability on the denitrification of nitrogen oxides (NOx), but also certain effects on the oxidation of carbon monoxide (CO) in the flue gas. Modification of traditional SCR catalysts with certain transition metals can further improve their catalytic oxidation ability of CO. Therefore, it is of great significance to reveal the catalytic oxidation mechanism of CO for developing modified SCR catalysts to achieve the co-removal of CO and NOx. Theoretical calculations based on density functional theory (DFT) were performed to probe the comprehensive reaction mechanism of CO oxidation on M doped V2O5/TiO2 catalysts (M = Mo, Fe, and Co). The whole CO oxidation cycles include three stages, i.e., the first CO oxidation, the re-oxidation of the surface, and the second CO oxidation. The terminal oxygen and the surface oxygen formed by the adsorbed O2 all play vital roles in the whole CO oxidation cycles. The activation barriers of the rate-determining steps for CO oxidation on Fe-V2O5/TiO2 and Co-V2O5/TiO2 are much lower than that of Mo-V2O5/TiO2, which indicates Fe and Co dopants can apparently promote the CO oxidation activities of the modified SCR catalysts. Meanwhile, the electronic structure analysis confirms that Fe and Co dopants can cause electron distribution change with strong oxidation ability at the active oxygen sites.

Intrinsic mechanism insight of the interaction between lead species and the Vanadium-based catalysts based on First-principles investigation.

Lead (Pb) species trigger serious poisoning of selective catalytic reduction (SCR) catalysts. To improve the Pb resistance ability, revealing the impact mechanism of Pb species on the commercial SCR catalysts from a molecular level is of great significance. Herein, first-principles calculations were applied to unveil the Pb adsorption mechanism on the vanadium-based catalysts, the results were also compared with the previous experimental findings. The intrinsic interaction mechanism between Pb and catalyst components was interpreted by clarifying the change of the catalyst electronic structures (including charge transfer, bond formation situations, and active sites reactivities). It is found that the adsorption of Pb species belongs to chemisorption, evident electron transfer with the catalyst surface is inspected and intense charge transfer indicates strong adsorption. A remarkable interaction with the V = O active sites occurs and stable Pb-O bonds are formed, which significantly changes the electronic structures of the V = O sites and inhibits the NH3 adsorption, thus suppressing the SCR activity. Finally, thermodynamic analysis was applied to elucidate the temperature influence on Pb adsorption. It is found that Pb adsorption on catalysts cannot proceed spontaneously over 500 K. At higher temperatures the adsorption is inhibited and the Pb species become less stable, which partially explains why the Pb-poisoning effect at high temperatures is relatively moderate than that at low temperatures.

Migration and transformation of lead species over CaO surface in municipal solid waste incineration fly Ash: A DFT study.

Heavy metal pollutants generated from municipal solid waste (MSW) incineration are mainly concentrated in the fly ash, among which lead species have received considerable attention due to their high content and biotoxicity. CaO is an active component in fly ash to adsorb heavy metal species. In this study, based on density functional theory (DFT) calculations, the migration and transformation mechanisms of lead species over the CaO (100) surface were investigated by calculating the adsorption configurations, energies, and electronic structures, etc. The results indicate that the adsorption of lead species over the CaO (100) surface is dominated by chemisorption, and PbCl2 molecule exhibits a stronger affinity to the CaO surface than Pb0. The dissociation of HCl molecule on the CaO (100) surface facilitates the adsorption and chemical reactivity of lead species. The chlorination of Pb0 to PbCl2 is a two-stage route. In the first stage, two HCl molecules are exothermically adsorbed on the surface without an energy barrier, and Pb0 is directly bonded to the active Cl atom, which is controlled by the Eley-Rideal mechanism. In the second stage, PbCl intermediate bonds with another Cl atom over the surface to form the PbCl2 molecule, following the Langmuir-Hinshelwood mechanism, which is also the rate-determining step. Compared with the homogeneous chlorination, CaO catalyzes the heterogeneous process to greatly reduce the oxidation energy barrier and promotes the formation of PbCl2. Consequently, CaO is able to accelerate the lead enrichment in fly ash, which is favorable for lead species purification.

First-principles insights into the adsorption and interaction mechanism of selenium on selective catalytic reduction catalyst.

Selenium (Se) species can deposit in selective catalytic reduction (SCR) system during the denitrification process, which is harmful to the catalyst. To improve the Se-poisoning resistance of SCR catalysts, the influence mechanism of Se species on vanadium-titanium-based catalysts should be elucidated from an atomic scale. In this paper, theoretical calculations were conducted to reveal the adsorption and interaction mechanism of Se species on V2O5-WO3(MoO3)/TiO2 surface based on the first-principles. The impact of Se species on the electronic structure of the catalyst was investigated from electron transfer, bond formation, and VO site activity. The results show that the adsorption of elementary Se (Se0) belongs to chemisorption, while SeO2 can undergo both physisorption and chemisorption. For the chemisorption of Se species, obvious charge transfer with the catalyst is observed and Se-O bond is formed, which enhances the oxidation activity of the catalyst, triggers the reaction of Se0 and SeO2 with the catalyst components to generate SeVOx and SeW(Mo)Ox. The active sites are thereby damaged and the SCR performance is reduced. The above conclusions are mutually confirmed with the previous experimental research. By studying the correlation with the adsorption energies of Se species, descriptors manifesting the Se species adsorption were initially investigated to unveil the relationship between the electronic structure and the adsorption energy. Finally, the influence of temperature on Se adsorption was investigated. The adsorption can only proceed spontaneously below 500 K and is inhibited at high temperatures.

Theoretical Connotation and Mechanism of Regulating Mental Activity by Dredging Collaterals in Treatment of Psycho-cardiological Diseases via Brain-derived Neurotrophic Factor / 中国实验方剂学杂志

The incidence of psycho-cardiological diseases， i.e.， cardiovascular diseases combined with psychological disorders， is increasing year by year. Brain-derived neurotrophic factor （BDNF） plays a role in the pathogenesis of such diseases. According to the theory of collateral diseases， our team innovates the concept of regulating mental activity by dredging collaterals in the treatment of psycho-cardiological diseases and summarizes the concepts of "heart of Qi and collaterals" and "heart of vessels and collaterals". We believe that obstructed collaterals and disturbed mental activity run through the whole course of psycho-cardiological diseases， being the core pathogenesis. BDNF closely related to the core pathogenesis can regulate nerve and vascular inflammation， alleviate oxidative stress， and mediate a variety of signaling pathways， thereby promoting the survival and repair of nerve cells and vascular endothelial cells to regulate emotion and protect the heart. Therefore， BDNF is one of the potential biomarkers for clinical treatment of psycho-cardiological diseases. Collateral obstruction caused by blood stasis is specifically manifested as collateral deficiency， blood stasis， and Qi stagnation in collaterals. It can easily lead to inflammation， free radical generation， and antioxidant system changes in the patients with psycho-cardiological diseases， which can cause oxidative stress damage， affect the BDNF level， and result in mental disorders， such as anxiety and depression. Disturbed mental activity is mainly caused by the disturbance in the heart of Qi and collaterals， which is specifically manifested as the disturbance of the mind and liver soul. It is prone to cause anxiety or depression symptoms， which is closely related to the BDNF-mediated abnormal activation of neural circuits， nerve injury， and inflammation. This article elaborates on the theoretical connotation and pathological mechanism of regulating mental activity by dredging collaterals in the treatment of psycho-cardiological diseases from the perspective of BDNF， aiming to provide new ideas for the prevention and treatment of psycho-cardiological diseases and collateral diseases.

Network meta-analysis of five Chinese patent medicines in the treatment of coronary microvascular disease / 国际中医中药杂志

Objective:To evaluate the clinical efficacy rate, vascular endothelial relaxation factor NO and safety of five different Chinese patent medicines combined with western medicine in the treatment of coronary microvascular disease (CMVD).Methods:Randomized controlled trials (RCTs) of Shexiang Baoxin Pills, Tongxinluo Capsules, Compound Danshen Dripping Pills, Yindan Xinnaotong Soft Capsules, and Xinkeshu Tablets combined with conventional western medicine therapy in the treatment of CMVD were retrieved from China National Knowledge Infrastructure (CNKI), China Academic Journal Database (Wanfang Data), Chinese Science and Technology Journal Database (Chongqing VIP), China Biomedical Literature Service System (SinoMed), PubMed, Cochrance Library and Embase databases from the establishment of the database to June 2022. The literature was imported and screened by EndNote software, and the risk quality of literature bias was evaluated by Revman 5.4 software. StataSE16 (64-bit) software was used for reticular meta analysis to compare the differences in clinical efficacy and drug safety of five proprietary Chinese medicines combined with western medicine.Results:A total of 24 RCT studies were included, 24 of which were double-arm studies, and five kinds of proprietary Chinese medicine combined with western medicine were compared. The results of reticular meta analysis: in terms of improving the clinical effective rate, the order of the five proprietary Chinese medicine combination groups was as follows: Yindan Xinnaotong Soft Capsules group > Shexiang Baoxin Pills group > Tongxinluo Capsules group > Xinkeshu Tablets group > Compound Danshen Dripping Pills group. In terms of regulating vasodilation factor NO, the order of the four proprietary Chinese medicine combination groups is as follows: Yindan Xinnaotong Soft Capsules group > Compound Danshen Dripping Pills group > Tongxinluo Capsules group > Shexiang Baoxin Pills group. In terms of safety, there were 3 reports of adverse reactions in the research literature of the five proprietary Chinese medicines.Conclusions:The clinical efficacy rate of five kinds of proprietary Chinese medicine combined with western medicine routine regimen is better than that of western medicine routine regimen alone, and the combination group of four kinds of proprietary Chinese medicine is superior to western medicine in regulating vasodilation factor NO, and Yindan Xinnaotong Soft Capsules group is superior in clinical efficacy rate and regulation of vasodilation factor NO. However, the quality and samples of this study are different, and the comparison of the curative effect of the combined group of proprietary Chinese medicine still needs a large sample and high-quality RCT study to demonstrate.

Chaihu Longgu Mulitang in Treatment of Coronary Heart Disease Complicated with Anxiety and Depression： A Review / 中国实验方剂学杂志

Coronary heart disease （CHD） with atherosclerosis is a common chronic disease worldwide， and anxiety and depression are potential and crucial risk factors for adverse prognosis in CHD. Chaihu Longgu Mulitang （CLMT）， first mentioned in the Shang Han Lun （《伤寒论》）， is a classic prescription for treating Shaoyang diseases combined with disturbance of the mind and spirit， with the effects of harmonizing Shaoyang and calming the mind. Current research on mechanisms has shown that CLMT can play a role in CHD complicated with anxiety and depression through multiple pathways， including regulating related signaling pathways， inhibiting the expression of inflammatory factors， improving oxidative stress damage， modulating neurotransmitter levels， suppressing the hypothalamic-pituitary-adrenal axis， promoting mobilization of mesenchymal stem cells from the bone marrow， and inhibiting platelet activation. Clinical studies have demonstrated that CLMT significantly improves symptoms such as angina and insomnia caused by CHD complicated with anxiety and depression， effectively reduces negative emotions， improves traditional Chinese medicine （TCM） syndrome scores， and decreases levels of inflammatory factors. Furthermore， it has fewer adverse reactions and higher safety than conventional western medicine treatments. This article provides a review of the mechanisms and clinical studies of CLMT in the treatment of CHD complicated with anxiety and depression based on a comprehensive analysis of literature from the China National Knowledge Infrastructure （CNKI）， Wanfang Data， VIP， PubMed， and other databases in the past 15 years， in order to provide references for further research on the use of CLMT in the management of CHD complicated with anxiety and depression.