Abstract Background Rising incidents of antibiotic resistance and development of multidrug resistance bacteria is an increasing concern in Jordan. Antimicrobial stewardship programs are of paramount importance in containing this problem. It is important to be aware of healthcare practitioners’ view of antimicrobial stewardship programs and how it influences their choice of antibiotics. Objective To assess Jordanian practitioners’ perceptions and practices towards antimicrobial stewardship programs. Methods This was a multicenter, cross sectional study in which physicians and clinical pharmacists were approached to fill out a close-ended structured questionnaire covering aspects related to antimicrobial stewardship program perceptions and practices. Main outcome measure Comparison of median scores (interquartile ranges). Results A total of 286 participants were enrolled in the study. There was an overall positive perception towards antimicrobial stewardship program, while practices related to this element was still suboptimal. Additional comparison of the overall perception scores among different demographic characteristics showed that longer years of practice, postgraduate studies, and practice in academic sectors yielded higher perception scores (p value= 0.0335, 0.0328, and 0.0007 respectively). Conclusion There is an imminent need to enhance Jordanian practitioners’ knowledge about antimicrobial stewardship programs. A clear recognition of integral antimicrobial stewardship programs’ components must be coupled with highlight changes in current practices related to antimicrobials usage and prescription. Keywords: Antibiotic, Stewardship, Jordan, Clinical Pharmacist, Physician, Perception, Practice

AIM: Orthopaedic procedures such as total hip and total knee replacements carry a significant risk of post-operative anaemia, necessitating allogenic blood transfusions (ABT), and an increased hospital length of stay. Our aim was to investigate whether the implementation of a local protocol designed to detect and treat pre-operative anaemia resulted in reduced ABT rates and a shorter duration of length of hospital stay (LOS). METHOD: We retrospectively audited 683 patients undergoing primary hip and knee replacements. We collated data for all patients about hospital length of stay and blood transfusions received. Both descriptive statistics and univariate analysis were performed. RESULTS: 21.6% of the cohort within the study who were anaemic at pre-operative clinic had a significantly increased median LOS of 2 days (P < 0.001), and an increased packed red cell transfusion rate compared to non-anaemic patients (26.1% vs 2.21%, P < 0.001). However, treatment of pre-operative anaemia did not show any significant difference in transfusion rates compared to patients who did not receive corrective treatment. The median LOS was higher by 1 day in the treated group compared to the non-treated cohort (P = 0.005). CONCLUSION: There is significant evidence to suggest that pre-operative anaemia can increase LOS and increase the risk of requiring post-operative blood transfusions. However, anaemia should be regarded as a characteristic that can add to the outcome in a cumulative manner, as opposed to an isolated factor. Further research is needed on how to better manage pre-operative anaemia in order to improve patients’ outcomes.

Cadmium (Cd), one of the heavy metal pollution sources, has a strong impact on crop growth and development, yield formation, and food safety. In this work, we perform the first comprehensive study on the molecular mechanisms of wheat (Triticum aestivum L.) selenium-binding protein-A (TaSBP-A) that is involved in Cd-tolerance. As a cytoplasm protein, TaSBP-A was highly conservative in plants, but showed a high expression in plant roots; moreover, both transcription and translation expression levels were highly induced by Cd stress. TaSBP-A overexpression in yeast, Arabidopsis and wheat protoplasts enhanced Cd-tolerance via free Cd2+ accumulation and detoxification. In vitro Cd2+ binding assay combined with a thermodynamics survey by isothermal titration calorimetry as well as secondary structure analysis by circular dichroism showed that the CXXC motif in TaSBP-A was a major Cd-binding site that played important roles in the detoxification under Cd stress via its interaction with free Cd2+. Our results provide new insights into the molecular mechanism of plant Cd-tolerance as well as into the candidate gene for improving crop heavy metal resistance.

Background: The coronavirus disease 2019 (COVID-19) is threatening the lives and health of people all over the world since its outbreak in Wuhan, Hubei province, China. Up to now, thousands of clinical trials have been registered, but there are still no effective and specific drugs for COVID-19 treatment. Large randomized controlled clinical trials face many challenges and the quality of COVID-19 clinical trials is also worrying. Methods: We searched all the COVID-19 clinical trials registered on the Chinese Clinical Trials Registry and ClinicalTrials.gov on June 29, 2020. Then we extracted the basic information of these COVID-19 clinical trials and analyzed the current dilemma of clinical trials of COVID-19. Results: A total of 3021 studies were retrieved, including 665 trials from the Chinese Clinical Trial Registry and 2356 trials from ClinicalTrials.gov. Among these clinical trials, 293 and 1314 intervention studies were registered in the Chinese Clinical Trial Registry and ClinicalTrials.gov, respectively. Up to now, only 4.48% of these intervention trials have completed their recruitment, and there were still 11.60% of studies registered in the Chinese Clinical Trials Registry have not yet been approved by the ethics committee. Phase II and phase III studies that could prove the safety and effectiveness of drugs accounted for 42.25%. The median and interquartile range (IQR) of sample size was 100 (60, 200) and 384 (50, 120) in the Chinese Clinical Trial Registry and ClinicalTrials.gov, respectively. The number of randomized controlled trials (RCTs) were rare, and 50.71% of these studies were open-label. Conclusions: The quality of COVID-19 clinical trials that have been registered was low, and no reliable results have been published due to the design deficiency. Well-designed and cooperative trials are urgently needed to defeat the COVID-19 epidemic.

ABSTRACT Introduction: Immunotherapy has become a standard treatment for lung cancer; the objective of this study was to evaluate the effectiveness, safety of pembrolizumab monotherapy in patients with advanced or metastatic Non-Small Cell Lung Cancer (NSCLC) used in real-world clinical practice. Material and methods: Retrospective observational study of every patients treated with pembrolizumab in our centre from January 2017 to June 2019. Outcomes collected: sex, age, ECOG, PDL-1 levels, previous metastatic line therapies, adverse events (AE) and smoking status. Results: A total of 62 patients were reviewed. The median age was 62.34±10.62 years, 48 (77.41%) were men and 91.93% of patients had ECOG 0. The median doses administered was 170.5 mg (108-240 mg) and median follow-up was 3 months (range: 1-38). A median of 4 cycles of pembrolizumab (range 1 to 56) were administered as monotherapy. The reason for treatment discontinuation was mainly due to disease progression in 38.70% patients or death in 30.64%. As first-line pembrolizumab monotherapy, median progression free survival was 7.7 months (95% CI: 3.66-11.73) (N=33). With respect to patients who were treated in second-thirdline treatment, median PFS was 3.5 months (95%CI: 2.40-4.59) (N=29). As to overall survival, pembrolizumab-treated patients as first-line treatment reached 19 months median OG (95% CI: 13.36-24.63) (N=33) and those treated in second-third-line treatment got 11 months (95% CI: 3.4-18.5). 64.51% of patients presented some AE to pembrolizumab however, only, 9.38% of them were grade 3. Conclusion: Pembrolizumab represents an effective and feasible alternative in terms of SLP. It is a well-tolerated treatment option.

# Python version import sys print('Python: {}'.format(sys.version)) import pandas as pd import numpy as np import matplotlib.pyplot as plt import datetime import os def rsi(series, period): delta = series.diff().dropna() u = delta * 0 d = u.copy() u[delta > 0] = delta[delta > 0] d[delta < 0] = -delta[delta < 0] u[u.index[period-1]] = np.mean( u[:period] ) #first value is sum of avg gains u = u.drop(u.index[:(period-1)]) d[d.index[period-1]] = np.mean( d[:period] ) #first value is sum of avg losses d = d.drop(d.index[:(period-1)]) rs = u.ewm(com=period-1, adjust=False).mean() / d.ewm(com=period-1, adjust=False).mean() # rs = u.ewm(com=period-1).mean() # rs = pd.ewma(u, com=period-1, adjust=False) / \ # pd.ewma(d, com=period-1, adjust=False) return 100 - 100 / (1 + rs) if __name__ == "__main__": os.makedirs('./result/',exist_ok=True) ref_time = datetime.datetime.now().strftime('%Y%m%d_%H%M%S') path_data = '../../Data/' df = pd.read_csv(path_data+'train.csv') df['Date']= pd.to_datetime(df['Date']) df = df.set_index('Date') # df = df.sort_values('Date') df_36 = df.resample('36Min').agg({'Open': 'first', 'High': 'max', 'Low': 'min', 'Close': 'last', 'Volume':'sum'}) df_36.index += datetime.timedelta(minutes=35) df_360 = df.resample('360Min').agg({'Open': 'first', 'High': 'max', 'Low': 'min', 'Close': 'last', 'Volume':'sum'}) df_360.index += datetime.timedelta(minutes=359) df_36_rsi = pd.DataFrame(rsi(df_36['Close'],14)).rename({'Close':'RSI 36'},axis=1) df_360_rsi = pd.DataFrame(rsi(df_360['Close'],14)).rename({'Close':'RSI 360'},axis=1) df_1 = df.copy() for k in range(6): df_1 = pd.merge(df_1,df_36_rsi.shift(periods=-k).rename({'RSI 36':'RSI 36 T-'+str(k)},axis=1),how='left',left_index=True,right_index=True) df_1 = pd.merge(df_1,df_360_rsi.shift(periods=k).rename({'RSI 360':'RSI 360 T-'+str(k)},axis=1),how='left',left_index=True,right_index=True) df_1 = df_1.fillna(method='ffill')

Identifying Clostridioides difficile infection (CDI) patients at risk of mortality or recurrence will facilitate prevention, timely treatment and improve clinical outcomes. We aim to establish an open-access web-based prediction system, which estimates CDI patients’ mortality and recurrence outcomes, and explains the machine learning prediction with patients’ characteristics. Prognostic models were developed using four various types of machine learning algorithms and statistical logistics regression model utilizing over 15,000 CDI patients from 41 hospitals in Hong Kong. The boosting-based machine learning algorithm Gradient Boosting Machine (Mortality AUC: 0.7878; Recurrence AUC: 0.7076) outperformed statistical models (Mortality AUC: 0.7573; Recurrence AUC: 0.6927) and other machine learning algorithms. The open-access prediction system for clinicians to assess and interpret the risk factors of CDI patients is now available at https://www.cdiml.care/. In this article, we explain the development of machine learning models and illustrate how to apply hyperparameter tuning with cross-validation to optimize the model accuracy.

Today we will think about analyzing stars that are photometrically variable. What is the range of astrophysical phenomena are we talking about here?extrinsic vs. intrinsicperiodic vs. aperiodic

Smoking as a modifying factor in chronic rhinosinusitisData from the National Chronic Rhinosinusitis Epidemiology StudyChief Investigator: Professor Carl Philpott, Professor of Rhinology & Olfactology at University of East Anglia and Honorary Consultant ENT Surgeon, James Paget University HospitalMr Kristian Hutson FRCS1, Dr Allan Clark PhD2, Professor Claire Hopkins FRCS3, Mr Shahzada Ahmed FRCS 4, Professor Nirmal Kumar FRCS5, Mr Sean Carrie FRCS6, Miss Sally Erskine MRCS 1, Mr Vishnu Sunkaraneni FRCS7, Professor Carl Philpott FRCS1,21 James Paget University Hospital NHS Foundation Trust, Gorleston, United Kingdom

Mini-commentary on BJOG-20-0442.R2: Impact of hysterectomy on analgesic, psychoactive and neuroactive drug use in women with endometriosis: nationwide cohort study

In this work, a series of phenothiazine based organic dye sensitizers for dye-sensitized solar cells (DSSCs) have been designed and screened. The electron-donor as a phenothiazine, cyanoacrylic acid as an electron acceptor based on donor-acceptor (D-A) as reference dye SB. So as to enhance the triple bond effect on spacer and acceptor moieties has been investigated based on SB dye. The substituent effect of the spacer and electron acceptor on the absorption spectra and photovoltaic (PV) properties have been investigated by the combination of density functional theory (DFT) and time‐dependent DFT (TD-DFT) method approaches. Different exchange-correlation functionals have been initially evaluated in order to establish an accurate methodology for calculating the excited state energy of the SB dye. Consequently, TD-CAM-B3LYP method and 6-311++G(d,p) basis set have used been the comparison of experimental value. From the calculated results, concluded that the phenothiazine-4-((7-ethynylbenzo[c][1, 2, 5]thiadiazol-4-yl)ethynyl)benzoic acid (PT-EBTEBA) dye was strongly grouped for more red-shift and electrons injected into semiconductors effectively. It is expected to provide some theoretical guidance on designing photosensitive with new metal-free organic dyes for application in DSSCs yielding highly efficient performance.

The impact of asymptomatic carriers on the survival of Mycoplasma bovis in the environment and the role of wildlife in transmitting M. bovis still requires to be extensively studied. In this study, we have extended the arsenal of factors implicated in pathogenicity of M. bovis to shed light on the current knowledge gap. A number of 460 lung samples (pneumonic; n=210 and apparently healthy; n=250) were randomly collected from one hundred humped camels (Camelus domedarius). Biochemically, 13/210 of the recovered isolates (27.3%) from the pneumonic lungs were recorded as putative mycoplasmas and to be confirmed by PCR to be M. bovis. Infection with M. bovis was not detected in the apparently healthy lungs. They were examined for their phenotypic virulence traits and antimicrobial resistance. Haemolysis and hydrogen sulphide (H2S) production was evident in 100% of the isolates. All 13 M. bovis isolates were weak in their ability to form biofilm on polystyrene surfaces and were 100% susceptible to florfenicol, spiromycin and streptomycin while 100% resistant to ciprofloxacin. Five different combinations of antibiotics representing one to three classes with the Macrolide erythromycin being the most represented. Surprisingly, we did not detect the uvrC and gapA virulence genes by PCR, however we did detect the vsp gene in 2 out of 13 isolates. In addition, we detected the parC gene encoding quinolone resistance in 2 out of 13 M. bovis isolates, but did not detect the gyrA gene. Moreover, we have showed H2S, a compound that has previously not been identified as a virulence factor in M. bovis.

Chylothorax is a well-recognized but uncommon complication during the postoperative period following the repair of left congenital diaphragmatic hernia. Conservative management with close monitoring of chylothorax output and patient status seems superior to surgery in managing this complication.

Laryngeal injury is a life-threatening risk in contact sports. Exercise-induced laryngeal obstruction (EILO) can occur as a result of trauma. Athletes can return to monitored training within weeks of laryngeal surgery. Due to the rarity and complexity of laryngeal trauma in sport, effective management requires a multidisciplinary approach.

Background: To assess the relationship between high-resolution computed tomography (HRCT) abnormalities with the clinical phenotypes and outcomes in preterm bronchopulmonary dysplasia (BPD) infants. Methods: Totally, 81 preterm infants were enrolled between 2013 and 2020. Clinical phenotypes of BPD mainly include BPD severity, pulmonary hypertension (PH), and large airway lesion (LAL). The outcomes included death before hospital discharge, home oxygen treatment, or home pulmonary vasodilator therapy, were assessed. Total scores (TS) of high-resolution CT (HRCT) were summed in every lobe in 7 aspects: hyperaeration score (HS), composing decreased attenuation, mosaic attenuation, and bulla/bleb; parenchyma score (PS), composing linear lesions, consolidation, bronchial wall thickening, and bronchiectasis. Results: TS (r=0.49), HS (r=0.31), PS (r=0.30), decreased attenuation (r=0.21), mosaic attenuation (r=0.31), bulla/Bleb (r=0.27) and linear densities (r=0.55) displayed a correlation with BPD severity. TS (r=0.28), PS (r=0.35), linear densities (r=0.34) and consolidation (r=0.24) displayed a correlation with PH. TS (OR 1.11, 95% CI 1.01-1.21), PS (OR 1.17, 95% CI 1.01-1.36) and linear densities (OR 2.23, 95% CI 1.34-3.71) was related to the composite outcomes. Linear densities (OR 2.30, 95% CI 0.96-5.49), TS (OR 1.16, 95% CI 1.01-1.33) and HS (OR 1.17, 95% CI 1.01-1.35) was associated with pulmonary vasodilator. Consolidation (OR 2.09, 95% CI 1.07-4.08) and PS (OR 1.27, 95% CI 1.00-1.60) was closely related to the death. Linear densities (OR 2.36, 95% CI 1.22-4.57, p=0.01) were risk factors of home oxygen therapy. Conclusions: HRCT scores were correlated with the BPD severity, PH and poor clinical outcome.

Plastic bronchitis is identified by the presence of branching mucoid bronchial casts that obstruct airways. It is an uncommon condition, which was more described in lung disease and post-surgery congenital heart disease. We reported a case of a 26-month-old boy born at 29+6 weeks who presented with cough, wheezing and respiratory distress secondary to atelectasis of the left lung. After admission, the patient was treated with intravenous injection of azithromycin and methylprednisolone, inhaled bronchodilators, inhaled budesonide with short-acting beta-agonists and inhaled nebulized N-acetylcysteine. Dramatically, the patient expelled large casts, shaping as the tracheobronchial tree after a severe cough just on the night before the bronchoscopy. In toddlers who were born preterm with recurrent wheezing, the discharge of airway mucus secretion is altered, and the possibility of bronchial plastics needs to be alert.

A pulmonary pseudocyst is defined as a cyst that lacks respiratory epithelial cells. Lung pseudocysts are rare lesions in children and their classification is usually combined with other parenchymal cystic lesions. The distinction between a pseudo and a true cyst is difficult to distinguish both in utero and postnatally and can only be achieved on histology. Radiological investigations such as x-ray and computed tomography are equally non-specific. Most literature focuses on pseudocysts in adults particularly following blunt or penetrating chest trauma. In this report, we narrate a case of a lung pseudocyst initially misdiagnosed as a congenital lobar over-inflation in a child who presented with progressive shortness of breath and failure to thrive

Background: Atherosclerotic cardiovascular disease (CVD) is severe and early-stage detection is crucial. Elevated arterial stiffness observed in childhood atherosclerosis is associated with CVD. Stiffness is an efficient marker of CVD in hypertensives. Assessment of stiffness includes waveform analysis and image-based techniques. Researchers observed several challenges: real-time application, accuracy, operator variability, image quality, scanning procedure, instrument variability and deficiency of standardized procedure in the assessment. Methods: We searched PubMed, Embase and Cochrane online library from inception up to July 2020. Multiple articles on stiffness, pulse wave velocity, assessment and deep learning (DL)-based methods were analysed. Above all, a DL-based technique for assessment of stiffness from cine-loop is proposed. The method includes region of interest (ROI) localisation in multiple frames, segmentation of lumen and parameter estimation. Results: Compared to conventional methods DL provide improved result in lumen diameter and intima-media thickness (IMT) measurements. Using convolutional neural network (CNN), IMT error was 0.08 mm. Further, error using extreme learning machine-autoencoder was 5.79±34.42 \mum. Furthermore, Jaccard index and Dice similarity in fully convolution neural network (FCN) manifested 0.94 and 0.97 for lumen segmentation respectively. Conclusion: This paper focuses on the association of stiffness and atherosclerosis leading to CVD. Success of image-based stiffness estimation depends on the visibility and orientation of arteries, operator experience, intensity variation, shadowing, artefacts, and noise. Traditional methods include transformations to compensate for these challenges. The success of DL-based techniques in segmentation and localisation inspired application in stiffness measurement. DL is used to estimate stiffness from cine-loop.

A document by Berat Engin. Click on the document to view its contents.

DS-ALL patients have a higher rate of relapse and treatment-related mortality. We describe a DS-ALL patient with late bone marrow relapse who was treated per British ALL R3 reinduction chemotherapy. The patient remained in remission for approximately two years after therapy was discontinued due to severe systemic infections.

Background: BPD remains a severe respiratory complication of preterm infants in NICUs. However, its pathogenesis has been unclear. Bioinformatics analysis, which can help us explore genetic alternations and recognize latent diagnostic biomarkers, has recently promoted the comprehension of the molecular mechanisms underlying disease occurrence and development. Methods: In this study, we identified key genes and miRNA-mRNA regulatory networks in BPD in preterm infants to elucidate the pathogenesis of BPD. We downloaded and analyzed miRNA and gene expression microarray datasets from the Gene Expression Omnibus database (GEO). Differentially expressed miRNA (DEMs) and differentially expressed genes (DEGs) were obtained through NetworkAnalyst. We performed pathway enrichment analysis using the Database for Annotation, Visualization and Integrated Discovery program (DAVID), Gene Ontology (GO), and Kyoto Encyclopedia of Genes and Genomes (KEGG). Then we used the STRING to establish protein–protein interactions and the Cytoscape tool to establish miRNA–mRNA regulatory networks. Results: We identified 19 significant DEMs and 140 and 33 significantly upregulated and downregulated DEGs, respectively. Functional enrichment analysis indicated that significant DEGs were associated with the antigen processing and presentation, and B-cell receptor signaling pathways in BPD. Key DEGs, such as CD19, CD79B, MS4A1, and FCGR2B were selected as hub genes in PPI networks. Conclusions: In this study, we screened out 19 DEMs that might play important roles in the regulatory networks of BPD. Higher expression of miRNAs such as miR-15b-5p, hsa-miR-32-5p, miR-3613-3p, and miR-33a-5p and lower expression of miRNAs such as miR-3960, miR-425-5p, and miR-3202 might be correlated with the process of BPD.

Background Early menarche is reported with the risk of endometriosis (EMS) with varying conclusions. Objective To assess the association between menarche age and EMS risk. Search strategy PubMed, Medline and Embase were searched using “endometriosis”, “early menarche” , “EMS”, “menarche age”, and “early menstrual characteristics”. Selection criteria Articles that reported the EMS risk in early menarche from Jan 2000 to May 2020 were included. Studies without control group, and lack of data of menarche age were excluded. Data collection and analysis EMS risks in these articles were collected and analysed through in random effects meta-analysis. In addition, subgroup analyses and meta-regressionwere were also performed. Main results A total of 16 studies (8913 EMS cases and 876477 controls) were included in the meta-analysis. The pooled risk of EMS in early menarche (<12 years) was 1.34 (95% CI: 1.16–1.54), with statistically significant heterogeneity across the studies (I2 = 72.0%). Stratified analysis showed that the risks of EMS by earlier menarche was increased in studies started after 2000, and in developing area, which was further confirmed by meta-regression analysis. In addition, higher quality in assessment of the exposure (menarche age) and control of potential confounders can elimenate heterogeneity. Conclusions The earlier age of menarche is a major risk factor of EMS, and its risk has an increasing trend in recent years and in developing countries. Large-scale studies in different ethnic groups are warranted.

Carotid artery dissection should be considered in the differential diagnosis when a clinician face with a case presenting with an unilateral Purtscher-like retinopathy.

Abstract Objective To evaluate the safety of maternal pertussis vaccination on pregnancy and birth outcomes. Design Prospective, multicentre cohort study. Setting Two major materiality hospitals in South Australia. Population A total of 1364 low-risk nulliparous women with a singleton pregnancy recruited at 9–16 weeks’ gestation between 2015 to 2018. Methods Participants were followed prospectively, with vaccination (confirmed by medical records), extensive amounts of pregnancy and birth outcome data collected by research midwives. Adjusted relative risks (aRRs) and hazard ratios (aHRs) were estimated accounting for time-varying vaccine exposure and the temporal nature of each outcome. Main Outcome Measures Pregnancy and birth outcomes. Results Of the 1272 women included in this study, 80.1% (n=1019) received maternal pertussis vaccination. Vaccinated women had an average 0.22 weeks (95% CI 0.001, 0.44) longer gestation at delivery compared to unvaccinated women. Maternal pertussis vaccination was not associated with chorioamnionitis (aRR 0.71, 95% CI 0.27,1.82), gestational hypertension (aHR 1.24, 95% CI, 0.66, 2.30), preeclampsia (aHR 0.75, 95% CI 0.47, 1.18) nor preterm birth (aHR 0.99, 95% CI 0.47, 2.07). Neither risk of low birth weight (aHR 0.72, 95% CI 0.41, 1.27) nor small for gestational age infants (aHR 0.67,95% CI 0.29, 1.55) were increased following maternal pertussis vaccination. No associations between pertussis vaccination during pregnancy and adverse birth outcomes including admission to the neonatal care unit, low Apgar scores, and mechanical ventilation were observed. Conclusions Our study provides reassuring evidence of the safety of maternal pertussis vaccination with no increased risk of adverse pregnancy and birth outcomes.