Background: Elevated Pre-discharge capillary blood gas partial pressure of carbon dioxide (pCO2) has been associated with increased adverse events including readmission. This study aimed to determine if pre-discharge pCO2 or 36-week pCO2 was associated with increased respiratory readmissions or other pulmonary healthcare utilization in the year after NICU discharge for infants with BPD discharged with home oxygen, using a standardized outpatient oxygen weaning protocol. Methods: This was a secondary cohort analysis of infants born <32 weeks gestational age with BPD, referred to our Pulmonary clinic for home oxygen therapy either from our level IV NICU or local level III NICUs between 2015-17. Infants with major non-respiratory comorbidities were excluded. Subject information was obtained from electronic health records. Results: Of 125 infants, 120 had complete 1-year follow-up. Twenty three percent of infants experienced a respiratory readmission after NICU discharge. There was no significant association between pre-discharge or 36-week pCO2 and respiratory readmissions, emergency room visits, new or increased bronchodilators or diuretics. Higher 36-week pCO2 was associated with a later corrected age when oxygen was discontinued (<6 months, median 54 mm Hg, Interquartile range (IQR) 51-61; 6-11 months, median 62 mm Hg IQR 57-65; ≥12 months, median 66 mm Hg, IQR 58-73; p=0.006). Conclusions: Neither pre-discharge pCO2 nor 36-week pCO2 was associated with one-year respiratory readmissions. Higher pCO2 at 36 weeks was associated with longer duration of home oxygen. Neonatal illness measures like 36-week pCO2 may be useful in communicating expectations for home oxygen therapy to families.

Autonomous dishwasher loading is a benchmark problem in robotics that highlights the challenges of robotic perception, planning and manipulation in an unstructured environment. Current approaches resort to a specialized solution, however, these technologies are not viable in a domestic setting. Learning-based solutions seem promising for a general purpose solutions, however, they require large amounts of catered data, to be applied in real-world scenarios. This paper presents a novel solution based on pre-trained object detection networks. By developing a perception, planning and manipulation framework around an off-the-shelf object detection network, we are able to develop robust pick-and-place solutions that are easy to develop and general purpose requiring only a RGB feedback and a pinch gripper. Analysis of a real-world canteen tray data is first performed and used for developing our in-lab experimental setup. Our results obtained from real-world scenarios indicate that such approaches are highly desirable for plug-and-play domestic applications with limited calibration. All the associated data and code of this work is shared in a public repository.

It is known that LIMA-to-LAD is the major determinant of the patient’s prognosis and long term survival for a large percentage of the population with coronary artery disease Off pump, minimally invasive LIMA-to-LAD provides excellent long-term results ). As Awad et al state, this pandemic has disrupted and challenged delivery of health care services worldwide ). LIMA-to-LAD can be performed with minimal resources in an isolated area from COVID-19 facilities within the hospital.Hybrid treatment of coronary heart disease is another option for patients under these circumstances . Surgeons must take the lead and play an active role in the decision process. . As the authors conclude, given fluidity of the current situation, there is need for new processes and clinical decision – making that will allow patients to receive appropriate treatment,

Objective: To assess the impact of IMT on the functional capacity of patients undergoing CABG with a high risk of PPC. Design: This is a randomized clinical trial. Setting: Instituto Nobre de Cardiologia (INCARDIO), Feira de Santana – Bahia. Subjects: In total, 29 patients were selected at high risk of pulmonary complications. Intervention: Patients were divided into two groups at risk of CPP: intervention group (IM) submitted to IMT and control group (CG) who received standard care. Considered a high risk patient, age over 60 years, diabetic, smoker and body mass index above 27 kg / m2. All were submitted to preoperative evaluation and hospital discharge for maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP) and six-minute walk test (6MWT). Results: 29 individuals were evaluated, 19 of whom were female (65%) and the mean age was 67±4 years. The IG showed MIP before of 103±15 and the CG 105±17cmH2O (p=0.35), at discharge the IG had 80±14 and the CG 75±15cmH2O (p=0.12). The 6MWT in the pre was 386±43 in the IG and 398±56 meters (p = 0.65). In the CG, at discharge they covered 285±51 meters in the IG and 288±45 in the CG (p=0.34). There were no differences between the variables of the groups. Conclusion: It is concluded that the IMT performed in the postoperative period did not show significance on the variables muscle strength and functional capacity in patients who were at high risk of pulmonary complications.

The pandemic has triggered worldwide social and economic disturbance, with the leading economic depression from the time when there was a Great Depression. Moreover, misleading information about the virus has spread far and wide; even some public members have raised direct questions about the possibilities of ticks to transmit the virus. These questions have not received a simple solution so far. Thus, the key idea of this paper is to provide hints and hypothesis about the publicly raised questions about the possibilities of ticks transmitting SARS-CoV-2. The approach of the mentioned questions was based on the broader perspective of using the systemic review, where this newly discovered virus (SARS-CoV-2) was put into context with respect to the once mentioned ticks coronavirus-like of Traavik et al., during the 1973-1980 period. The possibilities of ticks to transmit the virus was hypothesized. Proving or disproving this hypothesis for the emergence of SARS-CoV-2 might be possible. Therefore, the role of ticks to transmit the virus needs more attention. This could lead to more efficient measures, to block the rise of another coronavirus epidemic with persistent transmission in humans.

IntroductionThe first case of SARS-CoV2 was detected in the UK on 31st January 2020. On the 16th of March, the UK Government advised pregnant women to ‘shield’, reducing contact with others as much as possible, prior to a population-wide ‘lockdown’ commencing in the UK on 23rd March.Although many routine healthcare services in the UK were stopped or significantly reduced, maternity services have continued throughout the pandemic, with some modifications to services where feasible. This has meant that, unlike most people in the population, pregnant women in the UK have been attending hospitals and other healthcare settings throughout the pandemic for routine care rather than only for severe health issues. Therefore, pregnant women may be diagnosed with SARS-CoV2 when they attend hospital because of COVID-19 symptoms, but also may be diagnosed incidentally when they present for obstetric reasons. Increasingly, many obstetric units offer routine screening for SARS-CoV2 in all women who are admitted to hospital, with a view to identifying both symptomatic and asymptomatic patients.In our unit, swabbing for SARS-CoV2 was initially only recommended for women with symptoms suggestive of COVID-19, whether or not they attended because of those symptoms or for other obstetric reasons. These symptoms included a persistent cough or fever >37.8, with anosmia added in April 2020. From the week commencing 19th of April 2020, in line with governmental policy, increases in testing capacity enabled us to significantly increase the numbers of women tested. A pilot of surveillance screening of asymptomatic inpatients was carried out on 22nd of April, alongside commencement of routine swabbing of all women attending pre-assessment clinics for planned Caesarean section. A week later, on 29th April 2020, routine swabbing of all maternity admissions began. There are therefore two screening periods: ‘targeted’ screening prior to 19th April, and ‘enhanced’ screening after the 19th of April. Here we review the effect of these different screening strategies, in parallel with UK government advice to pregnant women, on the numbers of SARS-CoV2 cases detected within the maternity population at a large obstetric unit (approximately 7000 deliveries per year) in central London.

The natural history of patients with aortic regurgitation (AR) is not as benign as once believed, even in asymptomatic patients with preserved left ventricular function. Aortic valve surgery can prolong survival of these patients. However, both mechanical and biological aortic valve replacement have major disadvantages, especially in young patients. Aortic valve-preserving surgery (AVP) has attracted a great deal of attention as it has significant survival benefit over replacement. Nonetheless, AVP has not been widely adopted due to the complexity of its technique and assessment (i.e., long learning curve). With recent technical and theoretical advances, AVP has increasingly been performed with better outcomes, and therefore earlier indication for surgical intervention in cases of AR has been considered. Recent advances in AVP include repair-oriented classification of the etiology of AR, objective assessment of the cusp configuration (i.e., effective height and geometric height), use of aortic annuloplasty, introduction of two reproducible valve-sparing root replacement procedures (i.e., aortic valve reimplantation and aortic root remodeling techniques), standardization of AVP, and assessment of cusp configuration with aortoscopy. A number of prospective multicenter studies are currently underway and will clarify the role of AVP in surgical treatment of AR in the near future.

Letter to the Editor Introduction Since December 2019, severe acute respiratory syndrome coronavirus (SARS-CoV) 2 has caused an unprecedented public health crisis. Till date, more than two million cases have been diagnosed worldwide. In Singapore, where all confirmed cases are hospitalized early in the outbreak, immense pressure has been placed on the public healthcare system given the personal protective equipment and isolation needs in caring for these highly infectious patients. Coronavirus disease 2019 (COVID-19) transmission within healthcare facilities is a serious threat to medically vulnerable patients and healthcare workers. [1] We describe our experiences with regards to three atypical COVID-19 cases, seen in our institution.

We encountered a 34-year-old man with a significant vaping history who presented with acute hypoxic respiratory failure, headaches and gastrointestinal symptoms during the COVID-19 pandemic. Based on his laboratory and chest CT findings, we had a high clinical suspicion for COVID-19 and EVALI, yet distinguishing the diagnoses proved challenging. His SARS-CoV-2 nasopharyngeal PCR swabs were negative. However, this test has a low sensitivity. COVID-19 serology testing was negative, and the patient was ultimately diagnosed with EVALI based on subtle chest CT findings. To our knowledge, this is the first paper highlighting the similarities and distinguishing features of EVALI and COVID-19 acute lung injury.

Background : The invention of His bundle pacing technology bring a new revelation–Left bundle branch area pacing (LBBAP). LBBAP engages in the electrical activation through left bundle branch area and produces ventricular electrical synchronization, which can grab more cardiac cells and increase the safety of pacing compared to His bundle pacing (HBP). This pacing has been considered as an attractive mode to achieve normal physiological pace markers. However,as a new technology, LBBAP is still in the stage of clinical exploration and lacks adequate evaluation. Objective :This study aims to investigate the electrocardiogram characteristics,pacing parameters,the safety and the effectiveness of LBBAP. Method : A computerized search of PubMed, Embase, The CochraneLibrary, Chinese CNKI, CBM, Wanfang and Weipu Chinese Sci-tech Journals database for effects of Left bundle pacing. The baseline characteristics, the successful rate of implantation, capture threshold, R-wave amplitude, pacing impedance, QRS duration and follow-up date were extracted and summarized. Results : Thirteen studies including 618 patients were included in this analysis. The overall successful rate for implantation was 92.1%.Permanent LBBAP resulted in narrow QRS duration when patients with QRS duration＞120ms after implantation (P=0.02). QRS duration and capture threshold of LBBAP remained stable during follow-up. Moreover, there was a trend of increased R-wave amplitude and declined pacing impedance at follow-up compared to implantation (P=0.003 and P＜0.00001, respectively). Conclusion : Permanent LBBAP has shown promising results in pacemaker-indicated patients. Good electrical synchronization, high success rates, and stable pacemaker parameters point to the unparalleled advantages of LBBAP in physiological pacing.

BACKGROUND: COronaVIrus Disease 19 (COVID-19) pandemic is affecting almost the entire world since February 2020. Patients with chronic pulmonary diseases, such as asthma and chronic obstructive lung disease potentially and theoretically may be more vulnerable and therefore seriously ill if infected by SARS-CoV-2; however, according to the first epidemiological studies published so far, chronic pulmonary diseases are under-reported. No data is available, so far, about the incidence of COVID-19 in severe asthmatics and about which are the COVID-19 outcomes in this subgroup of patients. METHODS:: In this study, we investigated the incidence of COVID-19 cases in a large population of severe asthmatics in Italy, describing their clinical characteristics and clinical course of COVID-19 disease. RESULTS: Twenty-six (1.73%) out of 1504 severe asthmatics were identified as confirmed or highly suspect with COVID-19. Nine (34.6%) of infected patients experienced worsening of asthma during the COVID-19 symptomatic period. Severe asthmatics affected by COVID-19, compared to those who did not contracted the infection, had a significantly higher prevalence of non-insulin-dependent diabetes mellitus (NIDDM) (15.4% vs 3.8%, p=0.002); among COVID-19 patients the proportion of those treated anti-IL5 biologic agents was higher (71%) compared to the number of patients treated with anti-IgE (29%). CONCLUSIONS: In our large cohort of severe asthmatics, the incidence of COVID-19 was particularly low, with higher prevalence of NIDDM as comorbidity, suggesting that NIDDM might be a risk factor for COVID-19 in severe asthmatics.

The novel coronavirus disease 2019 (COVID-19) has turned into a global public health emergency after the first patients were detected in Wuhan, China, in December 2019. Methods This case-control study was conducted in two hospitals of Alborz Province in Iran. All symptomatic adults hospitalized as COVID-19 patients with compatible CT scan findings and available RT-PCR results were recruited in this study. The patients were categorized in positive and negative RT-PCR groups and evaluated for symptoms, initial vital signs, comorbidity, clinical and laboratory findings and the results were assessed by SPSS software. Results Between March 5 to April 5, 2020, 164 symptomatic COVID-19 patients were studied. In total, there were 111 RT-PCR positive (67.6%) and 53 RT-PCR negative patients (32.4%). In terms of statistics, the frequency of symptoms revealed no difference, except for cough (P.V:0.008), dizziness (P.V: 0.048) and weakness (P.V:0.022). Among initial vital signs, PR (P.V:0.041) and O2 Saturation (P.V: 0.014) were statistically different between the two groups. Evaluation of comorbidities revealed no difference except for hyperlipidemia (P.V:0.024). In comparison of laboratory findings, only WBC count (P.V: 0.001), lymphocyte count (P.V: 0.001) and Hb (P.V:0.008) were statistically different between the two groups. Conclusion In case of negative RT-PCR result, it is necessary to take a logical approach, and we recommended that the physician decide according to clinical manifestations, laboratory findings, and positive CT result

E. coli BL21 (DE3) is an excellent and widely used host for recombinant protein production. Many variant hosts were developed from from BL21 (DE3), but improving the expression of specific proteins remains a major challenge in biotechnology. In this study, we found that when BL21 (DE3) overexpressed glucose dehydrogenase (GDH), a significant industrial enzyme, serious autolysis was induced. Subsequently, we observed this phenomenon in the expression of 10 other recombinant proteins. This precludes a further increase of the produced enzyme activity by extending the fermentation time, which is not conducive to the reduction of industrial enzyme production costs. The membrane structure and mRNA expression analysis showed that cells suffered programmed cell death (PCD) during autolysis period. However, blocking three known PCD pathway in BL21 (DE3) cannot alleviate autolysis completely. Furthermore, we attempted to develop a strong expression host resistant to autolysis by controlling the speed of recombinant protein expression. To find a more suitable protein expression rate, the high- and low-strength promoter lacUV5 and lac were shuffled and recombined to yield the promoter variants lacUV5-1A and lac-1G. The results showed that only one base in lac promoter needs to be changed, and the A at the +1 position was changed to a G, resulting in a host of BL21 (DE3-lac1G), which successfully withstand the PCD of the host. The GDH activity at 43h was greatly increased from 37.5 U/mL to 452.0 U/mL. In scale-up fermentation, the new host was able to produce the model enzyme with a high rate of 89.55 U/mL/h at 43h, compared to the 3 U/mL/h of BL21 (DE3). Importantly, BL21 (DE3-lac1G) also successfully improved the production of other 10 enzymes. The engineered E. coli strain in the study conveniently optimizes recombinant protein overexpression by suppressing cell autolysis, and shows potential industrial applications.

The optimal growth, maturation and function of bioengineered tissues are mediated by both biochemical and physical cues. We here describe a 3D biomimetic environment directing stem cells towards a chondrogenic phenotype. This system comprises a collagen hydrogel and poly-lactic-co-glycolic acid microcarriers (PLGA-MCs) engineered to protect, carry and release a human Transforming Growth Factor b1 (hTFGb1) payload. PLGA-MCs were prepared using supercritical emulsion extraction technology and integrated into a collagen hydrogel co-seeded with human Bone Marrow Mesenchymal Stem Cells (hBM-MSCs). Testing different concentrations of hTFGb1 supplemented to cell monolayer cultures suggested 10 ng/mL as the most appropriate concentration to promote upregulation of SRY-Related HMG-BOXGene 9 (4-fold) and collagen type II (2-fold) specific markers, at Day 16. A similar growth factor concentration was delivered within the 3D bioengineered environment cultured in a dynamic via a custom perfusion bioreactor. A chondrogenic commitment was obtained as indicated by upregulation of collagen type II (5-fold) and downregulation of collagen types I and III (both 0.1-fold) at Day 16. Histological analysis confirmed the remodeling of the synthetic extracellular matrix in where an enhanced mass exchange was described by FEM analysis of fluid-dynamics and related nutrient mass transfer within the 3D construct. This study supports the use of 3D bioengineered scaffolds cultured in a dynamic environment as a suitable tissue engineered model to study chondrogenic differentiation in vitro and opens perspectives for an injectable collagen-based advanced therapy system.

Background: We report demographic profile and our initial experience of treating children and young adults with image guided pencil beam scanning proton beam therapy (PBS-PBT) at our centre. Material and methods: All patients younger than 25 years, consecutively treated with PBT based on a multi-disciplinary tumor board decision were analyzed. Patients were treated under daily on-board kilovoltage x-ray and/or cone beam CT scan guidance. The demographic profile, treatment characteristics and the acute toxicities were reported. Patient and treatment related factors and their association with acute toxicities were analyzed using univariate and multivariate analysis. Results: Forty-seven patients {27 with central nervous system(CNS) and 20 with non-CNS tumors} with a median age of 9 years were evaluated. Most common diagnoses were ependymoma, rhabdomyosarcoma and glioma. Median dose delivered was 54.8CGE(40-70.4) to a median clinical target volume of 175cc (18.7-3083cc) with 34% requiring concurrent chemotherapy(CCT). Acute grade-2 and 3 dermatitis, mucositis, and hematological toxicity was noted in 45% and 2%; 34% and 0%; 38% and 30%; respectively. Grade-2 fatigue was noted in 26%. On univariate analysis, CCT(p=0.009) and cranio-spinal irradiation(p<0.001) were associated with grade-2 or more hematological toxicity in patients with CNS tumors. Among non-CNS tumors, clinical target volume more than 150cc was associated with grade-2 or more fatigue(p=0.017). Conclusions: The demographic pattern of patients treated with PBT at this new and only centre in the region was similar to previously published literature. Image guided PBS-PBT resulted in acceptable acute toxicities both among children with CNS and non-CNS tumors.

The use of biota to analyze the spatial range and distribution of biogeographic regions is essential to gain a better understanding of the ecological processes that cause biotic differentiation and biodiversity at multiple spatiotemporal scales. Recently, the collection of high-resolution biological distribution data (e.g., specimens) and advances in analytical theory have led to their quantitative analysis and more refined spatial delineation. This study was conducted to redefine floristic zones in the southern part of the Korean Peninsula and to better understand the eco-evolutionary significance of the spatial distribution patterns. Based on the distribution data of 309,333 vascular plant species in the Korean Peninsula, we derived floristic zones using self-organizing maps. We compared the characteristics of the derived regions with those of historical floristic zones and ecologically important environmental factors (climate, geology, and geography). In a clustering analysis of the floristic assemblages, four distinct regions were identified, namely, the cold floristic zone (Zone I) in high-altitude regions at the center of the Korean Peninsula, cool floristic zone (Zone II) in high-altitude regions in the south of the Korean Peninsula, warm floristic zone (Zone III) in low-altitude regions in the central and southern parts of the Korean Peninsula, and maritime warm floristic zone (Zone IV) including the volcanic islands of Jejudo and Ulleungdo. A total of 1,099 taxa were common to the four floristic zones. Zone IV had the highest abundance of specific plants (those found in only one zone), with 404 taxa. This study improves floristic zone definitions using high-resolution regional biological distribution data. It will help better understand and re-establish regional species diversity. In addition, our study provides key data for hotspot analysis techniques required for the conservation of plant diversity.

Background To investigate the incidence and risk of cardiac toxicities between dual HER-2 blockade and anti-HER-2 monotherapy. Materials and methods We searched PubMed, EMBASE and Cochrane library databases to identify relevant trials between January 1 1990 and October 31 2019. Statistical analyses were conducted to calculate the summary incidence, Petro odds radio (Peto ORs) and 95% confidence intervals (CIs) by using either random-effects or fixed-effects models. Results A total of 16,375 patients from 15 randomized controlled trials were included for analysis; the pooled incidence of LVEF decline and CHF in dual HER-2 blocked were 4.6% and 0.9%, which was higher than that in anti-HER-2 monotherapy (3.2% and 0.7%, respectively). Dual HER-2 blockade therapy in breast cancer patients significantly increased the risk of developing LVEF decline (OR:1.19, 95%CI: 1.02-1.40, p=0.031) and CHF (OR:1.45, 95%CI: 1.00-2.11, p=0.049) when compared to anti-HER2 monotherapy. Sub-group analysis showed that addition of dual HER-2 blockade to adjuvant treatment for breast cancer significantly increased the risk of developing LVEF decline (p=0.048) and CHF (p=0.005). In addition, dual HER-2 blockade in breast cancer patients significantly increased the risk of developing LVEF decline (p=0.004) when compared to lapatinib alone, but not for CHF (p=0.11, respectively). Conclusion Dual HER-2 targeted therapy in HER-2 positive breast cancer significantly increase the risk of developing LVEF and CHF when compared to anti-HER-2 alone, though the overall incidence of cardiac toxicities is very low. Physicians should be aware of this risk and provide close monitoring during the administration of dual HER-2 targeted therapy.

Bacterial communities play a key role in maintaining ecosystem multifunctionality. With increasing land use intensity, soil biogeochemical and microbial characteristics change significantly and may influence the resulting multifunctionality of the ecosystem. The relationship between soil microbial communities and resistance of multiple ecosystem functions under land use change have not previously been assessed in the Karst region of Southwest China. Soils from four karst ecosystems (Primary forest; Secondary forest; Abandoned land; Cultivated land) were analyzed for microbial communities as predictor of multifunctional resistance to land use change by using high-throughput sequencing, structural equation modelling and random forest modelling. The resistance of Proteobacteria was highest in the forest, and the resistance of Verrucomicrobia highest in the abandoned and cultivated land. With increasing land use intensity, C-cycling functional resistance decreased by 77%, nitrogen and phosphorus functional resistance increased by 17% and 19% in abandoned land, compared to secondary forest. Structural equation modellings suggested the bacteria communities have the largest direct positive effect on multifunctional, and N-related functional resistance. Among bacterial communities, Verrucomicrobia and Chloroflexi were the two most important groups that affected soil multifunctional resistance. Regrading specific ecosystem function, Chthonomonadetes, Chloroflexia and OPB35_soil_group were the best predictor of TOC,TN and TP, respectively. Our results suggest strong links between microbial community composition and multifunctional resistance in various karst ecosystems, and provide insights into the importance of microbial community composition for recovering the ecosystems following human intervention.

Small bowel volvulus is a rare cause of small bowel obstruction, but must be considered as the likely diagnosis when mesenteric ‘whirlpool sign’ is present on imaging. Peritonism with such imaging findings warrants prompt intervention.

Differentiating plasmablastic lymphoma and plasmablastic myeloma is challenging due to overlapping morphological and immunophenotypical features. This case demonstrates the difficulty to distinguish a non-secretor myeloma with plasmablastic morphology from a plasmablastic lymphoma and the necessity of a multidisciplinary approach to make an accurate diagnosis because the treatment protocols are different.

Nephronophthisis is a pediatric genetic disease. The kidney effect is characterized by a CTN leading to ESRD. Many syndromes could be associated with NPHP. We reported a child affected by NPHP with dextrocardia, LSVC and LAV where the diagnostic was done by fluoroscopy after encountering unusual difficulties to perform CVC.

A 52-year-old female with a recently diagnosed esophageal cancer presented with hematemesis that needed emergent endotracheal intubation (ETT). Two-days later following respiratory compromised, computed tomography imaging showed an abnormally placed ETT which traversed from esophagus to trachea resulting in tracheoesophageal fistula. There was no pneumomediastinum or pneumothorax.

Acne associates with increased sebum production, bacterial colonization, and ongoing inflammation. Fluorescent light energy has reported clinical effect on acne. The complexity of acne often makes combination therapy highly beneficial. We here show that combining FLE with low-dose isotretinoin or tetracycline leads to clearance of acne without significant adverse effects.

Rationale: The optimal duration of antibiotic treatment for community-acquired pneumonia (CAP) is not well established. The aim of this study was to assess the impact of reducing the duration of antibiotic treatment on long-term prognosis in patients hospitalized with CAP. Methods: This was a multicenter study assessing complications developed during one year of patients previously hospitalized with CAP who had been included in a randomized clinical trial concerning the duration of antibiotic treatment. Mortality at 90 days, at 180 days and at 1 year were analyzed, as well as new admissions and cardiovascular complications. A subanalysis was carried out in one of the hospitals by measuring C-reactive protein (CRP), procalcitonin (PCT) and proadrenomedullin (proADM) at admission, at day 5 and at day 30. Results: A total of 312 patients were included, 150 in the control group and 162 in the intervention group. 90 day, 180 day and 1-year mortality in the per-protocol analysis were 8 (2.57%), 10 (3.22%) and 14 (4.50%), respectively. There were no significant differences between both groups in terms of 1-year mortality (p=0.94), new admissions (p= 0.84) or cardiovascular events (p=0.33). No differences were observed between biomarker level differences from day 5 to day 30 (CRP p=0.29; PCT p=0.44; proADM p=0.52). Conclusions: Reducing antibiotic treatment in hospitalized patients with CAP based on clinical stability criteria is safe, without leading to a greater number of long-term complications.