Rapid developments in materials engineering are accompanied by the equally rapid development of new technologies, which are now increasingly used in various branches of our life. The current research trend concerns the development of methods for obtaining new materials engineering systems and searching for relationships between the structure and physicochemical properties. A recent increase in the demand for well-defined and thermally stable systems has highlighted the importance of polyhedral oligomeric silsesquioxane (POSS) and double-decker silsesquioxane (DDSQ) architectures. This short review focuses on these two groups of silsesquioxane-based materials and their selected applications. This fascinating field of hybrid species has attracted considerable attention due to their daily applications with unique capabilities and their great potential, among others, in biomaterials as components of hydrogel networks, components in biofabrication techniques, and promising building blocks of DDSQ-based biohybrids. Moreover, they constitute attractive systems applied in materials engineering, including flame retardant nanocomposites and components of the heterogeneous Ziegler-Natta-type catalytic system. The public has dealt with many modern technology-related topics in the last decade. This phenomenon is directly allied with rapidly developing materials engineering. Whereas a few decades ago, the terms “self-assembling systems”, “self-healing materials”, or “artificial intelligence” sounded like a distant future, now it seems that these concepts are not detached from real applications. The rapidly developing materials engineering is accompanied by the equally rapid development of new technologies, which are now increasingly used in various branches of our life.This short review focuses on selected silicon-based materials and their applications. Among these species, we will focus on two groups of cage-like silsesquioxanes, polyhedral oligomeric silsesquioxanes (POSSs) and double-decker silsesquioxanes (DDSQs). The current research trend concerns the development of methods for obtaining new materials for materials engineering and the search for relationships between the structure and physicochemical and mechanical properties. This fascinating field of hybrid species has attracted considerable attention due to their daily applications with unique capabilities and their great potential, among others, in biomaterials and materials engineering, including flame retardant nanocomposites and catalysis.Silicon is one of the most common elements in the earth’s crust due to its abundance in various minerals, e.g., aluminosilicates. As an element of the fourteenth group of the periodic table, it has many similarities to carbon compounds. Comparing the silicon–carbon and carbon–carbon bonds, it can be seen that the first one is longer and weaker. Si–C bond length is 1.87 Å, with a bond energy of 337 kJ/mol, whereas C–C bond length equals 1.53 Å, manifesting a binding energy of 371 kJ/mol. The electronegativity of the carbon atom is greater than that of the silicon atom. Therefore, the Si–C bond is polarized towards the carbon atom and can be broken more easily than typical C–C bonds. A much stronger and longer bond concerning C–O  is the Si–O bond . The significant difference in the electronegativity of silicon and oxygen, which equal 1.8 and 3.5, respectively, makes the siloxane bonds ionic at 51%, which means their high susceptibility to heterolytic cleavage and high thermal stability. The longer length and half-ionic character of the Si–O bond contribute to much larger angles between the Si–O–Si bonds (143°) than C–O–C (112°) in the ethers, lowering the rotational barrier around the Si–O bond (2.5 kJ/mol) and the energy barrier of linearization of the Si–O–Si angle (1.3 kJ/mol), which consequently affects the extraordinary flexibility of the siloxane chain. The Si–O bond is one of silicon’s most thermally stable bonds, with 110 kcal/mol dissociation energy n , and they form various architectures  in the presence of acidic or basic catalysts. While the alkyl group forming the C–Si bond is inert in the hydrolysis reaction, the silyl group is labile and forms the Si–O–Si siloxane network. These silanes are readily hydrolyzed to form Si–OH silanol groups, which in further stages condense to form a siloxane cage. Among this group of cage-like silsesquioxanes, the most explored are T8 cage octasilsesquioxanes , which combine the advantages of an inorganic core and modifiable organic groups anchored to it.In recent years, hydrogel-based composites have been tested in various biomedical applications, such as medical dressing, wound-healing coatings, bone repair, tissue regeneration, drug delivery, and so forth. Increased interest in this type of materials derives from hydrogels’ good biocompatibility and biodegradability. However, their application is limited due to poor mechanical properties, low thermal stability, and rapid degradability in the organism. From this point of view, using cage-like silsesquioxanes as a sophisticated gel modifier, including cross-linking agent, reinforcement factor, building blocks for creating porous architectures, hydrophobic agent, etc., seems justified ,34. The 32) and acryloyl chloride  after photopolymerization of gelatin methacryolyl (GelMA), quaternized chitosan (QCS) and modified nanoparticles of polyhedral oligomeric silsesquioxanes (POSS-Ac) . Modifiechloride . The pri6-U2) [Another example of the mechanically robust hydrogels facilitating hard tissue remodeling and regeneration through epigenetic modulation is gel based on cage-like silsesquioxane designated as an inorganic core surrounded by six disulfide-linked PEG shells and two 2-ureido-4[1H]-pyrimidinone (UPy) substituents (POSS-P6-U2) . The res+ ions to the hydrogel positively affects its antibacterial properties. Other frequently used admixtures in hybrid biomaterials include strontium and magnesium ions, which have, among others, potential anti-osteoporotic, anti-inflammatory, and bacteriostatic properties . To. TotransDouble-decker silsesquioxanes can also be used as polarity mediators to obtain hierarchical porous films for bioengineering . Using DThe two examples of applications of DDSQ-based composite in the biomaterials field mentioned above are, according to our best knowledge, the only examples in the literature. In conclusion, the development of functionalized DDSQs represents a significant step forward in wound healing and tissue regeneration, and we look forward to continued advancements in this area.Because of silsesquioxane cages’ unique advantages, such as environmental neutrality, high thermal stability, fire retardancy, and mechanical performance, it is clear that these materials will find many potential applications in innovative technology and industry. They can find various promising applications, including thermally insulating aerogels, lightweight foams, shielding coatings, thermal management , electroPolymeric materials’ fire retardancy is a significant preoccupation due to the need to minimize fire risk and safety requirements. The combustion process of polymers can be interrupted and retarded by physical processes or chemical reactions of flame retardant (FR) compounds and polymer matrix. The effect of these processes is usually the formation of a protective char layer to prevent the transfer of combustible fuels and oxygen between the flame zone and the pyrolysis zone. Based on structural motive and modes of action, flame retardant compounds are classified as metal hydroxides, halogenated compounds, phosphorus-nitrogen, and silica-containing compounds . From en2 aggregates can form porous char on the surface that is next ineffective in the prevention of combustion of the underlying material. Additionally, the industry’s practical application of FR based only on POSS nanoparticles is limited by the high cost of these materials. Therefore, the combination of POSS and conventional FRs is the better option, but the appropriate fitting of components POSS, FR, and polymer matrix is crucial.Silsesquioxanes as nanosized mono/multifunctional POSS cages can be specially designed to increase compatibility and miscibility with polymers and enhance flame retardancy efficiency. In addition, even the low loading level of silsesquioxane nanoparticles in a polymeric matrix such as polycarbonate, polypropylene, and epoxy resin influence reduced flammability, connected with forming an insulating char layer ,60,61. HThe effective PET composite contains two FR components: 9 wt% zinc diethyl hypophosphite and 1 wt% octamethyl-POSS is an example of such a solution . Changin2, which can further react with phosphate in the char layer [The designing of two-component POSS-FR systems is based on applying classic FR as phosphorous/phosphorous-nitrogen-containing compounds and modification of silicone cages realized by functionalizing the reactive arm of POSS cages, which effectively influences the formed char layer of the compact structure. The comparison of POSS cages with various arms, such as vinyl-POSS, octamethyl-POSS, and dodecaphenyl-POSS, indicated that they form the differential multicellular structure of the char layer . Generalar layer ,68. The ar layer . The mixar layer ,71.The layer-by-layer assembly is the next valuable synthetic strategy employed to prepare flame-retardant polymeric materials by alternatively depositing POSS compound and oppositely charged FRs on the surface of the polymer . The mixThe new approaches involve using the composition of several nanomaterials with different geometries, nanoparticles, and nanoplatelets for obtaining polymeric nanocomposites with combined flame resistance and mechanical properties. For example, hybrid FR based on fullerene and graphene has been used in conventional polymers, such as polypropylene , phenoliDifferent types of polymers require a universal strategy for designing FR, and hybrid materials based on combining two or more nanomaterials and conventional FR could reach these requirements. An example of designing such multifunctional FR is material obtained by the reaction of POSS on the surface of graphene and classical DOPO flame retardant applied in a polypropylene matrix. A schematic representation of the combination of multi-structure FR, POSS-Graphene-DOPO  applied to PP matrix) is shown in Graphene and residue of the POSS compound reinforce the char layer and form a physical barrier. Furthermore, phosphorous-containing entities can catalyze the polymer’s carbonization, and during silsesquioxane cages’ degradation, nitrogen residue can form non-flammable volatiles . AlthougExploring POSS-based hybrid materials as complementary additives, fire retardants, and improved mechanical properties in polymeric materials is still attractive. However, the functionalization of POSS nanocomposites was focused on preparing hybrid materials containing POSS as pendants or end groups ,85,86,87In polymeric materials, POSS hybrids in multicomponent FR improve thermal and mechanical stability, increase oxidation resistance, and decrease flammability. Furthermore, less explored DDSQs create so-called main chain type polymers or nanocomposites that enhance thermal properties and form new FR for conventional polymeric matrices.2 support activated by trialkyl aluminum. The synthesis of real titanium base catalysts proceeds in situ in the presence of a Lewis base that reacts with titanium precatalysts and magnesium support [2 by unconventional components such as POSS [2 nano-aggregates and their influence on tuning the coordination behavior of titanium precatalysts were reported. Similarly, the study of new precatalyst MgCl2/THF/TiCl4 with porous microspheres containing POSS inner cores indicates a new direction for designing heterogeneous catalysts. The presented precatalysts exhibit excellent activity. The porous microspheres with POSS core constitute an attractive model for studying the heterogeneous Ziegler-Natta catalysts for improving their structural parameters and polymer performance. The porous support is an excellent model for the study of the role of Lewis bases in each stage of active site formation during the immobilization of titanium species on MgCl2. The presented results indicated that the structural stability of magnesium support is guaranteed by POSS nanocrystals serving as scaffold core for the growth of MgCl2 crystals. The obtained polyethylene using POSS/MgCl2 support exhibits fine particle size and improved toughness, strength, and stiffness [Among many different catalytic systems, heterogeneous Ziegler-Natta catalysts represent the most significant in the polyolefin industry in the context of both extremally high catalytic efficiency and low-cost production . General support ,94,95. F support . New gen support ,99,100.  support . However support ,105,106. as POSS . These stiffness .In many applications, organic-inorganic composites are the most popular and widely developed hybrid materials. The spectrum of applications is multidimensional, from medicine through everyday materials, to advanced space technologies. Despite the definition of a hybrid, which gives practically infinite possibilities for creating nanocomposites, silicon-based connections are definitely in the lead in the context of the inorganic area. Nanomaterials based on silica or silicone-containing polymers are still attractive. However, in the latest technologies, materials based on silsesquioxane cages of the POSS type and DDSQs have recently occupied a solid and leading position. The simplest method of obtaining hybrid materials based on silsesquioxane cages is to use them as an additive to polymer matrices to modify their properties, often involving a new function or expanding the application potential of the original material. Material chemistry often focuses on cages’ properties using their excellent thermomechanical parameters and biocompatibility. Hence, there are many publications about new materials, which are actually “old” ones only with the addition of POSS cages with functional arms that allow for further modifications. These materials will become widely available over time as long as the commercial synthesis of silsesquioxane cages is cost-effective and industrially scalable. This is one of the most anticipated trends in transferring scientific research to industrial implementation. However, the research and design of innovative materials with new functions require not reaching for commercially available additives ; it is crucial to combine the efforts of synthetics offering unique cage systems and to incorporate them into the structures of other materials, such as an advancement in material design with tailor-made function, literally made-to-order ,109,110.


P < 0.05). Additionally, the number of patients with increased IgG4 levels (≥135 mg/dL) in the TAO active group was markedly higher than that in the inactive and control groups (P < 0.05). The IgG4/IgG ratio was also significantly enhanced in the TAO active group compared to the inactive and control groups (P < 0.05). CAS was identified as an independent factor influencing IgG4 levels in patients with TAO. The levels of serum IgG4, as well as the IgG4/IgG ratio, were significantly increased in some patients with active TAO, and they were related to the CAS, suggesting that the pathogenesis of TAO may be heterogeneous.To evaluate the clinical significance of detecting serum IgG4 and the IgG4/IgG ratio in patients with thyroid-associated ophthalmopathy (TAO) and to explore whether high serum IgG4 levels and the IgG4/IgG ratio are associated with the severity and activity of TAO, we retrospectively assessed the records of 78 TAO patients and 32 controls collected in our hospital from July 2020 to July 2022. The TAO patients were divided into TAO inactive and TAO active phase groups according to the clinical activity score (CAS), and we evaluated the association between the serum IgG4 levels, the IgG4/IgG ratio, and the clinical data of the participants. The levels of IgG4 significantly increased in the TAO active group compared to those in the inactive and control groups ( It can occur in patients with distinctive thyroid functions . TAO is Immunoglobulin-G4-related disease (IgG4-RD) is a rare immune-mediated chronic inflammatory disease with fibrosis that can affect various organ systems . IgG4-RD22.1In this retrospective case–control study, we analyzed TAO patients who had undergone serum IgG subclass examination at our hospital between July 2020 and July 2022 by consulting medical records. We collected the following details: gender, age, type of thyroid disease, TAO course, exophthalmos, CAS, TAO severity, serum IgG4, and IgG levels of all selected patients. The serological examination results of the control population hospitalized during the same period were used as the control group. This study was approved by the Ethics Committee of the first affiliated hospital of Wenzhou medical university.Informed consent: Informed consent has been obtained from all individuals included in this study.Ethical approval: The research related to human use has been complied with all the relevant national regulations, institutional policies and in accordance with the tenets of the Helsinki Declaration, and has been approved by Ethics Committee of the first affiliated hospital of Wenzhou medical university.2.2The TAO diagnosis was based on the Bartley criteria . TAO pat2.32.3.1The Hertel bulbar protrusion meter was used to measure the vertical distance from the orbit’s outer edge to the cornea’s apex. The exocytosis of both eyes was measured, and the average value was analyzed.2.3.2The interval between the first occurrence of ocular symptoms and hospitalization was calculated as the course of TAO, according to the standard of Mourits et al. . The sta2.3.3According to Bartalena’s standards, the range is graded as light, moderate, and severe. The mild category meets the following four conditions: (1) no diplopia or intermittent diplopia, (2) mild soft tissue swelling, (3) increased protrusion of the eyeball <3 mm, and (4) retraction of the eyelid <2 mm. Moderate category meets any of the following four conditions: (1) diplopia occurs in the first eye position, (2) moderate soft tissue swelling, (3) increased ocular protrusion ≥3 mm, and (4) eyelid retraction ≥2. Severity is defined as the presence of corneal ulcer or optic nerve involvement.2.3.4Venous blood was collected from patients. Immune scattering turbidimetry was used to measure the levels of serum IgG4 and IgG subtypes. A fully automatic turbidimeter (Beckman AU5800) was used as the testing instrument.2.4χ2 test. The differences in continuous variables among the groups were evaluated by the one-way ANOVA or Kruskal–Wallis test. All statistical analyses were carried out with SPSS 25 software (IBM Corp). P  <  0.05 was considered statistically significant.The continuous variables were presented as mean ± standard deviation or median (quartile 25–75). Categorical variables were compared using the 33.1P > 0.05). The degree of exophthalmos and CAS in the TAO active group was significantly higher than in the inactive group . The disease duration was significantly shorter in the TAO active group than in the inactive group (P < 0.05).The initial exploration of our hospital’s electronic medical system revealed 176 patients with TAO from July 2020 to July 2022. Fifteen cases under the age of 18 were disqualified. After excluding 23 patients with severe chronic physical illnesses, 12 patients with alcohol and drug dependence, and 48 cases with incomplete data, 78 patients with TAO and 32 controls were qualified for this study . Accordi3.2P < 0.05, P < 0.05, The levels of serum IgG4, IgG, and other immunoglobulins in the serum were evaluated among the three groups. The results demonstrated that serum IgG4 levels were markedly higher in the TAO activity phase group than in the TAO inactive phase and control groups .Compared to the control group, the favorable rates of serum IgG1 and IgG4 in the TAO inactive phase and TAO activity phase groups were higher than those in the control group (3.4P < 0.05)  .3.5n = 7), moderate (n = 38), and severe (n = 33). The corresponding serum IgG4 levels are shown in P > 0.05).The TAO patients in this study were classified according to the severity degree and divided into three groups: mild (4TAO is an autoimmune disease in which helper T cells play a leading role mediated by autoantibodies . The occIgG contains four subtypes: IgG1, IgG2, IgG3, and IgG4, of which the content of IgG1 is the highest and the content of IgG4 is the lowest . IgG4 inAs a particular serological marker that can be present in various autoimmune diseases, the relationship between serum IgG4 and TAO deserves more research and attention. Evidence has indicated that serum IgG4 to IgG4/IgG increased in some patients with TAO . RecentlThe diagnosis and evaluation of TAO currently rely mainly on clinical manifestations and imaging examinations. CAS is a qualitative judgment based on a series of clinical signs, which is a crucial indicator to evaluate the activity of TAO and whether to carry out anti-inflammatory treatment orbital radiotherapy . There iTo sum up, this study found that serum IgG4 and IgG4/IgG levels were significantly increased in patients with active TAO but did not belong to the IgG4-related disease. The level of serum IgG4 in patients with TAO is related to CAS, which suggests that IgG4 may be involved in part of the pathological mechanism of TAO. Determining serum IgG4 level helps manage TAO and choose the appropriate treatment regimen. High IgG4 levels may help to screen out patients with high-risk factors of TAO in GD patients. Given the diagnostic and staging value of orbital MRI in TAO, combined with MRI examination is helpful to clarify the value of serum IgG4 in the prediction, diagnosis, and treatment of TAO, improve the predictability of clinical diagnosis and treatment, and provide new ideas for clinical diagnosis and treatment of TAO.


Antibiotics have helped to reduce the incidence of common infectious diseases in all modern healthcare systems, but improper use of antibiotics including their overuse and misuse can change the bacteria so much that antibiotics don’t work against them. In case of developing imposable selective pressure with regard to the proportion of hospitalized patients who receive antibiotics, the quantity of antibiotics that are prescribed to them, and the proportion of patients who receive antibiotic treatment is one of the major contributors to the rising global health issue of antimicrobial resistance. Concerning the levels of antibiotic consumption in Pakistani hospitals, there is negligible research data available.This study aimed to evaluate five-year inpatient antibiotic use in a tertiary care hospital in Islamabad using the World Health Organization (WHO) Recommended Anatomical Therapeutic Chemical (ATC) Classification / Defined Daily Dose (DDD) methodology.It was a descriptive study involving a retrospective record review of pharmacy records of antibiotics dispensed (amount in grams) to patients across different specialties of the hospital from January 2017 to December 2021 . The antibiotic consumption was calculated by using the DDD/100-Bed Days (BDs) formula, and then relative percent change was estimated using Microsoft Excel 2021 edition.A total of 148,483 (77%) patients who received antibiotics were included in the study out of 193,436 patients admitted in the hospital. Antibiotic consumption trends showed considerable fluctuations over a five-year period. It kept on declining irregularly from 2017 to 2019, inclined vigorously in 2020, and then suddenly dropped to the lowest DDD/100 BDs value (96.02) in the last year of the study. The overall percentage of encounters in which antibiotics were prescribed at tertiary care hospital was 77% which is very high compared to the WHO standard reference value (< 30%). WATCH group antibiotics were prescribed (76%) and consumed more within inpatient settings than Access (12%) and Reserve (12%) antibiotics.The hospital antibiotic consumption data is well maintained across different inpatient specialties but it is largely non-aligned with WHO AWaRe (Access-Watch-Reserve) antibiotics use and optimization during 2017–2021. Compared to the WHO standard reference figure, the overall percentage of antibiotics encountered was higher by about 47%. Antibiotic consumption trends vary with a slight increase in hospital occupancy rate, with positive relative changes being lower in number but higher in proportion than negative changes. Although the hospital antibiotics policy is in place but seems not to be followed with a high degree of adherence. In all health systems so far, antibiotics have lowered the prevalence of common infectious diseases and are indispensable in countless medical interventions . But inaIn order to optimize antibiotic consumption, the WHO Essential Medicines List (EML) Working Group developed a tool termed the AwaRe classification of antibiotics in 2017 and revised it in 2021 . The claAt individual hospitals, the connection between antibiotic use and resistance is widely understood across temporal and spatial scales , primaryDespite the direct relationship of antibiotic consumption to resistance, and public health consequences of emerging resistant microorganism to the effects of antibiotics , limitedThe study aimed to evaluate the five-year (between 2017 and 2021) inpatient antibiotic use in tertiary care hospital using the ATC/ DDD methodology.It was a descriptive study involving a retrospective record review of routinely maintained (aggregated quarterly surveillance) data of antibiotics dispensed to specialty wards of a tertiary care hospital.The selected hospital site comprised 550 quaternary care beds (refers to the extension of tertiary care where advanced-level care is being provided to the patients) providing healthcare facilities to local and international patients along with 21 specialty care units in Islamabad. These specialty care units included Cardiology, Cardiac surgery, Emergency, Endocrinology, Ear Nose Throat (ENT), Gastroenterology, General Surgery, Liver transplant, Medical specialty, Nephrology, Neurology, Neurosurgery, Obstetrics/Gynecology, Oncology, Orthopedic, Pediatrics, Pediatric Surgery, Pulmonology, Rheumatology, Plastic surgery, and Urology.Antibiotics that fall under the ATC classification system , and werAntibiotic consumption data for the selected years were extracted from the hospital’s pharmacy records with the help of HMIS . Consumption data included the antibiotics dispensed from 2017 to 2021 in form of an excel sheet containing specialty names, antibiotics (brand and generic name), dosage form, and amount of antibiotics (in gm or mg). Separate data of patient admission records for five years (2017–2021) was also extracted from the system with the help of the Information Technology (IT) department of the hospital.  was extracted from HMIS with the help of the Quality department.The conversations of data collection team with the clinical pharmacy staff about the antibiotics’ consumption were not formally recorded or documented, but data collectors were encouraged to diarize key findings.The WHO Collaborating Center for Drug Statistics Methodology advises using the ATC/DDD  classification . The samExcel was used to organize, and clean the imported and calculated data (Microsoft Excel 2021 edition). The cleaned data was analyzed for input accuracy before being subjected to a descriptive analysis for the research period in order to determine the process indicators. The categorical variables were reported as counts and proportions (%) for descriptive  analysis. While a central tendency test  was followed for the figures to show the trend of increase and decrease in relative change of antibiotics consumption.  patients who received antibiotics were included in the study out of 193,436 patients admitted during the study period (January 2017 to December 2021). The rate of antibiotic use (percentage of encounters with antibiotics) in the starting year of the study was 78.5% , dropped to 66.9%  in 2019 and then was extended up to highest mark of 84.4%  at the end of study. The hospital total bed capacity ranged from a minimum of 530 in 2017 to a maximum of 550 in 2021. While the bed occupancy rate showed a variation during first 3 years but remained constant in the last 2 years of study period.  whose mean relative change was calculated in this study. Out of them, 15 antibiotics belonged to Access group antibiotics (see Table Among the consumed (48 in number) AWaRe antibiotics, 20 antibiotics have a positive mean relative change which means their consumption has increased over the period of time and remaining 28 antibiotics have a negative mean relative change showing their consumption has decreased from 2017 to 2021.Viewing the antibiotics with positive mean relative change, in order to provide the magnitude and summary measure of antibiotics consumption, a measure of central tendency test was undertaken . So, aft— -30.27%). So, out of 28, only 14 antibiotics were consumed above than the median value mostly attributed by 3 antibiotics; Gentamicin (IV) consumption decreased (changed) by 92.68% during the years 2018–2021 in comparison to its consumption in 2017, closely followed by Ofloxacin  and Cefaclor  whose consumption trends respectively decreased by 91.92% and 78.74% during the study years. While lowest relative change was seen in case of Teicoplanin (IV) and Piperacillin + Tazobactam (IV), whose consumption only decreased by 30.37% and 31.19% from 2018 to 2021. Figure Viewing the dispersion of data set of remaining 28 antibiotics whose consumption decreased from 2018 to 2021, the median negative relative change of antibiotics was found to be -28.46%  level in Pakistan, using ATC/DDD methodology and WHO AWaRe policy for international comparison. Since Our study quantified AWaRe-classified antibiotic consumption changes over a 5-year period, giving us the opportunity to benchmark the gaps between antibiotic utilization in a JCI-accredited hospital, which would be informing for Pakistan’s AMR national action plan, healthcare providers , decision-makers , researchers as well as the public utilizing the health services in this setting.The overall percentage of encounters (for 5-years) in which antibiotics were prescribed at tertiary care hospital was 77% which is very high compared to the standard reference value < 30%) of globally introduced WHO prescribing indicators . This hi% of globAmong overall percentage of antibiotics encounter, WATCH group antibiotics were prescribed (76%) and consumed more within in-patient settings than Access (12%) and Reserve (12%) antibiotics. This proportion of AWaRe antibiotics consumption is opposite to the WHO General Program of Work 2019–2023 indicator which recommends that the proportion of Access antibiotics should be more than 60% of overall antibiotic use and Reserve antibiotics consumption should be limited for situations when all alternative antibiotics have failed. 32) This difference in AWaRe antibiotics according to WHO indicator is a huge gap and needs to be bridged by Hospital administration. This can be done by engaging the Antibiotic Stewardship team to make the healthcare team realize that, Access antibiotics represent first or second-line for empirical treatment of common infectious syndromes and have a favorable safety profile in comparison to Watch group antibiotics. Watch group antibiotics on the other hand, are among the highest priority critically important antimicrobials for human medicine recommended only for specific, limited indications but they have the higher potential to negatively impact AMR [ This difAcinobacter baumani was most common  in hospital during the study period and Colistin was the only drug in the hospital formulary/antibiogram that was sensitive or intermediate sensitive to these bacteria at that time. This finding is consistent with highest consumption of Colistin in the hospitals of Spain and Greece where the prevalence of hospitals isolates of such pathogens was high and Colistin was used to treat MDR Gram-negative pathogens [(including Acinetobacter species that are resistant to Carbapenems (such as Imipenem-Cilastatin which has the second highest increased RC in our study)]  , 34 35]Acinobact nature) , will liconsumed , 38 and Literature suggests two way-forwards for mitigating the antibiotic resistant bugs; one is related to the infection control team of health settings and the other is focused on hospital formulary inclusion criteria of antibiotics. The earlier approach may constitute Multi-site Gram-negative Surveillance Initiative (developed by Centre for Disease Control and Prevention) in response to growing concerns about pneumonia, bloodstream infections, wound or surgical site infections, and meningitis in healthcare and community settings . This isSecond way-forward will be to have some check involved first, for including an antibiotic into the hospital formulary and then continuous monitoring of consumption of the included antibiotic in accordance with the rationale presented by healthcare professionals for hospital formulary inclusion for that particular antibiotic . This wiGentamicin consumption has the highest negative relative change (decrease in consumption) over the study period. Its nephrotoxic effects might have been observed by clinical pharmacy team which possibly led to decrease in its use as discussed in another study . After iSince the proposed study site is the only and among one of the three Joint Commission International (JCI)-Accredited tertiary care hospital within Islamabad capital territory and Pakistan respectively, therefore the study results may thus add to surveillance data on national antibiotic use, which can be used to track long-term changes at the national and international levels.Additionally, gathering data on the extent, distribution, types, and nature of antibiotic usage in hospitals may make it easier to conduct future epidemiological studies on the connection between antibiotic use and resistance.Our study also has few limitations which were as follow:DDD/100-BDs among pediatric patient cannot be calculated properly as a complete injection dispensation will be ruled out from system where as the dose of a pediatric patient will be less than it.Antibiotics doses are adjusted in case of chronic kidney disease (CKD) patients according to their creatinine clearance and this cannot be rule out by DDD calculation method.Syrups are dispensed as unit dose and exact doses consumed from it cannot be ruled out.The hospital antibiotic consumption data is well maintained across different inpatient specialties but the mechanisms for routine monitoring of antibiotics use and optimization are still in early stages of development. Although the hospital antibiotics policy is in place but seems not to be followed with a high degree of adherence during 2017–2021 in terms of WHO AWaRe antibiotics categories; the overall percentage of encounters in which antibiotics were prescribed is exceeding by almost 47% in comparison to the WHO standard reference value, Watch antibiotics are prescribed and consumed by two-third (2/3) proportion when compared to the combined consumption of Access and Reserve group antibiotics, the mean relative change of antibiotics consumed positively are lower in number (10 vs. 14 antibiotics) but higher in proportion than antibiotics with negative relative change, a continuous variation in overall antibiotic consumption trend can be seen during a constant but slight increase in hospital occupancy rate in terms of DDD/100 BDs. The existing hospital workforce, in terms of resources and planning, is facing challenges to assess, control and implement antibiotics consumption posing an emerging threat of antibiotic resistance in coming years in the hospital.The impact of processes (policies and guidelines) and outcomes (improvement in patient care and antibiotic use) of hospital stewardship interventions needs to be monitored.The antibiotic stewardship program should prepare antibiotic resistance information  and regularly report this information to hospital leadership, prescribers, pharmacists and nurses.The hospital staff needs to be educated about optimal prescribing, adverse reactions and resistance associated with antibiotic misuse. This can be achieved through didactic presentations, poster messages, newsletters, flyers, or electronic communication.There should be an option for antibiotic prescribing in CPOE (Computerized physician order entry) that have the option whether the antibiotic is being prescribed for prophylactic / empiric / therapeutic purpose.The future studies could be focused on estimating antibiotic consumption by using days-of-therapy as an additional metric and across outpatient/ambulatory care settings.


In this paper, permeable geopolymer concrete with high compressive strength and permeability is prepared using alkali-activated metakaolin as a slurry, and its mechanical properties are reinforced by adding steel fibers. The influencing factors of the strength, porosity and permeability coefficient of the fiber-reinforced permeable geopolymer concrete, as well as its microstructure and curing mechanism, are determined by conducting an unconfined compressive strength test, scanning electron microscopy, energy-dispersive spectroscopy and X-ray diffraction. The test results show that, under the water permeability required to meet the specification conditions, when the alkali activator modulus is 1.4 and the activation-to-solid ratio is 0.9, the effect of metakaolin activation is the most obvious, and the unconfined compressive strength of the permeable geopolymer concrete is the highest. Moreover, the paste formed via the alkali activation of metakaolin contains a large number of silica–oxygen and aluminum–oxygen bonds with a dense and crack-free structure, which enables the paste to tightly combine with the aggregates; the strength of the permeable geopolymer concrete is early strength, and its strength at a curing age of 3 days is the highest. The strength at a curing age of 3 days can reach 43.62% of the 28-day strength; the admixture of steel fiber can effectively improve the strength of the permeable concrete, and with an increase in the amount of admixture, the strength of the fiber shows a trend of increasing, and then decreasing. Under the conditions of this test, a volume of steel fiber of 0.3% enables the optimum unconfined compressive strength to be reached. Chang et al. [To date, domestic and foreign scholars have carried out research work on geopolymer gelling materials. Wang Aiguo et al.  obtainedg et al.  combinedg et al.  showed tg et al.  can reacg et al.  used botAfter hardening, traditional permeable concrete has low strength, poor durability and other problems , and comThe current research mainly focuses on the mechanical properties of geopolymer concrete and traditional permeable cement concrete. There has been little research on the preparation of permeable geopolymer concrete using geopolymers instead of cement as the cementitious material; thus, the present study determines the strength and water permeability properties of permeable geopolymer concrete through an unconfined compressive strength test, a water permeability test, energy-dispersive spectroscopy and X-ray diffraction, based on which we can improve the mechanical properties of permeable geopolymer concrete through the addition of steel fibers to determine the optimal amount of steel fibers. In this paper, alkali-activated metakaolin is used as a cementitious material instead of cement to prepare permeable geopolymer concrete. While meeting the requirement of water permeability, steel fibers are added to increase the strength of the permeable geopolymer concrete. In addition, the use of metakaolin, a form of industrial waste, as a substitute for cement illustrates the feasibility of the comprehensive utilization of industrial waste and reduces carbon emission, making it environmentally friendly.3, as shown in Coarse aggregate with a particle size of 4.75~9.5 mm was purchased from Zhejiang Borui Co., Ltd., Wenzhou, China, with a compact packing density of 1530 kg/mm is the mass of each material, p is the apparent density of the material, P is the design porosity, c is the fiber, f is the metakaolin, g is the coarse aggregate, w is the alkali activator solubilization and a is the water reducer.This test specimen was made using a volumetric method; the porosity was determined first, and then the specimen material mix ratio was calculated according to Equation (1):The specimen preparation process included the weighing of raw materials, solution preparation, mixing, molding, vibration, standard maintenance and other steps. The process is shown in (1)Preparation stage: The aggregate is passed through a sieve with a pore size of 5 mm to remove extra sediment and impurities for spare parts. The alkali activator solution is configured 24 h in advance to ensure that the sodium hydroxide particles are fully dissolved in the sodium silicate solution, and then placed into a thermostat box for preservation after cooling to room temperature.(2)Production stage: First, a single horizontal-axis mixer is used to mix the aggregate and metakaolin for 30 s, so that the metakaolin powder evenly wraps around the aggregate; then, it is slowly poured into the alkali stimulant solution and mixed until no dry powdery metakaolin remains; and finally, the solution is poured into 100 mm × 100 mm × 100 mm molds, and the molds are placed on a shaking table where they undergo vibration for 9 s, and the surface of the test block is finally smoothed.(3)Maintenance stage: The test block is placed under outdoor maintenance for 24 h, and then placed into the maintenance box (temperature: 20 ± 2 °C/humidity: 98%) for steam maintenance 3 days after demolding, where it remains until the specified age.(1)Unconfined compressive strength testThe unconfined compressive strength test was performed using the microcomputer servo universal testing machine produced by Jilin Guanteng Automation Technology Co., Ltd., Changchun, China, which adopted uniform displacement speed control and a loading speed of 0.1 mm/s, and the load and deformation were automatically collected by the system. Three test blocks per batch were tested according to the standard and the results were averaged. According to the standard deviation, if there is a large dispersion of data, we should discard the data and re-select the test block for the test.(2)Determination of permeability coefficientK can be calculated using Equation (2).K is the permeability coefficient (cm/s); L is the thickness of the specimen (cm); H is the difference in water level, i.e., the height difference between the mouth of the overflow pipe and the mouth of the outlet pipe (cm); Q is the amount of exudate water in t seconds (mL); and A is the cross-sectional area of the specimen (cm2).We placed the specimen into a water permeability meter, as shown in (3)Porosity DeterminationW1, removed the specimen, placed it in the air to dry, and when the mass was constant , weighed the mass of the specimen in the air W2 and the volume of the specimen V. Three test blocks per batch were tested according to the standard and the results were averaged. According to the standard deviation, if there is a large dispersion of data, we should discard the data and re-select the test block for the test. The total porosity of permeable concrete en can be determined according to Equation (3):The porosity determination of the permeable concrete was carried out using the mass method. We soaked the specimen in water for 24 h to saturate it with the mass of the specimen in water (4)Scanning electron microscope and energy-dispersive spectroscopy analysisScanning electron microscopy (SEM) and energy-dispersive spectroscopy (EDS) were performed using a scanning electron microscope manufactured by Carl Zeiss Ltd., Shanghai, China.(5)X-ray diffraction analysisX-ray diffraction analysis using an X-ray diffractometer from Rigaku, Tokyo, Japan, only extracted, from the permeable geopolymer concrete slurry part of the ground powder placed in the X-ray diffractometer, the alkali activation of metakaolin products for the determination of the chemical composition.2); E is the modulus of elasticity (N/m2); γ is the material surface fracture energy (J); and α is half of the initial crack length (m).At present, the compressive strength prediction models based on pore structure characteristics are mostly expressions of the relationship between porosity and compressive strength, and demonstrate the effect of the percentage of pore space on the compressive strength of permeable concrete; these prediction models mostly involve simple regression fitting, and lack theoretical support. The Griffith fracture theory is often used as a classical theory to describe the relationship between the strength and porosity of solid brittle materials , and itsE0 is the elastic modulus of permeable concrete when the porosity is 0 (N/m2); m0 is the coefficient to be determined; and TP is the total porosity of the permeable concrete (%).Permeable concrete’s pores do not provide an elastic modulus, but there is a certain functional relationship with the elastic modulus. Studies have been conducted to establish the effective elastic modulus of porous materials as a function of porosity, and it has been found that the elastic modulus decreases as porosity increases. In this paper, the relationship between the two is expressed by the following equation:n0 is the coefficient to be determined.The surface fracture energy of a material refers to the energy required to fracture the material. For permeable concrete, the internal part of the fracture that requires energy at the point of breakage only refers to the solid–solid joint. Therefore, the surface fracture energy of permeable concrete is also related to the total porosity, with the expression:pd is used to measure the distribution of pore diameters within the permeable concrete [In Griffith fracture theory, concrete , and theSubstituting these three expressions into the theoretical model and normalizing the equivalent diameter to a constant term, the expression for the ultimate stress at damage of the modified permeable concrete was obtained as follows:Based on this expression, the test data were fitted as shown in R2 value is 0.972, and the corrected R2 value is 0.967 and the fitting is successful.This model was based on Griffith fracture theory, with the total porosity of permeable geopolymer concrete as the independent variable, and its prediction of compressive strength was established; its expression is shown in R2 is more than 0.9, which indicates a high degree of fitting, and could provide a basis for predicting unconfined compressive strength through total porosity.The total porosity and unconfined compressive strength are positively correlated in the range of the design porosity of the test block, and the relationship between the two is more clearly expressed on the basis of fracture theory. The As can be seen from 2O3 and SiO2, hydration products of the Ca (OH)2 secondary hydration reaction, which effectively reduces pores and cracks in the structure.2O3 and SiO2, with few other impurities. This represents the main area of geopolymer production. Combined with the X-ray diffractogram in This study of steel fiber-reinforced permeable geopolymer concrete shows that at an alkali activator solution modulus of 1.4, the activation of metakaolin is the best; when the activation-to-solid ratio is 0.9, the metakaolin can be fully activated; the permeability coefficient of the prepared permeable geopolymer concrete is 7.46 mm/s, with a strength of 20.29 MPa, which is in line with the design specification of permeable concrete. At the same time, the chemical properties of the alkali-activated metakaolin products obtained through chemical analysis are relatively stable. Therefore, this study confirms that geopolymer cementitious materials are high-quality materials that can be used instead of cement for making permeable concrete, and provides new ideas for other subsequent applications of geopolymer materials.In order to improve the brittleness of geopolymer cementitious materials, in this study, steel fibers are selected to improve the ductility of permeable geopolymer concrete, and signs of steel fibers providing load-bearing capacity at the point of specimen damage are observed from a microscopic point of view. By adding different quantities of steel fibers, the strength of the specimen is shown to increase and then decrease, and the specimen reaches optimum performance at an admixture volume of 0.3% of steel fibers. For the selection of fibers, subsequent studies could choose fibers from other materials to enhance the performance of permeable geopolymer concrete while better reducing the economic cost of production.


Introduction: With the diminishing use of whole-brain radiotherapy (WBRT), there is increasing debate regarding the maximum number of brain metastases that should be treated with stereotactic radiosurgery (SRS). In patients with >10-15 lesions, some groups are proposing a new approach - selected-lesion SRS (SL-SRS) - where only a subset of intracranial lesions are chosen for irradiation. This study is an initial look into this practice.Methods: This is a cross-sectional exploratory survey study. A survey of 19 questions was created by the International Radiosurgery Research Foundation (IRRF) using open-ended and multiple-choice style questions on SL-SRS practices and indications with the goal of qualitatively understanding how SL-SRS is being implemented worldwide. The survey was distributed to physicians in the United States (US) and internationally who are members of the IRRF and who perform SRS frequently. Ten out of 50 IRRF institutions provided responses reflecting the practices of 16 physicians.Results: SL-SRS is being performed at 8/10 institutions. The most common reasons for using SL-SRS included patients with prior WBRT, patients with progressing systemic disease with central nervous system (CNS)-penetrating or immunotherapies available, specific requests from medical oncology, and cooperative studies using this approach. Lesion size was cited as the most important factor when choosing to irradiate any single lesion. The majority of respondents reported 30 mm and 40 mm as size cutoffs (by largest dimension) for treatment of a lesion in eloquent and non-eloquent locations, respectively. Eloquence of lesion location and attributable symptoms were also considered important. Progression of untreated lesions was the most common reason reported for bringing patients back for additional treatment.Conclusion: The responses to this survey show that SL-SRS is being used, allowing for small/asymptomatic brain metastases to be left safely unirradiated. It is currently used in patients who have >10-15 lesions with prior WBRT, those with progression of extracranial disease but with acceptable systemic treatment options, and those with poor functional status. The incorporation of this new approach into clinical trials should be considered for the safe study of the efficacy of new CNS-penetrating systemic therapies. Intracranial stereotactic radiosurgery (SRS) has become the mainstay initial and salvage treatment for most patients with brain metastases, both singular and multiple -2. SRS oGiven the trend away from using WBRT , there hTraditionally, this approach was considered in patients who had prior WBRT and who presented with >10-15 metastases. In order to avoid repeat WBRT and its risk of neurotoxicity ,11-14, SMore recently, SL-SRS has been proposed in patients without prior WBRT treatment in the context of newer and more available systemic therapy options with some degree of central nervous system (CNS) penetration. With this treatment philosophy, asymptomatic brain metastasis can, therefore, be left unirradiated and instead monitored radiographically as a patient continues systemic therapy. As it currently stands, this approach is in direct contradiction to the standard approach to treatment of CNS metastatic disease. As such, there is no prospective literature to guide SL-SRS practices, including indications for SL-SRS and which lesions should be chosen for treatment. Therefore, we surveyed clinicians skilled in SRS at high-volume centers on their experience and approach to SL-SRS, including factors they used to decide how many and which lesions to treat.This was a cross-sectional exploratory survey study developed by members of the International Radiosurgery Research Foundation (IRRF) with the goal of understanding current opinions on SL-SRS. The IRRF is a non-profit scientific and educational entity consisting of neurosurgeons, radiation oncologists, and medical physicists at academic and clinical centers that perform SRS, track outcomes, and develop research proposals and clinical trials surrounding SRS. Membership to the IRRF is reviewed by a Board of Directors. The 19-question survey was generated by IRRF members and distributed via e-mail to all IRRF-participating centers (Table Types of questions included in the survey included open-ended (Question (Q)2, Q3, Q5, Q6, Q8, Q9), yes/no , multiple choice with single response only , multiple choice with unlimited responses , and one ranking question (Q15). For Question 14, respondents were presented with a hypothetical case of a patient with a biopsy-proven carcinoma with >15 previously radiosurgically-treated brain metastases and asked to designate factors that would encourage them to consider SL-SRS with no limit on the number of factors they could choose. For Question 15, respondents were asked to rank five factors influencing their decision to treat a specific lesion with radiosurgery. Rankings of 1-2 were classified as “most important,” 3-4 as “moderately important,” and 5 as “not important.” Descriptive statistics  were calculated for questions that solicited numerical responses where appropriate. However, no inferential statistics were performed.Ten out of 50 institutions responded to the survey, reflecting a total of 16 clinicians across the 10 institutions. Six centers were located in the United States (US), and an additional four were located in Canada, India, Taiwan, and Turkey. There were five institutions whose responses reflected the practices of >1 clinician.SRS practicesThe number of radiosurgery cases performed at each institution in 2021 ranged from 168 to 741 cases (mean 406) (Table The majority of programs (six out of 10) had no formal or informal upper limit for the number of brain metastases that could be treated by single or fractionated SRS. The range for programs that did report an upper limit was 15-25 brain metastases. Table SL-SRS practicesSL-SRS was performed at eight of 10 institutions  Table . HoweverRespondents were asked to rank the importance of five factors that may influence their decision to treat any single lesion in SL-SRS Figure . Ninety Respondents were asked to comment on size cutoffs for treating lesions in eloquent or non-eloquent areas. Responses are depicted in Table Respondents designated several factors that would encourage them to consider SL-SRS in a hypothetical case of a patient with biopsy-proven carcinoma and >15 previously treated brain metastases Figure . “Prior Finally, when asked which factors would drive clinicians to bring back patients for treatment of the remaining lesions, “progression of other lesions” was the most cited factor  with SL-SRS may help clarify and consolidate the indications for this strategy.More intriguingly, with several institutions now reportedly using SL-SRS, this practice may additionally provide the basis for a unique opportunity. As new targeted immunotherapies are being designed and approved at an increasingly rapid pace, there is an increased need for understanding the CNS efficacy of each of these drugs -26,28. IIn our opinion, the use of CNS-penetrating treatments is revolutionizing how we view the treatment of CNS metastasis. Focal therapy carries unique complications that could be deferred if only select lesions are treated. This survey shows that patients with >10-15 brain metastases who have had prior WBRT, those with progression of extracranial disease still with acceptable systemic treatment options available, and those with poor functional status are currently being considered for SL-SRS in institutions worldwide. Larger lesion size, functionally eloquent location, and presence of symptomatology are the most common reasons to choose any given lesion for SRS. Future studies evaluating outcomes after SL-SRS are needed to form a consensus on how to best implement SL-SRS into standard practice. In addition, consideration of this technique for incorporation into new drug clinical trials may allow brain metastases more access to new agents and provide data for each drug’s CNS efficacy.


Helicobacter pylori (H. pylori) keeps rising while the eradication rate continues to decline due to the increasing antibiotic resistance. Regional variations of antimicrobial resistance to H. pylori have been recommended by guidelines in recent years. This study aims to investigate the antibiotic resistance rate of H. pylori and its association with infected subjects’ characteristics in Liaoning Province, an area in north China.The prevalence of H. pylori positive participants without previous antibiotic use within four weeks were collected for H. pylori culture. Antibiotic susceptibility to furazolidone (AOZ), tetracycline (TC), levofloxacin (LFX), metronidazole (MET), clarithromycin (CLA), and amoxicillin (AMX) were examined with the agar dilution method. Associations between H. pylori resistance and patient characteristics were further analysed.Gastric tissues from 178 P = 0.021), and between resistance to MET and age (P < 0.001).No resistance was observed in AOZ or TC. For LFX, MET, CLA, and AMX, the overall resistance rates were 41.10%, 79.14%, 71.78%, and 22.09% respectively. There were significant differences between resistance to CLA and MALToma (The primary resistant rates of LEX, MET, CLA, and AMX were relatively high in Liaoning. Treatment effectiveness improvement could be achieved by prior antimicrobial susceptibility tests before antibiotic prescription. Helicobacter pylori (H. pylori) is a ubiquitous bacterium which is well resistant to the gastric acid. It was estimated that the global prevalence of H. pylori was approximately 50% , tetracycline (TC), levofloxacin (LFX), metronidazole (MET), clarithromycin (CLA), and amoxicillin (AMX). Unfortunately, the eradication rate of H. pylori has fallen due to ever increasing antibiotic resistance during the last decades. A systematic review and meta-analysis found the overall eradication rate of H. pylori resistant to antibiotics was significantly more than 16% lower than that sensitive to antibiotics , atrophic gastritis (AG), gastric cancer (GC), mucosa associated lymphoid tissue lymphoma (MALToma) and peptic ulcer diseases (PUD). The exclusion criteria included subjects administered any antibiotics in the past 4 weeks.The enrolled subjects were all patients at the gastroenterology department of the First Affiliated Hospital of China Medical University, a tertiary hospital in Liaoning Province during March 2021 to August 2022. Patients enrolled came from various cities in Liaoning Province. Every selected patient was H. pylori and to perform the antibiotic sensitivity test. Basic information of the subjects was obtained from HIS Information System Technical Support Services, including age, gender, current smoking status, current drinking conditions, BMI, hypertension, diabetes mellitus, endoscopic diagnosis, and H. pylori treatment history. The definition of current smoking and drinking in the present study is that participated subjects engaged in smoking and/or drinking behaviour in accordance with their personal smoking and/or drinking habits during the first 4 weeks before conducting the drug sensitivity test. This project was approved by the Human Ethics Review Committee of the First Affiliated Hospital of China Medical University (2021325). We have received written informed consent from participants.Gastric mucosa tissues of the subjects were obtained through the endoscopic biopsy process to confirm the infectious status of 13C-Urea Breath Test  through intaking 100-mg 13C-labelled reagent. The WLD600C13C Analyser  was applied to analyse the breath samples and a positive result was decided following instructions of the manufacturer. Three gastric biopsy specimens of each subject  were placed in a H. pylori transport culture medium (patent number: CN104762235A) . Then the samples were fully grounded and inoculated into Columbia blood agar (CBA) plates, supplemented with 5% sheep blood. The colony of H. pylori was observed after being cultured on the plate under microaerobic conditions  at 37 °C for three to four days. Positive urease, catalase and oxidase tests and Gram-staining were performed to identify colonies resembling H. pylori (H. pylori-positive.Urea breath test (UBT) was performed with The Kit For 762235A)  and tran. pylori . The patH. pylori to six antibiotics  was measured by the agar dilution method. Various concentrations of the targeted antibiotics were diluted in the agar mediums . Suspensions of H. pylori strains were transferred onto the plates, then we incubated those plates at 37 °C under microaerophilic conditions . After 72-hour cultivation, the presence of H. pylori colonies was observed. ATCC43504 was selected as a quality control. Resistance breakpoints of AOZ, TC, LFX, MET, CLA, and AMX were defined as MIC > 1, >1, >1, >8, >0.5, and >0.125 µg/mL, respectively, in accordance with the guidance of the European Committee on Antimicrobial Susceptibility Testing (EUCAST) .The minimal inhibitory concentration (MIC) of H. pylori treatment history, and antibiotic susceptibility. Chi-square test was applied to compare the difference between groups. Fisher’s exact test was applied when over 20% of the expected counts were below 5. P value less than 0.05 in two tails was considered statistically significant.All statistical analyses were performed using the statistical software SPSS . Categorical data were presented as number and percentage and continuous data were presented as mean  ± standard deviation (SD). The following characteristics data from participated subjects were processed using descriptive statistical analysis, including age, gender, current smoking status, current drinking conditions, BMI, hypertension, diabetes mellitus, endoscopic diagnosis, H. pylori positive by Urea breath test (UBT), successful bacterial cultures were obtained for 163 (91.57%) patients.Among 178 patients determined as H. pylori was presented in The base information of the 163 participants infected with H. pylori treatment history, along with MET (64.71%), LFX (47.06%), and AMX (17.65%). For 146 subjects once accepted H. pylori treatment, resistance rates in descending order were MET (80.82%), CLA (71.92%), LFX (40.41%), and AMX (22.60%), remaining in the same order as the overall resistance rates.No resistance to AOZ or TC was observed in the population. The overall resistance rates to both MET and CLA remained at about the same high level , with AMX having the lowest rate, but still at 22.09% . CLA  were sensitive to all the six antibiotics, and mono-resistance was found with LFX (1.23%), MET (20.25%), and CLA (4.91%). 50 (30.67%) isolates were double resistant . Triple resistance was found in 42 isolates with 31 (19.02%) resistant to LFX+MET+CLA, 1 (0.61%) to LFX+CLA+AMX and 10 (6.13%) to MET+CLA+AMX. 20 (12.27%) isolates were resistant to four antibiotics including LFX, MET, CLA and AMX  significantly differ . No other correlation was discovered between antibiotic resistance and patient characteristics including gender, current drinking conditions, BMI, hypertension, diabetes mellitus and H. pylori treatment history , probably relating to the extent of use for urinary tract infections  were similar to ours and demonstrated the combination of those two antibiotics were not recommended as the first-line treatment . This might result in the failure eradication in this region and indicate advance drug susceptibility tests are required for the use of these drugs.In terms of resistance patterns, among strains with no antibiotic resistance, treatment-naïve strains accounted for a larger proportion. In other resistance patterns, treatment-experienced group was the majority. Dual resistance was an exception, treatment-naïve population (41.18%) were more frequently found than the other(29.45%). Dual resistance occupied the largest ratio (30.67%) of resistance patterns. Isolates exhibiting simultaneous resistance to CLA and MET had the largest prevalence (19.63%), followed by CLA+LFX(6.13%). Dual antibiotic resistance rate to CLA and MET from an Iran study (reatment . Based oP = 0.010), we further analysed that MALToma (P = 0.021) was associated with resistance to CLA . MET is a high prescription rate medicine (Some factors were investigated to influence antibiotic resistance profiles in the present study. A significant relationship was found between CLA-resistance and endoscopic diagnosis (e to CLA . It has bacteria , and lonbacteria . An Austning CLA . Howevermedicine . Choe etmedicine  calculatH. pylori infectious patients in Liaoning. Researchers could carry this study continuously, by combining multiple hospitals and expanding the sample size, especially the number of subjects without experienced treatment history, and to explore a more stable antibiotic resistance profile in Liaoning. It is vital for clinical physicians to modify prescriptions, prevent unnecessary antibiotic consumption and evaluate the effectiveness of empirical treatment in time to improve eradication rate.Our study also had limitations. There were limited primary treatment subjects in this study. This is because in clinical practice, antibiotic sensitivity tests are usually applied to patients who have failed eradication several times. Patients without previous treatment history tend to choose empirical treatment regimen, so it is difficult to collect samples from first-treatment subjects, which is also a real problem. But we still offered an updated profile of H. pylori eradication to achieve good success rates and avoid severe antibiotic resistance.In conclusion, among this north China population, the primary resistance rates of LFX, MET, CLA, and AMX were relatively high and different in comparison with the overall or regional resistant data in China. To achieve good success rates, prior antimicrobial resistant tests are suggested before antibiotic prescription in 10.7717/peerj.15268/supp-1Data S1Antibiotic resistance rates and population characteristics, such as age, gender, current smoking status, current drinking conditions, BMI, hypertension, diabetes mellitus, endoscopic diagnosis and H. pylori treatment history.Click here for additional data file.


Self-compacting concrete has seen extensive application in both engineering and construction. In order to save building resources, aeolian sand—recycled coarse aggregate self-compacting concrete (ARSCC) is created by partially substituting recycled coarse aggregates (RCA) and aeolian sand (AS) for natural coarse aggregates. For ten groups with different mechanical and durable properties, this study examined the effects of sulfate erosion, chloride penetration resistance, and related impermeability, as well as AS replacement ratios of 20%, 40%, and 60% and RCA replacement ratios of 25%, 50%, and 75% in ARSCC and a control group (A0-R0). According to the study’s findings, after sulfate attack, the highest relative dynamic elastic modulus and corrosion resistance factor were obtained with the 20% AS replacement ratio and 50% RCA replacement ratio (A20-R50). The highest impermeability grade and lowest electric flux were obtained with the 20% AS replacement ratio and 25% RCA replacement ratio (A20-R25). X-ray diffraction (XRD) and mercury intrusion porosimetry (MIP) revealed that the addition of aeolian sand and recycled coarse aggregates improved the pore structure of the SCC and increased the densification of the self-compacting concrete, particularly following sulfate attack. This study highlights the importance of recycled aggregates and aeolian sand in engineering applications and the sustainable growth of the concrete industry, both of which support resource conservation and environmental protection. The quality, appropriate use, and environmental impact of recycled materials present a difficult situation in the construction business today. In order to produce high-quality concrete, which can have aggregate compositions of up to three-fourths of the volume of the concrete, the construction industry needs a vast amount of natural resources due to increased urbanization . TherefoIn an effort to increase the longevity of concrete constructions, self-compacting concrete (SCC) was introduced in 1988 . SubsequGlobally available aeolian sand can be converted into a green resource through appropriate processing and use ,15. Due Numerous studies have been conducted on the mechanical and durability characteristics of aeolian sand concrete, RCASCC, and recycled aggregate concrete. Trends in the durability characteristics of concrete made with RCA and AS  have beeThus, this study’s goal is to lower building costs and reinforce the idea of sustainability by employing recycled coarse aggregates and fine materials such as AS. Furthermore, it examines and emphasizes how replacing these materials affects water permeability and the long-term effectiveness of ARSCC in sulfate settings.2/kg. The cubic concrete specimens prepared for this study had a strength rating of C30. Fly ash from the Xinjiang Zhongtian Yintai firm and PO42.5 Portland cement, which complies with the standard, were utilized as binders in all concrete combinations during the production process. The specific gravity and specific surface area of Portland cement are 354 mThe fresh concrete was made sufficiently workable, and the water–binder ratio was lowered by using a water reducer with a water reduction rate of roughly 25–30%. The water utilized in this study is from Urumqi, where water is typically sourced from to make concrete.To make ARSCC, aeolian sand was extracted from the Gurbantungut Desert in northern Xinjiang. The ARSCC’s performance is greatly impacted by the characteristics of aeolian sand. This study’s fine aggregate’s fundamental physical characteristics are displayed in Recycled concrete aggregates were derived from Urumqi’s concrete waste. The research generally agrees that there is less mortar adhered to coarse recycled aggregate than fine recycled aggregate ,35. This3, volume substitution was chosen to preserve the stability of the concrete’s constituent parts after substitution and the substitution rate. The AS replacement ratios of 0%, 20%, 40%, and 60% by mass are represented by A0, A20, A40, and S60; the RCA replacement ratios of 0%, 25%, 50%, and 75% by volume are represented by R0, R25, R50, and R75. Water-to-binder (W/B) ratio was 0.33. Prior to molding, the experimental mixes including the different AS and RCA replacement ratios underwent a workability test, as indicated in As seen in After 28 days of curing, compressive strength tests were performed on all ARSCC mixes in compliance with the standard. Cube specimens measuring 150 mm × 150 mm × 150 mm and 100 mm × 100 mm × 100 mm were prepared for the tests.Hard ARSCC’s resistance to chloride penetration was determined with coulomb electric flux tests, and its resistance to water penetration was determined with progressive pressure loading tests using standard procedures. Furthermore, the dimensions of the test components are as follows: for water penetration testing, the round table body was Ø 175 mm × Ø 185 mm × 150 mm, and for electric flux tests, the cylinder measured Ø 100 mm × 50 mm.For four of the six examples in each group, the maximum seepage pressure multiplied by 10 yielded the grade of seepage resistance of the concrete in the absence of seepage. The formula for calculating the seepage resistance grade of concrete is P = 10H − 1, where P represents the impermeability grade and H denotes the seepage pressure (MPa) at which three out of the six specimens experience seepage.NaCl solution with a mass concentration of 3% and NaOH solution with a molar concentration of 0.3 mol/L were simultaneously injected into both sides of the test tank to provide access to 60 V direct current after the specimen was placed into the specimen tank to verify the device’s sealing. The initial current reading, I0, was recorded with the positive electrode on the NaOH side and the negative electrode on the NaCl side. As seen in 2SO4 solution for 15 h, followed by 6 h of drying as part of a 22 h drying–wetting process using HC-LSB concrete sulfate dry–wet cycle testing equipment  100%/m0, where m0 is the starting mass and mi is the mass after N of the dry and wet cycle, can be used to calculate the mass change Dm.With an accuracy of 0.1 g, the mass variations in the specimens under various dry–wet cycles were measured using an electronic balance. After the specimens were dried for 48 h at 45 °C in an oven, the mass was measured. The formula Di is the relative dynamic elastic modulus of the i th concrete sample after N dry and wet cycles; Using a nonmetallic ultrasonic testing analyzer, the concrete’s dynamic modulus of elasticity was determined. The sound velocity of the initial peak value of an ultrasonic wave traveling through the specimens was measured with the instrument, and the sound speed was translated into the concrete’s dynamic elastic modulus. Equations (1) and (2) provide an illustration of the precise formula:The ratio of the compressive strength of concrete specimens subjected to sulfate dry–wet cycle erosion to the compressive strength of the concrete specimens subjected to ordinary curing is known as the corrosion resistance factor . EquatioAn X-ray diffractometer (Bruker D8 advance) was utilized to assess the substances’ composition and content. Samples of cement mortar without gravel were chosen from the same group of sample fragments and crushed, mixed evenly, and filtered using a 300 mesh screen after the compressive strength test was finished. In the end, 1 g of each sample group was extracted for the X-ray diffraction (XRD) test. Following the test, all of the XRD samples were extracted from the pieces and pulverized in an agate mortar. The data files that were collected were then processed using MDI Jade, and graphs were created. XRD was carried out in the 2θ range of 10–75° at a scanning speed of 2°/min in the 2θ range of.3 cubes and drying it in the same conditions as the XRD experiments, the concrete samples for the MIP were taken from the surface of concrete cylinder specimens.An AutoPore Iv 9510 from American Micromeritics was utilized to perform mercury intrusion porosimetry (MIP) testing, which measures the changes in pore structure characteristics caused by sulfate assault. The pressure range tested was 0.2 MPa to 415 MPa. By chopping the concrete into roughly 1 cm2 = 0.758); if the A60-R25 sample is removed, R2 = 0.996 is achieved. The 6 h electric flux of ARSCC exhibits a declining trend as the impermeability grade rises. As a result, water finds it more difficult to pass through ARSCC at certain pressures, which is also indicative of the material’s increasing compactness, decreasing internal pore space, and steadily declining total permeability. Chloride ions also find it challenging to pass through ARSCC. As the impermeability grade rises, the electric flux tends to decrease. The ideal relationship between concrete’s electric flux and impermeability grade would be a strong linear one. However, because ARSCC is a non-homogeneous material, interference from multiple factors might affect its own state. Additionally, there will be varying degrees of impact on the concrete’s exterior morphology and interior structure in the specimen used for molding, curing, vibration, grinding, and other tests. As a result, ARSCC’s attributes cannot be fully represented in a linear relationship during the fitting process.The specimens show varying degrees of damage following varying periods of sulfate dry–wet cycle erosion. After 60 cycles, there was less mortar on the specimen’s exterior and around the prism’s edge, making the erosion phenomenon less noticeable. Following 120 cycles, the specimen’s prism cracks on the outside became more severe. The holes and cracks in the mortar on the specimen’s surface steadily enlarged as the number of sulfate dry–wet cycle erosion events increased; the pores were accompanied by noticeable white particles. Preliminary speculation suggests that the precipitated sulfate crystals were erosion products like ettringite or gypsum. The production of gypsum and secondary ettringite, which exert tension in the expanding concrete, is predicted by the attack model put forth by Santhanam et al.  in respoThe mass loss has been measured in the range of −1.048% to 0.724% for ARSCC mixtures. As seen in 42−.The dynamic elastic modulus was used to analyze the mechanical properties of concrete with the effect of freeze–thaw cycles. It assesses the compactness and faults in concrete with ultrasonic velocity ,41. For The compressive strengths of A20-R50 and A20-R25 declined by 4.9 MPa and 3.1 MPa after 30 to 120 cycles, respectively, compared with their strengths after 30 cycles. The compressive strength of A0-R0 decreased by 4.9 MPa. The findings of the ARSCC’s corrosion resistance factors are displayed in The production of C-S-H gels and the continual hydration of cement could be the cause of the 30-cycle corrosion resistance factor loss in the A0-R0 samples (−4.56%), A20-R25, and A20-R50 samples (−5.28% and −5.71%); however, the microcrack accumulation was enormous . The cor2 = 0.827 for mass change, R2 = 0.803 for relative dynamic elastic modulus, and R2 = 0.904 for corrosion resistance factor. It is evident that impermeability grade and durability are positively correlated. This is because water finds it difficult to pass through ARSCC at standard pressures. It is difficult to penetrate into ARSCC with SO42− ions, which also represents the increase in the compactness of ARSCC. Internal pore space is limited, and only the surface of the pore solution reacts. Concurrently, the fitted curve of the relative dynamic elastic modulus not only has the maximum R2, but also the maximum slope, demonstrating the benefit of the improved compaction, impermeability, and durability of ARSCC.2 when compared to samples with varying replacement ratios. Meanwhile, there are clear Ca(OH)2 peaks in the A60-R75 sample following 120 dry–wet cycles. Ettringite production is accelerated by corrosion time. As per the earlier research, the process of concrete corrosion due to sulfate attacks can be explained as follows: in the pore solution, the dissolved hydrated calcium hydroxide is devoured by the sulfate ions in the chemical reaction, leading to the creation of gypsum [The XRD patterns for samples of every mixture following the sulfate attack are seen in f gypsum ,45. Thenf gypsum . It is df gypsum . The finAs illustrated in As the replacement ratios of AS and RCA increase, the compressive strengths of 7 and 28 days first rise and then decrease thereafter, peaking at 20% AS replacement and 50% RCA replacement. This result implies that self-compacting concrete’s compressive strength can be raised by appropriately replacing the amount of AS and RCA.42− erosion, followed by the gradual enlargement of gel pores and macropores.Self-compacting concrete responds to the addition of AS and RCA with exceptional impermeability and durability. The link between durability and impermeability is unambiguously linear. The combination of increasing amounts of AS and RCA lowers the grade of impermeability significantly and speeds up the pace of degradation at later stages because the fine particles of AS and high porosity of RCA create additional channels for water and SO4 are the results of sulfate erosion. A20-R50 has superior compactness and resistance to sulfate assault, as seen by the pore distribution following the sulfate attack. Incorporating AS and RCA increases cement hydration and decreases erosion product generation. The erosion products gradually increase, the pores enlarge, and the resistance to sulfate attack decreases as the AS and RCA replacement ratio increases.The XRD analysis reveals that ettringite, AFt, and CaSOA thorough examination of the workability, compressive strength, impermeability grade, electric flux, and resistance to sulfate attack indicates that the appropriate replacement ratio is 20% AS to 50% RCA. This study’s narrow scope prevents a thorough evaluation of ARSCC’s performance; instead, it merely serves as a guide for the usage of ARSCC in specific contexts. It is hoped that increasingly complicated operating conditions, like loaded sulfate coupling, loaded freeze–thaw coupling, and chloride salt freeze–thaw coupling, can be researched for ARSCC.This study used the impermeability grade, electric flux, mass loss rate, relative dynamic elastic modulus, and corrosion resistance factor to examine the durability and impermeability of aeolian sand–recycled aggregate self-compacting concrete (ARSCC). The ARSCC was examined under a microscope both before and after the sulfate attack. The study’s primary conclusions are as follows:


Asymptomatic bacteriuria is one of the most common causes of antibiotic use in hospitalised patients. Antibiotic stewardship targeting asymptomatic bacteriuria ( ASB) should focus on diagnostic urine cultures, restricting unnecessary urine cultures, and preventing inappropriate antibiotic use. However, there is limited evidence from developing countries on the impact of the above interventions. This study aimed to assess the appropriateness of urine cultures ordered and also study the antibiotic prescribing pattern for the patient who underwent urine cultures.A prospective, observational study was conducted in a tertiary care hospital in south India between February 2023 and April 2023. The medical records of the hospitalised patients who underwent urine culture  were reviewed by using the validated audit tool, which contained details of demographic data, indications, results of urine culture, and antibiotics prescribed to the patients. The data was audited by the trained Pharm.D. students to establish the appropriateness of the urine cultures ordered and the antibiotic prescribing pattern for the patients who started antibiotics.During the study period 329 case records were audited. And the data is given in the table 1.Most of the urine cultures ( 90.5%) sent are without any urinary symptoms, and 69.5% of patients with asymptomatic bacteriuria receive antibiotics, which contribute to antibiotic resistance. It is necessary to put effective techniques into practice to increase the appropriateness of ordering urine cultures and the use of antibiotics in hospitals.All Authors: No reported disclosures