Search Results (13,639)

Background/Objectives: Adequate bowel preparation (BP) is crucial for effective colorectal cancer (CRC) surveillance in ulcerative colitis (UC). While active inflammation is known to negatively impact cleansing, data regarding predictors of BP quality specifically in UC patients with inactive disease remain limited. This study aimed to investigate risk factors for inadequate BP in UC patients in clinical/endoscopic remission and to compare the efficacy of 1L-PEG-ASC versus 2L-PEG regimens. Methods: A multicentric, retrospective, cohort study was conducted across eight Italian centers. Consecutive adult outpatients with UC undergoing colonoscopy between January-2021 and December-2022 who were in endoscopic and clinical remission were included. Boston Bowel Preparation Scale (BBPS) was assessed in patients undergoing 1L-PEG-ASC or 2L-PEG bowel preparation. Univariable and multivariable logistic regression analyses were performed to identify risk factors for inadequate BP and compare outcomes between PEG regimens. Results: A total of 379 patients were included (58% M, mean age 52.3 ± 15.4 years). The overall rate of adequate BP was 90.5%. Traditional risk factors, including demographic, clinical, and endoscopic characteristics, were not predictive of inadequate preparation in this remission cohort. Comparing regimens, 1L-PEG-ASC yielded significantly higher median total BBPS scores compared to 2L-PEG (8 [IQR 7–9] vs. 6 [IQR 6–8]; p < 0.001) and a higher exam completion rate (99.5% vs. 95.7%; p = 0.02), although the difference in adequate BP rates did not reach statistical significance (92.6% vs. 87.7%; p = 0.12). Multivariable analysis confirmed that 2L-PEG was independently associated with lower odds of achieving higher BBPS scores (OR 0.30; 95% CI 0.20–0.45). Conclusions: In UC patients with clinical and endoscopic remission, BP adequacy rates are high and comparable to the general population, suggesting that traditional IBD-related risk factors are less relevant in the absence of active inflammation. However, the 1L-PEG-ASC regimen demonstrated superior cleansing quality and exam completion rates compared to 2L-PEG. These findings support the prioritization of 1L-PEG-ASC to optimize mucosal visualization during CRC surveillance in this population. Full article

Background/Objectives: Lupus Nephritis (LN) is a major complication of Systemic Lupus Erythematosus (SLE) leading to significant morbidity. While biopsy is the gold standard, non-invasive tools are needed for longitudinal monitoring. This study aims to evaluate the diagnostic utility of Shear Wave Elastography (SWE) in detecting subclinical renal damage (fibrosis) in SLE patients with a history of LN who are currently in clinical remission (inactive disease), and to compare its efficacy with Doppler ultrasonography (DUS). Methods: This cross-sectional study included 80 SLE patients and 41 age- and sex-matched healthy controls. Crucially, all SLE patients were in the clinically inactive disease (SLEDAI-2K < 6) at the time of evaluation. Patients were stratified into two groups: those with a history of LN (LN Group, n = 37) and those without (Non-LN SLE Group, n = 43). Strict exclusion criteria were applied to eliminate non-SLE renal comorbidities. Renal parenchymal stiffness (kPa) was measured using SWE, and the renal resistive index (RI) was assessed using DUS. SWE findings were correlated with renal function tests and disease activity scores. Results: Despite being in clinical remission, the LN group exhibited significantly higher renal stiffness values (Median: 1.60 kPa) compared to the non-LN SLE group (1.40 kPa, p < 0.001) and healthy controls (1.32 kPa, p < 0.001). No significant difference was observed between the non-LN SLE group and controls. Unlike SWE, renal RI values showed no statistically significant difference among the groups (p > 0.05). Correlation analysis revealed that renal stiffness was positively associated with prior serum creatinine and disease activity (SLEDAI-2K), and negatively associated with eGFR. Conclusions: SWE is superior to DUS (RI) in detecting renal parenchymal changes in LN patients. The persistence of elevated stiffness during the inactive disease suggests that SWE captures cumulative chronic damage (remodeling and fibrosis) rather than just acute inflammation. Consequently, SWE holds promise as a non-invasive surrogate for monitoring disease chronicity in SLE patients. Full article

Introduction: Minor digestive ailments are a common reason for individuals to visit pharmacies, and can be efficiently managed through structured pharmaceutical advice. This study aimed to evaluate the effectiveness of advice provided by pharmacists in community pharmacies from the perspectives of both patients and pharmacists. The primary focus of the study was not on assessing the effectiveness of a specific medication, but rather on the pharmaceutical advice provided. Materials and Methods: This prospective multicenter observational study was conducted between January and March 2025 in community pharmacies across Poland among adult patients with dyspepsia without alarm symptoms and included two visits: an initial visit and a follow-up phone call after 7–14 days. Symptom severity across seven domains was assessed using a GSRS-based tool, and data on adherence, treatment regimen, patient satisfaction, and acceptable costs of the two-visit service were collected. Statistical analyses (p < 0.05) using both parametric and non-parametric tests were performed on data from 100 participants who completed the study, with cost data serving as a proxy for willingness to pay. Results: Most patients (92.7%) reported symptom improvement, with a median time to relief of 3 days and good treatment adherence. The greatest benefits were observed for abdominal pain and flatulence, and higher baseline symptom severity was consistently associated with greater improvement. Service acceptability was high, and patients’ reported willingness to pay suggests perceived value and potential economic feasibility of the service. Conclusions: Structured pharmaceutical advice for digestive ailments (including triage, education, management plans, and monitoring of effects) led to rapid and clinically significant improvements in most patients. This approach demonstrates high adherence rates and positive acceptability. The stability of effects across different demographic groups, along with a predictable pattern of changes in various domains, supports the expansion of this service and customization of educational messages. Full article

Since 2000, the vegetation cover in the Yellow River Basin (YRB) has significantly increased. However, the responses of carbon and water cycles to large-scale vegetation recovery in the basin and their driving mechanisms remain unclear. This study employs methods such as Sen’s slope trend test, partial correlation analysis, residual analysis, and interpretable machine learning models to investigate the variations in gross primary productivity (GPP), evaporation (ET), and water use efficiency (WUE) in the YRB. It aims to reveal the spatial differentiation mechanisms that drive GPP, ET, and WUE. The results indicate the following: (1) From 2001 to 2020, significant increasing trends were observed in GPP, ET, and WUE across the YRB (p < 0.05), with the most pronounced vegetation recovery observed in the middle reaches. (2) GPP, ET, and WUE are most strongly correlated with the Leaf Area Index, with median values of 0.78, 0.30, and 0.70, respectively. (3) On average, climate change contributes spatially 24.8%, 35.6%, and 24.3% to GPP, ET, and WUE, respectively, while human activities contribute, on average, 75.2%, 64.4%, and 75.7%. (4) Regarding their synergistic evolution, GPP changes predominantly drive WUE changes in the YRB relative to ET. (5) The contributions of NDVI changes to WUE, GPP, and ET changes are 60.4%, 73.1%, and 14.9%, respectively. Overall, NDVI changes dominate the changes in GPP and, by extension, in WUE. This research sheds light on the pathways toward ecological restoration and sustainable development in the YRB. Full article

Objectives: This study aimed to identify key predictors of prolonged hospitalization in children with community-acquired pneumonia by comparing demographic and clinical characteristics between patients with expected and extended hospital stays. Methods: A retrospective cohort study was conducted for children younger than 15 years hospitalized with pneumonia between May 2015 and March 2020. Patients with hospital-acquired pneumonia or additional diagnoses were excluded. Demographic and clinical variables were collected. Statistical analysis, including logistic regression, was performed using SPSS v28 to identify independent predictors of prolonged hospitalization. Results: A total of 455 pediatric patients were included, with a median age of 2 years and a median length of stay of 6 days. Prolonged hospitalization occurred in 27.5% (n = 125) of cases. Gender distribution did not differ significantly between groups (p = 0.727). Significant predictors of prolonged hospitalization included moderate-to-severe pneumonia (p < 0.001, OR = 9.7, 95% CI = 3.1–30.9), pneumonia complications (p = 0.019, OR = 15.16, 95% CI = 1.57–146.3), and underlying chronic conditions (p = 0.009, OR = 2.88, 95% CI = 1.3–6.4). While hypoxia, ventilatory support, and bacteremia were associated with prolonged stay, they did not emerge as independent predictors in the final multivariable model. Conclusion: Prolonged hospitalization in pediatric pneumonia is strongly associated with increased disease severity, complications, and chronic comorbidities. Early identification of high-risk patients may facilitate targeted management strategies, improve outcomes, and reduce healthcare burden. Full article

Background: Limited data inform the outcomes of patients with high-risk neuroblastoma (HR-NBL) who relapse after high-dose chemotherapy, autologous stem cell transplantation (ASCT), and external beam radiotherapy (EBRT). Methods: This is a multi-institutional retrospective study of 84 patients with HR-NBL diagnosed between 1997–2021 with a first recurrence after definitive upfront treatment, including ≥1 ASCT and EBRT. Site(s) of first relapse were defined with relation to a patient’s primary tumor location. Progression-free survival (PFS) and overall survival (OS) outcomes were analyzed using Kaplan–Meier curves and log-rank tests. Cox proportional hazard models were used for univariate and multivariable analyses. Results: Twenty-four patients had local recurrences with or without distant relapses (LR) and 60 had distant relapses only. The LR cohort had higher rates of MYCN amplification (70% vs. 36%, p = 0.016). At relapse, the LR cohort had lower rates of additional radiotherapy (32% vs. 61%, p = 0.029) and higher rates of additional surgery (29% vs. 5%, p = 0.005), with similar rates of chemotherapy for both cohorts. With a median follow-up after first relapse of 1.53 years (range: 0.03–15.82), there were no significant differences in interval PFS and OS between the cohorts. After controlling for age at diagnosis and pattern of recurrence, time to interval relapse ≥ 2 years was a significant predictor of improved OS (HR: 0.50, 95% CI: 0.29–0.85, p = 0.011). Conclusions: Patients with relapsed HR-NBL have poor outcomes with median OS < 2 years. Time to relapse was a significant predictor of OS. Full article

Background/Objectives: Patients with early-stage non-small cell lung cancer (NSCLC) or limited lung metastases and compromised lung function, such as those with interstitial lung disease (ILD) or chronic obstructive pulmonary disease (COPD), or other factors rendering them high-risk for surgery or medically inoperable, face increased risks of treatment-related toxicity from stereotactic ablative radiation therapy (SABR). This study evaluated a novel treatment approach to mitigate these risks. Methods: We investigated Personalized Ultra-Fractionated Stereotactic Adaptive Radiotherapy (PULSAR), delivered as pulsed radiation every three weeks, in patients with <5 cm lung tumors and ILD, COPD, or prior therapy. Treatment occurred between 2022 and 2024. Online adaptive radiotherapy (o-ART) was employed in 20 patients (80%) to modify treatment plans when anatomical changes warranted replanning. Primary outcomes included volumetric tumor response, changes in dose to organs at risk (OARs) and acute events, while secondary outcomes included local and tumor control, and overall survival. Results: Twenty-three patients received PULSAR treatment at doses between 40 Gy and 60 Gy in 5 fractions and one patient received 54 Gy in 3 fractions, with a median follow-up time of 16.2 months. Approximately half of treated patients demonstrated volumetric tumor response, with median residual volume of 70% (range 36–100%) at maximal response. Among the 20 patients (80%) who underwent online adaptive replanning, significant reductions in OAR dosimetry were observed for all organs assessed including the Dmax for heart (p = 0.0053), bronchus (p = 0.0003), esophagus (p = 0.0005), spinal cord (p = 0.025), and the lung V20 Gy and V12.5 Gy (p < 0.0001). Treatment-related toxicity included two grade 1–2 adverse events and six grade 3 events consisting of pneumonitis, dyspnea or lung infection, with no grade 4 or 5 events. Median progression-free survival was 21.1 months, with 1-year overall survival of 74% and 1-year local control of 100%. Conclusions: PULSAR shows promise as a feasible treatment option for high-risk patients with NSCLC or lung metastases, demonstrating no grade 5 events and complete tumor control. Additional research is needed to fully evaluate the safety profile of PULSAR in the high-risk subgroups and whether PULSAR’s treatment intervals and adaptive planning advantages lead to improved long-term outcomes compared to conventional, uninterrupted SABR regimens. Full article

Introduction: Step counts are increasingly used to assess mobility and track recovery following total knee arthroplasty (TKA). The purpose of this study was to assess the convergent validity of step count data captured by a smart implantable device (SID) in comparison with step counts derived from established, validated sensor-based technology. Methods: A secondary analysis of an anonymized commercial database (N = 7861, median age: 68, female: 59%, median BMI: 31.7) of patients who received an SID and used a digital care management application (App) with or without a smart watch. The SID recorded “qualified steps”, defined as periods of walking for at least seven steps that met predefined acceleration and cadence thresholds between 7 am and 10 pm. The App collected total daily step counts via smartwatch and/or smartphone. Pearson correlations were calculated between SID and App data at 30, 90, and 180 days post-operative. Step counts at 30, 90, and 180 days post-operative were compared between groups with the Mann–Whitney U test. Statistical significance was assessed at p < 0.001. Results: Step counts increased throughout the recovery period as measured by all three devices. SID-captured fewer qualified steps than App-captured step counts from watch-wearers throughout the post-operative period (p ≤ 0.001). SID step counts were similar to App step counts at 30 days post-operative and greater than App step counts at 90 and 180 days post-operative (p < 0.001). There were significant (p < 0.001), moderate correlations (r = 0.62 to r = 0.74) between step counts collected by the SID and App for both watch-wearers and smartphone-carriers at 30, 90, and 180 days post-operative. Conclusions: The SID’s qualified step metric demonstrated consistent, moderate, correlations with app-based step counts across 30, 90, and 180 days. While smartwatch-based tools recorded higher absolute step counts, both technologies reflected similar recovery trajectories. Full article

Several studies investigated risk and prognostic parameters for horses with colic; however, the consensus is still debated. The present work aimed to investigate colic outcomes and to identify risk factors in horses referred for colic. In this multicenter retrospective study, 236 clinical records of equids referred for colic at three different equine centers were reviewed. The following data were collected: history, signalment, physical examination at the time of admission, hematological and biochemical analysis, diagnosis, SIRS status and 0–6 point-scale SIRS score, colic type, treatment attempted, and outcome. Descriptive statistics were performed, and distribution of continuous variables was reported as median and percentile. A multivariable logistic regression model was applied to assess parameters associated with colic outcomes in horses (p < 0.05). A total of 138/236 horses were included in the study. The univariate analysis identified as potentially associated with the outcome: sex (p = 0.046), colic type (p < 0.001), treatment type (p < 0.001), SIRS score (p = 0.049), age (p-value = 0.057), heart rate (p = 0.013), and respiratory rate (p = 0.017). The logistic regression model indicated that colic type (p < 0.001) and age (p = 0.004) were significantly associated with a negative outcome. Equine colic risks are multifactorial; prognosis declines with age and strangulating obstructive non-strangulating colic. Poor outcomes link to cardiovascular signs like elevated heart rate, SIRS status and score, and blood lactate. Heterogeneity from diverse sites limits generalizability, but standardized protocols, binarized data, and a multicenter approach enhance robustness and representativeness while reducing local biases. Full article

Background: Velocity-based training (VBT) is used to estimate maximal strength and prescribe resistance-training loads, but evidence in untrained youth, especially early-adolescent females, is limited. In untrained early-adolescent females performing free-weight back squats, (1) the load–velocity relationship (LVR) is comparable to adult samples, albeit with greater between-subject variability, and (2) one-repetition maximum (1RM) estimates are affected by the minimum velocity threshold (MVT) anchor. Methods: Thirty-four untrained females (10–14 years) completed two progressive loading tests followed by actual 1RM attempts. Mean propulsive velocity (MPV) was recorded to model LVRs. Three MVTs were considered: (a) Actual (from Test 1), (b) General (0.30 m·s⁻¹), and (c) Optimal (individualized to minimize prediction error in Test 1). LVR-based 1RM estimates from Multi-point and Two-point approaches were generated in Test 2 using each MVT and compared with the actual 1RM. Results: MPV decreased near-linearly with load (median R² ≈ 0.996), from 1.00 ± 0.19 m·s⁻¹ at ~40%1RM to 0.30 ± 0.05 m·s⁻¹ at 100%1RM. Across MVTs, Two- and Multi-point models showed similar 1RM accuracy (≤~0.7% difference; p > 0.35). Actual and General MVTs overestimated 1RM (+5.1 kg; p < 0.001), whereas an individualized Optimal MVT (~0.38 m·s⁻¹) removed bias (+0.6 kg; p = 0.52) and reduced error (p ≈ 0.03). Conclusions: In untrained early-adolescent females, the back-squat LVR is highly linear, and 1RM estimation accuracy hinges on the MVT anchor. A streamlined Two-point LVR paired with an individualized Optimal MVT provides an efficient, accurate workflow for youth strength assessment. Full article

Background/Objectives: The study aims to provide a comprehensive understanding of personalized treatment for patients with inguinal hernias at our hospital, focusing on complications, recurrence rates, and hospitalization duration to optimize treatment outcomes. Methods: Our center performs inguinal hernia surgery using an algorithm tailored to individual clinical conditions, developed in collaboration with the anesthesiology department. We retrospectively reviewed outcomes of open, totally extraperitoneal (TEP), and transabdominal preperitoneal (TAPP) approaches, with all procedures performed by a single surgeon. Results: A total of 229 patients (213 males; age range, 24–92 years; median age, 69 years) underwent inguinal hernia repair at Busan National University Hospital between January 2018 and April 2024. Patients in the open group had higher age and comorbidity burden (age/ASA American Society of Anesthesiologists physical status classification: open 74/3.5 vs. TAPP 70/2.0 vs. TEP 68/2.0; p = 0.036/< 0.001). There were no statistically significant differences in intraoperative complications (p = 1.000); however, the conversion rate was slightly higher in the TEP group (TEP 2 vs. TAPP 1). Length of hospital stay was longest in the TAPP group (open 3.77 days vs. TAPP 3.98 days vs. TEP 3.27 days; p = 0.817), while postoperative complication rates did not differ significantly among groups (overall complications: open 15.4% vs. TAPP 6.2% vs. TEP 4.3%; p = 0.100). Conclusions: Laparoscopic surgery is recommended when general anesthesia is feasible, with TEP preferred for patients without previous surgeries and TAPP for those with preperitoneal space (PPS) access challenges due to previous surgeries or radiation therapy. Open surgery is suitable for patients unable to undergo general anesthesia. Anesthesia and surgical approaches should be based on patient preferences and individual clinical conditions. Full article

Background/Objectives: The prognostic significance of blood tumor mutational burden (bTMB) in metastatic colorectal cancer (mCRC) remains poorly defined. While tissue-based TMB has been associated with favorable outcomes in selected colorectal cancer subgroups, the clinical meaning of bTMB in real-world practice is unclear. This study evaluated the prognostic impact of bTMB measured through liquid biopsy in an unselected cohort of patients with mCRC. Methods: This monocentric, real-world study included 255 adult patients with pMMR/MSS mCRC who underwent routine comprehensive genomic profiling using the FoundationOne^® Liquid CDx assay. bTMB was quantified in mutations per megabase (mut/Mb), and patients were classified into bTMB-low and bTMB-high groups using the cohort median. The primary endpoint was overall survival (OS). Subgroup analyses, including stratification by RAS/BRAF mutation status, were descriptive. Results: The median bTMB was 5 mut/Mb. Patients in the bTMB-high group had an increased risk of death compared with those in the bTMB-low group (hazard ratio (HR) 1.88). The adverse prognostic effect for OS of high bTMB was more pronounced in patients with RAS mutant tumors (HR 2.32) than with RAS/BRAF wild-type tumors (HR 1.81), while no prognostic impact was observed in BRAF^V600E mutant tumors (HR 0.90). bTMB was strongly correlated with ctDNA fraction (p < 0.0001). Conclusions: In routine clinical practice, elevated bTMB is associated with poor prognosis in pMMR/MSS mCRC, particularly in RAS mutant tumors. These results contrast with prior tissue-based studies and indicate that bTMB may reflect tumor burden and aggressive disease biology rather than tumor immunogenicity. Prospective studies integrating bTMB with ctDNA fraction, tumor burden metrics, and longitudinal molecular dynamics are warranted to refine its clinical utility. Full article

Background: The learning curve for robotic low anterior resection (LAR) utilizing the modern da Vinci Xi system within a high-volume, standardized environment remains poorly defined. This study aimed to delineate the technical proficiency of a single high-volume surgeon using the Xi platform. Methods: A retrospective analysis of 95 consecutive patients undergoing robotic LAR for primary rectal malignancy between 2020 and 2023 was conducted. All procedures were performed by a single surgeon using the da Vinci Xi system under a standardized ERAS protocol. Cumulative sum (CUSUM) analysis of operative time was used to define learning phases. Results: CUSUM analysis identified a proficiency inflection point after 16 cases. Median docking time significantly decreased in the proficiency phase (14.5 vs. 10.0 min, p < 0.01). Notably, zero conversions to open surgery occurred throughout the series. Comparative analysis revealed comparable overall complication rates (0.0% vs. 13.9%, p = 0.201) and postoperative length of stay between phases. Short-term oncological quality, including lymph node yield and circumferential resection margins, remained satisfactory in both groups. Technical precision, reflected by consistently low robotic stapler firings (median 2.0), was maintained from the outset. Conclusions: Technical proficiency in robotic LAR using the da Vinci Xi system was rapidly achieved after approximately 16 cases in this high-volume standardized setting. This accelerated learning curve was not associated with compromised perioperative safety or oncological outcomes. Full article

Immune checkpoint inhibitors (ICIs) have improved outcomes in advanced non-small cell lung cancer (NSCLC). The influence of statin use, chemotherapy, PD-L1 expression, and sex on immunotherapy outcomes remains incompletely defined in real-world settings. We performed a multicenter retrospective analysis of patients with advanced NSCLC treated with immunotherapy-based regimens. Patients were stratified by statin exposure, chemotherapy use, PD-L1 expression (<1% vs. ≥1%), and sex. Overall survival (OS) and progression-free survival (PFS) were analyzed using Kaplan–Meier estimates and log-rank tests. Statin use was not associated with a significant OS benefit, while a numerical improvement in PFS was observed in selected subgroups. Among immunotherapy-treated patients, OS did not differ significantly by chemotherapy or statin use (median range, 19–27 months), whereas PFS differed significantly, with the longest PFS observed in patients receiving immunotherapy plus statins (26 months; p = 0.046). PD-L1 expression was the strongest determinant of outcomes, with PD-L1 ≥ 1% tumors demonstrating markedly longer OS and PFS compared with PD-L1 < 1% disease (OS up to 31 vs. 16 months; PFS up to 21 vs. 12 months; p < 0.001). No significant differences in OS or PFS were observed by sex or statin exposure (OS, 23–27 months; PFS, 14–19 months). In this real-world cohort, PD-L1 expression remained the primary predictor of survival outcomes following immunotherapy. Statin use was associated with modest PFS improvements but no consistent OS benefit, while sex did not significantly influence outcomes. These findings support continued reliance on established biomarkers and warrant prospective evaluation of statins as potential adjuncts to immunotherapy. Full article

Background/Objective: To identify the risks and outcomes of extensively drug-resistant Gram-negative bacilli (XDR-GNB) in neonates. Methods: This retrospective case–control study (1995–2024) included neonates with late-onset sepsis (n = 132) and XDR-GNB bacteremia (n = 26) compared with those without XDR-GNB (n = 106). Results: Median gestational age was 31 weeks and birth weight 1540 g. The prevalence of XDR-GNB was 19.7%. The most common XDR-GNB and non-XDR-GNB pathogens were Acinetobacter baumannii and Klebsiella pneumoniae. Sepsis onset occurred earlier in the XDR-GNB group than in the non-XDR-GNB group (7.0 vs. 12.5 days, p = 0.005). In multivariable analysis using Firth’s penalized likelihood method, the XDR-GNB group was more likely to have gastrointestinal anomalies (adjusted odds ratio 3.81, 95% confidence interval 1.24–12.01, p = 0.02) and history of umbilical arterial catheterization (adjusted odds ratio 3.04, 95% confidence interval 1.21–7.95, p = 0.02) compared to the non-XDR-GNB group. The XDR-GNB group had higher rates of septic shock (50.0% vs. 18.9%, p = 0.002) and inadequate empiric antimicrobial therapy (34.6% vs. 13.2%, p = 0.02). The non-susceptibility rates to third-generation cephalosporins, gentamicin, carbapenems, amikacin, and colistin were 83.3%, 58.3%, 48.1%, 30.4%, and 4.4%, respectively. Conclusions: Empirical colistin treatment is warranted for neonates in high-XDR environments who exhibit septic shock and have specific risk factors, such as gastrointestinal anomalies or the presence of an umbilical arterial catheter. Multimodal interventions, including antimicrobial stewardship programs, have been used to prevent or reduce the incidence of neonatal XDR-GNB sepsis. Full article