Identification and characterization of RAC1-related immune and prognostic subtypes of hepatocellular carcinoma.

BACKGROUND: Hepatocellular carcinoma (HCC) is a malignant tumor with significant variability in prognosis among patients. Ras-related C3 botulinum toxin substrate 1 (RAC1) is a key focus in the area of cancer research. However, the molecular mechanisms of RAC1 in HCC remain incompletely elucidated. MATERIALS AND METHODS: In this study, bioinformatics analysis was used, and public databases were used to obtain information about HCC cases. The samples were categorized into two groups of high and low expression based on the expression level of RAC1 gene. The limma package was used to calculate the differentially expressed genes between the two groups, and univariate Cox regression analysis was used to screen the prognostic related factors. Consensus clustering analysis was performed using the ConsensusClusterPlus package to identify molecular subtypes of HCC patients. Immune cell infiltration and ESTIMATE scores were assessed using the single sample gene set enrichment analysis and ESTIMATE algorithms. The sensitivity of different isoforms to chemotherapeutic agents was predicted by the oncoPredict package. Finally, we also performed cell function experiments to validate the biological role of RAC1 in vitro. Initially, we classified patients into high and low expression groups based on RAC1 gene expression levels and identified 195 up-regulated genes and 107 down-regulated genes. Through univariate Cox regression analysis, we screened out 169 prognosis-related factors. Furthermore, HCC patients were categorized into two subtypes. Subsequently, Kaplan-Meier survival curves showed that there was a significant difference in prognosis between the two molecular subtypes. Further analysis indicated substantial differences in gene expression levels and TIDE scores between two molecular subtypes. Moreover, these two subtypes exhibited varying sensitivity to chemotherapy drugs, as evidenced by differences in IC50 values. In addition, we found that the silence of RAC1 could effectively inhibit the migration and invasion of HCC cells in vitro. CONCLUSION: This study sheds light on the molecular intricacies of RAC1 in HCC and identifies patient populations that may benefit from immunotherapeutic interventions, with potential implications for tailored treatment strategies.

Construction of Cs2AgBiCl6/COF Heterojunction for Boosted Photocatalytic Thioester Oxidation.

Lead-free halide perovskites as a new kind of potential candidate for photocatalytic organic synthesis have attracted much attention recently. The rational heterojunction construction is regarded as an efficient strategy to delicately regulate their catalytic performances. Herein, a semi-conductive covalent organic framework (COF) nanosheet, C4N, is employed as the functional component to construct Cs2AgBiCl6/C4N (CABC/C4N) heterojunction. It is found that the C4N nanosheets with rich surface functional groups can serve as heterogeneous nucleation sites to manipulate the growth of CABC nanocrystals and afford close contact between each other, therefore facilitate the transfer and spatial separation of photogenerated charge carriers, as verified by in situ X-ray photoelectronic spectroscopy and Kelvin probe force microscopy. Moreover, the oxygen affinity of C4N endows the heterojunctions with outstanding aerobic reactivity, thus improving the photocatalytic performance largely. The optimal CABC/C4N heterojunction delivers a thioanisole conversion efficiency of 100% after 6 h, which is 2.2 and 7.7-fold of that of CABC and C4N. This work provides a new ideal for the design and application of lead-free perovskite heterojunction photocatalysts for organic reactions.

Band Structure Optimized by Electron-Acceptor Cations for Sensitive Perovskite Single Crystal Self-Powered Photodetectors.

Low-dimensional perovskites afford improved stability against moisture, heat, and ionic migration. However, the low dimensionality typically results in a wide bandgap and strong electron-phonon coupling, which is undesirable for optoelectronic applications. Herein, semiconducting A-site organic cation engineering by electron-acceptor bipyridine (bpy) cations (2,2'-bpy2+ and 4,4'-bpy2+) is employed to optimize band structure in low-dimensional perovskites. Benefiting from the merits of lower lowest unoccupied molecular orbital (LUMO) energy for 4,4'-bpy2+ cation, the corresponding (4,4'-bpy)PbI4 is endowed with a smaller bandgap (1.44 eV) than the (CH3NH3)PbI3 (1.57 eV) benchmark. Encouragingly, an intramolecular type II band alignment formation between inorganic Pb-I octahedron anions and bpy2+ cations favors photogenerated electron-hole pairs separation. In addition, a shortening distance between inorganic Pb-I octahedral chains in (4,4'-bpy)PbI4 single crystal (SC) can effectively promote carrier transfer. As a result, a self-powered photodetector based on (4,4'-bpy)PbI4 SC exhibits 131 folds higher on/off ratio (3807) than the counterpart of (2,2'-bpy)2Pb3I10 SC (29). The presented result provides an effective strategy for exporting novel organic cation-based low-dimensional perovskite SC for high-performance optoelectronic devices.

Congenital myopathies: pathophysiological mechanisms and promising therapies.

Congenital myopathies (CMs) are a kind of non-progressive or slow-progressive muscle diseases caused by genetic mutations, which are currently defined and categorized mainly according to their clinicopathological features. CMs exhibit pleiotropy and genetic heterogeneity. Currently, supportive treatment and pharmacological remission are the mainstay of treatment, with no cure available. Some adeno-associated viruses show promising prospects in the treatment of MTM1 and BIN1-associated myopathies; however, such gene-level therapeutic interventions target only specific mutation types and are not generalizable. Thus, it is particularly crucial to identify the specific causative genes. Here, we outline the pathogenic mechanisms based on the classification of causative genes: excitation-contraction coupling and triadic assembly (RYR1, MTM1, DNM2, BIN1), actin-myosin interaction and production of myofibril forces (NEB, ACTA1, TNNT1, TPM2, TPM3), as well as other biological processes. Furthermore, we provide a comprehensive overview of recent therapeutic advancements and potential treatment modalities of CMs. Despite ongoing research endeavors, targeted strategies and collaboration are imperative to address diagnostic uncertainties and explore potential treatments.

Ambient energy harvesters in wearable electronics: fundamentals, methodologies, and applications.

In recent years, wearable sensor devices with exceptional portability and the ability to continuously monitor physiological signals in real time have played increasingly prominent roles in the fields of disease diagnosis and health management. This transformation has been largely facilitated by materials science and micro/nano-processing technologies. However, as this technology continues to evolve, the demand for multifunctionality and flexibility in wearable devices has become increasingly urgent, thereby highlighting the problem of stable and sustainable miniaturized power supplies. Here, we comprehensively review the current mainstream energy technologies for powering wearable sensors, including batteries, supercapacitors, solar cells, biofuel cells, thermoelectric generators, radio frequency energy harvesters, and kinetic energy harvesters, as well as hybrid power systems that integrate multiple energy conversion modes. In addition, we consider the energy conversion mechanisms, fundamental characteristics, and typical application cases of these energy sources across various fields. In particular, we focus on the crucial roles of different materials, such as nanomaterials and nano-processing techniques, for enhancing the performance of devices. Finally, the challenges that affect power supplies for wearable electronic products and their future developmental trends are discussed in order to provide valuable references and insights for researchers in related fields.

Effectiveness and Safety of Early Versus Routine Switching from Low-Molecular-Weight Heparin to Maintenance Therapy of Rivaroxaban for Acute Iliofemoral Vein Thrombosis: A Retrospective Cohort Study.

BACKGROUND: The anticoagulation strategy of switching to rivaroxaban after 1 week of initial low-molecular-weight heparin (LMWH) therapy is recommended by a guideline for the treatment of acute iliofemoral deep vein thrombosis (DVT). However, the initial rivaroxaban dose in the switching strategy, as well as the effectiveness and safety of the early switching (less than 1 week) to rivaroxaban, remain inadequately substantiated. We aimed to evaluate the effectiveness and safety of early switching from LMWH to maintenance therapy of rivaroxaban (20 mg once daily) for acute iliofemoral DVT. METHODS: A retrospective cohort study was conducted using data from patients with acute iliofemoral DVT who received initial LMWH anticoagulation followed by rivaroxaban maintenance therapy. The clinical outcomes were compared between early (LMWH course ≤7 days) and routine (LMWH course >7 days) switching strategies within 3 months of initiating anticoagulation. RESULTS: 217 patients were included, 59 (27.2%) receiving early switching and 158 (72.8%) receiving routine switching. Compared with routine switching, patients with early switching had a significantly shorter hospital stay (7 days vs. 14 days, P < 0.001). The length of hospital stay was significantly positively correlated with the duration of LMWH (r = 0.762, P < 0.001). The incidences of recurrent venous thromboembolism (5.1% vs. 2.5%, P = 0.606), major bleeding (0% vs. 1.9%, P = 0.564), clinically relevant nonmajor bleeding (1.7% vs. 2.5%, P = 1.000) and all-cause mortality (6.8% vs. 2.5%, P = 0.283) were not statistically different between the 2 groups. CONCLUSIONS: Direct early switching from LMWH to maintenance therapy of rivaroxaban is effective and safe for acute iliofemoral DVT.

Strategies to engineer various nanocarrier-based hybrid catalysts for enhanced chemodynamic cancer therapy.

Chemodynamic therapy (CDT) is a newly developed cancer-therapeutic modality that kills cancer cells by the highly toxic hydroxyl radical (˙OH) generated from the in situ triggered Fenton/Fenton-like reactions in an acidic and H2O2-overproduced tumor microenvironment (TME). By taking the advantage of the TME-activated catalytic reaction, CDT enables a highly specific and minimally-invasive cancer treatment without external energy input, whose efficiency mainly depends on the reactant concentrations of both the catalytic ions and H2O2, and the reaction conditions (including pH, temperature, and amount of glutathione). Unfortunately, it suffers from unsatisfactory therapy efficiency for clinical application because of the limited activators (i.e., mild acid pH and insufficient H2O2 content) and overexpressed reducing substance in TME. Currently, various synergistic strategies have been elaborately developed to increase the CDT efficiency by regulating the TME, enhancing the catalytic efficiency of catalysts, or combining with other therapeutic modalities. To realize these strategies, the construction of diverse nanocarriers to deliver Fenton catalysts and cooperatively therapeutic agents to tumors is the key prerequisite, which is now being studied but has not been thoroughly summarized. In particular, nanocarriers that can not only serve as carriers but are also active themselves for therapy are recently attracting increasing attention because of their less risk of toxicity and metabolic burden compared to nanocarriers without therapeutic capabilities. These therapy-active nanocarriers well meet the requirements of an ideal therapy system with maximum multifunctionality but minimal components. From this new perspective, in this review, we comprehensively summarize the very recent research progress on nanocarrier-based systems for enhanced CDT and the strategies of how to integrate various Fenton agents into the nanocarriers, with particular focus on the studies of therapy-active nanocarriers for the construction of CDT catalysts, aiming to guide the design of nanosystems with less components and more functionalities for enhanced CDT. Finally, the challenges and prospects of such a burgeoning cancer-theranostic modality are outlooked to provide inspirations for the further development and clinical translation of CDT.

Multiple Nodes Co-Carrier Cooperative Transmission in LEO Communication Networks: Developing the Diversity Gain of Satellites.

Low Earth orbit (LEO) satellite communication (SATCOM) networks have gradually been recognized as an efficient solution to enhance ground-based wireless networks. As one of the main characteristics of LEO SATCOM, the beam-edge area could be covered by multiple satellite nodes. In this case, user terminals (UTs) located at the beam-edge have the chance to connect one or more LEO satellites. To develop the diversity gain of multiple nodes in the overlapping area, we propose two high spectral efficiency cooperative transmission strategies, i.e., directly combining (DC) and selection combining (SC). In the DC scheme, signals arrived at the UT simultaneously could be combined into one enhanced signal. For downlink time division multiplexing, the SC scheme enables the UT to select the strongest signal path. Further, as there exists a significant channel gain difference of the beam-center and beam-edge areas, UTs in these two areas can be allocated in one resource block. In this case, we derive co-carriers based on DC and SC, respectively. To deeply analyze the novel methods, we study the ergodic sum-rate and outage probability while the outage diversity gain is further provided. Simulation results show that the co-carrier-based DC method has the ability to provide a higher ergodic sum-rate while the SC method performs better in terms of the outage probability.

Calcium oxide enhances the anaerobic co-digestion of excess sludge and plant waste: performance and mechanism.

The study investigates the effect of the oxidant calcium oxide (CaO) on the codigestion of excess sludge (ES) and plant waste (PW) under mesophilic anaerobic conditions to enhance methane production. The findings indicate that CaO significantly elevated methane yield in the codigestion system, with an optimum CaO addition of 6% resulting in a maximum methane production of 461 mL/g volatile solids, which is approximately 1.3 times that of the control group. Mechanistic exploration revealed that CaO facilitated the disintegration of organic matter, enhanced the release of soluble chemical oxygen demand, and increased the concentrations of soluble proteins and polysaccharides within the codigestion substrate. The presence of CaO was conducive to the generation and biological transformation of volatile fatty acids, with a notable accumulation of acetic acid, a smaller carboxylic acid within the VFAs. The proportion of acetate in the CaO-amended group increased to 32.6-36.9%. Enzymatic analysis disclosed that CaO enhanced the activity of hydrolytic and acidogenic enzymes associated with the ES and PW codigestion process but suppressed the activity of coenzyme F420. Moreover, CaO augmented the nutrient load in the fermentation liquid. The study provides an alternative scheme for the efficient resource utilization of ES and PW.

Phosphonium Iodide Featuring Blue Thermally Activated Delayed Fluorescence for Highly Efficient X-Ray Scintillator.

Organic scintillators are praised for their abundant element reserves, facile preparation procedures, and rich structures. However, the weak X-ray attenuation ability and low exciton utilization efficiency result in unsatisfactory scintillation performance. Herein, a new family of highly efficient organic phosphonium halide salts with thermally activated delayed fluorescence (TADF) are designed by innovatively adopting quaternary phosphonium as the electron acceptor, while dimethylamine group and halide anions (I-) serve as the electron donor. The prepared butyl(2-[2-(dimethylamino)phenyl]phenyl)diphenylphosphonium iodide (C4-I) exhibits bright blue emission and an ultra-high photoluminescence quantum yield (PLQY) of 100 %. Efficient charge transfer is realized through the unique n-π and anion-π stacking in solid-state C4-I. Photophysical studies of C4-I suggest that the incorporation of I accounts for high intersystem crossing rate (kISC) and reverse intersystem crossing rate (kRISC), suppressing the intrinsic prompt fluorescence and enabling near-pure TADF emission at room temperature. Benefitting from the large Stokes shift, high PLQY, efficient exciton utilization, and remarkable X-ray attenuation ability endowed by I, C4-I delivers an outstanding light yield of 80721 photons/MeV and a low limit of detection (LoD) of 22.79 nGy ⋅ s-1. This work would provide a rational design concept and open up an appealing road for developing efficient organic scintillators with tunable emission, strong X-ray attenuation ability, and excellent scintillator performance.

In Situ Loading of Cu Nanocrystals on CsCuCl3 for Selective Photoreduction of CO2 to CH4.

Rational design and facile synthesis of efficient environmentally friendly all-inorganic lead-free halide perovskite catalysts are of great significance in photocatalytic CO2 reduction. Aiming at photogenerated charge carrier separation and CO2 reaction dynamics, in this paper, a CsCuCl3 /Cu nanocrystals (NCs) heterojunction catalyst is designed and synthesized via a simple acid-etching solution process by using Cu2 O as the sacrificed template. Due to the disproportionation reaction of Cu2 O induced by concentrated hydrochloric acid, Cu NCs can be deposited onto the surface of CsCuCl3 microcrystals directly and tightly. As revealed by photoelectrochemical analysis, in situ Fourier transform infrared spectra, etc., the Cu NCs contribute a lot to extracting photoelectrons of CsCuCl3 to improve the charge separation efficiency, regulating the CO2 adsorption and activation, and also stabilizing the reaction intermediates. Therefore, CsCuCl3 /Cu heterojunction exhibits a total electron consumption rate of 58.77 µmol g-1 h-1 , which is 2.9-fold of that of single CsCuCl3 . Moreover, high CH4 selectivity of up to 92.7% is achieved, which is much higher than that of CsCuCl3 (50.4%) and most lead-free halide perovskite-based catalysts. This work provides an ingenious but simple strategy to rationally design cocatalysts in situ decorated perovskite catalysts for manipulating both the catalytic activity and the product selectivity.

NHPI-Mediated Electrochemical α-Oxygenation of Amides to Benzimides.

This report describes a mild electrochemical α-oxygenation of a wide range of linear and cyclic benzamides mediated by N-hydroxyphthalimide (NHPI) in an undivided cell using O2 as the oxygen source and 2,4,6-trimethylpyridine perchlorate as an electrolyte. The radical scavenger experiment and the 18O labeling experiment were carried out, which indicated the involvement of a radical pathway and suggested O2 as an oxygen source in the imides, respectively.

Visible-Light-Driven Organocatalytic Alkoxylation of Benzylic C-H Bonds.

A variety of strategies for direct alkoxylation of the benzyl C-H bond have been developed toward the construction of benzyl ethers. The light-induced benzyl C-H bond alkoxylation provides an alternative strategy for the synthesis of these important intermediates. The photocatalyzed alkoxylation of the benzyl C-H bond has dominated by metal-catalyzed methods. Herein, we reported a light-driven organocatalytic approach for alkoxylation of the benzyl C-H bond by the use of 9,10-dibromoanthracene as a photocatalyst and employing N-fluorobenzenesulfonimide as an oxidant. This reaction proceeds at room temperature and is capable of converting a variety of alkyl biphenyl and coupling partners, including a variety of alcohol and carboxylic acid, as well as peroxide, to the desired products under 400 nm light irradiation.

Ag-N-C single atom catalyst with resistance for Ag loss in acetylene hydrochlorination.

Ag-N-C catalyst was synthesized by the calcination process with AgNO3as precursors, active carbon as support, and melamine as an N source. Series of characterizations showed that Ag was transferred into AgCl during the active phase by HCl, and pyridinic structure in the support was bonded with Ag components. Then, Ag-N-C single atom catalyst (SAC) was obtained by washing Ag-N-C with acid, aberration-correction high-angle-annular-dark-field scanning transmission electron microscopy showed that Ag presented in single atoms form, and Ag coordinated with the nitrogen atom in the support. Ag loss rate for Ag-N-C SAC was only 0.09% after running 10 h in acetylene hydrochlorination process, which was much smaller than Ag-N-C (57%), indicating that the presence of the Ag-N bond could be inhibiting Ag species loss.

Combating increased antifungal drug resistance in Cryptococcus, what should we do in the future?

Few therapeutic drugs and increased drug resistance have aggravated the current treatment difficulties of Cryptococcus in recent years. To better understand the antifungal drug resistance mechanism and treatment strategy of cryptococcosis. In this review, by combining the fundamental features of Cryptococcus reproduction leading to changes in its genome, we review recent research into the mechanism of four current anti-cryptococcal agents, coupled with new therapeutic strategies and the application of advanced technologies WGS and CRISPR-Cas9 in this field, hoping to provide a broad idea for the future clinical therapy of cryptococcosis.

Adversarial and Random Transformations for Robust Domain Adaptation and Generalization.

Data augmentation has been widely used to improve generalization in training deep neural networks. Recent works show that using worst-case transformations or adversarial augmentation strategies can significantly improve accuracy and robustness. However, due to the non-differentiable properties of image transformations, searching algorithms such as reinforcement learning or evolution strategy have to be applied, which are not computationally practical for large-scale problems. In this work, we show that by simply applying consistency training with random data augmentation, state-of-the-art results on domain adaptation (DA) and generalization (DG) can be obtained. To further improve the accuracy and robustness with adversarial examples, we propose a differentiable adversarial data augmentation method based on spatial transformer networks (STNs). The combined adversarial and random-transformation-based method outperforms the state-of-the-art on multiple DA and DG benchmark datasets. Furthermore, the proposed method shows desirable robustness to corruption, which is also validated on commonly used datasets.

Identifying Heterozipper ß-Sheet in Twisted Amyloid Aggregation.

Amyloid peptide (AP) self-assembly is a hierarchical process. However, the mechanistic rule of guiding peptides to organize well-ordered nanostructure in a clear and precise manner remains poorly understood. Herein we explored the molecular insight of AP motif aggregates underlying hierarchical process with helical fibrillar structure by atomic force microscope, cryo-electron microscopy (cryo-EM), and molecular dynamics simulation. AP assembly encompasses well-ordered twisted fibrils with uniform morphology, size, and periodicity. More importantly, a heterozipper ß-sheet was identified in a protofilament of AP assembly determined by cryo-EM with a high resolution of 3.5 Å. Each peptide heterozipper was further composed of two antiparallel ß strands and arranged by an alternative manner in a protofilament. The hydrophobic core and hydrophilic area in each zipper played the significant role for peptide assembling. This work proposed and verified the rule facilitating the basic building unit to form twisted fibrils and gave the explanation of peptide hierarchical assembling.

Deactivation and Regeneration of Nitrogen Doped Carbon Catalyst for Acetylene Hydrochlorination.

The poor stability of carbon materials doped with nitrogen limited their development in acetylene hydrochlorination. Therefore, investigating the deactivation reasons of carbon catalysts and researching regeneration methods became the research focus. Herein, carbon-nitrogen materials were synthesized by one-step pyrolysis, which using biomass materials with high nitrogen content, the synthesized material was used in an acetylene hydrochlorination reaction. The acetylene conversion rate of D-GH-800 catalyst was up to 99%, but the catalytic activity decreased by 30% after 60 h reaction. Thermogravimetric analysis results showed that the coke content was 5.87%, resulting in catalyst deactivation. Temperature-programmed desorption verified that the deactivation was due to the strong adsorption and difficult desorption of acetylene by the D-GH-800 catalyst, resulting in the accumulation of acetylene on the catalyst surface to form carbon polymers and leading to the pore blockage phenomenon. Furthermore, based on the catalyst deactivation by carbon accumulation, we proposed a new idea of regeneration by ZnCl2 activation to eliminate carbon deposition in the pores of the deactivated catalyst. As a result, the activity of D-GH-800 was recovered, and lifetime was also extended. Our strategy illustrated the mechanism of carbon deposition, and the recoverability of the catalyst has promising applications.

Secrecy Capacity Region of the AWGN MAC with External Eavesdropper and Feedback.

For the point-to-point additive white Gaussian noise (AWGN) channel with an eavesdropper and feedback, it has already been shown that the secrecy capacity can be achieved by a secret key-based feedback scheme, where the channel feedback is used for secret sharing, and then encrypting the transmitted message by the shared key. By secret sharing, any capacity-achieving coding scheme for the AWGN channel without feedback can be secure by itself, which indicates that the capacity of the same model without the secrecy constraint also affords an achievable secrecy rate to the AWGN channel with an eavesdropper and feedback. Then it is natural to ask: is the secret key-based feedback scheme still the optimal scheme for the AWGN multiple-access channel (MAC) with an external eavesdropper and channel feedback (AWGN-MAC-E-CF), namely, achieving the secrecy capacity region of the AWGN-MAC-E-CF? In this paper, we show that the answer to the aforementioned question is no, and propose the optimal feedback coding scheme for the AWGN-MAC-E-CF, which combines an existing linear feedback scheme for the AWGN MAC with feedback and the secret key scheme in the literature. This paper provides a way to find optimal coding schemes for AWGN multi-user channels in the presence of an external eavesdropper and channel feedback.

Benefits of pharmacist intervention in the critical care patients with infectious diseases: A propensity score matching retrospective cohort study.

BACKGROUND: The importance of optimising antimicrobial therapy is highlighted in the hospital intensive care unit (ICU) patients. But roles of ICU pharmacists are still in its infancy in China. OBJECTIVES: This study's objective was to evaluate the values of clinical pharmacist interventions in the antimicrobial stewardship (AMS) on ICU patients with infections. AIM: The aim of this study was to evaluate the value of clinical pharmacist interventions in the antimicrobial stewardship (AMS) in critically ill patients with infections. METHODS: From 2017 to 2019, a propensity score matching retrospective cohort research was conducted on critically ill patients with infectious illnesses. The trial was split into groups that received pharmacist assistance and those who did not. Baseline demographics, pharmacist actions, and clinical results were compared between the two groups. Factors influencing mortality were demonstrated using univariate analysis and bivariate logistic regression. The State Administration of Foreign Exchange in China monitored the exchange rate between the RMB and the US dollar and also gathered the charges of the agents as an economic indicator. RESULTS: Out of the 1523 patients who were evaluated, 102 critically ill patients with infectious diseases were included in each group after matching. The top five prescription regimens adjusted were settled by sickness progression, microbiological results, de-escalation, drug withdrawal, and therapeutic drug monitoring suggestions. The pharmacist exposure group's antibiotic use density (AUD) decreased significantly (p = 0.018) compared to the control group, going from 241.91 to 176.64 defined daily doses/100 bed days. Following pharmacist interventions, the AUD proportion for carbapenems dropped from 23.7 to 14.43%, while for tetracyclines, it dropped from 11.5 to 6.26%. In the group exposed to the pharmacist, the median cost of antibiotics decreased significantly from $836.3 to $362.15 per patient stay (p < 0.001), and the median cost of all medications dropped from $2868.18 to $1941.5 per patient stay (p = 0.06). RMB was converted into US dollars according to the current exchange rate. According to univariate analyses, pharmacist interventions did not differ between the groups that survived and died (p = 0.288). CONCLUSIONS: This study showed that antimicrobial stewardship had a significant financial return on investment without raising the mortality rate.