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To compare differences between candidemia and non-candidemia in the past 12 years and to construct a predictive model of candidemia to enrich clinical data and improve the diagnosis and treatment of candidemia. A matched case-control study design was used to collect the clinical data of inpatients in a tertiary hospital in Yunnan from 2013 to 2024. The patients were divided into candidemia group and non-candidemia group (control group), and accurately matched at 1:1. SPSS was used to compare the differences in epidemiological characteristics, risk factors and survival. Drug sensitivity analysis of candidemia was performed by broth dilution method. Logistic regression analysis was performed using R language and a clinical prediction model was constructed. A total of 134 cases were collected, including 67 with candidemia and 67 without candidemia. Elderly men were significantly more susceptible to candidemia and non-candidemia. The time to positivity of blood cultures, hospitalization duration, urolithiasis distribution rate, and mortality rate of patients with candidemia were significantly higher than those of patients without candidemia (all P < 0.05). Five types of Candida were isolated from patients with candidemia, and the antifungal drug sensitivities of amphotericin B, anidulafungin, caspofungin, and micafungin to all detected Candida strains were 100%. Chronic kidney disease, hepatorenal syndrome, tigecycline and amikacin use, abdominal infection, and invasive pulmonary fungal infection may be potential risk factors for candidemia. Logistic regression analysis showed that the time to positivity of blood cultures (≥ 2 days) (odds ratio [OR] = 121.03, P < 0.001), number of concurrent infections during hospitalization (OR = 3.9, P < 0.01), and blood transfusion treatment (OR = 6.91, P < 0.05) were risk factors, whereas fibrinogen levels (OR = 0.77, P < 0.01) and C-reactive protein levels (OR = 0.98, P < 0.01) were protective factors. The receiver operating characteristic curve, calibration curve, and clinical decision curve showed that the model was meaningful. This study found that there were differences in multiple outcomes between candidemia and non-candidemia. The five potential risk factors analyzed can be used as predictors of candidemia and may provide a reference for the diagnosis and treatment of clinical candidemia.
The purpose of this research is to investigate risk factors for postoperative intestinal fistula combined with pulmonary infection in patients with acute intestinal obstruction and the construction of a predictive model. Two hundred twenty-seven patients with acute intestinal obstruction admitted to our hospital from January 2018 to December 2024 were selected. Patients were divided into two groups based on whether postoperative intestinal fistula complicated with pulmonary infection occurred: the intestinal fistula complicated with pulmonary infection group (78 cases) and the control group (149 cases). Clinical data of patients were collected and peripheral blood levels of NLR and SAA were measured. Logistic regression analysis was employed to investigate the risk factors for postoperative intestinal fistula complicated with pulmonary infection in patients with acute intestinal obstruction. A nomogram model was established to predict the occurrence of postoperative intestinal fistula complicated with pulmonary infection in patients with acute intestinal obstruction. The goodness of fit of the predictive model was evaluated using the Hosmer-Lemeshow (H-L) chi-square test. The predictive value of the model was analyzed using receiver operating characteristic (ROC) curves and calibration curves. There were no statistical differences in age, gender ratio, intraoperative blood loss, operation duration, comorbidities, and smoking history between the two groups (all P>0.05); The postoperative hospitalization duration, BMI index, NLR and SAA levels in the intestinal fistula with pulmonary infection group were significantly higher than those in the control group (all P < 0.05). Logistic multivariate analysis indicated that BMI, NLR and SAA levels were independent factors for postoperative complications of intestinal fistula with pulmonary infection after acute intestinal obstruction surgery (all P < 0.05). The nomogram prediction model constructed based on the three factors showed acceptable calibration and moderate-to-high discriminative ability with AUC of 0.912, sensitivity and specificity of 0.890 and 0.897, respectively. After internal validation, the value of AUC was 0.853, with sensitivity and specificity being 0.872 and 0.864, respectively. BMI, NLR, and SAA are independent risk factors for postoperative intestinal fistula complicated with pulmonary infection in patients with acute intestinal obstruction. The predictive model constructed showed potentially useful predictive performance in this cohort for postoperative intestinal fistula complicated with pulmonary infection in such patients.
Interstitial lung diseases (ILDs) consist of idiopathic pulmonary fibrosis (IPF) and non-IPF ILDs. While pulmonary complications in IPF are relatively well-studied, there is a need for research on non-IPF ILDs, including connective tissue disease-associated ILDs (CTD-ILDs), and non-pulmonary outcomes of ILDs. We compare hospitalization, infection, and pulmonary/cardiac vascular event outcomes in patients with various ILDs. We used data from 82 healthcare organizations between 2014 and 2023 on the TriNetX Research Network. In addition to IPF, we included patients with rheumatoid arthritis (RA)-ILD, systemic sclerosis (SSc)-ILD, myositis-ILD, hypersensitivity pneumonitis (HP) and pulmonary sarcoidosis. We employed propensity score matching (PSM) and assessed outcomes, including hospitalization, infection, and pulmonary/cardiac vascular events within one year of diagnosis. A total of 66,771 patients met the inclusion criteria, with 15,228 diagnosed with IPF and 51,543 with non-IPF ILDs. Anti-fibrotic agents were used in 30.4% of IPF patients. IPF patients had higher risks of hospitalization, cytomegalovirus disease, aspergillosis, and pulmonary/cardiac vascular event compared to those with non-IPF ILDs. Within CTD-ILDs, RA-ILD was associated with increased risks of sepsis, bacteremia, and pneumonia, while SSc-ILD had higher risks of pulmonary vascular events. Myositis-ILD showed elevated risks of hospitalization and mortality compared to RA-ILD, whereas patients with HP and pulmonary sarcoidosis experienced more favorable outcomes. We identified distinct risk profiles across ILD subtypes, with increased infection risks in RA-ILD and heightened pulmonary/cardiac vascular event risks in SSc-ILD and IPF. These findings emphasize the need for targeted surveillance/management strategies for different ILD subtypes.
To investigate the landscape of targetable genomic alterations and programmed cell death ligand 1 (PD-L1) expression in pulmonary ground-glass opacities (GGOs) and their association with age. A total of 2509 patients with GGOs were retrospectively analyzed. Tumor characteristics, PD-L1 expression, and prevalence of targetable alterations were compared across age groups. In GGOs, the mutation rates of EGFR (61.5%) and ERBB2 (12.0%) were relatively high, whereas those of KRAS (8.2%) and ALK rearrangements (2.3%) were relatively low. The patients exhibited a low tumor mutational burden (TMB), and PD-L1 expression was negative in 86.7% of cases. TMB, PD-L1 expression, and the mutation rates of EGFR, KRAS, and MET increased significantly with age, whereas the rates of ERBB2 mutations, ALK rearrangements, and RET rearrangements decreased significantly with age. Age was identified as an independent predictor for the above eight variables. The optimal age cutoff was determined to be 53 years. Compared with the younger age group (< 53 years), the older age group (≥ 53 years) showed a 31.6%, 130.4%, and 800.0% higher likelihood of harboring EGFR, KRAS, and MET mutations, respectively. Conversely, compared with the older age group, the younger age group showed a 289.1%, 94.1%, and 108.7% higher likelihood of harboring ERBB2 mutations, ALK rearrangements, and RET rearrangements, respectively. GGOs exhibit a distinct genomic and PD-L1 profile with significant age-related heterogeneity, providing insights for age-stratified therapeutic strategies.
Pulmonary fibrosis (PF) is a progressive and fatal disease with limited therapies. Anemoside B4 (AB4), an oleanane-type pentacyclic triterpenoid saponin isolated from the roots of Pulsatilla chinensis (Bunge) Regel, exhibits anti-inflammatory and anti-apoptotic activities, yet its mechanisms of action in PF have yet to be elucidated. This study aimed to define the protective effects of AB4 against PF, focusing on the Keap1/Nrf2 axis, NLRP3-mediated pyroptosis, and epithelial-mesenchymal transition (EMT). A bleomycin (BLM)-induced PF model was established in wild-type and Nlrp3-/- mice. AB4's efficacy was evaluated through pulmonary function, histology, and biochemical assays. Bulk RNA-seq, scRNA-seq, molecular docking, Co-IP, CETSA, and nuclear-cytoplasmic fractionation were utilized to dissect mechanisms. Key pathways were validated with HO-1and NLRP3 inhibitors ZnPP and MCC950, respectively. AB4 ameliorated weight loss, improved lung function, and reduced collagen deposition in the BLM challenge. It directly bound Keap1, disrupting the Keap1-Nrf2 complex and promoting Nrf2 nuclear translocation, which upregulated HO-1 and attenuated oxidative stress. AB4 subsequently inhibited NLRP3 inflammasome activation and pyroptosis. Single-cell analysis confirmed suppression of EMT. AB4's anti-fibrotic effect depended on HO-1 activity and was phenocopied in Nlrp3-deficient mice. This study first identifies AB4 as a preventive, rather than therapeutic, agent against PF. AB4 targets Keap1 to activate Nrf2-driven antioxidant responses, inhibits NLRP3-dependent pyroptosis, and attenuates secretome-driven EMT. AB4 thus presents a novel, mechanism-based candidate for clinical translation, specifically for the prevention or early intervention of progressive PF.
Idiopathic pulmonary arterial hypertension (IPAH) is characterized by irreversible pulmonary vascular remodeling. This pathological remodeling is mainly driven by the aberrant proliferation and migration of pulmonary artery smooth muscle cells (PASMCs). However, the molecular mechanisms underlying these dysfunctions remain incompletely understood. In this study, we integrated single-cell RNA sequencing (scRNA-seq) analysis with in vivo and in vitro validation to identify key driver genes implicated in IPAH. The GSE169471 dataset was acquired from the Gene Expression Omnibus and processed via quality control, clustering, and cell subtype annotation. Further analyses identified dominant cell subtypes, cell-cell communication networks, and differentially expressed genes (DEGs). Hub genes were then screened using multiple bioinformatic algorithms. The selected hub genes were validated in pulmonary arteries from a monocrotaline (MCT)-induced PAH rat model via qPCR and Western blotting. Furthermore, siRNA-mediated knockdown was conducted to investigate the effects of hub gene silencing on HMGB1-induced PASMC proliferation and migration. Our results revealed that SMCs were the dominant communicating cell subtype and were significantly increased in IPAH. A total of 63 upregulated DEGs were identified, primarily enriched in biological processes such as extracellular matrix organization and signaling pathways, including the focal adhesion pathway. Four hub genes (COL1A1, MYL9, COL1A2, and TPM2) were identified, with significantly increased expression observed in the pulmonary arteries of PAH rats. Subsequently, silencing these genes notably reduced HMGB1-induced PASMC proliferation and migration. These findings provide novel insights into the molecular mechanisms of IPAH and highlight these hub genes as potential therapeutic targets.
Severe scoliosis with prior corrective spinal surgery poses significant anesthetic challenges in obstetric patients due to altered spinal anatomy and potential respiratory compromise. Conventional neuraxial or general anesthesia may be risky, making alternative approaches necessary for safe cesarean delivery. The Taylor paramedian technique provides an effective option by bypassing distorted midline anatomy. A 35-year-old primigravida (G1P0) at 37±1 week's gestation with surgically corrected thoracolumbar scoliosis and restrictive pulmonary disease, complicated by bronchopneumonia, was admitted for cesarean delivery. Preanesthetic assessment revealed limited cervical mobility, restricted mouth opening, and challenging spinal landmarks. Initial midline puncture at L3-L4 failed, so a paramedian Taylor approach at L5-S1 using anatomical landmarks was performed. Intrathecal 12 mg plain 0.5% bupivacaine with 20 µg fentanyl achieved complete sensory and motor block. Maternal hemodynamics remained stable with normal oxygenation. Cesarean section was completed uneventfully, delivering a healthy neonate weighing 3 kg with Apgar scores 8 and 9. Postoperative recovery was smooth, and the patient was discharged on day 3. Paramedian Taylor spinal anesthesia is a safe and effective alternative in parturients with severe scoliosis and restrictive pulmonary disease. Individualized planning, technical expertise, and careful execution allow complete sensomotor block, minimize respiratory risk, and ensure successful cesarean delivery in high-risk patients.
There is increasing recognition of the importance of left ventricular (LV) assessment in pulmonary arterial hypertension (PAH). Hemodynamic patterns derived from hemodynamic force (HDF) analysis is an approach to evaluate hemodynamic patterns and myocardial dysfunction. However, its prognostic value with PAH remains unclear. PAH participants who underwent cardiac magnetic resonance (CMR) between January 2015 and July 2023 were prospectively and consecutively enrolled. LV HDF analysis was performed on the 2-, 3-, and 4-chamber long axis view. The primary endpoint was all-cause mortality. Cox regression analysis and Kaplan-Meier survival analysis were performed to identify the association between parameters and outcomes. The incremental prognostic value of hemodynamic pattern and CMR scores were assessed using χ2 test, net reclassification improvement (NRI) and integrated discrimination improvement (IDI). There were 311 participants (mean age, 38 ± 14 years; 87 men) evaluated. During a median follow-up of 38 months (interquartile range, 16-54 months), 55 participants reached the primary endpoint. Full cardiac cycle (FCC) and diastolic deceleration impulse (DDI) HDF ratios, but not systolic ejection impulse, were significantly lower in PAH patients compared to healthy controls (P= 0.003 and P=0.009, respectively). In multivariable Cox regression analysis, DDI HDF ratios were independent predictors of the primary endpoint in PAH patients and CHD-PAH subgroup (hazard ratio [HR], 0.83, [95% CI: 0.72, 0.96; P= 0.009]; HR, 0.74, [95% CI: 0.56, 0.97; P= 0.03]). Adding the DDI HDF ratio to established clinical models significantly improved risk classification, yielding a continuous NRI of 0.27 (P=0.01) and an IDI of 0.01 (P=0.03) for the overall cohort, with consistent improvements in the CHD-PAH subgroup (NRI 0.30, P=0.04; IDI 0.02, P=0.03). LV hemodynamic patterns derived from CMR-based DDI HDF ratio were identified as independent prognostic predictor in pulmonary hypertension, providing incremental prognostic value beyond established risk scores. This study was registered in the Chinese clinical trial registry (ChiCTR1800019314 and ChiCTR1900025518). URL: https://www.chictr.org.cn/.
High-altitude pulmonary hypertension (HAPH), classified as Group 3 pulmonary hypertension, is a significant threat to the health of high-altitude populations. The scarcity of studies in diverse populations has become a research bottleneck, limiting diagnostic and therapeutic advances. In this first proteomic study focusing on the eastern Pamir Plateau (Kizilsu Kyrgyz Autonomous Prefecture, Xinjiang), plasma samples were analyzed using data-independent acquisition (DIA) mass spectrometry. Differential expression analysis in parallel with weighted gene co-expression network analysis was performed to identify core pathways and hub proteins, and gene set enrichment analysis was used for quality assessment. Integrative analysis of the two methods was used to select candidates for validation by enzyme-linked immunosorbent assay (ELISA) in an independent cohort. Among > 1400 detected proteins, 123 were differentially expressed and 45 were identified as hub proteins significantly associated with HAPH. Extracellular matrix (ECM) remodeling- and angiogenesis-related proteins were upregulated, whereas proteins related to enzyme activity, iron metabolism, and inflammatory responses were downregulated. Integrative analysis identified 23 core proteins, with ECM-receptor interaction and TGF-β/Smad signaling identified as key pathways. ELISA confirmed that plasma levels of THBS2, LOXL1, and POSTN were significantly elevated in patients with HAPH (P < 0.05). Among these, THBS2 and LOXL1 levels were positively correlated with mPAP (THBS2: r = 0.389, 95% CI: 0.034-0.657, P = 0.033; LOXL1: r = 0.457, 95% CI: 0.115-0.701, P = 0.011). ECM remodeling is closely associated with HAPH in this indigenous high-altitude population. THBS2, LOXL1, and POSTN show potential as biomarkers and therapeutic targets.
Pulmonary hypertension-induced right ventricular (RV) overload can result in right atrial (RA) remodeling and tricuspid regurgitation (TR), which in turn affects RV function and negatively impacts patient prognosis. This study aimed to clarify the prognostic significance of RA function and TR in patients with chronic thromboembolic pulmonary hypertension (CTEPH). For this retrospective analysis of 97 patients with CTEPH who underwent balloon pulmonary angioplasty (BPA), clinical, hemodynamic, and echocardiographic data were acquired before the first BPA and after the final BPA. The composite end point was hospitalization due to right heart failure and all-cause death. After BPA, patients experienced significant increases in RA reservoir strain (RASr, 26.7 ± 9.1% vs. 35.2 ± 11.3%, P<.001) and conduit strain (15.0[9.6] % vs. 22.6[9.6] %, P<.001), with no significant change in RA contraction strain. TR was significantly improved after BPA, decreasing from 49.5% to 22.7% in patients with significant TR (P<.001). Over a mean follow-up of 24.7 ± 12.4 months, 22 patients met the composite end point. On multivariate Cox regression analysis, Right atrial reservoir strain (RASr) was independently associated with composite clinical outcomes(P=.012). Patients with post-BPA RASr ≥ 29.85% exhibited superior event-free survival compared to those with lower values. Right atrial reservoir and conduit functions were impaired in CTEPH patients and showed significant improvement following BPA. Post-BPA RASr ≥ 29.85% demonstrated an independent association with long-term clinical outcomes. These findings support the inclusion of RA strain in postoperative assessments and long-term follow-up of CTEPH patients treated with BPA. In this study, 2D-speckle tracking echocardiography can be used to better monitor right heart status of patients. To some extent, it can help clinicians to provide better treatment for patients and improve the quality of life of patients.
Examine the relationship between the inter-superior vena cava (SVC) distance and pulmonary blood flow (PBF) splitting, post-Fontan outcomes, hemodynamics, Fontan geometry, and pulmonary artery (PA) growth in bilateral bidirectional Glenn (BBDG) patients compared to unilateral bidirectional Glenn (BDG) patients. A single center retrospective cohort study comparing demographic, hemodynamic, and post-Fontan outcome variables between BBDG patients and a randomized cohort of BDG patients was conducted. A simple linear regression model was created to evaluate the relationship between Fontan geometry and PBF splitting. Cardiac magnetic resonance images were segmented using Slicer 5.6.2 and center line distance between the right and left SVC was calculated using an in-house code. The relationship between SVC distance and PBF was examined. The Nakata index was compared for BBDG and BDG patients. 42 patients (21 BBDG and 21 BDG) were included. Demographics, post-Fontan complications, and hemodynamics between groups were not different. PBF flow splitting increased as a function of inter-SVC distance. Patients with BBDG experienced a decrease in PA size over time with the mean difference in Nakata index between groups of 128.5 ± 23.73 (95% CI: 75.66, 181.4; p = 0.0003). Patients with BBDG have poor central PA growth compared to BDG patients. Although outcomes and hemodynamics were equivalent between groups, inter-SVC distance impacts PBF. This study provides a foundation on which to direct further prospective, studies of flow efficiencies in patients with BBDG circulations to guide patient-specific reconstruction techniques that maximize pulmonary artery growth potential and Fontan efficiency.
While the use of transesophageal echocardiography (TEE) or pulmonary artery catheters (PAC) has been studied in coronary artery bypass grafting (CABG), outcomes associated with their concurrent use remain understudied. Therefore, we sought to investigate the association between intraoperative TEE, with or without PAC, and patient outcomes following isolated CABG. This population-based study included adults (≥ 18 years old) undergoing isolated CABG from 2009 to 2019 across 11 Ontario centers using administrative databases. The primary outcome was a composite of 30-day mortality and major complications. Multivariable regression with general estimating equations was performed, adjusting for patient, surgical, and hospital factors. Subgroup analyses by surgical urgency and left ventricular ejection fraction (LVEF), and a weighted propensity score sensitivity analysis were done. Among 70,065 patients undergoing CABG, 45.5% received TEE and 70.7% PAC. PAC alone (45.2%) was the most common, followed by TEE + PAC (25.5%). Adjusted analyses revealed a higher risk of the primary outcome for TEE + PAC (aRR 1.18; 95% CI, 1.11-1.25) and PAC alone (aRR 1.05; 95% CI, 1.02-1.09), while TEE alone was not significant (aRR 1.06; 95% CI, 0.99-1.14) versus neither modality. PAC alone was associated with lower 30-day mortality (aRR 0.67; 95% CI, 0.49-0.93) versus neither modality. Sensitivity analyses were consistent. TEE + PAC was associated with a higher risk of the primary outcome in elective and emergent surgeries versus neither modality. For LVEF ≥ 35%, both TEE + PAC and PAC alone were linked to higher risk; no differences were observed in LVEF < 35%. When compared to TEE alone, TEE + PAC was associated with a lower risk of 30-day mortality (aRR 0.59; 95% CI, 0.36-0.96). Combined TEE + PAC use in CABG was associated with higher adverse outcomes versus neither modality. PAC use was associated with mixed findings depending on the comparator. Prospective studies are needed to identify subgroups benefiting from specific modalities and evaluate longer-term outcomes.
Hypertension is a major global health concern and a leading risk factor for cardiovascular diseases, including stroke, myocardial infarction, and heart failure. A hallmark of hypertension is elevated total peripheral vascular resistance, often driven by sustained and abnormal vasoconstriction. Calcium ions (Ca²⁺) play a central role in vascular smooth muscle cell (VSMC) contraction, and their intracellular concentration is tightly regulated by multiple signaling pathways. Among these, the inositol 1,4,5-trisphosphate receptor (IP3R) and the transient receptor potential canonical type 3 (TRPC3) channel are critical mediators of Ca²⁺ signaling. IP3R activation triggers Ca²⁺ release from the endoplasmic reticulum, while TRPC3 channels facilitate Ca²⁺ and Na⁺ influx across the plasma membrane. Several studies have shown that both IP3Rs and TRPC3 channels are upregulated in hypertensive animal models. Human studies have also demonstrated elevated TRPC3 expression in the context of pulmonary arterial hypertension (PAH). This review provides a comprehensive overview of the structural domains and membrane microdomains that facilitate IP3R-TRPC3 coupling and Ca²⁺ influx. IP₃ and endothelin-1 stimulate TRPC3 channels and promote their molecular coupling to IP3Rs, leading to activation of nonselective cation currents in artery myocytes. Increased expression and/or activity of IP3Rs and TRPC3 channels amplifies this signaling, contributing to the increased vascular tone characteristic of the hypertensive state. Understanding the molecular interplay between IP3Rs and TRPC3 channels offers new insight into the dysregulated Ca²⁺ signaling underlying hypertension. Targeting this coupling mechanism may represent a novel therapeutic strategy to restore vascular homeostasis and reduce blood pressure in affected individuals.
Centenarian patients constitute a rapidly growing yet understudied population in emergency medicine. Evidence regarding prognostic factors and one-year outcomes in individuals aged 100 years and older presenting to the emergency department remains limited. This retrospective observational study was conducted in the emergency department of Giresun Training and Research Hospital and included centenarian patients presenting between 2010 and 2023. A total of 160 emergency department visits from 83 unique patients were evaluated. Demographic characteristics, clinical variables, comorbidities, frailty indices, and laboratory parameters obtained at admission were recorded. Frailty was assessed using a modified frailty index excluding functional dependence (mFI-4) and the Clinical Frailty Scale (CFS). The primary outcome was one-year all-cause mortality. Kaplan-Meier survival analysis and Cox proportional hazards regression analysis were performed at the patient level using the index emergency department visit. In the descriptive visit-level analysis, non-survivor visits showed higher hospitalization frequency and less favorable inflammatory and renal function marker profiles than survivor visits, while pulmonary diseases were more frequent among non-survivors and cardiovascular diseases were more common among survivors. Modified frailty index scores did not differ significantly between groups. Higher CFS categories were associated with shorter median survival times, although Kaplan-Meier analysis showed no statistically significant separation between frailty categories. In Cox regression analysis, hospitalization at the index emergency department visit and higher blood urea nitrogen levels remained independently associated with one-year mortality. In centenarian patients presenting to the emergency department, traditional comorbidity-based frailty indices show limited discriminatory value for one-year mortality. Acute clinical presentation and laboratory parameters reflecting inflammatory burden, renal function, and physiological reserve appear to be more closely associated with outcomes. The study is not registered in a clinical trial registry.
Lung ultrasound could be useful tool in prediction and management of bronchopulmonary dysplasia (BPD). This study aimed to assess the effectiveness of the extended lung ultrasound (eLUS) score and posterior zone assessment in predicting BPD. Prospective cohort study held at the Neonatal-Intensive-Care Unit of Alexandria-University-Maternity-Hospital between November-2024 and May-2025. A total of 100 neonates with gestational age < 32 weeks, still requiring respiratory support on day-7, had regular LUS on days 7, 14, and 28 postnatally. They were categorized into two groups: BPD and non-BPD. A comparative analysis was performed between the groups. The predictive power of LUS for BPD development at 36 weeks of postmenstrual age was evaluated by ROC curve analysis. The mean (SD) gestational age for the entire group was 29.52 ± 1.05 weeks. Infants who developed BPD exhibited statistically higher eLUS scores on both day-7 and day-14 afterbirth (P < 0.001). A day-7 eLUS and posterior zones score cutoff of more than 13 and more than 4 points, respectively, predicted BPD with a sensitivity of 97% and 97.1% and a specificity of 92% and 89.39%. The eLUS score on day-7 exhibited a strong correlation with invasive mechanical ventilation (IMV) on day-7, the duration of IMV, and oxygen saturation index. Both eLUS score and posterior zones at day-7 strongly predicts BPD in preterm-infants. Evaluating posterior lung zones appears crucial for improving LUS diagnostic accuracy. LUS scores increased with increasing BPD severity.
Inflammatory lung diseases, including community-acquired pneumonia, acute respiratory distress syndrome (ARDS), severe viral pneumonia (including COVID-19), ventilator-associated pneumonia, and exacerbations of chronic obstructive pulmonary disease (COPD), necessitate prompt diagnostic and prognostic assessments accompanied by microbiological confirmation of the causative pathogen. Conventional biomarkers, including C-reactive protein and procalcitonin, are insufficient to distinguish between localized pulmonary and systemic inflammation. This narrative review summarizes the studies on Pentraxin-3 (PTX3), a locally synthesized, extrahepatic acute-phase protein secreted by endothelial cells, epithelial cells, and myeloid leukocytes at sites of inflammation, as a diagnostic and prognostic biomarker in the continuum of inflammatory lung diseases. Plasma PTX3 indicates systemic endothelial activation and disease severity, whereas bronchoalveolar lavage PTX3 concentrations provide compartment-specific diagnostic data, identify follow-up infections, and allow therapeutic escalation in relation to the disease phenotype. Nevertheless, clinical laboratory implementation involves matrix-specific reference levels, analytical validation containing limits of detection/quantification, precision, linearity, and interfering studies according to CLSI, commutable calibrators, and traceability hierarchies. The pre-analytical procedure is standardized, and platform-independent decision limits through harmonized assays, preparation of external quality assessment, and compatibility of acute-care turnaround times are required to implement multicenter PTX3 in routine clinical laboratory diagnostics.
Patients undergoing durable left ventricular assist device (LVAD) implantation frequently require prolonged perioperative respiratory support. However, the long-term pulmonary consequences of different surgical pump placement strategies remain unclear. We investigated longitudinal pulmonary function changes following intrathoracic versus extrathoracic LVAD implantation. This single-center retrospective cohort study included patients who underwent LVAD implantation and completed pulmonary function testing (PFT) preoperatively and at 1 year postoperatively. Intrathoracic HeartMate 3 recipients were compared with extrathoracic HeartMate II recipients. Linear mixed-effects models assessed longitudinal changes in forced vital capacity (FVC), percent predicted FVC (%FVC), forced expiratory volume in 1 s (FEV₁), and percent predicted FEV₁ (%FEV₁), adjusting for age, sex, body surface area, and surgery era. Among 190 patients (intrathoracic, n = 76; extrathoracic, n = 114), greater declines in FVC, %FVC, and FEV₁ were observed at 1 year in the intrathoracic group. Significant time-by-placement interactions were identified for FVC (P = 0.010), %FVC (P = 0.010), and FEV₁ (P = 0.011), whereas %FEV₁ showed comparable trends between groups. Smaller body surface area and female sex were independently associated with lower lung volumes, whereas the apparent association with female sex was largely explained by body size. Intrathoracic LVAD implantation was associated with greater restrictive changes in pulmonary function at one year. These findings suggest that surgical pump positioning and patient body size may influence long-term respiratory trajectories and may be relevant for perioperative planning and postoperative follow-up.
Post-obstructive pulmonary edema (POPE) is a rare, life-threatening complication of strangulation. Management is based on low-grade evidence, and outcomes are poorly characterized. To report a systematic review of POPE following near-hanging, illustrated by a case report that represents the first documented African case. We combined a novel case report with a systematic review of published case reports and case series, conducted per a pre-registered protocol on the Open Science Framework (OSF). A clinical trial number was not applicable. A comprehensive search of major databases identified all relevant published cases. Data on demographics, management, and outcomes were extracted and synthesized descriptively. Fifteen cases from 11 publications were included. Patients were predominantly young (median age 24). Symptoms overwhelmingly presented pre-hospital (93%). Glasgow Coma Scale (GCS) on admission was low (median 6), and the overall mortality rate was 40% (6/15). Adjunctive therapies were reported to be administered more frequently in survivors than in non-survivors, including diuretics (55.6% vs. 16.7%) and corticosteroids (44.4% vs. 16.7%), representing a potential clinical signal. POPE following strangulation is associated with high mortality in young, otherwise healthy populations. This review identified a tentative association between adjunctive diuretic or corticosteroid therapy and improved survival. While these hypothesis-generating findings require cautious interpretation due to the low-level evidence, they represent a potential clinical signal necessitating further prospective evaluation and standardized reporting.
The clinical trajectory of pulmonary vascular disease (PVD) is governed by the functional and molecular integration of the right ventricle (RV) and pulmonary vasculature-the cardiopulmonary unit. Right ventricular-pulmonary arterial (RV-PA) coupling (Ees/Ea) is the principal determinant of survival. This review synthesizes contemporary pathophysiology and therapeutics through the lens of RV-PA coupling, reflecting the recognition of active heart-lung crosstalk. Advancing beyond traditional reviews, this article (1) formalizes a phenotype-guided treatment algorithm based on coupling derangement, (2) integrates emerging concepts of molecular crosstalk mediated by extracellular vesicles, and (3) positions sotatercept as a "coupling drug" targeting both components of the cardiopulmonary unit. We detail maladaptive pathways-including metabolic reprogramming, inflammation, fibrosis, and sex hormone signaling-that degrade RV contractility (Ees) under chronic pressure overload. The pharmacotherapeutic landscape is critically evaluated: from established vasodilators that indirectly support the RV by reducing afterload (Ea) to transformative disease-modifying agents like sotatercept that reverse vascular remodeling and the emerging frontier of direct RV-targeted therapies. We argue that the future of PVD management lies in a precision-based strategy using deep phenotyping to classify patients by dominant coupling derangements and matching them with mechanism-based therapies. The paradigm must shift beyond symptomatic vasodilation toward regimens explicitly designed to restore the physiological balance of the cardiopulmonary unit, carefully distinguishing between validated standards of care and investigational approaches.
Transthoracic CT-guided biopsy performed with the coaxial technique is a minimally invasive procedure that facilitates the diagnosis of lung lesions (nodules or masses) and/or mediastinopulmonary lesions suspected of malignancy. This procedure is the source of several complications, the most frequent of which is pneumothorax. To describe the epidemiological, diagnostic, and therapeutic aspects of iatrogenic pneumothorax after CT-guided biopsy performed using the coaxial technique. Prospective longitudinal study, conducted over a period of 2 years and 10 months, from April 1, 2023, to February 1, 2026, at the Mohammed V Military Teaching Hospital in Rabat, including all patients who presented with a pneumothorax following a transthoracic CT-guided biopsy, according to the coaxial technique, confirmed clinically and/or radiologically. The study included 30 cases of pneumothorax following CT-guided biopsy according to the coaxial technique. Biopsies were performed in 217 patients, and the incidence of pneumothorax was 13.8%. The median age was 68 years [58.8-71.5], with a predominance of males (90%). The most frequent characteristics observed among patients with pneumothorax were pulmonary emphysema (73.3%), lower-lobe lesions (33.3%), and central lesions with a median depth of 3.6 cm [2.9-4.2]. Procedure-related characteristics included practitioner status and biopsy needle diameter (18-gauge). Most patients were asymptomatic (60%). Diagnosis was established by chest CT during the procedure in 26.7% of cases and by chest X-ray after the procedure in 73.3% of cases. Small pneumothorax was the most common presentation (40%). Treatment was conservative in 53.3% of cases, and intervention was required in 46.7% (7 cases drained and 7 cases exsufflated). A complication was observed in 5 cases, after initial treatment. Only one patient underwent thoracoscopic pleurodesis after 14 days of chest drainage. The median length of hospital stay was 4 days [2-5.75]. Pneumothorax is a major complication of CT-guided transthoracic biopsy, whether performed coaxially or non-coaxially. In our descriptive series, pulmonary emphysema, lower-lobe location, and lesion depth were frequent characteristics among patients who developed pneumothorax. We believe that the radiologist's experience is a determining factor in preventing a very high incidence of pneumothorax cases.