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Background: Septic Charcot neuroarthropathy is a limb- and life-threatening condition characterized by the coexistence of neuropathic joint destruction and infection. In patients with severe systemic compromise, major amputation is often considered inevitable. Case Presentation: A 47-year-old man with untreated diabetes mellitus presented with progressive painless swelling of the left foot. He had morbid obesity (120 kg, 165 cm; body mass index 44.1 kg/m2), severe hypoalbuminemia, and chronic kidney disease associated with nephrotic syndrome. Laboratory tests showed marked inflammation and poor glycemic control, and blood cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA). Radiographs and computed tomography demonstrated destructive changes involving the talonavicular and subtalar joints, consistent with septic Charcot neuroarthropathy involving the midfoot. Because of sepsis, pulmonary edema, and heart failure, below-knee amputation was proposed at the referring hospital. However, limb salvage was attempted using aggressive debridement, continuous local antibiotic perfusion (CLAP; gentamicin 1200 μg/mL) administered for 14 days, and temporary circular external fixation. Serum gentamicin concentrations and renal function were regularly monitored to ensure systemic safety and avoid nephrotoxicity. Results: Repeat irrigation and final debridement were performed 20 days after the index surgery, at which time the external fixator was removed and intraoperative cultures were negative. The patient was discharged 2 months after surgery without evidence of recurrent infection. At 4-year follow-up, no recurrence had occurred, and the patient was able to walk independently. Conclusions: Limb salvage may be feasible even in severely compromised patients with septic Charcot midfoot and MRSA bacteremia when aggressive debridement, CLAP, and temporary external fixation are combined with careful systemic safety monitoring. This case suggests that limb salvage may be considered in selected high-risk patients, although further studies are required.
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Clinical suspicion and diagnosis of Pneumocystis infections rely on a combination of compatible clinical, radiologic, and diagnostic findings. We noted an extrapulmonary Pneumocystis infection when evaluating residual plasma samples from patients with possible invasive fungal infections using cell-free DNA (cfDNA) Giant Magnetoresistance (GMR) (FungiFlex®, Zepto Life Technology). A man, immunocompromised for 27 years due to kidney transplantations, developed fever and rising aminotransferase enzyme levels during transient escalation of immunosuppressive therapy. Except for an elevated (1,3)-beta-D-glucan, further laboratory testing did not find the highly suspected histoplasmosis. Daily plasma blood samples for cfDNA fungal GMR testing were examined for histoplasmosis; however, the fungal GMR signal was only positive for Pneumocystis jirovecii in all four samples. In retrospect, the transient escalation of immunosuppressive dosing created a temporary net state of over-immunosuppression that was permissive for Pneumocystis. Additionally, the assay corroborated pulmonary pneumocystosis for a second patient, was negative for a third patient with colonization, and was negative for a fourth patient when fevers correlated with an abdominal bacterial process. Within the exploratory nature of the findings, we find that the reference standard for defining Pneumocystis is imperfect and may not accurately identify all cases. cfDNA testing may supplement existing laboratory testing and improve the diagnosis of Pneumocystis.
Image-guided thermal ablation has been used for the treatment of primary lung carcinoma but its use in the treatment of multiple lung carcinoma and effects on survival have not been well established. This study compares the long-term survival metrics for stage 1 single primary lung cancer and multiple primary lung cancer (MPLC) in patients treated with image-guided thermal ablation (IGTA). A retrospective institutional review included 37 NSCLC patients (mean age 71.6 ± 8.8 years) with ≥5 years follow-up. In total, 119 IGTA procedures were performed. Among patients with a single tumor (n = 14, 37.8%), each underwent a single ablation session. In contrast, patients with MPLC (n = 23, 62.2%) underwent 88 ablation sessions to treat 105 tumors. Data included demographics, tumor features, procedural details, safety, adverse events, and outcomes. Primary endpoints were 5-year overall survival (OS), progression-free survival (PFS), and cancer-specific survival (CSS). All ablations were completed successfully. Severe AEs occurred in 5.8% (7/119) of the ablations and were limited to pneumothorax requiring chest tube placement with hospitalization. At the time of ablation, individual nodules were staged at T1A = 46 (38.7%), T1B = 54 (45.4%), T1C = 16 (13.5%) and T2A = 3 (2.5%). Local recurrence was observed in 4/119 (3.3%) ablated tumors, all at stage T1B, and all were retreated with ablation. The 5-year OS was better for patients with MPLC at 85.6% compared to patients with a single tumor at 35.7% (HR = 0.14, p = 0.003, 95% CI: 0.037, 0.51). The 5-year OS for tumors based on T classification for T1A, T1B, TIC and T2A was 71.4%, 66.8%,66.7% and 0%. The 5-year PFS was 77.4% for patients with MPLC compared to 35.7% for patients with single primary lung cancer (HR = 0.25, p = 0.014, 95% CI: 0.084, 0.76). The 5-year CSS was 95.2% for patients with MPLC compared to 83.1% for patients with single primary lung cancer (HR = 0.21, p = 0.16, 95% CI: 0.018, 2.33). IGTA is an effective and safe treatment for patients with stage 1 single primary lung cancer and MPLC with limited local recurrence. Tumor size up to 3 cm did not have significant impact on survival. Overall survival was improved in patients with MPLC compared to those with single NSCLC. IGTA can be safely performed in patients with single primary lung cancer and MPLC, with limited local recurrence rate. Key Findings: IGTA effectively treats patients with stage 1 single primary lung cancer and MPLC, with 3.3% recurrence, which can be retreated with ablation. The five-year OS was higher in patients with MPLC (85.6%) versus those with single lung cancer (35.7%, p = 0.003). OS by T classification: 71.4% for T1A, 66.8% for T1B, 66.7% for TIC, and 0% for T2A. IGTA effectively treats patients with single primary lung cancer and MPLC with low recurrence. Tumor size < 3 cm showed no impact on overall survival.
Background: Anaplasmosis is an emerging tick-borne infection that typically presents as a non-specific febrile illness, with variable degrees of cytopenias and liver tests abnormalities. Severe complications remain atypical and uncommon. Case Report: We report a case of acute pulmonary embolism (PE) occurring during confirmed anaplasmosis in a 73-year-old male with no traditional thromboembolic risk factors. The patient presented with fever, constitutional symptoms, thrombocytopenia, leukopenia, and abnormal liver tests, raising suspicion for a tick-borne illness. Despite early clinical improvement on doxycycline, persistent tachycardia triggered further evaluation and uncovered an acute PE. Comprehensive workup at admission and repeated 14 months later excluded inherited and acquired thrombophilias, malignancies, autoimmune diseases, and alternative infectious etiologies. The patient was treated with doxycycline 100 mg orally twice daily for 10 days and anticoagulation with unfractionated heparin followed by 6 months of apixaban for a first episode of provoked PE. He attained complete clinical recovery without recurrence of thrombosis at the two-year follow-up. Discussion: Infectious diseases are increasingly recognized as contributors to thrombosis through inflammation-mediated hypercoagulability and endothelial dysfunction. Pulmonary involvement in anaplasmosis typically manifests as pneumonitis, pneumonia or acute respiratory distress syndrome, but thrombotic complications such as PE are exceedingly rare. This case highlights a rare but clinically significant vascular complication of anaplasmosis and underscores the importance of considering thromboembolic events in patients with persistent or unexplained tachycardia. Conclusions: As the incidence of anaplasmosis continues to rise, greater awareness of its potential cardiovascular manifestations is essential. Early recognition and prompt treatment with doxycycline remain critical, while further studies are needed to better define the thrombotic risk associated with this infection.
Hydatid disease, caused primarily by Echinococcus granulosus, remains a significant public health challenge in endemic regions. While hepatic (80-85%) and pulmonary (15-20%) involvements are common, multi-organ dissemination involving rare sites such as the pericardium, diaphragm, and mediastinum occurs in less than 0.1-2% of cases. We present a rare case of a 26-year-old male, a farmer for 10 years, with occupational exposure to dogs and horses, with a personal history of multiple surgically treated abdominal cysts in 2016, admitted after abdominal computed tomography revealed liver cysts greater than 5 cm, as well as mediastinal and diaphragmatic cysts. Histopathological examination of the surgically resected hepatic cyst material confirmed echinococcosis. Serology was also positive for echinococcosis. Echocardiography revealed a pericardial cyst, posterior to the left atrium. Under these circumstances, antiparasitic treatment was initiated by an infectious disease specialist, followed by surgical treatment of the abdominal cysts, confirming the final diagnosis of hydatid disease, and subsequently, surgical treatment of the thoracic hydatid cysts was performed. The postoperative course was complicated by bronchial superinfection with Stenotrophomonas maltophilia, identified from bronchial aspirate culture after extended incubation and managed with trimethoprim-sulfamethoxazole. This case underscores the necessity of lifelong surveillance in hydatid disease, the potential role of postoperative antiparasitic therapy in preventing long-term recurrence, and the vital role of a multidisciplinary team in managing complex, disseminated relapses.
Eucalyptus cinerea is known for anti-inflammatory/antioxidant properties in Tunisian traditional medicine, but research on its seeds for the treatment of pulmonary fibrosis (PF) is insufficient. The study investigated the phytochemical properties and the curative potential of Eucalyptus cinerea seeds aqueous extract (ECAE) against bleomycin (BLEO)-induced sub-acute experimental PF as well as the mechanisms implicated in such protection. Firstly, the phytochemical analysis of ECAE revealed the presence of 7 phenolic compounds, including 3 phenolic acids, 3 flavonoids, and 1 tannin. Results of the in vivo assay showed that ECAE treatment significantly reduced BLEO-induced lung lesions and improved histopathological alterations. ECAE attenuated BLEO-induced plasma and pulmonary lipid peroxidation and the depletion of both enzymatic and non-enzymatic antioxidants. More importantly, intratracheal instillation of BLEO increased hydrogen peroxide and calcium levels, while the ECAE treatment reversed all intracellular mediator perturbations. Also, ECAE exhibited anti-inflammatory and immunomodulatory properties. These results suggest that Eucalyptus cinerea seeds contain anti-inflammatory compounds that could help fight PF, making them a potential ingredient for functional foods.
Methicillin-resistant Staphylococcus aureus (MRSA) remains a major cause of serious infection and is associated with substantial morbidity and mortality. Clinical presentations range from localized disease to severe, life-threatening infections, including bacteremia and sepsis with metastatic complications such as infective endocarditis and osteoarticular involvement. MRSA bacteremia carries a high risk of dissemination and death, underscoring the importance of early recognition and effective management. Optimal treatment requires timely initiation of appropriate antimicrobial therapy in conjunction with source control when indicated. Despite advancements in treatment, persistent MRSA bacteremia continues to pose significant clinical challenges. Given the complexity of these infections, a clear understanding of current treatment strategies is essential for clinicians. In this narrative review, we summarize contemporary guideline-based approaches to the management of MRSA bacteremia, highlight key pharmacologic considerations of available antimicrobial agents, and discuss knowledge gaps and recent developments in both established and emerging therapies aimed at improving outcomes in these challenging infections.
Background: Ventricular septal defects (VSD) are the most common form of congenital heart disease (CHD). Current guidelines recommend surveillance transthoracic echocardiograms (TTE) following surgical closure of perimembranous VSDs (pVSD); however, duration of screening is not explicitly stated. The goal of this study is to determine the utility of follow-up TTEs after uncomplicated pVSD surgical closure. Methods: Single-site retrospective analysis was conducted on patients who underwent pVSD surgical closure. Patients were excluded if diagnosed with other CHD, had complications 1 year post-repair, or lacked data 1 year post-repair. Serial TTEs were reviewed. A Kaplan-Meier curve was used to illustrate the 5-year complication-free survival. Results: A total of 117 patients met inclusion criteria. A 97% 5-year complication-free survival was observed. Four patients had complications >1 year post-repair: one non-obstructive subaortic ridge, one pulmonary vein stenosis, one pinhole residual pVSD, and one ventricular ectopy with ventricular dysfunction. Of the 113 complication-free patients, 197 TTEs were performed with no change in clinical management. Conclusions: Beyond 1 year post-repair, the occurrence of new complications following uncomplicated pVSD surgical closure is rare. Unless clinical concerns arise, the utility of routine TTEs > 1 year post-repair in this uncomplicated post-surgical cohort should be reassessed. Larger multicenter studies are needed to determine the utility of routine TTEs.
Sublobar pulmonary resection has become an increasingly adopted approach for early-stage non-small cell lung cancer, driven by evidence that anatomical segmentectomy can achieve oncological outcomes comparable to lobectomy in selected patients. Safe execution of sublobar resection depends on accurate preoperative identification of segmental bronchovascular anatomy, which demonstrates substantial variability. Conventional two-dimensional (2D) computed tomography (CT) imposes significant limitations on anatomical interpretation, particularly at the segmental and subsegmental level. Three-dimensional (3D) bronchovascular modelling provides patient-specific representations of segmental anatomy and relationships that address these limitations. This narrative review examines the current and emerging roles of 3D modelling in personalised thoracic surgery. It discusses the anatomical basis for its application, the limitations of conventional imaging, and the contribution of 3D modelling to preoperative planning and intraoperative decision making. It also considers broader applications, current limitations, and future directions, with emphasis on how patient-specific 3D modelling can support more tailored operative strategies and more individualised surgical care.
Radiologic findings associated with SARS-CoV-2 infection have been well described since its emergence. However, long-term clinical and radiologic complications of pediatric SARS-CoV-2 infection are less defined, including radiologic findings in children following recovery. This study compares chest radiographic (CXR) and low-dose chest computed tomography (CT) findings in pediatric participants; a longitudinal cohort of children who have recovered from SARS-CoV-2 infection and uninfected controls. Eight hundred forty-six children (700 laboratory confirmed SARS-CoV-2-infected children and 146 uninfected controls) completed a radiologic exam at the baseline visit, which occurred 9.8 months (mean) post-infection. CXR (n=485) and CT (n=362) images were evaluated by three radiologists for known radiologic manifestations of COVID-19 including various patterns of opacities (ground glass, reticular, consolidation), nodules, perihilar thickening, effusions, and/or cystic changes. Comparisons were made using generalized estimating equations with cohort (infected vs. uninfected) as the predictor. Overall, the incidence of radiologic abnormalities detected at baseline was 32.1% in the infected cohort and 24.0% in the uninfected cohorts. Infected participants were more likely to have CXR abnormalities than uninfected (21.2% vs. 12.4%; OR 2.44; 95% CI 1.19-5.02; P=0.016). This was primarily due to an increased incidence of perihilar peribronchial thickening (17.4% in infected vs. 10.1% in noninfected). There were no statistically significant differences between cohorts for CT abnormalities (46.2% vs. 42.1%; OR 1.24; 95% CI 0.71-2.16; P=0.46). Radiologic abnormalities were not statistically significantly associated with presence of pulmonary symptoms after recovery. At the baseline visit, infected participants were more likely than uninfected controls to have chest radiographic abnormalities, limited to perihilar peribronchial thickening. There was no significant difference in CT abnormalities between the two cohorts. There was no increased frequency of radiographic findings in children with underlying asthma, nor in children who experienced pulmonary symptoms following recovery at the baseline visit.
Background and Clinical Significance: Susac syndrome is a rare autoimmune-mediated microangiopathy characterized by the triad of encephalopathy, branch retinal artery occlusion (BRAO), and sensorineural hearing loss. Due to its variable onset and protean manifestations, the syndrome is frequently misdiagnosed, potentially leading to delayed treatment and irreversible organ damage. Ocular involvement is common and often provides the first diagnostic clue. Multimodal imaging, particularly fluorescein angiography (FA) and optical coherence tomography (OCT) as well as optical coherence tomography angiography (OCT-A), enables the detection of both acute and chronic ischemic retinal changes. Their complementary application yields critical insights into disease activity, supports monitoring of relapses, and guides therapeutic strategies. Case Presentation: We describe two patients with Susac syndrome presenting with distinct ocular and neurological features. A 43-year-old male developed recurrent BRAOs in both eyes, documented by FA, OCT, and OCT-A, with preserved best-corrected visual acuity (BCVA) of 0.00 logMAR in both eyes (OU). OCT demonstrated progressive thinning of the retinal nerve fiber layer (RNFL) and inner retinal layers, consistent with sequelae of microinfarctions, while FA revealed focal arteriolar wall hyperfluorescence. Immunosuppressive therapy with corticosteroids and mycophenolate mofetil stabilized his condition. A 31-year-old female with a history of migraine and encephalopathy showed thinning of the RNFL and ganglion cell layer (GCL) with macular atrophy on OCT. FA demonstrated peripheral arteriolar wall hyperfluorescence and microaneurysms. Despite these structural alterations, visual acuity remained unaffected. Serial imaging initially demonstrated mild progression on OCT and OCT-A, followed by disease stabilization under systemic immunosuppressive therapy. Conclusions: These cases highlight the pivotal role of multimodal imaging in the early recognition and long-term monitoring of Susac syndrome. OCT provides a detailed assessment of retinal microinfarctions and chronic atrophy, while FA remains indispensable for detecting vascular leakage and disease activity. The complementary use of OCT, OCT-A, and FA enhances diagnostic accuracy, facilitates timely therapeutic interventions, and supports individualized management. Regular ophthalmological monitoring, including advanced imaging modalities, should be considered an essential component of care in Susac syndrome.
Objectives: This study aimed to investigate the therapeutic effects and potential mechanisms of Lonicerae japonicae Flos (Jinyinhua, JYH) against respiratory syncytial virus (RSV)-induced pneumonia by integrating lung tissue metabolomics with gut microbiota analysis. Methods: An RSV-infected mouse model was established through intranasal inoculation. Lung pathological changes, viral RNA levels, lung index, and inflammatory cytokine levels were evaluated. Untargeted metabolomics and 16S rRNA gene amplicon sequencing were performed to characterize JYH-mediated alterations in pulmonary metabolites and the gut microbiota. Spearman correlation analysis was conducted to assess associations between differentially abundant bacterial genera and significantly altered metabolites. Results: JYH alleviated RSV-induced pulmonary histopathological injury, reduced viral RNA levels, decreased lung index and interleukin-6 (IL-6) levels, and increased interferon-γ (IFN-γ) levels. Metabolomic profiling identified 46 differential metabolites, among which 26 showed a reversal trend following JYH administration. These metabolites were mainly enriched in pathways associated with the synaptic vesicle cycle, lysosomal function, and Forkhead box O (FoxO) signaling. Gut microbiota analysis showed that JYH increased microbial richness and diversity, whereas KEGG-based functional prediction indicated that the differentially abundant taxa were primarily involved in amino acid, carbohydrate, and nucleotide metabolism. Moreover, correlation analysis revealed significant associations between key bacterial genera, including Gemella, Sutterella, and CC_115, and differential metabolites such as pyridoxamine, uridine monophosphate (UMP), and argininosuccinic acid. Conclusions: JYH may protect against RSV-induced pneumonia by restoring pulmonary metabolic homeostasis and modulating gut microbiota composition. These findings provide new insights into metabolite-microbiota interactions underlying the anti-RSV activity of JYH.
Decompression sickness (DCS) is a clinical syndrome caused by a substantial reduction in barometric pressure. DCS is more common among divers but may also occur during flight or altitude chamber (hypobaric chamber) training. DCS is classified according to symptoms as either Type 1 (musculoskeletal and skin involvement) or Type 2 (neurological and pulmonary involvement). DCS may be life threatening and often necessitates treatment with hyperbaric oxygen therapy (HBOT). To examine the risk for altitude decompression sickness (ADCS) in altitude chamber training and to compare ADCS symptoms and treatment to those of DCS in divers (DDCS). We conducted a retrospective cohort study that included all cases of ADCS in the Israeli Air Force between 2015 to 2022. We collected demographic, flight platform, altitude chamber training, clinical manifestations, and treatment data. Data regarding DDCS was obtained via a literature review. There were 2279 altitude chamber trainees and aviation physiology instructors. Of these, 11 presented ADCS, leading to a calculated ADCS risk of 0.5%. An additional four cases were reported following combat flights. Musculoskeletal involvement was the most common symptom in both DDCS and ADCS. A shorter HBOT protocol was used in 53% of the ADCS cases but only in 30% of the DDCS cases. Overall, ADCS is a rare event, occurring in less than 1% of altitude chamber trainees. The common manifestation is of musculoskeletal involvement, and the mainstay of treatment remains HBOT.
Pulmonary arterial hypertension (PAH) is a fatal vascular disorder with poor prognosis. 6:2 chloro-polyfluorooctane ether sulfonate (F-53B), a persistent environmental contaminant detected in humans, is known to be vasculotoxic, yet its association with PAH remains unexplored. This study aims to elucidate the mechanisms linking F-53B exposure to PAH by integrating network toxicology, molecular docking and in vitro experiments. Potential F-53B targets were predicted using ChEMBL, PharmMapper, and TargetNet. PAH-related genes were compiled from GeneCards, Online Mendelian Inheritance in Man (OMIM), Therapeutic Target Database (TTD), and GSE254617. We identified 42 key targets of F-53B-related PAH. Functional enrichment revealed terms such as inflammatory response and extracellular matrix. Protein-protein interaction (PPI) analysis identified five hub genes: CCL2, CXCL8, CCL5, CCR2, and CCL11. Molecular docking confirmed strong binding between F-53B and these core targets, with CCR2 showing the strongest affinity (-10 kcal/mol). Molecular dynamics simulations further verified stable binding to CCR2. In vitro experiments demonstrated that F-53B activated the CCL2/CCR2 axis and induced IL-1β, TNF-α, and IL-6 in HUVECs and RAW264.7 cells. This study reveals that F-53B is linked to PAH through dysregulation of chemokine signaling networks and induction of inflammatory cytokines. These findings suggest F-53B as a potential environmental risk factor for PAH and pinpoint potential targets for intervention.
Pulmonary arterial hypertension (PAH) is a refractory cardiopulmonary disorder with a high mortality rate and few treatment options. Fisetin, a natural flavonoid, exhibits pleiotropic effects including anti-angiogenic, anti-proliferative, anti-inflammatory, and autophagy-modulating activities. To evaluate the therapeutic potential of Fisetin, we established two experimental models: a rat model of monocrotaline (MCT)-induced pulmonary arterial hypertension (PAH) and a platelet-derived growth factor (PDGF)-induced human pulmonary artery smooth muscle cell (PASMC) proliferation model. The therapeutic efficacy and underlying mechanisms of Fisetin were comprehensively assessed using a combination of in vivo and in vitro approaches, including right heart catheterization, masson's trichrome and hematoxylin-eosin staining, immunohistochemistry, westernblot, immunofluorescence, ELISA, and transmission electron microscopy. Additionally, Protein-protein docking predicts interactions between proteins, whereas molecular docking predicts interactions between small molecules and proteins. Fisetin significantly ameliorated pulmonary vascular remodeling and reduced both right ventricular systolic pressure and the right ventricular hypertrophy index in monocrotaline (MCT)-induced PAH rats. The underlying mechanism may involve suppression of the TGF-β1/Smad2/3 pathway, which regulates autophagy, cell proliferation, migration, and inflammatory responses. In vitro, Fisetin exerted a dose-dependent suppressive effect on these molecular events. This study suggests that Fisetin may alleviate MCT-induced PAH rats by suppressing aberrant TGF-β1/Smad2/3 pathway activation. These findings provide experimental and theoretical support for Fisetin as a promising therapeutic candidate for PAH.
Hospital quality reporting remains a manual, costly process with critical limitations as a mechanism to improve care outcomes. To assess whether near-real-time quality measurement, enabled by large language models (LLMs), can improve quality performance as measured by the Centers for Medicare & Medicaid Services (CMS) Severe Sepsis and Septic Shock Management Bundle (SEP-1) quality metric. This single-blind, unstratified, cluster randomized trial was conducted between December 13, 2024, and July 8, 2025, at 2 academic emergency departments (EDs) within the University of California, San Diego (UCSD) health system. Participants included all 66 attending physicians who practiced in the UCSD EDs and worked more than 3 shifts per month prior to study initiation. Participants were randomized to receive targeted feedback from LLM-determined compliance with SEP-1 at the time of patient discharge or standard process. The primary outcome was overall compliance with SEP-1. Secondary outcomes included expert agreement with the LLM SEP-1 determination, 30-day mortality, and intensive care unit admissions of patients with severe sepsis and/or septic shock in the ED. Effect sizes were estimated from a mixed-effects logistic regression model with the intervention group as a fixed effect and a random intercept for physician. The study population included 66 physicians who treated 301 patients (121 in the control group and 180 in the intervention group; median age, 64.3 [IQR, 51.1-75.7] years; 171 [56.8%] male; 52 [17.3%] with chronic kidney disease; 52 [17.3%] with chronic heart failure) who met CMS inclusion criteria for SEP-1. Physicians in the control group had a SEP-1 compliance rate of 70.1%, while those in the intervention group had a rate of 82.9%. Assignment to the intervention group resulted in a 13.0% absolute improvement in SEP-1 compliance (95% CI, 2.5%-23.4%; odds ratio, 2.10 [95% CI, 1.15-3.81]; P = .02) in the mixed-effects model. The largest difference between the intervention group and control group was in noncompletion of the 30-mL/kg fluid bolus component (3 of 180 [1.7%] vs 16 of 121 [13.2%]), a documentation-sensitive component of the quality measure. Agreement between LLM determination and expert review was 92%. No significant differences existed in intensive care unit admissions or 30-day mortality. In this cluster randomized trial of artificial intelligence (AI)-enabled medical record abstraction for sepsis care, rapid assessment of SEP-1 performance and targeted feedback improved overall compliance with the measure. AI-driven quality clinical integration may address limitations in existing hospital quality reporting and better support a learning health system. ClinicalTrials.gov Identifier: NCT07581340.
Background: Systemic sclerosis (SSc) is an autoimmune disease with interstitial lung disease (ILD) representing the leading cause of mortality. Diaphragmatic muscle impairment, which may contribute to respiratory dysfunction, is underexplored in SSc. Objective: This study aimed to assess diaphragmatic thickness using HRCT in patients with SSc-ILD and to investigate whether this parameter correlates with disease severity and clinical outcomes. Methods: We conducted a multicentric retrospective observational study that included 161 participants: 69 with SSc-ILD and 92 matched controls without pulmonary disease. Preliminary findings from this cohort were previously communicated as a conference abstract at EULAR 2024. Diaphragmatic thickness was measured on axial and coronal CT images at the celiac axis level by two independent radiologists. Clinical and functional parameters were collected, including forced vital capacity (FVC), diffusing capacity for carbon monoxide (DLCO), echocardiographic findings, and 6 min walking test performance. Results: The left hemidiaphragm was significantly thinner in patients with SSc-ILD compared with controls (2.98 ± 1.04 mm vs. 3.44 ± 0.97 mm; p = 0.004), while the right hemidiaphragm showed a non-significant trend toward reduction (3.21 ± 1.09 mm vs. 3.52 ± 1.05 mm; p = 0.072). Thinning of the right hemidiaphragm correlated significantly with lower FVC (p < 0.05). ROC analysis identified an optimal left diaphragm cut-off of ≤3.115 mm (AUC = 0.635, 95% CI: 0.556-0.709, sensitivity = 66.7%, specificity = 60.9%). No associations were found with the autoantibody profile, disease duration, or treatment. Interobserver reliability was excellent (Bland-Altman mean difference -0.002 mm, p = 0.95). Conclusions: HRCT-measured left hemidiaphragm thickness is significantly reduced in patients with SSc-ILD compared with controls, and right hemidiaphragm thickness correlates with impaired lung function. Although its discriminative performance is modest (AUC 0.635), this parameter may serve as a supplementary zero-burden addition to routine HRCT evaluation alongside pulmonary function tests. The retrospective cross-sectional design precludes conclusions about causality or prognosis; prospective studies incorporating concurrent functional diaphragm assessment are warranted.
Chronic obstructive pulmonary disease (COPD) is a respiratory disease that progressively impairs airway function. Its aetiology and clinical presentation are very complex, resulting in an unpredictable course of the disease. The most important causes include smoking and environmental pollutants. However, upper airway microbiome dysbiosis has been linked with COPD severity. Through this review, we aim to compare the microbiome of the respiratory tract between its sites, and to see if there are any significant differences in the composition of the microbial flora of patients with COPD when compared to healthy individuals. While preparing this review, the PubMed database was searched using keywords such as bacteriome, COPD, exacerbation, and microbiome. Analysis of the airway microbiome shows that the three most abundant phyla are Firmicutes, Proteobacteria, and Bacteroidetes. The severity of the disease and the selected therapeutic methods influence the ratio of Proteobacteria and Firmicutes. It has been observed that a decrease in microbial diversity resulted in lower values of FEV1 in patients and could be related with COPD's progress and exacerbation events. While exacerbation cases need quick treatment, COPD's complex background makes it difficult to find a singular, microbial cause.
Objective: The present study aimed to determine clinical and surgical variables associated with postoperative morbidity and 10-year mortality in isolated mitral valve replacement (MVR) and to assess the association between sex and postoperative outcomes. Materials and Methods: A total of 1629 patients undergoing isolated MVR in one center during the period between January 2000 and December 2015 were retrospectively analyzed. Hospital records provided demographic, clinical, echocardiographic, and operative data. Cox regression analyses were used to determine factors associated with postoperative morbidity and long-term mortality. The Kaplan-Meier method was used to analyze long-term survival, and the log-rank test was used to compare the groups. Results: A total of 866 (53.1%) patients were male and 763 (46.9%) were female, and the average age was 63.8 ± 10.9 years. There were no significant differences in female and male patients regarding basic demographic and clinical characteristics. The first 30-day in-hospital morbidity rate was also significantly greater in women than in men (25.7% vs. 20.6%; p = 0.015). The in-hospital mortality was more prevalent among women (5.0% vs. 3.0%; p = 0.043). Age, sex (female), diabetes mellitus, pulmonary hypertension, chronic obstructive pulmonary disease, critical preoperative condition, high body mass index, longer cardiopulmonary bypass time, and low left ventricular functioning were significantly associated with postoperative morbidity in multivariable analysis. The total mortality rate during a 10-year follow-up was 33.2%, which was considerably higher among women compared to men (36.3 vs. 30.5; p = 0.013). Kaplan-Meier analysis demonstrated significantly lower long-term survival in female patients (log-rank p = 0.011). Conclusions: Morbidity and mortality following isolated MVR are closely related to patient-related factors. Female sex showed a significant adjusted association with higher 10-year mortality in multivariable analysis, warranting careful long-term risk assessment in female patients.