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Despite widespread use of multiple PCR, a substantial proportion of pediatric acute respiratory tract infections (ARTIs) lack identifiable pathogens and are classified as unknown etiology. The microbial characteristics and clinical relevance of these cases remain unclear. In this study, we compared the airway microbiomes of PCR-positive and PCR-negative ARTIs and examined their relationships with sampling site and disease severity. A total of 514 hospitalized children with ARTIs were enrolled. Nasopharyngeal swabs (NS) and bronchoalveolar lavage fluid (BALF) samples were tested using a 22-target multiplex PCR panel and subsequently stratified by pathogen status for pooled metatranscriptomic sequencing to profile active microbial communities, viral genotypes, and antibiotic resistance genes. PCR identified common respiratory pathogens in 77.0% of NS and 54.1% of BALF samples. Metatranscriptomic analysis showed that PCR-negative pools displayed markedly lower viral activity and comparatively higher bacterial transcript abundance, with notable enrichment of Pseudomonas. Microbial signatures differed between upper and lower airway samples and across clinical severity, with severe cases demonstrating increased bacterial burden and Pseudomonas enrichment, whereas mild infections exhibited relatively stronger viral signals. Under current thresholds, antibiotic resistance genes were detected in patient pools but not in healthy controls. Overall, PCR-negative pediatric ARTIs exhibited distinct, bacteria-enriched microbial profiles. Integrating metatranscriptomics with PCR enhances pathogen characterization and reveals site- and severity-related microbial patterns that may support diagnostic evaluation and clinical management.

Inappropriate antibiotic prescribing remains a global concern, as it contributes to adverse drug reactions, increased healthcare costs, and the spread of antimicrobial resistance. In Japan, several studies have investigated antibiotic prescription patterns; however, most rely solely on insurance claims data, which may not accurately reflect clinical diagnoses. This study aimed to evaluate the appropriateness of antibiotic use for acute respiratory tract infections (ARTIs) by cross-referencing disease names recorded in insurance claims with diagnoses documented in electronic medical records. We conducted a retrospective review of outpatient records from Hino Hospital, a community-based general hospital providing primary care services, between April 1, 2017, and March 31, 2018. Patients diagnosed with ARTIs were identified through claims data, and their diagnoses were confirmed using their medical records. The appropriateness of antibiotic prescriptions was assessed based on the Japanese clinical guideline, Manual for Appropriate Antimicrobial Use. A total of 485 patients were included. The overall antibiotic prescription rate for ARTIs was 17.1%, and among those prescribed antibiotics, only 14.5% were deemed appropriate. The general medicine department had the lowest prescription rate and the highest rate of appropriate use among all departments. This study provides a chart-based analysis of inappropriate antibiotic use for ARTIs in Japan. To reduce inappropriate antibiotic prescriptions, multifaceted interventions and continuous evaluation will be necessary.

Antimicrobial resistance (AMR) is a major health challenge in Kyrgyzstan, where acute respiratory tract infections (ARTIs) are common and frequently treated with antibiotics. Although C-reactive protein (CRP) point-of-care testing can support rational prescribing, there is no consensus on safe CRP thresholds for adults. Patient information leaflets (PILs) may further reduce inappropriate antibiotic use by improving understanding of ARTIs and addressing expectations for antibiotics. The 2CARE trial evaluates whether combining PILs with CRP testing can safely reduce antibiotic use among adults with ARTIs in Kyrgyz primary care. 2CARE is a multicentre, open-label, individually randomised controlled trial conducted in 15 primary healthcare centres in Kyrgyzstan. Adults aged 18-70 years with acute respiratory symptoms (<14 days) are randomised 1:1 to receive a PIL or no PIL, and independently 1:1:1 to one of three CRP cut-off levels (20, 40, or 60&#xa0;mg/L), yielding six parallel groups. Primary outcomes are: (1) total antibiotic use within 21 days, and (2) hospital admission within 21 days. Secondary outcomes include baseline antibiotic prescribing, re-consultations, recovery, hospital referral, antiviral use, and mortality. Analyses will follow the intention-to-treat principle, with per-protocol analysis for non-inferiority, using regression models and generalized estimating equations. A total sample of 1,050 participants provides 90% power for both primary comparisons. This trial will generate evidence on the effectiveness of PILs in reducing antibiotic use and establish safe CRP thresholds for adults with ARTIs in a low-resource setting. Findings will inform antimicrobial stewardship policies and guide national CRP implementation in Kyrgyzstan. ClinicalTrials.gov Identifier: NCT07261969.

Human adenoviruses (HAdVs) are important causes of pediatric acute respiratory tract infections (ARTIs), with disease severity potentially varying by type. The impact of COVID-19-related non-pharmaceutical interventions (NPIs) and their relaxation on the relative prevalence of various HAdV types, RNase P-normalized viral load distributions, and associated clinical outcomes remains incompletely defined. We conducted a retrospective cohort study of children hospitalized for ARTIs at Shanghai Children's Hospital from 2021 to 2023, integrating epidemiologic trends, clinical phenotypes, HAdV typing and RNase P-normalized HAdV DNA quantification by droplet digital PCR (ddPCR). Multivariable logistic regression was used to identify independent correlates of severe community-acquired pneumonia (SCAP). Among 19,537 hospitalized children, HAdV was detected in 600 (3.07%), with annual detection rates of 2.85%, 2.36% and 3.44% in 2021, 2022 and 2023, respectively (p&#x2009;=&#x2009;0.002). A marked type replacement occurred, shifting from species C (predominantly HAdV-108) in 2021-2022 to species B (predominantly HAdV-3) in 2023. Among 507 HAdV-positive cases with complete data, post-pandemic cases in 2023 involved older children and showed higher proportions of species B infection, Mycoplasma pneumoniae (MP) co-infection, and SCAP (14.74% vs. 3.08% in 2021-2022; p&#x2009;<&#x2009;0.001). In multivariable analyses, MP co-infection (aOR 4.16) and HAdV-B species (aOR 3.34) remained independently associated with SCAP. RNase P-normalized viral loads were highest in acute tonsillitis and comparatively lower in severe pneumonia and in patients with comorbidities or complications (p&#x2009;<&#x2009;0.05), supporting a limited role of viral burden alone in severe outcomes. In conclusion, hospitalized pediatric ARTIs at Shanghai Children's Hospital during 2021-2023 showed a post-pandemic shift toward species B predominance and more severe phenotypes, closely linked to MP co-infection. Integrated molecular surveillance and routine MP screening may support earlier risk stratification for severe HAdV-associated respiratory disease in children.

Acute respiratory tract infections (ARTIs) are among the most common reasons for pediatric primary care visits and antibiotic receipt. Telemedicine outside of primary care settings has been associated with overuse of antibiotics for ARTIs in children. The quality of telemedicine when integrated within primary care for children is not clear. To compare antibiotic management during primary care visits conducted through telemedicine vs in-person. This retrospective, cross-sectional study analyzed visits for ARTIs in children younger than 18 years between January 1 and December 31, 2023, at 694 US primary care practices (including community health organizations, independent pediatric practices, and practice networks affiliated with large health systems). Analyses were performed between October 1, 2024, and February 12, 2026. Primary care telemedicine vs primary care in-person index visits. The primary outcomes were percentage of index visits with antibiotics prescribed and percentage with antibiotic management concordant with guidelines for visit diagnosis. Secondary outcomes included index visit diagnosis, follow-up visits within 14 days, and antibiotic prescription within 14 days. Weighted analyses were conducted using a propensity score model to estimate the probability of an ARTI index visit being conducted via telemedicine and estimated the average treatment effect associated with telemedicine. This study included 438&#x202f;148 in-person and 11&#x202f;482 telemedicine index ARTI visits at primary care practices by 302&#x202f;817 children (mean [SD] age: 6.6 [4.7] years; 51.4% male). Antibiotic prescription occurred during 46.8% (95% CI, 45.1%-48.4%) of primary care in-person visits vs 34.6% (95% CI, 27.0%-42.3%) of primary care telemedicine visits in the propensity score-weighted model, with a difference of -12.1 (95% CI, -19.3 to -5.0) percentage points. Antibiotic management was guideline concordant for 86.2% (95% CI, 85.1%-87.3%) of primary care in-person visits vs 85.5% (95% CI, 80.5%-90.4%) of primary care telemedicine visits, with a difference of -0.7 (95% CI, -5.3 to 3.8) percentage points. The proportion of follow-up visits and antibiotic prescription within 14 days after initial visit did not vary significantly by index visit modality. In this cross-sectional study of primary care practices caring for children, telemedicine integrated within primary care was associated with judicious antibiotic prescribing without increased follow-up visits or subsequent antibiotics prescribed. Supporting primary care practices in offering telemedicine for acute concerns may be a strategy to limit unnecessary antibiotic receipt.

Molecular point-of-care testing (mPOCT) offers rapid identification of respiratory pathogens, but its impact on antibiotic use and patient outcomes remains uncertain. We aimed to comprehensively evaluate the effects of mPOCT on antibiotic use and major clinical outcomes in patients presenting with acute respiratory tract infections (ARTIs). We searched MEDLINE, Embase, Web of Science, CENTRAL, CNKI, and Wanfang Data from inception to July 1, 2025, for randomised controlled trials (RCTs) evaluating mPOCT for patients presenting with ARTIs (PROSPERO CRD420251069333). The primary outcome was antibiotic use, assessed using pooled risk ratio (RR) with random-effects models. Risk of bias and certainty of evidence were assessed using the Risk Of Bias instrument for Use in SysTematic reviews-for Randomised Controlled Trials (ROBUST-RCT) and core Grading of Recommendations, Assessment, Development and Evaluation (GRADE), respectively. We included 25 RCTs involving 12,638 patients, of whom 61.0% were adults. Overall, mPOCT probably had little to no important effect on antibiotic use (RR 0.95, 95% CI 0.90-1.00; moderate certainty) or treatment duration (mean difference -0.44 days, 95% CI -0.98 to 0.09; moderate certainty). In adults, high-certainty evidence showed no effect on antibiotic use (RR 1.00, 95% CI 0.98-1.02), whereas in children, low-certainty evidence suggested a potential reduction (RR 0.79, 95% CI 0.65-0.97). Although mPOCT increased appropriate antibiotic prescribing (RR 2.07, 95% CI 1.55-2.77; moderate certainty), it did not affect 30-day mortality (RR 0.97, 95% CI 0.82-1.15; high certainty) and intensive care unit admission (RR 0.90, 95% CI 0.65-1.25; high certainty). Moderate to high certainty evidence suggests that mPOCT does not meaningfully reduce overall antibiotic use or improve patient outcomes, particularly in adults, despite enhancing prescribing appropriateness. Routine use of mPOCT for adults with ARTIs is therefore not supported. National Natural Science Foundation of China, the Postdoctoral Science Foundation, the Chongqing Municipality Joint Science and Health Major Medical Research Project, Outstanding Youth in Science and Technology, the Chongqing Youth Talent Fund, and the Research Foundation Flanders.

The COVID-19 pandemic and associated public health measures disrupted the circulation of respiratory viruses worldwide. However, the long-term impact of these changes on pediatric respiratory tract infections (ARTIs) remains incompletely understood. We conducted a prospective study in children under 14&#xa0;years hospitalized for ARTIs in Severo Ochoa Hospital (Spain) from January/2006 to September/2023. The cohort was divided into three periods: pre-pandemic (T1), pandemic (T2), and post-pandemic (T3). Clinical and virological results were compared. 6048 children were included (T1:5,101; T2:122; T3:825). Viral detection increased in T3 (91%) compared to T1 (78.7%) and T2 (69.5%), p&#x2009;<&#x2009;0.001, with higher rate of coinfections, p&#x2009;<&#x2009;0.001, and pneumonia diagnoses, p&#x2009;<&#x2009;0.001. HRV and RSV were the most frequent viruses across periods, with HRV maintaining year-round circulation and RSV showing marked seasonal disruption in T2, followed by return to its typical winter pattern in T3. Detection of PIV and HMPV increased in T3, with altered seasonal peaks and a shift toward older age groups. Influenza infections, nearly absent in T2, re-emerged in T3 with delayed seasonal peaks and higher median ages. HBoV circulation declined and became more evenly distributed throughout the year. Clinically, children in T3 were older, with more hypoxia, radiological infiltrates, and pneumonia, while bronchiolitis cases decreased. Most pneumonia cases in T3 had a viral etiology, with HRV, RSV, HMPV, and PIV as the main contributors. Post-pandemic shifts in viral circulation and disease profiles among children with ARTIs highlight the ongoing impact of COVID-19 on pediatric respiratory health. The increased burden of viral pneumonia and the change in seasonal distribution of infections underscore the need for updated surveillance, diagnostic strategies, and prevention programs tailored to the post-pandemic context.

To evaluate clinical outcomes after implantation of new presbyopia-correcting intraocular lens (IOL): Artis Symbiose&#xae; (Cristalens Industrie, France). Tertiary referral center, Brest, France. Non-comparative prospective interventional study. Patients undergoing bilateral IOL implantation were included. Visual acuity (VA) for distance, intermediate (70cm) and near (40cm) vision were measured. In addition, defocus curves were obtained at 1 and 6months, and a reading speed test was assessed using the Salzburg Reading Desk&#xae; (SRD) 3months after surgery. The VF-14 questionnaire was evaluated at 1, 3 and 6months after surgery to measure spectacle independence, and a level of satisfaction questionnaire was completed at the 6-month follow-up visit. The study included 48 eyes. Mean postoperative monocular uncorrected VA, for MID and PLUS respectively, was 0.028&#xb1;0.08 LogMAR and 0.057&#xb1;0.10 at distance (UDVA), 0.035&#xb1;0.10 and 0.037&#xb1;0.09 at intermediate (UIVA), 0.078&#xb1;0.11 and 0.030&#xb1;0.10 at near (UNVA). Binocularly, uncorrected VA was -0.022&#xb1;0.02 at distance, -0.002 at intermediate, and 0.015 at near. The binocular defocus curve at 6months after surgery was above 0 LogMAR between +0.50 D and -2.50 D. The mean satisfaction rate at 6months was 83%. The Artis Symbiose&#xae; IOL provides functional uncorrected visual acuity at distance, intermediate and near positions, without the need for additional optical aid. It is an effective option in active presbyopic patients, with a continuous and extended depth-of-focus, providing added value compared to trifocal implants.

Detection of ischemia and intracranial hemorrhage (ICH) directly after endovascular thrombectomy (EVT) could enable earlier diagnosis and treatment. We evaluated whether post-EVT Sine Spin cone-beam computed tomography (CBCT) on the Siemens ARTIS Icono biplane system at the end of the procedure can predict ischemia and ICH on subsequent follow-up computed tomography (FUCT) within 48 hours. Adult patients undergoing EVT in 2024 with available CBCT and FUCT were included. Two interventional neuroradiologists independently evaluated the CBCT examinations for ischemia, ICH (including Heidelberg classification), and image quality. FUCT, annotated by a neuroradiologist, was used as reference standard. Large ischemia was defined as ischemia involving &#x2265;3 predefined vascular territories. Of 331 patients with EVT, 225 had both CBCT and FUCT, of which 197 (88%) were successfully recanalized. Ischemia was observed in 127 (56%) and ICH in 64 (28%) of the FUCTs. For ICH, sensitivity was 75%/77% (reviewer 1/reviewer 2), specificity 85%/84%, and positive predictive value 67% for both reviewers, negative predictive value 92%/91%, and accuracy 84%/83%. Accuracy for large ischemia (n=24, 11%) was 78%/67%. Sensitivity for correctly located ischemia on CBCT was 48%/73%, with specificity of 87%/60%, positive predictive value of 82%/71%, negative predictive value of 56%/63%, and accuracy of 65%/68%. CBCT was rated overall nondiagnostic in 0%/1% of the cases. For the posterior fossa specifically, 6%/16% of examinations were rated nondiagnostic. Sine Spin CBCT on the Siemens ARTIS Icono biplane system after EVT showed high accuracy for predicting ICH and large ischemia on FUCT. CBCT may help identify patients needing closer monitoring or early neurosurgical intervention.

Chlamydia pneumoniae is a common pathogen involved in acute respiratory tract infections (ARTIs) in children. Children with ARTIs attending the West China Second Hospital of Sichuan University from January 2022 to December 2023 were selected. IgM antibodies against Chlamydia pneumoniae (C. pneumoniae) were detected using a chemiluminescence immunoassay. Demographic and temporal differences in IgM positivity were compared between 2022 and 2023. Over the two-year period, 20,689 children were included. In 2022, under stringent COVID-19 non-pharmaceutical interventions (NPIs), 453 positive and 10,092 negative cases, with IgM seropositivity rate of 4.3%. In 2023, following the nationwide relaxation of these NPIs, 602 positive cases, and 9,542 negative cases for IgM seropositivity rate of 5.9%, which was significantly higher than that in 2022 (P < 0.001). The IgM seropositivity rate of C. pneumoniae infection in children aged 3 to 14 years was significantly higher in 2023 than in 2022 (P < 0.05). The IgM seropositivity rate from January to May 2023 was significantly higher than that during the same period of 2022 (P < 0.001), while the IgM seropositivity rate from July to October 2023 was significantly lower than that during the same period in 2022 (P < 0.05). The IgM seropositivity rate in females aged 3 to 6 years was significantly higher than that of males in the same age group (P < 0.05). With the exception of 0- to 1-year-olds, the IgM seropositivity rates of females were significantly higher than those of males in the same age groups in 2023 (P < 0.05). Moreover, the IgM seropositivity rate of females was significantly higher than that of males in March, June, and September in 2022 (P < 0.05), and the IgM seropositivity rate of females was significantly higher than that of males in the same period in January, May, October, and November in 2023 (P < 0.05). The results revealed that the epidemic trend and population susceptible to C. pneumoniae changed from 2022 to 2023, providing valuable insights into the prevention, diagnosis and management of C. pneumoniae infection in this region.

Acute respiratory tract infections (ARTIs) are a major driver of antibiotic prescribing in pediatric outpatient care, much of which is inappropriate. Multiple randomized trials have evaluated antimicrobial stewardship interventions; however, the consistency of effects across different intervention mechanisms remains unclear. We conducted a systematic review of randomized and cluster-randomized controlled trials evaluating interventions aimed at reducing antibiotic prescribing for pediatric ARTIs in outpatient and primary care settings. Searches were performed in PubMed, Embase, the Cochrane Library, and Google Scholar from inception to January 2026. Due to substantial clinical and methodological heterogeneity, findings were synthesized narratively. Eight randomized controlled trials were included. Intervention effects were heterogeneous, with strategies incorporating accountability and performance feedback demonstrating more consistent directional effects toward reduced or more appropriate antibiotic use. In contrast, shared decision-making, communication-based, diagnostic-guided, and stand-alone digital interventions showed mixed or neutral effects. Where reported, reductions or neutral effects were not associated with increased reconsultation, hospital admission, or symptom deterioration. Interventions incorporating accountability mechanisms demonstrated more consistent influence on pediatric antibiotic prescribing than single-component strategies, supporting the use of multicomponent antimicrobial stewardship approaches in outpatient pediatric care.

This study aimed to apply targeted next-generation sequencing (tNGS) to analyze the pathogen distribution in children with acute respiratory tract infections (ARTIs) in our region, compare the diagnostic performance of tNGS with that of the rapid Mycoplasma pneumoniae (MP) immunoglobulin M (IgM) antibody test, and investigate the clinical characteristics of MP infection, the impact of macrolide resistance genes on disease severity, factors associated with the need for bronchoalveolar lavage (BAL), and the clinical relevance of tetracycline use. Our findings are intended to provide a scientific basis for precise diagnosis and rational antimicrobial therapy in pediatric respiratory infections. Blood parameters, including white blood cell (WBC) count, neutrophil percentage (Neut%), high-sensitivity C-reactive protein (hs-CRP), procalcitonin (PCT), and MP-IgM, were collected from pediatric patients aged 3 months to 13 years [median 7 years (interquartile range, IQR: 4-8 years)]. A retrospective analysis was performed by integrating these laboratory findings with oropharyngeal swab tNGS results, clinical data, and medication records. Viruses were the most frequently detected pathogens in children with ARTIs, accounting for 70.57% of cases. WBC count showed statistically significant differences in assessing infection types among children aged >6 years. Among MP-IgM (colloidal gold assay)-positive cases, 53.90% tested negative for MP by tNGS. The overall MP detection rate was 32.20%, with a macrolide resistance gene detection rate of 86.3%; all resistance mutations occurred at the A2063G site of the 23S rRNA gene. The MP-positive group more frequently presented with lobar pneumonia (54.21% vs. 7.59%), longer fever duration (5.25 vs. 4.00 days), and older age (7 vs. 5 years). The MP-negative group had higher rates of bilateral lung involvement (70.89% vs. 42.06%), viral detection (86.10% vs. 46.73%), and wheezing (11.39% vs. 2.80%). Tetracycline therapy did not significantly improve clinical outcomes in MP-infected children. Neut%, lobar pneumonia, use of cephalosporins, and intravenous immunoglobulin (IVIG) were independent predictors for BAL requirement. The presence of resistance genes was not associated with more severe outcomes, whereas MP positivity and lobar pneumonia were identified as risk factors for disease progression. Age, fever duration, and lobar pneumonia may assist in the assessment of MP infection. MP-IgM (colloidal gold assay) results should be interpreted in conjunction with other clinical indicators. The use of tetracyclines for MP infection requires careful benefit-risk evaluation. Cephalosporin use was associated with a lower likelihood of BAL requirement, whereas a higher Neut% and the presence of lobar pneumonia were associated with a higher likelihood of BAL requirement.

Epidemiological studies of Talaromyces marneffei (T. marneffei) infection are largely confined to HIV-positive populations and specific geographic regions, whereas its population-scale characteristics and environmental factors associated with infection in China are lacking. This study investigates spatiotemporal patterns, host susceptibility, and environmental correlates of T. marneffei detection in Chinese mainland. Targeted next-generation sequencing (tNGS) data from patients hospitalized for acute respiratory tract infections (ARTIs) from 2022 to 2024 were used for epidemiological, spatiotemporal, and co-detection analyses. Geographical detector models with the q-statistic were employed to quantify the associations of meteorological, host distribution, and social factors on detection risk, where the q-statistic measures the proportion of spatial variance explained by each factor. Among 2,316 reported cases, we identified significant spatial clustering, with bimodal seasonal peaks in detection rate. Males and individuals aged 41-50 showed the highest susceptibility. Pneumocystis jirovecii was the predominant co-detected pathogen; 5 pathogens were positively and 16 were negatively correlated with T. marneffei. Univariate analysis using the q-statistic revealed that dew point temperature had the strongest explanatory power for T. marneffei detection at 48.55%. Bivariate interaction analysis demonstrated that paired factor combinations exhibited enhanced explanatory power for disease prevalence compared with single factors. Average air pressure, which alone explained only 1.4% of the spatial variance, showed markedly higher explanatory power when paired with other variables. This study revealed spatiotemporal heterogeneity, population susceptibility, and environmental factors associated with T. marneffei detection in Chinese mainland, which can guide disease monitoring and control through enhanced surveillance and tailored interventions in epidemic hotspots and among high-risk groups.

Background/Objective: Root resective procedures are well established tooth-preserving techniques used when pathology is confined to one root of a multirooted tooth or in the furcation area. Although in recent years implant therapy has become a standard approach in many cases, the rising incidence of peri-implantitis has renewed interest in classical conservative treatment alternatives, such as hemisection, root resection and bicuspidization. The aim of this study is to present clinical cases in which hemisection and bicuspidization were performed to maintain compromised molars in function and achieve long-term outcomes. Methods: This retrospective case series study was conducted in a private dental practice and included three patients treated between 2009 and 2017. The presented cases involved molar teeth exhibiting a vertical fracture or extensive subgingival carries in one root while the remaining root(s) demonstrated favourable periodontal, endodontic and restorative prognosis. An interdisciplinary approach was followed in each case, involving comprehensive clinical and radiographic evaluation including cone beam computed tomography when indicated. The clinical treatment included an endodontic approach (primary treatment or retreatment if required) followed by hemisection or bicuspidization and placement of a permanent prosthetic rehabilitation with full-coverage restoration designed to optimize proper load distribution. Clinical and radiographic follow-up examination was done up to six years in case one, after six months in case two and up to six years in case three. Results: The teeth remained in function through their respective follow-up periods. Clinical and radiographic assessments, according to predefined success criteria, demonstrated periodontal stability (probing depth &#x2264; 4 mm), no evidence of secondary caries or root fracture, absence of clinical symptoms, normal tooth mobility and masticatory function, absence or reduction in periradicular radiolucency, and stable bone levels. Conclusions: Resective techniques require an interdisciplinary approach, namely, careful case selection, lege artis endodontic treatment, precise surgical technique, and appropriate prosthetic rehabilitation, in order to provide predictable and long-term outcomes. Within the limitations of this case series, resective techniques appeared to be a reliable and predictable alternative to extraction and implant placement in carefully selected clinical cases.

Inappropriate antibiotic prescribing contributes to antimicrobial resistance. Antimicrobial stewardship (AMS) programs increasingly rely on electronic health record (EHR)-based clinical decision support (CDS) alerts to guide evidence-based care, yet poorly designed alerts can increase cognitive burden and contribute to burnout. Usability testing offers a structured approach to improving alert design and adoption. This study aimed to evaluate and iteratively refine interruptive CDS alerts developed to support appropriate antibiotic prescribing for pediatric acute respiratory tract infections (ARTIs) within an urban academic health system as part of a larger implementation project. Twelve providers participated in four waves of virtual usability testing using scripted clinical scenarios reflecting common workflows. Participants interacted with three clinical alerts and one design-focused scenario. Quantitative outcomes included task effectiveness, efficiency, satisfaction, and perceived difficulty. Qualitative feedback was gathered via think-aloud techniques and synthesized using a "rainbow spreadsheet." Iterative modifications were implemented between waves until thematic saturation was achieved. Task completion across scenarios was high (83.3%). Effectiveness and efficiency improved over waves, and satisfaction increased when alerts embedded actionable tasks such as ordering tests, adding diagnoses, or switching antibiotics. Participants emphasized the importance of clear, concise text and intuitive defaults. Including links to evidence-based guidelines improved trust. Alert refinements reduced cognitive load and improved workflow alignment. Rapid, iterative usability testing substantially improved the clarity and workflow integration of interruptive CDS alerts. Incorporating usability evaluation into CDS stewardship efforts can enhance adoption, reduce alert fatigue, and strengthen implementation of evidence-based practices.

Respiratory syncytial virus (RSV) resurged in many regions after the relaxation of stringent non-pharmaceutical interventions (NPIs) implemented during the COVID-19 pandemic. Here, we characterized the epidemiological patterns and molecular evolution of RSV among pediatric inpatients with acute respiratory tract infections (ARTIs) on tropical Hainan Island, China. We retrospectively analyzed 32,329 children (&#x2264;18 years) hospitalized at Hainan Women and Children's Medical Center from January 2021 to December 2024. RSV positivity was determined using targeted next-generation sequencing. In total, 4483/32,329 (13.86%) patients were RSV-positive, with a high positivity in 2021 (20.27%, 957/4721), marked suppression in 2022 (2.03%, 106/5227) during intensive NPIs, and a rebound in 2023-2024 (15.31%, 1490/9732; 15.26%, 1930/12,649). RSV positivity was higher in boys than girls (14.42% vs. 13.00%). Seasonality shifted from a summer-autumn peak in 2021 to a spring-summer predominance in 2023-2024. Among 56 sequenced RSV-positive specimens (29 RSV-A; 27 RSV-B), all RSV-A strains belonged to genotype ON1 (lineages A.D.3 and A.D.5.2), and all RSV-B strains belonged to genotype BA9 (lineages B.D.4.1.1, B.D.E.1, and B.D.E.2). Subtype dominance transitioned from RSV-A (2021-2023; mainly A.D.3) to RSV-B in 2024 (all B.D.E.1). Lineage-specific amino-acid and predicted N-glycosylation changes were observed, including loss of the N179 site in A.D.5.2 and acquisition of N258 in B.D.E.1. These findings indicate that RSV circulation on tropical Hainan was strongly suppressed during intensive NPIs and re-established after policy relaxation, accompanied by earlier seasonal activity and clear lineage replacement, underscoring the need for sustained genomic surveillance to inform locally tailored clinical preparedness and immunization strategies.

Background: Coronary angiography and percutaneous coronary intervention are essential procedures for managing coronary artery disease but expose patients and healthcare personnel to ionizing radiation. Radiation exposure varies with procedural complexity and vascular access route, and repeated occupational exposure in catheterization laboratories (cath-labs) has been linked to serious health hazards among operators. Objectives: Given the high procedural volume and limited routine monitoring at Bangladesh Medical University (BMU), Bangladesh, this study aimed to quantify operator radiation exposure and identify factors influencing radiation dose. Methods: This analytical cross-sectional study was conducted from November 2023 to April 2024 in two cardiac cath-labs at BMU using two Siemens Axiom Artis angiography systems. Patient, operator, and procedural data, including demographics, operator experience, procedure type, vascular access route, fluoroscopic view, procedure duration, and radiation exposure, were collected from randomly selected routine procedures. Operator radiation exposure was measured at four working positions using a dosimeter, and cumulative annual exposure was estimated based on procedural workload. Descriptive, univariable, and multivariable analyses were performed to identify factors associated with radiation exposure. Results: The study analyzed 776 procedures, in which most patients were aged 46-65 years and male. The majority of procedures were coronary angiography performed via the femoral route. On average, each procedure required 14.28 fluoroscopic views and lasted 8.16 min, with a mean radiation exposure of 1034.5 mGy. Procedural complexity, radial access, and stent use were associated with higher fluoroscopic views, longer procedure time, and increased radiation exposure. Multivariable analysis showed that procedure type and stent number are primarily determinants for the number of fluoroscopic views, while procedure time was mainly driven by imaging demand and vascular access route. Radiation exposure was strongly associated with both procedure time and the number of views, and was higher among male and older patients but slightly lower with femoral access and among older operators. Direct measurements showed higher radiation levels near the operator's X-ray beam, while estimated annual operator exposure remained low inside the lead apron (0.03-0.05 mSv) compared with outside the lead apron (0.6-1.1 mSv), which is within the limit of internationally accepted cumulative absorbed radiation. Conclusions: This study provides the first comprehensive evaluation of operator radiation exposure in a cardiac cath-lab in the country and the wider region. Procedural characteristics, particularly fluoroscopy use and procedural complexity, were the primary determinants of radiation exposure, while effective shielding and increased distance substantially reduced operator dose. These findings highlight the importance of imaging optimization and consistent implementation of the ALARA principle through structured radiation safety training and careful procedural planning to further minimize occupational exposure.

Shared decision-making (SDM) is a collaborative process in which healthcare providers and patients work together to make informed healthcare choices, significantly reducing unnecessary antimicrobial prescriptions by aligning treatment decisions with both clinical evidence and patient values. There is limited qualitative research exploring physicians' perspectives on its implementation in the study area. This study aims to explore physicians' perspectives and experience of SDM in the management of Acute Respiratory Tract Infections (ARTIs) at public primary healthcare centres. Purposive sampling was applied to recruit physicians from selected primary healthcare centres in the Amhara region of Ethiopia. The sample size was determined using the concept of data saturation. The data were collected through semi-structured interviews and analysed using thematic analysis with the assistance of NVivo software (version 14). Twenty physicians were interviewed, and four main themes were identified: (1) awareness and understanding of SDM; (2) perceived value of SDM; (3) barriers to implementing SDM; (4) facilitators to enhance SDM implementation. The study found that, despite its recognised benefits, SDM is not yet a routine practice in primary healthcare centres in the study area due to identified barriers. Addressing these challenges and implementing the solutions suggested by participants will be essential to realise the full benefits of SDM and strengthen antimicrobial resistance mitigation efforts.

Repeated and additional prosthetic bypass to the femoral artery causes femoral crowding and adhesion and increases the risk of bypass infection. The femoral crowding may cause the&#xa0;stenosis of native and prosthetic bypass during hip flexion. An obturator foramen bypass is a bypass from a particular branch of the abdominal aorta to the lower limb artery to circumvent groin infection. This procedure is particularly effective in treating infected femoral prosthetic bypasses and mycotic femoral artery aneurysms; however, the bypass is routed through a narrow obturator foramen, which requires advanced technical skills. A 57-year-old Japanese man with a history of a coronary stent occlusion and a terminal aorta-left common femoral artery (CFA) prosthetic&#xa0;bypass occlusion underwent a right external iliac artery (EIA)-left superficial femoral artery (SFA) crossover prosthetic bypass. At the age of 61 years, the patient presented with pain in the left first toe with purulent discharge and noticed that the toe turned purple when his left hip joint was flexed during soaking in the bathtub. Contrast-enhanced computed tomography revealed occlusion of the right EIA-left SFA crossover prosthetic bypass and left narrow and shaggy CFA and SFA. Compression of the left CFA between the two occluded prosthetic bypasses and the caput femoris during hip flexion was considered to limit the blood flow to the lower limb, leading to chronic limb-threatening ischemia (CLTI). Those multiple femoral prosthetic bypasses had resulted in left femoral crowding, raising concerns that a new bypass to the left CFA might be compromised by the dynamic femoral compression during hip flexion. Therefore, an alternative bypass route was necessary. We successfully performed a 25-cm thrombectomy of the left femoral artery, followed by a right common iliac artery (CIA)-left SFA crossover prosthetic bypass through the left obturator foramen under live fluoroscopic guidance using Artis zeego (Siemens Healthineers, Erlangen, Germany). The postoperative course was uneventful. The graft remained patent over 12 months. Obturator foramen bypass may be considered an option not only in avoiding inguinal infections but also in addressing femoral crowding and compression caused by hip flexion. Penetrating the obturator foramen should be performed at the center or lower&#xa0;position. Preoperative vascular assessment of the foramen ovale on&#xa0;CT is also important. The procedure can be safely performed under live fluoroscopic guidance.