Infants born prematurely often develop apnea of prematurity (AOP), characterized by periodic apneas with intermittent hypoxia (IH) and commonly treated with supplemental oxygen. On the other hand, infants born at high altitude experience sustained hypoxia from birth. Thus, during critical developmental period, many infants experience abnormal oxygen environments, including hypoxia or hyperoxia. Emerging evidence indicates that disrupted neonatal oxygen homeostasis can produce long-lasting effects on cardiorespiratory function. Preterm infants also exhibit systemic inflammation, and elevated inflammatory cytokines, which may influence respiratory control. This review summarizes clinical and experimental studies examining how neonatal extreme O2 environment and inflammation affect respiratory control, with an emphasis on underlying mechanisms. Clinical and experimental findings show that IH associated with AOP enhances the hypoxic ventilatory response (HVR) and promotes breathing instability, largely through carotid body chemoreflex sensitization. These changes can persist in adulthood and may increase susceptibility to early-onset cardiorespiratory disease, potentially through epigenetic disruption of redox homeostasis. By contrast, neonatal sustained hypoxia transiently impairs carotid body oxygen sensing and ventilatory responses but typically resolves with maturation. Neonatal hyperoxia, however, causes persistent structural and functional impairment of carotid body function. Whether shared epigenetic mechanisms underlie IH and hyperoxia-induced effects, and how altered carotid body signaling reshapes central respiratory networks, remain important questions for future research.
Adoptive T-cell transfer therapy (ACT) has significantly propelled the advancement of tumor immunotherapy. Among various strategies targeting solid tumors, the T-cell receptor (TCR)-engineered T-cell (TCR-T cell) therapy has emerged as a highly promising approach, exhibiting an expanded therapeutic window across diverse patient populations and superior tumoricidal activity in certain solid malignancies compared with chimeric antigen receptor T cell (CAR-T) and tumor-infiltrating T cells/lymphocyte (TIL) therapies. However, its clinical efficacy remains constrained. In this paper, we introduce the limitations and challenges faced by TCR-T cells in solid tumor treatment, and summarize recent efforts overcoming these limitations and translating TCR-T cell therapies into clinical application. Furthermore, their current status and effectiveness in clinical solid tumor patients were analyzed. We expect that the precision therapies of TCR-T cells, with the support of high-affinity TCRs and a diverse array of target antigens, multimodal synergistic therapy strategies and efficient in vitro production processes, will benefit a wider patient population, thus revealing new clinical application potential.
Postoperative pulmonary complications after upper gastrointestinal endoscopic procedures under general anaesthesia are clinically important and may be exacerbated by residual neuromuscular block. We evaluated whether antagonism of neuromuscular block with sugammadex rather than neostigmine is associated with improved respiratory outcomes in this setting. We performed a retrospective multicentre cohort study using a federated health record network. Adults undergoing upper gastrointestinal endoscopy who received rocuronium and antagonism of neuromuscular blockade with either sugammadex or neostigmine were identified. Propensity score matched analysis was conducted. The primary outcome was failure of tracheal extubation, defined as postoperative ventilator dependence or tracheal reintubation within 30 days. Secondary outcomes included coded lung atelectasis and unplanned admission to an ICU. A prespecified subgroup analysis was performed in patients without chronic pulmonary disease. After matching, 15,730 patients were included (7865 per group). Failure of tracheal extubation occurred in 305 patients (3.88%) in the sugammadex group and 455 patients (5.79%) in the neostigmine group (risk ratio 1.49, 95%CI 1.30-1.72, p < 0.0001), an absolute risk reduction of 1.91% and a number needed to treat of 52. Sugammadex was also associated with lower rates of lung atelectasis or collapse (6.74% compared with 7.76%, p = 0.014) and unplanned ICU admission (8.27% compared with 9.45%, p = 0.009). In the subgroup without chronic pulmonary disease (4624 patient pairs), failure of tracheal extubation occurred in 3.05% and 4.97% and unplanned ICU admission in 6.66% and 8.54% after sugammadex and neostigmine, respectively (all p < 0.001). In this large cohort of adults undergoing upper gastrointestinal endoscopy, sugammadex use was associated with important reductions in tracheal extubation failure, lung atelectasis or collapse, and unplanned ICU admission compared with neostigmine, including in those patients without known chronic pulmonary disease. We studied a large group of adults who had a camera test of their stomach or food pipe while under general anaesthesia. During these procedures, doctors used medicines to relax the muscles and then gave another medicine to reverse this effect at the end. We compared two reversal medicines, called sugammadex and neostigmine, to see which one led to better breathing outcomes after the procedure. After anaesthesia, some patients can have breathing problems if the muscle‐relaxing medicine has not fully worn off. This can lead to serious complications, like needing help to breathe again or being admitted to intensive care. We wanted to find out which reversal medicine is safer and helps patients recover their breathing more effectively. We found that patients who received sugammadex were less likely to have breathing problems after their procedure compared with those who received neostigmine. They were less likely to need a breathing tube again, less likely to have parts of their lungs collapse and less likely to need unexpected care in intensive care. This was true even for patients who did not already have lung disease. Overall, sugammadex appeared to be the safer option for helping patients breathe normally again after anaesthesia.
In outpatient clinics, close contact between doctors and patients increases the infection risk for doctors due to the presence of pathogenic bioaerosols exhaled by patients. Therefore, investigating the bioaerosols dispersion in outpatient clinics and evaluating the intervention effects of air purifiers is of significant practical importance. In this study, employing Serratia marcescens as a tracer to conduct a comparative analysis of the aerosol control effects of air purifiers. Then, numerical simulation is utilized to complement bioaerosol experiments. Analyzed six different placement positions and heights for the air purifiers. The results indicate that air purifiers can effectively reduce aerosol concentrations. The time to reach 95% of the steady-state concentration decreased from about 400 s to 200 s. The peak concentrations being reduced to 25% of those in the original clinic. Placement at breathing height significantly outperformed ground-level placement, achieving "near-source capture." Furthermore, relying solely on spatial average concentrations is insufficient to evaluate the purification effect; incorrect placements may reduce spatial concentrations but primarily increase wall deposition (increased by 13%) rather than actual removal. Additionally, the interference of the purifier exhaust with the original airflow may inadvertently increase the exposure risk for the doctor. Aligning the exhaust of the purifier towards the room's exhaust vent can enhance expulsion efficiency. Considering three dimensions, CPB (Conventional position at breathing height) and SPB (Source capture position at breathing height) emerge as the optimal configurations.
Long-term consumption of alcohol is associated with metabolic syndrome, central obesity, and cardiovascular disease. Nonalcoholic fatty liver disease (NAFLD) not only affects the liver but also alters the functions of the cardiovascular system. These changes are responsible for increased cardiac morbidity and mortality. Diabetes, uncontrolled high blood pressure (BP), long-term heavy drinking, and autoimmune disorders cause damage or injury to the nerves and result in autonomic dysfunction. This comparative and cross-sectional study included 78 alcoholic fatty liver disease (AFLD) and 54 NAFLD patients. Autonomic function was assessed using cardiovascular reactivity tests, including heart rate response to standing (30:15 ratio), heart rate response to deep breathing (E:I ratio), BP response to standing, and BP response to sustained handgrip test. Liver function tests were recorded from their clinical laboratory reports. Heart rate response to standing was significantly higher in the AFLD group as compared to the NAFLD group. Heart rate response to deep breathing was significantly higher in the NAFLD group as compared to the AFLD group. Among the biochemical parameters, ALT levels showed statistically significant difference between the groups, and total bilirubin was significantly higher in the AFLD group as compared to NAFLD. Autonomic functions were altered in both alcoholic and NAFLD patients. Parasympathetic activity was relatively reduced in AFLD compared to NAFLD. These findings suggest alcohol induced and metabolic related liver injury influences cardiovascular autonomic function. Lifestyle modification and alcohol withdrawal may help prevent disease progression and associated cardiovascular risk. Résumé Contexte:La consommation prolongée d’alcool est associée au syndrome métabolique, à l’obésité centrale et aux maladies cardiovasculaires. La stéatose hépatique non alcoolique (NAFLD) n’affecte pas seulement le foie, mais elle altère également la fonction cardiovasculaire. Ces changements sont responsables de l’augmentation de la morbidité et de la mortalité cardiaques. Le diabète, l’hypertension non contrôlée, la consommation excessive d’alcool chronique et les maladies auto-immunes provoquent des lésions nerveuses conduisant à un dysfonctionnement autonome.Matériels et méthodes:Cette étude comparative transversale a inclus 78 patients atteints de stéatose hépatique alcoolique (AFLD) et 54 patients atteints de NAFLD. La fonction autonome a été évaluée à l’aide de tests de réactivité cardiovasculaire, incluant la réponse du rythme cardiaque au repos (ratio 30:15), la réponse du rythme cardiaque à la respiration profonde (ratio E:I), la réponse de la pression artérielle (PA) au repos et la réponse de la PA au test de contraction manuelle soutenue. Les tests de la fonction hépatique ont été obtenus à partir des rapports de laboratoire clinique des patients.Résultats:La réponse de la fréquence cardiaque au repos était significativement plus élevée dans le groupe AFLD par rapport au groupe NAFLD. La réponse du rythme cardiaque à la respiration profonde était significativement plus élevée dans le groupe NAFLD par rapport au groupe AFLD. Parmi les paramètres biochimiques, les niveaux d’alanine aminotransférase (ALT) ont montré une différence statistiquement significative entre les groupes et la bilirubine totale était significativement plus élevée dans le groupe AFLD par rapport au groupe NAFLD.Conclusion:La fonction autonome était altérée chez les patients atteints d’AFLD et de NAFLD. L’activité parasympathique était relativement réduite dans la AFLD par rapport à la NAFLD. Ces résultats suggèrent que les lésions hépatiques induites par l’alcool et les troubles métaboliques influencent la fonction autonome cardiovasculaire. Les modifications du mode de vie et l’arrêt de la consommation d’alcool peuvent aider à prévenir la progression de la maladie et le risque cardiovasculaire associé.
Parasympathetic activity is reduced in chronic hypoxia, but the underlying mechanism(s) are unclear. We investigated whether (i) arterial chemoreflex activation, (ii) increased pulmonary ventilation and/or (iii) pulmonary stretch, (iv) hypocapnia resulting from increased ventilation or (v) hypovolemia due to plasma volume contraction reduce parasympathetic activity in chronic hypoxia. In 13 lowlanders (8M/5F), we administered β-adrenergic blockade (intravenous propranolol) to isolate parasympathetic control of HR and thus use HR as a reciprocal index of parasympathetic activity, first at sea level (SL) and then after 9-12 days of exposure to high altitude (HA, 3800 m). Under β-adrenergic blockade, HR was 9.3 ± 6.5bpm higher at HA than at SL (P < 0.001), supporting parasympathetic withdrawal in chronic hypoxia. This HA-induced HR increase remained unchanged when (i) the arterial chemoreflex was inhibited by pure oxygen breathing (P = 0.083) but decreased when (ii) pulmonary ventilation was matched between SL and HA by paced breathing (P = 0.031). Performing apnoeas abolishing differences in pulmonary stretch (iii) did not reduce the HA-induced HR acceleration (P = 0.275), whereas (iv) increasing end-tidal CO2 partial pressure to counteract hypocapnia at HA further enhanced it (P = 0.006). Restoring blood volume at HA to SL values by saline infusion (v) also failed to reduce the HA-induced HR acceleration (P = 0.813). Our findings support a contribution of increased ventilation, but not of arterial chemoreflex activation, hypocapnia or hypovolemia, to the parasympathetic withdrawal associated with chronic hypoxia. That performing apnoea failed to reduce the HA-induced elevation in HR furthermore indicates that the increased ventilation reduces parasympathetic activity via mechanisms other than pulmonary stretch. KEY POINTS: Chronic hypoxia reduces parasympathetic activity, but the underlying mechanisms remain unclear. At sea level and after 9-12 days of sojourn at high altitude, we used β-adrenergic blockade to isolate parasympathetic control of the heart, so that heart rate could be used as a reciprocal index for parasympathetic activity. Heart rate under β-adrenergic blockade was higher at high altitude than at sea level, supporting parasympathetic withdrawal in chronic hypoxia. Matching ventilation between sea level and high altitude reduced the high altitude-induced heart rate acceleration, indicating that the increased pulmonary ventilation in chronic hypoxia contributes to parasympathetic withdrawal. Conversely, the high altitude-induced heart rate acceleration was not reduced by inhibition of the arterial chemoreflex, or removal of hypoxia-indued hypocapnia or hypovolemia, thus not supporting these as mechanisms of reduced parasympathetic activity in chronic hypoxia.
Central respiratory chemoreceptors (CRCs) are critically important for maintaining normal systemic levels of pH and PCO2. Their specific identity has been controversial. It is widely acknowledged that CRCs must respond to small changes in pH via cell-autonomous (intrinsic) mechanisms. However most studies designed to identify CRCs have only blocked a limited subset of synaptic mechanisms. Here we used patch-clamp recordings to compare chemosensitivity of two candidates for CRCs: (1) Phox2b-expressing neurones of the retrotrapezoid nucleus (RTN) and (2) serotonin (5-HT)-producing neurones of the medullary raphe nuclei. We used acute dissociation to ensure responses were intrinsic. In response to a change in CO2 from 5% to 9% (pH 7.4 to ≈7.2) 48% of medullary 5-HT neurones (n = 118) increased their firing rate by more than 20% with a mean increase of 139%, whereas 16% of RTN neurones (n = 93) increased their firing rate by more than 20% with a mean increase of 46%. RTN neurones that expressed Neuromedin B (Nmb) (a proposed biomarker of RTN CRCs) were not more likely to have a larger pH response. After 3 days in culture many RTN neurones began to receive excitatory synaptic drive from 5-HT neurones and also responded to acidosis. These results support the conclusion that a subset of medullary 5-HT neurones are CRCs. Many RTN neurones may play a role in integration and relay of pH information from 5-HT neurones and other chemoreceptor sites but contribute less to direct pH sensation. KEY POINTS: Central respiratory chemoreceptors in the brainstem detect changes in CO2 and pH via intrinsic mechanisms and induce changes in breathing to maintain pH homoeostasis. The identity of these cells is controversial. We measured the pH response of two prominent candidates for these chemoreceptors after they were acutely isolated from all other cells to ensure that their responses were intrinsic. A small percentage of neurones from the retrotrapezoid nucleus had a small response to acidosis. A much larger percentage of serotonin neurones were stimulated by acidosis with a large increase in firing rate. Over the first few days in cultured neuronal preparations serotonin neurones formed synapses on retrotrapezoid neurones and stimulated them in response to acidosis. These results reveal that a large subset of serotonin neurones have properties consistent with central chemoreceptors, whereas a small number of retrotrapezoid neurones have a small response, and may be more important as relays of chemoreceptor information rather than as direct sensors of pH themselves.
Long-COVID is a heterogenous, episodic, and multisystemic condition which can result following infection with a novel pathogen, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Whilst a precise pathophysiological cause is unknown, several mechanisms are hypothesised, each with plausible scientific rationale. Most people experiencing persistent symptoms following COVID-19 infection recover, yet some experience severe and debilitating illness for years after infection. Strategies to manage the sequelae of Long-COVID can improve the lives of sufferers. To describe the physiotherapy management of Long-COVID based on current evidence. Those with 'invisible illness' (illness without outwardly visible signs), such as Long-COVID, often report stigmatisation and scepticism from healthcare systems. Validation of the experience of those with Long-COVID is therefore crucial to ensure patient-centred care. Thorough patient assessment is required to provide tailored management approaches given the diversity of Long-COVID presentations. Red flags that may contraindicate certain rehabilitation approaches (particularly exercise-based interventions) or that warrant further investigation should be considered. Assessments of fatigue, post-exertional malaise, respiratory symptoms, neurocognitive symptoms (i.e., brain fog), physical function, and orthostatic intolerance are strongly recommended. Management strategies may involve pacing and energy conservation techniques, pulmonary rehabilitation, inspiratory muscle training, dysfunctional breathing retraining, lifestyle and dietary strategies to manage orthostatic intolerance, and return-to-work planning. Physiotherapists are well positioned to deliver individualised, patient-centred, and validating care based on best available evidence.
ObjectiveTo describe demographics, semiology, etiology, and clinical features in individuals with insulo-opercular and pure insular onset presenting with hyperkinetic seizures (HKS).MethodsUnder PRISMA guidelines, Embase, PubMed, Medline, and Cochrane were searched for articles between 1969 and January 10, 2025, using terms for hyperkinetic/hypermotor seizures, insular epilepsy, sleep-related hypermotor epilepsy, nocturnal paroxysmal dyskinesia/dystonia, nocturnal frontal lobe epilepsy, and complex motor behavior. Eligible studies were reports or retrospective series of patients with pure insular or insulo-opercular epilepsy and HKS, documented with SEEG or subdural recordings, with at least 6 months of postsurgical follow-up and Engels class I. Of 271 studies, 14 met inclusion criteria.ResultsFourteen studies including 34 patients were analyzed; 61.8% had pure insular onset. Focal cortical dysplasia was the most common etiology, present in two-thirds of cases. Most HKS began with non-motor semiology (76.5%). Hyperkinetic automatisms type 3, defined by integrated/natural hyperkinetic behaviors, manipulation/utilization behaviors, and distal stereotypies, were reported in 49.9% of patients with pure insular onset. Compared with insulo-opercular onset, pure insular onset was associated with a higher frequency of these behaviors, along with agitation, vocalization, and breathing difficulties (p < 0.05). These findings are based on small, heterogeneous samples and should be interpreted cautiously.ConclusionHKS were more frequently associated with pure insular onset. Focal cortical dysplasia was the most common etiology, and integrated/natural hyperkinetic behavior was more frequent with pure insular onset. Given limited sample size, heterogeneity, and study design constraints, these findings should be considered exploratory rather than definitive.
Male infertility, particularly severe oligozoospermia, presents a significant challenge in reproductive health, often associated with high oxidative stress and poor lifestyle practices. This case report highlights the potential therapeutic role of a structured yoga regimen in improving semen quality, reducing stress, and enhancing quality of life in a male with long-standing infertility. The novelty lies in documenting comprehensive improvements across semen parameters and psychological well-being following a nonpharmacological intervention. A 30-year-old Indian male diagnosed with severe oligozoospermia presented with a four-year history of primary infertility. His 30-year-old Indian female partner had no identifiable reproductive abnormalities. The couple sought consultation at a tertiary care centre. The male patient reported a high-stress lifestyle due to his occupation as an architectural researcher involving extensive travel and irregular routines. He underwent a six-month structured yoga intervention (five days per week) comprising guided sessions involving breathing exercises, meditation, and specific physical postures, supervised by a certified yoga therapist. Pre- and post-intervention assessments included semen analysis, sperm DNA integrity, oxidative stress markers in seminal fluid, and quality of life using a standardized assessment tool. Post-intervention, the patient exhibited notable improvements in semen parameters, including increased sperm count and motility, reduced morphological abnormalities, and decreased seminal oxidative stress levels leading to sperm DNA fragmentation index decline. Improvements were also observed in quality-of-life scores across physical, psychological, social, and environmental domains. Following these outcomes, intrauterine insemination was advised as a fertility treatment option. This case illustrates the potential of yoga as an adjunctive, noninvasive therapy for managing male infertility, particularly in individuals with stress-related reproductive dysfunction. The structured yoga program led to substantial improvement in semen quality and quality of life, suggesting a mind-body connection that may influence reproductive health. This single case provides preliminary insight into the potential link between lifestyle factors and reproductive health, though broader studies are required. Further studies involving larger cohorts are needed to validate and expand upon these promising results.
Racial disparities in end-of-life (EOL) care persist, yet the role of caregiver availability in shaping these inequities remains poorly understood. We examined whether caregiver availability modifies racial differences in perceived EOL care quality and tested the hypothesis that Black older adults without caregivers face compounded disadvantages in EOL care. We analyzed data from 2228 non-Hispanic White and Black decedents (weighted N = 10.1 million) from the 2017-2024 National Health and Aging Trends Study. Proxy respondents completed Last Month of Life interviews. Outcomes included overall care quality ratings and receipt of help managing pain, breathing difficulties, and anxiety/sadness. Survey-weighted logistic regression models assessed associations between caregiver availability and outcomes, adjusting for demographic, clinical, and functional characteristics. Interaction terms examined joint effects of race and caregiver availability. Black decedents were less likely than White decedents to receive excellent/very good care (64.9% vs. 77.8%; p < 0.001) and help with anxiety (28.2% vs. 38.7%; p < 0.001). A significant race-caregiver interaction suggested intersectional disadvantage: compared with White decedents with caregivers, Black decedents without caregivers had the lowest odds of excellent/very good care (OR = 0.36; 95% CI, 0.19-0.67). Black decedents with caregivers also had reduced odds (OR = 0.52; 95% CI, 0.36-0.76) despite receiving more caregiving hours (7.0 vs. 3.4 h/week; p = 0.005). Black older adults without caregivers had the worst observed EOL care quality. Caregiver presence was associated with narrower but persistent racial differences, suggesting structural factors that may attenuate the benefits of caregiving for Black older adults. Policy interventions designed to provide culturally responsive support to minority caregivers may help reduce racial disparities in EOL care quality.
Within the family Osphronemidae, mouth-brooding fighting fishes are small, air-breathing fish species that hold their eggs and offspring in their buccal cavities as a parental care behavior, usually found in running waters and distributed in the wild throughout Southeast Asia. This study aims to describe the morphological development and generate identification keys for the larval and juvenile stages of seven wild mouth-brooding fighting fish species found in Thailand, i.e., Betta apollon, B. ferox, B. pallida, B. pi, B. prima, B. pugnax, and B. simplex from the wild. The broodstocks were collected from type localities or based on characteristics that most closely matched each species description, with healthy fishes selected and breeding continued for our size-series collection, including B. simplex, a previous study. The results showed that mouth-brooders released their offspring when developed to the post-flexion stage within 11-12 (mode = 11) days after fertilization (DAF), except B. pi, which took 18-20 DAF, and the post-flexion larva developed to the juvenile stage within 18-30 days after release. The main characteristics of the new-release post-flexion larva were an oblong and depressed body, a large head, an oval to rounded eye, and rays where the caudal fin began to develop, as well as having fully developed ventral fins with two or three dorsal, central, and ventral stripes and a caudal spot. Myomere numbers and fin rays differed among species across a range of 8-10 dorsal, 10-13 pectoral, 6 ventral, 24-31 anal, and 10-13 caudal fin rays. Diagnostic characters were selected to create a dichotomous identification key, with an illustration provided. In terms of taxonomy, the different larval stages also differed in pigmentation patterns among species, with pigmentation patterns on head (pre-orbital, sub-orbital, post-orbital, and sub-opercular bands) and longitudinal stripes on the side of the body able to be used to distinguish among different development stages as well as different species.
Pediatric cardiomyopathies represent a heterogeneous group of myocardial diseases with significant morbidity and mortality. Conventional cardiovascular magnetic resonance (CMR) techniques provide functional and tissue characterization but offer limited insight into myocardial microstructural organization. Diffusion tensor imaging (DTI) enables non-invasive assessment of myocardial microstructure through quantitative metrics such as apparent diffusion coefficient (ADC) and fractional anisotropy (FA). This study aims to evaluate the utility of DTI in differentiating dilated and hypertrophic cardiomyopathies in pediatric patients through quantitative analysis of ADC and FA, hypothesizing that these metrics provide distinct microstructural biomarkers that correlate with ventricular function. This study employed a mixed retrospective-prospective design and included 21 pediatric patients (0-18 years) with confirmed cardiomyopathies (12 dilated, 9 hypertrophic) and 11 healthy volunteers. Cardiac DTI was performed on a 3 T MRI system using a free-breathing, motion-compensated protocol. Quantitative analysis of ADC and FA was conducted in the interventricular septum. Group comparisons were performed using non-parametric statistical tests, correlations with left ventricular ejection fraction (LVEF) were assessed using Spearman analysis, and receiver operating characteristic (ROC) curves were generated to evaluate discriminatory performance. Significant differences were observed in ADC (H = 24.50, p < 0.001) and FA (H = 15.31, p < 0.001) among groups. Dilated cardiomyopathy (DCM) demonstrated the highest ADC values (0.068 ± 0.013 mm2/s) and the lowest FA (0.413 ± 0.058), whereas hypertrophic cardiomyopathy (HCM) showed moderately elevated ADC (0.044 ± 0.005 mm2/s) with preserved FA (0.527 ± 0.029), not significantly different from healthy volunteers. ADC correlated inversely with LVEF (ρ =  - 0.409, p < 0.001), while FA showed a positive correlation (ρ = +0.443, p < 0.001), assessed in patients with complete LVEF data (n = 18). ROC analysis demonstrated excellent discriminatory performance for ADC in DCM identification (AUC = 1.000) and good performance for FA in both DCM (AUC = 0.912) and HCM identification (AUC = 0.813). Cardiac DTI-derived metrics reveal distinct microstructural patterns in pediatric cardiomyopathies and show significant associations with ventricular function. These findings suggest that DTI may provide complementary quantitative biomarkers for myocardial characterization in pediatric populations, warranting further validation in prospective and multicenter studies.
Polycystic Ovary Syndrome (PCOS), a prevalent metabolic and reproductive disorder, significantly impacts women of reproductive age. The conventional approach offers various symptomatic pharmacological interventions for PCOS, but some of them have adverse effects too. In this context, yoga has emerged as a promising non-pharmacological complementary approach. This systematic review aims to explore the therapeutic potential of yoga for managing PCOS with a focus on anthropometric, metabolic, endocrine, and psychological outcomes. A systematic search was conducted across three databases i.e., PubMed, Web of Science and Scopus on 17.1.2025. Screening of articles was performed by two authors in two step process. Risk of Bias (RoB) of each study was assessed using Cochrane Risk of Bias version 2.0 (RoB 2). Due to high heterogeneity among studies in terms of type of intervention, duration, outcomes measured etc., meta-analysis could not be performed. Of the 303 studies initially identified, 9 randomized controlled trials (RCTs) met the inclusion criteria for the systematic review. However, four of these were conducted by the same research group and were considered as a single study in the analysis. Yoga interventions, such as asanas (physical postures) and pranayama (breathing exercises), demonstrated improvement in PCOS symptoms including anthropometric (weight, BMI, hip circumference), metabolic (insulin resistance, serum insulin, fasting blood glucose and lipid profile), endocrine (hirsutism, free testosterone, Anti-mullerian hormone, Luteinizing hormone, Dehydroepiandrosterone etc.), menstrual and psychological outcomes. Meditation and mindfulness-based interventions may help to improve mainly psychological symptoms such as body image, stress, anxiety, depression and quality of life etc. However, it is important to note that there were very few number of studies, that too with lots of heterogeneity, low sample size, diverse outcomes; therefore generalizability of this evidence are limited. Yoga is a promising non-pharmacological complementary intervention for PCOS management that may offer diverse benefits for anthropometric, endocrine, metabolic and psychological health. However, further clinical trials with robust protocol, large sample size and standardized yoga protocol are essential to establish its long-term efficacy and integration into routine PCOS care. https://www.crd.york.ac.uk/PROSPERO/view/CRD420261286708, identifier CRD420261286708.
Physiotherapists play a crucial role within the healthcare team in intensive care units (ICUs), with increasing evidence supporting the impact of physiotherapy interventions in enhancing the recovery of patients experiencing prolonged mechanical ventilation (MV). Despite this, there is limited evidence available for whether this evidence has translated into usual respiratory physiotherapy practice in this patient group. In this context, a comprehensive understanding of contemporary usual care respiratory physiotherapy for ventilator-dependent patients is necessary. The aim of this study was to describe usual care respiratory physiotherapy practice in ICU patients who have received prolonged MV (>4 days). A prospective observational study of respiratory physiotherapy was conducted across 22 Australian ICUs in six jurisdictions from day 5 of MV for 6 weeks or until discharge from acute physiotherapy, whichever occurred first. In total, 288 patients across 22 hospitals received 10 551 interventions during the audit period. The most frequently delivered interventions in the ICU were suctioning (1892, 23% of ICU interventions), mobilisation (1854, 22%), and manual techniques (percussion/vibration) (834, 10%). After ICU discharge to the ward, the most frequently delivered interventions were mobilisation (1166, 53%), deep breathing (190, 9%), and education (186, 8%). These findings were broadly consistent across most regions. Some interventions with limited supporting evidence (e.g. incentive spirometry, 2%) were delivered more frequently than interventions with stronger evidence (e.g., inspiratory muscle training, 1%). This study describes the broad range of respiratory physiotherapy interventions most frequently delivered in patients receiving prolonged MV in the ICU, with consistency across most regions. Findings support the idea that a "usual care" definition can be applied broadly across Australian ICUs, but this "usual care" appears to lag behind current evidence for some interventions, including inspiratory muscle training and incentive spirometry.
To develop machine learning models for sleep stage classification, arousal detection, and respiratory event detection from overnight polysomnography, and to evaluate their performance relative to expert scorers. Overnight polysomnography recordings were obtained from healthy participants and participants referred for suspected sleep-disordered breathing. Four certified scorers completed calibration sessions and generated reference annotations for sleep stages, arousals, and respiratory events. A subset of recordings was independently annotated by all scorers to support consensus analyses, enabling direct comparison between model outputs and human inter-scorer agreement. Gradient-boosted decision tree models were trained using hand-crafted features derived from standard physiological signals. Sleep stage classification achieved an accuracy of 0.840, a Cohen's kappa of 0.791, and an F1-score of 0.841, with limits of agreement for total sleep time of approximately ±0.5 h. Arousal detection achieved an F1-score of 0.733, with limits of agreement for the arousal index of approximately ±15 events/h. Respiratory event detection achieved an F1-score of 0.818, with limits of agreement for the apnea-hypopnea index also within approximately ±15 events/h. In consensus analyses, model performance was comparable to human inter-scorer agreement for sleep stages and arousals, while remaining below human inter-scorer agreement for respiratory events, despite high absolute performance relative to prior studies. The proposed models achieved performance approaching human-level agreement across major sleep scoring tasks. These findings indicate that high consistency in expert annotations is a key factor underlying robust model performance and support the use of quality-controlled annotations for developing reliable automated sleep analysis systems.
Patients with obstructive lung diseases are vulnerable to dynamic hyperinflation and increased work of breathing (WOB). Although ventilator circuit components influence respiratory mechanics, the impact of the expiratory port design on WOB has received limited attention. This study examined whether exhalation resistance measurements can predict expiratory pressure-volume area (PVA) in an obstructive lung disease model. Four expiratory ports were tested Intersurgical (IS), Philips (P), ResMed (RM), and HSINER (H). Exhalation resistance, end-expiratory pressure, and expiratory PVA were measured using a PF-301 flow analyzer. Exhalation resistance was measured using a high-flow nasal cannula at 30, 40, 50, and 60 L/min. An obstructive lung model was created using a test lung in pressure control mode (PEEP 5 cm H2O). Statistical analyses included two-way analysis of variance (ANOVA) for exhalation resistance and one-way ANOVA with Tukey-Kramer post hoc tests for end-expiratory pressure and PVA. The P port exhibited the lowest exhalation resistance (0.343 cm H2O/L/s) but the highest PVA (0.013 ± 0.001 J/L) and end-expiratory pressure (0.134 ± 0.007 cm H2O), significantly exceeding those of all other ports. The IS port demonstrated the highest exhalation resistance (0.37 cm H2O/L/s) but intermediate PVA (0.004 ± 0.004 J/L). The H port demonstrated PVA below 0.001 J/L, and the RM port showed 0.001 ± 0.001 J/L. No significant correlation was observed between exhalation resistance and PVA (r = -0.892, R2 = 0.796, P = .11). Exhalation resistance measurements did not predict respiratory mechanical burden in this obstructive lung disease model. Despite exhibiting the lowest exhalation resistance, the P port generated the highest PVA and an end-expiratory pressure elevation of 0.14 cm H2O above set PEEP. Expiratory port characteristics beyond exhalation resistance, including structural features affecting pressure dynamics, should be evaluated to optimize circuit configuration for patients with obstructive lung disease who are vulnerable to dynamic hyperinflation.
Out-of-hospital cardiac arrest (OHCA) remains a leading cause of death. Although emergency medical dispatchers represent the first link in the Chain of Survival, a persistent "AI translation gap" exists, whereby traditional machine learning models demonstrate high diagnostic performance but limited impact on clinical outcomes. This paper proposes a paradigm shift from passive AI-assisted OHCA recognition towards a dynamic, multimodal large language model (LLM)-enabled Tele-CPR system, conceptualised as an "AI dispatcher copilot". This narrative synthesis integrates recent developments in large language models, computer vision, and cognitive load theory, aligned with the European Resuscitation Council (ERC) Guidelines 2025. It evaluates the conceptual feasibility of an integrated AI-driven decision-support architecture for emergency medical dispatch. In contrast to narrow machine learning approaches, multimodal LLMs can integrate acoustic signals (including potential agonal breathing detection) with semantic interpretation of caller narratives to reduce ambiguity in OHCA recognition. Proposed functionalities include adaptive instruction generation tailored to caller stress to reduce cognitive load, real-time video-assisted CPR coaching with closed-loop feedback on compression quality, and automated resource orchestration through parallel activation of community first responders and automated external defibrillator (AED) routing. The AI dispatcher copilot represents a potentially transformative evolution in Tele-CPR systems. However, translation into clinical practice requires rigorous ethical governance addressing algorithmic bias, automation bias, and data privacy, alongside prospective validation to demonstrate improvement in neurologically intact survival.
Depression, anxiety and work-related stress affect a significant number of adults disrupting their productivity, ability to function and attend work. These highly comorbid disorders tend to be difficult to treat effectively, and more information about integrative treatment approaches is needed. This study investigates the effectiveness of music therapy in treating depression-related disorders. The intervention is targeted at people of 18-65 years of age who are in employment, in their studies, temporarily unemployed, on short-term sick leave or rehabilitation allowance and suffer from depression-related disorders, which include one or several of the following: depression, anxiety, work-related stress or exhaustion. The interventions applied are Integrative Improvisational Music Therapy (IIMT) with or without the additional elements of music listening and vibroacoustic treatment. All sessions will begin with a preparative exercise called Resonance Frequency Breathing to enhance the effect of the therapy. All participants will receive the intervention for 6 weeks (60-min therapy session twice a week). The participants will be randomised into four groups that will have different modifications of the intervention, and the group without additional elements will serve as a waiting-list control group. The primary outcome will measure psychological distress. Secondary outcomes will address depression, anxiety, exhaustion, burnout, health-related quality of life and challenges in recognising emotions (alexithymia). The trial will elevate our understanding of the efficacy of integrative improvisational music therapy for depression-related disorders. Results will give more information about the combinations of additional elements used as part of the intervention. Extensive dataset will allow us to investigate the dynamics of therapeutic change and the factors that predict certain responsiveness to the intervention or explain the effects. Prospectively registered on ISRCTN on 12.04.2024 (ISRCTN26812986). Study was approved by the Regional Medical Research Ethics Committee of Wellbeing Services County of Central Finland 15.02.2024 (ref: 7U/2023).