Objective: To assess the anatomical and genioglossus electromyography (ggEMG) indicators in obstruction patterns classified by the VOTE system. Methods: This prospective study was conducted from September 2019 to April 2023, with a total of 107 adult patients (101 males and 6 females) aged 20-59 (38.8±8.0) years old (AHI≥15 times/hour) diagnosed with moderate to severe obstructive sleep apnea (OSA) at Beijing Tsinghua Changgung Hospital. Each subject underwent 3-D upper airway computed tomography (UACT), drug-induced sleep endoscopy and intraoral surface ggEMG monitoring. Based on VOTE system, the characteristics of UA collapses were classified and compared. Statistical analysis was conducted by SPSS 21.0. Results: All 107 patients with moderate to severe OSA had complete collapse of the velopharynx airway (including 47 cases in anteroposterior collapse group, 10 cases in the lateral collapse group, and 50 cases in the concentric collapse group). Comparing patient data from three different collapse modes, it was found that the velum pattern groups showed no statistical ggEMG differences (P>0.05); however, the lateral group exhibited the narrowest velopharynx mLAT [AP: 14.45(12.0, 16.2) mm, Lat: 11.40(9.6, 14.4) mm, Con: 12.70(11.0, 15.8) mm,H=6.41, P=0.041], and largest glossopharynx mAP[AP: 11.90(9.0, 15.7) mm, Lat: 14.30(11.8, 20.3) mm, Con: 14.10(11.8, 16.9) mm,H=8.40, P=0.015]. We found that patients with complete oropharynx lateral walls and partial tongue base collapse tended to have a higher BMI [(29.43±3.35)kg/m² vs.(26.70±2.53) kg/m²,t=-2.83, P=0.007], longer glossopharynx length [(25.94±5.80) mm vs. (20.90±5.48)mm, t=-2.60,P=0.014], narrower glossopharynx mLAT [(15.59±3.87) mm vs. (21.10±8.07) mm, t=2.59, P=0.017], and were more likely to combine ggEMG dysfunction during obstructive apnea events [R4,(0.02±0.01)vs.(0.01±0.01), t=2.08, P=0.045)]. Moreover, all patients were classified according to the degree of epiglottic collapse (including 31 cases of no collapse, 33 cases of patial collapse, and 43 cases of complete collapse). The complete epiglottic collapse group exhibited the narrowest velopharynx minimal cross-sectional airway area (H=11.01, P=0.004) and the narrowest glossopharynx anteroposterior airway dimensions (H=7.06, P=0.029) and the longest glossopharynx length (H=9.65,P=0.008), whereas, the group of no epiglottic collapse showed the lowest ggEMG activation while awake (R1,H=8.59,P=0.014) and during sleep-onset (R2,H=9.79,P=0.007). Conclusions: The multiple plane collapse of the UA under DISE is the result of the combined effects of anatomical and functional factors, while the VOTE system cannot accurately describe the impact of different anatomical and functional causes. Among them, the degree of oropharynx lateral walls, tongue base and epiglottic collapse can all be affected by the function of the genioglossus muscle. This study can provide a theoretical basis for the comprehensive etiological treatment of OSA patients with multiple plane collapse.

Objective: To analyze the characteristics of electroencephalogram (EEG) power spectral density (PSD), slow wave oscillation, and sleep spindles across different sleep stages, brain regions, and levels of severity in patients with obstructive sleep apnea (OSA). Methods: This case-control study collected data from 1 821 suspected OSA patients, comprising 1 422 males and 399 females, with a median age 39 (32, 49) years, who attended our hospital between July 2018 and July 2024. EEG features, including PSD, slow wave oscillations, and sleep spindles, were extracted from polysomnography recordings across different sleep stages and brain regions. The changing trends of these features were analyzed between the OSA and non-OSA groups, as well as across different OSA severity levels. For non-normally distributed variables, the Mann-Whitney U test was used for two-group comparisons, and the Kruskal-Wallis H test with Bonferroni correction was used for multi-group comparisons. For normally distributed variables, the t-test (for two groups) and one-way ANOVA with Bonferroni correction (for multiple groups) were applied. The chi-square test was used for comparisons of categorical variables. Results: Among the 1 821 subjects, 1 706 were diagnosed with OSA including 302 mild, 351 moderate, and 1 053 severe cases. Compared with the control group, the OSA group exhibited the following whole-brain EEG changes: increased PSD in Delta, Theta, Alpha, and Beta bands during N1 stage; increased PSD in Alpha, Beta, and Gamma bands during N2 stage; and increased PSD in all frequency bands during N3 and REM stages (all P<0.05). Moreover, PSD in all frequency bands showed a significant increasing trend with increasing OSA severity (all P _{for trend}<0.001). During N3 stage, the OSA group showed significantly higher density, duration, and amplitude of slow oscillations compared with the control group (P<0.05); during N2 stage, the OSA group showed significantly lower sleep spindle density compared with the control group (P<0.05). Changes in sleep EEG microstructural features were significantly correlated with OSA severity (all P _{for trend}<0.05). Conclusion: Patients with OSA exhibit EEG features during sleep characterized by cortical hyperarousal and thalamocortical rhythm dysregulation, which intensify with increasing disease severity. The observed alterations in EEG microstructural features suggest their potential value as indicators for assessing OSA-related brain functional impairment.

We compared data from the 2015 and 2024 pertussis epidemics in New South Wales, Australia. In 2024, we found twice as many notifications and a shift in distribution to older children. COVID-19 interventions and lack of circulation of pertussis likely contributed to an age cohort immunity gap and increased infections.

Antisense oligonucleotides (ASOs) are advantageous for the development of antiviral drugs against respiratory viruses. However, the methodology for efficiently identifying antiviral ASOs has not been well established, and to date no ASOs have successfully been developed for treating viral respiratory diseases. In this chapter, we describe a scheme that consists of three stepwise evaluation assays to identify ASOs having antiviral effects against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative pathogen of coronavirus disease 2019 (COVID-19). The primary evaluation employs a luciferase-based assay without virus infection, which can be applied to high-throughput screening without the need for a high biosafety level facility. The secondary evaluation exploits a cell-based infection assay that assesses antiviral activity by detecting SARS-CoV-2-induced cytopathic effects, viral RNA, and proteins. Candidate ASOs are then further evaluated in a mouse SARS-CoV-2 infection model by detecting viral propagation and pathogenesis in vivo. This scheme permits systematic identification of antiviral agents starting from a library with a large number of ASOs.

Fibrotic interstitial lung diseases (ILDs) are characterized by progressive extracellular-matrix accumulation but arise from biologically diverse injuries. This narrative review examines endoplasmic reticulum (ER) stress as a context-dependent regulator of maladaptive repair, prioritizing evidence from human genetics, tissue, single-cell and spatial studies, patient-derived systems, biomarkers, and clinical trials. In selected familial surfactant disorders, pathogenic variants provide direct evidence that impaired proteostasis can cause fibrotic lung disease. In sporadic idiopathic pulmonary fibrosis (IPF), epithelial unfolded protein response (UPR) signatures and KRT8/KRT17-enriched transitional states are associated with arrested alveolar regeneration, but do not establish a single causal pathway. IRE1α, PERK-eIF2α, and ATF6 can support adaptive proteostasis during acute stress yet may contribute to inflammatory signaling, epithelial injury, or differentiation arrest when activation is persistent. Human spatial studies place stressed epithelium within SPP1-positive macrophage, activated-fibroblast, and endothelial niches, although ER-stress activity outside epithelium remains less certain. Evidence is strongest in IPF and familial surfactant disorders; extension to progressive pulmonary fibrosis, connective-tissue-disease-associated ILD, or fibrotic hypersensitivity pneumonitis remains inferential. Current antifibrotic and PDE4B-directed therapies slow functional decline but do not demonstrate correction of epithelial proteostasis. Direct ER, UPR, or integrated-stress-response strategies have not established human efficacy in fibrotic ILD. Future studies should define disease- and cell-specific repair states, measure target engagement longitudinally, and test interventions during potentially reversible windows of repair arrest.

Carbapenem-resistant Klebsiella pneumoniae (CRKp) strains are a major public health threat.

This study aimed to compare multiplex lateral flow immunochromatographic testing (LFT) and polymerase chain reaction (PCR) for detecting carbapenemase genes in carbapenem-resistant K. pneumoniae (CRKp). A secondary objective was to assess the gene-specific susceptibility profile of these isolates to critical antimicrobial agents: ceftazidime-avibactam (CZA), last-resort options (colistin, amikacin).

CRKp isolates from patient samples (blood, urine, and respiratory tract) were identified based on colony morphology, Gram stain, and the BD Phoenix M50system. Isolates resistant to ≥1 carbapenem per EUCAST criteria were included. Resistant isolates underwent PCR for bla KPC, bla NDM, bla VIM, bla IMP, and bla OXA-48 genes, and carbapenemase production was phenotypically confirmed using a commercial immunochromatographic test (ICT) kit (detecting OXA-48-like, NDM, VIM, IMP, KPC simultaneously). Susceptibility to ceftazidime-avibactam (CAZ-AVI), colistin, and amikacin was assessed according to EUCAST standards. The study was conducted in Western Anatolia, in Balıkesir, Türkiye.

The distribution patterns of the isolates showed that blaOXA-48 predominated (n = 27, 38.0% of positive isolates), followed by blaKPC (n = 15, 21.1%) and blaNDM (n = 7, 9.9%). Notably, 22 isolates (31.0%) harbored multiple carbapenemase genes: OXA-48 + NDM (n = 14, 19.7%), KPC + NDM (n = 4, 5.6%), and OXA-48 + KPC (n = 4, 5.6%). Neither blaVIM nor blaIMP was detected. The lateral flow test (LFT) demonstrated good agreement with PCR for the detection of blaKPC and blaOXA-48 genes (Cohen's κ = 0.72 and 0.65, respectively); however, its accuracy decreased in isolates harboring multiple carbapenemase genes. While susceptibility to ceftazidime- avibactam averaged 28.6% overall among CP-Kp isolates, it varied according to carbapenemase type, with KPC producers exhibiting the highest rate (46.7%).

These findings highlight the importance of rapid and easily applicable diagnostic tests, as well as the urgent need for new antimicrobial agents and novel therapeutic approaches (e.g, Phage therapy, immunotherapies).

Signal peptide-CUB-EGF domain-containing protein 1 (SCUBE1) is a platelet- and endotheliumassociated glycoprotein implicated in platelet activation, thrombus propagation, and endothelial injury. Because these processes underpin thrombo-inflammatory cardiovascular and cardiopulmonary diseases, circulating SCUBE1 has attracted interest as a candidate biomarker. This systematic review aimed to critically synthesize comparative clinical evidence on circulating SCUBE1 levels across thrombotic or ischemic cardiovascular and cardiopulmonary conditions relative to control or comparator groups.

A systematic search of PubMed, ScienceDirect, and SpringerLink was conducted for Englishlanguage studies published from 1 January 2015 to 27 September 2025. The protocol was prospectively registered in PROSPERO (CRD420251178563). Eligibility was guided by a PECO framework and included observational and diagnostic accuracy studies that measured circulating SCUBE1 in serum or plasma and reported patientcomparator data. Two reviewers independently screened studies, extracted data, and assessed methodological quality using design-specific Joanna Briggs Institute tools and ROBINS-I. Owing to clinical and methodological heterogeneity, findings were synthesized narratively without meta-analysis.

Nine studies were included (four cross-sectional, three case-control, one cohort, and one diagnostic accuracy study). SCUBE1 levels were generally higher in patients with thrombotic or ischemic cardiovascular and cardiopulmonary diseases than in comparators, supporting associations with platelet-endothelial activation, thrombotic burden, endothelial dysfunction, and ischemia-reperfusion stress. However, absolute concentrations varied markedly across studies, precluding direct comparison and limiting interpretability of proposed cut-off values. Eight studies had moderate risk of bias and one had serious risk.

SCUBE1 is a biologically plausible but still investigational biomarker; robust multicenter prospective studies with standardized assays are required before clinical translation in routine clinical practice.

Pneumonia is one of the causes of child death in the world. One of the non-pharmacological therapies given to overcome the impact of pneumonia in children is Pursed Lips Breathing (PLB) exercises. PLB is given to help overcome the ineffectiveness of airway clearance in patients with pneumonia by increasing the development of the alveoli in each lung lobe so that it can induce a normal breathing pattern and the child becomes more relaxed. The purpose of this study was to determine the effectiveness of PLB using pinwheel game on oxygenation status in children with pneumonia.

This study is a quantitative study using a quasi-experimental design using a pretest and posttest approach with control group design. This study consisted of two groups, namely the intervention group given PLB blowing a pinwheel with a penguin game, while the control group was given LPS. The study was conducted at Reksodiwiryo Army Hospital Padang with 15 respondents in the intervention group and 15 in the control group. Data analysis was carried out using a pooled t-test and paired ttest.

The effectiveness of PLB using a pinwheel on oxygenation status in children with pneumonia found in this study can be used as evidence-based practice in treating children with pneumonia.

PLB can be used as an independent nursing intervention that can be implemented in hospitals.

There is growing scientific interest in uncovering the mechanisms of lung regeneration, aiming to inform the development of innovative therapies for irreversible lung damage associated with chronic diseases. Cellular metabolism and its associated metabolites are increasingly recognised as active regulators of stem cell behaviour and tissue repair in other organs, yet little is known about how metabolic programmes and metabolite-mediated processes influence lung progenitor cell fate decisions. This Review explores current knowledge of how cellular metabolism directs the stem cell functions of alveolar type 2 (AT2) cells, the main epithelial progenitor cells of the distal lungs. Recent studies suggest that AT2 cell regenerative functions are linked to shifts in glycolytic and oxidative metabolism and require tight regulation of mitochondrial function and lipid metabolism for effective repair. Dysregulation of AT2 cell metabolism, as observed in chronic lung diseases, such as pulmonary fibrosis and chronic obstructive pulmonary disease, is emerging as a mechanism of regenerative failure and associated with respiratory disease progression. Improving our understanding of how AT2 cell metabolism 'fails to fuel' and starts 'fuelling to fail' lung repair is paramount for the development of innovative therapies that may slow or reverse the progression of chronic lung diseases.

Healthcare-associated infections (HAIs) represent a major public health challenge requiring urgent attention. These infections impose substantial burdens on both society and healthcare institutions. Patients in the pediatric intensive care unit (PICU) are at particularly high risk of HAI. This study aimed to analyze the status of targeted HAI surveillance in the PICU over 10 consecutive years and to provide evidence for improving HAI prevention and control strategies.

Data were collected from PICU patients of Children's Hospital of Chongqing Medical University who were monitored through a real-time HAI surveillance system from January 2015 to December 2024. Collected indicators included HAI incidence, infection sites, incidence of device-associated infections, distribution of pathogens, and the detection rates and incidence of multidrug-resistant organisms (MDROs).

A total of 20,120 patients were monitored, with an overall HAI incidence of 3.36%. The annual incidence of HAI in the PICU exhibited a significant downward trend over the 10 years (p < 0.001). The respiratory system was the most common site of infection. The incidences of central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI) were 0.70 per 1000 central line-days, 1.84 per 1000 mechanical ventilation-days, and 0.11 per 1000 urinary catheter-days, respectively. A total of 643 pathogenic strains were isolated, predominantly Gram-negative bacteria (73.41%), with Acinetobacter baumannii being the most frequently detected (18.35%). The detection rates of carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Klebsiella pneumoniae (CRKP) were 67.33% and 31.42%, respectively, both showing significant upward trends over the decade (both p < 0.001). The detection rate of carbapenem-resistant Escherichia coli (CREC) was 16.30% and showed a significant downward trend for 10 consecutive years (p < 0.001). The incidence of MDRO-related HAI was 0.68%, with CRAB (0.32%) and CRKP (0.13%) having the two highest incidence rates.

The incidence of HAI in the PICU significantly decreased over the study period, indicating progress in infection prevention and control. However, CLABSI, VAP, and MDROs remain key priorities in ongoing HAI prevention efforts in the PICU.