The patient is a 66-year-old man. He came to our hospital with fever for two weeks. Based on blood sampling and abdominal computed tomography (CT) scan, a diagnosis of liver abscess was made, and antibiotic treatment was started, but symptoms did not improve, so percutaneous drainage was performed. One week later, he became dyspnea and chest CT scan revealed right pyothorax, so video-assisted thoracoscopic curettage was performed. It has been reported that liver abscesses are complicated by pyothorax in a few percent of cases. There are two hypotheses as to the mechanism. The one is the spread of inflammation from the liver abscess through the diaphragm into the pleural space, and the other is iatrogenic complication of percutaneous liver drainage.

Infective and noninfective pulmonary complications occur with biologic agents and targeted small molecule inhibitors used to treat immune-mediated inflammatory conditions. The most common lower respiratory tract infection is bacterial pneumonia. Opportunistic infections including tuberculosis can also occur at increased rates depending on the immunosuppressive agent, specific disease, and epidemiologic background of the patient. The most common noninfectious sequela is drug-induced interstitial lung disease.

Nerandomilast, a selective phosphodiesterase 4B (PDE4B) inhibitor, has been extensively investigated for the treatment of pulmonary fibrosis; however, its therapeutic potential and mechanisms of action in idiopathic inflammatory myopathies-associated interstitial lung disease (IIM-ILD) remain to be elucidated.

A myositis-associated ILD mouse model was treated with nerandomilast (BI 1015550), and lung pathology was assessed histologically. Human lung microvascular endothelial cells-5a were stimulated with neutrophil extracellular traps (NETs) to induce endothelial-mesenchymal transition (EndMT). Western blotting, immunofluorescence, qPCR and ELISA were employed to analyse pathways and cytokines.

PDE4B was upregulated in the lungs of patients with IIM-ILD and in mice. Treatment with BI 1015550 significantly reduced lung inflammation and fibrosis scores, decreased inflammatory cytokines in bronchoalveolar lavage fluid and serum, alleviated muscle inflammation and lowered kinase activity without evident hepatorenal toxicity. Immunofluorescence and immunohistochemistry revealed diminished NET markers, reduced inflammatory cell infiltration (CD3, CD11b, F4/80), suppression of EndMT, downregulation of Ras homolog family member A (RhoA) and inhibition of key fibrotic pathways: phosphorylated phosphoinositide 3-kinase (P-PI3K), phosphorylated protein kinase B (P-AKT), phosphorylated p38 mitogen-activated protein kinase (P-P38), phosphorylated extracellular signal-regulated kinase (P-ERK), phosphorylated nuclear factor kappa-B (P-NF-κB). In vitro, BI 1015550 inhibited phorbol 12-myristate 13-acetate-induced neutrophil extracellular trap formation (NETosis) and EndMT.

Nerandomilast alleviates IIM-ILD by inhibiting NET formation and suppressing EndMT in lung microvascular endothelial cells, potentially through non-Smad signalling pathway modulation and cAMP-PKA-RhoA pathway activation. These findings suggest that the specific inhibition of PDE4B is a potential therapeutic approach for IIM-ILD.

Coughing is a common clinical symptom and a protective respiratory reflex closely associated with various respiratory system diseases. The acoustic characteristics of cough sounds are influenced by underlying pathological factors, with distinct acoustic signatures corresponding to different etiologies. Through rigorous analysis of these sounds, rapid identification and preliminary diagnosis of related conditions may be achieved. This approach holds great potential for broad application in mobile health and ubiquitous health platforms.

This study aimed to explore the application of acoustic analysis of cough sounds in the diagnosis of respiratory diseases to enhance the diagnostic efficiency of health care professionals.

In this study, we conducted extensive data collection, including voluntary cough audio recordings from patients diagnosed with respiratory diseases (eg, chronic obstructive pulmonary disease, lung cancer, COVID-19, and pneumonia) and from healthy participants. A total of 2610 audio samples were collected. We incorporated a channel attention mechanism (CAM) into the final convolutional block of each residual block in the ResNet18 neural network, thereby constructing the CAM-ResNet18 neural network model. The recorded cough audio samples were converted into spectrograms to form the input dataset for model training. The CAM-ResNet18 model was trained on the training set of this dataset, with iterative parameter adjustments until convergence was achieved. Finally, spectrograms from the test set were fed into the pretrained model for accurate classification of the cough-related conditions.

Experimental results on the collected audio dataset demonstrate that the proposed CAM-ResNet18 model achieves an accuracy of 83.9% and an average F1-score of 82.52% in classifying 5 types of cough sounds. In comparison, the traditional ResNet18 model achieves an accuracy of 78.16% and an average F1-score of 78.29%, indicating a clear performance improvement with the integration of the CAM.

The experimental results validate the effectiveness of the proposed method, highlighting its significant potential for application in clinical diagnosis.

Clade 2.3.4.4b influenza A(H5N1) viruses have circulated across migratory bird flyways in the United States since 2022, including in Washington, where backyard flock detections have been reported annually. In November 2025, a Washington resident died from acute respiratory failure after receiving a positive influenza A(H5) test result at a hospital laboratory. Washington Public Health Laboratories confirmed influenza A(H5), and genomic sequencing identified influenza A(H5N5) virus (A6 genotype). Polymerase chain reaction testing detected highly pathogenic avian influenza A(H5) virus clade 2.3.4.4b from an apparently healthy backyard flock of ducks and sediment from a watering basin on the patient's property. Six of eight gene segments from the environmental sample and one duck sample (partial neuraminidase segment) were highly genetically similar to the patient's virus sequence. Although existing wild bird surveillance had not detected influenza A(H5N5) virus (A6) in the U.S. Pacific Flyway, introduction via wild birds into the environment of the backyard flock was likely the source of the patient's exposure. The public health investigation identified approximately 135 exposed persons; symptom monitoring and influenza testing detected no additional cases. The overall risk for avian influenza A remains low among the general U.S. population; however, novel avian influenza A virus infection should be considered in persons with symptoms of influenza and potential exposures.

Cardiovascular multimorbidity (CVD MM), defined as two or more cardiovascular conditions, poses a significant public health challenge. Substance use disorders (SUDs) may elevate CVD MM risk, and health insurance disparities could exacerbate this relationship. We examined if insurance type moderates the association between SUDs and CVD MM.

We analyzed cross-sectional data from 45,133 US adults in the 2023 National Survey on Drug Use and Health (NSDUH). CVD MM was defined as two or more specific cardiovascular conditions. SUDs included illicit drugs and cannabis, excluding nicotine dependence and alcohol use disorder. Logistic regression models examined the SUDs-CVD MM relationship and tested for an interaction between insurance type and SUDs, adjusting for covariates.

Individuals in the representative sample of US adults were 60.8% privately insured, 17.4% with Medicaid, 9.1% with Medicare, 8.7% uninsured, and 4.0% with other types of insurance. CVD MM (12.7% Uninsured to 47.7% Medicare; p < 0.0001) and SUDs (2.8% Medicare to 8.3% Medicaid; p < 0.0001) prevalence varied significantly by insurance type. In adjusted models, SUDs were not associated with CVD MM; however, Medicaid enrollees had higher odds of CVD MM than those privately insured. In interaction models, insurance type was a statistically significant moderator of the SUDs-CVD MM association (p = 0.0146). Stratified models showed uninsured adults with SUDs had higher odds of CVD MM (aOR:2.25, 95% CI:1.28,3.93) compared to uninsured counterparts without SUDs. No significant association was found among privately insured, Medicaid, or other insured individuals.

Uninsured individuals with SUDs face an elevated risk of CVD MM. Interventions improving access to care for this vulnerable population are crucial for reducing cardiovascular health disparities.

Although some migrant origin groups in Europe show elevated risk for cardiovascular diseases (CVDs) and type 2 diabetes (T2D), information is sparse and fragmented. This study examines availability and possibilities for harmonization of health examination survey (HES) data on major determinants of CVD and T2D among migrant origin and ethnic minority groups in EU Member states and EU4Health associated countries (Norway, Iceland, Ukraine, Moldova, Montenegro).

We conducted a scoping review, following PRISMA-ScR in PubMed and Web of Science, supplemented by targeted grey literature searches of national health institutes, to identify HESs covering core risk factors for CVD and T2D among migrant origin and ethnic minority groups, older than 18 years and living in EU Member states and selected associated countries. Studies were published between 2014 and 2026. Altogether 2537 peer-reviewed records and 348 grey literature reports were screened. Following full-text screening, 57 peer-reviewed papers were included.

In total, 24 individual HESs in 10 countries were identified. The majority (n = 38, 67%) of the surveys were conducted in the Netherlands or Sweden. None of the HESs used nationally representative samples, having been conducted regionally. There was notable heterogeneity in how persons with a migration background and ethnic minorities were defined and grouped. Reported risk factors included obesity, hypertension, hypercholesterolemia, and hyperglycemia. Measurement methods of these risk factors varied by the migrant origin group and country where the study was conducted.

We did not identify any eligible publications on CVD or T2D risk factors in migrant origin or ethnic minority groups in 69% of EU Member States/selected associated countries, indicating substantial knowledge gaps among these population groups in Europe. The heterogeneity in measurement methods makes cross-country comparison and data harmonization challenging. Data availability and cross-country comparability should be improved to support effective evidence-based health promotion and prevention measures.

Critically ill patients with liver cirrhosis present numerous challenges in clinical evaluation of bleeding risk. Their deficiencies in both pro- and anticoagulant factors result in a particularly fragile hemostatic system and bleeding complications. While the risk of the particular bleeding complication of intracerebral hemorrhage (ICH) is a major clinical concern, the question of whether ICH occurs more frequently in patients with acute-on-chronic liver failure (ACLF) compared to a control group and which parameters predict cerebral bleeding, remain unresolved and was the aim of this study.

One hundred two critically ill ACLF patients and 166 patients in the control group were included retrospectively. Clinical parameters and occurrence of spontaneous ICH were compared to controls.

Cerebral computer tomography detected ICH in 15 out of 102 patients (14.7%) in the ACLF group compared to 16 out of 166 patients (9.6%) in the control group. While patients in the ACLF group exhibited prolonged prothrombin time (pTT) (median [IQR]: (57 [45-71] s vs. 42 [35-52] s, p < 0.001) and higher INR values (1.9 [1.5-2.4] vs. 1.2 [1.1-1.4], p < 0.001), significantly lower platelet count compared to control group (43 [24-64] × 10³/µL vs. 87 [39-159] × 10³/µL, p < 0.001) as risk factors for cerebral bleeding, statistical analysis revealed a trend towards a higher incidence among patients in the ACLF group compared to controls (OR: 1.61, chi-square-test, p-value = 0.24).

Although statistical analysis showed a tendency to a higher incidence of ICH in the ACLF group compared to controls, ICH did not occur significantly more frequently in patients with ACLF. While no correlation was shown between the occurrence of ICH and high systolic blood pressure or dysregulated INR and pTT, low platelet counts were associated with spontaneous ICH in both groups.

Cardiovascular drug therapy in adults is steadily progressing. However, the extent to which children with heart disease in Switzerland benefit from this progress remains unknown. This survey aimed to investigate the current outpatient prescribing practices among paediatric cardiologists in Switzerland. We conducted a cross-sectional survey among Swiss paediatric cardiologists. The physicians were asked to state how often they administer drugs on a pre-defined list for the following indications: heart failure, arrhythmia and thromboembolism. Forty-three (56%) out of 77 eligible physicians completed the survey. For paediatric heart failure, the three most frequently prescribed drugs were hydrochlorothiazide ('often prescribed' by n = 25, 58%), lisinopril (n = 24, 56%), and spironolactone (n = 32, 74%). The most frequently prescribed drugs for arrhythmia and thromboembolism were propranolol (n = 26, 60%) and acetylsalicylic acid (n = 31, 72%), respectively. Newer drugs such as sacubitril/valsartan ('never prescribed' by n = 20, 47%), sodium-glucose cotransporter type 2 inhibitors (n = 40, 93%), and direct oral anticoagulants (n = 20, 47%) were rarely used.

 The drugs used to treat heart failure, arrhythmia, and thromboembolism in Switzerland largely reflect current international recommendations. Nevertheless, novel drugs are rarely used. In addition to the lack of large randomized controlled drug trials in children, important obstacles are lack of authorization, lack of reimbursement, and lack of suitable formulations. These issues should be addressed by both the industry and healthcare providers to continuously improve drug therapy for children with heart disease.

• Evidence for drug use in Paediatric cardiology mostly relies on extrapolation from adult studies and pathophysiological considerations. • Drug choices are also influenced by drug approval, insurance reimbursement, and availability of age-appropriate formulations.

• Swiss paediatric cardiologists predominantly rely on established drugs to treat cardiovascular diseases in children, with the use of newer drugs remaining limited. • On top of expert consensus, adult evidence, and drug availability, drug prescription appears to be strongly influenced by the availability of child-friendly formulations.

Juvenile hypermobility syndrome can cause various symptoms in children, including widespread musculoskeletal pain, digestive issues, tingling sensations, urinary problems, sleep disturbances, fatigue, and anxiety. This study aimed to investigate how juvenile hypermobility syndrome and its associated symptoms affect the quality of life of children. The study involved 152 patients between the ages of 6 and 18 who experienced joint pain. The diagnosis of joint hypermobility syndrome was based on the Beighton criteria, and the quality of life was assessed using the Pediatric Quality of Life Inventory 4.0 (PedsQL). Our study included 152 patients, of whom 96 (63.2%) were female. The average age of the patients was 11.2 ± 3.6 years. The knee was the most commonly affected area, with 92 patients (60.5%). The average Beighton score was 6.9 ± 1.3. Accompanying findings were observed in 146 patients; the most common finding was myalgia, which was observed in 32 patients (21.1%). The median PedsQL score reported by the children was 74 (17.7-95.8), with physical health at 78.1 (9.4-100), emotional functionality at 70 (0-100), social functionality at 79.2 (8.3-83.3), and school functionality at 70 (10-100). Similarly, the median PedsQL score reported by the parents for their child was 77.1 (8.3-95.8), with physical health at 75 (3.1-100), emotional functionality at 75 (0-100), social functionality at 83.3 (83.3-83.3), and school functionality at 80 (20-100).

Many children diagnosed with juvenile hypermobility syndrome experience additional symptoms that affect not only their physical functionality, but also their school and social lives, which can impact their emotional well-being. This can cause concern for parents, and both the child and the family require appropriate support, especially in terms of emotional and social functionality. It is important to ensure that both the child and their family receive necessary support to deal with juvenile hypermobility syndrome.

• Many children diagnosed with juvenile hypermobility syndrome experience additional symptoms that affect not only their physical functionality, but also their school and social lives, which can impact their emotional well-being.

• This can cause concern for parents, and both the child and the family require appropriate support, especially in terms of emotional and social functionality. It is important to ensure that both the child and their family receive necessary support to deal with juvenile hypermobility syndrome.