Opioid-induced respiratory depression (OIRD) is a potentially fatal complication associated with postoperative opioid use, even in low-risk populations. The subtle onset and progression of OIRD can delay detection, potentially leading to cardiorespiratory collapse within minutes.

A 55-year-old opioid-naïve male who underwent emergency surgery for abdominal penetrating trauma and unstable pelvic fracture. Postoperatively, despite sufentanil-based patient-controlled intravenous analgesia (PCIA), the patient experienced persistent moderate-to-severe pain. After acute pain service adjustment of PCIA parameters, the patient developed sudden unconsciousness with respiratory depression (respiratory rate, 7 breaths/min), hypoxemia (SpO2, 90%), bilateral 2-mm pinpoint pupils with sluggish reflexes, and generalized rigidity, despite no additional PCIA activations.

The critical care team promptly recognized the signs of opioid-induced wooden-chest syndrome, a rare and severe form of OIRD and implemented targeted interventions.

Initial administration of naloxone failed to reverse symptoms. The patient required urgent endotracheal intubation, during which marked chest wall rigidity was observed.

These timely interventions enabled the successful rescue of the patient, who was transferred back to a general nursing unit on postoperative day 2.

This case of OIRD due to opioid-induced wooden-chest syndrome underscores the danger of omitting dose titration in opioid-naïve patients. We therefore advocate for vigilant monitoring, strict titration protocols, and enhanced staff training to manage such emergencies.

Paragonimiasis, a rare parasitic disease, often presents diagnostic challenges due to its insidious onset, multiorgan involvement, and nonspecific clinical manifestations, frequently leading to misdiagnosis. While numerous reports describe diagnostic errors in paragonimiasis management, cases involving repeated misdiagnoses across multiple tertiary hospitals over 2 years (particularly with comprehensive epidemiological evidence of freshwater crab consumption) remain exceptionally uncommon. We herein present such a noteworthy case.

A 45-year-old male was hospitalized 5 times across 4 tertiary centers in Guilin (January 2023-October 2024) for recurrent cough, hemoptysis, and persistent eosinophilia (lasting 2 years). Initial leukocytosis normalized, while serial chest computed tomography (CT) revealed dynamic, migratory pulmonary lesions. Extensive investigations (X-pert/T-pert, repeated bronchoscopy with bronchoalveolar lavage fluid next-generation sequencing) were nondiagnostic, leading to successive misdiagnoses of viral pneumonia, mycoplasma infection, pulmonary mycosis, tuberculosis, and suspected malignancy.

During the hospitalization at the 924 Hospital, a bronchoscopy was performed. Bronchoalveolar lavage fluid high-throughput sequencing revealed the presence of Paragonimus westermani (sequence count: 6). Upon further inquiry, the patient reported a history of capturing and consuming raw freshwater crabs during a trip to Guizhou Province in June 2022, with a self-recorded video of this activity shared on social media. Subsequent diagnostic evaluation included multiple sputum examinations for parasitic eggs. Paragonimus eggs were identified during the third sputum concentration test, confirming a diagnosis of paragonimiasis.

Treatment consisted of oral praziquantel (0.2 g 3 times daily for 3 days), followed by a second cycle of anthelmintic therapy after a 1-week interval.

During the 4-month postdischarge period, the patient remained asymptomatic with complete resolution of both cough and hemoptysis. Serial laboratory monitoring demonstrated normalization of previously elevated eosinophil counts. Follow-up chest CT revealed significant radiographic improvement, including the complete disappearance of the irregular nodule in the left upper lobe and marked resolution of perilesional infiltrates surrounding the right pulmonary cavity.

In cases presenting with recurrent hemoptysis, persistent eosinophilia, and a history of raw crustacean consumption, accompanied by dynamic migratory pulmonary infiltrates on serial CT imaging, paragonimiasis should be strongly suspected despite initial diagnostic challenges.

The emergence of SARS-CoV-2 and the implementation of non-pharmaceutical interventions (NPIs) profoundly disrupted the transmission dynamics of respiratory viruses, altering their epidemiology and seasonality. However, comprehensive long-term data on these shifts and their post-pandemic implications remain limited. This study analyzed syndromic multiplex panel testing data from 83'823 respiratory specimens collected from 56,519 patients with respiratory tract infections (RTIs) at two tertiary care centers in northwestern Switzerland to systematically assess changes in respiratory virus circulation, seasonality, age distribution, and disease burden across pre-pandemic (2010-2019), pandemic (2019-2022), and post-pandemic (2022-2024) periods. Pre-pandemic, influenza virus (IV), respiratory syncytial virus (RSV), human coronavirus (HCoV), human metapneumovirus (hMPV), and human parainfluenza virus (HPIV) followed distinct seasonal patterns. During the pandemic, SARS-CoV-2 replaced these viruses, leading to a 70-90% decline in their activity (p < 0.001), while rhinovirus/enterovirus and adenovirus were less affected. After NPIs were lifted, substantial off-season activity with markedly higher case numbers and more hospitalizations, especially among pediatric patients, occurred for IV-A/B, RSV, and atypical bacteria. In post pandemic years, virus-specific seasonality is rebounding, with patterns resembling those seen pre-pandemic. However, higher case numbers, increased hospitalizations, and sustained shifts in age distribution persist. The COVID-19 panemic significantly impacted the etiology, seasonality, and age distribution of RTIs. As NPIs were eased, susceptibility to RTIs, particularly among pediatric patients, increased, resulting in more hospitalizations. While post-pandemic periods show a return to pre-pandemic activity patterns, ongoing monitoring is essential to anticipate shifts in respiratory virus dynamics as immunity levels and virus characteristics evolve.

This study aimed to comprehensively analyze the epidemiology of pertussis based on case characteristics and vaccination history in Zhejiang Province.

We analyzed clinically diagnosed and laboratory-confirmed pertussis cases (aged 0-18 years old) reported in Zhejiang Province from January 2016 to December 2024. Vaccination history data were matched from the Zhejiang Provincial Immunization Information System.

A total of 63,664 pertussis cases were identified in Zhejiang Province, China. The annual incidence of pertussis among individuals aged 0-18 years increased gradually from 2016 (1.46/100,000) to 2023 (14.22/100,000), followed by a drastic surge to 512.56/100,000 in 2024. During the resurgence, incidence rose most substantially in kindergarten (3-6 years) and lower elementary (7-9 years) children, surpassing the incidence of infants in 2024. Among 55,968 identified pertussis cases with data on vaccination status, the proportion of fully vaccinated cases increased from 12.50% in 2016 to 79.24% in 2024. Among 43,004 fully vaccinated cases, kindergarten children accounted for the highest proportion (51.27%), followed by the lower elementary children (34.58%). Regarding infection timing, 68.4% of fully vaccinated cases occurred after 6 years old, whereas 31.6% occurred before 6. The median interval between last vaccine dose and disease onset was 61.45 months (interquartile range: 48.15-79.47 months).

Our findings underscore the critical need for booster vaccination at 4-6 years, and highlight the necessity for future research to focus on vaccine safety, effectiveness, and cost-effectiveness in optimizing vaccination strategies.

This report presents the first case of a patient with high cervical spinal cord injury who underwent successful laparoscopic implantation of a diaphragm pacing system in Taiwan. It also compares the pros and cons of laparoscopic and thoracoscopic implantation and discusses postoperative care.

The diaphragm pacing system (DPS) represents a substantial advancement in respiratory support technology, particularly for patients with chronic respiratory insufficiency. It electrically stimulates the phrenic nerve, which in turn activates the diaphragm-the primary muscle involved in respiration [1]. This stimulation mimics the natural neural impulses that drive diaphragmatic contractions, thereby promoting inhalation and a more efficient lung ventilation. The DPS typically consists of implanted electrodes, an external pulse generator, and connecting leads [2]. It is mainly used in patients with high spinal cord injuries, amyotrophic lateral sclerosis, and central hypoventilation syndrome. These conditions often result in compromised neural control of the diaphragm, leading to severe respiratory insufficiency. By restoring diaphragm function, DPS can enhance the patients' quality of life, reduce dependence on mechanical ventilators, and lower the risk of ventilator-associated complications [3]. Despite its benefits, DPS is not without challenges. Patient selection and the surgical approach are critical to perform successful DPS implantation for the restoration of diaphragm function [4]. This report presents the first case of a patient with cervical spine injury who underwent successful laparoscopic implantation of DPS in Taiwan. Furthermore, it discusses postoperative ICU care and reviews the pros and cons of different surgical approaches to performing DPS implantation.

Allergic rhinitis (AR) and recurrent respiratory infections (RRIs) are common conditions that significantly impact quality of life and healthcare systems. Thermal water inhalation therapies have emerged as a potential non-pharmacological option due to their immunomodulatory and anti-inflammatory properties. This narrative review aimed to evaluate the efficacy and safety of thermal water inhalations in managing patients with AR and RRIs. The inclusion criteria were pertinent articles written in English and published in journals listed in PubMed. Six studies conducted in Italy, involving 548 participants (most of whom were children and adolescents), met the inclusion criteria. Significant improvements were observed in nasal mucociliary transport time, with reductions ranging from 2 to 8 min across treatment groups. Total Symptom Scores decreased significantly (one study reported a > 50% reduction). The frequency and duration of upper respiratory tract infections were reduced considerably in the treatment groups compared to the controls. However, results for nasal cytology were inconsistent, and heterogeneity in study designs limited comparability. The reviewed studies highlighted the potential of thermal water therapies to enhance mucociliary clearance, alleviate symptoms, and reduce reliance on other pharmacological treatments. On the other hand, these studies have a regional limitation and this review was not systematic. In conclusion, this narrative review may suggest that thermal water inhalations could be a promising option for managing patients with AR and RRIs, providing an alternative therapy with significant clinical benefits. Nevertheless, further high-quality, standardized, and international studies are necessary to confirm these findings and facilitate meta-analyses. These treatments could play a valuable role in reducing the burden of respiratory and allergic conditions.

Clinical features influence cytokine profiles and can inform biomarker studies.

We assessed the impact of 13 preselected patient characteristics on the circulating levels of 15 Th-1/2/17 cytokines in moderate-to-severe asthma patients on omalizumab, anti-IL-5 (mepolizumab, benralizumab), or dupilumab (n = 76) versus controls (n = 162) not yet on biologics but meeting eligibility criteria for a T2-biologic.

Plasma cytokines (Olink) were analyzed for associations with these clinical/lifestyle factors using LASSO regression and observed variance explained estimated using generalized linear models. Differential expression analysis was conducted using limma.

In controls, IL-6 had the highest variance explained by clinical/lifestyle factors (50% in non-allergic rhinitis patients, 22% in allergic rhinitis), with BMI and exacerbations contributing most to this. In T2-biologics users, eotaxin-1 had the highest explained variance (26.0%) and smoking was the most linked to Th1/17 cytokines. In omalizumab users: IFN-γ (51%) was most explained (exacerbations, smoking, age). In anti-IL-5 users, eotaxin-1 (58%; BMI, sex) and in dupilumab users, IL-4 (83%) was most explained (exacerbations, sex, BMI). The association between patient characteristics and cytokine levels differed by the season of sample collection. In non-biologic users, IL-6 was the cytokine with the most explained variance in the Winter (asthma admissions accounted for most of this variance) and IL-18 in the Spring/Summer/Fall. In T2-biologic users, TNF-α was the top cytokine in the Winter (smoking accounted for most of this variance); IL-4 (allergic rhinitis), IL-33 (IgE and eosinophil), and CXCL10 (allergic rhinitis and IgE) were the top cytokines in the Spring/Summer/Fall. In differential expression analyses, IL-1β was lower in biologics users than non-biologics users.

In moderate-to-severe asthma, multiple clinical features and season are associated with cytokine levels and might impact inference from proteomics studies. Smoking and BMI are the key proinflammatory factors in biologics-treated and untreated patients.

We aimed to estimate mental disorder disparities in cardiovascular disease (CVD) incidence and determine whether these disparities were worsened by the COVID-19 pandemic.

For each outcome (myocardial infarction (MI), heart failure and stroke), we created a population-based cohort of people without a prior diagnosis of the outcome using linked electronic health records, with follow-up from November 2019 until December 2023. We ascertained pre-existing schizophrenia, bipolar disorder and depression, and each CVD outcome from primary care and hospital admission records and (for CVD outcomes) mortality records. We calculated sex-stratified age-standardised incidence rates by mental disorder diagnosis and used quasi-Poisson modelling to obtain rate ratios (RRs) of CVD among people with each of schizophrenia, bipolar disorder or depression versus those without any of these disorders, adjusting for sociodemographic factors and time period. We investigated whether mental disorder disparities changed as a consequence of the COVID-19 pandemic by including an interaction term between mental disorder and time.

During follow-up, 383 365 people had incident MI, 868 590 had incident heart failure and 455 300 had incident stroke. Age-standardised incidence of each CVD outcome decreased markedly between February and April 2020, with incidence levels returning to, but not exceeding, prepandemic levels in subsequent years. Mental disorder was associated with a higher incidence of each CVD outcome, with RRs ranging from 1.31 (95% CI 1.25 to 1.38) to 2.15 (95% CI 2.05 to 2.24). There was generally no evidence of interaction between mental disorder and time, with mental disorder disparities in CVD incidence stable over time.

We found no clear evidence that the mental disorder disparities in CVD incidence widened during the acute period of the pandemic or during the subsequent years. Continued monitoring of the CVD burden in the general population and among marginalised groups is critical to identifying longer-term impacts on CVD and worsening disparities.

Minimally invasive autopsy (MIA) is used to understand the pathophysiological mechanisms and clinical outcome of diseases. One of its many advantages is the lower risk of contamination in case of infectious diseases and the quick tissue collection procedure compared to conventional autopsies, which reduces cold ischemia time. Here we investigated the potential role of MIA for molecular pathology studies by comparing RNA yield and quality after RNA extraction from frozen lung tissue samples collected from different methods: MIA, lobectomy, and transbronchial biopsy (TBB). Our results revealed that RNA yield was significantly higher (P<0.05) in the TBB group compared to the lobectomy and MIA groups. However, 93% of MIA samples were non-degraded, showing similar results to TBB, where all had a DV200≥70%. Therefore, MIA proves to be a novel tool for molecular pulmonary pathology in diagnostic and/or research settings.

The cellular basis of COVID-19 severity in patients with deficiencies in type I IFN immunity remains unclear. In this study, we differentiated cardiomyocytes and macrophages from IFNAR1 competent (IFNAR1^comp) and deficient (IFNAR1^def) induced pluripotent stem cells (iPSCs), and analyzed virus replication and cytokine production after exposure to SARS-CoV-2. Cardiomyocytes expressed the SARS-CoV-2 receptor angiotensin-converting enzyme 2 (ACE2) and showed abundant SARS-CoV-2 replication, which was higher in IFNAR1^def than IFNAR1^comp cells. Treatment with exogenous IFNα mitigated infection in IFNAR1^comp, but not in IFNAR1^def cardiomyocytes. In contrast, macrophages did not express ACE2 and did not support SARS-CoV-2 replication, but produced pro-inflammatory cytokines upon virus exposure, which was impaired in IFNAR1^def macrophages. In conclusion, type I IFNs decrease SARS-CoV-2 replication in human iPSC-derived cardiomyocytes, while they increase cytokine responses of macrophages.