Silicosis is a preventable occupational lung disease caused by inhalation of respirable crystalline silica. Although traditionally associated with mining, it is increasingly recognized among workers who fabricate engineered stone, also referred to as artificial stone, for kitchen and other countertops. In Canada, updated surveillance data are limited, and no published case series have characterized engineered stone-associated silicosis.

We report a retrospective case series of 20 patients diagnosed with silicosis following occupational exposure to engineered stone in Ontario, Canada, between November 2015 and September 2025. Demographic, occupational, clinical, radiologic, and functional data were extracted from medical records. Continuous variables are reported as median and interquartile range (IQR).

The median age at diagnosis was 52 years (IQR: 41.5-64.5), and all patients were male, predominantly immigrants from Southeast Asia. Median occupational exposure to silica was 19 years (IQR: 10.5-27.5). Although 80% reported respirator use, adherence was inconsistent, and workplace controls were often inadequate. Cough and dyspnea were the most common presenting symptoms (60% each), with a median diagnostic delay of 13.5 months. Imaging showed simple silicosis in 70% and progressive massive fibrosis in 30%. Pulmonary function tests demonstrated predominantly restrictive impairment with reduced diffusion capacity. Outcomes were significant, including 15% mortality, median age at death of 43 years, chronic hypoxia in 35%, and lung transplant referral in 30%.

Engineered stone-associated silicosis in Ontario is characterized by prolonged silica exposure, inadequate workplace protections, delayed diagnosis, and severe disease at presentation. These findings underscore the urgent need for strengthened regulatory measures to protect engineered stone workers: more effective occupational silica exposure controls, systematic respiratory health surveillance of workers at risk, and earlier recognition and diagnosis of silicosis.

Primary Ciliary Dyskinesia (PCD) is a genetic disorder associated with recurrent infections and irreversible airway damage. No single diagnostic test exists, necessitating use of a diagnostic algorithm that varies internationally. This retrospective study aimed to describe the clinical characteristics of patients, and algorithm used to diagnose PCD in New South Wales between 2014 and 2024.

A retrospective review of patients diagnosed with PCD at Concord Repatriation General Hospital (CRGH) from 2014 to 2024 was performed.

This study included 52 patients with median age of diagnosis 7.0 years. The diagnostic algorithm consists of nasal nitric oxide (nNO) in patients > 5 years, and nasal brushings for high-speed video microscopy (HSVMA), immunofluorescence (IF) and electron microscopy (EM). Whole exome sequencing is not routine and was performed in 33% of the cohort. The diagnosis was confirmed by a multidisciplinary team that considered the test results and clinical phenotype. Non-diagnostic results occurred in 14% (nNO), 15% (HSVMA), 41% (IF) and 30% (EM) of patients eventually diagnosed with PCD or PCD "highly likely". Cumulatively, 56% of patients had at least one non-diagnostic result. Of the 17 patients who underwent whole exome sequencing with a PCD panel, 41% had diagnostic genetic results.

Ciliary studies continue to be the mainstay of PCD diagnosis at CRGH. Although genetic testing is not part of the CRGH diagnostic algorithm, the CRGH algorithm has similar diagnostic performance to the ERS and ATS guidelines.

Respiratory failure is the leading cause of death in amyotrophic lateral sclerosis (ALS). Conventional pulmonary function tests are effort-dependent and may fail to detect early nocturnal hypoventilation. Transcutaneous carbon dioxide (PtcCO₂) measurement is a non-invasive method for assessing ventilation, but its role in ALS remains unclear. We performed a scoping review to map the current evidence.

PubMed, Web of Science, Scopus, and Google Scholar were searched from inception to April 2026. Original studies evaluating PtcCO₂ monitoring in ALS were included. Due to heterogeneity in study designs, populations, and outcomes, a narrative synthesis was performed, categorized by study characteristics, measurement protocols, and clinical endpoints.

Twenty-one studies were included. Most were observational and conducted in tertiary centres. Twelve studies evaluated PtcCO₂ as a surrogate marker for nocturnal hypoventilation, mainly to guide initiation or titration of non-invasive ventilation. Definitions of hypoventilation and reported PtcCO₂ metrics varied widely. Only three studies evaluated PtcCO₂ in relation to respiratory impairment or hypercapnia, but none reported formal measures of diagnostic accuracy. Evidence regarding the prognostic value was limited and inconsistent. Three studies showed that nocturnal hypercapnia preceded abnormalities in spirometry or daytime hypercapnia.

PtcCO₂ monitoring shows promise as a non-invasive method for assessing nocturnal ventilatory abnormalities in ALS, including nocturnal hypoventilation. However, due to methodological heterogeneity, its diagnostic and prognostic roles remain uncertain. Current evidence is insufficient to support PtcCO₂ as a standalone criterion for NIV initiation. Large-scale prospective studies with standardized protocols are essential to delineate its clinical utility.

Matrix metalloproteinase-8 (MMP-8) regulates inflammatory responses, but its contributions to the pathogenesis of influenza A viral (IAV) disease are not known. Plasma MMP-8 levels were increased 30-fold in subjects infected with H1N1 or seasonal IAV and were inversely associated with the PaO₂/FiO₂ ratio, suggesting potential value as a candidate marker of lung injury severity that requires validation in larger cohorts. MMP-8 levels were elevated in the lungs of H1N1-infected wild-type (WT) mice and localized to airway epithelial cells, macrophages, and polymorphonuclear neutrophils (PMNs). H1N1-infected Mmp-8^-/- mice exhibited lower mortality and reduced lung viral burdens, but developed more severe lung injury than WT mice. Gene expression profiling revealed enhanced necroptosis and an exaggerated immune response in the lungs of infected Mmp-8^-/- mice. Infected Mmp-8^-/- mice had increased airway epithelial necroptosis with higher pulmonary levels of Type I interferons (IFNs), and increased frequencies of Class II MHC molecule-expressing macrophages and CD4⁺ and CD8⁺ T cells, and higher levels of some Th1 cytokines. In vitro, MMP-8 cleaved IL-1β and IL-6, but not Type I IFNs. These findings suggest that Mmp-8 deficiency is associated with restricted influenza virus spread and increased lung injury, accompanied by enhanced Type I IFN-associated necroptotic signaling and augmented antiviral immune responses. The latter may partly involve loss of MMP-8-mediated processing of pro-inflammatory mediators. MMP-8 may represent a host-response target in severe influenza infection, although therapeutic strategies targeting MMP-8 will need to balance enhanced viral clearance against the risk of increased lung immunopathology.

Obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS) are strongly linked to pulmonary hypertension and left ventricular abnormalities, driving cardiovascular issues. OHS, with daytime hypercapnia, affects 10%-20% of OSA patients. Continuous positive airway pressure (CPAP) is the first-line therapy, but its cardiac effects are inconsistent.

We conducted a systematic review and meta-analysis adhering to the PRISMA 2020 statement. Risk of bias was assessed using RoB 2 (RCTs) and the Newcastle-Ottawa Scale (NOS; cohort studies). Continuous outcomes were pooled as mean differences (MDs) with 95% CIs using random-effects models (restricted maximum likelihood) with Hartung-Knapp adjustment.

Eight studies (574 participants; 2 RCTs, 6 cohorts) were included, showing that CPAP significantly reduced pulmonary arterial pressure (MD = -2.32 mmHg, 95% CI: -3.88 to -0.76, p = 0.004) versus controls. Secondary analyses indicated improved left ventricular diastolic function (early-to-late diastolic mitral inflow velocity [E/A] ratio: MD = 0.29, 95% CI: 0.09 to 0.48, p = 0.004). No significant effects on left ventricular mass index (LVMi) (MD = -2.31 percentage points, 95% CI: -6.38 to 1.77, p = 0.27) or left ventricular ejection fraction (LVEF) (MD = 0.53 percentage points, 95% CI: -1.49 to 2.55, p = 0.61) were found. Sensitivity analyses confirmed robustness. Funnel plot analysis suggested potential publication bias for pulmonary artery systolic pressure (PASP)/mean pulmonary artery pressure (mPAP), E/A ratio, and LVEF, while LVMi showed low bias.

In adults with OSA or OHS, CPAP reduces pulmonary arterial pressure and improves LV diastolic function, but it does not significantly alter LVMi or ejection fraction. These findings support CPAP as a key intervention to mitigate pulmonary hemodynamic burden and diastolic dysfunction in this high-risk population, while its potential to reverse structural cardiac remodeling requires further study.

Preserved ratio impaired spirometry (PRISm), an abnormal spirometry condition characterized by a decreased forced expiratory volume at the first second (FEV₁), is recognized as a precursor of chronic obstructive pulmonary disease (COPD). Growing studies demonstrate that PRISm is associated with an increased risk of the development of fixed airflow obstruction (FAO) and cardiovascular mortality. However, there is still a lack of comprehensive understanding of the patterns and predictors of lung function trajectories in PRISm. Furthermore, standardized interventions that can prevent the deterioration of lung function in PRISm remain unclear. The purpose of this narrative review is to examine the natural history of PRISm by summarizing current evidence on its progression over time, key determinants, and modifiable factors, thereby identifying opportunities for early intervention. In this review, three main patterns of PRISm trajectories were reported, including PRISm to normal spirometry, persistent PRISm, and PRISm to FAO. In accordance, several important factors, such as body mass index (BMI), smoking status, baseline lung function values, comorbid respiratory symptoms and various diseases, and PRISm subtypes, were identified as predictors for the transition of PRISm to other lung function status. Additionally, several potential intervention strategies were developed to slow down the decline of lung function in PRISm and reduce PRISm-related mortality, including early screening and regular monitoring, non-pharmacological interventions, pharmacological interventions, and hierarchical management.

China's heterogeneous climatic conditions and geographic complexity contribute to distinct influenza patterns between northern and southern regions, complicating incidence prediction. Utilizing real-world data, this study aimed to characterize the epidemiology of influenza among elderly populations in Shenzhen and Beijing (representative southern and northern cities) and evaluate the impact of meteorological factors on influenza risk. Laboratory-confirmed influenza cases in individuals aged ≥ 60 years were obtained from China's National Notifiable Infectious Disease Surveillance System (January 2017-April 2024). Spearman correlation analysis identified meteorological factors associated with weekly case counts. Significant factors were incorporated into a distributed lag non-linear model (DLNM) to quantify city-specific, non-linear lagged effects of meteorological variables on influenza risk across pre-pandemic (2017-2019) and post-pandemic (2023-2024) periods. From 2017 to 2024, a total of 31,126 cases of influenza in the elderly were reported in Shenzhen and 22,907 cases were reported in three districts of Beijing. DLNM model fitting showed that each meteorological factor had a nonlinear relationship with influenza incidence. Low temperatures in Shenzhen post-pandemic (lag second weeks: RR = 2.54, 2.20, 2.94), and in Beijing pre-pandemic (lag second weeks: RR = 9.3, 5.23,16.55), post-pandemic (lag third weeks: RR = 9.57, 7.08,12.93) promote the onset of influenza. In Beijing, pre-pandemic high precipitation had an RR of 33.38 (1.48, 7.68) at lag third weeks, which decreased to < 1 post-pandemic. For high precipitation, Shenzhen's pre-pandemic RR at lag third weeks was 9.84 (6.30, 15.37), declining to 5.74 (4.28, 7.70) post-pandemic. Post-pandemic, low atmospheric pressure in Shenzhen (lag third weeks: RR = 1.54, 1.22, 1.94) and high pressure in Beijing (lag third weeks: RR = 5.20, 3.88, 6.96) were associated with elevated influenza risk. The exposure curve for wind speed has a "valley" shape, the RR decreases and then increases as the wind speed changes from low to high, and the risk of influenza is higher for either too high or too low wind speeds. The impact of meteorological factors on influenza among the elderly demonstrates significant spatiotemporal heterogeneity. In both Shenzhen and Beijing, low temperatures and extreme wind speeds (high and low) promote influenza incidence. High precipitation consistently enhances influenza risk in Shenzhen, while in Beijing, its effect shifted from promoting to protective. Post-pandemic, low pressure in Shenzhen and high pressure in Beijing were associated with increased influenza. These findings underscore the importance of integrating regional meteorological and socio-environmental factors into influenza prevention, control, and prediction strategies to more accurately assess epidemic trends and risks.

Acute respiratory infection (ARI) outbreaks in Beijing caused by human adenovirus B114 (HAdV-B114) have long been misclassified as HAdV-B3. Its origin, evolutionary trajectory and long-term transmission dynamics remain poorly understood. This study aimed to clarify its epidemiological characteristics, genomic variations, recombination features and evolutionary history. Among 51 HAdV outbreaks in Beijing from 2017 to 2024, 32 originally designated as HAdV-B3 were studied. Viral isolation was performed on 267 positive samples, conducted targeted and whole-genome sequencing, and carried out phylogenetic, amino acid variation, recombination and Bayesian analyses on core capsid genes. All 32 outbreaks were confirmed to be caused by HAdV-B114, which had circulated in Beijing since 2017, mainly causing outbreaks among young primary school students. We obtained 177 isolates, and successfully acquired penton, hexon and fiber genes from 127 strains. These three genes were fully identical in isolates from the same outbreak, so one strain per outbreak was selected as representative. Phylogenetic analysis showed its penton gene clustered with HAdV-B7, while hexon and fiber genes resembled HAdV-B3. Compared with HAdV-B114 reference sequence, variants had mutations and insertions in hexon and penton. 34-nt deletion mutants of HAdV-B114 were discovered in the 2023-2024 outbreaks, and they were confirmed as HAdV-B3/B7 recombinants. The most recent common ancestor (tMRCA) of HAdV-B114 penton gene divergence was 1993.718, and variant 24SYYQ0247 formed an independent sublineage. HAdV-B114 is a misidentified re-emergent virus that has long circulated in Beijing and achieved widespread prevalence. Sustained adenovirus molecular surveillance is essential for ARI prevention.

Liver resection creates a clinical tension between limiting operative bleeding and maintaining organ perfusion. Low central venous pressure, fluid restriction, vascular inflow occlusion and vasoactive treatment can coincide with lower arterial pressure, yet existing reviews have centred on blood loss and transfusion. They have not resolved whether directly quantified intraoperative hypotension is associated with postoperative acute kidney injury or myocardial injury, or whether comparative haemodynamic strategies alter these outcomes. We will address both questions while keeping exposure associations distinct from management effects and kidney outcomes distinct from myocardial outcomes.

This prospectively registered review will search four bibliographic databases and two trial registries from inception, supplemented by citation searching and author contact, without language or date restrictions. Eligible studies will include adults undergoing partial liver resection and report a quantified intraoperative arterial-hypotension exposure or a comparative pressure- or flow-directed strategy with acute kidney injury or myocardial injury. Two reviewers will independently select studies, extract data and assess risk of bias, with independent handling of review-team-authored studies. Four prespecified synthesis domains will separate exposure from management evidence and kidney from myocardial outcomes. Compatible estimates will undergo random-effects meta-analysis; otherwise, structured synthesis without meta-analysis will be used. Heterogeneity, missing evidence and certainty will be assessed. This design aims to distinguish prognostic association from evidence about modifiable haemodynamic management.

PROSPERO CRD420261476933; Open Science Framework https://doi.org/10.17605/OSF.IO/3GCY2.

Out-of-hospital cardiac arrest remains a major public health concern, and early cardiopulmonary resuscitation (CPR) by bystanders is crucial for improving survival outcomes. University students represent an important target population for CPR education because they are socially active, highly accessible, and capable of disseminating lifesaving knowledge within the wider community. However, inadequate CPR knowledge, low willingness to perform CPR, and poor self-efficacy remain common among university students in Malaysia.

This two-phase study aims to determine the prevalence of self-reported CPR-related knowledge, willingness, and self-efficacy among students in a Malaysian tertiary institution (Phase 1) and to explore the preliminary changes in these outcomes following a peer-led CPR workshop (Phase 2).

In Phase 1, a cross-sectional survey was conducted at a tertiary institute in Selangor, Malaysia using a validated questionnaire on knowledge, attitudes, behavioral intention, and self-efficacy (KABSE) (N = 431). In Phase 2, a two-hour peer-led workshop, delivered by medical students, targeted students without CPR training in the past two years, and pre-post KABSE changes were measured (N = 33).

Phase 1 baseline findings revealed CPR knowledge and self-efficacy levels were relatively lower than attitudes and willingness to perform CPR. Females showed higher knowledge and attitudes, while males reported greater self-efficacy. Older and married participants demonstrated better attitudes, and those with a healthcare-related background had higher knowledge, attitudes, and self-efficacy, though similar behavioral intention. Higher scores were also linked to AED awareness, AED usage capability, and recent CPR training. Statistical analysis revealed significant associations among the KABSE domains. Following the peer-led workshop, the participants showed significant gains in self-reported knowledge (p < 0.001), attitude (p < 0.001), behavioral intention (p < 0.01), and self-efficacy (p < 0.001).

Although participants displayed positive attitudes toward CPR, baseline knowledge and self-efficacy were limited. The peer-led workshop demonstrated feasibility as a proof-of-concept intervention, generating significant short-term gains in self-reported knowledge and confidence.