Massive hemoptysis and postpneumonectomy acute respiratory distress syndrome (ARDS) are rare but life-threatening conditions with limited therapeutic options. This case highlights the feasibility of combining venovenous extracorporeal membrane oxygenation (VV-ECMO) with esophageal pressure-guided ventilation to support both surgical and respiratory management in a critically ill patient.

A 67-year-old woman developed massive hemoptysis after bronchoscopic biopsy of a left hilar lung mass. Despite bronchial artery embolization and selective right lung ventilation, severe ARDS ensued. A salvage left pneumonectomy was performed under VV-ECMO due to refractory bleeding. Postoperatively, the patient developed right-lung ARDS with total airway closure and high elastance. Esophageal pressure monitoring enabled safe adjustment of ventilator settings. She was weaned from ECMO on postoperative day 16 and later discharged from ICU. Final pathology confirmed an atypical carcinoid tumor with negative margins.

VV-ECMO can enable life-saving pneumonectomy in select patients. Esophageal pressure monitoring may optimize ventilation in postpneumonectomy ARDS with severe mechanical impairment.

Post-COVID-19 condition is associated with persistent respiratory symptoms and impaired functional capacity. This study evaluated the effects of adding an incentive spirometer to standard rehabilitation in adults with post-COVID-19 condition, with peak expiratory flow, dyspnoea, and quality of life as the prespecified primary outcomes.

Randomized controlled trial.

Eighty-two previously hospitalized adults diagnosed with post-COVID-19 condition, were randomly assigned to an experimental group (rehabilitation plus incentive spirometer, n = 41) or a control group (rehabilitation alone, n = 41).

Eight outcomes were assessed at baseline and 1 month, including peak expiratory flow, Medical Research Council dyspnoea scale, EQ-5D-5L, and functional performance tests.

Both groups improve at 1-month follow-up. The experimental group showed greater improvements in peak expiratory flow (between-group difference = 65.85 L/min; 95% CI: 4.35 to 127.35; p = 0.007), and dyspnoea (MRC difference = -1.08; 95% CI: -1.54 to -0.62; p < 0.001) compared with the control group. No significant between-group differences were observed for quality of life or functional performance measures.

Adding incentive spirometry to standard rehabilitation improved peak expiratory flow and reduced dyspnoea in adults with post-COVID-19 condition, supporting its use as a low-cost adjunct for respiratory symptom management.

Chalcones, a naturally occurring class of molecules found in various plants, serve as both precursors and final products in the biosynthesis of flavonoids. Renowned for their diverse therapeutic actions, chalcones demonstrate anti-inflammatory, antitumoral, antimalarial and antiviral activities. The structure of chalcones allows chemical manipulation, making them attractive for metal coordination, such as with copper, an essential metal for living organisms. Here, we characterize the activity of CuL₂phen and CuL₁phen against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in which L1 and L2 are two forms of the chalcones 3-(4-(benzyloxy)phenyl)-1-(4-fluoro-2-hydroxyphenyl)prop-2-en-1-one and 3-(4-(benzyloxy)phenyl)-1-(2-hydroxyphenyl)prop-2-en-1-one, respectively, and phen is phenanthroline. CuL₁phen and CuL₂phen anti-SARS-CoV-2 activity were studied in the viral replication cycle employing both the SARS-CoV-2-NeonGreen infectious clone and wild-type isolates. The SI of CuL₁phen and CuL₂phen was found to be 1.7 and 5.5, respectively, demonstrating that CuL₂phen is a more promising compound. CuL₂phen impaired SARS-CoV-2 entry, predicted by molecular docking calculations to disrupt the glycoprotein S and angiotensin-converting enzyme 2 (ACE2) binding, emphasized by the low EC₅₀ in pseudotyped virus entry assay. Further, CuL₂phen was identified as SARS-CoV-2 post-entry inhibitor, probably due to its strong interaction with SARS-CoV-2 double stranded RNA. Altogether, the data suggest that CuL₂phen acts by impairing SARS-CoV-2 entry by disrupting the viral envelope as well as interrupting RNA replication through specifically intercalating into the dsRNA. The obtained results give us mechanistic insights into the activity of this promising Cu(II) metallodrug candidate in SARS-CoV-2 infection.

Randomized clinical trials comparing the breadth and long-term persistence of immunity between different COVID-19 vaccine types and between ancestral and Omicron-targeted vaccines are limited. The PRIBIVAC study (Phase D) is a randomized clinical trial comparing the immunogenicity of monovalent mRNA vs bivalent mRNA vs protein-based NVX-CoV2373 administered as second booster in 176 triple mRNA-vaccinated adults. Primary objective was neutralizing antibody levels against Omicron subvariants at day 28. A 4th vaccine dose significantly boosted 50% neutralization titers against emerging strain XBB.1.16 by 3.2-, 4.1- and 1.6-fold in monovalent mRNA, bivalent mRNA and NVX-CoV2373 group respectively at day 28. The largest absolute increase in inhibition level at day 28 post-booster was observed against the KP.2 subvariant, with bivalent mRNA vaccines exhibiting the highest neutralization level (91.7%) compared with monovalent mRNA (84.4%; p = .027) and NVX-CoV2373 (81.4%; p < .0001). While bivalent mRNA vaccines elicited the highest early immunogenicity, neutralization levels against all Omicron variants tested waned to similar levels between groups by 12 months post-vaccination. Although NVX-CoV2373 induced a lower peak anti-S antibody response, anti-S decay rate was slower in NVX-CoV2373 compared with mRNA vaccines. The geometric mean anti-S fold change (D360/D28) in NVX-CoV2373 group was higher (0.51) relative to both mRNA vaccines (monovalent: 0.31, p = .010 and bivalent: 0.35, p = .017). Improved neutralizing antibody responses against diverse SARS-CoV-2 variants by the ancestral or variant vaccine highlight the immunological benefits of COVID-19 vaccine boosters regardless of the latest variant-based vaccine. Further studies to determine if different vaccine combinations translate to differing protection against infection remain necessary.

Admission to the intensive care unit represents a profound psychological ordeal for patients' family members. Far beyond the initial shock related to the severity of the illness, the hospital experience exposes families to a cumulative burden of stress, including prolonged uncertainty, confrontation with medical technology, physical exhaustion, loneliness, opaque medical language, and a sense of helplessness. Numerous studies show that during the months following an ICU stay, up to 70% of relatives experience symptoms of anxiety, 35% symptoms of depression, and nearly one third symptoms consistent with post-traumatic stress disorder. To name this specific burden, we propose the concept of HILLY (healthcare-associated family mental injury). HILLY does not pathologize families' experiences nor does it assign individual blame; rather, it highlights the often-unintentional role of certain care-delivery and organizational practices in the emergence of an avoidable trauma, which adds to that of critical illness itself. Restricted visiting policies, fragmented or jargon-laden communication, lack of dedicated spaces for listening, and insufficient recognition of the role of relatives all contribute to exacerbating this injury. The COVID-19 pandemic starkly illustrated the consequences of family exclusion, leading to complicated grief and heightened psychological symptoms among both relatives and healthcare professionals. Preventing HILLY requires a systemic approach: acknowledging this injury, training teams in communication skills, integrating family mental health into quality indicators, valuing relational time, and organizing structured follow-up after ICU discharge. Thinking HILLY means broadening the ethical framework of care to include those who accompany patients, and recognizing that caring for a patient also means caring for their family.

Respiratory infections with influenza, respiratory syncytial virus (RSV), and SARS-CoV-2 are a major cause of global mortality. Vaccination is a cornerstone of disease prevention, though traditional platforms face challenges. Recently, several vaccines utilizing mRNA and adenovirus platforms were brought to the market, with additional vaccines undergoing Phase 3 clinical testing.

This review assesses vaccine literature primarily from 2020 to the present, using National Library of Medicine databases. The rapidity of mRNA technology was tested and implemented successfully during the COVID-19 pandemic. Since then, the mRNA RSV vaccine has been licensed as well. mRNA platforms also offer the ability of combining antigens for multivalent vaccines against multiple pathogens. Several combination products have been used in phase III clinical trials. Adenovirus-vectored vaccines for respiratory viruses have the added advantage of mucosal-based delivery and inducing a potentially stronger local immune response. However, both of these platforms have immunogenicity and safety shortcomings.

Novel respiratory virus vaccine platforms have demonstrated their importance with both endemic and pandemic pathogens, because of decades of concerted efforts and investment in research. Expediting future vaccine development requires a continuation of these efforts with a focus on pre-clinical models and a better understanding of correlates of protection.

Respiratory syncytial virus (RSV) is a leading cause of hospitalization in children. The impact of viral factors like RSV subtype and viral load (VL) on disease severity remains unclear.

We screened 1171 hospitalized children ≤3 years of age with respiratory symptoms in winter seasons (2017-2020) for RSV infection by Reverse Transcription Polymerase Chain reaction. Disease severity was assessed using length of hospital stay and a previously validated disease severity score (RSV-CLASS, range 0-4, higher scores indicating more severe disease). Univariate/multivariate analyses were performed to identify predictors of VL.

In total, n = 351/1171 children were tested RSV positive (RSV A: n = 146/351 [41.6%], RSV B: n = 205/351 [58.4%]) with a median VL of 4.7 × 108 (interquartile range [IQR] 5.6 × 107 to 1.3 × 109). The median age was 3.5 months (IQR 1.5-11.0), and most children were <6 months (n = 223/351 [63.5%]). Bronchiolitis was the leading admission diagnosis, and children were hospitalized for a median duration of 3 days (IQR 2-5), and the median RSV-CLASS disease severity score value was 2 (IQR 1-3). Higher clinical severity scores were observed in children with lower respiratory tract infections (P < 0.01) and were associated with longer hospital stay (ρ = 0.14, 95% confidence interval [CI]: 0.04-0.25). Clinical symptoms did not differ between RSV subtypes. However, younger age, shorter symptom duration, lower weight and reduced blood leukocyte count were associated with higher VL. In multivariate linear regression analysis adjusted for age and sex, weight and leukocyte count remained significant.

This study highlights that RSV subtype and VL are not associated with disease severity in hospitalized children.

Social risk factors contribute to cardiovascular, kidney, and metabolic disease; however, their associations with advanced cardiovascular-kidney-metabolic (CKM) syndrome and variation across demographic subgroups remain unclear.

To examine the association between individual social risk factors and advanced CKM syndrome and to assess whether these associations vary by age group, sex, and race and ethnicity.

This is a cross-sectional study of adults aged 30 years or older from the National Health and Nutrition Examination Survey 2005 to 2018 cycles. Data analysis was conducted from July to October 2025. Analyses incorporated survey weights to generate nationally representative estimates.

Five social risk domains: economic instability, poor neighborhood environment, limited education, limited health care access, and poor social and/or community context.

The primary outcome was advanced CKM syndrome (stages 3-4) defined using American Heart Association criteria. Following tests for interactions by age, race and ethnicity, and sex, weighted logistic regression tested associations between social risks and advanced CKM syndrome, stratified by race and ethnicity and sex.

Among 28 218 participants (representing 165.8 million US adults; mean [SD] age, 52.6 [14.2] years; 14 402 female participants [52.0%]), 12 614 (44.7%) had advanced CKM syndrome. No significant interactions were found for age. Economic instability was associated with higher odds of advanced CKM syndrome among non-Hispanic Black (odds ratio [OR], 1.27; 95% CI, 1.08-1.50) and non-Hispanic White adults (OR, 1.22; 95% CI, 1.08-1.37). Poor neighborhood environment was significant for non-Hispanic Black adults (OR, 1.20; 95% CI, 1.03-1.38). Limited education was associated with advanced CKM syndrome among non-Hispanic White adults (OR, 1.29; 95% CI, 1.13-1.48). Poor social and/or community context was associated across all groups, with the highest OR among Hispanic adults (OR, 1.72; 95% CI, 1.43-2.08). By sex, social risks were more associated with advanced CKM syndrome in women, with associations for men less prevalent and limited to economic instability, poor neighborhood environment, and poor social and/or community context.

In this cross-sectional study of US adults, multiple social risks factors were associated with advanced CKM syndrome, with meaningful variation by race and ethnicity and sex. Integrating social risk screening into CKM syndrome prevention and tailoring interventions to high-risk subgroups may help reduce disparities and slow CKM syndrome progression.

Maternal adult congenital heart disease (ACHD) has been associated with increased offspring congenital heart disease (CHD), but evidence from resource-limited regions remains scarce. The association between maternal acquired heart disease (AHD) and offspring CHD is unknown.

To quantify the overall and subtype-specific CHD risk in offspring associated with maternal ACHD and AHD, examine the association of maternal ACHD and AHD with outcomes in offspring with CHD, and identify maternal factors that may modify the associations between maternal cardiac diseases and offspring CHD risk.

This prospective birth cohort study enrolled pregnant women receiving prenatal care between August 1, 2011, and December 31, 2021, at a major cardiac referral center in China. Participants included pregnant women with ACHD, with AHD, or without cardiac disease and were followed up through delivery; their offspring were followed up until 1 year of age. All follow-ups were completed by December 15, 2023. Data were analyzed from April 1, 2024, through April 31, 2025.

Maternal ACHD and AHD, confirmed via the center's electronic medical records.

The main outcome was offspring CHD, which was diagnosed using echocardiography. Log-binomial regression was used to estimate relative risks (risk ratios [RRs]) and 95% CIs. Adverse outcomes were compared using pairwise tests. Stratification analyses identified potential effect modifiers.

A total of 14 336 pregnant women with 15 677 offspring (8480 males [54.1%]) were included. The mean (SD) maternal age and gestational age at enrollment were 31.4 (4.5) years and 16.4 (6.4) weeks, respectively. Both maternal ACHD and AHD were associated with higher CHD risk in offspring (RR, 1.71 [95% CI, 1.26-2.31] and 1.38 [95% CI, 1.02-1.87], respectively). Minor CHDs, particularly septal defects, were the subtypes with the greatest magnitude of associations with maternal ACHD (RR, 2.95; 95% CI, 1.97-4.43) and AHD (RR, 2.28; 95% CI, 1.50-3.45). Right ventricular outflow tract obstruction (RR, 6.17; 95% CI, 3.59-10.60) and valvular heart disease (RR, 1.65; 95% CI, 1.11-2.45) were the key contributors to offspring CHD risk. Preterm birth had higher rates among offspring with CHD and mothers with ACHD as well as offspring with CHD and mothers without ACHD compared with offspring without CHD and mothers without cardiac disease (12 of 39 [30.8%] and 121 of 780 [15.5%] vs 1287 of 14 088 [9.1%]; all P < .001). Higher rates of chromosomal (5 of 39 [12.8%] and 38 of 780 [4.9%] vs 75 of 14 088 [0.5%]; all P < .001) and genetic aberrations (3 of 39 [7.7%] and 16 of 780 [2.1%] vs 57/14 088 [0.4%]; all P < .001) were found among offspring with CHD and mothers with AHD as well as offspring with CHD and mothers without AHCD compared with offspring without CHD and mothers without cardiac disease. Associations between maternal cardiac disease and offspring CHD were robust in primiparous women (ACHD: RR, 2.15 [95% CI, 1.48-3.11], P for interaction < .001; AHD: RR, 1.73 [95% CI, 1.17-2.56], P for interaction = .02) and those with periconceptional exposure to hazardous substances (ACHD: RR, 2.22 [95% CI, 1.56-3.16], P for interaction < .001; AHD: RR, 1.57 [95% CI, 1.05-2.36], P for interaction = .02).

In this cohort study, maternal ACHD and AHD were associated with increased risks and adverse outcomes of offspring CHD. Targeted modification of identified maternal factors could help mitigate offspring CHD risk in this high-risk population.

Intravascular lithotripsy (IVL) utilizes high-energy sonic waves to create controlled fractures in calcified plaques, facilitating vessel preparation and improving stent apposition.

The study was designed to evaluate the safety and efficacy of IVL in a patient population that included individuals with acute myocardial infarction (MI). A total of 201 consecutive patients who underwent percutaneous coronary intervention (PCI) using IVL [Shockwave C2 or C2+ (Shockwave Medical Inc, Santa Clara, CA, US)] from April 2020 onward were included in this single-center registry. The study population comprised 76 patients with acute MI (Group 1) and 125 patients with non-MI (Group 2).

Left ventricular ejection fraction was lower (46.0% ± 13.1% vs. 50.9% ± 10.5%; p = 0.022), while SYNTAX Score was significantly higher (20.0 ± 11.3 vs. 16.5 ± 10.2; p = 0.059) in Group 1 than in Group 2 (46.0% ± 13.1% vs. 50.9% ± 10.5%; p = 0.022). The overall IVL success rate and procedure success rate were very high (97.5% and 99.5%, respectively). A mean increase in lumen area was observed in Group 1 and Group 2: 5.9 ± 3.7 mm2 vs. 4.5 ± 2.2 mm2 and 237% vs. 239%, respectively. In the long-term follow-up there was no difference in all-cause mortality between Group 1 and Group 2 (9.0% vs. 8.1%; p = 0.997), cardiac death (p = 0.340), repeat MI (p = 0.986) and major adverse cardiovascular events [MACE; cardiac death, myocardial infarction, stroke] (16.8% vs. 9.8%; p = 0.501). Prior chronic kidney disease (CKD), post rota-atherectomy debulking, prior coronary artery bypass graft (CABG) and longer lesions were independent predictors of long-term all-cause mortality.

Intravascular lithotripsy is an effective treatment for the modification of calcified atherosclerotic lesions, with a high success rate and few periprocedural complications. The long-term outcomes achieved in this complex population are satisfactory.