Clinical data link the prevalent respiratory tract anaerobe Prevotella with reduced pneumonia mortality, but the mechanisms directing Prevotella regulation of lung immune homeostasis are unclear. Here, single-cell RNA sequencing was employed to define the transcriptional immune signatures underlying improved clearance of Streptococcus pneumoniae following lung exposure to Prevotella melaninogenica. Overall, we observed a substantial shift in myeloid cell transcriptional programming from interferon-dominant to a more antibacterial profile in S. pneumoniae-infected mice after pre-exposure to P. melaninogenica, correlating with increased macrophage and neutrophil phagocytosis of S. pneumoniae and improved pathogen clearance. In neutrophils, tumor necrosis factor (TNF) signaling through TNFR2 was essential for increased antimicrobial function. Moreover, improved defense required CCR2-dependent monocyte-derived macrophages, with selective enrichment of more a mature Cxcl3+ population which was distinct from the hallmark S. pneumoniae-associated C1qa+ population enriched in the absence of effective clearance. Together, these findings inform the myeloid cell transcriptional changes associated with natural infection resistance mediated by pulmonary microbial exposures.

A man in his early 60s presented with dyspnoea superimposed on a 2-month to 3-month history of spontaneous mucocutaneous bleeding. Laboratory testing revealed unmeasurably elevated international normalised ratio (INR) and activated partial thromboplastin time. CT of the neck demonstrated supraglottic soft tissue swelling with severe airway narrowing, requiring intubation for airway protection. Further history revealed occupational exposure to rodenticides during pest control work without consistent use of personal protective equipment. Markedly reduced activity of vitamin K-dependent clotting factors (II, VII, IX and X) supported a presumptive diagnosis of superwarfarin toxicity. Treatment with 4-factor prothrombin complex concentrate and vitamin K1 rapidly corrected the coagulopathy, although prolonged high-dose oral vitamin K1 was required because of recurrent INR elevation. He was discharged after 9 days and completed a 3-week vitamin K1 taper. This case highlights a rare presentation of presumed transdermal superwarfarin toxicity causing life-threatening coagulopathy and airway compromise.

We examine how political polarization and prolonged crisis governance contribute to narrative numbing in public health emergencies and explore how these dynamics reshape executive emergency powers in the United States. Using Google Trends data, we assess changes in public attention to the opioid epidemic. We follow this with an explanatory case study of Pennsylvania's opioid state of emergency and a comparative review of national legislative reforms to state emergency powers. Prolonged emergency governance during COVID-19 coincided with narrative numbing, weakening the agenda-setting power of emergency declarations. In Pennsylvania, this shift was associated with legislative reforms that constrained executive authority with downstream effects on the opioid emergency. Nationally, state legislatures adopted time-limit, legislative termination, and scope constraints that reallocated authority from executives to legislatures. Narrative numbing is reflected in legislative reforms and has reshaped public health governance by limiting states' capacity to sustain emergency responses to prolonged or recurring public health crises. These changes carry implications for regional health equity and population health outcomes, demonstrating the need to maintain political legitimacy for sustained public health action. (Am J Public Health. 2026;116(11):1719-1726. https://doi.org/10.2105/AJPH.2026.308730).

Previous studies have evaluated the association between myxomatous mitral valve disease (MMVD) and pancreatic lipase activity, but medications remain unconsidered.

Elevated serum pancreatic lipase activity is related to cardiac medication in dogs with MMVD.

Eighty-two client-owned dogs without clinical signs of pancreatitis (MMVD, n = 67 [stage B1 = 24; stage B2 = 22; non-medicated stage C = 9; medicated stage C = 12]; controls, n = 15).

Retrospective cross-sectional study. Dogs were classified into MMVD stage and control groups. Serum pancreatic lipase activity was compared among groups, and correlation and multivariable linear regression analyses were performed.

In non-medicated dogs, pancreatic lipase activity did not differ among groups. In contrast, medicated stage C dogs had higher pancreatic lipase activity than controls (median difference, 67.5 U/L; 95% CI, 19.0-184.0), stage B1 (57.0 U/L; 95% CI, 12.0-145.0), stage B2 (65.8 U/L; 95% CI, 18.0-156.0), and non-medicated stage C (58.0 U/L; 95% CI, 9.0-268.0). Moreover, 25% (3/12) of medicated stage C dogs had pancreatic lipase activity exceeding 400 U/L, whereas no non-medicated stage C dogs reached this threshold. Pancreatic lipase activity was positively correlated with furosemide (ρ = 0.67) and duration of angiotensin-converting enzyme inhibitor (ρ = 0.62) administration. In multivariable analysis, medication was the independent predictor of pancreatic lipase activity in dogs with MMVD.

Pancreatic lipase activity might be elevated in some dogs with MMVD receiving cardiac medications, highlighting the importance of considering medication history in clinical interpretation.

배경: 기존 연구에서 개의 점액종성 승모판막질병(myxomatous mitral valve disease, MMVD)과 혈청 췌장 라이페이스 활성도의 연관성이 평가되었으나, 심장약물이 혈청 라이페이스 활성도에 미치는 영향은 고려되지 않았다. 가설: MMVD에 이환된 개에서 혈청 췌장 라이페이스 활성도의 증가는 심장약물 투여와 관련이 있을 것이다. 연구대상: 췌장염의 임상증상이 없는 개 82마리를 대상으로 하였다(MMVD 67마리 [Stage B1 = 24마리, Stage B2 = 22마리, 심장약물을 투여 받지 않은 Stage C = 9마리, 심장약물을 투여 받은 Stage C = 12마리]와 대조군 15마리). 연구방법: 후향적 단면연구를 수행하였다. 연구대상 개를 MMVD 단계 및 대조군으로 분류하였다. 그룹 간 혈청 췌장 라이페이스 활성도를 비교하였으며, 상관분석과 다변량 선형회귀분석을 수행하였다. 결과: 심장약물을 투여 받지 않은 개에서는 그룹 간 췌장 라이페이스 활성도에 유의한 차이가 없었다. 반면, 심장약물을 투여 받은 Stage C 개에서는 대조군(중앙값 차이 67.5 U/L; 95% 신뢰구간 [CI], 19.0-184.0), Stage B1(57.0 U/L; 95% CI, 12.0-145.0), Stage B2(65.8 U/L; 95% CI, 18.0-156.0) 및 심장약물을 투여 받지 않은 Stage C(58.0 U/L; 95% CI, 9.0-268.0)에 비해 췌장 라이페이스 활성도가 높았다. 또한 심장약물을 투여 받은 Stage C 개의 25%(3/12)에서 췌장 라이페이스 활성도가 400 U/L를 초과한 반면, 심장약물을 투여 받지 않은 Stage C 개에서는 400 U/L를 초과한 개가 없었다. 췌장 라이페이스 활성도는 푸로세마이드 투여기간(ρ = 0.67) 및 안지오텐신-전환 효소 억제제 투여기간(ρ = 0.62)과 양의 상관관계를 보였다. 다변량 분석에서 심장약물 투여는 MMVD 개의 췌장 라이페이스 활성도와 독립적 연관 요인이었다. 결론 및 임상적 의의: 심장약물을 투여 받는 일부 MMVD 개에서 췌장 라이페이스 활성도가 증가할 수 있으 므로, MMVD 개에서 췌장 라이페이스 검사 결과 해석 시 심장약물 투여 이력을 함께 고려해야 한다.

ObjectiveCoronary heart disease (CHD) constitutes a primary cause of morbidity and mortality worldwide. The estimated glucose disposal rate (eGDR) serves as a surrogate marker of insulin resistance, whereas the albumin-bilirubin (ALBI) score reflects liver-related systemic status. However, their joint associations with CHD have not been well characterized.MethodsWe conducted a cross-sectional analysis of participants from the National Health and Nutrition Examination Survey (NHANES) from 1999 to March 2020. Survey-weighted logistic regression models were used to evaluate the individual and joint associations of eGDR and ALBI with CHD prevalence. Restricted cubic spline (RCS) models were applied to assess nonlinear associations. Subgroup, complete-case, covariate-exclusion, and age-stratified sensitivity analyses were performed to evaluate robustness of the findings.ResultsA total of 18,712 participants, involving 725 with CHD, were included. In the fully adjusted model, higher eGDR was associated with lower odds of CHD (odds ratio [OR] 0.740, 95% confidence interval [CI] 0.687-0.797; P < 0.001), whereas higher ALBI was associated with greater odds of CHD (OR 1.779, 95% CI 1.231-2.570; P = 0.002). RCS analysis showed a nonlinear inverse association for eGDR and an approximately linear positive association for ALBI. The high-ALBI/low-eGDR group had the highest odds of CHD compared with the low-ALBI/high-eGDR group (OR 4.307, 95% CI 2.530-7.332; P < 0.001). The principal findings remained consistent across all sensitivity analyses.ConclusionLower eGDR and higher ALBI were each associated with higher CHD prevalence. Their joint assessment may provide complementary information for population-level cardiometabolic risk evaluation, although longitudinal validation is required.

Hard-to-heal (chronic) venous leg ulcers (VLUs) are challenging to heal with standard of care (SoC) alone. This study evaluated whether adding a thigh-administered intermittent pneumatic compression (IPC) device (WoundExpress, Huntleigh Healthcare Ltd., UK) to SoC improved outcomes in patients with hard-to-heal venous or mixed leg ulcers (venous and arterial), was suitable for home use and was safe.

A multicentre, pragmatic, open-label, randomised controlled trial (RCT) was conducted across the UK, US, Germany and France. Adults with hard-to-heal lower limb VLUs and mixed ulcers already receiving compression were randomised 1:1 to adjunctive IPC (two hours/day; intervention) plus SoC, or SoC alone (control), for 16 weeks. The primary outcome was percentage change in wound area. Secondary outcomes included: complete healing; wound pain; quality of life (QoL); acceptability; usage; and safety.

A total of 136 patients were randomised (n=65 IPC; n=71 control); 116 patients completed the study. Median wound area reduction at 16 weeks was similar: (intervention: 64.0% versus control: 67.7%; p=0.35). Complete healing occurred in 16.9% (IPC) and 18.3% (control) patients (p=0.80). Pain scores and QoL improved modestly in both groups, with no between-group differences. The IPC device was well tolerated: 64% of patients rated it 'very good' or 'excellent'. Mean use was ~2.0 hours/day, as reported in patient diaries. Adverse events were primarily mild and comparable (54% IPC; 59% control); only one mild event was device-related.

In this RCT, thigh-administered IPC did not improve healing beyond SoC in this patient population, although it was safe, well-tolerated, and feasible for home use.

The aetiology of hard-to-heal (chronic) wounds is usually categorised as either 'diabetic foot', 'venous leg ulcer (VLU)', 'arterial', 'pressure injury', 'postoperative' and 'other'. Due to the homogeneity of patients with a diabetic foot ulcer, the majority of studies regarding the efficacy of placental allografts have been in this population of patients, with a small fraction conducted with patients with VLUs. However, insufficient research has been performed regarding advanced modalities for the treatment of other, open hard-to-heal wounds resulting from alternative aetiologies, such as trauma or failed surgical procedures. The aim of this case series was to evaluate the efficacy and safety of a placental allograft in the treatment of hard-to-heal VLUs.

This prospective case series encompassed patients with hard-to-heal open wounds on various parts of their body and who received weekly applications of a placental allograft (Neothelium FT, Surgenex, LLC., US). Wound surface area was measured weekly prior to each application of the placental allograft to quantify wound size and calculate percent area reduction (PAR).

A total of 10 patients-three males and seven females- were included. Mean initial wound area was 11.98cm². Of the eight patients who achieved complete healing (80% closure rate), the average number of allograft applications was 5.13 (median: 5). The patients demonstrated an average PAR of 87.48% by study completion.

The findings of this study suggest that the placental allograft used may offer an effective treatment option for patients with hard-to-heal open wounds.

The health-economic burden of hard-to-heal wounds is rising across the Asia-Pacific (APAC) region, yet regional data remain sparse, particularly for venous leg ulcers and pressure injuries. Effective wound bed preparation, including management of bioburden and biofilm, is central to healing outcomes, but debridement practice across APAC is inconsistent. In May 2026, the Journal of Wound Care published the continuous integral debridement (CID) concept, built around a four-step cleanse, debride, cleanse, dress (CDCD) cycle designed to standardise debridement in everyday clinical practice. This article reports the outcomes of a July 2026 APAC expert panel convened to review the CID concept and its applicability to the region. The panel considered the concept's alignment with established frameworks and its relevance across wound types and care settings. It identifies barriers to implementation, among them variable clinician competence, resource constraints and inconsistent access to education, and sets out recommendations for overcoming these through structured education, multidisciplinary collaboration and the development of local champions. The panel also highlights the role of audit in supporting quality improvement as CID is introduced into practice. These recommendations aim to support clinicians across the APAC region in adopting a consistent, evidence-based approach to wound debridement, with the goal of improving healing outcomes for patients with hard-to-heal wounds.

We describe the rationale for and implementation of the Right Care Initiative and its University of Best Practices (UBP), a model designed to close the implementation gap between clinical evidence and the real-world management of cardiovascular risk factors. The model aims to move beyond institutional silos toward an accountable care model that emphasizes interorganizational partnerships and the systematic sharing of best practices to eliminate preventable mortality.

We summarize lessons from a 17-year learning collaborative involving clinicians, pharmacists, health plans, and public health officials. The collaborative focuses on sharing best practices, peer accountability, and the dissemination of team-based care. The article synthesizes evidence from regional pilot projects, performance variation, and federal policy shifts to support a transition to precision prevention.

Effective strategies identified include integrating clinical pharmacists into primary care to manage complex biometrics and utilizing coronary artery calcium imaging for early disease staging. Collaborative learning models address clinical inertia by identifying drug therapy problems and scaling proven interventions, including support for healthy nutrition, weight reduction, and physical activity, across health systems. Aligning value-based payment models with measurable reductions in cardiovascular disease risk holds promise to improve population health.

Making progress toward 0 preventable cardiovascular deaths requires developing organizational infrastructure rather than just generating new science. By fostering radical collaboration and adopting advanced diagnostic and team-based tools, health care leaders can ensure that lifesaving evidence reaches patients effectively.

Early thymectomy during congenital heart disease repair may impair thymic output, but long-term effects across age groups remain incompletely defined. We evaluated T-cell receptor excision circles (TRECs) and a comprehensive panel of lymphocyte subsets in 20 adults (mean age, 29.6 years) and 16 children (mean age, 10.7 years) who underwent thymectomy within the first year of life, and in age- and sex-matched controls. TRECs were lower in patients than controls in adults (34 ± 25 vs. 79 ± 45 copies/μL; FDR-adjusted p = 0.001) and children (9 [7-15] vs. 95 [65-160] copies/μL; FDR-adjusted p < 0.0001). Total lymphocyte and T-cell counts were reduced in both age groups, mainly due to lower naïve CD4⁺ and CD8⁺ T cells, including recent thymic emigrants. Most non-naïve subsets did not differ significantly from controls. Regulatory T-cell (Treg) alterations differed by age: children showed broad reductions, whereas adults showed selective naïve Treg reduction. Early thymectomy is associated with persistent thymic output impairment, including in adults approximately three decades after surgery, and with age-specific Treg alterations.