This study assessed the associations between asthma, gastro-oesophageal reflux disease (GORD) and health-related quality-of-life (HRQoL) among adolescents.

A cross-sectional survey.

Six randomly selected schools across all five educational zones of the Anuradhapura district in Sri Lanka.

A total of 1127 adolescents aged 13-14 years were included from six randomly selected schools representing all five educational zones in the Anuradhapura district, Sri Lanka.

Prevalence of asthma and GORD, the associations between asthma, GORD and HRQoL among adolescents in Sri Lanka.

This study of 1127 adolescents (44.8% male, mean age 13.66±0.56 years) found that 16.1% (n=181) had current asthma and 17.9% (n=202) exhibited symptoms of GORD. A significant association was observed between current asthma and GORD (OR 2.30, 95% CI 1.59 to 3.31, p=0.0005). Comorbidity of asthma and GORD was observed in 4.8% of participants (n=54). The total HRQoL score was not associated with asthma, GORD or those having both asthma and GORD. However, the presence of GORD was associated with poor emotional functioning (unstandardized regression coefficient ± standard error = -4.7±1.7, p=0.008).

Asthma and GORD were significantly associated among early adolescents in Sri Lanka. While overall HRQoL did not differ by disease status, the presence of GORD was associated with poorer emotional functioning.

Assessment of lung function variability is recommended for the diagnosis of asthma, but its specificity in separating asthmatic from COPD subjects is low. This study aimed to test the hypothesis that the day-to-day variability of respiratory resistance depends on the respiratory phase considered and observation time.

Respiratory resistance was measured daily by oscillometry at 5 Hz in 47 mild asthmatics, 20 moderate-to-severe COPD, and 35 healthy subjects. The coefficient of variation was calculated over multiple time scales using full breaths, inspiratory phase, or mid-inspiratory phase.

The coefficient of variation of mid-inspiratory resistance was significantly higher in asthmatic than healthy and COPD groups at time scales >7 days, but not different between healthy and COPD. The accuracy of the 14-days coefficient of variation of mid-inspiratory resistance in separating asthmatic from the other groups, calculated as the area under the receiver-operating characteristic curve, was 0.86, with 73% sensitivity and 83% specificity at the optimal cutoff of 10%. Moreover, the coefficient of variation was significantly higher in asthma than COPD despite an increased mean resistance in the latter.

When expressed as the day-to-day coefficient of variation of mid-inspiratory oscillometric resistance, the variability of lung function does not appear related to the presence or degree of airflow obstruction. Two-week assessment of day-to-day variability of mid-inspiratory resistance provides accurate separation of asthmatic from both healthy and COPD subjects. These findings demonstrate that simple, self-administered daily oscillometry can provide useful clinical information, supporting more accurate asthma diagnosis in real-world settings. Clinical and Translational Impact-The coefficient of variation of mid-inspiratory resistance computed over 14-days separated asthmatic from healthy and COPD subjects with 73% sensitivity and 83% specificity. Daily self-administered oscillometry can support asthma diagnosis.

Dysregulated gut microbiota is increasingly recognized as a major contributor to allergic diseases and their progression. A key clinical manifestation of this progression is the atopic march, in which atopic dermatitis (AD) precedes the development of allergic airway disease. Although prebiotics and probiotics individually improve AD symptoms, their combined use as synbiotics, especially with regard to preventing the progression from cutaneous inflammation to airway hypersensitivity, has not been clearly established. In this study, we assessed the biological activity of a synbiotic composed of fructo-oligosaccharides (FOS) and Lactococcus lactis LB1022 in an ovalbumin (OVA)-induced murine model of AD and asthma-like inflammation. Female BALB/c mice were treated for eight weeks with FOS, L. lactis LB1022, or their combination following OVA sensitization. The synbiotic formulation produced the strongest protective effects, markedly reducing AD-like skin pathology, suppressing airway inflammatory cell influx, and lowering Th2-skewed cytokine responses. These protective effects were further supported by significant reductions in serum IgE and Th2-associated IgG1 levels. Synbiotic treatment also enriched multiple short-chain fatty acid (SCFA)-producing taxa, including Lactobacillus and Bifidobacterium species, resulting in increased fecal SCFA concentrations that were closely associated with improvements in systemic and mucosal immunity. These results demonstrate that the FOS-L. lactis LB1022 synbiotic mitigates both epidermal and respiratory allergic inflammation through coordinated regulation of the microbiota-gut-skin-lung axis. The findings highlight a promising dietary approach for reducing the risk of progression along the atopic march and address an important gap in current allergy-related microbiome research.

Objective:To analyze and summarize the detection results and distribution of common inhaled allergens in children with nosebleed in Fuzhou area. Methods:A total of 226 children with allergic rhinitis and common serum aspiration allergen sIgE were selected from the Otolaryngology clinic of our hospital due to rhinorrhagia from June 2021 to June 2023. The distribution of common inhaled allergens in children with epistaxis was analyzed according to gender, age, season of treatment and living environment. Results:Dust mites and household dust mites were the most important allergens, followed by weed pollen mixing and mold mixing. The sIgE positive rate of male children against dust mites and household dust mites was higher than that of female children. At the same time, with the increase of age, the sIgE positive rate of dust mite, house dust mite and weed pollen also showed an increasing trend. The positive rate of sIgE in the mixed mold group was higher than that in other seasons. The sIgE positive rate of mixed tree pollen and mixed weed pollen in mountainous rural group was higher than that in urban group and coastal rural group. Conclusion:Dust mites and dust mites are the most common inhalation allergens in children with nosebleed in Fuzhou area. The positive rate of common inhalation allergen sIgE in children with nosebleeds was different in gender, age, season of treatment and living environment.

The increasing prevalence of non-tuberculous mycobacteria pulmonary disease (NTM PD) is a burden to public health. Successful management of NTM PD critically depends on accurate species identification and reliable drug susceptibility testing to guide appropriate antibiotic therapy. Emerging molecular technologies offer rapid diagnostic solutions compared to conventional methods, but their performance varies. This study aims to provide a comprehensive evaluation of current molecular techniques for NTM identification and to present a global antibiotic resistance profile.

A systematic literature search was conducted in PubMed and Web of Science for studies published between 2005 and 2024. Studies applying molecular methods for NTM identification and resistance detection in humans were included. Data on study characteristics, diagnostic methods, sample types, sample sizes, identification sensitivity, and drug susceptibility results were extracted. Meta-analysis was performed using R with the meta4diag package. The quality of included studies was assessed using the QUADAS-2 tool.

The analysis included 49 studies on NTM identification and 33 studies on antibiotic resistance. For species identification, all evaluated molecular technologies (MALDI-TOF MS, PCR-based methods, Sequencing, DNA chip, and DNA strip) demonstrated high pooled sensitivities (>0.92). Subgroup analysis revealed that sample type significantly affected performance for MALDI-TOF MS. Preliminary analysis of antibiotic resistance rates revealed varying patterns. For slowly growing mycobacteria, a significantly high Ethambutol resistance rate was observed in M. avium (69.20%). Among rapidly growing mycobacteria, resistance to Imipenem was notable (54.22%), and Clarithromycin resistance varied significantly within the Mycobacterium abscessus complex.

Emerging molecular technologies have revolutionized the methodology for NTM identification with excellent performance. However, their performance can be influenced by sample type, particularly for MALDI-TOF MS. The alarming and heterogeneous antibiotic resistance patterns also highlight the critical need for rapid and accurate species identification and drug susceptibility testing to inform effective therapeutic strategies. Key messagesMolecular technologies demonstrate high accuracy for NTM identification.Antibiotic resistance is a serious concern with variations among NTM species and subspecies.Rapid and accurate species identification and drug susceptibility testing are crucial for guiding effective clinical management of NTM PD.

Human metapneumovirus (hMPV) is a significant respiratory pathogen in infants and young children. Although most infections present as nonsevere cases in outpatient settings, severe courses can lead to hospitalization. Few potential risk factors for hospitalization have already been identified, but studies comparing the clinical presentation of children with hMPV in inpatient versus outpatient settings are lacking.

This retrospective analysis used data from the Pediatric Airway Pathogen Incidence study, a multicenter surveillance study of lower respiratory tract infections, conducted in Germany during winter seasons 2021/22 and 2022/23 (weeks 40-17 each season). We compared 102 hospitalized and 114 outpatient pediatric cases with laboratory-confirmed hMPV infection after excluding coinfections with respiratory syncytial virus. Detailed clinical and demographic data were collected.

Hospitalized patients were significantly younger (median age 9 vs. 14 months, P = 0.003) than outpatients. Prematurity was notably higher in severe cases (25% vs. 6.2%, P < 0.001), and extreme prematurity (gestational age <28 weeks) was present only in hospitalized patients. Hospitalized cases were independently associated with a history of recurrent wheezing, but not with neonatal invasive and noninvasive respiratory support, inhalative steroids and bronchopulmonary dysplasia. On clinical examination, hospitalized children more often exhibited wheezing, crackles, tachypnea, hypoxemia and reduced fluid intake. Hypoxemia in hMPV was independently associated with gestational age at birth, but not with age at diagnosis.

The clinical presentation of hMPV in hospitalized young children differed from that observed in outpatient settings. We identified multiple factors that were independently associated with hMPV-related hospitalization.

Amorphous silicon dioxide nanoparticles (SiO₂ NPs) are abundant within the earth's crust and can be released into the air through industrial and manufacturing activities. Such materials are often used in industrial processes, in pharmaceutical and in the cosmetic industries. Amorphous SiO₂ NPs are pulmonary toxicants; however, the mechanism of toxicity is uncertain. In the current study, toxicity of SiO₂ NPs was assessed using inhalation exposure in an in vivo system to study a possible mechanism of pulmonary injury. Golden Syrian Hamsters were divided into 4 groups: 1- room air control, 2- vehicle control, 3- low concentration (6 mg/m³) and 4- high concentration (12 mg/m³). Hamsters were treated for 4 h a day for 8 days. Bronchoalveolar Lavage Fluid (BALF) analysis found increases in total cell counts (p < 0.0001), neutrophils (p < 0.0001), lymphocytes (p < 0.001), eosinophils (p < 0.01), multinucleated macrophages (p < 0.01), total protein (p < 0.0001), alkaline phosphatase (p < 0.0001), and lactate dehydrogenase (p < 0.001) in the high concentration group. Histopathological analysis found an increase in air space, quantified by Mean Linear Intercept (p < 0.0001), and a significant increase in TUNEL positive cells (p < 0.001), in the high concentration group. SEM and TEM found structural alterations to the lung tissue including increase in the number holes in the alveolar walls and in apoptotic bodies within tissue. Caspase 3 (p < 0.05), and 8 (p < 0.05), were significantly increased along with cellular inflammation markers TNF-α (p < 0.05), and HSP70 (p < 0.05) in the high concentration group. Results of the study indicate exposure to SiO₂ NPs may induce extrinsic apoptotic pathway, leading to tissue damage and significant airspace enlargement.

The novel thin-strut sirolimus-eluting iron bioresorbable scaffold (IBS) demonstrated safety and efficacy in a nonrandomized first-in-human study.

The objective of this study was to compare the IBS with contemporary metallic cobalt chromium everolimus-eluting stents (CoCr-EES) in patients with coronary artery disease.

IRONMAN-II was a prospective, multicenter, single-blinded, noninferiority randomized trial across 36 centers in China. Eligible patients had myocardial ischemia and 1 or 2 de novo target lesions. Patients were randomly assigned (1:1) to IBS or CoCr-EES, with allocation masked. Optical coherence tomography (OCT) was performed in the first 25 participant pairs. Clinical follow-up was scheduled at 1, 6, and 12 months, and annually to 5 years, with angiographic and OCT follow-up at 2 years. The primary endpoint was 2-year angiographic in-segment late lumen loss (LLL). Powered secondary endpoints included target vessel quantitative flow ratio (QFR) and OCT-derived cross-sectional mean flow area. Other secondary endpoints included target lesion failure (cardiac death, target vessel myocardial infarction [MI], or ischemia-driven target vessel revascularization), the patient-oriented composite endpoint (all-cause death, MI, or any revascularization), their individual components, and device thrombosis.

Between March 10 and December 13, 2022, 518 patients were randomized to IBS (n = 259) or CoCr-EES (n = 259). At 2 years, lesion-level in-segment LLL was 0.28 (0.52) mm with IBS and 0.23 (0.43) mm with CoCr-EES (difference: 0.08 mm; 95% CI: -0.02 to 0.18; P_{noninferiority} = 0.03). Mean QFR was 0.90 (0.13) with IBS and 0.92 (0.09) with CoCr-EES (difference: -0.02; 95% CI: -0.04 to 0; P_{noninferiority} = 0.05). Mean OCT flow area was 6.92 (3.48) mm² with IBS and 6.64 (2.44) mm² with CoCr-EES (difference: 0.27; 95% CI: -0.09 to 0.63; P_{noninferiority} < 0.0001). Two-year target lesion failure occurred in 7.4% of IBS patients and 5.4% of CoCr-EES patients (HR: 1.37; 95% CI: 0.69-2.73; P = 0.37). No significant between-group differences in the rates of patient-oriented composite endpoint, death, or MI were present between the 2 groups. No scaffold thromboses occurred in the IBS group, whereas 1 stent thrombosis occurred with CoCr-EES. Binary restenosis and revascularization rates were higher with IBS, however, most such events were non-ischemia-driven.

In IRONMAN-II, the sirolimus-eluting IBS was noninferior to CoCr-EES for 2-year in-segment LLL, QFR, and OCT-derived flow area. Clinical event rates were also comparable between groups although non-ischemia-driven revascularization rates were higher after IBS. Longer-term follow-up is necessary to demonstrate whether late benefits are realized after complete IBS resorption. (A Clinical Investigation to Evaluate the Safety and Efficacy of IBS in Patients With Coronary Artery Disease; NCT05206084).

To evaluate the effects of direct and remote ischemic preconditioning and postconditioning on kidney ischemia-reperfusion injury in young rats.

This study was divided into two experimental phases: preconditioning and postconditioning. In each phase, 78 rats were randomly assigned to four groups: control (CG), ischemia-reperfusion (IRG), direct ischemic pre/postconditioning (DIPG), and remote ischemic pre/postconditioning (RIPG). Animals were euthanized at 0- or 24-hours post-procedure, and samples were collected for histological and biochemical analyses.

The sum of the histological findings revealed no significant differences among the pre/postconditioning groups. However, serum calcium levels were significantly higher in preconditioning, DIPG compared to the control group (p = 0.002), and in postconditioning, DIPG and RIPG compared to the control group (p = 0.028 and p = 0.005, respectively). In postconditioning, the chlorine levels were higher in IRG compared to the DIPG group (p = 0.029).

In our findings, ischemic preconditioning and ischemic postconditioning no provided significant protection of renal tissue.

Dengue is an endemic viral infection of tropical regions that can present with clinical presentations ranging from mild forms to severe complications. Dengue-associated myocarditis, although uncommon, is a potentially fatal complication that should be suspected in febrile patients from endemic areas presenting with signs of cardiovascular dysfunction. We present the case of a 21-year-old male, resident in the Peruvian Amazon, who developed acute heart failure and refractory cardiogenic shock secondary to dengue myocarditis, with a fatal outcome on the third day of hospitalization. This case highlights the importance of early recognition of myocardial involvement and timely cardiovascular monitoring to reduce mortality associated with this infection.