Pulmonary rehabilitation (PR) is effective for improving symptoms and functional status in patients with chronic obstructive pulmonary disease (COPD), particularly respiratory training. However, its effectiveness is often compromised by poor adherence. Music therapy has increasingly being applied to COPD PR, due to its safety, low cost, and potential to motivate and enhance participation. Therefore, an integrated intervention combining music-guided breathing training and singing may represent a more appealing alternative rehabilitation strategy. This study protocol aims to evaluate whether this music-based integrated intervention is non-inferior to conventional PR therapy in terms of functional mobility, adherence and other patient-centered outcomes will be assessed as secondary or exploratory outcomes.

This is a multicenter, double-arm, parallel-group, randomized controlled non-inferiority trial. We plan to recruit 76 patients with stable moderate-to-severe COPD, and randomize them in a 1:1 ratio to either the Music Therapy group (MTG) or the Conventional Pulmonary Rehabilitation group (CPRG). The MTG will receive music-guided breathing exercises and singing; the CPRG will receive non-music-guided breathing exercises and aerobic exercise. Both groups undergo interventions at a frequency of 60 min per session, 3 times per week, for 6 weeks. The primary outcome is the between-group difference in change in the 6-min walk distance (6MWD) from baseline to week 6, assessed under a non-inferiority framework. Key secondary outcomes include dyspnea severity, respiratory health status, pulmonary function, and adherence-related measures. Exploratory outcomes include arterial blood gas parameters, Traditional Chinese Medicine (TCM) syndrome assessment, patient satisfaction, safety, and the number of acute exacerbations of COPD (AECOPD) during the 1-year post-intervention follow-up. This trial protocol has been approved by the ethics committees of all participating centers.

This study aims to evaluate whether an integrated rehabilitation intervention of music-guided breathing training and singing is non-inferior to conventional PR in terms of functional outcomes for patients with COPD. Secondary outcomes, including adherence, feasibility, and patient-reported measures, will be assessed as secondary or exploratory outcomes and interpreted cautiously. The findings may help inform the development of alternative rehabilitation strategies for this population.

https://itmctr.ccebtcm.org.cn, identifier ITMCTR2026000211.

Newly diagnosed patients with pulmonary tuberculosis usually have insufficient self-management ability. LEARNS model-based health education has been shown to significantly improve patients' self-management and treatment outcomes. This randomized controlled trial aimed to evaluate the effects of the LEARNS model-based self-management intervention on six indicators among patients with newly diagnosed tuberculosis: self-management, tuberculosis prevention and control knowledge, anxiety, depression, social support, and treatment efficacy.

This prospective, two-arm, parallel-group randomized controlled trial was registered (ChiCTR2400090561). Seventy-two inpatients with newly diagnosed pulmonary tuberculosis were enrolled from the tuberculosis department of a tertiary hospital in Ningxia between May and July 2024. Participants were randomly assigned to receive either routine tuberculosis self-management education (control group) or standardized LEARNS model-based self-management education (intervention group). Self-management was defined as the primary outcome. Secondary outcomes encompassed tuberculosis prevention and control knowledge, perceived social support, anxiety, depression, sputum smear and culture conversion rates, and chest CT lesion improvement rates. All participants underwent a 2-month integrated intervention program involving inpatient-based education and continuous post-discharge follow-up. All study outcomes were evaluated 3 months after program completion. All intention-to-treat analyses were performed using generalized estimating equations to evaluate short-term intervention effects.

At 3 months following the 2-month integrated intervention program, the intervention group showed significant improvements in self-management (β = 15.51, 95% CI: 5.03-25.99, P = 0.004), tuberculosis prevention and control knowledge (β = 0.87,95%CI: 0.14-1.60, P = 0.019), and chest radiograph improvement rate (χ² = 7.497, P = 0.024) compared with the control group. No significant between-group differences were observed in perceived social support (β = -1.09, 95% CI: -6.26 to 4.07, P = 0.678), anxiety (β = 0.96, 95% CI: -0.36 to 2.27, P = 0.154), depression (β = 0.13, 95% CI: -1.36 to 1.62, P = 0.864), or sputum smear and culture conversion rates (χ² = 1.857, P = 0.395).

The LEARNS model-based self-management program benefits inpatients with newly diagnosed pulmonary tuberculosis. It effectively improves patients' self-management and tuberculosis prevention and control knowledge, and improves chest radiographic findings. However, this intervention yields no significant effects on anxiety, depression, social support, and sputum bacteriological conversion.

Moraxella catarrhalis (M. catarrhalis) is an important opportunistic pathogen causing respiratory tract infections, and current detection methods are limited by low sensitivity, heavy instrument dependence or complex operation, which cannot meet the needs of rapid clinical and on-site testing.

The copB gene is a species-specific conserved gene of M. catarrhalis, which was selected as the target for specific detection. Primers and probe were designed using Primer Premier 5.0 software and online tools. The limit of detection was determined using standard strains, and the clinical applicability of the recombinase polymerase amplification-lateral flow strip assay (RPA-LFS) was evaluated by testing 300 clinical samples. Culture combined with real-time quantitative PCR (qPCR) was applied as the composite reference standard to evaluate clinical diagnostic performance.

The optimized RPA-LFS assay was incubated at 37 °C for 15 minutes, which specifically detected all 20 M. catarrhalis strains without cross-reactivity with other pathogens, and its limit of detection reached 13.4 CFU/mL without interference from heterologous bacterial DNA. The clinical sensitivity and specificity of RPA-LFS were 96.26% and 88.08%, respectively.The positive detection rate of the assay in clinical specimens was 42%, significantly higher than that of PCR (15%) and conventional culture (9%).

The established copB-based RPA-LFS assay is rapid, simple, instrument-independent, highly sensitive and specific, with excellent clinical detection performance, which can serve as an effective technical tool for the rapid and on-site detection of M. catarrhalis and support early clinical diagnosis of its infections.

Otitis media and conductive hearing loss are common in patients with primary ciliary dyskinesia (PCD). We primarily aimed to assess the impact of otologic features of individuals with PCD on health-related quality of life (QOL), and our secondary aims are characterization of the coexisting pulmonary and sinonasal findings.

Demographic data, spirometry values, a health-related quality of life questionnaire for PCD patients (QOL-PCD), physical examination data of sinonasal and otologic systems, the sinonasal outcome test-22, and audiologic tests were recorded in this cross-sectional study. The pure tone audiometry, distortion product otoacoustic emission (DPOAE), tympanogram, and the Turkish matrix test (TUR-matrix) evaluating speech understanding in noise were performed.

Fifty-six patients with PCD were included in the study. The scores of the social, upper, and lower respiratory domains of the QOL-PCD were significantly lower in adults than in children and adolescents (p-value < 0.001, 0.02, and 0.01, respectively). The hearing and the TUR-matrix were pathologic in 26 (46.4%) and 36 (64.3%) cases, respectively. Patients with pathological hearing had significantly worse results in regards to the FEV₁ z-score (-1.7 vs. -0.8, p = 0.01), the TUR-matrix test (20 vs. 16 cases, p = 0.001), the DPOAE (25 vs. 11 cases, p < 0.001), and the tympanogram (26 vs. 12 cases, p < 0.001) than patients with normal hearing.

Sinopulmonary involvement and hearing manifestations are very common in patients with PCD, and speech understanding in noise is often impaired. These manifestations impact QOL in various areas.

Bronchial stump fistula (BSF), which is located on the bronchial stump following pulmonary resection, represents a distinct subtype of bronchopleural fistula (BPF). Although the endobronchial valve (EBV) has been used to treat BPF, few clinical studies involve BSF occluded by EBV because the abnormal bronchial stump makes EBV implantation challenging. The present research reports novel methods of using a circular loop ligation technique for securing EBV to achieve BSF occlusion and a new classification of BSF that is compatible with these novel methods.

Based on the length of the bronchial stump, small visible BSF (SVBSF, less than 8 mm) is classified into the following types: SVBSF1 (< 3 mm), SVBSF2 (≥ 3 mm but shorter than a normal bronchus), and SVBSF3 (preserves a complete bronchial structure). SVBSF2 is further classified into SVBSF2a (the stump base remains partially intact) and SVBSF2b (complete destruction of the stump base). This retrospective research involved SVBSF2 patients who underwent EBV fixation with circular loop ligation. Detailed medical records were collected and analyzed to evaluate the efficacy of the novel procedure.

A total of 15 patients underwent EBV implantation and fixation. All patients achieved a resolution of air leakage. Postoperative assessment revealed no instances of EBV displacement among VBSF2a patients, with all cases exhibiting significant improvement.

The circular loop ligation methods for securing the EBV enable effective BSF closure in SVBSF2, especially SVBSF2a cases. This technique enables some BSF patients with abnormal structures at bronchial stumps to successfully perform the EBV occlusion.

Wearing a mask is part of the comprehensive strategy to suppress transmission of the SARS-CoV-2 virus and respiratory tract infections. Despite available COVID-19 vaccines, wearing a mask has remained one of the simplest and most effective ways. There was, however, little data available regarding the filtration of fabrics in masks against infectious aerosols or particles of viral size. This study reviewed the filtration performance of fabrics against virus-sized particles.

The systematic review was conducted according to the PRISMA 2020 statement. The literature search started with seven electronic databases (PubMed, Google Scholar, Scopus, Institute of Science Index, EMBASE, Cochrane Library, SciFinder) and two preprints, then manual search. Quality assessment was performed on all included studies using an adaptive tool for in vitro studies.

Eighteen studies were finally included. Cotton was most commonly investigated, followed by polymers and nanofibers. A study reported filtration performance as droplet blocking efficiency (%), and materials with the highest blocking efficiency comprised polypropylene (99.7 [95.2-99.9]), cotton (98.9 [96.8-99.8]), silk (98.7 [81.1-99.8]), and polyester/polyamide (98.2 [90-99.8]). Other studies reported filtration efficiency (%). Fabrics showing highest filtration efficiency were polymers (polypropylene, polyethylene, spunbond/meltblown/spunbond) (100, 94.4, 93.9, respectively), nanofibers (nanofiber-fabric-layered composite, polyvinyl alcohol/nylon-taffeta composite) (99.8 ± 0.24, 97.3, respectively), cotton (cotton/chiffon, cotton quilt, cotton/flannel, cotton/silk) (97 ± 2, 96 ± 2, 95 ± 2, 94 ± 2, respectively). Quality assessment showed that most of the studies were adequate to evaluate the filtration performance against aerosol or virus particles.

Some fabrics showed effectiveness in protective applications for respiratory infections; particularly nanofibers and polymers were promising materials for specialized masks or respirators.

Staphylococcus aureus frequently colonizes the skin and upper airways and produces a broad repertoire of immunomodulatory molecules. In asthma, the most consistent evidence concerns staphylococcal enterotoxins (SEs), which can act both as superantigens and as allergens, and IgE sensitization to SEs (SE-sIgE). SE-sIgE is associated with severe asthma, type 2 inflammation, chronic rhinosinusitis with nasal polyps (CRSwNP), exacerbations, and, in some longitudinal studies, persistent airflow obstruction. However, this relationship is not necessarily causal: SE-sIgE may reflect exposure, an immune response, or a biologically active endotype, whereas colonization, local toxin production, and systemic sensitization are not equivalent. SEs simultaneously bind class II MHC molecules and Vbeta regions of the T-cell receptor, activating large fractions of T lymphocytes; they also promote IL-4, IL-5, and IL-13 production, polyclonal B-cell activation, local IgE synthesis, mast-cell degranulation, eosinophilia, and IL-8/neutrophil circuits. Alpha-toxin (Hla) and SEB can damage the epithelial barrier, facilitating allergen penetration and alarmin signalling. These observations support an interaction model in which dysbiosis, barrier dysfunction, and type 2 immunity mutually reinforce one another along the nasobronchial axis. Corticosteroids and antibiotics may modify selected nodes in this circuit, but current evidence is insufficient to recommend decolonization or antitoxin therapy in stable asthma. Biologics interrupt downstream pathways potentially fuelled by toxins: omalizumab neutralizes free IgE; mepolizumab and benralizumab reduce the eosinophilic axis; dupilumab blocks IL-4/IL-13 signalling; and tezepelumab acts upstream on TSLP. Nevertheless, randomized trials stratified by SE-sIgE are lacking, and no evidence demonstrates that these treatments eliminate colonization or toxin production. SE-sIgE therefore appears to be a promising biomarker, particularly in severe asthma with CRSwNP, but it is not yet an autonomous criterion for biologic selection. A broader barrier-organ analysis also identifies nasal, cutaneous, and intestinal colonization as distinct ecological states; atopic dermatitis as a complementary model of toxin-amplified type 2 inflammation; and biofilms and extracellular vesicles as candidate mechanisms of persistent toxin delivery. These data increase biological plausibility but remain indirect for asthma.

Background: Empiric antibiotic prescribing is frequently used in low- and middle-income countries because microbiological diagnostic capacity is often limited, highlighting the need for locally generated microbiological data to support evidence-informed empiric antibiotic selection. However, data on pediatric antibiotic prescribing practices in Mozambique remain scarce. This study aimed to characterize empiric antibiotic prescribing among hospitalized pediatric patients at Maputo Central Hospital prior to the implementation of a syndromic antibiogram intervention. Methods: An exploratory, retrospective, descriptive baseline analysis was conducted among pediatric patients aged 1 month to 14 years admitted with suspected bacterial infections between January and December 2023, prior to the implementation of a syndromic antibiogram intervention. Sociodemographic, clinical, microbiological, and antibiotic prescribing data were extracted from clinical records. Antibiotics were classified according to the WHO AWaRe framework, and associations between patient characteristics, treatment strategies, and outcomes were analyzed using R software version 4.6.0. Results: A total of 358 pediatric patients were included, with a median age of 14 months (IQR: 6-48), and 57% were male. Lower respiratory tract infections were the most frequent diagnosis. Empiric treatment predominated, accounting for 89% of cases, whereas microbiologically guided therapy was observed in only 11%. Urinary tract infections showed significantly higher proportions of microbiologically guided treatment compared with respiratory infections (p < 0.001). Monotherapy predominated, while Watch antibiotics accounted for 64.7% of prescriptions. Prolonged hospitalization was associated with respiratory distress, decreased skin turgor, referral status, infection type, and anemia. Conclusions: Pediatric antibiotic prescribing was characterized by extensive empiric therapy and high Watch antibiotic use, highlighting important antimicrobial stewardship challenges in Mozambique.

Background: Acute respiratory distress syndrome (ARDS) occurs in 20-40% of patients following esophagectomy and is associated with substantial postoperative morbidity and mortality. A major contributor to postoperative ARDS is pulmonary ischemia-reperfusion injury (IRI); however, the role of IRI in ARDS following esophagectomy is not adequately addressed in current experimental models. In this study, we established a large animal model of pulmonary IRI that reproduces key physiological, inflammatory, and histopathological features of pulmonary ischemia-reperfusion-induced acute lung injury relevant to postoperative ARDS after esophagectomy. Methods: Sequential pulmonary ischemia-reperfusion injury was induced in ten anesthetized Landrace pigs using unilateral hilar inflow occlusion. Right lung ischemia was achieved by clamping the hilar inflow for three hours, followed by reperfusion. Subsequently, the left lung underwent two hours of ischemia. Hemodynamic, respiratory, and inflammatory parameters were continuously monitored throughout the experiment. Blood samples were collected to assess leukocyte counts and circulating inflammatory cytokines, including tumor necrosis factor-α and interleukin-6. Lung tissue samples were obtained for histopathological evaluation. Results: ARDS-like lung injury was successfully induced in all animals, with PaO₂/FiO₂ ratios falling below 200 mmHg during the predefined reperfusion observation period. Lung compliance decreased by approximately 50% after ischemia and further declined following reperfusion. Progressive leukocyte elevation and elevated tumor necrosis factor-α and interleukin-6 levels were observed, indicating a systemic inflammatory response. Hallmark features of ARDS were histologically confirmed, including intra-alveolar hemorrhage, interstitial and perivascular edema, and neutrophil infiltration. Conclusions: This porcine model reproduces key physiological, inflammatory, and histopathological features consistent with pulmonary ischemia-reperfusion-induced ARDS-like lung injury. Although it does not reproduce the complete clinical syndrome of post-esophagectomy ARDS, it provides a clinically relevant translational platform for investigating pulmonary ischemia-reperfusion injury and evaluating potential preventive and therapeutic strategies.

Arterial stiffness is a determinant of cardiovascular risk and has been increasingly associated with obstructive sleep apnea (OSA), although its independent contribution remains unclear due to the presence of comorbidities, the most important of which is hypertension. This narrative review synthesizes current evidence on the relationship between OSA, hypertension, and arterial stiffness, with a particular focus on the mediating role of hypertension and its clinical phenotypes. Evidence from observational and longitudinal studies indicates that OSA is generally associated with increased arterial stiffness, particularly in younger and normotensive individuals. A stepwise increase in pulse wave velocity (PWV) is consistently observed across control, OSA, hypertension, and combined OSA-hypertension groups, supporting an additive vascular burden. Hypertension emerges as a central correlate and amplifier of vascular remodeling, with its presence attenuating the independent association between OSA and arterial stiffness. Findings regarding masked hypertension are heterogeneous, with some studies showing increased PWV in OSA while others demonstrate minimal differences after adjustment. In contrast, resistant hypertension is consistently associated with high-risk hemodynamic and metabolic profiles, although the independent contribution of OSA to arterial stiffness in this group is often limited after multivariable adjustment. Large cohort evidence further suggests that associations between OSA and arterial stiffness surrogates are largely explained by age, blood pressure status, and cardiometabolic comorbidities. Because the evidence base is predominantly cross-sectional, these findings should be interpreted as showing that OSA's association with arterial stiffening is closely intertwined with the presence and development of hypertension, rather than establishing a causal or temporal sequence. Future longitudinal and interventional studies are needed to clarify causal pathways and therapeutic implications.