Stenotrophomonas maltophilia complex is an important nosocomial cause of bacteraemia. The complex comprises multiple species, but their relative clinical and genomic significance remains unclear. We examined clinical and genomic differences between S. maltophilia and non-S. maltophilia species to better understand their virulence and implications for patient care. Hospitalized adult patients (≥ 21years) between January 2022 and June 2024 with Stenotrophomonas species bacteraemia were examined. Clinical data were extracted from electronic medical records. Whole-genome sequencing was performed on all isolates, with species assignment confirmed by average nucleotide identity. S. maltophilia and non-S. maltophilia species were compared. Fifty-three S. maltophilia complex isolates were identified, of which 45 had clinical data. S. maltophilia predominated (n = 32), followed by S. pavanii (n = 7), S. sepilia (n = 4), S. muris (n = 1), and S. geniculata (n = 1). S. maltophilia isolates formed multiple clades with diverse sequence types, consistent with both clonal expansion and ongoing diversification. Virulence genes, including stmPr, smoR, and iron acquisition-associated genes were conserved across S. maltophilia lineages, but stmPr1 was less frequently observed in non-S. maltophilia. Most infections were line-related. Pneumonia-associated bacteraemia appeared more frequently among with S. maltophilia infections. Polymicrobial bacteraemia appeared more commonly in non-S. maltophilia infections. Mortality was similar between groups, but recurrence of infection within one year occurred only in S. maltophilia. Compared with non-S. maltophilia, S. maltophilia appeared to be associated with pneumonia and recurrent bacteraemia episodes, although mortality was similar. These exploratory findings suggest potential differences within the complex, but require validation in larger studies.

Little is known about the outcomes of extracorporeal cardiopulmonary resuscitation (ECPR) for cardiopulmonary arrest occurring after major cardiac surgery. This study aimed to evaluate our institutional experience with ECPR in this setting. We retrospectively reviewed all adult patients who underwent extracorporeal membrane oxygenation (ECMO) for cardiopulmonary arrest within 30 days after major cardiac surgery outside the operating room between 2015 and 2023. Baseline characteristics, operative details, and clinical outcomes were analyzed. A total of 21 patients who underwent ECPR were identified. Index operations included valve surgery (n = 5), coronary artery bypass grafting (CABG) (n = 10), and others. The location of arrest was the intensive care unit (ICU) in 8 patients (38.1%) and the step-down unit in 13 patients (61.9%). Nine patients (42.9%) underwent central cannulation with an open chest, and 12 (57.1%) underwent femoral cannulation with chest compressions. Twelve patients (57.4%) were successfully decannulated, whereas nine (42.6%) died while on ECMO. In-hospital mortality was 47.6% (n = 10) and similar between central and femoral cannulation (44.4 vs. 50.0%; p = NS). Of the 11 in-hospital survivors, 7 (33.3%) were neurologically intact at discharge. Kaplan-Meier analysis showed a 1 year survival rate of 41.2%.

Pulmonary arterial hypertension (PAH) is a syndrome characterized by elevated pulmonary artery pressure. We developed a population pharmacokinetic (PPK) model using combined plasma drug concentration data from Japanese paediatric (<15 years) and adult (≥15 years) patients with PAH to investigate the pharmacokinetic characteristics of PAH treatments (sildenafil, tadalafil, bosentan and ambrisentan). PPK analysis was conducted using a nonlinear mixed-effects modelling approach. A one-compartment model was selected as the structural model, and an exponential error model was used to describe interindividual variability. Individual patient clearance (CL), adjusted for bioavailability (F) using Bayesian estimation based on the PPK model, was used to estimate the steady-state plasma concentrations (Css) of the drugs in paediatric and adult patients receiving clinical dosages. PPK analysis was performed on data from 35 paediatric and 16 adult subjects to estimate pharmacokinetic parameters. The population mean CL/F values for sildenafil, tadalafil, bosentan and ambrisentan were estimated at 60.6, 1.76, 8.85 and 0.594 L/h, respectively. Covariates that improved model performance and were incorporated into the final model included the effect of bodyweight on the CL/F of each drug. The estimated Css values for all drugs were 26.0%-72.2% lower in paediatric than in adult patients. This study clarified the pharmacokinetic parameters and their variability for sildenafil, tadalafil, bosentan and ambrisentan using combined data from Japanese paediatric and adult patients with PAH. The results of Bayesian estimation suggest that at current clinical dosages, plasma concentrations of these drugs may be lower in paediatric than adult patients.

A multicenter, randomized, double-blind, imipenem/cilastatin-controlled clinical study of cefiderocol for the treatment of complicated urinary tract infections caused by gram-negative pathogens in chinese adults.

Εsophageal Crohn's disease in adults: A systematic review of the literature.

Long-term changes and risk factors for persistent cough and sputum in adult patients with asthma treated by Japanese specialists: The SARAS study (1997-2023).

Odontogenic maxillofacial space infections are life-threatening conditions that result from untreated dental problems, in which bacteria infect the facial fascial spaces from the affected teeth and supporting tissues. Despite their clinical severity, epidemiological data from sub-Saharan Africa and Ethiopia remain limited. Understanding their prevalence and associated factors is essential for effective management and prevention. To determine the prevalence and associated factors of odontogenic maxillofacial space infection among adult patients (aged > 18 years) admitted to the Oral and Maxillofacial Surgery Unit at Hawassa University Comprehensive Specialized Hospital over 3 years (2023-2025). A retrospective cross-sectional study using patients' medical records was conducted among patients admitted to the Oral and Maxillofacial Surgery between January 2023 and December 2025. Of these cases, 419 were deemed eligible according to predefined inclusion and exclusion criteria, and data were systematically extracted from the records. For a case to be included, there was a need to have clinical or radiographic evidence that the subject was infected and had pus drainage upon incision and drainage. Data were entered into Epi-Data 4.6, and data analysis was carried out using SPSS Version 26.0 (Windows 10). Descriptive statistics, such as frequencies and percentages, and logistic regression analysis were done. p < 0.05 was considered statistically significant. This study included 419 patient charts; 50 patients had confirmed odontogenic maxillofacial space infection. The prevalence of odontogenic maxillofacial space infection was 12.0% (95% CI: 9.0%-15.0%) among admitted patients. On multivariate analysis, rural residence (AOR = 2.70, 95% CI: 1.35-5.40), hypertension (AOR = 2.40; 95% CI: 1.15-5.00), diabetes mellitus (AOR = 3.10, 95% CI: 1.45-6.60), and delay in healthcare seeking (AOR = 4.00, 95% CI: 1.95-8.20) were independently associated. The prevalence of odontogenic maxillofacial space infections was relatively high among admitted patients in this tertiary hospital. Rural residence, hypertension, diabetes mellitus, and delay in healthcare seeking are associated with the infection. Strengthening early diagnosis and treatment of dental infections, improving access to oral health services, and encouraging timely healthcare-seeking behaviour helps reduce the burden of odontogenic maxillofacial space infections.

Current United States palliative care practice guidelines are intended to cover care across all age groups. Previous research with pediatric providers and caregivers concluded that pediatric hospice and palliative care have unique attributes. Not known is how adolescent hospice and palliative care patients understand quality palliative care. The purpose of this study was to characterize and define quality of care domains as described by adolescent and young adult patients receiving home-based hospice and palliative care. Semi-structured interviews with 10-26 year-olds who received home-based hospice and/or palliative care visits in the prior three years at six diverse sites in the United States. Data were analyzed using Krippendorff's semantic content analysis methodology. There were 32 participants (63% female) who had a median(range) age of 17.5 (10-26) years old, and 69% (n = 22) were White. The domains with the highest number of themes were Structure and Processes of Care and Compassionate Care. The results address an important gap by including adolescent/young adult patients' voices regarding delivery of home-based hospice and palliative care. Clinical implications include prioritizing and making time to build trusting relationships directly with the AYA, empowering them to participate in their care to the extent appropriate and prepare for transition to adult care when needed, providing support for family members, and training for all providers in generalist spiritual care.

Based on data from large international registries, the clinical presentation of fibromuscular dysplasia (FMD) in adult patients is now well established. By contrast, characteristics of FMD in children and adolescents remain poorly described. We present the first systematic review and meta-analysis focused on pediatric FMD. Seven databases were searched for studies published since 2000. Data were pooled using random-effects models. Subsequently, the characteristics of pediatric FMD patients were compared with those of adult patients included in the US and FEIRI registries. Nine retrospective studies totalizing 218 children/adolescents with FMD were identified. All had renal FMD and 93.7% were revascularized. The mean age at diagnosis was 11.7 years. Fifty-two % were females (U.S. Registry 94.7%; FEIRI 81.5%). Most patients (66.6%) had focal FMD (U.S. Registry 24.0%; FEIRI 28%). Despite incomplete screening, multivessel FMD was identified in 19.1% (U.S. Registry 55.1%; FEIRI 57.4%), and aneurysms and dissections in 15.3% and 1.7%, respectively (U.S. Registry 22.7%, 28.1%; FEIRI 21.6%, 5.6%). The proportion of mid-aortic syndrome (MAS) was 6.3%. In ethnicity-stratified analyses, the female proportion was 43.6% in Asian vs. 58.1% in Caucasian children, and the prevalence of multifocal FMD was 21.8% vs. 37.9%. In conclusion, compared with adult patients, children/adolescents with FMD are characterized by a lower proportion of females and a higher proportion of focal FMD, both in Asians and Caucasians. While associated MAS appears less frequent than previously thought, multivessel involvement and aneurysms were frequently reported, suggesting the interest of a systematic arterial exploration in children with FMD, as recommended in adults.

Prurigo nodularis (PN) is a chronic inflammatory dermatosis with severe, persistent pruritus and limited effective therapies. Janus kinase (JAK) inhibition has emerged as a targeted strategy for PN. This phaseI/II, randomized, double-blind, vehicle-controlled, multicenter clinical trial was conducted in China to evaluate the safety, pharmacokinetics, and efficacy of topical 1.5% ruxolitinib gel (HDM3010) in adults with PN. Adult patients with PN were randomized 2:1 to receive HDM3010 or vehicle, administered once daily (QD) or twice daily (BID), during a 4-week double-blind treatment period. Forty-nine patients were randomized. HDM3010 demonstrated a safety profile characterized by treatment-emergent adverse events in 18.8% of QD and 25.0% of BID patients, compared with 12.5% of vehicle QD and 55.6% of vehicle BID patients. Treatment-related adverse events were infrequent (4.1%) and limited to mild-to-moderate severity. Pharmacokinetic analyses showed low systemic exposure, with mean peak plasma concentrations below 7ng/mL at steady state. Compared with vehicle, HDM3010 was associated with higher proportions of ≥ 4-point Worst Itch Numerical Rating Scale (WI-NRS) responders and greater improvements in WI-NRS, Investigator's Global Assessment for Prurigo Nodularis-Stage (IGA PN-S), and Investigator's Global Assessment for Prurigo Nodularis-Activity (IGA PN-A) scores. HDM3010 demonstrated a favorable safety profile, minimal systemic exposure, and positive trends in reducing pruritus and lesions in adults with PN. Chinese Clinical Trial Registry ( http://www.chictr.org.cn ): ChiCTR2500096434 (registered January 23, 2025).

We explored the effects of continuation care based on trans-theoretical model (TTM) in adult patients with acute leukemia (AL). Patients with AL who had been discharged from our hospital were randomly assigned to the control group (n = 68) and intervention group (n = 74). The control group received routine nursing, while the intervention group received a structured psychoeducational follow-up program based on the Transtheoretical Model (TTM). 2 months after intervention, the quality of life (QoL), mood, self-care ability, and incidence of complications were assessed and compared. The patients were then followed up for 18 months to observe their long-term survival. The incidence of complications was significantly lower in the intervention group than in the control group, whereas the QoL scores, positive mood scores, and self-nursing ability scores were higher (P<0.05). At a median follow-up of 18 months, the overall survival was significantly better in the intervention group than in the control group (P = 0.013). The Program effectively reduced the incidence of complications and improved the QoL, emotional well-being, and self-nursing ability, thereby offering certain advantages in enhancing the AL patients' survival rates. The TTM-based continuation care can be implemented to improve the QoL in patients with AL, and is worth promoting.

Superimposed pressure (SP) is the hydrostatic pressure compressing dependent lung regions and is a major determinant of dorsal collapse in adult patients with acute respiratory distress syndrome (ARDS). CT studies clarify its role in determining the need for positive end-expiratory pressure (PEEP) in ARDS. We therefore aimed to describe SP in pediatric ARDS (pARDS) and assess its associations with anthropometric, clinical, and quantitative CT parameters. Retrospective cohort study. Urban academic tertiary care children's hospital in Italy. All children with pARDS undergoing noncontrast chest CT between 2014 and 2024 compared with age-matched control patients with normal lung findings undergoing chest CT. We included 12 pARDS patients and 24 controls. Quantitative CT analysis was used to measure lung aeration and the SP in 10 ventral-to-dorsal regions. The median (interquartile range [IQR]) SP increased from ventral to dorsal in both groups but was higher in pARDS patients: (dorsal SP, 5.9 cm H2O [IQR, 4.4-7.5 cm H2O] vs. 3.0 cm H2O [IQR, 2.4-4.0 cm H2O]; p < 0.001). Compared with controls, we found that pARDS patients had higher lung weight, lower gas/tissue ratio, and less normally aerated tissue. In pARDS patients, SP correlated with chest circumference (ρ = 0.60; p = 0.043), lung weight (ρ = 0.76; p = 0.006) and inversely with normally aerated tissue (ρ = -0.72; p = 0.011). We failed to identify a relationship between SP and oxygenation indices. None. SP in pARDS is lower and more variable compared with descriptions in adult patients with ARDS and is both affected by disease severity and chest size. We failed to identify an association between oxygenation indices and SP, which raises concerns about titrating PEEP based on oxygenation targets alone. Further studies are needed to confirm and integrate these in pARDS.

The fracture orthopedic risk of non-home discharge (FORD) score: A novel bedside predictive tool for non-home discharge in orthopedic trauma patients.

ARDSMLpred: A machine learning model for predicting SCAP-associated ARDS based on MIMIC-IV database.

Minimal change disease (MCD) is a common cause of nephrotic syndrome in adults, with limited evidence available on its treatment and prognosis. In this study, we retrospectively included the clinical characteristics and treatment results of adult MCD patients in our center and explored and analyzed potential risk factors for relapse in MCD patients. We included 51 adult MCD patients with a median age of 29 years, and 30 were men. Among them, 16 patients (31.37%) had acute kidney injury (AKI) at presentation. The average urinary protein excretion was 6.39 ± 5.54 g. Notably, 29 (59%) patients had hematuria; 16 (31.37%) patients developed AKI; and 25 patients (49.02%) experienced at least 1 relapse. 13 patients (25.49%) experienced 2 relapses, and 9 patients (17.65%) experienced 3 or more relapses during the observation period. Compared with non-relapse patients, relapse patients were younger (mean age, 18 years (18 - 32 years)), and fewer patients (n = 8, 32%) had positive urinary red blood cells. The time from treatment to remission and baseline albumin, renal function, urine protein quantification, and other laboratory indicators did not significantly differ between the two groups (all, p > 0.05). Single and multivariate logistic regression analysis revealed age of onset, drug-related adverse effects during treatment, and AKI as the risk factors for relapse. This study identified young age at onset, treatment-related adverse effects, and AKI as independent risk factors for relapse in adult-onset MCD patients. Rituximab may be an effective treatment for relapsed MCD patients.

Resistance to thyroid hormone alpha (RTHα) is a rare genetic disorder with symptoms of hypothyroidism, but normal or close-to-normal thyroid function tests. Treatment with levothyroxine (L-T4) may be beneficial. This study investigated the efficacy, safety and biochemical changes of high-dose L-T4 and liothyronine (L-T3) treatment. Four RTHα (Ala263Val) patients were treated with L-T4 (1.75 µg/kg) in a pilot open-label study and monitored for three years. Quality of life (QoL) was assessed using ThyPro. Analysis of auxiological- and biochemical-parameters, bone mineral density (BMD) and exploratory metabolomics was performed. A partial replacement of L-T4 with L-T3 was attempted. Treatment with L-T4 increased FT4, FT3, and rT3 to supraphysiological concentrations (relative to reference intervals) and suppressed thyroid-stimulating hormone with no adverse effects. Heart rate, bone markers, and sex hormone-binding globulin transiently increased. Several classes of lipids were reduced. BMD appeared unaltered. Patients reported improved QoL. One patient presented a short non-sustained ventricular tachycardia on L-T3 + L-T4. L-T4 treatment of adult RTHα patients was safe and improved QoL in adherent patients.

Bronchiectasis is a common but neglected respiratory condition, particularly in resource-poor countries such as Bangladesh. Cystic fibrosis (CF), a recognized cause of bronchiectasis in children, especially among Caucasians, is increasingly reported in adults of Asian descent. However, CF remains under-recognized in Bangladesh, and no prior data exist on its prevalence in adults. This study aimed to determine the prevalence of CF in adult bronchiectasis patients and to assess their lung function characteristics using spirometry in Bangladesh. This cross-sectional study was conducted in the Department of Respiratory Medicine at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from June 2023 to November 2024. A total of 130 adults with bronchiectasis were enrolled in accordance with the inclusion and exclusion criteria. CF diagnosis was established using pilocarpine iontophoresis sweat chloride testing, and lung function severity was assessed by spirometry. Statistical analyses were performed using SPSS version 25. Among 130 participants, 12 were diagnosed with CF, representing 9.2% of patients. Obstructive airway abnormality was the predominant pattern among CF patients (75.0%), with half presenting in the mild category. A moderate negative correlation was observed between forced expiratory volume in 1 s (FEV1 % predicted) and sweat chloride concentration (Cl-) (Spearman's rho = *-0.477, p = 0.117). Approximately one in ten adult bronchiectasis patients in Bangladesh were found to have CF, and most had mild airway obstruction. These findings highlight that CF, traditionally regarded as a childhood disease, should also be considered in adult bronchiectasis, particularly in South Asian populations where it remains underdiagnosed.

Permissive hypotension in adult trauma: A systematic review of outcomes across clinical settings, injury type, and resuscitation strategies.

CT-derived optic nerve sheath diameter as a noninvasive proxy for intracranial pressure in traumatic brain injury patients undergoing preoperative ICP monitoring: An institutional analysis and scoping review.

Thrombocytopenia is frequent in adult intensive care unit (ICU) patients and may contribute to adverse outcomes, including bleeding, morbidity and mortality. To reduce the risk of bleeding, platelet transfusions are commonly used, yet transfusion thresholds vary, and the evidence base is very limited. Randomised clinical trials investigating platelet transfusion strategies in ICU patients are therefore a high research priority. With this survey, we aim to assess ICU doctors' willingness to randomise adult ICU patients to restrictive versus liberal platelet transfusion thresholds across clinically relevant scenarios in a future randomised trial. We will conduct an international, web-based survey targeting ICU doctors within an established research network. The survey includes questions on respondent characteristics and willingness to enrol patients with an indication for platelet transfusion across a range of transfusion thresholds in different clinical scenarios, including non-bleeding patients, those undergoing invasive procedures, and those with bleeding. The survey has been pilot-tested and refined twice before distribution. We will summarise results using descriptive statistics and conduct stratified analyses by country and ICU type. This international survey will assess ICU doctors' willingness to randomise adult ICU patients to restrictive versus liberal platelet transfusion strategies across multiple clinical scenarios.