Dystrophic calcification affecting cardiac structures secondary to hyperadrenocorticism (HAC) is rare in dogs. This case report describes the clinical, imaging, surgical, and pathological findings of a 9-year-old spayed female Maltese dog with severe mitral regurgitation and HAC-related systemic calcification presenting as an intracardiac calcified mass. Severe mitral valve thickening and a mobile hyperechoic mass attached to the chordae tendineae were detected on echocardiography. Mitral valvuloplasty was performed, and the calcified mass was excised. Histopathology confirmed a non-neoplastic calcified lesion. Computed tomography revealed extensive calcification in various tissues. The dog developed postoperative aspiration pneumonia and died on postoperative day 2. This case highlights the potential for intracardiac dystrophic calcification in dogs with HAC and severe mitral valve disease.

Reported causes and outcome of hypoxaemia vary greatly. Brachycephalic dogs have anatomic abnormalities that result in oxygenation changes. Dogs diagnosed with hypoxaemia based on SpO2 or PaO2 measurements between January 2014 and December 2021 were retrospectively recruited. One hundred and five dogs met the inclusion criteria. Signalment, clinical signs, treatments before referral, diagnostic tests, final diagnoses, treatment and outcome were recorded. Outcomes were documented according to survival to discharge and during the study period. Descriptive analytics were performed. Aspiration pneumonia was the most common cause of hypoxaemia (n = 33). Administration of antibiotics or glucocorticoids in dogs diagnosed with aspiration pneumonia before referral did not improve outcome (Fisher's, p = 0.3 and 0.48, respectively). There was no statistical difference between a lower SpO2 or PaO2 at presentation and survival (p = 0.069). Brachycephalic breeds had higher survival rates (79.2% vs. 40.0%, Fisher's, p < 0.001) regardless of their final diagnosis. Limitations include low sample size, retrospective case study and selection bias. Lower SpO2 and PaO2 values at presentation are not a negative prognostic indicator. Provision of antibiosis prior to referral of a hypoxaemic patient did not provide a survival or improved outcome advantage. Brachycephalic breeds do not have a worse prognosis.

A neonate with a history of a brief resolved unexplained event presented to the emergency department with white oral plaques initially diagnosed as thrush and treated with nystatin. He subsequently developed progressive feeding difficulties and respiratory distress requiring supplemental oxygen. Despite treatment with fluconazole and supportive care, symptoms persisted. Multiple swallow studies revealed frank aspiration, delayed swallow initiation and poor oral motor control. Diagnostic investigation, including MRI brain and flexible nasal laryngoscopy, revealed no structural anomalies. A breakthrough occurred when nursing staff were notified that the infant had been bottle-fed hot milk prior to symptom onset. The diagnosis of oral thermal burns leading to dysphagia and aspiration pneumonitis was made. With multidisciplinary therapy, swallow function improved and the infant transitioned to full oral feeds. This case highlights the importance of maintaining a broad differential when evaluating common neonatal findings and demonstrates the potential complications of overlooked thermal injuries in this population.

The effect of individualized high positive end-expiratory pressure (PEEP) and recruitment maneuvers, targeting a low driving pressure, on clinical outcomes in patients undergoing open abdominal surgery is uncertain. To compare driving pressure-guided high PEEP and recruitment maneuvers with standard low PEEP without recruitment maneuvers with respect to postoperative pulmonary complications. Randomized clinical trial of 1435 adults at increased risk for postoperative pulmonary complications who were scheduled for open abdominal surgery. The trial was conducted at 29 sites in 5 countries across Europe from April 2019 to December 2024; final follow-up was in March 2025. Statistical analysis was conducted in May 2025. Patients were randomized to undergo intraoperative ventilation with driving pressure-guided high PEEP and recruitment maneuvers (n = 718) or to intraoperative ventilation with standard low PEEP (n = 717). All patients received low tidal volume ventilation. The primary outcome was a composite of pulmonary complications within the first 5 postoperative days, including severe respiratory failure, bronchospasm, suspected pulmonary infection, pulmonary infiltrates, aspiration pneumonitis, atelectasis, acute respiratory distress syndrome, pleural effusion, cardiopulmonary edema, and pneumothorax. Among the 16 prespecified secondary outcomes, 4 concerned intraoperative complications, including hypotension (decrease in mean arterial pressure of >20% for >3 minutes) and desaturation (Spo2 <92% for >1 minute). Among 1468 adults, 1435 (98%) completed the trial (median [IQR] age, 66 [57-74] years; 52% female). In the primary analysis population, the primary outcome occurred in 142 of 718 patients (19.8%) in the driving pressure-guided high PEEP group compared with 125 of 717 patients (17.4%) in the low PEEP group (absolute difference, 2.5% [95% CI, -1.5% to 6.4%]; P = .23). The incidence of hypotension (382 [54.0%] vs 317 [45.0%]) and use of vasoactive agents (224 [32.0%] vs 130 [18.8%]) was higher in the high PEEP group; the incidence of intraoperative desaturation (6 [0.8%] vs 20 [2.8%]) was higher in the low PEEP group. Among patients at increased risk for postoperative pulmonary complications undergoing open abdominal surgery under general anesthesia, intraoperative ventilation with driving pressure-guided high PEEP and recruitment maneuvers, compared with a strategy with standard low PEEP, did not reduce postoperative pulmonary complications. ClinicalTrials.gov Identifier: NCT03884543.

Impact of Living Place on the Prognosis of Aspiration Pneumonia in Elderly Patients: A Retrospective Study in Tokyo

This case report describes a 72-year-old female with a confirmed diagnosis of Granulomatosis with Polyangiitis (GPA), who developed a complex and ultimately fatal clinical course complicated by refractory cytomegalovirus (CMV) meningoencephalitis. Despite initial immunosuppressive treatment for GPA and subsequent antimicrobial therapies for suspected bacterial and fungal infections, the patient presented with recurrent fevers, delirium, and cerebrospinal fluid (CSF) pleocytosis. Repeated CSF analyses and imaging revealed a perplexing picture, with a final diagnosis of CMV infection of the central nervous system (CNS) confirmed by PCR. The infection proved resistant to first-line antiviral therapy with ganciclovir, necessitating the addition of foscarnet. The patient’s condition deteriorated, culminating in aspiration pneumonia, hemodynamic instability, and death. This case highlights the diagnostic challenges of CNS infections in immunosuppressed patients and the potential for severe, treatment-resistant viral opportunistic infections in the context of GPA and its treatment.

Anti-infective management in brain-dead organ donors - A retrospective analysis at two centers reveals need for improvement.

Halo, Collar, Anterior, or Posterior Fusion? Comparative Outcomes in Typical and Atypical Hangman's Fractures: A Systematic Review of Fusion Rate and Complication Profile.

Italian SIGENP (Italian Society of gastroenterology, hepatology and pediatric nutrition) registry of pediatric home artificial nutrition: First report.

Iatrogenic aspiration pneumonia in six horses: A retrospective case series.

Fragile X-associated tremor/ataxia syndrome (FXTAS) affects motor and coordination pathways and is linked to swallowing and choking difficulties, which can lead to aspiration pneumonia, a leading cause of death in late-stage FXTAS. Despite their severity, these issues are under-investigated. This study examined their association with FXTAS stages and potential as markers of disease progression in FMR1 premutation (PM) carriers. A secondary analysis of Genotype-Phenotype cohort data (2017–2025, MIND Institute, UC Davis) examined swallowing/choking problems, FXTAS stage, neuroimaging, and psychological distress (Symptom Checklist-90-Revised; SCL-90-R). Associations between independent and dependent variables were tested using Generalized Estimating Equation (GEE) regression due to their correlated data. The study included 169 PM carriers (mean age 65 ± 10.9 years; 54% male), with approximately 35% reporting swallowing/choking difficulties. After adjusting for age and sex, individuals in the severe stage of FXTAS (stage 4–5) had a significantly higher risk of swallowing/choking problems compared to those without FXTAS (adjusted odds ratio [aOR] = 4.17; 95%CI = 1.28–13.58). PM carriers with swallowing/choking problems showed a significantly increased association with magnetic resonance imaging (MRI) findings of moderate to severe abnormalities in several brain regions, including cerebral atrophy (aOR = 2.69, p = 0.027), cerebellar atrophy (aOR = 3.34, p = 0.013), cerebellar white matter hyperintensity (aOR = 3.33, p = 0.012), and pons white matter hyperintensity (aOR = 3.93, p = 0.035). Swallowing/choking problems are common in FXTAS, particularly in later stages, and may represent an important clinical marker of disease progression. These patients should be referred to speech-language pathologists for evaluation and treatment. Such interventions could reduce morbidity-mortality associated with these problems.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-25959-5.

Stroke is the second-largest cause of death and disability worldwide, and many patients require intensive care for airway compromise, hemodynamic instability, cerebral edema, or systemic complications. This review summarizes key aspects of ICU management in both acute ischemic stroke (AIS) and hemorrhagic stroke (HS). Priorities are airway protection, oxygenation, individualized blood pressure targets, and strict control of temperature and glucose. Neurological monitoring and prompt management of intracranial pressure (ICP), together with timely surgical interventions (hemicraniectomy or hematoma evacuation), are central to acute care. Seizures are treated promptly, while routine prophylaxis is not recommended. Prevention of aspiration pneumonia, venous thromboembolism, infections, and other intensive care unit (ICU) complications is essential, along with early nutrition, mobilization, and rehabilitation. Prognosis and decisions about intensity of care require shared discussions with families and involvement of palliative services, when appropriate. Many practices remain based on observational data or extrapolation from other populations, underlining the need for stroke-specific clinical trials. Outcomes are consistently better when patients are managed in specialized stroke or neurocritical care units with a multidisciplinary treatment approach

Limited reports exist on the treatment outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma in the remnant esophagus after subtotal esophagectomy. Therefore, we aimed to investigate the feasibility and efficacy of endoscopic submucosal dissection in such cases. We identified consecutive patients who underwent endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma in the remnant esophagus after subtotal esophagectomy between January 2010 and June 2024 from a prospectively maintained database and retrospectively evaluated the short- and long-term outcomes. A total of 43 consecutive patients with 49 lesions were included in this study. All lesions, including 15 involving the anastomotic site, were resected en bloc with tumor-free vertical margins. The median resection time was 40 min. No perforations, delayed bleeding, or aspiration pneumonia were observed. The median lesion size was 15 mm with most being intramucosal cancer (97%, 48/49). Post-ESD stricture occurred in three patients (6%). In univariate analysis, larger lesion size and greater circumferential extent were significantly associated with longer resection time (≥ 90 min). Lesions involving the anastomotic site were not significantly associated with longer resection times. No local recurrence was observed during a median follow-up period of 3 years. The 3-year overall survival and disease-specific survival rates were 89% and 100%, respectively. Endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma in the remnant esophagus after subtotal esophagectomy is technically feasible and effective, with favorable long-term outcomes. It might present a reasonable treatment option for such cases.

IntroductionPatients who have experienced a stroke are at risk of developing aspiration pneumonia. The risk of aspiration pneumonia is often attributed to dysphagia, which is a condition observed in stroke patients due to the weakening of the muscles involved in swallowing. Nursing care related to oral hygiene, feeding, positioning, and mobilization can reduce the risk of aspiration pneumonia in poststroke patients. This study aims to explore nurses’ experiences with prevention practices for aspiration pneumonia in poststroke patients.MethodsThis study employed a qualitative, exploratory, descriptive design. Twelve registered nurses were recruited from the stroke unit of a Teaching Hospital in Accra, Ghana. Data were collected through in-depth, face-to-face, semi-structured interviews, using an interview guide. The data were transcribed and analyzed using thematic analysis.ResultsThe findings revealed two main themes and five subthemes about nurse practice to prevent aspiration pneumonia in poststroke patients. They included prevention practices, describing what participants thought were prevention practices for aspiration pneumonia. The second theme, attitudes towards prevention practices, generated the participants’ beliefs and attitudes as they related them to carrying out various prevention practices. Highlights of the findings included the participants’ detailed descriptions of the preventative measures they utilized and their positive attitudes towards the various patient-centered prevention practices they detailed. These encompassed a dynamic process of care, attentiveness to signs and symptoms of aspiration in poststroke patients, and perceptions of the negative aspects of prevention practices.ConclusionsNursing practice should place strong emphasis on the critical role nurses play in preventing respiratory complications, particularly aspiration pneumonia, in poststroke patients. In addition, further research into the burden of pneumonia among stroke survivors and the effectiveness of nurse-led preventive interventions is essential for enhancing the quality of poststroke care.

Laryngomalacia is the most common cause of congenital stridor in infants and can lead to feeding difficulties, failure to thrive, and respiratory distress. Diagnosis typically requires flexible fiberoptic laryngoscopy, which more often than not, not available in resource-limited settings. We report a 12-day-old male infant who presented to the emergency department with apnea following a choking episode. He required cardiopulmonary resuscitation and was admitted to the neonatal intensive care unit. Clinical findings included chest retractions, cyanosis, weight loss (from 3500g at birth to 2700g), and feeding difficulties. Chest radiograph showed right-sided perihilar infiltrates consistent with aspiration pneumonia. Despite initial clinical improvement, the infant developed new-onset positional stridor on day ten of hospitalization, particularly when supine. These findings raised strong suspicion of underlying laryngomalacia. These signs raised a strong clinical suspicion of laryngomalacia. Due to absence of flexible fiberoptic laryngoscopy, diagnosis could not be confirmed. The infant was stabilised with supportive care and feeding adjustments before being referred to a tertiary center for definitive evaluation and management. This case highlights the importance of prompt recognition and early stabilisation of neonates with aspiration-related complications and suspected airway anomalies, particularly in low-resource settings. Timely referral is essential to prevent deterioration and guide appropriate long-term management.

Rett Syndrome is a rare, x-linked genetic neurological disorder caused by MECP2 gene mutations. This progressive neurodevelopmental disorder hinders patients' ability to breathe and eat normally. It is unclear how Mecp2- deficiency results in a high percentage of dysphagia and aspiration pneumonia in patients with Rett syndrome. We aim to determine the effects of Mecp2 -deficiency on swallow related neuromuscular mechanisms contributing to dysphagia in Rett syndrome. Swallow and breathing were detected using electrophysiology in the submental and laryngeal muscle complexes and the hypoglossal and vagus nerves. Several medullary motoneuron populations involved in swallowing were examined by immunohistochemistry in pre and post symptomatic Mecp2 -deficient male and female mice. Swallow-related submental complex duration and amplitude were significantly decreased in both Mecp2 -/y and Mecp2 +/-compared to wild-type, due to decreased motor unit activation. In both Mecp2- deficient mice, cholinergic staining in hypoglossal, facial, and trigeminal nuclei were decreased. We noted a significant increase in the transition time from inspiration to swallow, swallow to the subsequent inspiration, and impaired respiratory rhythm regeneration in Mecp2 -/y, but not Mecp2 +/- mice. Mecp2- deficiency resulted in impaired brainstem cholinergic signaling, which contribute to weakened submental muscle complex activity, and impaired swallow related laryngeal vestibular closure. These results suggest Mecp2- deficient mice are a viable pre-clinical model to further study dysphagia in Rett syndrome.

BackgroundPneumonia is a serious complication of stroke, particularly in patients with dysphagia during inpatient rehabilitation, as it significantly increases morbidity, prolongs hospital stays, and impairs functional recovery. Early identification of patients at risk for pneumonia is crucial for improving outcomes and reducing post-stroke complications. This study aimed to develop a comprehensive algorithm for predicting post-stroke pneumonia risk by integrating clinical assessments of defense mechanisms against pneumonia.MethodsThis case-control study enrolled stroke patients at a single tertiary hospital and followed them for 4 weeks to assess pneumonia incidence. A total of 812 patients aged 20 years or older with ischemic or hemorrhagic stroke and signs of dysphagia were screened. Of these, 484 were excluded based on the following criteria: inability to maintain a sitting posture with back support, dyspnea requiring oxygen supplementation, concurrent aspiration pneumonia before enrollment, infectious diseases requiring isolation, and refusal to participate. Final cohort of 328 patients was enrolled. All participants underwent evaluations, including a videofluoroscopic swallowing study (VFSS), a modified cough reflex test (mCRT), and assessments of nutritional status (serum albumin) and cognitive function [Mini-Mental State Examination (MMSE)]. Pneumonia was diagnosed using the Mann criteria, and predictive factors were analyzed using univariate logistic regression and classification and regression tree (CART) analysis.ResultsAmong 328 participants, 28 (8.5%) developed pneumonia. Significant predictors included tracheostomy status (OR 9.34), VFSS-confirmed aspiration (OR 8.21) and bilateral stroke lesions (OR 5.91). CART analysis revealed tracheostomy, VFSS-confirmed aspiration, cough frequency, albumin levels, and MMSE scores as key predictors. The algorithm demonstrated a predictive accuracy of 92.7% with an AUC of 0.89 (95% CI: 0.82–0.95).ConclusionThis study developed a highly accurate predictive algorithm for post-stroke pneumonia, emphasizing the role of defense mechanisms against pneumonia. Implementing this algorithm in clinical practice could enable early preventive measures, reduce pneumonia incidence, and improve patient outcomes.

Gastroesophageal reflux during anaesthesia is a common event occurring in dogs with the potential to cause oesophageal injury and aspiration pneumonia. The objective of the current study was to evaluate the effect of the novel metabotropic glutamate receptor 5 antagonist TT001 on gastroesophageal reflux during anaesthesia in dogs using two different protocols. One hundred and nineteen client-owned dogs were included and randomly assigned to receive test-drug containing either active TT001 (n = 58) or placebo vehicle (n = 61). In protocol 1 (n = 77), test-drug was administered shortly before induction and in protocol 2 (n = 42) test-drug was administered 15 minutes before standardised pre-anaesthetic drugs. Gastroesophageal reflux (pH <4) was measured and recorded using oesophageal pH-metry throughout the duration of the anaesthesia. Gastroesophageal reflux was registered in 45.4% of dogs, in protocol 1: 44.2%, and in protocol 2: 47.6%. No overall statistically significant difference between the dogs receiving active TT001 (group A, 48.3%) and placebo (group B, 42.6%) was observed, regardless of the protocol tested (protocol 1: group A: 47.4%, group B: 41.0%; protocol 2: group A: 50.0%, group B: 45.5%). Administration of metabotropic glutamate receptor 5 antagonist TT001 as a single intravenous bolus injection before or after pre-anaesthetic drugs has limited effect on the incidence of gastroesophageal reflux in anaesthetised dogs.

Robotic surgical platforms facilitate accurate dissection with the help of high-definition 3D camera and greater freedom of manoeuvrability of robotic instruments. Aim was to evaluate short-term results (mucosal integrity and hospital stay) and long-term outcomes [symptom improvement and Quality of life (QoL)] of patients undergoing Robotic Heller's Cardiomyotomy (RHC). A retrospective analysis of data collected prospectively of achalasia patients undergoing primary RHC between July 2009 and June 2025. Information collected were demography, Eckardt symptom score (ESS), QoL scores with SF-36, type and stage of achalasia, peri and post-operative data. Sixty-eight patients underwent RHC (33-males). Median age was 46 years (18-82). Median length of myotomy was 8cm (7-11). Median length of hospital stay was 2 days (1-28). One patient had aspiration pneumonia and DVT, and another had a postoperative leak needing emergency surgery. There was no mortality. Median follow-up was 102 months (3- 192). Twenty-one (31%) needed further intervention during follow-up. There was a significant improvement in ESS and in all components of QoL (p < 0.05). RHC can be performed very accurately with a very low leak rate. RHC improves symptoms and quality of life and is an alternative to Laparoscopic Heller's Cardiomyotomy or per-oral endoscopic myotomy (POEM) in the Modern Era.

Postoperative pneumonia is a serious lung cancer surgery complication. Perioperative oral management can help prevent its development. This study aimed to determine the characteristics of patients who developed postoperative pneumonia despite perioperative oral management. This study included 396 consecutive patients who underwent lung cancer surgery under general anesthesia at Fujita Health University Okazaki Medical Center from April 2020, the opening of the hospital, to the end of December 2023. Patient data, including age, gender, body mass index, underlying disease, smoking index, spirogram, operative time, amount of blood loss during operation, and operative procedure, were obtained from medical records. Oral examinations were conducted to determine the number of remaining teeth and whether dental caries are present and to examine tooth mobility and probing pocket depths > 4 mm. Furthermore, the patients were asked whether they had regular dental checkups. The patients were divided into the pneumonia and no-pneumonia groups following lung surgery, and the factors involved in postoperative pneumonia were investigated. A total of 390 patients were analyzed (six were excluded), of whom 33 developed postoperative pneumonia. Among them, 17 were excluded from the analysis due to preoperative interstitial pneumonia. Consequently, the incidence of postoperative pneumonia was 16 of 373 patients (4.3%). Significant differences were observed between the groups in terms of age, sex, chronic obstructive pulmonary disease, smoking index, operative time, number of remaining teeth, and regular dental checkups. Logistic regression analysis using these significant items revealed that fewer than 20 remaining teeth were significantly associated with the development of postoperative pneumonia (p = 0.043). The results of this study indicated that the incidence of postoperative pneumonia following perioperative oral function management was maintained as low as that reported previously. The importance of dental intervention in the perioperative period was also elucidated. A high number of patients who developed postoperative pneumonia despite these interventions had fewer than 20 remaining teeth, suggesting that more attention should be paid to perioperative oral management, including the prevention of aspiration pneumonia.