Objective Airway foreign body (AFB) in adults remains a potentially life-threatening emergency, which lacks standardized clinical pathways of management. This review aims to synthesize current evidence on the clinical recognition, imaging work-up, and bronchoscopic management of AFB in adults and to propose a practical, stepwise algorithm, enabling interventional pulmonologists to establish a systematic retrieval framework as early as possible and thereby optimize care for adult patients. Methods A narrative review was conducted by searching PubMed for studies focusing on the bronchoscopic management of AFB in adults. The emphasis is on the tool selection, critical techniques, and procedural nuances for AFB retrieval. Personal clinical experience also informed the interpretation and contextualization. Results Adult AFB typically presents with chronic cough, dyspnea, wheeze, or recurrent post-obstructive pneumonia. Computed tomography (CT) is the first-line imaging modality (pooled sensitivity 98.8%, specificity 96.6%), but radiolucent organic material may yield false-negative results; therefore, high clinical suspicion warrants direct bronchoscopy. The right main bronchus is the most common site because of its anatomical features. Pre-intervention planning matches AFB characteristics (site, size & shape, and substance) with patient status to decide between rigid and flexible scopes and to select retrieval accessories. Flexible bronchoscopy under general anesthesia via laryngeal mask airway achieves > 90% success in adults, which is preferred for peripheral items, whereas rigid bronchoscopy remains the gold standard for large, sharp, or proximal AFBs. Tool choice follows an object-specific strategy: forceps for metal/bone, snare for bulky, irregular items, basket for smooth, round seeds, balloon for impacted distal AFBs after dilation, and cryoprobe for semisolid, water-rich material (blood clot, mucus plug, food). Complication rates are lowest when dislodgement and extraction are performed as a single, controlled maneuver under continuous visualization; hybrid rigid–flexible approaches further improve safety. Conclusions Consider AFB in adults with unexplained chronic respiratory symptoms. CT guides but does not replace bronchoscopy. An individualized strategy—flexible scope first (in patients with stable status), rigid scope reserved for selected complex cases—combined with object-tailored tools optimizes successful AFB retrieval while minimizing morbidity. Maintaining both rigid and flexible systems, trained multidisciplinary teams, and strict manometric monitoring are essential components of AFB retrieval.

Atezolizumab is a widely used immune checkpoint inhibitor (ICI) for cancer treatment, and postmarketing testing is important. This study aims to provide a reference for the safe and rational use of drugs in clinical practice by mining and analyzing the adverse event (AE) signals of atezolizumab on the basis of the FDA Adverse Event Reporting System (FAERS). This research extracted AE reports from the second quarter (Q2) of 2016 to Q2 of 2024 from the FAERS. AEs were standardized and classified on the basis of the System Organ Class (SOC) and Preferred Term (PT) from the Medical Dictionary for Regulatory Activities (MedDRA) version 23.0. This study utilized disproportionality analysis (DPA) for signal mining and analysis, including the reporting odds ratio (ROR) method, the Medicines and Healthcare Products Regulatory Agency (MHRA) method, and the Bayesian confidence propagation neural network (BCPNN) method. We obtained a total of 3,124 AE signals and identified 640 PTs and 21 SOCs for atezolizumab. The highest signal intensity was systemic immune activation (n = 15, ROR = 449.20, PRR = 449.07, IC = 8.06), and the most frequently reported AEs were death, pyrexia, infectious pneumonia, anaemia, and febrile neutropenia. The top 100 PTs in terms of signal intensity involved a total of 16 SOCs, including those associated with endocrine disorders; respiratory, thoracic and mediastinal disorders; and renal and urinary disorders. This study revealed that AEs in the endocrine, respiratory and urinary systems need to be monitored in clinical practice.

Efficacy and safety of postoperative autologous blood transfusion in cardiac surgery (RESCUE): Rationale, design, and study protocol of a multicenter randomized controlled trial.

Vaccinations to Prevent Infections in Adult Individuals With CKD and After Kidney transplantation: A Review.

To compare the nature and frequency of complications between French Bulldogs (FBDs) and Miniature Dachshunds (MDs) with thoracolumbar or lumbar intervertebral disk extrusion (IVDE). This retrospective, single-center study included dogs diagnosed with thoracolumbar or lumbar IVDE between January 1, 2019, and December 31, 2023, with complete medical records. Dogs with a confirmed history of previous IVDE were excluded. Perioperative complications, length of hospitalization, and total cost of care were documented and compared between the 2 breeds. A total of 379 patients (211 FBDs, 168 MDs) were included in the study. Complications occurred in 50.2% (106 of 211) of FBDs and 13.1% (22 of 168) of MDs. Diarrhea was the most common complication for both breeds. Regurgitation and urinary tract infection commonly occurred in FBDs. Brachycephalic obstructive airway syndrome was only recorded in FBDs. Progressive myelomalacia was diagnosed in 3 FBDs and 4 MDs postoperatively. Corneal ulceration, surgical site infection, seroma, and aspiration pneumonia were rare complications reported in FBDs only. The median length of hospitalization was 5 days for both breeds. The median total cost of care was higher for FBDs. Significant differences were found in the types and frequency of complications between FBDs and MDs. This study highlighted both shared and breed-specific perioperative complications in 2 popular breeds commonly affected by IVDE and the related differences in cost of care. These findings support the importance of breed-specific preoperative counseling and perioperative planning, particularly for FBDs, in which more complications and higher costs were found.

Healthcare-associated infections pose a significant risk to high-risk infants, particularly those with very low birth weight (< 1500g) and those born very preterm (< 32 weeks gestation). The burden of healthcare-associated infections, contributing risk factors, and efficacy of prevention strategies in the neonatal population remain underinvestigated, with few national and international networks. To address this gap, an international team of experts in neonatology, epidemiology, and infection prevention and control from diverse healthcare settings collaborated as consortium partners within the NeoIPC Project to design a surveillance program focused on healthcare-associated infections and multidrug-resistant organisms in neonatal units. Data collection includes the most prevalent neonatal healthcare-associated infections (primary and secondary bloodstream infections, clinical sepsis, pneumonia, necrotizing enterocolitis, and surgical site infections), the presence of multidrug-resistant bacteria and associated risk and protective factors for healthcare-associated infections. By providing standardized methods and reference data for benchmarking, the NeoIPC Surveillance aims to support infection prevention and antibiotic stewardship programs, improve neonatal care outcomes and foster international collaboration. This article outlines the methods of the NeoIPC Surveillance Core Module (Version 1.2), details data collection, management, and analysis, and serves as a comprehensive reference for healthcare professionals and researchers worldwide aiming to implement effective surveillance for healthcare-associated infections in neonatal units.

The metabolic and immunological functions of the lungs are the subject of active scientific research. In recent years, methods for studying organic and inorganic volatile compounds in exhaled air and its condensate have been standardized. The metabolic function of the lung parenchyma involves the regulation of water and electrolyte balance, as well as biologically active amines and peptides. The unique properties of type 2 alveolar cells and alveolar macrophages are manifested in the synthesis and recirculation of surfactant. Pulmonary capillary endothelial cells play a special role, converting angiotensin-1 (a decapeptide) into angiotensin-2 (an octapeptide) with the help of angiotensin-converting enzyme. The aim was to study the metabolic, immunological and endocrinological functions of the lungs, as well as the diagnostic role of exhaled air condensate. Results. The adult lungs contain approximately 20% immune cells, which maintain normal homeostasis and participate in the implementation of a protective barrier against various pathogens and allergens. A significant role is played by mucosal immunity, which involves mucosa-associated lymphoid tissue, immune cells, secretory immunoglobulin A, and various enzymes. Clinical manifestations of immunopathological reactions of the respiratory system are diverse. Thus, allergic reactions of both immediate and delayed types can be observed in clinical practice. Granulomatous processes of the pulmonary parenchyma have a special place. Neuroepithelium in the mucous membrane of the respiratory tract plays an important role in the differentiation of cell structures and in the morphogenesis of lung tissue. However, the participation of the lungs in endocrinological reactions remains a poorly studied direction. Conclusion. The research of metabolic, immunological and endocrinological functions of the lungs identified a number of biological markers associated with bronchial asthma, COPD, lung cancer, and pneumonia. Studies of the proteome of exhaled air condensate have brought us closer to the discovery of new biological markers.

Bronchiolitis obliterans (BO) is a rare, chronic obstructive airway disease affecting infants and children, often occurring after severe lower respiratory tract infections. We describe the case of a 5-month-old male who experienced recurrent severe pneumonia, a prolonged stay in the pediatric intensive care unit, and ongoing respiratory distress. His condition was complicated by Stage II hypertension, severe acute malnutrition, moderate anemia, and global developmental delay. Serial high-resolution computed tomography scans revealed progressive bilateral ground-glass opacities, consolidations, and bronchiectatic changes consistent with post-infectious BO. The patient required extended mechanical ventilation, long-term supplemental oxygen, multiple courses of antibiotics, antivirals, corticosteroids, and antihypertensive medications. This case emphasizes the diagnostic challenges and complex multidisciplinary management of BO in infancy.

Video-assisted thoracoscopic lobectomy for a migrated duck bone foreign body complicated by severe peribronchial inflammation: a case report

A 17-year-old male, born to consanguineous parents, presented with recurrent pneumonia since infancy and a persistent fever for 7 months. Serial chest CT demonstrated migrating multi-lobar consolidations. Initial empirical antibiotic therapy was ineffective and culture of bronchoalveolar lavage fluid was negative. A transbronchial biopsy revealed necrotizing granulomatous inflammation. Dihydrorhodamine assay demonstrated absent oxidative burst in the patient, subsequent genomic analysis identified a homozygous pathogenic NCF1 variation (c.75_76del; p.Tyr26Hisfs*26), confirming the diagnosis of chronic granulomatous disease. His symptoms resolved with treatment of trimethoprim-sulfamethoxazole, itraconazole and glucocorticoids. Significant radiographic improvement was documented at 3-month follow-up.

To assess the incidence of grade 3 or higher opportunistic pneumonia or drug-induced interstitial lung disease (DILD) during the treatment of patients with advancedRET fusion-positive (RET+) non-small-cell lung cancer (NSCLC) using pralsetinib. A retrospective analysis was conducted on the clinical data of 44 patients with advanced RET + NSCLC treated at Chinese PLA General Hospital from March 2017 to October 2023. Patients were divided into a severe pneumonia group and a control group using propensity score matching, and differences in efficacy, survival, and prognostic factors were compared between the two groups. Nine patients were in the severe pneumonia group and 35 in the control group. The objective response rate (ORR) for RET + NSCLC patients was 50%, and for the severe pneumonia group, 62.5%. There was no significant difference in the median progression-free survival (PFS) and overall survival (OS) between the two groups. An ECOG score of ≥ 2 was an important prognostic factor affecting OS (HR = 4.55, P = 0.016), while the impact of severe infectious pneumonia did not reach statistical significance. These findings provide new insights into the individualized treatment of RET+NSCLC patients and emphasize the importance of considering the overall health status of patients in treatment decisions.

Cedecea lapagei is a rare opportunistic pathogen that can colonize environmental surfaces and form biofilms. Despite its unclear clinical relevance, it has been linked to bacteremia, pneumonia, urinary tract, and wound infections, particularly in immunocompromised individuals. Herein, we describe a rare case of C. lapagei bacteremia characterized by markedly limited therapeutic options and contextualize it within the existing literature. A 35-year-old woman with epilepsy presented with fever, dyspnea and worsening general condition. Thoracic computed tomography (CT) showed left-lung pneumonic infiltrates. Empirical therapy with piperacillin/tazobactam plus clarithromycin was started, but progressive respiratory distress required intensive care. Blood-cultures grew C. lapagei, identified using the BD Phoenix 100 (Becton Dickinson, USA). C. lapagei belongs to the Enterobacteriaceae family. European Committee on Antimicrobial Susceptibility Testing (EUCAST) has defined breakpoints for antimicrobial susceptibility at the family level; however, species-specific breakpoints for C. lapagei are not available. A methodological appraisal of published Cedecea cases shows that few reports describe the criteria used for susceptibility testing. Herein, we interpreted susceptibility according to EUCAST breakpoints established for Enterobacterales. Despite appropriate therapy, the outcome was fatal. This case reinforces that C. lapagei, though rare, poses a growing threat through its expanding resistance and capacity to cause severe community-onset infections.

Sepsis-induced cardiac dysfunction significantly impacts patient outcomes, with inotropic support playing a crucial role in management. Levosimendan and dobutamine are commonly used, but their comparative efficacy remains debated. This meta-analysis evaluates the efficacy and safety of levosimendan versus dobutamine in sepsis-related cardiac impairment, focusing on mortality, intensive care unit (ICU) outcomes, and infection risks. We systematically analyzed randomized controlled trials (RCTs) comparing levosimendan and dobutamine in septic patients with cardiac dysfunction. Primary outcomes included mortality and ICU length of stay, while secondary outcomes assessed pneumonia, peritonitis, and urinary tract infection (UTI) risks. Model selection for pooled odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CI) was based on heterogeneity, employing random-effects models for substantial heterogeneity (I² > 50%) and fixed-effects models otherwise. Meta-analyses were performed using Rev-Man 5.4. Prospero ID (CRD420261283881). The meta-analysis included 9 RCTs (n = 289 patients) in total. For mortality, data were available from 8 RCTs (n = 239 patients), revealing no significant reduction with levosimendan compared to dobutamine (OR: 0.89, 95% CI: 0.52-1.54, P = 0.68; I²=0%). For ICU length of stay, 7 RCTs (n = 241 patients) were included, showing no significant difference (MD - 2.02 days, 95% CI - 6.44 to 2.39; P = 0.37; I²=83%). Regarding hospital-acquired infections, pneumonia was analyzed in 5 RCTs (n = 143 patients) (OR: 1.05, 95% CI: 0.48-2.29, P = 0.90; I²=0%), peritonitis in 3 RCTs (n = 98 patients) (OR 1.56, 95% CI 0.62-3.95; P = 0.35; I²=0%), and urinary tract infections in 3 RCTs (n = 91 patients) (OR: 0.70, 95% CI: 0.17-2.81, P = 0.61; I²=0%). Current evidence indicates that levosimendan does not reduce mortality or ICU length of stay compared to dobutamine in sepsis-induced cardiac dysfunction, and infection risks are comparable. The high heterogeneity in ICU outcomes warrants cautious interpretation. These findings do not support the routine preferential use of levosimendan over dobutamine. Larger, well-designed trials are needed to identify specific patient subgroups that may benefit from levosimendan.

Tylvalosin (acetylisovaleryltylosin), a breakthrough semi-synthetic derivative of tylosin engineered to address pharmacokinetic limitations and bacterial resistance, exhibits dual therapeutic efficacy against porcine reproductive and PRRSV-associated pneumonia and mycoplasma infections in swine. Limited research has yet to investigate pharmacokinetic profiles of tylvalosin and its metabolites. This study, therefore, aims to pioneer a robust UPLC-MS/MS method for simultaneous quantification of tylvalosin and its key bioactive metabolites, desmycosin 3-acetate and tylosin 3-acetate, in swine plasma and tissues, and to investigate the pharmacokinetic properties of different tylvalosin formulations. A robust UPLC-MS/MS method was developed and validated, showing excellent performance with good linearity, low deviation, high accuracy, minimal carry-over and matrix effects, as well as favorable stability under various conditions. Pharmacokinetic analysis following intravenous (i.v.) or intragastric administration in swine revealed that formulation I outperformed other formulations, exhibiting the highest bioavailability (F, 57.32%), the longest elimination half-life (t1/2, 7.93h), and a delayed time to maximum plasma concentration (tmax, 3.14h). Dose-normalized metabolites exposures were also significantly higher for formulation I compared to other formulations. Critically, tylvalosin and its metabolites preferentially accumulated in pulmonary and lymphatic tissues at 48h post-administration, indicating rapid absorption, swift metabolism, and slow elimination. The findings confirm the optimized therapeutic potential of tylvalosin, particularly formulation I, supported by its favorable pharmacokinetic profile and tissue distribution. This study establishes a new standard for veterinary PK-PD research and provides a PK evidence-based formulation optimization approaches to enhance treatment efficacy.

Immune checkpoint inhibitor-related pneumonitis (ICI-P) is apotentially serious complication of cancer therapy with immune checkpoint inhibitors. The clinical presentation is nonspecific, typically involving dyspnea and cough. Differentiating the imaging patterns on computed tomography (CT) is challenging. The most important differential diagnoses include infectious pneumonia, radiation-induced changes, and tumor progression with lymphangitic carcinomatosis. Noncontrast high-resolution thin-section CT (HRCT) is the modality of choice. Common patterns include bilateral ground-glass opacities and patterns of organizing pneumonia (OP), nonspecific interstitial pneumonia (NSIP), bronchiolocentric interstitial pneumonia (BIP), and diffuse alveolar damage (DAD). Diagnosis is based on correlation with clinical presentation, laboratory parameters, and exclusion of infectious causes, if necessary by bronchoalveolar lavage (BAL). Pattern classifications according to the recommendations of the Fleischner Society facilitate systematic categorization of the heterogeneous CT findings. Particular attention should be paid to distinguishing these from infection and lymphangitic carcinomatosis. Assessment over time is important, as CT changes often resolve with delay, and specific courses such as chronic ICI pneumonitis or pneumonitis flares may occur. In cases of new pulmonary changes, the typical temporal association with ICI therapy (weeks to months, on average 3months after the first ICI dose), risk factors, and characteristic HRCT patterns should be taken into account. The changes usually regress over weeks to months upon interruption of ICI therapy and/or administration of glucocorticoids.

The GALLIUM trial showed improved progression-free survival (PFS) with obinutuzumab (O)-based chemoimmunotherapy in first-line treatment of follicular lymphoma (FL), although with increased toxicity compared to rituximab (R). Our previous real-world study found similar toxicity between these protocols during induction. To compare real-world toxicity and outcomes of R versus O maintenance therapy in FL patients following first-line chemoimmunotherapy. A multicenter retrospective study included FL patients treated with first-line R- or O-based chemoimmunotherapy. The primary outcome was any infection up to 6 months post-maintenance. Secondary outcomes included other toxicities, PFS, and overall survival (OS). We analyzed 134 patients (R: 71, O: 63). Baseline characteristics were similar except for higher diabetes and hypertension rates in the R group. The median number of maintenance cycles was comparable. Infections occurred in 56% of patients, with no significant difference (50.7% R vs. 61.9% O, p = 0.21). Grade 3 infections, febrile neutropenia, and treatment discontinuation rates were comparable between groups. Pneumonia and viral infections were less frequent with R versus O (13.8% vs. 28.1%, p = 0.019 and 19% vs. 39%, p = 0.004, respectively), while infusion reactions were higher (8.4% vs. 0%, p = 0.028). After 5.5 years, PFS favored O (19.7% vs. 4.8%, p = 0.028), with similar OS. In real-world settings, rituximab- and obinutuzumab-based chemoimmunotherapy with maintenance for FL exhibited a similar toxicity profile, with differences in specific infections. Obinutuzumab had superior PFS and similar OS compared with rituximab therapy, supporting obinutuzumab usage in first-line chemoimmunotherapy, especially in selected young and fit patients.

Fatigue is a common and persistent symptom in patients with tuberculosis (TB), particularly in recurrent cases and when accompanied by pneumonia. Increased systemic inflammation and reduced activity tolerance often lead to functional decline, while pharmacological treatment alone may not sufficiently address fatigue. Progressive muscle relaxation (PMR) is a non-pharmacological intervention that reduces muscle tension and stress, support physiological recovery. This study describes the effect of PMR to reduce fatigue in a patient with recurrent tuberculosis and pneumonia. This study is a case review involving a 65-year-old female patient diagnosed with pulmonary TB and pneumonia. PMR was administered over four consecutive days, with one session lasting 15–20 minutes per session. The sessions were conducted at varying times, including in the morning, afternoon, or before bedtime. Fatigue levels were measured after each session using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) Scale. The patient showed improvement in vital signs, with blood pressure increasing from 108/65 mmHg to 116/61 mmHg, heart rate decreasing from 111 to 62 beats per minute, and the FACIT-F score improved from 12 (severe fatigue) to 36 (mild fatigue), indicating a reduction in fatigue severity. Functionally, the patient was able to walk to the bathroom independently and no longer experienced weakness or dyspnea post-activity. These findings indicate that PMR contributed to a reduction in the patient’s fatigue level. This intervention has potential as a supportive rehabilitative strategy, with adjustments in duration and frequency based on patient condition.

We hypothesized that performing bone marrow transplant (BMT) using marrow extracted from the vertebral bodies (VB) of an unrelated deceased lung transplant (LTX) donor would be able to establish persistent hematopoiesis, generate immunity, and tolerance. A teenager with severe combined immunodeficiency with lung failure due to recurrent pneumonias underwent LTX in 2016 from a 1/8 HLA allele-matched unrelated donor, followed by BMT 4 months later using T-cell/B-cell-depleted, cryopreserved VB marrow. Rapid engraftment was followed by accelerating immune competence at 6 months, with independence from immunosuppression by 16 months. Donor T-cell (>95%) and myeloid chimerism (7-10%) have persisted for over nine years. At two years post-BMT, circulating T cells were hyporesponsive to host dendritic cells in vitro. T-cell receptor clonotyping revealed the disappearance of host-reactive clones, and T-cell RNA-sequencing exhibited downmodulated signaling pathways for cytotoxicity/rejection, paired with upregulated immunomodulatory pathways, suggesting active suppression. In parallel, host monocytes upregulated certain signaling pathways, indicating active interactions between post-thymic donor T cells and host monocytes. In summary, durable hematopoietic engraftment, immunity, and tolerance were demonstrable for the first time in a recipient of BMT obtained from VB graft.

Clinical Warning Signs in Detecting Inborn Errors of Immunity in Children: A Diagnostic Accuracy Systematic Review.

Gastric conduit is the preferred reconstruction following oesophagectomy. Patients can develop delayed gastric conduit emptying because of dilatation and poor drainage. We present a novel technique utilising endoscopic suturing to plicate the gastric conduit, improving drainage, reducing sumping and improving quality of life. An 81-year-old man who underwent an oesophagectomy for pT1bN0M0 oesophageal adenocarcinoma presented 6 years later with nutritional failure, body mass index (BMI) 17.5 and recurrent aspiration pneumonia. The gastric conduit had dilated, resulting in significant redundancy and sumping. Endoscopic suture plication of the conduit was performed to avoid the risks of surgical revision. Expertise developed in the practice of endoscopic sleeve gastroplasty was utilised to perform intrathoracic gastric conduit plication, eliminating sumping and reducing conduit redundancy. Following endoscopic gastric conduit plication, contrast swallow demonstrated improved shape and drainage of the conduit. At 6- and 12-month follow-up the patient reported improved diet tolerance, an increased BMI of 24.7 and there had been no hospitalisations for aspiration. EORTC QLQ OG25 scores improved from 60 to 32. Our novel technique for plication of an intrathoracic gastric conduit represents a useful strategy to increase the longevity and function of gastric conduits in oesophageal cancer survivors and those undergoing benign resections where long-term high-quality function of the conduit is important for optimal patient outcomes.