Search Results (195)

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity, mortality, and healthcare utilization. Lung volume reduction surgery improves outcomes in a select cohort but portends high morbidity. Bronchoscopic lung volume reduction (BLVR) is a less invasive, reversible manner of lung volume reduction, using one-way valves to improve lung function, quality of life, and exercise capacity. Nevertheless, knowledge gaps persist regarding factors that predict procedural success. Methods: We retrospectively reviewed 142 patients who underwent BLVR at the University of Chicago between December 2018 and July 2024 to assess the relationship between comorbidities and procedural outcomes. Using logistic and multinomial regression, we determined odds ratios (ORs) for a binary outcome of success and failure and relative risk ratios (RRRs) for failure sub-categories relative to procedural success. Results: We observed a procedural success rate of 48.1% and pneumothorax prevalence of 21.8%. After adjusting for age, sex, race, and body mass index (BMI), comorbidities associated with procedural failure included chronic kidney disease (CKD), congestive heart failure (CHF), anemia, and a BMI, Obstruction, Dyspnea and Exercise (BODE) Index of 5 or greater. Obstructive sleep apnea (OSA) was associated with procedural success. Conclusions: Comorbidities associated with dyspnea appear to have a significant effect on procedural success in BLVR. Full article

Tan sheep are a characteristic and economically important local breed in the Ningxia Hui Autonomous Region of China, where respiratory diseases continue to pose challenges to animal health and production. In this study, a Pasteurella multocida strain (P6) was isolated from the lung tissue of a single Tan sheep presenting with severe and fatal respiratory disease, and subjected to case-based genomic and pathogenic characterization. The isolate was identified as capsular serotype A based on biochemical profiling, 16S rRNA gene sequencing, kmt-1 PCR, and capsular typing. To provide supportive evidence of virulence potential, a murine infection model was employed, in which P6 induced acute clinical signs and severe pulmonary lesions, including congestion, edema, hemorrhage, and fibrinous inflammatory exudation. Whole-genome sequencing revealed that strain P6 possesses a 2,289,251 bp genome with a GC content of 40.2%, encoding 2155 predicted genes and multiple mobile genetic elements, including genomic islands, prophages, transposons, and a CRISPR locus. Phylogenetic analysis based on seven housekeeping genes placed P6 in close relationship with strains 166CV and 103220, distinct from several rodent- and avian-derived isolates. Functional genomic analyses identified numerous genes associated with carbohydrate metabolism, secondary metabolite biosynthesis, host–pathogen interaction, virulence-related functions, and antimicrobial resistance. Comparative genomic analysis with the reference strain PM70 indicated a largely conserved functional framework, accompanied by a significant enrichment of mobilome-associated genes, suggesting enhanced genomic plasticity. Overall, this study provides a descriptive genomic overview of a P. multocida isolate associated with respiratory disease in Tan sheep and highlights its genetic features and potential adaptive capacity, while acknowledging the limitations inherent to a single-case investigation. Full article

Background: Ventricular function assessments in Fontan patients remain challenging. Ejection fraction (EF) lacks sensitivity for early dysfunction, and the roles of strain and advanced imaging in systemic left ventricle (LV) physiology are not fully defined. We aimed to compare (i) LV and atrial strain indices between pediatric Fontan patients with preserved EF (P-LVEF) versus reduced EF (R-LVEF) and (ii) echocardiographic global longitudinal strain, segmental longitudinal strain indices, and conventional 2D and 3D echocardiographic parameters through cardiac morphology. Methods: Pediatric patients with Fontan circulation and systemic LV morphology underwent clinical, hemodynamic, and multimodality echocardiographic evaluation, including 2D/3D parameters, global and segmental LV strain, and left atrial strain. Outcomes were analyzed according to EF status and congenital morphology. Significant results from multiple comparisons were followed by post hoc analysis, where appropriate. Results: Patients with a reduced EF exhibited a worse clinical status, a higher pulmonary vascular resistance index, and greater systemic congestion compared with those with a preserved EF. Conventional 2D indices showed no significant differences between the two studied groups except for LV end-systolic volume (ESV) (p = 0.0315) and LV end-systolic longitudinal diameter (ESL) (p = 0.0024), which showed higher values in the R-LVEF group. Although the relative frequency of impaired deformation was higher in Fontan patients with an unbalanced atrioventricular canal compared with the Fontan patients with a tricuspid atresia + pulmonary stenosis + ventricular septal defect, the difference did not reach statistical significance (p = 0.1365). Most segmental longitudinal strain values were not significantly different across patients with different cardiac morphology, except for the basal anterior segment and apical inferoseptal segment (p < 0.05). Conclusions: In pediatric Fontan patients with systemic LV morphology, a reduced EF was associated with a worse clinical and hemodynamic status. Conventional echocardiographic indices showed a limited ability to differentiate between the compared groups. Although no statistically significant differences were detected between pediatric Fontan patients with preserved EF and reduced EF, LV and atrial strain indices provided complementary information on ventricular–atrial interactions and myocardial deformation. These findings are exploratory and warrant confirmation in larger, prospective studies. Full article

Cirrhotic cardiomyopathy encompasses structural and functional cardiac abnormalities occurring in patients with liver cirrhosis despite the absence of pre-existing heart disease, yet its diagnosis remains challenging. Although echocardiography is the standard diagnostic tool, circulating biomarkers may provide complementary value when imaging findings are inconclusive. This study evaluated the association between N-terminal pro-B-type natriuretic Peptide (NT-proBNP), soluble Suppression of Tumorigenicity 2 (sST2), and diastolic dysfunction in cirrhotic patients without known cardiac disease. We conducted a prospective case–control study including 83 participants (43 patients with non-alcoholic cirrhosis and 40 healthy controls), assessed clinically, biochemically, and echocardiographically between June 2020 and July 2021. Cirrhotic patients showed significantly higher NT-proBNP (94.17 ± 151.36 pg/mL vs. 19.2 ± 5.47 pg/mL, p < 0.001) and sST2 levels (5.4 ± 2.31 ng/mL vs. 2.4 ± 0.99 ng/mL, p < 0.001). NT-proBNP demonstrated limited diagnostic accuracy for diastolic dysfunction (accuracy 52.6%, sensitivity 50%, specificity 60%, AUC 0.51), but it correlated modestly with congestion markers such as left atrial volume and pulmonary artery systolic pressure. A multimarker model combining age, NT-proBNP, and sST2 substantially improved diagnostic performance for diastolic dysfunction (accuracy 75%, sensitivity 77.1%, specificity 71.4%, AUC 0.925). In conclusion, NT-proBNP is associated with diastolic dysfunction but is influenced by cirrhosis congestion status. A combined NT-proBNP and sST2 assessment enhances diagnostic precision and may aid therapeutic decision-making, particularly regarding congestion and diuretic management in cirrhotic patients. Full article

This case report describes a male bottlenose dolphin (Tursiops truncatus) from a republic aquarium in Quanzhou City, Fujian Province, China, in 2024. The dolphin exhibited prolonged vomiting that did not improve despite extended antibiotic treatment, followed by progressive deterioration in physical condition until death. Antemortem biochemical analyses indicated hepatic dysfunction (ALT: 269.8 IU/L, AST: 1357.5 IU/L, LDH: 2913.3 IU/L) and renal impairment (TBIL: 55.84 μmol/L, BUN: 31.93 mmol/L, Cr: 200.2 μmol/L). Necropsy showed atrophy of coronary fat in the heart, hepatomegaly with extensive yellow discoloration, splenomegaly with congestion, diffuse dark-red discoloration of the lungs, renal atrophy, segmental dark-red discoloration of the intestines, and dark-red enlargement of intestinal lymph nodes. Histopathological examination revealed hepatic steatosis with necrosis, extensive pulmonary hemorrhage with foreign bodies in the trachea and alveoli, intestinal necrosis with visible fungus, and congestion and necrosis of intestinal lymph nodes with visible fungus present; the fungus hyphae were periodic acid–Schiff (PAS)-positive. Fungal PCR targeting the fungus internal transcribed spacer (ITS) region identified the intestine fungus as Cladosporium. Infection with Cladosporium is extremely rare, and this report highlights the potential risks of emerging infectious diseases in marine mammals. Full article

Chronic kidney disease (CKD) affects nearly 850 million people worldwide, and most patients with kidney failure are treated with kidney replacement therapy. Despite technological progress, venous congestion remains a major determinant of morbidity and mortality, and is often underdetected by conventional tools such as clinical evaluation, weight changes, blood pressure measurement, or bioimpedance. Point-of-care ultrasonography (PoCUS) has transformed this diagnostic landscape by providing real-time, physiology-based insights into both left- and right-sided filling pressures. In dialysis care, multiple or confluent B-lines and subtle pleural irregularities suggest elevated pulmonary capillary wedge pressure, while a dilated inferior vena cava (IVC) with reduced collapsibility and increased portal vein pulsatility indicate elevated right atrial pressures. Integrating these sonographic findings into a multiparametric assessment that also includes clinical assessment, bioimpedance, and biosensor feedback enhances diagnostic sensitivity and refines fluid management. Advanced practice nurses (APNs) trained in PoCUS can perform focused examinations of the lungs, IVC, portal venous system, arteriovenous access, and skeletal muscle, translating ultrasound findings into physiological interpretations that guide individualized ultrafiltration strategies and patient care. Nutritional ultrasound (NUS) further complements congestion assessment by quantifying muscle mass and quality, linking nutritional reserve and functional status with hemodynamic tolerance. The implementation of structured education, competency-based training, and standardized scanning protocols allows nurses to incorporate these techniques safely and reproducibly into daily dialysis workflows. By integrating PoCUS and NUS within interdisciplinary decision-making, nursing practice evolves from procedural to diagnostic, supporting early identification of congestion, protection of vascular access, and detection of malnutrition. This multiparametric, physiology-guided approach exemplifies the concept of precision nursing, where patient evaluation becomes continuous, individualized, and grounded in real-time pathophysiological insight. Full article

Newcastle disease (ND), caused by avian orthoavulavirus 1 (AOAV-1), poses a global threat to poultry and wild birds. In early 2025, an outbreak of pigeon paramyxovirus type 1 (PPMV-1, genotype VI AOAV-1) was detected in a wildlife rehabilitation centre in northern Portugal, affecting Streptopelia decaocto, Streptopelia risoria, and Columba livia. Birds showed acute neurological signs and died rapidly. Necropsy revealed brain and pulmonary congestion, splenomegaly, and cloacal lesions, while histopathology demonstrated hepatocellular necrosis, hemorrhage, and eosinophilic intracytoplasmic inclusions in hepatocytes and renal tubular cells. Matrix (M) gene PCR using standard primers was negative, but metagenomic sequencing identified genotype VI as being closely related to strains from Iran and Cyprus. Partial fusion (F) gene analysis revealed the velogenic RRQKRF motif. These findings confirm the circulation of highly virulent PPMV-1 in Portugal, highlight that standard, recommended primers may fail to detect some genetically diverse strains, and emphasize the role of Columbidae as reservoirs with potential transmission to domestic poultry. Full article

There have been few reports of neoplasia in hyenas to date. In this report, we describe a captive adult female spotted hyena (Crocuta crocuta) that developed inappetence, lethargy and marked abdominal distension over a 3-day period. The hyena was chemically immobilised to allow clinical investigation of the severe symptoms; however, she died before any internal examination occurred. At necropsy, severe serosanguinous hydropericardium was evident, as well as pulmonary congestion and oedema, ascites and chronic passive congestion of the liver with mild fibrosis. Histopathological examination of the pericardial surface revealed fibrous proliferations lined by mostly a single layer of large proliferating neoplastic mesothelial cells forming papillary projections into the lumen of the pericardial sac as well as infiltration into the pericardial connective tissue, with innumerable haemosiderin-laden macrophages in places, suggestive of chronic haemorrhage. The liver revealed severe congestion and interstitial fibrosis, and the lung revealed congestion and oedema, with moderate numbers of alveolar macrophages and marked anthracosis. The diagnosis was pericardial well-differentiated papillary mesothelioma, with death under anaesthesia caused by cardiogenic shock due to pericardial mesothelioma-associated cardiac tamponade. As primary pericardial mesothelioma (PPM) is a rare tumour type for both animals and humans, and this is the first report of a PPM in a hyena, we compare the clinical findings with those seen in other species. Full article

Background/Objectives: This is the first prospective, same-day, multi-modality comparison of lung ultrasound (LUS) and chest radiography (CXR) for detecting acute heart failure (AHF) in non-critical patients with dyspnoea, examining the impact of chronic heart failure and pleural effusion, using low-dose chest CT (LDCT) as an objective comparator, and cardiologists-adjudicated AHF as reference standard. Methods: An observational study of 240 consecutive non-critical patients ≥50 years admitted with dyspnoea was conducted. Unstable AHF cases were deemed ineligible. Each modality was evaluated at the population level with area under the curve (AUC), sensitivity, and specificity, and compared at the patient level using conditional odds ratio for the association to AHF adjudicated by blinded cardiologists. Congestion was defined by LUS as (a) ≥3 B-lines bilaterally, or (b) B-lines combined with pleural effusion, and (c) CXR, interpreted by two thoracic radiologists, using (d) LDCT as an objective comparator. Results: Among 240 patients (66 with cardiologist-adjudicated AHF, 58 with chronic heart failure), LUS (b) demonstrated a diagnostic accuracy at population level of AUC = 0.82 (sensitivity = 80%, specificity = 84%), while CXR (c) achieved AUC = 0.80 (sensitivity = 68%, specificity = 91%), with CXR showing a modest but statistically significant difference over LUS at the patient level (OR = 1.51, p = 0.03). Incorporating pleural effusion into LUS increased its AUC from 0.67 to 0.82 (a vs. b, p < 0.001). The objective comparator, LDCT (d), achieved an AUC = 0.92 (sensitivity = 74%, specificity = 96%). In patients with chronic heart failure, LUS (b) and CXR (c) performed comparably (p = 0.87), whereas in those without chronic heart failure, CXR was superior (p = 0.04). Conclusions: In non-critical, diagnostically challenging patients with dyspnoea, in whom critical AHF cases were not eligible, including pleural effusion improved LUS accuracy for AHF. Diagnostic performance differed by heart failure history, with CXR superior in new-onset heart failure, while LUS and CXR performed comparably in chronic heart failure. Full article

Tricuspid atresia (TA) is a cyanotic congenital heart defect defined by agenesis of the tricuspid valve and resultant right ventricular hypoplasia, representing 1.4–2.9% of congenital heart disease. Survival depends on interatrial and interventricular shunts that permit systemic and pulmonary blood flow, with staged surgical palliation culminating in the Fontan procedure. While surgical advances have improved long-term outcomes, Fontan circulation remains a delicate physiology characterized by preload dependence, elevated pulmonary vascular resistance, chronic venous hypertension, and a prothrombotic state. These features predispose patients to arrhythmias, lymphatic complications, hepatic congestion, and progressive circulatory failure. For anesthesiologists, perioperative management of TA and Fontan patients is uniquely complex. Anesthetic considerations include meticulous preload optimization, modulation of systemic and pulmonary vascular resistance, and ventilatory strategies that minimize adverse effects on venous return. Additional challenges include the high risk of air embolism, individualized anticoagulation needs, and hemodynamic sensitivity to patient positioning. Preoperative evaluation with echocardiography and electrocardiography provides critical insight into anatomy and physiology, while intraoperative planning must emphasize goal-directed fluid management, careful agent selection, and tailored ventilation. Postoperatively, vigilant monitoring, effective pain control, and prevention of complications are essential. This review synthesizes classification systems, pathophysiology, and the evolution of surgical palliation, while emphasizing anesthetic principles for the perioperative care of patients with TA and Fontan circulation. As survival improves and the population of Fontan patients expands, a nuanced understanding of this physiology is essential for optimizing outcomes across cardiac and non-cardiac surgical settings. Full article

Background/Objectives: Heart failure (HF) causes systemic and regional haemodynamic alterations that extend beyond the heart, profoundly affecting splanchnic circulation. Venous congestion is a hallmark of heart failure (HF) and a major determinant of clinical deterioration and multiorgan dysfunction. The splanchnic venous system—comprising the portal, hepatic, and renal veins—acts as a key reservoir for intravascular volume redistribution. Conventional ultrasound (US), using grayscale and Doppler imaging, offers a direct, non-invasive approach to visualize these haemodynamic changes. This review, Part 1 of a two-part series, summarizes the current evidence and clinical applications of conventional US for assessing splanchnic, cardiac and pulmonary vascular alterations in patients with HF. Methods: A systematic review was performed in PubMed, Embase, and the Cochrane Library up to current date, following PRISMA 2020 guidelines. Eligible studies included adult human investigations evaluating splanchnic vascular changes in HF using B-mode, color Doppler, or pulsed Doppler ultrasonography. Exclusion criteria were pediatric, animal, or non-English studies and non-standard imaging methods. Data on ultrasonographic parameters, haemodynamic correlations, and prognostic value were extracted and qualitatively synthesized; Results: A total of 148 eligible studies (n ≈ 7000 patients) demonstrated consistent associations between HF severity and alterations in splanchnic, cardiac and pulmonary flow. Findings included increased bowel wall thickness, portal vein dilation with elevated pulsatility, and monophasic or reversed hepatic vein waveforms, all correlating with higher right atrial pressure and adverse clinical outcomes. The integration of these parameters into the Venous Excess Ultrasound (VExUS) framework enhanced detection of systemic venous congestion, in addition to the study of the cardiac and pulmonary circulation. Conclusions: Conventional ultrasound assessment of splanchnic vasculature provides valuable, reproducible insight into systemic congestion in HF. Incorporating hepatic and portal Doppler indices into standard evaluation protocols may improve risk stratification, optimize decongestion therapy, and guide management. Further prospective randomized and outcome-driven studies are required before VExUS-based therapeutic thresholds can be universally recommended and define prognostic thresholds. Full article

Left-sided congestive heart failure (CHF) is a common cause of acute respiratory distress in cats, and echocardiographic assessment of left atrial (LA) size is an important test to differentiate it from respiratory diseases that cause similar clinical signs. Furosemide, a potent loop diuretic, is the first-line therapy for cardiogenic pulmonary edema, but its effect on LA size has not been systematically investigated in cats. Some dyspneic cats are referred after having received high doses of furosemide by the referring veterinarian without prior point-of-care ultrasound (POCUS). This can make the diagnosis of CHF challenging. If furosemide significantly reduces left atrial size, it could potentially lead to misdiagnosis, by erroneously categorizing these cats as not having CHF. This prospective, observational multicenter study enrolled 25 cats with acute left-sided CHF. Point-of-care ultrasound was used to assess LA to aortic ratio (LA:Ao) and maximal LA diameter (LAD) at admission and three hours after furosemide administration. Significant reductions were observed in LA:Ao (2.48 ± 0.35 to 2.17 ± 0.40; p < 0.001), LAD (21.0 ± 2.8 mm to 18.4 ± 3.2 mm; p < 0.001), and respiratory rate (64 ± 30 to 40 ± 14 breaths/min; p < 0.001). Normalization of respiratory rate occurred in 50% of cats, while normalization of maximum LAD occurred in 32%. One cat achieved normalization of LA:Ao. We found that furosemide induced rapid reduction in LA size and respiratory rate in cats with left-sided CHF. Clinicians should be aware that severe LA dilation can be absent in referred dyspneic cats that had already received furosemide. Full article

Cardiovascular diseases in dogs have diverse causes and may progress rapidly to life-threatening complications. This review outlines the relevant pathological conditions involving the cardiovascular system in dogs, especially the myocardium, including myocarditis caused by canine parvovirus (CPV-2), heartworm disease (Dirofilaria immitis), hemangiosarcoma, and polyarteritis nodosa (PAN). CPV-2 affects the myocardium of puppies during the early weeks of life, leading to necrosis, fibrosis, and congestive heart failure. Heartworm disease is caused by adult D. immitis residing mainly in the pulmonary arteries, inducing pulmonary hypertension, right ventricular overload, and vascular damage, with the severity being related to the worm burden and duration of infestation. Hemangiosarcoma is a malignant vascular tumor, most frequently originating in the spleen or right atrium, often diagnosed at an advanced stage, with widespread metastases. Polyarteritis nodosa in dogs is a necrotizing, systemic vasculitis of medium-sized arteries that may affect the coronary arteries of the heart. Its pathogenesis is still unclear, though an immune-mediated mechanism is suspected. By presenting these lesions, the review underscores the many factors that can trigger cardiovascular diseases in dogs, as well as the clinical significance and the need for further research into their pathogenesis and treatment. Full article

Introduction: Charred bodies represents a significant challenge for forensic pathologists due to the destructive effects of fire on human remains. Although most fire-related deaths are accidental, cases of suicide and homicide are not uncommon. Case Report: We report a peculiar case of a severely burned body discovered inside a torched vehicle. Under judicial investigation, a full autopsy was performed, including macroscopic and microscopic examination of key anatomical structures: the inspection of oral cavity revealed no soot deposits; a foreign object (a chestnut) was found anterior to the epiglottis, though not lodged within the glottis; no thermal injuries or soot were observed in the upper or lower airways. Histological analysis excluded thermal damage at the alveolar–capillary interface. Alveolar spaces appeared both hyperinflated and ectatic, likely due to septal rupture, suggestive of acute pulmonary emphysema and multiorgan congestion. Carboxyhemoglobin levels were below 5%, indicating a low level which did not support intravital inhalation of combustion gases. Based on the comprehensive medico-legal findings, the cause of death was attributed to an asphyxial mechanism. It was further demonstrated that the burning of the body occurred post-mortem. DNA extraction from two dental specimens enabled positive identification of the victim. Subsequent investigations confirmed the case to be a femicide. The perpetrator, following a domestic altercation over jealousy, suffocated his young wife and attempted to simulate accidental choking by placing a chestnut in her mouth. He then staged a vehicular fire to mimic a fatal accident. Conclusions: The case underlines that a multidisciplinary forensic approach is essential, and must integrate different methodologies and the analysis of both circumstantial evidence and scene investigation. Full article

Heart failure (HF) remains a leading cause of recurrent hospitalisations worldwide, largely driven by acute episodes of decompensation. Early identification of impending decompensation could enable timely intervention and potentially prevent costly admissions. Non-invasive wearable devices have emerged as promising tools for continuously monitoring physiological parameters and detecting early signs of deterioration. This review summarises recent advances in wearable technologies designed to predict HF decompensation and appraises their ability to generate clinically useful alerts. It will examine various modalities designed to monitor different aspects of cardiorespiratory physiology that have the potential to detect abnormalities preceding heart failure decompensation. Broadly, these devices either monitor physical activity capacity and cardiac function or monitor changes in pulmonary fluid congestion. We will also cover evidence exploring whether these devices can generate timely alerts for interventions to improve patient outcomes and reduce hospitalisations. However, despite advances in these technologies, challenges remain regarding their accuracy and usability for remote monitoring, as well as concerns with data storage, processing, patient adherence, and integration into existing healthcare workflows. While current limitations exist, previous results warrant further research into this area, with a focus on larger randomised trials, exploring both single- and multi-sensor systems, using artificial intelligence and cost-effectiveness analysis. Overall, non-invasive wearables represent an opportunity to create a more proactive approach to HF management, with the potential to shift the paradigm from reactive treatment to anticipatory care. Full article