Search Results (12,097)

Introduction: Pneumonitis represents one of the clinically significant adverse events observed in patients with non-small-cell lung cancer (NSCLC) who receive durvalumab as consolidation therapy after chemoradiotherapy (CRT). Although clinical factors such as radiation dose (e.g., V20) and interstitial lung abnormalities (ILAs) have been reported as risk predictors, accurate and objective prognostication remains difficult. This study aimed to develop a radiomics-based machine learning model to predict grade ≥ 2 pneumonitis. Methods: This retrospective study included patients with unresectable NSCLC who received CRT followed by durvalumab. Radiomic features, including first-order and texture and shape-based features with wavelet transformation were extracted from whole-lung regions on pre-durvalumab computed tomography (CT) images. Machine learning models, support vector machines, k-nearest neighbor, neural networks, and naïve Bayes classifiers were developed and evaluated using a testing cohort. Model performance was assessed using five-fold cross-validation. Conventional predictors, including V20 and ILAs, were also assessed using logistic regression and receiver operating characteristic analysis. Results: Among 123 patients, 44 (35.8%) developed grade ≥ 2 pneumonitis. The best-performing model, a support vector machine, achieved an AUC of 0.88 and accuracy of 0.81, the conventional model showed lower performance with an AUC of 0.71 and accuracy of 0.64. Conclusions: Radiomics-based machine learning demonstrated superior performance over clinical parameters in predicting pneumonitis. This approach may enable individualized risk stratification and support early intervention in patients with NSCLC. Full article

Isodonis Excisoidis Herba (IEH) is a newly discovered herbal medicine used to treat esophageal cancer, chronic pharyngitis, and hepatitis, and ent-kaurane diterpenoids are its main active components. However, systematic studies on the chemical profile of ent-kaurane diterpenoids are lacking. In this study, UHPLC-LTQ-Orbitrap-MS was performed to investigate the fragmentation behaviors of three different types of ent-kaurane diterpenoids from IEH. Bridgehead-unsubstituted 7,20-epoxy-ent-kaurane diterpenoids yielded ions with typical losses of R₇H, R₁H, R₁₄H, CH₂O, CO, and R₆H. The [M + NH₄ − NH₃ − R₂₀]⁺ precursor ions at 331.1895 and the characteristic ions at m/z 313.1792, 295.1686, 285.1842, 277.1581, 267.1737, and 249.1632 were the most possible fragmentation pathways for bridgehead-substituted 7,20-epoxy-ent-kaurane diterpenoids. Fragmentation with the successive loss of multiple 18, 42, or 60 Da occurring in the OH groups and OAc groups is characteristic of 7,20-non-epoxy-kaurane diterpenoids. Using accurate mass measurements for each precursor ion and the subsequent fragmented ions, a total of 94 ent-kaurane diterpenoids were identified or tentatively characterized in IEH, including 48 potentially new ent-kaurane diterpenoids. Full article

Background: Chronic Obstructive Pulmonary Disease (COPD) affects over 400 million people worldwide. Ireland reports the highest COPD-related mortality and hospitalizations in Europe. Dysphagia impacts approximately 50% of people with COPD (PwCOPD) and contributes to COPD exacerbations, hospitalizations, and mortality. Expiratory Muscle Strength Training (EMST) improves respiration and swallowing for PwCOPD; however, little is known about its clinical use by Speech-Language Pathologists (SLPs). Methods: A cross-sectional online survey, developed in accordance with CHERRIES and CROSS guidelines, aimed to explore SLPs awareness, assessment approaches, treatment protocols, training, and confidence in EMST delivery. It was distributed to SLPs working with adults with dysphagia in Ireland. Purposive and snowball sampling were used, with a target sample size of n = 258. Results: The response rate was 36%% (n = 92). Awareness of EMST was high (99%, n = 91). 53% (n = 49) reported using EMST. Among EMST users, 20% employed objective assessments of maximal expiratory pressure (MEP), while most calibrated devices to 75% of MEP and followed the “rule of fives” treatment protocol. 29% had formal training in EMST. SLPs with ≤10 years’ clinical experience and those working in acute hospitals used EMST most often. Confidence was influenced by training, experience, access to specialized respiratory equipment, and interdisciplinary team members. Conclusions: SLPs EMST awareness is high, but implementation practices remains variable, with low uptake of formal training and limited use of objective MEP assessment. Findings highlight the need for structured training and population-specific protocols to support consistent and confident EMST delivery for PwCOPD. Full article

Astroviruses are non-enveloped, positive-sense single-stranded RNA viruses known to infect various mammals and birds, including humans, often causing gastrointestinal disorders. In recent years, astroviruses have also been linked to neurological and respiratory diseases across several species, including ruminants, mink, deer, and other mammals. Notably, astrovirus infections in goats have been documented in countries such as Switzerland and China, where novel genotypes have been identified in fecal samples. However, their role in the context of disease remains unclear, and reports focusing solely on goat astrovirus in the United States have not been published. A necropsy case of a Boer goat kid with a history of diarrhea was submitted for investigation following death in January 2025. Fresh tissues were received and used for histopathology and enteric pathogen testing, including parasitic, bacterial, and viral workups. Metagenomic-based next-generation sequencing (mNGS) was also applied for this case. Histological examination revealed severe necrotizing enterocolitis. The small intestine exhibited epithelial ulcerations, villus atrophy, hyperplastic and dilated crypts with necrotic debris, few intraenterocytic coccidian parasites, and increased inflammatory cells in the lamina propria. The large intestine showed similar findings with pleomorphic crypt enterocytes. Standard enteric pathogen tests were negative except for aerobic culture that identified Escherichia.coli and Enterococcus hirae. mNGS and bioinformatic analysis identified a novel astrovirus in the intestinal content that showed the highest nucleotide identity (86%) to the sheep strain Mamastrovirus 13 sheep/HA3 from China based on BLAST analysis. Phylogenetic analysis indicated that the newly identified caprine astrovirus IL90175 clustered with astrovirus strains from small ruminants in Asia and Europe. This research reports the discovery, histopathologic features, and genetic characteristics of a gastrointestinal disease-causing astrovirus in a goat kid, which had not been previously described in the United States. Full article

The reasons for disease outbreaks caused by Actinobacillus pleuropneumoniae (APP) in vaccinated pigs are often unknown and remain a challenge for farmers and veterinarians. One hypothesis for APP vaccine failure is the timing of APP vaccination during field or vaccine-induced viremia with Porcine Reproductive and Respiratory Syndrome Virus (PRRSV), which may negatively affect the immune response to APP vaccination. In this study, fattening pigs were vaccinated with a modified live vaccine (MLV) against PRRSV either at the beginning of the fattening period (group G1) or six weeks later (group G2). All pigs were vaccinated against APP five days after the start of fattening, which coincided with MLV-PRRSV viremia in G1. Within both G1 and G2, four subgroups of pigs (n = 10) were vaccinated with three different APP vaccines or remained unvaccinated to assess serological responses to various APP antigens. MLV-PRRSV viremia had no significant effect on APP-ApxII (p = 0.127), APP-LPS (p = 0.120), or opsonophagocytic antibody responses on day 40 of fattening. Lung lesion scores at slaughter were significantly higher (p = 0.004) in pigs from G2 (1.82 ± 2.38) compared with those from G1 (0.65 ± 0.88). All APP vaccines elicited presumably protective opsonophagocytic antibodies. In conclusion, no effects of MLV-PRRSV viremia on serological responses following APP vaccination were observed. Full article

Background: Post-COVID-19 syndrome (PCS) is defined as the persistence or development of new symptoms 3 months after the initial infection with the SARS-CoV-2 virus, these clinical aspects being most often associated with functional respiratory changes, as well as imagistic modifications. This study aimed to evaluate longitudinal changes in pulmonary function among patients with PCS, in relation to the severity of the acute COVID-19 episode and the time elapsed since infection. Methods: A retrospective, observational study was conducted at the Clinical Hospital of Pulmonary Diseases Iași, Romania, between January 2021 and December 2022, including 97 adult patients with confirmed PCS. Demographic, clinical, and functional data were collected from medical records. Pulmonary function tests (PFTs) were performed according to ATS/ERS standards, assessing Forced Vital Capacity (FVC), Forced Expiratory Volume in the First Second (FEV₁), FEV₁/FVC ratio (Tiffeneau Index), Maximal Expiratory Flow at 50% and 25% of FVC (MEF50, MEF25), Diffusing Capacity of the Lung for Carbon Monoxide (adjusted for haemoglobin) (DLCO), Carbon Monoxide Transfer Coefficient (KCO), Alveolar Volume (AV), Total Lung Capacity (TLC) and Residual Volume (RV). Patients were grouped by time elapsed since infection (1–3, 4–7, 9–12, and up to 22 months). Statistical analyses included the Mann–Whitney U test, Spearman’s correlation, ROC curve analysis, and Principal Component Analysis (PCA). Results: A progressive improvement in FVC was observed up to 9–18 months post-infection (p < 0.05), while FEV₁ remained stable, suggesting a predominantly restrictive ventilatory pattern. Patients with moderate acute COVID-19 presented significantly lower FVC%, FEV₁%, DLCO%, and KCO% values compared with those with mild disease (p < 0.05). Diffusion abnormalities (DLCO and KCO) persisted beyond 12 months, indicating lasting alveolar-capillary impairment. ROC analysis identified TLC (AUC = 0.857), AV (AUC = 0.855), and KCO (AUC = 0.805) as the most discriminative parameters for residual dysfunction. PCA revealed three major functional domains—airflow limitation, diffusion capacity, and lung volume—explaining up to 70% of total variance. Conclusions: We are facing the emergence of a new phenomenon, namely a secondary post-COVID-19 pandemic of patients confronting with persistent post-COVID-19 symptoms who present with functional respiratory changes and who require careful monitoring in dynamics, personalized treatments and a multidisciplinary approach. Full article

Background: Lung carcinoids—typical and atypical—are rare neuroendocrine tumors (NETs) representing 1–2% of lung cancers. Despite clinicopathological differences, their clinical management often mirrors lung cancer protocols rather than NET-specific recommendations. Objectives: Portray a 12-year real-world experience with lung carcinoids at a Comprehensive Cancer Center, identifying gaps in diagnostic work-up, treatment decision-making, and follow-up. Methods: Retrospective observational cohort study of adult patients with histologically confirmed lung carcinoids diagnosed at IPO Porto between January 2013 and December 2024. Demographic, clinical, imaging, and treatment data were collected from electronic patient records. Analyses were descriptive. Results: Among 179 identified cases, 129 met eligibility criteria. Median age was 62 years (range 18–84); 53.6% were women and 53.5% were non-smokers; 84.5% had ECOG-PS 0–1. The most frequent presentation was respiratory symptoms (34.1%), followed by incidental findings (43.4%, of which ~20% were during staging or surveillance of other cancers). Typical carcinoids accounted for 49.6% and atypical for 43.4%. FDG-PET/CT was requested in 70.9% of cases, including many with typical carcinoid, and SSTR-PET/CT in 64.6% (dual PET in 38.8%). Most patients (65.1%) presented with stage I disease; 17.1% were stage IV. Mean time-to-first treatment was 83 days (range 1–259). Surgery was the first treatment option for 78.3% of patients. Conclusions: This real-world series highlights heterogeneity in diagnostic pathways, excessive FDG-PET use in typical carcinoids, and non-standardized follow-up. Dedicated multidisciplinary lung-NET boards and national reference centers are needed to homogenize and streamline patient management. Full article

Background/Objectives: Post-COVID-19 condition (PCC) remains poorly characterized beyond two years, particularly among intensive care unit (ICU) survivors. We aimed to describe the prevalence, persistence, and late consequences of PCC up to 32 months after discharge in an ICU cohort. Methods: This single-center longitudinal cohort included 170 adults with confirmed SARS-CoV-2 infection admitted to an ICU in Cáceres (Spain) between March 2020 and March 2021. 94 survivors entered follow-up at discharge and 3, 6, 12, 18, 24, and 32 months. PCC manifestations were grouped into five organ system domains (respiratory, cardiovascular, renal, infectious, and musculoskeletal/neuromuscular) and recorded only when supported by clinician-confirmed diagnoses or diagnostic tests. Prevalence at each visit, persistence, and new onset of manifestations between 3 and 6 months, and the cumulative incidence of new chronic diseases between 18 and 32 months were estimated with 95% confidence intervals. Results: Any PCC manifestation was almost universal at discharge (96.8% [95% CI, 91.1–98.9]) and remained high at 12 months (85.2% [95% CI, 76.3–91.2]), declining to 48.6% at 24 months and 25.7% at 32 months. Respiratory manifestations predominated early and were largely resolved by 32 months, whereas musculoskeletal/neuromuscular involvement remained relatively stable. From 18 to 32 months, 36.5% (95% CI, 26.4–47.9) of survivors developed at least one chronic condition, most frequently cardiovascular disease (14.9% [95% CI, 8.5–24.7]). Conclusions: Long-term PCC manifestations and incident chronic diseases are common among ICU COVID-19 survivors, underscoring the need for prolonged follow-up and post-ICU care. Full article

Background/objectives: RSV is a major cause of mortality in infants, and despite recent progress to prevent RSV in the very young, an RSV vaccine for this population is still highly warranted. Clinical studies in infants in the 1960s using formalin-inactivated RSV (FI-RSV) led to life-threatening enhanced respiratory disease (ERD). Therefore, a thorough safety assessment of RSV vaccine candidates intended for RSV seronegative infants is crucial. Methods: Prior to clinical pediatric development of Ad26.RSV.preF, an adenovirus type 26 vector-encoding RSV F protein stabilized in its prefusion conformation, predisposition to ERD was extensively assessed in cotton rat and mouse models. Results: Cotton rats intramuscularly immunized with a wide dose range of Ad26.RSV.preF, including low and sub-protective vaccine doses, and challenged with vaccine homologous RSV A2 or heterologous RSV B Wash 18537, did not show signs of predisposition to ERD. Histopathology scores for alveolitis, peribronchiolitis, interstitial pneumonia, and perivasculitis after challenge were significantly lower for Ad26.RSV.preF-immunized cotton rats compared to FI-RSV-immunized cotton rats and comparable to or lower than scores in cotton rats intranasally pre-exposed to RSV prior to challenge to mimic natural repeated infection. These results were observed in animals with or without viral replication in the lung after RSV challenge, in the presence or absence of vaccine-induced antibodies. Similar results were observed in mice, where more extensive assessment of mono- and polymorphonuclear cell alveolitis, mucus cell hyperplasia, and mucus accumulation was performed. Conclusions: Based on these extensive analyses, we conclude that there are no indications of ERD predisposition after Ad26.RSV.preF vaccination in rodent models, irrespective of the vaccine dose, challenge virus strain, or presence of viral replication in the lung. These results are crucial for the pediatric development of this vaccine. Full article

This study aimed to develop an immersive virtual reality (VR) program and conduct preliminary evaluation of its feasibility and learner perception for enhancing nursing students’ clinical practicum education. The VR program was designed using the ADDIE model (analysis, design, development, implementation, and evaluation) and implemented on the UNITY 3D platform. Expert evaluation was conducted through a VR application, and its effectiveness was further assessed among 25 fourth-year nursing students in terms of immersion, presence, and satisfaction. The expert evaluation yielded a mean score of 6.54 out of 7, indicating acceptable content validity. Among learners, evaluation demonstrated immersion at 42.28 ± 2.37 out of 50 (95% CI: 41.30–43.26), presence at 81.36 ± 7.32 out of 95 (95% CI: 78.34–84.38), and satisfaction at 13.48 ± 1.26 out of 15 (95% CI: 12.96–14.00). Overall, the developed VR program demonstrated acceptable expert validity and positive learner perceptions. These preliminary findings suggest feasibility as a supplementary practicum. However, the single-group design without control comparison and reliance on self-reported measures preclude conclusions about educational effectiveness. Full article

Curcumin, a natural polyphenol derived from turmeric, functions as a potent exogenous antioxidant and exhibits a range of benefits in the prevention and management of metabolic diseases. Despite its extremely low systemic bioavailability, curcumin demonstrates significant bioactivity in vivo, a phenomenon likely attributable to its accumulation in the intestines and subsequent modulation of systemic oxidative stress and inflammation. This article systematically reviews the comprehensive regulatory effects of curcumin on systemic metabolic networks—including glucose metabolism, amino acid metabolism, lipid metabolism, and mitochondrial metabolism—and explores their molecular basis, particularly how curcumin facilitates systemic metabolic improvements by alleviating oxidative stress and interacting with inflammation. Preclinical studies indicate that curcumin accumulates in the intestines, where it remodels the microbiota through prebiotic effects, enhances barrier integrity, and reduces endotoxin influx—all of which are critical drivers of systemic oxidative stress and inflammation. Consequently, curcumin improves insulin resistance, hyperglycemia, and dyslipidemia across multiple organs (liver, muscle, adipose) by activating antioxidant defense systems (e.g., Nrf2), enhancing mitochondrial respiratory function (via PGC-1α/AMPK), and suppressing pro-inflammatory pathways (e.g., NF-κB). Clinical trials have corroborated these effects, demonstrating that curcumin supplementation significantly enhances glycemic control, lipid profiles, adipokine levels, and markers of oxidative stress and inflammation in patients with obesity, type 2 diabetes, and non-alcoholic fatty liver disease. Therefore, curcumin emerges as a promising multi-target therapeutic agent against metabolic diseases through its systemic antioxidant and anti-inflammatory networks. Future research should prioritize addressing its bioavailability limitations and validating its efficacy through large-scale trials to translate this natural antioxidant into a precision medicine strategy for metabolic disorders. Full article

Respiratory diseases pose a significant threat to intensive pig farming, and cough recognition serves as a key indicator for early intervention. However, its practical application is constrained by the scarcity of labeled samples and the complex acoustic conditions of farm environments. To address these challenges, this study proposes a lightweight pig cough recognition method based on a pre-trained model. By freezing the backbone of a pre-trained audio neural network and fine-tuning only the classifier, our approach achieves effective knowledge transfer and domain adaptation with very limited data. We further enhance the model’s ability to capture temporal–spectral features of coughs through a time–frequency dual-stream module. On a dataset consisting of 107 cough events and 590 environmental noise clips, the proposed method achieved an accuracy of 94.59% and an F1-score of 92.86%, significantly outperforming several traditional machine learning and deep learning baseline models. Ablation studies validated the effectiveness of each component, with the model attaining a mean accuracy of 96.99% in cross-validation and demonstrating good calibration. The results indicate that our framework can achieve high-accuracy and well-generalized pig cough recognition under small-sample conditions. The main contribution of this work lies in proposing a lightweight fine-tuning paradigm for small-sample audio recognition in agricultural settings, offering a reliable technical solution for early warning of respiratory diseases on farms. It also highlights the potential of transfer learning in resource-limited scenarios. Full article

Background/Objectives: Chronic Obstructive Pulmonary Disease (COPD) is frequently associated with dyspnea, impaired health-related quality of life (HRQoL), and cognitive dysfunction. Although pulmonary rehabilitation (PR) is considered a core therapeutic strategy, its specific effects on cognitive function, dyspnea, and dysphonia remain unclear. This systematic review aimed to evaluate the impact of PR and respiratory or cognitive-focused rehabilitative interventions on dyspnea, quality of life, cognitive performance, and voice outcomes in adults with COPD. Methods: This review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251131325). A systematic search of PubMed, Scopus and Web of Science identified studies published between 2010 and 21 August 2025. Eligible designs included randomized and non-randomized controlled studies, cohort, and mixed-method studies involving adults with COPD undergoing rehabilitative interventions targeting dyspnea, cognition, dysphonia, or swallowing. Outcomes included cognitive measures, dyspnea scales, voice parameters, and HRQoL indices. Results: Twelve studies (n ≈ 810 participants) met inclusion criteria. Most PR and exercise-based programs showed improvements in global cognition and executive functions, particularly when combined with cognitive training or high-intensity exercise modalities. Dyspnea improved consistently following short- to medium-term PR or respiratory muscle training, whereas low-frequency long-term programs yielded limited benefit. HRQoL improved across structured PR programs, especially in multidimensional interventions. Only one study assessed dysphonia, reporting transient improvements in maximum phonation time following inspiratory muscle training. No included study evaluated dysphagia-related outcomes. Conclusions: PR and respiratory muscle training can enhance cognition, dyspnea, and HRQoL in COPD, although evidence for dysphonia remains scarce and dysphagia is entirely unaddressed. Future high-quality trials should adopt standardized outcome measures, include long-term follow-up, and integrate voice and swallowing assessments within PR pathways. Full article

Background/Objectives: Acute sinusitis (AS) is a common infection of the upper respiratory tract that places considerable clinical and economic burden worldwide. Although frequently encountered in practice, the factors that predispose individuals to AS remain poorly understood. This study examined how different respiratory disorders and comorbidities influence the likelihood of developing AS, aiming to clarify its underlying risk profile. Methods: A longitudinal analysis was performed using electronic health records from the Clinical Center of the University of Debrecen Hospital. The study cohort (2007–2022) encompassed 37,164 observations. To evaluate the risk of AS progression, Log-Rank tests and Cox proportional hazards regressions were applied whilst adjusting for covariates. Results: The risk of developing AS was significantly higher among individuals with preceding respiratory conditions. Patients with common cold demonstrated a 2.3-fold increased risk of developing AS (95% CI [1.51–3.40]). Compared to those without such disorders, participants with acute bronchitis had a 2.5-fold higher hazard of AS (95% CI 1.90–3.26). The strongest association was observed for allergic rhinitis (HR = 4.04, 95% CI 3.18–5.13), followed by chronic sinusitis (HR = 3.10, 95% CI 2.13–4.51). Chronic obstructive pulmonary disease was also identified as a significant predictor for AS (HR = 1.62, 95% CI 1.04–2.52), whereas dental pathologies were associated with a modest protective effect (HR = 0.69, 95% CI 0.48–0.97). Conclusions: Patients with allergic rhinitis, chronic sinusitis, acute bronchitis, common cold, or chronic obstructive pulmonary disease have a markedly higher risk of developing AS. Clinicians should actively screen for these conditions when assessing patients with recurrent or severe sinus infections. Early recognition and management of underlying respiratory disorders may reduce AS episodes, promote symptom control, and lessen healthcare burdens. Future research should concentrate on precision medicine to leverage AS preventive and management strategies. Full article

Even though environmental health and climate change are rapidly intensifying the severity of determinants of disease and inequity, training for health professionals in these areas remains fragmented across Europe. To address this gap, the European Medical Association (EMA), in collaboration with the European Network on Climate and Health Education (ENCHE), the International Network on Public Health and Environment Tracking (INPHET) and University College London, convened a one-day hybrid roundtable in London on 17 September 2025, focused on “Preparing Health Professionals for Environmental Health and Climate Change: A Challenge for Europe”. The programme combined keynote presentations on global and European policy, health economics and curriculum design with three disease-focused roundtables (respiratory, cardiovascular and neurological conditions), each examining the following topics: (A) climate and environment as preventable causes of disease; (B) healthcare as a source of environmental harm; and (C) capacity building through education and training. Contributors highlighted how environmental epidemiology, community-based prevention programmes and sustainable clinical practice can be integrated into teaching, illustrating models from respiratory, cardiovascular, surgical and neurological care. EU-level speakers outlined the policy framework (European Green Deal, Zero Pollution Action Plan and forthcoming global health programme) and tools through which professional and scientific societies can both inform and benefit from European action on environment and health. Discussions converged on persistent obstacles, including patchy national commitments to decarbonising healthcare, isolated innovations that are not scaled and curricula that do not yet embed sustainability in examinable clinical competencies. The conference concluded with proposals to develop an operational education package on environmental and climate health; map and harmonise core competencies across undergraduate, postgraduate and Continuing -professional-development pathways; and establish a permanent EMA-led working group to co-produce a broader position paper with professional and scientific societies. This conference report summarises the main messages and is intended as a bridge between practice-based experience and a formal EMA position on environmental-health training in Europe. Full article