Chikungunya fever is an arboviral disease caused by an alphavirus belonging to the family Togaviridae. It commonly presents with fever, severe arthralgia, rash, and myalgia, while severe pulmonary involvement causing acute respiratory distress syndrome (ARDS) is rare. We report a 62-year-old man with obesity, diabetes mellitus, hypertension, obstructive sleep apnoea, coronary artery disease, and interstitial lung disease, who presented with high-grade fever, severe arthralgia, facial puffiness, and rapidly progressive dyspnoea, following recent travel to Lucknow, India. On admission, he had severe hypoxemia with a PaO₂/FiO₂ ratio below 100, requiring mechanical ventilation. During intubation, he developed cardiac arrest but achieved return of spontaneous circulation after cardiopulmonary resuscitation. Chikungunya IgM and reverse transcriptase polymerase chain reaction (RT-PCR) were positive. Chest imaging showed diffuse bilateral infiltrates and ground-glass opacities consistent with severe ARDS. Dengue, malaria, and scrub typhus were excluded. The patient was managed with lung-protective ventilation, prone positioning, and corticosteroids according to the Meduri protocol with transient improvement. However, he later developed worsening respiratory failure and multiorgan dysfunction and eventually succumbed after 41 days of hospitalization. Although chikungunya is not typically considered a respiratory virus, clinicians should recognize that severe pulmonary manifestations, including ARDS, may occur, particularly in elderly patients with significant comorbidities.

The percentage of long-term survival in out‑of‑hospital cardiac arrest cases is remarkably low. One approach would be to increase the effectiveness of cardiopulmonary resuscitation (CPR), which is currently not measurable in a quantifiable way. The most significant challenge in providing a mobile solution for CPR evaluation is a mobile, hazard‑free sensor attachment with high usability. We present a sensor attachment solution usable for semiautomatic ultrasonic (US) Doppler measurements. Components are attached to a Stifneck Select Collar™ (Laerdal). An inflatable cushion (TR-Band™, Terumo) allows adjustable contact pressure. A clinical study was conducted in which the system was evaluated based on comfort, pain, sensor support, the viability of Doppler signals, and the absence of skin irritations. The system was utilized in a prospective study involving 102 healthy probands. On a scale between 1 (Low) and 10 (Intense), ratings were 1.19 (SD 0.46), 6.52 (SD 1.78), and 9.95 (SD 0.32) for pain, comfort, and support, respectively. The average duration of application was 31.19 minutes (SD 16.75 minutes). Audible Doppler signals were achieved in 92.2% of the probands, and Doppler curve evaluation was usable in 73.5%. No skin irritations were observed. A hands‑free sensor attachment for a US probe was developed that caused no significant complaints by healthy study volunteers. Medical users assessed its attachment as robust. With its adjustable positioning and easy attachment, the Stifneck modification can form a basis for a mobile US Doppler device, capable of evaluating carotid artery flow during CPR.

Brain ischemia is a leading cause of morbidity and mortality in the aging population, yet no effective neuroprotective interventions currently exist. This therapeutic gap stems from two key challenges: the inability to deliver neuroprotective drugs before reperfusion and limited understanding of post-reperfusion events leading to delayed neurodegeneration. Zn2+ is an important contributor to ischemic brain injury, with mitochondrial Zn2+ uptake playing a central role in its neurotoxic effects. Ongoing Zn2+ accumulation occurs through the mitochondrial Ca2+ uniporter (MCU) in selectively vulnerable CA1 neurons after transient ischemia, contributing to delayed mitochondrial dysfunction. We previously demonstrated that post-ischemic administration of the non-selective MCU antagonist, ruthenium red attenuated neuronal damage in both an ex vivo oxygen glucose deprivation (OGD) mouse brain slice model and in an in vivo rat cardiac arrest (CA) model. In the present study, we test post-ischemic treatment with Ru265, a novel selective MCU blocker, in both ischemic models. In the slice model, OGD induced delayed Zn2+ accumulation in CA1 neuronal mitochondria (as previously reported), followed by late-onset persistent mitochondrial depolarization and sustained elevation of cytoplasmic Ca2+ levels, indicating loss of Ca2+ homeostasis. Application of Ru265 after OGD termination inhibited the mitochondrial Zn2+ accumulation and largely prevented subsequent mitochondrial depolarization and loss of cytosolic Ca2+ homeostasis. In the CA model, intravenous Ru265 administration during cardiopulmonary resuscitation largely mitigated mitochondrial damage, markedly reduced neuronal injury and improved behavioral outcomes 20-24 hours after ischemia. These findings suggest that post-ischemic MCU blockade may constitute a promising neuroprotective therapeutic strategy.

Esomeprazole-induced anaphylactic shock followed by cardiac arrest is an extremely rare but life-threatening adverse event, particularly in patients with acute appendicitis. Clinical nursing experience in managing such critical conditions remains limited, and this case report provides valuable insights into emergency and intensive nursing care.

Medical education systems vary widely across countries, yet the structure of medical and postgraduate training in China remains relatively unfamiliar to international readers. China has developed a relatively comprehensive pathway spanning undergraduate education, postgraduate programs, standardized residency training, and standardized specialty training, thereby shaping an evolving framework that aims to integrate clinical practice with scientific research. Within this framework, postgraduate nephrology education highlights both clinical training and research development. In recent years, Critical Care Nephrology has demonstrated notable strengths in the management of critical illness, blood purification, and multidisciplinary collaboration. This review provides an overview of the development, current status, and future trends in medical and postgraduate nephrology education in China, with a particular focus on the emerging role of Critical Care Nephrology.