Chronic lung allograft dysfunction (CLAD) is the primary cause of late graft loss after lung transplantation, affecting up to half of lung transplant recipients within 5 years and presenting with heterogeneous phenotypes, most commonly bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome. Prevention and treatment of CLAD are challenging. This European Society for Organ Transplantation (ESOT) clinical practice guideline was developed by a multidisciplinary Task Force, including patient and allied healthcare representation, using systematic reviews and GRADE methodology. Eight key PICO questions addressing prevention and treatment of CLAD were evaluated. In terms of prevention, recommendations are in favor of using tacrolimus over cyclosporine, either mycophenolate or azathioprine, and azithromycin to reduce the risk of CLAD. Regarding treatment, montelukast could be considered in early-stage BOS. Current data are inconclusive in demonstrating benefits of anti-thymocyte globulin, alemtuzumab or extracorporeal photopheresis compared with standard of care, and do not support the use of antifibrotics in BOS. The Task Force emphasizes the urgent need for high-quality clinical trials and standardized care pathways in CLAD management.

Cystic fibrosis (CF) is a multisystem disease affecting epithelia of the respiratory tract, exocrine pancreas, intestine, hepatobiliary system, and exocrine sweat glands. Morbidities include progressive obstructive lung disease with bronchiectasis, frequent hospitalizations for pulmonary disease, pancreatic insufficiency and malnutrition, recurrent sinusitis and bronchitis, and male infertility. Pulmonary disease is the major cause of morbidity and mortality in CF. Meconium ileus occurs at birth in 15%-20% of newborns with CF. More than 95% of males with CF are infertile. Congenital absence of the vas deferens (CAVD) is generally identified during evaluation of infertility or as an incidental finding at the time of a surgical procedure. Hypoplasia or aplasia of the vas deferens and seminal vesicles may occur either bilaterally or unilaterally. Testicular development and function and spermatogenesis are usually normal.

Cough is a prominent and often persistent manifestation of chronic bronchitis (CB) that is frequently difficult to resolve. While Qi Feng Gu Biao Granules (QFGBG) is a traditional Chinese medicine commonly used to treat CB, its pharmacological basis for CB-related cough remains unclear.This study characterized the chemical profile of QFGBG by UPLC-Q-TOF/MS, evaluated its antitussive and anti-inflammatory effects in a rat model induced by lipopolysaccharide instillation combined with cigarette smoke exposure, and integrated network pharmacology, molecular docking, Western blotting, and plasma metabolomics to explore the underlying mechanism.QFGBG reduced cough frequency, prolonged cough latency, improved body-weight gain, and decreased the lung index and wet-to-dry ratio. Histological analyses showed attenuation of lung and tracheal inflammatory injury and mucus hypersecretion. QFGBG also decreased the expression of inflammatory and cough-related factors. Network pharmacology identified 215 overlapping QFGBG-CB targets, with enrichment in inflammatory and metabolic pathways, including the AGEs/RAGE signaling pathway. Molecular docking suggested favorable binding of core components, including Formononetin, Acacetin, and Vanillin, to key targets. Western blotting confirmed that QFGBG downregulated AGEs, RAGE, p-STAT1/STAT1、p-STAT3/STAT3. Metabolomics indicated regulation of glycerophospholipid and arachidonic acid metabolism. These findings suggest that the active components of QFGBG may alleviate CB-related cough by inhibiting the AGEs/RAGE signaling pathway and regulating arachidonic acid and glycerophospholipid metabolism, thereby reducing pulmonary and neurogenic inflammation and the release of cough-related mediators.

Infectious bronchitis virus (IBV) is a highly contagious avian coronavirus that causes substantial economic losses in poultry production due to respiratory disease, reduced performance, and impaired egg production. In Iran, IBV has been repeatedly reported over the past two decades; however, evidence on diagnostic approaches and circulating lineages remains fragmented. This systematic review aimed to summarize the available Iranian literature on the molecular epidemiology and genetic diversity of IBV in poultry. We conducted a comprehensive search for relevant papers that reported the identification or molecular characterization of infectious bronchitis virus in Iranian poultry using key scientific databases and associated resources. We included 32 studies published between 2003 and 2022. Most investigations were conducted in broiler flocks, and most studies used molecular diagnostic methods, with RT-PCR being the most frequently reported approach, followed by real-time RT-PCR and nested RT-PCR; ELISA was used in a limited number of studies. Diverse circulating lineages were reported; GI-1 (Massachusetts-type), GI-13 (793/B-type), GI-19 (QX-like), and GI-23 (Variant-2/IS-1494/06-like) strains were often documented, suggesting co-circulation of many lineages in Iranian poultry populations. Genotype reporting was inconsistent across studies, and several investigations lacked complete molecular characterization. Additionally, quantitative synthesis of prevalence estimates could not be performed because the extracted dataset did not consistently report denominators (sample size) and numbers of positive samples. Overall, the evidence suggests sustained circulation of genetically diverse IBV lineages in Iran, supporting the need for continuous molecular surveillance, harmonized reporting, and vaccination strategies aligned with locally circulating strains to improve control of infectious bronchitis in Iranian poultry.

Infectious bronchitis virus (IBV) remains one of the major respiratory pathogens affecting broiler production, compromising performance, respiratory integrity, and immune function. This study evaluated the effects of a water-soluble additive containing eucalyptus, camphor, mint, and copaiba essential oils administered either by environmental spraying or through the drinking water to broilers subjected to an experimental IBV challenge. A total of 280 one-day-old Cobb 500 male broilers were allocated to four treatments: nonchallenged control, IBV challenge (challenged untreated group), IBV challenge plus soluble additive by spraying, and IBV challenge plus soluble additive via drinking water. Birds were challenged at 8 d of age using a 10-fold dose of the attenuated Massachusetts H120 vaccine strain, whereas the essential oil additive was administered from 9 to 13 d of age. Growth performance, antibody titers, carcass yield, relative organ weights, tracheal and spleen histology, tracheal antioxidant metabolism, and expression of genes related to immunity, oxidative stress, and epithelial barrier integrity were evaluated until 35 d of age. The experimental challenge affected productive performance, including final body weight (P = 0.0369) and feed conversion ratio (P = 0.0441), and reduced breast yield, with the control group showing a higher breast yield (27.46 %) than the challenged untreated group (24.98 %). Antibody titers differed among treatments at 16 and 35 d (P < 0.0001), with higher titers observed in challenged birds receiving the soluble additive; however, these differences indicate an altered serological response rather than evidence of enhanced protection. Qualitative histological evaluation revealed alterations in tracheal and splenic tissues following the experimental challenge, whereas additive-treated birds showed less pronounced tissue alterations. The additive was also associated with changes in oxidative status, including lower lipid peroxidation and differences in total superoxide dismutase activity, as well as modulation of genes involved in innate immune signaling and epithelial barrier function. Overall, the soluble essential oil additive modulated selected physiological, serological, oxidative, and molecular responses in broilers subjected to an experimental challenge with the attenuated H120 strain. However, the absence of a nonchallenged group receiving the additive limits the ability to distinguish challenge-dependent responses from the independent effects of the additive.

Bacterial pneumonia in horses typically occurs secondary to predisposing factors that compromise defence mechanisms. This 10-year retrospective study evaluated bacterial pneumonia in 81 horses treated at the equine clinic of Freie Universität Berlin from January 2015 to December 2024. Horses infected with primary pathogens such as Rhodococcus equi or Streptococcus equi ssp. equi were not included in the study. The most common predisposing events were aspiration, mainly following oesophageal obstruction (37.0%), post-anaesthetic disease (27.2%), primary respiratory signs (24.7%), and other conditions (11.1%). Horses with aspiration were significantly older than the "other" groups. Tachypnoea, tachycardia, and fever were common but not universal. Bronchopneumonia was the most frequent diagnosis overall and predominated after aspiration, whereas pleuropneumonia was more common after general anaesthesia and in horses with primary respiratory signs. Bacteriological examinations were performed in 51 horses. Mixed infections were common, and Streptococcus equi ssp. zooepidemicus was frequently isolated. Resistant isolates were detected in most tested cases, and multidrug resistance was especially common in post-anaesthetic horses. Overall survival to discharge was 77.8% and did not differ significantly between predisposing events. However, initial lymphopenia, pleural effusion, and the need for thoracic drainage were associated with reduced survival. Anaerobic bacterial isolation, pulmonary abscessation, and diagnosis were associated with readmission because of respiratory signs. Most survivors had acceptable long-term outcomes, although recurrent respiratory signs were common.

Respiratory syncytial virus (RSV) remains a leading cause of lower respiratory tract infection (LRTI) and hospitalization in early infancy. Following the introduction of universal nirsevimab prophylaxis in Italy during the 2024-2025 RSV season, we evaluated its real-world effectiveness against RSV-associated hospitalization and severe clinical outcomes within a test-negative design framework. We conducted a multicenter retrospective test-negative study across 88 Italian neonatal centers, including infants hospitalized for LRTI from 1 September 2024 to 30 April 2025. Clinical data were collected from hospital records using a standardized electronic questionnaire. RSV-positive hospitalized infants were considered cases, and RSV-negative hospitalized infants served as controls. Secondary outcomes included respiratory support and Neonatal Intensive Care Unit (NICU) admission. Effectiveness was estimated using multivariable logistic regression and targeted maximum likelihood estimation. Overall, 737 infants were included, of whom 306 (41.52%) had previously received nirsevimab. RSV infection was identified in 398 infants (54.00%), including 104/306 (33.99%) nirsevimab-immunized and 294/431 (68.21%) non-immunized infants (p < 0.001). Immunized infants also required respiratory support less frequently (55.23% vs. 70.07%; p < 0.001), with lower use of high-flow oxygen therapy (40.85% vs. 48.96%; p = 0.036) and Continuous Positive Airway Pressure (CPAP) (18.95% vs. 33.87%; p < 0.001). Within the test-negative design framework, adjusted effectiveness against RSV-associated hospitalization was estimated at 78.3%. Among hospitalized infants, previous nirsevimab immunization was additionally associated with adjusted relative reductions in the odds of respiratory support and NICU admission of 80.2% and 64.3%, respectively. In conclusion, among infants hospitalized for LRTI in routine Italian clinical practice, previous nirsevimab immunization was associated with lower odds of RSV positivity and a reduced need for respiratory support. Although these findings provide further evidence of the real-world effectiveness of nirsevimab against severe RSV disease, further studies are needed to provide direct estimates of hospitalization incidence in immunized and non-immunized source populations.

Background/Objectives: Feeding difficulties are common during bronchiolitis hospitalization and may lead to reduced caloric intake. Evidence evaluating the relationship between caloric adequacy and hospital length of stay (LOS) remains limited. We aimed to characterize daily caloric adequacy during bronchiolitis hospitalization and evaluate its relationship with LOS. Methods: An ambispective cohort study included children younger than 2 years hospitalized with bronchiolitis between 2013 and 2023 at a tertiary hospital in Valencia, Spain. Caloric adequacy was calculated as the percentage of WHO/FAO estimated caloric requirements achieved, including all nutritional and intravenous caloric sources. Associations with LOS were evaluated using correlation and multivariable regression analyses. Results: A total of 613 patients were included, with caloric intake data available for 607. Median LOS was 5 days (IQR 3-7). Lower caloric adequacy during the first days of hospitalization was associated with longer LOS. Hospitalization day 2 showed the strongest early association with LOS (ρ = -0.230; p <0.001). After multivariable adjustment, each 10-percentage-point increase in day-2 caloric adequacy was associated with a 3.32% shorter LOS (95% CI, 1.74-4.87%; p < 0.001); subgroup associations were mainly observed in children younger than 12 months and were strongest in those with moderate acute malnutrition. Patients with longer LOS showed delayed achievement of ≥80% caloric adequacy, particularly those with LOS ≥ 9 days (day 6). Conclusions: Early caloric adequacy was associated with LOS in children hospitalized with bronchiolitis. Failure to achieve ≥80% within the first 48 h may serve as an early marker of a slower clinical course.

Background and Objectives: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide and represents a major contributor to the global burden of disease. According to the World Health Organization it is the third leading cause of death worldwide and the seventh leading cause of poor health worldwide. Our aim was to evaluate the effectiveness of active case finding of COPD in Romanian primary care through the COPD Assessment Test (CAT) and the Modified Medical Research Council (mMRC) dyspnea scale and post-bronchodilator (post-BD) spirometry. Materials and Methods: A prospective active case-finding study was conducted among 220 proactively selected patients with an age over 40 years and a documented history of at least one major respiratory risk factor. The study enrolled patients from one General Practitioner (GP) office. The exclusion criteria were malignancies and previously diagnosed obstructive disease. Demographics, tobacco exposure, clinical history and validated case-finding questionnaires (CAT and mMRC) were recorded. All participants underwent diagnostic post-bronchodilator spirometry. Airflow limitation was defined as a post-bronchodilator FEV1/FVC <0.70. The statistical analysis was performed with The Statistical Package for the Social Sciences version 27 (SPSS, Chicago, IL, USA). Results: Spirometry confirmed a positive COPD diagnosis in 48.2% (n = 106) of the study cohort. Severity staging revealed that 34.9% met criteria for GOLD 1 (Mild), 49.1% for GOLD 2 (Moderate), 15.1% for GOLD 3 (Severe), and 0.9% for GOLD 4 (Very Severe). Smoking history (p < 0.001) was significantly higher in the COPD group. While the mMRC scale at a cut-off ≥2 demonstrated excellent diagnostic specificity (82.5%), its low sensitivity (41.5%) means that relying solely on breathlessness in primary care questionnaires would result in missing probably more than half of the patients with a positive diagnosis. In contrast, the CAT score at a threshold ≥17 offers a more balanced trade-off (64.2% sensitivity, 74.6% specificity) for active case finding of COPD patients. Discussion: The findings of this study acknowledge the clinical utility of using validated questionnaires in active case finding of COPD in Romanian primary care. A comprehensive evaluation of symptoms-incorporating cough, sputum production, and sleep impact-provides a much more reliable clinical trigger for diagnostic spirometry than dyspnea alone. While tobacco smoking remains the predominant driver of airflow limitation in our cohort, the identification of obstruction in 4.7% of never-smokers acknowledges the clinical necessity of accounting for non-smoking risk factors, occupational dust, environmental exposures and documented histories of recurrent winter bronchitis, persistent morning cough, or unexplained sputum production. In the study cohort, a CAT score ≥17 showed the best observed balance between sensitivity and specificity; this threshold should be considered cohort-specific and requires external validation before being adopted as a universal screening cut-off. This study had limitations, including the small, single-center sample size, which may limit generalization to the Romanian population. Conclusions: The results support the implementation of a targeted active case-finding strategy in Romanian primary care. These findings support further evaluation of targeted case-finding strategies incorporating symptom burden and smoking exposure as well as algorithms like spirometry on individuals over 40 who present with a CAT score ≥ 17, or a tobacco history.

Avian infectious bronchitis virus (IBV) is widely distributed worldwide and causes substantial economic losses to the poultry industry. Because IBV undergoes frequent mutation, prevention and control of infection remain challenging. Immunization is an important measure for the prevention and control of IB. Therefore, there is an urgent need for a rapid, sensitive, specific, and convenient method for the detection of antibodies against IBV. In this study, we firstly developed an indirect colloidal gold immunochromatographic strip for the rapid detection of antibodies against IBV based on a conserved epitope peptide. The recombinant epitope peptide recognized by N2D5 monoclonal antibody (mAb) against the N protein of IBV was expressed as a GST fusion protein (GST-N2D5) based on the conserved antigenic epitope previously identified in our laboratory. Colloidal gold-labeled GST-N2D5 was used as the detection reagent to generate visual signals. Rabbit anti-chicken IgY and mouse anti-GST mAb were immobilized on the nitrocellulose membrane as the test line (T line) and control line (C line), respectively. The optimal pH and optimal protein concentration for conjugation of gold nanoparticles (AuNPs) with GST-N2D5 were pH 8.5 and 72 µg/mL, respectively. Specificity was evaluated using common avian pathogens, and no cross-reactivity was observed. The detection limit of the strip for IBV-positive serum was 1:180. In addition, the assay showed good reproducibility and stability, and results could be observed within 5 min without any specialized equipment. Clinical chicken serum samples were tested using both the developed strip and an enzyme-linked immunosorbent assay (ELISA), and the strip showed high agreement with the ELISA. In conclusion, the established immunochromatographic strip is rapid, sensitive, specific, and easy to operate, and therefore has potential as an on-site tool for the rapid detection of antibodies against IBV, particularly in resource-limited settings.

Background/Objectives: Periodontal inflammation has been implicated in respiratory disease, but longitudinal evidence regarding chronic bronchitis (CB) remains limited. This study examined the association between claims-based periodontal status and newly recorded CB in a nationally representative Korean cohort. Methods: This retrospective cohort study used Korean National Health Insurance Service-National Sample Cohort data from 2002 to 2015. Periodontal status was assessed during 2002-2004, and 189,274 adults were followed during 2005-2015. Participants were classified as No PD, Gingivitis (K05.0-K05.1), or Periodontitis-related (K05.2-K05.6). Periodontal treatment was defined as recorded scaling or root planing. Cox models estimated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). Results: During follow-up, 52,955 participants (28.0%) had newly recorded CB. Periodontitis-related diagnoses were associated with a modestly higher CB risk than No PD (aHR = 1.05, 95% CI = 1.02-1.08), whereas Gingivitis was not (aHR = 1.01, 95% CI = 0.99-1.03). The association was observed among adults aged 40-59 years (aHR = 1.06, 95% CI = 1.02-1.11) and those without recorded periodontal treatment (aHR = 1.08, 95% CI = 1.03-1.12). No significant association was observed among treated participants (aHR = 0.86, 95% CI = 0.74-1.01). Conclusions: Periodontitis-related diagnoses were associated with a small increase in newly recorded CB risk, whereas Gingivitis was not. Treatment-stratified findings were exploratory and should not be interpreted as evidence that periodontal treatment prevents CB.

Pathological changes and viral presence in the bursa of Fabricius (BF) have been reported, but the immunosuppression of infectious bronchitis virus (IBV) remains poorly characterized. Here, we systematically evaluated the pathogenicity of two GI-19 lineage IBV isolates, CK/CH/FJ-B3/2023 (bursal origin) and CK/CH/FJ-T5/2023 (tracheal origin), in 7-day-old specific pathogen-free (SPF) chicks, including further assessments of serum cytokines and the bursal apoptosis. We further assessed the impacts of these two IBV isolates on the Newcastle disease virus (NDV) inactivated vaccine-induced hemagglutination inhibition (HI) antibody response. This study reveals that both GI-19 lineage IBV isolates, which originated from the recombination of the 4/91 vaccine strain, exhibit bursa-tropism, inducing bursal pathological atrophy, prolonged viral detection [up to 35 days post-infection (dpi)] and delayed seroconversion until 14 dpi. Notably, IBV infection induces humoral immunosuppression in SPF chickens, evidenced by a ≥ 1log2 reduction in NDV-HI antibody titers at 14 and 28 dpi, with antibody production recovering to normal levels by 35 dpi. This is accompanied by a sustained systemic proinflammatory response characterized by persistent upregulation of tumor necrosis factor-α (TNF-α), interleukin 1β (IL-1β), IL-6, and interferon-gamma (IFN-γ) in the serum of infected chicks up to 28 dpi. Early-onset bursal apoptosis was detected as early as 1 dpi, with the bursal apoptosis index significantly higher than that of the negative control throughout the observation period. These findings highlight the humoral immunosuppression induced by IBV variants. Further characterization of IBV types is warranted to elucidate IBV immunosuppressive mechanisms.