BackgroundDysregulated breathing is a major cause of persisting breathlessness for many people following acute COVID-19 illness. There is little evidence to support the use of breathing interventions within this population.MethodsA feasibility study was conducted to investigate the potential role of supervised, remote online yogic breathing as an intervention, compared to usual care. The intervention was a six-week group programme, in which they were encouraged to attend bi-weekly. Primary outcomes of attendance, completion and acceptability were recorded and a survey following the intervention. Secondary measures of breathlessness and physical function were collected.ResultsOf 122 people invited who had reported dysregulated breathing at the time of clinical consult, 40 consented and 34 were randomised (Intervention n=17, usual care n=17), 33 had initial assessment (n=16 and n=17) and with post-intervention outcomes available in n=13 and n=14, respectively. Of the 13 in the intervention arm, 5 people completed >75% of sessions and the post intervention assessment. The median number of sessions attended per participant was 7. No safety issues were recorded. The survey (n=13) of the actual intervention highlighted it was well received but there was limited options for attending. Although some breathlessness measures improved in the people receiving the intervention, there was no significant difference when comparing the intervention to usual care arms.ConclusionsThe feasibility of the study was limited in this select population of people after COVID-19 with dysregulated breathing. The intervention was well received, but attendance at all the sessions was challenged by the limited options for the sessions.

This study extracted radiomics features of blood clots from computed tomography pulmonary angiography (CTPA) images of acute pulmonary embolism (APE) patients, and constructs a predictive model for APE patient risk stratification by comparing multiple machine learning (ML) algorithms. This retrospective study analyzed patients with APE, documenting their clinical characteristics (clinical and hematological indicators), conventional CTPA imaging parameters. Patients are stratified into low-risk group and high-risk group based on risk stratification. The data were randomly divided into a training cohort and a validation cohort in a 7:3 ratio. We developed 2 distinct models: nomogram model based on clinical characteristics and an image parameter model based on conventional CTPA imaging parameters. Features were screened by the least absolute shrinkage and selection operator (LASSO) method. The radiomics predictive model was constructed using 7 ML algorithms and selected the one with the best performance.The combined model was constructed by integrating radiomics features with clinical characteristics and image parameter using an optimal algorithm. Model performance was evaluated using receiver operating characteristic curves and decision curves analysis, with the area under the curve (AUC) compared via the DeLong test. A total of 202 patients were included. The training cohort contained 141 cases, while the validation cohort included 61 cases. Multivariate logistic analysis revealed that the pulmonary embolism severity index, dyspnea, troponin, and right ventricle/ left ventricle short-axis maximum diameter ratio were independent clinical predictors (P < .05). A total of 12 radiomics features were selected through LASSO screening. Logistic regression demonstrated the best performance among the 7 ML algorithms. In the validation cohort, the combined model demonstrated significantly superior predictive performance (AUC = 0.935) compared to the nomogram model (AUC = 0.805), the image parameter model (AUC = 0.788), and the radiomics model (AUC = 0.860) (P < .05). Decision curve analysis indicated that the combined model demonstrated higher clinical net benefit when the risk threshold exceeded 0.04. Calibration curves and Hosmer-Lemeshow test further confirmed the combined model's goodness of fit in both the training and validation cohorts. The combined model combining clinical characteristics, conventional CTPA imaging parameters, and radiomics features demonstrated outstanding predictive performance and clinical applicability in risk stratification for APE patients.

Objective: To analyze the clinical diagnosis and treatment strategies for acquired tracheoesophageal fistula (aTEF) and bronchoesophageal fistula (aBEF) in children, and explore the value of interventional bronchoscopy in their management. Methods: A case series study analyzed the clinical data of 9 pediatric patients with aTEF and aBEF admitted to the Departments of Respiratory Interventional and Gastroenterology, Children's Hospital Affiliated to Shandong University, from February 2014 to July 2025. The clinical features, diagnostic and therapeutic processes, and treatment outcomes were summarized. Results: Among the 9 patients, 7 were male and 2 were female, the age of onset was 1.7 (1.0, 4.0) years. Etiologies included esophageal corrosive injury due to button battery ingestion (4 cases), and 1 case each of esophageal corrosive injury from caustic alkali ingestion, esophageal perforation by foreign body, fall from height, neck stab wound, and iatrogenic injury.Clinical manifestations: 6 cases of dyspnea, 5 cases of recurrent cough and choking during feeding. There were 6 cases of aTEF and 3 cases of aBEF. Seven patients underwent interventional therapy via bronchoscopy or gastrointestinal endoscopy: 4 cases received covered metallic stent placement via bronchoscopy for fistula occlusion, 1 case underwent titanium clip closure via gastroscopy, 1 case underwent mucosal deepithelialization combined with titanium clip closure via gastroscopy, and 1 case received combined bronchoscopic stent placement, epidermal growth factor injection, and gastroscopic titanium clip closure. Seven patients underwent surgical treatment, including aTEF or aBEF repair in 6 cases, gastric fundoplication with gastrostomy in 2 cases, and jejunostomy in 1 case. Conclusions: The management of aTEF, aBEF in children is challenging. For patients presenting with respiratory symptoms, palliative interventions such as airway-covered stent placement or gastroscopic fistula clip closure can be considered to occlude the fistula. A multidisciplinary collaborative approach is essential for managing children with aTEF, aBEF, improve nutrition and manage complications to enhance the quality of life of the pediatric patients.

BACKGROUND Autoimmune hemolytic anemia (AIHA) is characterized by immune-mediated premature red blood cell destruction. Although AIHA has been reported after solid organ transplantation, it remains uncommon, and very late-onset presentations occurring decades after transplantation are rare. Both warm and cold AIHA have been reported after transplant. Reported etiologies include immune dysregulation, infections, post-transplant lymphoproliferative disorders, and medication-associated immune hemolysis, including calcineurin inhibitor-related effects. CASE REPORT A 30-year-old woman with orthotopic liver transplantation at age 9 for biliary atresia, on long-term tacrolimus, presented 21 years after transplant with exertional dyspnea and symptomatic anemia. Laboratory evaluation revealed severe anemia with biochemical evidence of hemolysis, including undetectable haptoglobin and reticulocytosis. A direct antiglobulin test was positive for IgG, confirming warm autoimmune hemolytic anemia. Antibody identification revealed a warm autoantibody, and crossmatch-compatible red blood cells were transfused without reaction. Extensive evaluation excluded gastrointestinal bleeding, infection including Epstein-Barr virus, post-transplant lymphoproliferative disorder, and thrombotic microangiopathy. She was treated with high-dose corticosteroids with partial response, followed by early rituximab due to persistent hemoglobin instability. The tacrolimus dose was modestly reduced but not discontinued. Bone marrow biopsy excluded hematolymphoid malignancy. The patient achieved complete remission with normalization of hemoglobin and hemolysis markers after 4 rituximab doses and steroid tapering. CONCLUSIONS Warm autoimmune hemolytic anemia can present decades after solid organ transplantation and should be considered in transplant recipients with unexplained anemia. Remission can be achieved with corticosteroids and early rituximab without discontinuation of tacrolimus. Further studies are needed to clarify optimal treatment strategies for late-onset post-transplant AIHA, including the role of early rituximab.