We report a case of a 45-year-old man presenting with hypotension, hyponatremia, hyperkalemia, hypoglycemia and diffuse hyperpigmentation. Monitoring serum cortisol was 0.5 μg/dL, and the computerized tomography (CT) scan showed bilateral adrenal enlargement, consistent with primarily adrenal insufficiency (AI) likely due to adrenal tuberculosis (TB). There was no active pulmonary TB. This case underscores the diagnostic delay and management challenges of TB-related AI in resource-limited settings. Even today, clinicians should remain aware of AI due to TB in resource-limited settings.

The coexistence of preeclampsia and uncontrolled thyrotoxicosis leading to acute respiratory failure is rare and poses significant diagnostic and therapeutic challenges, particularly with respect to safe fluid management in the obstetric intensive care setting. We report the case of a 35-year-old woman at 37-week gestation who presented with progressive dyspnea, acute pulmonary edema, and fetal distress, necessitating emergency cesarean section and subsequent intensive care admission. Point-of-care ultrasound (POCUS) demonstrated impaired left ventricular systolic function (ejection fraction 40%), reduced left ventricular outflow tract velocity time integral (LVOT VTI 10-11 cm), a dilated inferior vena cava, and diffuse pulmonary B-lines, consistent with volume overload and compromised forward cardiac output. Serial POCUS-guided assessments were used to titrate diuretic therapy and optimize mechanical ventilation, resulting in progressive improvement in LVOT VTI (up to 20 cm), resolution of pulmonary edema, achievement of negative fluid balance, and clinical recovery. The patient was successfully extubated on day 5 and discharged home on day 7. This case demonstrates the clinical utility of POCUS, particularly serial LVOT VTI measurements, in providing actionable, dynamic bedside data to safely guide fluid management when static hemodynamic indices are unreliable, highlighting the value of POCUS in complex high-risk obstetric critical care.

Objective: To develop an interpretable machine learning model to predict the risk of respiratory failure in patients with pneumoconiosis. Methods: In February 2025, based on the retrospective West China Occupational Pneumoconiosis Cohort, 1367 hospitalized pneumoconiosis patients in West China Fourth Hospital of Sichuan University from January 1, 2012 to November 30, 2021 were selected as the research objects. Predictive variables were selected using least absolute shrinkage and selection operator (LASSO) -Cox regression. Four machine learning models, including random survival forest model (RSF), gradient boosting survival model (GBM), extreme gradient boosting survival model (XGBoost), and survival support vector machine (SSVM), as well as a traditional Cox proportional hazards regression model (CPH) were constructed. The performance of the model was evaluated using the concordance index (C-index), Brier score, area under the curve (AUC) of the receiver operating characteristic curve, and decision curve analysis (DCA). Shapley additive explanations (SHAP) were used to analyze the interpretability of the model. The stability of the model was tested using an external validation set. Results: The median follow-up time for pneumoconiosis patients was 2.69 years. During the follow-up period, 197 patients were complicated with respiratory failure, and the cumulative incidence rate was 14.41%. Fifteen variables were selected by LASSO-Cox regression and included in the prediction models, mainly including age, pneumoconiosis stage, albumin, and concurrent pulmonary hypertension. The model evaluation results showed that the C-index of the GBM model in the test set was 0.794, the Brier score was 0.044, and the 3-year AUC was 0.788, with better performance than other models. DCA showed that in the probability range of 0% to 50%, the GBM model had a high clinical net benefit in predicting the risk of respiratory failure. In the external validation, the C-index of the GBM model was 0.644. The top three influential factors in the SHAP feature importance ranking were pneumoconiosis stage, age, and body mass index. Conclusion: The prediction model for the concurrent respiratory failure in pneumoconiosis patients constructed based on GBM has high reliability and accuracy.

BackgroundInferior vena cava filter (IVCF) is used to prevent pulmonary embolism (PE) due to deep vein thrombosis (DVT), and some filters are indwelling for a long time, which increase the risk of thrombotic events. Single-channel anticoagulation is still inadequate in the prevention of thrombosis. This study aims to explore the efficacy and safety of rivaroxaban combined with aspirin versus rivaroxaban alone in the prevention of thrombotic events in patients with long-term IVCF implantation.MethodsA retrospective analysis was conducted on patients with long-term IVCF implantation in the two centers from August 2021 to October 2024. Among them, 58 cases were in the single-channel (SC) group, who only took rivaroxaban orally after surgery, and 61 cases were in the dual-channel (DC) group, who took rivaroxaban and aspirin orally after surgery. The follow-up period was 12 months. The primary endpoint was the incidence of combined venous thromboembolism (VTE). The secondary endpoints were the recurrence rate of lower extremity DVT, the incidence of IVCF thrombosis (IVCFT), PE, and adverse events, Venous Clinical Severity Score (VCSS) and Chronic Venous Insufficiency Questionnaire (CIVIQ-20).ResultsThe incidence of combined VTE in Group SC (14/58, 24.1%) was higher than that in Group DC (6/61, 9.8%) (HR: 0.38, 95% CI: 0.14-0.98, P=0.037). The incidence of IVCFT, VCSS and CIVIQ-20 at 12 months in Group SC were higher than those in Group DC. There were no significant differences in the incidence of DVT recurrence, PE, bleeding-related adverse events, and all-cause mortality between the two groups.ConclusionFor patients with long-term IVCF implantation, compared with rivaroxaban alone, the dual-channel inhibition of rivaroxaban combined with aspirin may reduce the occurrence of thrombotic events, alleviate clinical symptoms and improve the quality of life of patients, without increasing the risk of adverse events such as bleeding.

Background: Sarcopenia and frailty are highly prevalent extrapulmonary manifestations of chronic obstructive pulmonary disease (COPD) and are strongly associated with reduced exercise tolerance, exacerbation risk, hospitalizations, and mortality. Beyond inflammation, oxidative stress, and physical inactivity, emerging evidence highlights nutrition as a major modifiable driver of muscle deterioration in COPD. Nutritional deficits impair anabolic signaling, exacerbate proteolysis, worsen mitochondrial dysfunction, and contribute to frailty progression. Methods: This narrative review synthesizes evidence from PubMed, Embase, Scopus, and Web of Science up to 2025, integrating mechanistic, metabolic, nutritional, and biomarker-related pathways underlying muscle dysfunction in COPD. Studies examining inflammation, hypoxemia, oxidative stress, hormonal imbalance, nutrition, and emerging biomarkers were included. Results: COPD-related sarcopenia results from converging inflammatory (TNF-α, IL-6), catabolic (FOXO, UPS), metabolic, and vascular mechanisms, compounded by energy deficiency, protein insufficiency, and micronutrient deficits. Inadequate intake of protein, vitamin D, antioxidants, and omega-3 fatty acids increase anabolic resistance, enhance muscle catabolism, and worsen frailty. Nutritional interventions, particularly high-protein supplementation, leucine-enriched formulas, vitamin D repletion, omega-3 fatty acids, and multimodal nutrition-exercise programs, demonstrate benefits in muscle mass, strength, and physical performance. Biomarkers such as GDF-15, CAF22, and specific microRNAs reflect nutritional status and correlate with muscle health in COPD. Conclusions: Sarcopenia and frailty in COPD arise from a complex interplay of inflammatory, metabolic, nutritional, and lifestyle-related factors. Integrating nutritional assessment and targeted dietary interventions with exercise and pulmonary rehabilitation is essential to counteract anabolic resistance and improve functional outcomes. Advances in biomarker research may support earlier diagnosis and personalized nutrition-based therapeutic strategies.

Background and Objectives: To evaluate the prognostic value of end-tidal carbon dioxide (ETCO2), arterial carbon dioxide (PaCO2), their difference (ΔCO2 = PaCO2-ETCO2), and the ETCO2/PaCO2 ratio for 30-day mortality in adult patients intubated for acute respiratory failure in the emergency department (ED). Materials and Methods: In this single-center, prospective observational study, we enrolled consecutive adults intubated in the ED who had at least two paired arterial blood gas and capnography measurements within 90 min post-intubation. PaCO2 and ETCO2 were recorded at 0, 30, 60, and 90 min, and ΔCO2 and ETCO2/PaCO2 were calculated at each time point. Between-group comparisons, repeated-measures analyses, and logistic regression were used to explore associations, and prognostic performance was assessed using receiver operating characteristic curves. Results: Among 100 patients (36% female); 30- and 90-day mortality were 64% and 70%, respectively. Non-survivors were older, had lower mean arterial pressure after intubation, higher inflammatory and coagulation markers, and more frequent pneumonia and pulmonary embolism. ETCO2 values were consistently lower in non-survivors at 0, 30, and 60 min, while PaCO2 was also lower at early time points. ΔCO2 and the ETCO2/PaCO2 ratio did not differ between survivors and non-survivors. Among all CO2 metrics and time points, only ETCO2 showed low-to-moderate discrimination for 30-day mortality (area under the curve 0.65-0.70). Conclusions: In ED patients emergently intubated for acute respiratory failure, absolute ETCO2 values in the early post-intubation period provide modest prognostic information for short-term mortality, whereas ΔCO2 and ETCO2/PaCO2 do not appear to add prognostic value beyond ETCO2 alone.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive disease that occurs due to fibrotic remodeling of the pulmonary vessels. This leads to increased pressure overload onto the right ventricle, resulting in complications such as heart failure. Pulmonary endarterectomy (PEA) remains the gold standard of treatment for CTEPH, yet many patients experience life-threatening perioperative complications, including refractory right ventricular failure, reperfusion pulmonary edema, and endobronchial hemorrhage. Extracorporeal membrane oxygenation (ECMO) has been used as a form of mechanical circulatory support to aid recovery in patients with perioperative complications in the context of CTEPH. This review identifies preoperative risk factors, including pulmonary vascular resistance, high body mass index, and elevated neutrophil-to-lymphocyte ratios. It also identifies differences in ECMO configuration, with veno-arterial ECMO preferred for hemodynamic instability and veno-venous ECMO for respiratory failure. Finally, we posit that, based on contemporary literature, the implementation of early ECMO in decompensated patients may be associated with reduced hospital mortality, and in those who survive beget excellent mid-term survival.

Objective: Rapid assessment of early treatment-related physiological improvement in emergency department (ED) patients with respiratory failure (RF) remains challenging. Blood gas analysis is informative but invasive and not ideal for repeated use. The vertical displacement index (VDI), an ultrasound-derived parameter based on pleural motion, may provide dynamic bedside information on early physiological change. This study evaluated whether changes in VDI are associated with early physiological improvement in ED patients with RF. Methods: This prospective observational study was conducted in the EDs of two tertiary care hospitals. Adult patients presenting with dyspnea and clinical evidence of RF were included. VDI was measured by lung ultrasound at baseline and 30 min after initial treatment. The primary endpoint was the change in VDI 30 min after the initial treatment, calculated as the difference between pre-treatment and post-treatment VDI. The expected direction was a post-treatment decrease in VDI, with greater VDI reduction expected to be associated with greater early physiological improvement. Secondary analyses included comparisons of VDI changes across oxygen saturation and diagnostic groups, as well as correlations between ΔVDI and physiological changes. Patients were grouped by admission oxygen saturation (<80%, 80-90%, and ≥90%). Results: Seventy-nine patients were included. Pre-treatment VDI differed significantly between oxygen saturation groups, with the highest values in the most hypoxemic patients (p = 0.028). VDI decreased significantly after treatment in all groups (p < 0.001 for all), with the greatest reduction in the <80% group. By diagnosis, VDI decreased significantly in pulmonary edema, COPD/asthma, and pneumonia, but not in pulmonary embolism (p = 0.138). VDI reduction correlated positively with improvements in oxygen saturation (r = 0.27, p = 0.016) and pH (r = 0.24, p = 0.037), but not with CO2. Conclusions: VDI may be explored as a practical ultrasound-derived bedside parameter associated with early physiological improvement in ED patients with RF.