The repetition of a condition following endoscopic sinus surgery (ESS) poses an important difficulty in type 2 chronic rhinosinusitis with nasal polyps (CRSwNP) therapy. The recurrent nature of the disease is probably linked to the dynamic interplay of the enduring type 2 inflammatory microenvironment and the imbalanced sinonasal microbiome. The microbiomic characteristics and pathogenic mechanisms of postoperative recurrence are systematically elaborated in this paper, indicating that recurrent CRSwNP is characterized by microbial dysbiosis featured by enrichment of Staphylococcus aureus, depletion of Corynebacterium, and reduction in α-diversity. Its core mechanisms involve superantigen-mediated immune hijacking, epithelial barrier collapse caused by microbial metabolic imbalance, and physiological tolerance mediated by biofilms. On this basis, as a scoping review, this paper further reviews the shift of intervention strategies from "broad-spectrum bactericidal" to "precise ecological restoration", including narrow-spectrum antibacterial and phage therapies targeting Staphylococcus aureus, ecological replacement therapy by supplementing nasal-specific commensal bacteria (such as Corynebacterium), and synergistic regulation strategies using biological agents such as dupilumab to indirectly reshape the microecology by inhibiting type 2 inflammation. In addition, the paper also discusses the potential of constructing postoperative recurrence prediction models based on microbial biomarkers, aiming to provide a theoretical basis for the precise and dynamic management of CRSwNP.

Pediatric respiratory diseases are significantly associated with growth impairment. Through core pathways including chronic hypoxia, systemic inflammation, metabolic dysregulation, and pharmacological interference, these conditions suppress the growth hormone-insulin‑like growth factor axis and peripheral signaling, resulting in growth retardation. This article summarizes mechanistic advances regarding growth impairment in obstructive sleep apnea, asthma, chronic lung injury, and recurrent respiratory infections. Accordingly, it discusses intervention strategies encompassing growth monitoring, etiology‑targeted therapy, and the standardized use of growth hormone, while highlighting differences from the management of idiopathic short stature. The aim is to elucidate the underlying pathophysiology and provide evidence to optimize clinical management and improve growth outcomes.

Recurrent respiratory papillomatosis is a chronic airway disease that occurs in both children and adults. It is caused by the human papillomavirus, more than 90% by HPV types 6 and HPV 11. The clinical presentation is nonspecific and most patients present with hoarseness, stridor or dyspnea. Although there is no definitive treatment, the objective focuses on improving voice quality and maintaining airway patency, in our case it was achieved through the placement of a Y-shaped stent placed in airway added to adjuvant treatment with Bevacizumab. Surgical management is the mainstay of treatment and around 20% of patients benefit from adjuvant therapies.

Gorlin-Goltz syndrome (GGS) is a rare hereditary autosomal dominant condition. Cardiac fibromas are one of the clinical manifestations of this disease. The presence of these benign heart tumors may lead to life-threatening complications. We present the case of a 5-year-old girl with GGS and a large cardiac fibroma who had ventricular fibrillation during respiratory tract infection. Several options of treatment were considered in the secondary prevention of cardiac arrest. A partial resection of the tumor was performed to prevent recurrence of malignant arrhythmia. The loop recorder implanted postoperatively didn't record any episodes of sustained ventricular arrhythmia in a 9-month follow-up. In conclusion, cardiac fibromas, especially with the presence of infections, increase risk of ventricular arrhythmias. Partial resection of tumor can be effective and relatively safe in the secondary prevention of ventricular fibrillation in patients with large cardiac fibromas with GGS.

Older adult residents of long-term care facilities (LTCFs) suffered high rates of mortality during the initial stages of the COVID-19 pandemic but their clinical risk has decreased markedly following vaccination. Here we determined humoral and cellular immunity following delivery of a 5th vaccine dose, an mRNA spike B1:BA.1 bivalent vaccine, to care home residents. The delivery of a 5th vaccine elicited a plateau of spike-specific immunity that remained broadly stable over 100 days in almost all people. Despite this, 15% of residents had a primary infection and 30% became reinfected during 6-months of follow up. These findings reveal that serial vaccine delivery can establish robust systemic spike-specific immune responses in frail older people but that this does not reliably prevent SARS-CoV-2 reinfection. As such, additional approaches should be considered to reduce reinfection risk in this vulnerable population group.

Since Fleming's discovery of penicillin, antibiotic resistance has remained an inevitable biological reality; however, our guidelines and diagnostic practices are not keeping pace with the rising medical need. This viewpoint uses a real family case of recurrent Group C streptococcal pharyngitis to illustrate these gaps in an outpatient setting. The situation is obviously more dire with life threatening infections. Addressing the fragile antibiotic pipeline requires updated, accessible guidelines, routine culturing upon relapse, and public education to support fair pricing and sustained investment in novel antibiotics and companion diagnostics.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory disease in which type 2 inflammation, epithelial dysfunction, and tissue remodeling determine severity, recurrence, and treatment response. Although molecular biomarkers have clarified disease endotypes, their routine use remains limited by cost, availability, and invasiveness. Nasal cytology offers a simple, repeatable, and minimally invasive method to assess-at the mucosal surface-both epithelial morphology and the dominant inflammatory infiltrate, whether neutrophilic, eosinophilic, mast cell, or mixed. Clinical-Cytological Grading (CCG) integrates the dominant cytological pattern with selected comorbidities, including asthma, allergy, and NSAID-exacerbated respiratory disease (N-ERD), into a weighted clinical-cytological framework. In the founding cohort, the highest relapse association was observed when mixed eosinophil-mast cell inflammation coexisted with asthma and N-ERD. This review discusses the rationale, clinical relevance, and translational applications of CCG in CRSwNP, addressing eosinophilic and mixed mast cell-eosinophilic inflammation, epithelial morphology, disease recurrence, difficult-to-treat phenotypes, biologic monitoring, and the operative dialogue between nasal cytology and histopathology. By linking cytological findings with selected clinical comorbidities, CCG may support biologically informed patient characterization and may prompt targeted mast cell assessment in tissue. However, its prognostic accuracy, incremental clinical value, and role in therapeutic decision-making require independent external validation.

Eosinophilic chronic rhinosinusitis (CRS), characterized by prominent eosinophil infiltration, has the highest postoperative recurrence rate among CRS subtypes. Given the critical role of eotaxins in CRS pathogenesis, this study aimed to identify eotaxins associated with eosinophilic CRS and evaluate their correlation with surgical outcomes. Transcriptomic data from GSE36830 revealed 125 differentially expressed genes (49 up-regulated, 76 down-regulated) in CRSwNP compared to CRSsNP, with significant enrichment of eosinophil and dendritic cell infiltration pathways. Functional analysis identified chemotaxis and cell migration as key dysregulated processes in CRSwNP. Among eotaxins, CCL26 and CCL13 emerged as hub molecules from the intersection of these dysregulated pathways. In a clinical cohort of 115 CRS patients, preoperative serum CCL26 and CCL13 levels were significantly elevated in CRSwNP compared to CRSsNP (P<0.001). ROC analysis demonstrated strong diagnostic power for nasal polyps (CCL26: AUC=0.895; CCL13: AUC=0.830). Higher preoperative CCL26 levels predicted poorer symptom improvement post-surgery (standardized β=-0.564, P<0.001). In conclusion, preoperative serum CCL26 serves as both a diagnostic biomarker for CRSwNP and a prognostic indicator for surgical outcomes, with elevated levels associated with reduced symptom improvement.

The ductal malformation known as a "Window Ductus" or "type B ductus" is a very rare congenital anomaly. The unique anatomy results in a diagnostic and surgical dilemma. It can easily be mistaken for a "typical" patent ductus arteriosus and approached via left thoracotomy. This can potentially result in a surgical misadventure. We report a patient diagnosed with a Window Ductus at 2 months of age with recurrent upper respiratory tract infections and complete left lung collapse. Repair was performed through a median sternotomy on cardiopulmonary bypass. The Window Ductus was clamped only on the aortic side and divided, the aortic cuff was closed primarily, and the resultant opening in the pulmonary artery was patched with autologous pericardium. The patient had a successful repair and complete reexpansion of the left lung over time. Advanced cross-sectional imaging (CT scan) provides the best views for planning the surgical approach for a Window Ductus. Median sternotomy with cardiopulmonary bypass allows a safe and reproducible repair.

The threshold interpretation of R0 can fail to describe elimination in epidemic models with imperfect vaccination and reinfection. We study an SEIRV model in which vaccinated individuals remain partially susceptible and recovered individuals may be reinfected. The main novelty is an explicit threshold account of how reinfection can sustain endemic equilibria even when the vaccinated-population reproduction number satisfies R0<1. We derive the disease-free equilibrium, R0, and a sufficient condition for convergence to the disease-free state, showing why local disease-free stability and global elimination are distinct. We reduce the endemic-equilibrium problem to a scalar equation and identify a reinfection threshold β2∗ determining the local direction of bifurcation at R0=1. When β2>β2∗, we prove a lower critical threshold R0C<1 separating elimination from subcritical endemic persistence. We also give an efficient-vaccine approximation and general numerical algorithm for computing R0C. Simulations using an illustrative Omicron-era parameterisation show how these thresholds organise the model dynamics.