Daily Respiratory Research Analysis

Exposure to environmental pollutants has been linked to increased antibiotic resistance, a critical global health challenge. The respiratory microbiome constitutes a key reservoir of antibiotic resistance genes (ARGs). Here, we constructed a respiratory ARG catalog from sputum metagenomes of 1,128 individuals. We demonstrate that exposures, particularly to cigarette smoke and biofuels, are associated with increased abundance and enhanced mobility of respiratory ARGs. These resistome alterations correlate inversely with lung function, with elevated mobile ARG abundance detectable even in individuals with mild airflow limitation within normal spirometry. Specific ARGs, including opmD and tet(K), interact with smoking in relation to lung function impairment. Murine experiments recapitulate these findings, showing exposure-induced increases in homologous ARGs that confer heightened phenotypic resistance in cultured respiratory bacteria. Our results elucidate a pathway through which environmental pollutants augment the respiratory resistome, suggesting the need for actions to mitigate the antimicrobial resistance burden by addressing environmental pollution.

BACKGROUND: Mechanical power (MP) quantifies the total energy delivered from the ventilator to the respiratory system per unit time, integrating tidal volume, airway pressures, respiratory rate, and flow. MP has been proposed as a surrogate marker of ventilator-induced lung injury (VILI), but the consistency and generalizability of this association across patient populations remain uncertain. OBJECTIVES: To provide the most comprehensive systematic evaluation to date of the relationship between MP and VILI-related outcomes in adult patients receiving invasive mechanical ventilation. METHODS: We conducted a systematic review following PRISMA guidelines. Four databases (PubMed, Embase, Scopus, Web of Science) were searched for original studies reporting MP and clinical outcomes related to VILI. Risk of bias was assessed using RoB 2.0 and ROBINS-I tools. Certainty of evidence was rated using the GRADE approach. RESULTS: Forty-six studies including 314,823 patients were analyzed. Forty (87 %) demonstrated a statistically significant association between higher MP and adverse outcomes (mortality, prolonged ventilation, or ICU stay). Threshold effects were identified in 23 studies, most consistently between 14 and 18 J/min. Normalized MP (e.g., per predicted body weight or well-aerated lung volume) improved prognostic performance in selected cohorts. Despite heterogeneity and mostly observational designs, the overall signal was robust across diverse populations and clinical contexts. CONCLUSIONS: This review establishes mechanical power as a consistent and clinically relevant predictor of adverse outcomes in mechanically ventilated adults. By synthesizing >300,000 patients, it provides the most reliable evidence base to date, identifies reproducible thresholds, and highlights the importance of normalization strategies. These findings suggest that MP could complement tidal volume and driving pressure in lung-protective ventilation and define priorities for future prospective trials.

BACKGROUND: Acute respiratory infections (ARIs) caused by viruses, bacteria, Mycoplasma, and other microorganisms rank among the most serious human health threats, and they typically manifest similar flu-like symptoms during the early stages of infection. The rapid and accurate diagnosis of pathogens causing ARIs is crucial for treating diseases and controlling pathogen transmission. Quantitative real-time polymerase chain reaction (qRT-PCR) serves as the primary detection method, yet current workflows are time-consuming and have limited multiplexing capacity; thus, they fail to meet on-site diagnostic requirements. Our aim is to develop a novel method that enhances heating and cooling rates, thereby significantly shortening PCR cycling time and enabling the on-site rapid detection of ARI pathogens. RESULTS: A high-efficiency temperature cycling technology controlled by a time-based algorithm was developed. Its core mechanism involves the precise cyclic movement of reaction tubes among three independent temperature modules, utilizing the large temperature differences between the modules to significantly enhance heating and cooling rates. Employing this innovation, a portable fluorescence quantitative PCR (qPCR) instrument FQ-8B was developed that completed amplification in as little as 15 min. While substantially reducing amplification time, the FQ-8B maintains performance comparable to conventional instruments, demonstrating 95-105% amplification efficiency across six-channel fluorescence. The instrument exhibits exceptional specificity and reproducibility, achieving detection sensitivities of 75-100 copies/mL across diverse viruses. Clinical validation of 208 suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and 216 suspected influenza A virus (IAV) specimens showed overall concordance rates of 99.04% (kappa = 0.852, P < 0.001) and 95.37% (kappa = 0.881, P < 0.001), respectively, compared to standard instrument detection. The on-site rapid detection capacity of FQ-8B was validated using 1227 respiratory specimens from a primary hospital, demonstrating 15-pathogen screening capability per specimen within 30 min. Testing results revealed a local epidemic of four pathogens: SARS-CoV-2, influenza B virus, Mycoplasma pneumoniae, and IAV, from August 2023 to January 2024. CONCLUSIONS: The FQ-8B, developed based on three independent temperature modules and a time-based algorithm, demonstrates rapid, sensitive, specific, cost-effective, and portable characteristics. It provides timely on-site screening of multiple respiratory pathogens, rendering it a potent tool for infectious disease diagnosis and monitoring.