Background: Influenza A (H1N1) infection usually has a self-limiting course (5–7 days), but some patients may progress to severe pneumonia or complications, resulting in a significantly prolonged course of the disease. This case reports a special case of protracted H1N1 infection lasting more than one month. The patient presented with persistent chest pain (>1 month) as the initial symptom. The preliminary diagnosis was “encapsulated empyema.” The results of multiple PCR tests on respiratory samples (swabs from the throat and sputum) in the early stage of fever were negative, masking the existence of the disease, and secondary bacterial mixed infections occurred. Through targeted next-generation sequencing (tNGS) of bronchoalveolar lavage fluid (BALF), it was finally confirmed as H1N1 virus infection. This highlights the crucial diagnostic value of lower respiratory tract sample testing in overcoming false negatives in upper respiratory tract testing. Further analysis revealed that the patient’s weakened immunity might be a new risk factor for protracted influenza, providing clinical implications for the delayed initiation of antiviral treatment and the management of encapsulated empyema.
Case Presentation: This article reports a 49-year-old male patient who had a history of gastric perforation surgery and appendicitis surgery. He was admitted to the hospital with chest pain for more than 1 month and fever for 2 days. The final diagnosis was influenza A (H1N1) combined with purulent pleural effusion caused by Fusobacterium nucleatum and Klebsiella pneumoniae infection. The patient initially presented with a large amount of encapsulated pleural effusion on the right side. Empirical use of “ceftriaxone” for 5 days of anti-infection treatment was ineffective. The pleural fluid tNGS indicated “Fusobacterium nucleatum sequence number 9, relative abundance 49.9%.” Subsequently, the treatment was adjusted to “piperacillin-tazobactam” for 3 days. The patient no longer had fever, but on the 18^th day of treatment, the patient had a fever again. The re-examination of nasopharyngeal swabs for influenza A and B antigens was all “negative.” The treatment continued with “piperacillin-tazobactam.” On the 21^st day, the patient still had a fever. Bronchoalveolar lavage fluid tNGS indicated “influenza A virus H1N1 sequence number 1344, relative abundance 76.2%, Klebsiella pneumoniae sequence number 50, relative abundance 0.3%.” On the 22^nd day, oseltamivir was added for antiviral treatment for 1 day. The fever was controlled, and the patient’s condition improved and was discharged. On the 29^th day of follow-up after discharge, the patient’s pulmonary infection and pleural effusion had significantly absorbed.
Conclusion: This case suggests that for patients with refractory pleural effusion and repeated fever, the possibility of mixed viral and bacterial infection should be considered. When traditional respiratory tract tests are negative, molecular techniques such as BALF tNGS should be actively adopted to clarify the etiological diagnosis and guide precise treatment.

This case report presented the anesthetic management of a 53-year-old male (173 cm, 59 kg) with a giant left thyroid carcinoma causing severe tracheal compression (narrowest diameter ~4 mm) and left vocal cord paralysis, scheduled for resection. Preoperative assessment highlighted a high risk for difficult airway and major hemorrhage.
Anesthesia was induced with incremental sevoflurane to preserve spontaneous ventilation and to confirm unimpeded mask ventilation, followed by rapid sequence induction and successful video laryngoscopy-guided intubation using a 6.5-mm internal diameter nerve monitoring endotracheal tube advanced to 25.5 cm to bypass the stenotic segment. Total intravenous anesthesia (TIVA) with propofol and remifentanil was maintained under BIS guidance.
The 9.5-hour procedure involved significant blood loss (2800 ml), managed with invasive hemodynamic monitoring, vasopressor support (norepinephrine), transfusion of 9 units PRBCs and 800 ml FFP, and TEG-guided coagulation therapy (additional FFP and tranexamic acid) for coagulation factor deficiency and hyperfibrinolysis. Lung-protective ventilation and active thermoregulation were employed.
Despite these measures, prolonged intubation contributed to postoperative pneumonia. The patient was extubated on postoperative day 3, transferred to the ward on day 5, and discharged home on day 18. This case underscores the critical importance of meticulous preoperative planning, advanced airway techniques, goal-directed hemostatic and hemodynamic management, and proactive complication prevention in complex head and neck oncologic surgery with critical airway compromise.

Current case is a 54-year-old female with alcohol-associated liver disease (ALD). She suffered from depression, panic disorder, and self-harm in her 30’s, and has recently drunk more. The blood chemistry in 2023 showed AST 144 U/L, ALT 22 U/L, gamma-glutamyl transpeptidase (GGT) 1117 U/L, uric acid (UA) 12.2 mg/dL, and mean corpuscular volume (MCV) 115 fL, and then she was hospitalized and treated. Furthermore, she was diagnosed with psoriasis, probably related to alcoholism. She recently showed improvement in blood tests, and fatty liver, gallstones, and a pancreatic cyst by abdominal CT scan. Elevated AST/ALT ratio may indicate the advance of liver fibrosis.

Isolated aortic arch aneurysms are relatively rare, accounting for 21.3% of thoracic aortic aneurysms. However, with an aging population and advancements in imaging technology, the detection rate of aortic arch aneurysms has gradually increased. Key risk factors include age, gender, hypertension, atherosclerosis, hereditary connective tissue disorders, and infections. A giant aortic arch aneurysm is not only a “ticking time bomb” within the patient but also poses significant challenges for anesthesiologists when associated with airway compression, which can lead to airway and circulatory collapse during induction. We report a case of a 52-year-old male who presented with chest pain; imaging revealed a giant aortic arch aneurysm compressing the main airway. The patient underwent total aortic arch replacement under general anesthesia, with a successful surgery. We share this case to discuss the anesthetic induction process and insights for managing aortic arch aneurysms with airway compression.

Traumatic diaphragmatic hernia (TDH) poses significant airway management challenges due to risks of visceral herniation and respiratory compromise during positive-pressure ventilation. We present detailed use of awake fiberoptic double-lumen intubation in a 58-year-old male with left-sided TDH following a car accident. Preoperative CT imaging demonstrated a 12 cm diaphragmatic defect with gastric herniation and rightward tracheal deviation (> 15 mm displacement). Given the possible difficult airway and high aspiration risk, we implemented awake fiberoptic double-lumen intubation with topical lidocaine analgesia, maintaining spontaneous breathing without neuromuscular blockade until the hernia sac was controlled. The patient kept oxygen saturation > 95% with stable hemodynamics (BP 135–145/75–88 mmHg, HR 70–85 bpm, RR 16–20 bpm).

Infants possess unique anatomical and physiological characteristics that increase the risk of severe hypoxemia during airway management. A floor of mouth mass causing tongue displacement may directly induce airway obstruction, further elevating anesthetic risks. This report details the anesthesia induction strategy for a 3-month-old infant with a giant floor of mouth mass, discussing safe airway establishment in pediatric difficult airways.

Oliceridine is a new class of μ-opioid receptor agonists, which is relatively selective to μ-opioid receptors and exerts analgesic effects by interacting with μ-opioid receptors (MORS). Compared with morphine, it has the characteristics of fast onset, strong analgesic effect, low incidence of respiratory depression and gastrointestinal adverse reactions, and less neurological complications. It is a safe and effective intravenous analgesic, providing a better choice for the treatment of patients with moderate to severe acute pain. In this paper, the mechanism of action, pharmacodynamics and pharmacokinetics, clinical application and development trend of oliceridine were reviewed, so as to provide theoretical basis for clinical application.

Fibromyalgia (FM) is a prevalent nociplastic pain disorder characterized by widespread musculoskeletal pain, fatigue, sleep disturbance, and cognitive impairment. Central sensitization (CS), amplified pain processing within the central nervous system, is widely accepted as a core mechanism in FM pathophysiology. Whether ongoing peripheral nociceptor input is required to initiate and sustain CS in established FM remains controversial, despite evidence of subtle inflammation, muscle or metabolic abnormalities, and small-fiber pathology. This systematic review and meta-analysis integrate mechanistic and observational evidence from quantitative sensory testing, local anesthetic blocks, small-fiber neuropathy (SFN) studies, muscle and microcirculatory assessments, and markers of low-grade inflammation to reappraise the peripheral contribution to CS. Findings from local anesthetic block studies show that tonic peripheral input can dynamically modulate and maintain CS in some individuals, whereas the frequent observation of SFN (approximately 50%) and emerging metabolic or inflammatory data suggest clinically relevant peripheral drivers may define distinct FM phenotypes. Debate persists over the relative importance of peripheral versus central mechanisms, the clinical relevance of SFN, and the impact of minor peripheral changes when overt pathology is absent. Clarifying these issues has important implications for patient stratification and personalized treatment. The review underscores the need for high-quality longitudinal trials that simultaneously track peripheral and central sensitization dynamics, to illuminate the dynamic interplay between peripheral pathology and central pain amplification in FM.
This review was retrospectively registered with PROSPERO (CRD420251077548).

Polyneuropathy is a condition that can be caused by a variety of factors, including environmental, dietary, and lifestyle. This case study examines the impact of these factors on a patient’s polyneuropathy symptoms. The objectives were to examine the symptoms and lab results of a patient with polyneuropathy symptoms and discuss the importance of physicians considering all aspects of a patient’s lifestyle when determining the cause of such symptoms. We examined X-rays, lab results, and notes related to the patient’s case, as well as conducted a web-based search, to describe the patient’s history and condition. Based on the results of this research, factors such as smoking, alcohol use, arsenic and cadmium toxicity (i.e., through recently increased seafood intake or past occupational exposure), and pre-diabetes may have precipitated the patient’s polyneuropathy symptoms. This case demonstrates that it is crucial to examine all layers of a patient’s condition to recommend accurate treatment for the condition and effective alleviation of symptoms.

Bronchospasm is an anesthetic emergency, and early diagnosis and timely treatment are crucial for patient recovery. If not reversed in time, it may further progress to silent lung, potentially leading to life-threatening respiratory and cardiac complications. This case report details the crisis encountered by a 54-year-old male after tracheal intubation and proposes some reflections and airway management strategies based on this experience and lesson.

Tracheal stenosis may have multiple etiologies: primary or secondary, congenital or acquired. For unanticipated tracheal stenosis, it often poses certain challenges to anesthesia, endotracheal intubation, and even fatal crises. This case details the crisis encountered during endotracheal intubation in a 60-year-old man and suggests some reflexive recommendations and airway management strategies.

Background: Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease encountered in clinical practice. It consists of ventricular septal defect (VSD), overriding aorta, right ventricular outflow tract obstruction (RVOTO), and right ventricular hypertrophy (RVH). Clinical severity depends on the degree of RVOTO, presence or absence of extracardiac shunts or collaterals, and other factors. Only 10% of untreated patients survive into adulthood.
Objective: To describe late presentation of TOF and uncommon survival in a 31-year-old patient.
Case Report: A 31-year-old male presented at the cardiology clinic of a secondary healthcare facility in Gombe, Gombe State, Nigeria, with complaints of exercise intolerance. His symptoms started at 4 years of age, and he did not have any significant limitation in day-to-day activities. He had no history of prior cardiac investigation or care. Significant examination findings were plethora, central cyanosis, grade 4 finger clubbing, height 170 cm, weight 70 kg, body mass index 24.2 kg/m², grade 3/6 systolic murmur at the left upper sternal border, and blood pressure of 110/70 mmHg. Packed cell volume was 71%, SPO₂ was 84%; chest X-ray showed a normal-sized heart with boot-shaped appearance, presence of pulmonary bay, and lung oligemia. Electrocardiographic findings were in keeping with RVH. Transthoracic echocardiography revealed a large subaortic VSD, overriding aorta, severe valvular pulmonary stenosis, and right ventricular hypertrophy.
Conclusion: There should be a high index of suspicion for CHDs in adults presenting with dyspnea on exertion and cyanosis. Also, there is a need for early diagnosis of CHD through prompt referral of patients with respiratory or cardiac symptoms to centers that can perform echocardiography.

Using the medical apparatus FreeStyle Libre 3 with smartphone as Continuous Glucose Monitoring (CGM), detailed blood glucose variability was studied. Current case is a registered nurse aged 59 years who has been treated with some oral hypoglycemic agents (OHAs). Her diabetic state has been stable with HbA1c 6.6–6.9%. The purpose was to monitor the glucose fluctuation in response to various food intake. Post-prandial hyperglycemia (PPH) was observed by carbohydrate intake, such as rice, bread, and noodles. By drinking pre-prandial milk 70 cc just before 3 meals a day, PPH showed enough reduction, which suggests a clinically beneficial effect of milk from now.

As the development of continuous glucose monitoring (CGM) progresses, the clinical effects of whey protein on postprandial hyperglycemia (PPH) have been identified. Whey protein includes milk protein, yogurt, casein, almond milk, and so on. Milk protein supplementation has been shown to reduce fasting blood glucose (FBG) by -1.83 mg/dL, fasting insulin by -1.06 μU/mL, and HOMA-IR by -0.27. Whey protein was administered in doses of 0–30 g before breakfast, and the incremental area under the curve (AUC) was reduced when taking 15–30 g. Premeal whey showed a lower glucose peak by -1.0 mmol/L (-18 mg/dL) in patients with gestational diabetes mellitus (GDM). Further research development is expected for PPH.

Introduction: Rosacea is a chronic inflammatory dermatosis that primarily affects the midface (cheeks, nose, chin, forehead), although it can also affect other areas of the body such as the scalp, neck, auricle, chest, and eyes.
Objective: To describe the clinical characteristics of a patient with extensive rosacea injuries on her skin and their possible treatment with non-ablative lasers.
Clinical Case: Observational study in a 62-year-old patient with a dermatological diagnosis of rosacea, who was treated with non-ablative lasers with excellent results, leaving no scars and resolving the injuries in just five sessions.
Conclusions: Rosacea is a benign dermatological lesion, and treatment with non-ablative lasers is effective, leaving no scars and requiring no additional treatments.

Authors and co-researchers have conducted clinical research on psychosomatic medicine. The current case is a 21-year-old university student who has been visually impaired due to retinoblastoma since birth. He was raised in a music therapy environment and is good at playing the piano, singing, and academic activities, gaining valuable experience. His daily life on campus was featured on a Japanese national educational television program. He received Charism Judge, which applies micro-vibration analysis of the human head, eyes, and face, as well as the vestibulo-ocular reflex (VOR). His overall mental score was 222.2 points, classified as the hope category level. Although he is almost blind, Charism Judge can evaluate his novel psychosomatic measurement.