Although the combination of polymyxin and tigecycline is widely used in treating carbapenem-resistant bacterial infections, the benefit of this combination is still uncertain. To assess whether adding polymyxin B to the high-dose tigecycline regimen would result in better clinical outcomes than the high-dose tigecycline therapy in patients with pneumonia caused by carbapenem-resistant Klebsiella pneumoniae and Acinetobacter baumannii, we conducted a propensity score-matched cohort study in a single center between July 2019 and December 2021. Of the 162 eligible patients, 102 were included in the 1:1 matched cohort. The overall 14-day mortality in the matched cohort was 24.5%. Compared with high-dose tigecycline, the combination therapy was not associated with better clinical outcomes, and showed similar 14-day mortality (OR, 0.72, 95% CI 0.27–1.83, p = 0.486), clinical cure (OR, 1.09, 95% CI 0.48–2.54, p = 0.823), microbiological cure (OR, 0.96, 95% CI 0.39–2.53, p = 0.928) and rate of nephrotoxicity (OR 0.85, 95% CI 0.36–1.99, p = 0.712). Subgroup analyses also did not demonstrate any statistical differences. Based on these results, it is reasonable to recommend against adding polymyxin B to the high-dose tigecycline regimen in treating pneumonia caused by carbapenem-resistant K. pneumoniae and A. baumannii.

Background: Acute compartment syndrome (ACS) is a critical condition resulting from increased intra-compartmental pressure, causing tissue ischemia and necrosis. ACS following cardiovascular surgery is rare but catastrophic. Postoperative sedation and analgesia often obscure classic symptoms, delaying diagnosis. This underscores the importance of vigilance and early detection, particularly in high-risk scenarios such as prolonged extracorporeal circulation and femoral artery cannulation. Enhanced monitoring, including tissue oxygen saturation and transcutaneous oxygen pressure, may facilitate timely diagnosis. Case summary: We report a 56-year-old male who developed ACS after valve replacement surgery involving femoral artery cannulation for cardiopulmonary bypass. Approximately 12 h postoperatively, the patient exhibited severe lower limb swelling, mottling, and diminished dorsalis pedis pulse. Laboratory findings revealed elevated myoglobin and creatine kinase levels. Diagnosis was confirmed via clinical and ultrasound evaluation, prompting emergent fasciotomy. Postoperative management included wound care, renal replacement therapy, and skin flap reconstruction. At 6 months follow-up, the patient achieved complete functional recovery of the affected limb. Conclusion: ACS is a rare but severe complication of cardiovascular surgery. This case highlights the necessity for heightened vigilance, early recognition, and timely intervention to mitigate adverse outcomes. Further studies are needed to validate and establish standardized monitoring protocols and management strategies, including early use of distal perfusion techniques, to improve surgical safety and patient outcomes.

Neoadjuvant chemotherapy with paclitaxel and cisplatin (TP regimen) is a cornerstone of treatment for locally advanced laryngeal squamous cell carcinoma. W

Airway foreign-body aspiration in adults is uncommon but can be life-threatening.Flexible bronchoscopy is the standard first-line therapy,but critically ill patients may need extracorporeal life support.This study aims to characterize the diagnosis,management,and outcomes of adult airway foreign-body cases treated at a single center over nearly 12 years to inform a standardized clinical pathway.A single-center retrospective observational study of consecutive patients aged ≥14 years with confirmed airway foreign body who were treated at a tertiary hospital in China were conducted.Medical records of consecutive adolescent and adult patients diagnosed with airway foreign-body aspiration and admitted to the hospital from 01/01/ 2014–30/11/2025 were reviewed.Data included demographics,imaging,extraction method, respiratory support and so on.Descriptive statistics were reported as medians with interquartile ranges or counts and percentages.A total of 41 patients were included,with a median age of 59.5 years(interquartile ranges 51–72) and 65.85% male.Flexible bronchoscopy was attempted as the primary intervention in 38 patients(92.68%) and succeeded in 81.58%(31/38) to remove airway foreign body.Most patients(78.05%) required only nasal cannula oxygen,while nine patients(21.95%) needed advanced support including mechanical ventilation (14.63%),high-flow oxygen(4.88%),and extracorporeal life support (2.44%).At discharge,most survivors had a good neurological outcome,with 36 patients(87.80%) having a Cerebral Performance Categories score of 1.The 28-day survival rate was 92.68%.These findings show that flexible bronchoscopy is an effective first-line therapy,and rigid bronchoscopy or surgery is useful when flexible bronchoscopy fails.In unstable cases,timely extracorporeal life support can bridge to definitive removal.These results support a tiered,multidisciplinary approach incorporating early chest computed tomography,flexible bronchoscopy,and escalation to advanced airway or extracorporeal support.

BACKGROUND Hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening systemic inflammatory disorder characterized by cytokine storm, coagulation abnormalities, and pancytopenia, which can rapidly progress to multi-organ failure. Although acute respiratory distress syndrome (ARDS) is a less common but severe complication of HLH, veno-venous extracorporeal membrane oxygenation (VV-ECMO) can serve as a lifesaving intervention in cases unresponsive to standard treatments. Emerging case reports indicate that, when appropriately indicated, VV-ECMO can offer substantial clinical benefits. CASE REPORT A 45-year-old woman presented with 1 week of high-grade fever, fatigue, anorexia, and progressive dyspnea. Initial workup showed thrombocytopenia (platelets 30×10⁹/L), elevated C-reactive protein, and bilateral ground-glass opacities on chest computed tomography. Despite lung-protective settings, her PaO₂/FiO₂ ratio stayed below 80 mmHg. VV-ECMO was started on day 2 in the Intensive Care Unit, promptly restoring SpO₂ and reducing vasopressor needs. Further evaluation met HLH-2004 criteria: hyperferritinemia, high soluble CD25, splenomegaly, bone marrow hemophagocytosis, and elevated EBV DNA. Under ECMO support, she received high-dose methylprednisolone (1 g/day×5 days), a prednisone taper, and etoposide on day 18. She was weaned from ECMO on day 8, extubated on day 20, and discharged on day 45, with normalized laboratory values. At the 4-year follow-up, she remained in complete remission. CONCLUSIONS Early VV-ECMO can be life-saving in adult patients with HLH-associated ARDS by providing a window for targeted immunosuppression and chemotherapy. Rapid HLH recognition, multidisciplinary management, and timely ECMO initiation are essential. Further studies should refine patient selection, timing, and integrated treatment protocols.