To evaluate the association between the timing of maternal magnesium sulfate (MgSO₄) discontinuation before delivery and the risk of apnea of prematurity (AOP) in late-preterm twin infants.

This retrospective cohort study included 161 twin pregnancies (322 infants) delivered between 34 0/7 and 36 6/7 weeks at Yamanashi Prefectural Central Hospital (2017-2025). Infants with major anomalies or intrauterine fetal demise were excluded. The primary exposure was the interval between MgSO₄ cessation and delivery, categorized as: no exposure, < 12, 12-24, and ≥ 24 h. Two multivariable logistic regression models were constructed. Model 1 evaluated the association between any maternal MgSO₄ exposure and AOP. Model 2 further incorporated the timing of MgSO₄ discontinuation as a categorical exposure, adjusting for gestational age, chorionicity, small-for-gestational-age status, sex, and 1-min Apgar score.

Among the 322 infants, 112 (34.8%) developed AOP. In Model 1, maternal MgSO₄ exposure itself was not significantly associated with AOP. However, in Model 2, delivery within 12 h after cessation of MgSO₄ was independently associated with AOP (adjusted odds ratio, 7.44; 95% confidence interval, 1.48-37.4), whereas longer discontinuation intervals (12-24 or ≥ 24 h) were not.

Among late-preterm twin infants, maternal MgSO₄ exposure itself was not independently associated with AOP; however, delivery soon after MgSO₄ discontinuation was associated with an increased risk of AOP. These findings support consideration of MgSO₄ discontinuation timing in perinatal risk assessment and neonatal respiratory monitoring and may help guide future studies.

Respiratory tract infections (RTIs) pose a major diagnostic challenge, complicated by multiple microbial etiologies. Conventional low-throughput methods may underestimate the prevalence and impact of co-infections. This study aimed to evaluate a novel super-multiplex microfluidic qPCR system for comprehensive 49 target pathogens screening and co-infection analysis in patients with influenza-like illness (ILI). Throat swab samples (n = 288) were collected from febrile patients in Beijing during the spring of 2025. All samples were tested using the super-multiplex microfluidic qPCR chip, with a subset (n = 96) validated by conventional qPCR to determine analytical sensitivity, specificity, and Cohen's kappa. The assay demonstrated an overall pathogen detection rate of 66.32%. Influenza A virus (IAV) was the most prevalent pathogen, identified in 50.00% of all samples and constituting 70.69% of single infections, followed by SARS-CoV-2 (14.24%) and Epstein-Barr virus (EBV, 11.81%). Co-infections were frequent (39.27% of positive cases), predominantly dual (23.04%) and triple (10.47%) infections. Notably, IAV was implicated in 84.0% of co-infections. The microfluidic qPCR showed high concordance with conventional qPCR (sensitivity 91.07%, specificity 92.50%, κ = 0.83, indicating almost perfect agreement). This study reveals a complex respiratory pathogen landscape dominated by IAV and marked by frequent polymicrobial co-infections. The super-multiplex microfluidic qPCR chip is a reliable, high-throughput platform that effectively addresses the need for improved detection of co-infections, offering valuable insights for both clinical decision-making and public health surveillance.

Obstructive sleep apnoea (OSA) in children is diagnosed using polysomnography (PSG), but children with neurodisability are >3 times more likely to not tolerate leads and sensors. The diagnostic accuracy of Sunrise, a small sensor applied to the chin, has not been assessed in this special population.

Compare the diagnostic accuracy of Sunrise to simultaneously recorded in-laboratory PSG.

We conducted a prospective, cross-sectional study of children aged 3-18 years with neurodisability, who attended the Queensland Children's Hospital sleep laboratory for diagnostic PSG between February 2024 and September 2025. Sunrise- and PSG-derived measures of sleep disordered breathing were compared, and questionnaire data examining interest in novel sensor technology, and portable, home-based sleep studies were also collected.

There were 48 children with a neurodisability (mean [SD] age = 11.2 [3.6]; 39% female). For 43 children with complete Sunrise data, sensitivity and specificity for identifying moderate-severe obstructive sleep apnoea (OSA) using calibrated MM-ORDI were 0.88 (95% CI: 0.45-1.00) and 0.63 (95% CI: 0.45-0.79), respectively. The concordance correlation coefficient of the obstructive respiratory disturbance index was 0.65 (95% CI: 0.5-0.8) and the median absolute error was 5.7 (IQR: 2.7-13.1) events per hour. Most carers in attendance preferred in-laboratory sleep studies (56%) to home (33%), but the majority preferred Sunrise (50%) to limited-channel (17%) or full PSG (10%).

Sunrise shows excellent ability to exclude moderate-severe OSA in children with neurodisability with moderate specificity. There is substantial appetite among parents and carers for alternative sleep testing modalities.

Hypoxemia is the most common adverse event during sedated gastrointestinal endoscopy. Patients with high obstructive sleep apnea (OSA) risk (STOP-Bang ≥5) are susceptible due to sedation-induced loss of upper airway tone exacerbating airway collapsibility. Although high-flow nasal cannula (HFNC) benefits general at-risk populations, its efficacy in this specific cohort remains uncertain, as its mild positive pressure falls far below therapeutic continuous positive airway pressure levels for moderate-to-severe OSA, questioning its ability to stent the collapsible airway. Our prior proof-of-concept study in this cohort observed a 5% incidence of hypoxemia with HFNC, confirming feasibility and safety and justifying this confirmatory trial.

This prospective, multicenter, randomized controlled single-blind trial will enroll 600 adults (STOP-Bang score ≥5) undergoing elective sedated gastroenteroscopy across three centers. Participants will be 1:1 randomized (stratified by center) to HFNC (30 L/min pre-oxygenation, 60 L/min post-induction) or conventional nasal cannula (6 L/min). Both groups receive standardized propofol-alfentanil sedation. The primary outcome is the proportion of patients with at least one episode of hypoxemia (SpO₂ 75%-90% <60 s). Secondary outcomes include the proportion of patients with at least one episode of severe hypoxemia (SpO₂ <75% or 75%≤SpO₂<90% ≥60 s), the proportion with subclinical respiratory depression (90%≤SpO₂<95%), and the frequency of other adverse events.

This trial will provide definitive evidence on HFNC's efficacy in high-risk OSA patients, addressing whether it can overcome pressure limitations to prevent hypoxemia. Results are expected to inform sedation management guidelines, establish a new standard of care for this subgroup, and enhance procedural safety.

The trial was registered at the ClinicalTrials.gov on 14 December 2025 (NCT07307560).

We estimated the XBB.1.5 vaccine effectiveness (VE) against COVID-19 hospitalization and death in Belgium, Denmark, Italy, Portugal, Spain (Navarre), and Sweden following the 2023-24 fall vaccination campaign among immunocompromised persons (ICPs).

We conducted a multi-country retrospective cohort study using electronic health records. Study sites identified ICPs aged ≥18 years through a common set of immunocompromising conditions and follow-up started the first day of the 2023 vaccination campaign until 12 months later. VE was calculated by time since vaccination (14-59, 60-119, 120-179, 180-365 days after vaccination) for ICPs by pooling study site level confounder adjusted hazard ratios (aHR) of vaccination, estimated with Cox proportional hazards regression models, using a random effect meta-analysis with VE = 100 × (1-pooled aHR).

The XBB.1.5 VE was 52% (95% confidence interval (CI): 41 to 60) and 75% (95%CI: 60 to 84) against hospitalization and death, respectively, 14-59 days after vaccination, and VE decreased with time since vaccination with no remaining protection at 180-365 days after vaccination.

Adapted XBB.1.5 vaccine provided moderate protection within 120 days after vaccination against severe COVID-19 outcomes among ICPs aged ≥18 years during a period with BA.2.86/JN.1 replacing the XBB.1.5 variant.

Objective: To analyze the prevalence of pulmonary tuberculosis (TB) in students in Shaanxi Province from 2015 to 2023 and identify influencing factors of adverse outcomes. Methods: The prevalence data of pulmonary TB in students in Shaanxi from 2015 to 2023 were derived from the TB subsystem of Chinese Disease Prevention and Control Information System. Software Joinpoint 5.4.0 was used to analyze the changing trends of the registration rate of pulmonary TB in students and the composition ratio of the TB patients in different age groups. Multivariate logistic regression model was used to identify influencing factors of adverse outcomes of pulmonary TB in students. Results: From 2015 to 2023, a total of 10 347 pulmonary TB cases were registered in students in Shaanxi, in which the cases in boy students accounted for 61.02% and the cases in students with education level at or above senior high school accounted for 79.06%. The cases were mainly distributed in Yan'an , Ankang, Shangluo and Yulin with average annual registration rates of 26.12/100 000,25.55/100 000,23.33/100 000 and 20.11/100 000 respectively. The registration rate increased from 19.36/100 000 in 2015 to 28.01/100 000 in 2018, and then declined to 9.90/100 000 in 2023 [annual percentage change (APC)=14.90%, 95%CI: 1.34%-30.27%; APC=-20.45%, 95%CI:-24.20% - -16.52%], showing an overall downward trend [average annual percentage change=-8.69%, 95%CI: -12.23% - -5.02%]. The results of multivariate logistic regression analysis showed that the risk factors for adverse outcomes of pulmonary TB in students included being in other ethnic groups (aOR=4.43,95%CI: 2.36-8.30) and living in Southern Shaanxi (aOR=1.51,95%CI: 1.12-2.02), living in Northern Shaanxi (aOR=1.73,95%CI: 1.33-2.24), floating population (aOR=1.58,95%CI: 1.26-1.98), being positive in etiology (aOR=1.28,95%CI: 1.01-1.61), no etiological result (aOR=4.06,95%CI: 2.68-6.17), self-medication or family management (aOR=2.46,95%CI: 1.29-4.71), using no fixed-dose combination (FDC)(aOR=2.21,95%CI: 1.75-2.80). Conclusions: From 2015 to 2023, the registration rate of pulmonary TB in students in Shaanxi showed an overall downward trend. Particular attention should be paid to the impact of factors such as other ethnic groups, the southern and northern regions of Shaanxi, migrant populations, positive bacteriology, no bacteriological results, self-medication or management by family members, and non-use of FDC on the unfavorable outcomes of student pulmonary tuberculosis.

Fibrosing interstitial lung diseases (F-ILD) are associated with reduced exercise capacity and functional limitations. Motor-cognitive dual-task performance refers to the ability to perform a mobility task while simultaneously completing a cognitive task, reflecting the motor-cognitive demands of everyday multitasking. Dual-task performance has not been systematically compared between patients with F-ILD and healthy individuals.

To compare motor-cognitive dual-task performance between patients with fibrosing interstitial lung disease and healthy controls, and to examine associations with clinical parameters.

Cross-sectional comparative study.

Forty-five patients with F-ILD and 45 age-matched healthy controls completed the Timed Up and Go (TUG) test under single-task and dual-task (serial subtraction) conditions. Dual-task interference (DTI) was computed as the percentage change from single-task performance. Pulmonary function tests, the six-minute walk distance (6MWT), and the Montreal cognitive assessment (MoCA) were administered. Between-group differences were assessed with the Mann-Whitney U test. Associations were examined using Spearman's correlation and multivariable regression adjusted for age, body mass index, and comorbidity count.

Compared to controls, patients with F-ILD demonstrated slower TUG dual-task performance (12.35 vs 10.21 s; p = 0.0016), reduced dual-task accuracy (66.7% vs 77.8%; p < 0.001), and increased cognitive interference (36.6% vs 10.9%; p < 0.001). Physical interference was also elevated (p = 0.0328). In ILD patients, a shorter 6MWT distance was associated with longer TUG dual-task time (ρ = -0.42, p = 0.004) and greater cognitive interference (ρ = -0.38, p = 0.009). No correlations were found with FVC, FEV₁, or MoCA. After adjusting for confounders, ILD status independently correlated with longer TUG dual-task time (p = 0.029), lower accuracy (p = 0.0003), and increased cognitive DTI (p < 0.001).

Patients with F-ILD show significant motor and cognitive dual-task impairments compared with healthy controls, partly independent of conventional lung function measures.

Not applicable.

Nontuberculous mycobacterial pulmonary disease in low-risk patients is rare and typically indolent. We report a case of Mycobacterium abscessus complex (MABC) pulmonary disease in a 71-year-old immunocompetent Italian man who presented with mild dyspnoea that markedly worsened following SARS-CoV-2 infection three months before admission. High-resolution CT showed diffuse small, irregular, predominantly consolidative opacities with peripheral bronchial thickening. Extensive investigations for tuberculosis, fungal infection, other pathogens, and malignancy were negative. Respiratory cultures subsequently yielded MABC, and molecular testing identified a functional erm(41) gene conferring inducible macrolide resistance, consistent with M. abscessus subsp. abscessus. Guideline-based multidrug therapy with intravenous amikacin, tedizolid, clofazimine, and moxifloxacin was initiated. Nephrotoxicity required substitution of intravenous amikacin with an inhaled formulation, followed by ototoxicity and further modification with tigecycline. Despite these adjustments, cultures remained persistently positive. Severe gastrointestinal intolerance and progressive weight loss ultimately led to treatment discontinuation and home oxygen therapy. One year after diagnosis, imaging revealed new cavitary lesions with advanced bilateral disease. The patient died from respiratory failure and severe cachexia. This case shows that MABC infection may follow an aggressive, life-threatening course even in immunocompetent individuals. Antimicrobial resistance combined with treatment-limiting toxicity underscores the urgent need for more effective, better-tolerated therapies and early multidisciplinary management.

Viral respiratory tract infections, particularly Human Bocavirus (HBoV) infections, are a significant global health concern. COVID-19 has provided a suitable platform for infectious diseases caused by multiple pathogens. This review highlights key aspects of the current status and future prospects of HBoV research in the Kingdom of Saudi Arabia, including global and local prevalence, clinical impact, and diagnostic challenges. It also emphasizes the need for future research, particularly in Saudi Arabia, to fill knowledge gaps, improve diagnosis, and design and develop future treatment and prevention strategies. HBoV was identified from a ten-year-old infected patient in Sweden from collected nasopharyngeal samples in 2005. It has been classified into four genotypes (1-4), and HBoV-1 causes respiratory infections requiring hospitalization. Co-infections with other viruses are well known, with the most common symptoms being pneumonia, cough, fever, and wheezing. Most studies on HBoV diagnosis have relied primarily on polymerase chain reaction techniques. Even though pediatric HBoV infections are common worldwide, due to limited HBoV research, there is a lack of awareness among healthcare providers, especially in Saudi Arabia and the Middle East & North Africa region. Expanding research and awareness on HBoV is urgently required to address the burden of respiratory infections in these regions, not only to explore long-term effects, potential treatments, and vaccine development, but also to use advanced diagnostic methods to analyze the changing epidemiology of respiratory pathogens and achieve effective infection control measures.

High-dose intravenous vitamin C (HDIVC) has been investigated as a potential adjunctive therapy in critical illness, including sepsis, acute respiratory distress syndrome (ARDS), and COVID-19. Despite a strong mechanistic rationale, clinical trials have yielded inconsistent results. From a clinical pharmacology perspective, this variability may reflect, at least in part, differences in pharmacokinetic exposure, timing of administration, and patient selection rather than a lack of biological activity. Intravenous administration enables plasma concentrations in the millimolar range (≈1-5 mM), far exceeding those achievable with oral dosing (<100 µM), thereby reaching thresholds required for pharmacodynamic effects on oxidative stress, immune signaling, and endothelial function. This exposure-dependent transition distinguishes vitamin C as a pharmacological agent rather than a nutritional supplement in critically ill populations. Therapeutic response may be influenced by timing relative to disease progression, with earlier administration representing a biologically plausible strategy that warrants prospective evaluation rather than a clinically established therapeutic window. Interindividual variability in transporter function, redox status, and genetic background may further contribute to heterogeneous responses. Biomarkers such as interleukin-6 (IL-6), C-reactive protein (CRP), D-dimer, and markers of endothelial injury provide a framework for patient stratification and monitoring of pharmacodynamic effects. Integrated with pharmacokinetic principles, these markers support a shift toward biomarker-guided, precision-based therapeutic strategies. This review synthesizes current clinical and mechanistic evidence through an exposure-response conceptual framework, framing HDIVC as a context-dependent pharmacological intervention and advancing a shift toward biomarker-guided, precision-based therapeutic strategies in critical illness.