During a pandemic, influencers played a key role in promoting vaccination. This study examines the impact of influencer types (political vs. expert) on vaccination in the context of a future pandemic caused by a novel virus.

A 2 × 2 between-subjects experimental design was employed, with 287 valid adult participants recruited from China. Among all participants, 41.81% were male and 58.19% were female, with an average age of 30.20 years (SD = 7.64). Participants were exposed to simulated social media posts that manipulated influencer types (political vs. expert) and message framing (gain vs. loss). Influencers were presented with different profile pictures, nicknames and background descriptions, while follower counts remained unchanged. Message framing was manipulated by presenting vaccination information using a gain frame (emphasizing the benefits of vaccination) or a loss frame (emphasizing the risks of non-vaccination). Analysis of variance (ANOVA) was used to test the impact of influencer type, and its interaction with message framing on vaccination intentions. Meanwhile, the mediating effect of perceived credibility was tested using the PROCESS Macro Model 4 in R.

Results indicate a key main effect of influencer type on vaccination willingness (p < 0.01, η _p ² = 0.04). Political influencers (M = 5.93, SD = 0.93) were more persuasive than expert influencers (M = 5.60, SD = 0.81) in promoting vaccination. This effect was mediated by perceived credibility (b = 0.17, boot CI = [0.003, 0.332]). A significant interaction existed between influencer type and message framing (p < 0.05, η _p ² = 0.015).

Our findings highlight the importance of political influencers during pandemics, a discovery consistent with the informational entropy-based notion of value. This persuasive effect is achieved by enhancing perceived credibility, which can be explained by meaning transfer. Political influencers often align with mainstream authorities, and audiences view their messages as the government's stance. Therefore, the public's trust in the government shifts to political influencers, thus enhancing their influence during the pandemic. Interaction analysis indicates that correctly matching influencer type and message framing enhances vaccination intention. This matching effect is driven by the image the influencer represent. These findings contribute to more effective vaccine promotion during pandemics.

To explore the impact of epidemic diseases outbreak on the psychological status of medical workers.

A total of 266 online questionnaires were distributed to medical staff in several mobile cabin hospitals in Beijing. The questionnaires were divided into a General Demographic Characteristics Questionnaire and the 12-item General Health Questionnaire (GHQ-12), and a total score of ≥4 in the GHQ-12 was considered to be a decline in mental health.

A total of 266 members of medical staff participated in this study, and 30.1% experienced a decline in mental health recently. The highest prevalence of emotional distress was found among those who were female, married without children, working as doctors and other occupations, aged 30-39 years, working in the confirmation department, supporting the mobile cabin hospitals three times or more, the duration of this support for 1 month or longer, and having a previous state of anxiety and depression. In addition, females experienced higher rates of insomnia due to worry compared to males, as did medical staff in the confirmation department compared to the administration and logistics departments. In the same stressful environment, men and doctors had a greater rate of perceived loss of self-worth than women and nurses.

The outbreak of epidemic makes medical workers face the risk of emotional distress. To achieve the purpose of preventing and treating emotional distress of medical workers, we need to carry out continuous and strict research and evaluation on the mental health planning of medical workers, formulate relevant policies and carry out professional psychological intervention.

Multisystem inflammatory syndrome in children (MIS-C) is an uncommon delayed complication of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children, whose cause remains unknown. The aim of this study was to investigate the role of genetic predisposition to COVID-19 and dysregulated inflammatory response in the development of MIS-C in Italian children.

Eighteen individuals were enrolled: 12 with classical MIS-C and 6 with a Kawasaki-SARS-CoV-2-related disease (KD). The frequency distribution of the main common risk variants underpinning COVID-19 susceptibility (ABO tagging SNPs) and severity (five GWAS-prioritized loci) was compared between patients and children with COVID-19 without MIS-C and with adult controls (n = 79 and n = 2,848, respectively). Whole exome sequencing (WES) was performed in the MIS-C cohort to examine the frequency of rare damaging variants in a panel of 207 immune-related genes as compared to that of local controls (n = 266).

Blood group B alleles conferred an increased risk of MIS-C independently of sex, ethnicity, the presence of COVID-19, and blood group A [odds ratio (OR) 2.9; 95% confidence interval (CI) 1.04-8.5; p = 0.04], with a larger impact on the KD subphenotype (OR 6.8; 95% CI 1.7-35.1; p = 0.007). A total of 49 rare damaging variants, 4 classified as pathogenic, were prioritized in 39 immune-related genes; all patients harbored at least one variant.

These results not only support a role of blood group B as a risk factor for MIS-C development in children with COVID-19, possibly through modulation of the coagulability and microvascular dysfunction, but also support an immune-genetic basis for this condition.

The development of rapidly progressive interstitial lung disease (RP-ILD) in patients with anti-MDA5-positive dermatomyositis-associated interstitial lung disease (MDA5+ DM-ILD) is a major cause of adverse outcomes, including mortality. This study aimed to identify factors influencing the occurrence of RP-ILD in patients with MDA5+ DM-ILD.

A systematic search was conducted in PubMed, EMBASE, the Cochrane Library, Web of Science, and Scopus for studies investigating factors associated with RP-ILD in MDA5+ DM-ILD, with the search period extending to January 1, 2026. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using Stata 18.0 software.

Fifteen studies were included in the meta-analysis, all of which were of high quality, with an average NOS score of 7.9. The meta-analysis revealed that male sex (OR = 1.99, 95% CI: 1.27-3.12), advanced age (OR = 2.54, 95% CI: 1.40-4.60), disease duration <3 months (OR = 3.23, 95% CI: 2.23-4.70), fever (OR = 2.46, 95% CI: 1.55-3.90), anti-Ro52 antibody positivity (OR = 5.05, 95% CI: 3.21-7.96), elevated C-reactive protein (CRP) (OR = 2.29, 95% CI: 1.78-2.94), elevated neutrophil-to-lymphocyte ratio (NLR) (OR = 2.29, 95% CI: 1.28-4.08), elevated lactate dehydrogenase (LDH) (OR = 3.39, 95% CI: 2.20-5.22), elevated aspartate aminotransferase (AST) (OR = 1.03, 95% CI: 1.00-1.06), elevated alanine aminotransferase (ALT) (OR = 2.42, 95% CI: 1.22-4.80), elevated serum ferritin (SF) (OR = 3.81, 95% CI: 1.95-7.42), lymphopenia (OR = 2.14, 95% CI: 1.10-4.16), and elevated carcinoembryonic antigen (CEA) (OR = 3.38, 95% CI: 1.32-8.66) were risk factors for RP-ILD. Conversely, arthralgia/arthritis (OR = 0.26, 95% CI: 0.16-0.44) and lymphocytosis (OR = 0.17, 95% CI: 0.09-0.31) were identified as potential protective factors.

This study explored potential risk and protective factors associated with the development of RP-ILD in patients with MDA5+ DM-ILD, providing a basis for early identification and management.

https://www.crd.york.ac.uk/prospero/, identifier CRD420261287925.

The one-strength injection regimen has increasingly become the mainstream paradigm for subcutaneous immunotherapy (SCIT). This study aimed to assess the safety and tolerability of an optimal accelerated scheme for SCIT using a house dust mite (HDM) product in adolescents and adults with allergic rhinitis (AR) or rhinoconjunctivitis (ARC), with or without asthma in China.

In this multicenter, open-label trial, patients were randomized to either One-strength or Standard group. The One-strength scheme included 6 injections with one-strength (5,000 TU/mL) followed by 4 injections at the maximum tolerated dose, administered without dose reduction when initiating a new vial. In contrast, the Standard regimen involved 14 injections across three strengths (50, 500 and 5,000 TU/mL), followed by 4 maintenance injections administered according to the medication instruction. Safety outcomes were determined by assessing Adverse Drug Reactions (ADRs), while tolerability was evaluated using a 5-point Likert scale.

Overall, 211 patients were randomized, with 108 assigned to the One-strength group, and 103 to the Standard group. Among all participants, 57.3% reported ADRs, of which 95.3% were local reactions. Systemic ADRs were observed in 7.4% of patients in the One-strength group and 8.7% in the Standard group, with no significant difference between the two groups (p=0.7233). All ADRs were classified as WAO grade 1 or 2, with no grade ≥3. In both adolescent and adult subgroups, the incidence of systemic ADRs remained comparable between the two arms (p > 0.05). However, in adults, only the incidence of local ADRs in the One-strength group was significantly higher than that in the Standard group (p=0.0004). Tolerability was rated as "good" or "very good" by approximately 84% of patients and investigators in the One-strength group and 70% of the Standard group (p=0.0131 for patient rating; p=0.0142 for investigator rating).

The One-strength scheme, consisting of 6 injections and no dose reduction when starting a new pack during the maintenance phase, is as safe and tolerable as standard SCIT regimen in adolescents and adults in China.

www.chictr.org.cn, identifier ChiCTR2200060194.

The COVID-19 pandemic caused varied disease outcomes globally, with individuals experiencing severe, non-severe, or no disease. Immune responses generated post-exposure to SARS-CoV-2 play a critical role in protecting against severe COVID-19 upon re-infection. This study aimed to analyze immune-cell phenotypes and functions in COVID-19 Recovered Patients (C-19RPs) from varying disease severities.

To compare the immune-cell phenotypes and functions in C-19RPs from different forms of the disease, more than six months post-infection.

Between September 2021 and July 2023, 101 C-19RPs with hospital data (median age 31) were recruited from Mbeya Zonal Referral Hospital, Tanzania. In addition, seven uninfected and 19 Actively Infected Patients (AIPs) (median age 34 and 58.5, respectively) were included as controls. Blood samples were collected for SARS-CoV-2 serology, immune and genomic analysis, whereas demographic and vaccination data were gathered through a questionnaire.

Serum anti-SARS-CoV-2 levels were similar between severe and non-severe C-19RPs but significantly higher in vaccinated non-severe cases than in unvaccinated ones. Severe C-19RPs and AIPs showed a trend towards decreased switched memory B cells. Frequencies of T-cell subsets were broadly similar across groups, but AIPs had increased central memory and decreased effector memory and effector CD4 T cells. T-cell responses to SARS-CoV-2 nucleocapsid peptides were not affected, but severe C-19RPs had increased CD8 cytokine responses and degranulation upon stimulation with Staphylococcus enterotoxin B (SEB). The frequency of CD56Dim_CD16Bright NK subsets was high in C-19RPs, while CD56Dim_CD16Neg subsets were reduced only in severe C-19RPs. DNA sequence analysis of the HLA from 18 C-19RPs and five uninfected participants revealed 11 and 20 alleles, which were exclusively found in severe and non-severe C-19RPs, respectively.

COVID-19 vaccination was particularly beneficial for non-severe C-19RPs, highlighting the benefits of vaccination in this group. Frequencies of B and NK cell subsets were long-term altered in the C-19RPs, while CD4 T-cell subset alterations were only in the AIPs. The enhanced T-cell response to SEB in the severe C-19RPs suggests potential long-term T-cell hyperresponsiveness, warranting further research. The unique HLA alleles exclusively found in either severe or non-severe C-19RPs may require additional exploration to confirm their association with disease severity.

To investigate the prevalence of antiphospholipid antibodies (aPLs) in pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and their impact on maternal-fetal outcomes, with an emphasis on gestational stage-specific differences and lupus anticoagulant (LAC) positivity.

This prospective, observational cohort study was conducted at the Department of Obstetrics, Peking University People's Hospital, from December 2022 to January 2023. Eligible participants were singleton pregnant women without pre-existing pregnancy complications who tested positive for SARS-CoV-2. Serum samples were collected 2-4 weeks post-infection for testing of aPLs, including LAC, anti-β2-glycoprotein I (aβ2GPI), and anticardiolipin antibodies. Maternal and fetal outcomes were monitored according to standard prenatal care protocols, with specific attention to placental dysfunction related complications.

The overall prevalence of aPLs in pregnant women infected with SARS-CoV-2 was 18.75%. All positive cases were single-antibody positive, either for aβ2GPI or LAC, with no instances of multiple antibody co-positivity. The prevalence of aPLs was significantly correlated with the gestational stage at the time of infection, rising from 5.88% in the first trimester to 16.00% in the second trimester and 26.31% in the third trimester (P<0.05). Notably, all LAC-positive cases (constituting 8.25% of total infections) were exclusive to women infected during the third trimester. The group with aPLs positive status experienced a significantly higher incidence of placental dysfunction related complications, such as gestational hypertension, oligohydramnios, and fetal growth restriction, compared to the aPLs-negative group (60.00% vs. 29.23%, P=0.036). The LAC-positive subgroup exhibited an even higher incidence of complications (71.43%, P=0.037), with numerically higher complication rates observed in LAC-positive cases than other aPLs. Univariate logistic regression analysis revealed that aPLs positivity (P=0.030) and specifically LAC positivity (P=0.041) were independent risk factors for placental dysfunction.

SARS-CoV-2 infection during pregnancy significantly increases the prevalence of aPLs, with a pattern that is dependent on the gestational stage. Positivity for aPLs, particularly LAC, is an independent risk factor for complications related to placental dysfunction. Our findings suggest that pregnant women infected with SARS-CoV-2, especially those in the third trimester, should undergo aPLs screening 2-4 weeks post-infection, along with enhanced monitoring for placental dysfunction, there should be vigilant surveillance of infection status, coagulation function, and appropriate obstetric management.

Acute respiratory infections (ARIs) are a leading cause of morbidity and mortality in children under five years of age and contribute to healthcare visits and hospitalisations globally. Vitamin D deficiency is common amongst pregnant women and young children. Given that vitamin D supplementation is safe, affordable, and easy to administer, its potential to reduce ARI-related healthcare visits holds substantial public health relevance. This review evaluates the benefit and harm of vitamin D supplementation in preventing ARI-related healthcare visits in young children, aiming to inform supplementation policies during pregnancy and early childhood.

To determine the benefit and harm of vitamin D supplementation for preventing ARIs in children up to five years of age.

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, Web of Science, WHO Global Index Medicus, and four clinical trial registries on 18 March 2025.

We included randomised controlled trials (RCTs) comparing vitamin D to placebo, or a higher dose (≥ 1000 IU) versus a lower dose (≤ 1000 IU) administered from early pregnancy through to five years of age. We excluded studies involving children with chronic respiratory or systemic conditions.

Critical outcomes: 1) healthcare visits made by children for an ARI: (a) the proportion of children with healthcare visits made for ARIs; (b) the mean number of healthcare visits made for ARIs per child; and 2) hypercalcaemia: the number of pregnant women and children with hypercalcaemia.

We assessed risk of bias using the Cochrane risk of bias (RoB) 1 tool for outcomes reported in the summary of findings tables.

We synthesised outcome data using meta-analyses, calculating risk ratios (RR) for dichotomous, and mean differences (MD) for continuous outcomes, each with 95% confidence intervals (CI). Where meta-analysis was not feasible, we summarised the results narratively. We used GRADE to assess the certainty of the evidence for pre-specified outcomes.

We included 107 RCTs involving 31,521 participants. Vitamin D supplementation was administered during pregnancy, early childhood, or both, and in some cases to both infants and lactating mothers. Interventions used vitamin D₂, D₃, both, or unspecified forms, with dosages ranging from daily administration to large single or quarterly boluses. Most were delivered orally, typically on a daily schedule, but also weekly or quarterly, over durations ranging from a single dose to 18 months. Settings included hospitals, day-care centres, communities, and homes.

Vitamin D supplementation may result in a slight reduction in the proportion of children who make ARI-related healthcare visits compared to placebo (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.91 to 1.00; P = 0.03; 10 studies, 2447 participants; low-certainty evidence), but probably does not reduce the mean number of ARI-related healthcare visits per child (mean difference (MD) 0.07, 95% CI -0.06 to 0.20; P = 0.32; 3 studies, 561 participants; moderate-certainty evidence). Comparisons between higher and lower doses of vitamin D probably do not reduce the proportion of children making ARI-related healthcare visits (RR 0.94, 95% CI 0.81 to 1.10; P = 0.46; 2 studies, 1382 participants; moderate-certainty evidence), and do not reduce the mean number of ARI-related healthcare visits per child (MD -0.10, 95% CI -0.59 to 0.39; P = 0.69; 1 study, 579 participants; low-certainty evidence). No cases of hypercalcaemia were reported among pregnant women in trials comparing vitamin D supplementation with placebo. In higher versus lower dose comparisons, supplementation may result in little to no difference in the risk of hypercalcaemia among pregnant women (RR 1.61, 95% CI 0.60 to 4.31; P = 0.34; 6 studies, 2379 participants; low-certainty evidence). Similarly, the evidence that vitamin D supplementation has little to no effect on the risk of hypercalcaemia in children, when compared with placebo, is very uncertain (RR 0.81, 95% CI 0.53 to 1.24; 7 studies, 1542 participants; very low-certainty evidence) and may result in little to no difference in the risk of hypercalcaemia in children when higher doses are compared to lower doses (RR 1.23, 95% CI 0.82 to 1.85; 7 studies, 1287 participants; low-certainty evidence).

We found low-certainty evidence that vitamin D supplementation during pregnancy or early childhood may result in a slight reduction in the proportion of children under five years of age who make ARI-related healthcare visits, but probably does not reduce the mean number of healthcare visits for ARIs per child. This finding highlights the need for large, well-designed, placebo-controlled trials to confirm the potential benefit. We found moderate-certainty evidence that higher-dose vitamin D supplementation, compared with lower doses, probably does not reduce the proportion of children making healthcare visits for ARIs and does not reduce the mean number of ARI-related healthcare visits per child. Hypercalcaemia occurs infrequently in both pregnant women and children receiving vitamin D supplementation. Where hypercalcaemia could be measured, specifically in children receiving vitamin D versus placebo, vitamin D supplementation may have little to no effect on the risk of hypercalcaemia (very low-certainty evidence). In both children and pregnant women, a higher dose of vitamin D compared to a lower dose may result in little to no difference in the risk of hypercalcaemia (low-certainty evidence).

This Cochrane review had no dedicated funding.

Protocol (2022) DOI: 10.1002/14651858.CD015111.

Objective:To compare the effects of remote interactive voice therapy versus traditional in-person therapy on treatment adherence and clinical outcomes in patients with voice disorders. Methods:A retrospective historical control study was conducted, categorizing patients into three groups based on distinct periods of COVID-19 prevention policies: the 2019 traditional therapy group（n=82）, the 2021 traditional therapy group（n=43）, and the 2022 remote therapy group（n=54）. Adherence differences were analyzed by geographic subgroup（Guangzhou vs. non-Guangzhou）, and improvements in Voice Handicap Index（VHI）, jitter, and shimmer were compared pre-and post-treatment. Results:Adherence: The overall〓adherence rate in the 2022 remote therapy group（38.89%） was higher than in the 2019（31.71%） and 2021（23.26%） traditional groups, although the difference was not statistically significant（P>0.05）. Notably, non-Guangzhou patients exhibited significantly higher adherence with remote therapy（2022: 45.45%） compared to traditional therapy（2019: 5.00%; 2021: 0）（P<0.01 for both comparisons）. Efficacy: Among patients with good adherence, all three groups showed significant improvements in VHI, jitter, and shimmer（all P<0.01）. Further analysis revealed no statistically significant differences in the magnitude of improvement between the 2022 remote group and the 2019/2021 traditional groups（all P>0.05）, indicating comparable therapeutic efficacy. Conclusion:Remote interactive voice therapy significantly enhances adherence among non-local patients, with equivalent efficacy to traditional in-person therapy. This approach provides an effective solution to overcome spatial and temporal barriers in voice rehabilitation, and holds important practical significance for optimizing voice disorder management strategies and improvinghealthcare service accessibility.

Objective:To establish a standardized operational procedure for T-tube insertion in the treatment of laryngotracheal stenosis and explore its clinical application outcomes. Methods:We established a standardized operational procedure for T-tube insertion treatment in laryngotracheal stenosis, which includes preoperative endoscopic and radiological evaluation, intraoperative endoscopic examination and measurement, airway reconstruction, determination of the length of the superior and inferior limbs of the T-tube, insertion method, as well as postoperative management and efficacy evaluation. This protocol was applied in the treatment of 25 cases of laryngotracheal stenosis to analyze its therapeutic efficacy and safety. Results:The cohort included 25 patients aged 21-72 years（mean age 26±9 years） with a disease duration of 1-30 months（median duration 5 months）. There were 21 males and 4 females. According to the classification method proposed by the European Laryngological Society, 14 cases were classified as Grade Ⅳa, 2 cases as Grade Ⅳb, and 9 as Grade Ⅲa. The T-tube superior limb crossed the glottis in 6 cases and did not cross the glottis in 19 cases. Postoperative follow-up ranged from 12 to 32 months（median 22 months）. A total of 21 patients successfully underwent T-tube removal after the first treatment, yielding a tube removal rate of 84%, among which, 16 patients（64%） were cured, 5 patients（20%） had an effective outcome. In the 4 ineffective cases, 2 patients were cured by secondary sleeve resection and end-to-end anastomosis, while the other 2 patients underwent repeat T-tube placement, and they currently maintain healthy survival with the T-tube blocked, and the long-term efficacy remains to be further observed. Conclusion:T-tube insertion is an effective therapeutic modality for the management of laryngotracheal stenosis. The establishment of a standardized operational procedure and its appropriate application are important guarantees for improving the success rate of treatment.