Objective:To analyze the distribution, prevalence, clinical characteristics, risk factors, treatment, prevention and control of Artemisia pollen-induced allergic rhinitis（PiAR） in Hohhot, Inner Mongolia, northern China. Methods:From April to June 2023, a multi-stage, stratified and random sampling method was used to conduct a full coverage epidemiological investigation in the 4 districts and 5 counties of Hohhot City. Face-to-face questionnaire surveys and skin prick tests（SPT） were conducted on the population, while pollen counts were used to monitor pollen exposure levels, to observe the prevalence, population distribution characteristics, major risk factors and control of Artemisia pollen PiAR. Data processing was carried out using SAS software 9.4. Results:A total of 1 621 patients allergic to Artemisia pollen completed the questionnaire, with a prevalence rate of 26.7%. The high-incidence age group was 13-17 years old, and the prevalence rate in urban areas was higher than that in rural areas. The main clinical symptoms are mainly nasal itching, sneezing and clear nasal discharge. The pollen amount of Artemisia reaches its peak in September. The peak time of the frequency of clinical symptoms in patients with Artemisia PiAR is about one month earlier than the peak time of pollen concentration. Under the comprehensive prevention and control strategy, compared with 2020, the application of antihistamines and nasal spray hormones has increased, and the degree of symptom reduction, the proportion of preventive medication in advance during the pollen season, and the proportion of regular medication during the pollen season have also increased（P<0.01）. Conclusion:This study clarified the prevalence rate, risk factors and prevention and control of PiAR in Artemisia pollen. It provides rich data and basis for in-depth research and prevention and control of this disease.

Objective:To identify reliable anatomical landmarks through endoscopic dissection of the palatovaginal canal（PVC） and to introduce a novel posterior nasal neurectomy（PNN） approach via this canal, while evaluating its clinical efficacy in allergic rhinitis（AR）. Methods:Surgical-route dissection was performed on 10 dry skulls and 2 fresh cadaveric heads to obtain high-definition images of the PVC region. A retrospective analysis was conducted on 30 AR patients who underwent PNN in which the PVC served as the key landmark. Symptom severity was assessed with a visual analogue scale（VAS） pre-operatively and 12 months post-operatively. Results:Critical landmarks for the new approach were identified, including the sphenoidal process of the palatine bone, posterior aperture of the PVC, posterior sulcus, PVC itself, vomerovaginal canal, vaginal process, and sphenopalatine foramen. One year after surgery, mean VAS scores for nasal obstruction, itching, sneezing, rhinorrhea, and overall discomfort were all lower than baseline with statistically significant differences. Aside from transient palatal numbness in five patients, no other complications occurred. Conclusion:Endoscopic PNN via the palatovaginal canal is a safe and effective surgical method for the treatment of allergic rhinitis.

The Japan Society for Endoscopic Surgery (JSES) conducts a nationwide survey every 2 years to evaluate the status and trends of endoscopic surgery in Japan. This article reports the results of the 17th Nationwide Survey conducted by the JSES in 2022 and 2023. A questionnaire assessing the current status of endoscopic surgery was distributed to institutions nationwide. Since 1990, a total of 4 286 446 endoscopic procedures have been performed in Japan, with a continuous increase in most surgical fields. Although the number of procedures temporarily declined during the COVID-19 pandemic, endoscopic surgical activity steadily recovered and increased across all disciplines. Furthermore, the use of robot-assisted surgery has expanded rapidly in multiple specialties, reflecting broader clinical adoption and technological progress. These nationwide data demonstrate that endoscopic surgery is widely and safely performed across all surgical specialties in Japan. The findings of this multidisciplinary survey provide valuable insights into current practice patterns and will contribute to further development, standardization, and safe dissemination of endoscopic surgery.

Despite widespread vaccination, SARS-CoV-2 transmission continues, and serological testing remains relevant for selected diagnostic scenarios and population-based assessments of antibody responses. Rapid diagnostic tests (RDTs) for SARS-CoV-2 antibodies are attractive for field use and decentralized settings, but their diagnostic performance varies and requires independent evaluation. We assessed the performance of three commercially available lateral flow RDTs (PANBIO™ COVID-19 IgG/IgM Rapid Test Device, Bio-Manguinhos-Fiocruz TR COVID-19 (IgM-IgG), and Bio-Manguinhos-Fiocruz TR DPP® COVID-19 IgM/IgG) in Salvador, Brazil.

Using blind analyses, we evaluated 257 serum samples from RT-PCR-confirmed cases and 199 control samples from individuals with other febrile illnesses or healthy donors collected before and during the pandemic.

Overall sensitivity for IgM or IgG detection was limited across all tests (52%-58%), while specificity was high for two assays (97%-98%) and lower for one (80%). Sensitivity peaked between 11 and 20 days after symptom onset (80%-91%) and declined thereafter. Among 75 vaccinated individuals without prior COVID-19, antibody positivity ranged from 39% to 55%.

These findings indicate that the evaluated RDTs had high specificity but insufficient sensitivity for reliable clinical diagnosis or for assessing vaccination status in serological surveys. Our results support cautious use of these assays and highlight the need for more accurate and robust antibody-based rapid tests to strengthen immunological surveillance and public health preparedness in the post-pandemic period.

Treatment guidelines for acute respiratory distress syndrome (ARDS) recommend the use of high-dose corticosteroids based on their anti-inflammatory effects, yet the efficacy of this therapeutic strategy in patients with COVID-19 related ARDS is inconclusive. To more thoroughly understand the mechanism of action for high-dose corticosteroids in patients with COVID-19-related ARDS, we hypothesized that the reduction of inflammatory markers induced by high-dose corticosteroids would reduce mortality (i.e., inflammation as a mediator).

In this retrospective cohort study, we included patients with COVID-19-related ARDS admitted to the intensive care unit (ICU) of an academic hospital in Rotterdam, the Netherlands between March 2020 and June 2022. High-dose corticosteroids were defined as > 6 mg of dexamethasone/day or equivalent. Biomarkers included C-reactive protein (CRP), d-dimer, ferritin, leukocyte count, interleukin-6 (IL-6), lactate dehydrogenase, and neutrophil-to-lymphocyte ratio (NLR). Using a causal mediation framework, we estimated the average mediation effect (AME) and % mediation for each biomarker, allowing to quantify the degree to which continuous levels of inflammatory markers mediate the association between receiving high-dose corticosteroids and mortality. The models used in this framework accounted for time-varying treatment/mediation with inverse probability of treatment weights, determined from the covariates PaO₂/FiO₂ ratio, sex at birth, age, NLR, and ICU length of stay.

Of the 327 patients included, 122 (37.3%) received high-dose corticosteroids. The risk of death was higher in patients who did vs. did not receive high-dose corticosteroids [incidence rate = 0.54, 95% confidence interval (CI) = 0.42-0.71 and 0.21, 95% CI = 0.15-0.29/person-month, respectively; p < 0.001]. This effect remained in most analyses accounting for time-varying treatment/mediation. The association between high-dose corticosteroids and mortality was reduced (i.e., mediated) with lower levels of CRP (AME = -0.006, 95% CI = -0.011, -0.002; %-mediation = -82.0%), d-dimer (AME = -0.002, 95% CI = -0.005, -0.001; %-mediation = -33.1%), and IL-6 (AME = -0.002, 95% CI = -0.004, -0.001; %-mediation = -25.5%). There was no evidence of mediation for other biomarkers.

CRP, d-dimer, and IL-6 mediated the association between high-dose corticosteroids and mortality. When inflammation was reduced, the deleterious effect of high-dose corticosteroids was eliminated.

Alveolar echinococcosis (AE) caused by Echinococcus multilocularis, is a rare but potentially fatal zoonotic infection. AE most commonly presents with multiple cysts in the liver, may spread to other organs through infiltration or metastasis and can mimic malignancy with fatal consequences if not diagnosed early. Its occurrence in childhood is extremely rare and simultaneous hepatic and pulmonary involvement has been reported only in a few cases. This report aimed to discuss a pediatric AE case with concurrent hepatic and pulmonary involvement, initially misdiagnosed as malignancy, in the light of current literature. The presenting complaints, physical examination findings, diagnostic methods, treatment and follow-up results of a pediatric AE case with hepatic and pulmonary involvement were documented and pediatric AE cases available in the literature were reviewed. A 10-year-old boy presented with a fivemonth history of intermittent fever and weight loss. At admission, multiple cystic lesions were detected in the liver parenchyma, along with widespread cystic foci in both lungs. Laboratory tests revealed marked eosinophilia (44.5%), and E.multilocularis serology (IgG, IHA) together with Western blot (Em70, Em90 positivity) confirmed the diagnosis. According to the "parasitic mass in the liver, neighboring organs involvement and metastasis" classification; the case was staged as P4N0M1. Since surgical resection was not feasible, continuous albendazole therapy (15 mg/kg/day) was initiated. After one year of follow-up, significant radiological regression was observed, without new lesion development or treatment-related toxicity. Pediatric AE with multi-organ involvement may mimic malignancy and cause diagnostic delays. Early diagnosis and appropriate antiparasitic therapy can achieve favorable outcomes even when surgery is not feasible. However, the prolonged duration of therapy and the lack of a well-defined treatment endpoint pose significant challenges in terms of monitoring and potential toxicity. More clinical data are needed to establish optimal treatment duration and follow-up protocols in children.

The one health perspective is an integrative and holistic approach that recognizes the interconnection and interdependence of human, animal and plant health and aims to improve each sustainably. This perspective has gained particular importance following the coronavirus disease-2019 pandemic and has been acknowledged as a component of public health. Fungal infections also pose significant risks to ecosystems, ranging from crops to animals and humans. These risks partly arise from human and animal mobility and have increased alongside climate change. Therefore, food safety has become an integral part of developing societies. Apples are the most widely consumed fruit worldwide. They are known to have multiple health benefits and have been reported to reduce the risk of chronic diseases such as cancer, diabetes, heart disease and stroke. Previous studies have shown that important human pathogens, including multidrug-resistant Candidozyma auris and Candida parapsilosis were isolated from apple peels. Moreover, although rarely, dematiaceous fungi such as Exophiala dermatitidis and Exophiala phaeomuriformis, which can also be pathogenic for humans and animals, have been identified in apples. The aims of the study were to investigate, the presence of extremotolerant Exophiala species in apples that undergo post-harvest storage processes and are sold in local markets across different regions of Türkiye, as well as the polyaromatic hydrocarbon (PAH) levels in the apples from which these isolates were obtained. Additionally, given their resistance to these molecules, the value of culturing Exophiala species on apples as a biological indicator of PAH pollution and to discuss the findings within the framework of the One Health perspective and to draw attention to this issue were aimed in the study. In the present study, the presence of dematiaceous fungi was investigated in 549 apples collected from local markets in 24 different provinces of Türkiye. Sampling was performed from apple skins using sterile swabs and inoculation was carried out on Sabouraud dextrose agar, Staib agar and Czapek media. Isolates compatible with dematiaceous fungi were subsequently identified by sequencing the rDNA internal transcribed spacer region. Antifungal susceptibility testing against five different triazoles was performed using the CLSI microdilution method. Furthermore, benzo[a]anthracene, benzo[b]fluoranthene, benzo[a] pyrene, and chrysene were measured as indicators to determine the amount of polycyclic aromatic hydrocarbons (PAHs) in the skins of apples from which dematiaceous fungi were recovered. In this study, E.phaeomuriformis was identified in four apples (0.7%). These isolates were detected in the provinces of Ankara, Antalya (Finike district), Kayseri, and Kars (Sarıkamış district). Antifungal susceptibility testing was performed for three isolates, and low MIC values were found for all triazole antifungals except fluconazole.. The levels of the four compounds, considered primary environmental pollutants were determined to be high in the skins of all four apples according to the European Union and Turkish Food Codex limits. This suggests that E.phaeomuriformis, which is known to utilize aromatic hydrocarbons as a carbon source, could be used as a biological indicator of PAH pollution. Additionally, apple skins were considered to represent an oligotrophic habitat. In conclusion, beyond food safety, the need to improve and strengthen public health services is evident.

Pneumocystis pneumonia (PcP) caused by Pneumocystis jirovecii is one of the most common and serious opportunistic infections in immunocompromised patients. People at risk for developing Pneumocystis pneumonia include human immunodeficiency virus positive individuals, cancer patients, people receiving immunosuppressive therapy, organ transplant recipients and people with compromised immune systems. Despite effective treatment and prophylaxis, mortality is reported to be between 15-40%, even in people with immunodeficiency other than acquired immunodeficiency syndrome. Although the number of immunosuppressed patients is increasing, diagnostic and epidemiological studies for this agent are still insufficient. This study aimed to investigate the prevalance and epidemiological characteristics of P.jirovecii isolated from various patient groups. Among the 469 bronchoalveolar lavage fluids or sputum samples sent to the medical microbiology laboratory from various units, 114 samples were selected for indirect fluorescent antibody (IFA) testing and molecular studies based on an examination of the patients' files to determine underlying diseases, use of immunosuppressive drugs, corticosteroid treatments received and the presence of patchy or nodular ground-glass opacity on computed tomography scans and the presence of a cyst-like structure on May-Grunwald Giemsa staining. The presence of P.jirovecii was investigated by IFA and polymerase chain reaction methods and genotyping was performed by sequencing of mtLSU rRNA and internal transcribed spacer (ITS) region. The obtained ITS gene region DNA sequences were aligned and TCS network analysis was performed in the aligned region. As a result, positivity was found in eight samples out of 469 samples by using mtLSU rRNA genotyping, Genotype 1 (n= 3; 37.5%) was found to be the most common genotype in our samples. Genotype 2 (n= 2, 25%), genotype 4 (n= 2, 25%) and genotype 3 were the most frequently detected other genotypes, respectively. When the relationships between the sequences were examined, it was observed that our samples were generally related to the samples originating from Iran. In the present study, the genotyping analysis of the ITS region, constructed using the consensus sequence employed in the study by Lee et al., revealed that the most common genotype was Eh (n=3; 42.85%), followed by Bg (n= 2; 28.57%), Bi (n= 1; 14.28%) and Eg (n=1; 14.28%). Our study is the first genotyping study conducted in our country using the ITS gene region. Different epidemiological findings were found in P.jirovecii genotype frequencies in studies conducted in different geographies. This suggests that genetic variations in P.jirovecii have a geographical component and this may affect the distribution of P.jirovecii strains among humans. According to TCS network analysis, our samples are generally associated with samples originating from Iran. None of our samples are found alongside samples originating from India. However, in certain areas of the analysis, New World and Old-World samples exist together. It can be assumed that globalization and thus the increase in human movement over time has led to the spread of different genotypes to different geographical regions and the formation of genotypic mosaics in certain geographical regions. Man-made destruction of nature and the consequent intertwining of urban and rural boundaries, as well as global warming and climate change have undeniably contributed to these movements.

The first influenza A(H5N1) human case associated with the A(H5N1) dairy cattle outbreak in the United States was identified in April 2024. The U.S. CDC response to this outbreak was activated days later and remained active until July 2025. During this time, 70 human cases of influenza A(H5N1) were detected with a range of epidemiological links to sources of exposure. Next-generation sequencing (NGS) of human samples was an effectual mechanism for tracking and analyzing the outbreak evolution throughout the response. Due to the specimens' importance and their variable physical quality, an assortment of laboratory methods was utilized including influenza segment-specific amplification, enrichment capture, short-read, and long-read sequencing. Combining these methods allowed for high-quality genomic data production with rapid turnaround times-typically 2 days from sample receipt to public database submission. By leveraging replicate sequencing, enrichment capture, and sequencing of diagnostic amplicons, valuable genomic data could be produced directly from human clinical specimens that would have normally been considered too weak for routine virologic surveillance sequencing. The resulting assemblies were characterized and analyzed by CDC and shared with local and state public health authorities to facilitate case investigations and risk assessment. These data were further used for phylogenetic analyses of viruses from human cases to investigate likely animal-to-human transmission events and identify clusters within the outbreak that might indicate trends in the types of exposures. Through the adaptable laboratory workflow and the rapid release of viral genomic data, the public health risk mitigation strategies could be evaluated and adjusted in real time.

Long COVID (LC), also referred to as post-acute sequelae of SARS-CoV-2 infection, is characterized by persistent symptoms originating 3 months following acute COVID-19, lasting for at least two months and frequently affecting individuals who initially experienced mild to moderate disease. The clinical spectrum is heterogeneous, involving respiratory, cardiovascular, neurological, renal, gastrointestinal, and endocrine systems, thereby posing substantial diagnostic and therapeutic challenges. Despite extensive investigation, the precise immunopathogenic mechanisms underlying LC remain incompletely defined. Accumulating evidence suggests that LC is driven by a multifactorial interplay of persistent viral antigen reservoirs, chronic immune activation, dysregulated innate and adaptive immune responses, autoimmunity, endothelial dysfunction, microvascular injury, and aberrant tissue repair. These systemic immune perturbations manifest variably across different organs, contributing to the diverse clinical phenotypes observed. However, mechanistic clarity is hindered by heterogeneity in study designs, limited longitudinal data, and the absence of standardized immunological profiling. This narrative review provides integrative insights into the immunopathogenesis of LC, synthesizing current evidence on systemic immune dysregulation and organ-specific immunological mechanisms. A conceptual framework is proposed to facilitate a structured understanding of this complex syndrome and to guide future research toward targeted immunomodulatory strategies.