While prior research has linked brain responses in late pregnancy to caregiving quality, no study has examined how neural responses to infant cues change across gestation and relate to postpartum parenting. Using fNIRS, we measured prefrontal responses to infant cues each trimester in 76 birthing parents (M = 29.49 years; 62.2% White, 14.9% Black, 16.2% other). Greater increases in right DLPFC and VMPFC responsivity to infant cries predicted more sensitive parenting, while increases in DLPFC responses to happy faces predicted greater parental structuring. Findings suggest a gradual, lateralized tuning of prefrontal systems to emotionally salient infant cues beginning early in gestation. Results highlight pregnancy as a sensitive window to support emerging caregiving capacities and inform early interventions for expectant parents.

The global escalation of morbid obesity has expanded the scope of bariatric and metabolic surgery in addressing obesity and its associated comorbidities. This pilot study retrospectively evaluates the efficacy of Braun anastomosis in the management of nausea, vomiting and hypoalbuminaemia following single anastomosis sleeve ileal (SASI) bypass surgery.

Nineteen patients who underwent SASI bypass for obesity and Type 2 diabetes mellitus between June 2020 and June 2023 and subsequently developed nausea, vomiting and hypoalbuminaemia were included. Braun anastomosis was performed as a revision procedure. Pre-operative and post-operative assessments at 1, 6 and 12 months included serum albumin, haemoglobin A1c and body mass index (BMI).

Pre-operative mean serum albumin levels of 1.86 ± 0.24 g/dL increased significantly to 3.38 ± 0.15 g/dL by the 6th post-operative month (P < 0.001). BMI decreased from a pre-operative mean of 32.58 ± 2.26 kg/m2 to 27.60 ± 1.53 kg/m2 at 6 months postoperatively (P < 0.001). Haemoglobin A1c showed a non-significant reduction from 6.40% ±0.60% preoperatively to 6.20% ±0.37% at 6 months postoperatively (P = 0.250). Bile reflux, present preoperatively, resolved by the 6th post-operative month. A marked reduction in nausea and vomiting was also noted following the revision surgery.

Braun anastomosis was effective in managing the complications following SASI bypass, leading to significant improvements in serum albumin and BMI. Further studies are required to assess the long-term safety of SASI and the role of Braun anastomosis in the management of post-SASI complications. These results suggest that Braun anastomosis may play a valuable role in optimising the outcomes following SASI bypass.

Copyright: &copy; 2026 Gentilini et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. This article investigates the potential association between modified mRNA (modRNA) COVID-19 vaccinations and the development of haematopoietic cancers. We present a case involving a healthy, young, athletic woman who developed acute lymphoblastic leukaemia (ALL) and lymphoblastic lymphoma (LBL) following her second dose of the Pfizer/BioNTech COVID-19 vaccine (Comirnaty&#x00AE;). This case is part of an expanding body of literature documenting similar occurrences after modRNA vaccinations, which we critically examine. Emerging evidence suggests that the biodistribution and persistence of modRNA, facilitated by lipid nanoparticles, can affect various tissues and organs, including the bone marrow and other blood-forming organs. Notably, modRNA vaccines exhibit a particular affinity for the bone marrow, potentially influencing the immune system at multiple levels and triggering both autoimmune disorders and neoplastic processes. In this article, we assess the risk of developing haematopoietic cancers post-modRNA vaccination based on current scientific literature and explore the reported potential genetic and molecular mechanisms involved in disease pathogenesis. By integrating clinical observations and current research, we aim to provide valuable insights into the potential carcinogenic outcomes associated with modRNA vaccination.

This study evaluated the clinical implementation of bronchoscopic lung volume reduction (BLVR) with endobronchial valves (EBV) for patients with advanced emphysema and COPD at a university hospital in Sweden. Between 2022 and 2025, a total of 116 patients were evaluated, of whom 32 were treated. BLVR with EBV significantly improved lung function (FEV1), exercise capacity (6-MWT), and symptom burden (CAT score), with mean improvements exceeding the minimal clinically important difference. 3 patients (11 %) experienced complications (2 with pneumothorax, 7 %; 1 with COPD exacerbation, 4%). A dedicated multidisciplinary team with expertise in COPD, bronchoscopic interventions, and thoracic radiology is essential for treatment success. This study highlights BLVR as a promising treatment option in Sweden, with a potential for broader implementation.

People with cystic fibrosis (PwCF) face considerable burden from medical expenses, medications, and daily living with a chronic disease. PwCF want to discuss financial challenges with their care team, although little is known about cystic fibrosis (CF) clinicians discussion practices. We described the current practices and perspectives of CF clinicians regarding cost and financial discussions.

We administered a national, cross-sectional, online survey to CF clinicians through CF Foundation listservs.

192 respondents completed the survey and represented all multidisciplinary team members such as licensed practitioners, social workers, nurses, pharmacists, and other involved disciplines. Most respondents (80%) believed CF clinicians should discuss costs of medical care although less than half felt comfortable discussing cost. Social workers were more likely than licensed prescribers to discuss costs and feel comfortable with discussions. 52% of respondents reported having at least one conversation about the annual cost of CF medical care and 73% discussed out-of-pocket costs in the last year. Social workers were identified as the clinician that should be primarily responsible for discussing financial matters. Lack of time during visits (77%), lack of knowledge about topics (74%), and lack of clinician comfort (64%) were the most commonly identified barriers to discussions.

Most CF clinicians believe that cost and financial discussions are important and reported engaging in these conversations with patients at least annually. Differences in comfort level and discussion practices were observed between social workers and licensed prescribers. Results demonstrate the opportunity for educational interventions to address clinician knowledge and improve comfort level with discussions.

Bronchopulmonary dysplasia is a hallmark respiratory complication of prematurity and remains a major health determinant of individuals born very preterm. Its impact, however, extends far beyond the neonatal period and far beyond the lungs. Children, adolescents and adults born very preterm often follow diverse developmental trajectories that diverge from typical postnatal growth. These trajectories often display early airflow limitation, as well as features of increased cardiovascular vulnerability and altered multisystemic profiles. Although common respiratory labels such as asthma are often applied to these patients, evidence highlights distinct pathobiological mechanisms rooted in arrested alveolar and vascular growth, with a possible contribution from persistent airway inflammation and oxidative stress. Extrapulmonary involvement, including cardiovascular, neurodevelopmental, neurosensory, renal and metabolic domains, further shapes long-term outcomes and should be systematically integrated into long-term monitoring. Yet, despite improving survival and growing recognition of this multisystemic burden, current evidence remains insufficient to design a dedicated, holistic, multidisciplinary follow-up programme tailored to the diverse subgroups of preterm-born individuals. Increasing awareness among healthcare professionals of the long-term implications of prematurity is essential to ensure that these patients receive appropriate and coordinated attention. Emerging lines of research, spanning new preventive and therapeutic options, advanced imaging, mechanistic studies, and long-term cohort designs, hold promise in elucidating the biological determinants of disease. Integrating these insights into clinical pathways, together with sustained implementation of family-centred care models, will be crucial to optimise organ function trajectories, delay deterioration and ultimately improve the quality of life of the growing population of survivors of prematurity.

COPD frequently coexists with cardiovascular diseases. Cardiovascular death is also a major contributor to mortality in COPD patients. Inhaled corticosteroids (ICS), as the most commonly prescribed inhaled anti-inflammatory medications, have been widely used for management of COPD patients who experience frequent exacerbations. However, whether ICS have a cardiovascular protective effect remains unclear. The purpose of this work was to comprehensively ascertain the risks of cardiovascular deaths related to ICS in COPD patients.

PubMed, the Cochrane Library and Embase were searched to screen qualifying articles from September to November 2022. An updated search was conducted in October 2025. We identified trials of any ICS for treatment of COPD and reported on cardiovascular deaths. Meta-analyses were conducted to calculate risk ratios with 95% confidence intervals. The primary end-point was cardiovascular mortality.

35 randomised controlled trials enrolling 74 004 subjects were analysed. Inhaled formulations containing ICS significantly reduced the risk of cardiovascular deaths compared with inhaled formulations without ICS (risk ratio 0.84, 95% CI 0.74-0.95). ICS/long-acting muscarinic antagonist (LAMA)/long-acting β₂-agonist (LABA) significantly reduced the risk of cardiovascular deaths compared with dual LAMA/LABA therapy (risk ratio 0.56, 95% CI 0.37-0.86). ICS monotherapy also significantly reduced the risk of cardiovascular deaths compared with placebo (risk ratio 0.81, 95% CI 0.66-0.99). However, ICS/LABA did not significantly reduce the risk of cardiovascular deaths compared to LABA monotherapy (risk ratio 0.98, 95% CI 0.80-1.20).

Inhaled formulations containing ICS are associated with a reduced risk of cardiovascular deaths in patients with COPD.

Pulmonary fibrosis (PF), the irreversible scarring of the lungs in many interstitial lung diseases, remains fatal despite currently approved antifibrotic therapy. Converging evidence shows that dysregulated innate and adaptive immunity orchestrates every stage of the fibrotic cascade. Roughly 20% of PF susceptibility loci map to immune regulatory genes, including Toll-interacting protein, interleukin (IL)-1 receptor antagonist, Toll-like receptor-3, complement receptor-1 and tumour necrosis factor-α (TNF-α), indicating that genetically primed host defence pathways predispose to maladaptive repair. Recurrent epithelial injury triggers a type 1 inflammatory response that gradually shifts toward type 2-skewed wound healing; the resulting cytokine milieu rich in transforming growth factor-β, IL-13, IL-6 and platelet-derived growth factor reprogrammes fibroblasts into collagen-secreting myofibroblasts. Spatial-omic profiling of PF lungs corroborates this model, revealing niches where profibrotic macrophages, T-helper cells and inflammatory fibroblasts colocalise within a stiff, collagen-rich matrix. Beyond their direct antimesenchymal actions, the current therapeutics pirfenidone and nintedanib also temper innate and adaptive immune signalling. Proof of concept for sharper immunomodulation now comes from recent phase III trials of nerandomilast, a highly selective phosphodiesterase-4B inhibitor that preserved forced vital capacity and downregulated TNF-α, IL-6 and IL-17 networks. These results demonstrate that immune pathway modulation can complement existing antifibrotics and invigorate efforts to align mechanism-based therapies with patient-specific immune endotypes, steered by genetics, cellular phenotypes and circulating biomarkers. This review synthesises current understanding of how immunity initiates, amplifies and perpetuates PF, linking genetic and mechanistic insights to emerging therapeutic opportunities. A deeper grasp of immune-epithelial-fibroblast crosstalk is essential for transforming disease-slowing care into genuinely disease-modifying intervention.

Autoimmune pulmonary alveolar proteinosis (aPAP) is characterised by abnormal alveolar surfactant accumulation and reduced pulmonary gas transfer. Disease severity and progression depend on pulmonary surfactant accumulation, the rate of which varies widely among patients. Currently, whole-lung lavage (WLL) is the most widely accepted therapy. This review addresses the burden of aPAP on patients, caregivers and society.

MEDLINE and Embase databases were systematically searched for reports on the manifestations, treatment burden, caregiver impact and healthcare costs of aPAP published after 2000.

Out of 1023 publications identified, 50 reported relevant data (for 2855 aPAP patients), including 43 observational studies and seven phase 2/3 trials. Commonly reported symptoms included dyspnoea, cough and sputum production. Clinical manifestations included progressive hypoxaemia, reduced exercise capacity, reduced quality of life, and an increased rate of serious infections. Low prevalence and nonspecific signs and symptoms contributed to delayed diagnosis of aPAP, frequent misdiagnoses, use of multiple tests with nondiagnostic results, and therapies that were inappropriate or exacerbated the disease. WLL was the most frequently administered therapy, and many patients required repeat procedures. Medical care costs were higher for PAP patients than for non-PAP control patients.

The results highlight the multifactorial and substantial burden of aPAP on patients. Significant unmet needs remain, particularly in achieving timely and accurate diagnosis and in providing effective, well-tolerated therapies that address the underlying pathophysiology of the disease.

Respiratory viruses, frequently detected in asthma, are associated with worse outcomes. This meta-analysis systematically quantifies the prevalence of respiratory viruses in stable and acute asthma, across children and adults, and explores factors associated with increased viral burden through meta-regression.

This prospectively registered meta-analysis (PROSPERO-CRD42023375108) included studies employing molecular techniques to assess respiratory virus prevalence in asthma. Three databases were searched in August 2024. Risk of bias and certainty of evidence were assessed. We performed random-effects meta-analysis of proportions.

We included 111 eligible studies. Moderate-certainty evidence indicated a pooled prevalence of any respiratory virus of 33.9% (95% confidence interval 24.8-43.7%) in children and 23.0% (12.9-35.0%) in adults with stable asthma. In acute asthma, prevalence increased to 58.8% (52.5-65.0%) in children and 49.9% (41.2-58.5%) in adults (moderate certainty). Rhinovirus was the most frequently identified virus, especially in acute asthma (45.0% in children versus 21.2% in adults). Respiratory syncytial virus and bocavirus were more common in younger children, while coronavirus and influenza were more frequently detected in adults; respiratory syncytial virus peaked in older adults too. A higher prevalence of influenza virus B and adenovirus in children, and of influenza virus A and parainfluenza 2 in adults with severe versus non-severe acute asthma suggests a potential association with more severe acute attacks.

Respiratory viruses are common in both stable and acute asthma. This suggests that the diagnostic value of a positive viral test during acute episodes may be limited and could benefit from complementary biomarkers to improve interpretation.