Asthma is one of the most common chronic diseases affecting children in the United States, with millions impacted annually. There is ongoing concern and disparity in the pediatric workforce. However, there is limited research evaluating how the geographic distribution of these providers aligns with pediatric asthma burden across states.

To assess the degree of geographic alignment between pediatric asthma prevalence and the distribution of general pediatricians and pediatric hospitalists in the United States using inequality metrics and spatial analysis.

This was a cross-sectional, state-level ecological study using publicly available data. Pediatric asthma prevalence was obtained from the CDC Behavioral Risk Factor Surveillance System. Pediatric provider data were sourced from the American Board of Pediatrics, and child population estimates were retrieved from the U.S. Census Bureau. Workforce density was calculated as the number of general pediatricians and pediatric hospitalists per 100,000 children in each state. Lorenz curves and Gini coefficients were used to quantify geographic inequality in asthma burden and workforce distribution. Bivariate choropleth maps and Pearson correlation coefficients were employed to assess spatial mismatch and association between asthma prevalence and provider availability.

General pediatricians had a mean state-level density of 70.6 per 100,000 children, while pediatric hospitalists had a mean density of 5.3 per 100,000 children (p < 0.0001). Gini coefficients revealed moderate inequality in the distribution of general pediatricians (0.20) and higher inequality among pediatric hospitalists (0.33). In contrast, the Gini index for pediatric asthma prevalence was 0.11. Correlation analysis showed a weak, marginally significant association between asthma prevalence and general pediatrician density (r = 0.30, p = 0.032), and a non-significant association with pediatric hospitalist density (r = 0.24, p = 0.094). Bivariate mapping identified several states with high asthma burden and low provider density, revealing substantial spatial mismatches.

There is a misalignment between the burden of pediatric asthma and the distribution of pediatric healthcare providers in the U.S., particularly in pediatric hospital medicine. States with higher asthma prevalence are not consistently supported by proportionally larger pediatric workforces. Policies that support provider redistribution, rural practice incentives, and data-driven workforce modeling are essential to improving health equity and optimizing care for children with asthma.

Severe Mycoplasma pneumoniae pneumonia (MPP) in children is associated with immune dysregulation and unfavorable outcomes; however, the clinical significance of routinely measured immune and inflammatory markers remains uncertain. This retrospective exploratory study evaluated factors associated with poor prognosis and the individual discriminatory performance of immunoglobulin A (IgA), immunoglobulin G (IgG), immunoglobulin M (IgM), and C-reactive protein (CRP). A total of 172 children with MPP treated between April 2018 and April 2021, and 40 healthy controls were included. Biomarker levels were compared across disease severity and prognostic groups. Individual receiver operating characteristic (ROC) curve analyses and exploratory logistic regression were performed. Serum IgA, IgG, and IgM levels were significantly lower, whereas CRP levels were significantly higher, in children with severe disease and in those with poor prognosis than in the corresponding comparison groups (P < 0.05). The areas under the ROC curve (AUCs) for IgA, IgG, IgM, and CRP were 0.788, 0.707, 0.696, and 0.796, respectively. Fever duration, lesion type, immune dysfunction, elevated CRP, and extrapulmonary complications differed significantly between the prognostic groups. Exploratory multivariable analysis identified immune dysfunction and extrapulmonary complications as independent factors associated with poor prognosis. These findings support further investigation of immune and inflammatory biomarkers for risk stratification in children with severe MPP; however, prospective studies are needed to validate their clinical utility, and the present results should not be interpreted as a validated clinical prediction model.

Timely access to COVID-19 antivirals is essential for high-risk populations; however, access remains inequitable for many multicultural communities. This study aims to capture the perspectives and experiences of frontline and multicultural support workers on barriers and enablers to antiviral access for members of multicultural communities in New South Wales (NSW) during COVID-19. We conducted three focus groups with 13 frontline and multicultural support workers employed by NSW Health in three local health districts between February and April 2025 to capture participants' reflections on the 2022 COVID antiviral rollout. During the pandemic, all participants highlighted the extensive and rapid provision of information related to vaccination. In comparison, they received little information and had limited awareness about the rollout of COVID antivirals. Emerging barriers were identified, such as no training on antivirals for multicultural support workers, health system strain from COVID fatigue, and a lack of community trust in novel medications. Trusted relationships within the community were recognised as a key enabling factor in facilitating access to health information during the public health emergency. Persistent health inequities are evident in how multicultural communities were supported to access antivirals, even as these groups have experienced disproportionate impacts across multiple dimensions of the pandemic.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and healthcare expenditure worldwide. Disease burden and economic value are typically evaluated separately, limiting integrated assessment for value-based healthcare and resource allocation. This review integrated COPD burden-reduction potential with the incremental cost-effectiveness ratio (ICER) to prioritise interventions by health impact and economic value.

This narrative review was conducted with reference to the Scale for the Assessment of Narrative Review Articles (SANRA). PubMed, Embase, and the Cochrane Library were searched from inception to August 2026 for evidence on COPD burden, healthcare costs, and intervention economic outcomes. Reporting completeness and methodological quality were assessed using CHEERS 2022, the CHEC-list, and AMSTAR 2, as appropriate. Interventions were synthesised within an integrated disability-adjusted life years (DALYs)-ICER framework.

Eighty publications contributed to the synthesis. Acute exacerbations, pulmonary complications, and major comorbidities were the principal drivers of COPD burden and healthcare costs. Smoking cessation and pulmonary rehabilitation showed the most favourable combination of burden-reduction and economic value. Influenza and pneumococcal vaccination showed favourable profiles, although their classification remains provisional because COPD-specific economic evidence is limited. Triple inhaled therapy showed context-dependent economic value across healthcare settings, while long-term azithromycin and long-term oxygen therapy combined with home mechanical ventilation were economically favourable primarily in selected high-risk populations. Ensifentrine and mepolizumab in type 2 COPD demonstrated clinically meaningful benefits but less favourable economic value at the prices evaluated in their source settings. ICS-containing therapy in low-eosinophil, non-exacerbating patients, household air pollution control, and comorbidity-directed interventions could not be formally classified because applicable COPD-specific economic evidence was insufficient.

Integrating burden-reduction potential with ICER-based cost-effectiveness provides a conceptual framework for prioritising COPD interventions by health impact and economic value, while highlighting priorities for COPD-specific economic evaluation and future validation.

Sarcopenia is a common but underdiagnosed extrapulmonary complication in patients with chronic obstructive pulmonary disease (COPD) and contributes to poor clinical outcomes. This study aimed to investigate the screening utility of rectus femoris cross-sectional area (RFCSA), femoral muscle thickness (FMT), and quadriceps femoris muscle thickness (QFMT) for sarcopenia in COPD patients.

This single-center cross-sectional study enrolled 61 COPD patients. According to the sarcopenia criteria, patients were classified into sarcopenia group (n=24) and non-sarcopenia group (n=37). All participants underwent pulmonary function tests, grip strength measurement, 6-meter walk test, 5-repetition sit-to-stand test, and bioelectrical impedance analysis. QFMT, FMT, and RFCSA were measured by a single experienced sonographer using a standardized protocol. Multivariable logistic regression and receiver operating characteristic (ROC) curve analysis were performed.

The proportion of participants with sarcopenia in this COPD cohort was 39.34% (24/61). All ultrasound parameters were significantly reduced in the sarcopenia group: QFMT (2.28 cm vs 2.57 cm, p<0.001), FMT (1.30±0.21 cm vs 1.43±0.23 cm, p=0.033), and RFCSA (4.25±0.75 cm² vs 4.72±0.75 cm², p=0.019). Multivariable logistic regression adjusting for age, sex, BMI, and FEV₁% pred confirmed QFMT as an independent factor of sarcopenia (OR=0.121, 95% CI: 0.021-0.697, p=0.018). ROC analysis revealed that QFMT had the highest AUC among single parameters (AUC=0.767, 95% CI: 0.642-0.866). At the optimal cut-off of 2.833 cm, QFMT showed a sensitivity of 100% and specificity of 43.24%. When QFMT, FMT, and RFCSA were combined, the AUC was 0.777 (95% CI: 0.652-0.874), with a sensitivity of 50% and specificity of 94.59%, representing only a marginal improvement over QFMT alone (p=0.711 by DeLong test).

Lower limb muscle ultrasound parameters, particularly QFMT, are significantly reduced in COPD patients with sarcopenia. Ultrasound appears promising as a screening tool but requires validation in larger, prospective, multicenter studies.

To develop a consensus document on how to follow-up patients with COPD in clinical practice in Spain.

A qualitative, three-round Delphi survey was conducted in the framework of Spanish pneumologists attending COPD patients in routine daily practice. Participants completed a 35-item questionnaire on how to follow-up COPD patients, according to four sections: 1) assessment of the patient's clinical conditions, 2) therapeutical interventions, 3) frequency of follow-up visits, and 4) healthcare pathways. Consensus was defined if more than 70% of participants agree.

A total of 155 specialists in respiratory medicine (53% men; mean age 47 years) participated in the study (69% with more than 10 years of professional practice). More than 80% of participants agreed on the use of clinical practice guidelines but 81.9% considered that recommendations on follow-up should be more explicit. Assessment of lung function (FEV1), dyspnea, and exacerbations were the clinical variables that reached a higher level of consensus. Dyspnea values were reported as the main indicator to assess increased bronchodilation, and exacerbations were the most important to assess the use of inhaled corticosteroids. Follow-up of low-risk patients should be performed in the primary care setting, and patients should be visited every 12 months, whereas high‑risk patients should be monitored by pneumologists and including nursing visits.

The participants agree that the guidelines should include more specific indications to define the follow-up of the COPD patient, and there is lack of evidence in many aspects. There is consensus on the importance of care to coordinate with nursing and primary care, but the protocols to follow and the working tasks for each healthcare setting remain unclear.

To establish a prediction model for the 9-year risk of depression in individuals with chronic obstructive pulmonary disease (COPD) using survey data from a random, nationally representative population of Chinese adults with COPD.

Data from 851 middle-aged and older adults with COPD participating in the China Health and Retirement Longitudinal Study (CHARLS) were analyzed. Depression risk was described as the development of depression during follow-up among participants who were free of depression risk at baseline (CHARLS 2011) and met the depression risk criteria at the 9-year follow-up (CHARLS 2020). Relationships between candidate predictive factors and depression risk were examined using logistic regression, with bootstrapping applied to validate the final model. Model discrimination was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve, while calibration was examined via the Hosmer-Lemeshow test.

Of the 851 participants included in the analysis, 434 developed depression risk during the subsequent 9 years. The final multivariable model incorporated age, educational level, marital status, exercise levels, peak expiratory flow (PEF), and smoking. The discriminative ability of the model was good, with an AUC of 0.717 (95% CI: 0.683-0.751). The Hosmer-Lemeshow test indicated satisfactory calibration (χ ² = 9.400, p = 0.310). A simple clinical scoring system was also developed to facilitate quantitative estimation of depression risk.

This predictive model may facilitate earlier identification of COPD patients likely to develop depression within 9 years and may help inform targeted preventive interventions.

Liver transplant (LT) recipients may experience substantial clinical and psychosocial vulnerability during infectious disease outbreaks because of lifelong immunosuppression. This study evaluated COVID-19 vaccination uptake, vaccine acceptance and hesitancy, preventive behavior, risk perception, and psychosocial well-being among LT recipients.

This cross-sectional analytical study included 311 adult LT recipients followed at a tertiary liver transplantation institute in Türkiye. Data were collected through structured face-to-face interviews using a standardized questionnaire and three validated instruments: the Short Depression-Happiness Scale (SDHS), COVID-19 Prevention Guidelines Compliance Scale (COVID-PGCS), and COVID-19 Risk Perception Scale (COVID-RPS). Exploratory group comparisons, correlation analyses, and multivariable linear regression models were performed.

COVID-19 vaccination uptake was 84.9%. The most frequently reported reasons for vaccination were recommendations from health professionals, perceived higher mortality among patients with chronic diseases, high vaccine effectiveness, and recommendations from health authorities. The leading reasons for vaccine hesitancy were insufficient evidence regarding vaccine effectiveness and safety, anti-vaccination messages on social media, and concerns about adverse effects. In multivariable analyses, higher SDHS scores were independently associated with middle income (p = 0.006), high income (p = 0.021), everolimus use (p = 0.041), and influence of scientific journals and official documents (p = 0.006), whereas COVID-19 infection after BNT162b2 vaccination was associated with lower SDHS scores (p = 0.004). The latter estimate should be interpreted cautiously because this subgroup included only seven recipients. No individual variable was independently associated with COVID-PGCS scores. In the full COVID-RPS model, middle income was independently associated with lower scores (p = 0.011), whereas motivation to protect parents and children was associated with higher scores (p = 0.040). COVID-19 vaccination status and the infection-timing categories were not statistically significant in the full model. Sensitivity analyses showed that vaccination status became significant when infection timing was excluded (p = 0.009), whereas infection before vaccination became significant when vaccination status was excluded (p = 0.006), indicating model-specification dependence.

COVID-19 vaccination uptake was high among LT recipients. Psychosocial well-being and risk perception were associated with selected socioeconomic, clinical, and informational factors, whereas no individual variable examined was independently associated with preventive compliance. Vaccination status and infection timing should not be interpreted as robust, mutually independent determinants of COVID-19 risk perception. These findings support reliable scientific communication, psychosocial support, and sustained engagement with transplant recipients during future infectious disease outbreaks.

A lung recruitment maneuver (LRM) combined with a dynamic lung compliance-guided positive end-expiratory pressure (PEEP) strategy can reduce the risk of postoperative pulmonary complications (PPCs) in patients undergoing pulmonary resection. However, the lung-protective effects of this strategy and its impact on hemodynamics in patients with hypertension remain unclear. This study aims to evaluate the effects of an LRM combined with a dynamic lung compliance-guided PEEP strategy on PPCs and perioperative hemodynamics in hypertensive patients undergoing thoracoscopic pulmonary resection, thereby providing scientific evidence for the safe application of this strategy in this population.

A total of 100 hypertensive patients scheduled to undergo thoracoscopic pulmonary resection with one-lung ventilation (OLV) at the Affiliated Hospital of Jiangnan University between November 28, 2024 and August 15, 2025 were enrolled. Using a random number table, the patients were assigned to a conventional protective ventilation group (control group) or an LRM combined with individualized PEEP group (intervention group), with 50 patients in each group. In the control group, intraoperative PEEP was set at 5 cmH₂O (1 cmH₂O=0.098 kPa). In the intervention group, an LRM followed by decremental PEEP titration was performed after the initiation of OLV, and the optimal PEEP was determined according to dynamic lung compliance. Before the end of OLV, an LRM was performed once in both groups. The primary outcome was the incidence of PPCs within 5 days after surgery. Secondary outcomes included the incidence of intraoperative hypotension, use of vasoactive drugs, incidence of arrhythmia and hypotension within 5 days after surgery, postoperative renal function indices, and length of postoperative hospital stay.

There were no statistically significant differences in preoperative baseline characteristics between the control and intervention groups (all P>0.05). Compared with the control group, the intervention group had higher intraoperative PEEP, lower driving pressure, and slightly higher airway plateau pressure (Pplat), pulse oxygen saturation (SpO₂), and dynamic lung compliance (all P<0.05). The incidence of intraoperative hypotension was higher in the intervention group than in the control group [52% (26/50) vs 30% (15/50), P<0.05], as was the intraoperative use of vasoactive drugs [54% (27/50) vs 20% (10/50), P<0.05]. No statistically significant differences were observed between the 2 groups in surgical site, type of surgery, heart rate, mean arterial pressure (MAP), pulse pressure variation (PPV), intraoperative fluid volume, respiratory rate, or tidal volume (all P>0.05). The incidence of PPCs was lower in the intervention group than in the control group [22% (11/50) vs 42% (21/50), P<0.05]. There were no statistically significant differences between the 2 groups in postoperative arrhythmia, postoperative hypotension, or length of hospital stay (all P>0.05). In both the intervention and control groups, serum creatinine (SCr) and blood urea nitrogen (BUN) levels on postoperative day 1 and BUN levels on postoperative day 3 were higher than their respective preoperative levels (all P<0.05). No statistically significant between-group differences were observed in SCr or BUN levels preoperatively or on postoperative days 1, 3, and 5 (all P>0.05). After multivariable logistic regression adjustment for age, body mass index (BMI), hypertension grade, American Society of Anesthesiologists (ASA) physical status, and type of surgery, the risk of intraoperative hypotension in the intervention group was 2.8 times that in the control group (OR=2.8, 95% CI 1.2 to 6.9; P<0.05). Subgroup analysis for intraoperative hypotension showed that patients aged ≥65 years, those with a BMI >24 kg/m², grade 3 hypertension, ASA physical status III, or those scheduled to undergo segmentectomy were more likely to develop intraoperative hypotension when receiving the LRM combined with individualized PEEP strategy.

An LRM combined with individualized PEEP can reduce the incidence of PPCs. Although this strategy is associated with a higher incidence of intraoperative hypotension, most episodes can be rapidly corrected with timely intervention, are of short duration, and do not adversely affect postoperative cardiac or renal function. Older patients, those with grade 3 hypertension, and overweight patients may be at greater risk of intraoperative hypotension; therefore, enhanced intraoperative hemodynamic monitoring and timely individualized management are warranted.

The ongoing COVID-19 pandemic caused by SARS-CoV-2 continues to pose significant challenges to global public health. Small-molecule ligands targeting G-quadruplex (G4) structures have shown considerable potential in antiviral therapy. However, existing studies have largely focused on individual viruses or isolated host systems, primarily employing in vitro or in vivo approaches to examine interactions between specific ligands and particular G4 structures. There remains a need for novel intervention strategies and a deeper mechanistic understanding of G4-ligand interactions to advance rational drug design.

This study proposes, for the first time, a dual-targeting strategy that simultaneously engages G4 structures in both the SARS-CoV-2 viral genome and host genes relevant to viral entry (ACE2, AXL, and TMPRSS2). Four potential G4-forming sequences from these targets were experimentally confirmed to fold into stable RNA G4 structures. Using an integrated approach of spectroscopic analysis, isothermal titration calorimetry (ITC), and molecular dynamics (MD) simulations, we systematically evaluated the binding of three small-molecule ligands, berbamine (BBM), TMPyP4 (TMP), and topotecan (TPT), to the G4s. Among them, TMP demonstrated superior G4-stabilizing capability and significantly higher binding affinity compared to BBM and TPT. Energy decomposition analysis revealed that strong electrostatic interactions contributed by the positively charged pyridine groups of TMP are critical for stable binding. These results suggest that incorporating charged functional groups into ligand scaffolds can enhance G4-binding affinity.

By integrating comprehensive experimental characterization and molecular dynamics simulations to explore dual-targeting G4-ligand interactions, this work establishes a systematic methodology for in vitro G4-ligand research and provides critical insights for designing new SARS-CoV-2 therapeutics. This strategy holds significant potential not only against COVID-19 but also as a proactive blueprint for addressing future emerging viral threats.