Primary care clinicians who provide medical homes for neonatal intensive care unit (NICU) graduates may benefit from an enhanced understanding of new breathing support strategies available in NICUs. Understanding the severity of a patient's respiratory course in the NICU may help anticipate the patient's tolerance of future viral illnesses. Primary care clinicians may also serve as the leaders of neonatal resuscitation teams in referring hospitals. Understanding new equipment options in the delivery room setting and the rationale for these changes can help resuscitation teams adopt new practices. This review highlights recent changes in how and when endotracheal intubation is performed, how surfactant is administered for respiratory distress syndrome (RDS), how mechanical ventilation is provided in the hospital setting and occasionally in the home setting via tracheostomy, and how and why noninvasive respiratory support is offered to infants born preterm with active RDS, apnea of prematurity, or ongoing lung growth needs.

As SARS-CoV-2 continues to evolve and vaccine-induced protection wanes over time, future annual or periodic COVID-19 vaccination may become important for long-term disease control. China's adjustment of national COVID-19 response policies provided an opportunity to assess vaccination attitudes after extensive prior vaccination and widespread SARS-CoV-2 exposure. Evidence remains limited on physicians' and medical trainees' willingness to receive future COVID-19 vaccination and to support COVID-19 vaccination for older adults and young children.

This study aimed to evaluate willingness to receive future annual COVID-19 vaccination among physicians and medical trainees in China, identify factors associated with hesitancy toward future vaccination, and assess willingness to support COVID-19 vaccination for older adults and young children.

A nationwide, multicenter cross-sectional survey was conducted from February to April 2023, shortly after China adjusted its national COVID-19 response policies. Physicians and medical trainees were recruited from 21 public hospitals across 7 regions of China using prespecified recruitment targets for each hospital and career-stage group. Participants completed a confidential, self-administered electronic questionnaire. Modified Poisson regression models with robust SEs were used to estimate adjusted prevalence ratios (aPRs) and 95% CIs.

The analysis included 3169 participants comprising 2877 physicians (90.8%) and 292 medical trainees (9.2%). Overall, 1899 participants (59.9%) were willing to receive future annual COVID-19 vaccination, although 3074 (97%) had previously received at least 1 dose of a COVID-19 vaccine. Among previously vaccinated participants, 2862 (93.1%) had received an inactivated vaccine. Overall, 2857 participants (90.2%) were willing to support COVID-19 vaccination for older adults, and 2320 (73.2%) were willing to support vaccination for young children. Lack of willingness to receive influenza vaccination was strongly associated with hesitancy toward future annual COVID-19 vaccination (aPR 4.11; 95% CI 3.71-4.55), as was no prior COVID-19 vaccination (aPR 1.27; 95% CI 1.11-1.46). Participants with hesitancy toward future annual COVID-19 vaccination were more likely to report hesitancy to support vaccination for older adults (aPR 5.13; 95% CI 3.95-6.66) and young children (aPR 2.88; 95% CI 2.54-3.27). Among participants hesitant about future annual vaccination, the most commonly reported concerns were vaccine effectiveness (674/1270, 53.1%), vaccine safety (424/1270, 33.4%), and insufficient disclosure of clinical trial data (368/1270, 29%).

Hesitancy toward future annual COVID-19 vaccination was substantial among physicians and medical trainees in China despite near-universal prior vaccination. The most commonly reported concerns were related to vaccine effectiveness, vaccine safety, and clinical data transparency. Clear and timely communication of vaccine evidence to clinical professionals may support future routine or periodic COVID-19 vaccination strategies and strengthen vaccination support for older adults and young children.

Gerontological and population health sciences increasingly emphasize life-course, biosocial frameworks linking social environments to biological aging and disease processes, for which high-quality biological data are essential. We report on the collection, assay, and quality of aging-related biomarkers in the National Longitudinal Study of Adolescent to Adult Health (Add Health) Waves V and VI.

Staff collected blood specimens during in-home health exams, processed them locally, and shipped them to the lab for further processing, assay completion, and archiving. Analytes assessed cardiovascular disease risk, glucose homeostasis, lipids, renal function, hepatic injury, inflammation, immune system processes, and neurodegeneration. Inter-assay coefficients of variation (CVs) were estimated for sample sets. In 2% of participants, a duplicate specimen was collected within 2 weeks and assays repeated; intraclass correlation coefficients (ICCs) were calculated to assess short-term reliability.

Wave V collected blood from 92% of 5,381 participants who completed the exam (mean age 38); Wave VI collected blood from 91% of 6,073 participants (mean age 44). Reliability was excellent (ICC ≥ 0.75) and highest for hemoglobin A1c at Waves V-VI and GFAP and HSV and SARS-CoV-2 serologies at Wave VI. Reliability was fair to good (ICC 0.40 to <0.75) for assays of low-abundance proteins reflecting temporally dynamic biological processes; none were poor (ICC < 0.40). CVs were desirable (<10%) for established clinical chemistry assays but less so (≥10%) for low-abundance proteins, markers of temporally dynamic biological processes, and SARS-CoV-2.

High-quality biological data from Add Health Waves V and VI greatly expand the study's capacity to support life-course, biosocial research.

To investigate the detection rate, clinical characteristics, and factors associated with intensive care unit (ICU) admission in hospitalized children with acute respiratory tract infection (ARTI) involving Escherichia coli (E. coli). Bronchoalveolar lavage fluid samples from 4,199 hospitalized children were tested using targeted next-generation sequencing (tNGS). Clinical characteristics, laboratory parameters, imaging findings, and outcomes of E. coli-positive children were analyzed, with comparisons between ICU and non-ICU groups. E. coli was detected in 107 cases (2.5%). The median age was 7 months; males accounted for 70.1%, and 29.0% had underlying diseases. Mixed infections occurred in 95.3% of cases, with cytomegalovirus (47.7%), Pneumocystis jirovecii (38.3%), Mycoplasma pneumoniae (28.0%), and rhinovirus (27.1%) being the most common co-pathogens. Chest CT findings mainly showed increased bronchovascular markings (78.2%) and patchy opacities (72.3%). Respiratory support was required in 43.9% of cases, and 18.7% were admitted to the ICU. The median hospital stay was 9 days, and 95.3% were discharged after recovery. Compared with the non-ICU group, the ICU group had higher proportions of children aged ≤ 1 month (25.0% vs. 8.0%), underlying diseases (50.0% vs. 24.1%), fever, tachypnea, and dyspnea, as well as elevated procalcitonin and D-dimer levels (all P < 0.05). The detection rate of E. coli in hospitalized children with ARTI was 2.5%, predominantly affecting young infants and frequently involving underlying comorbidities (29.0%). Mixed infections are common, and 18.7% of patients require admission to the ICU. Young age, underlying diseases, fever, tachypnea, and elevated procalcitonin and D-dimer levels were clinical features significantly associated with ICU admission in affected children.

Background Acute exacerbations worsen outcomes in idiopathic pulmonary fibrosis (IPF), but the role of vascular remodeling remains unclear. Purpose To determine whether quantitative CT-derived vascular metrics are independently associated with acute exacerbations in mild IPF and whether arterial or venous remodeling mediates the effects of fibrosis burden. Materials and Methods In this retrospective cohort study, patients with mild IPF (forced vital capacity ≥ 80% and diffusing capacity for carbon monoxide ≥ 55%) underwent baseline volumetric high-spatial-resolution unenhanced chest CT between April 2011 and December 2021 at a single tertiary hospital. Fibrosis score (FS) and vascular metrics were assessed using deep learning-based software. The primary outcome was time to acute exacerbation; the secondary outcome was event-free survival for acute exacerbation, lung transplantation, and death (composite outcome). Multivariable Cox models were used to evaluate both outcomes, adjusting for age, smoking status, and pack-years. Mediation analysis was used to assess whether vascular remodeling mediated the association between FS and the outcomes. Results Among 313 patients (mean age, 66.4 years ± 7.1 [SD]; 245 male patients), 86 (27.5%) experienced acute exacerbation, two (0.6%) underwent lung transplantation, and 120 (38.3%) died during a median 6.3 years of follow-up. Higher FS was associated with a higher estimated risk of acute exacerbation (adjusted hazard ratio [aHR] range across models, 1.05-1.09; P value range, .001-.10) and of the composite outcome (aHR range, 1.08-1.20; all P ≤ .001). Venous dilatation (aHR, 7.93 [95% CI: 2.56, 24.59]) and venous diameter heterogeneity (aHR, 1.37 [95% CI: 1.16, 1.63]) were associated with increased acute exacerbation risk, whereas higher small-artery volume fraction was associated with reduced risk (aHR, 0.91 [95% CI: 0.86, 0.96]). FS effects on acute exacerbation were mediated by venous remodeling (57.1% mediation; P = .001) and by small-artery volume fraction (21.5%; P = .02). Conclusion In mild IPF, fibrosis burden and vascular remodeling were associated with acute exacerbation risk, with venous and arterial remodeling mediating fibrosis effects, and higher small-artery volume fraction associated with reduced acute exacerbation risk. © RSNA, 2026 Supplemental material is available for this article. See also the editorial by Iwasawa in this issue.

Understanding which factors impact vaccine uptake is important for supporting ongoing and future vaccine programmes among youth.

This study examined predictors of COVID-19 vaccination uptake among South African youth in the eThekwini District.

Cross-sectional data from an online survey (AYAZAZI RIGHTS: December 2021-May 2022) of youth aged 18-24 in the eThekwini district, South Africa, were analyzed using a gender-stratified logistic regression of vaccination status on candidate predictors of interest (k = 14). A full model with backwards selection using Akaike's Information Criterion was employed to remove predictors that did not add to the model's explanatory power.

Of 1383 participants, 54% were women, with a median sample age of 21.8 years. Overall, 37.9% (n = 525) of participants had received a COVID-19 vaccine, 58.6% of whom were women. In this cross‑sectional, observational analysis, the most consistent predictors of vaccination status were older age, living with seniors in the home, and personal proximity to severe pandemic outcomes, specifically knowing people who had been hospitalized or died due to COVID-19. Gender‑specific predictors included ethnicity, having children for women, employment, and relationship status.

Socio-demographic as well as community factors predicted receiving a COVID-19 vaccination, varying by gender. Better understanding of modifiable factors to support vaccine uptake, and curbing vaccine hesitancy related to mistrust and misinformation, will help support South Africa's immunization programs among youth, and can help inform targeted, inclusive, and equity-oriented public-health strategies.

Childhood allergic diseases often coexist, but phenotype-based evidence that includes food and drug allergy remains limited. The study aimed to derive potential allergic comorbidity phenotypes across five allergic diseases (eczema, rhinitis, asthma, food allergy, and drug allergy) and examine associations between identified phenotypic clusters and associated health outcomes in children and adolescents.

In this population-based cross-sectional study, 18,371 children and adolescents aged 3-14 years were enrolled from Beijing and Tangshan. Parent-reported physician diagnoses of eczema, rhinitis, and asthma, together with questionnaire-based food and drug allergy, were analyzed using latent class analysis (LCA). Multinomial and binary logistic regression models were used to identify factors associated with allergic phenotype membership and to assess associations between phenotype membership and related health outcomes, respectively.

Three phenotypes were identified via LCA: low-allergy (13,505, 73.5%), rhinitis-dominant (3147, 17.1%), and multi-allergic (1719, 9.4%). Female sex, higher maternal education, middle household income, and shorter outdoor time were associated with significantly higher odds of both rhinitis-dominant and multi-allergic phenotypes. Early-life factors were mainly associated with the rhinitis-dominant phenotype. Longer sitting time and 1-2/week fast-food intake were associated with the multi-allergic phenotype. Compared with the low-allergy phenotype, rhinitis-dominant and multi-allergic phenotypes showed higher odds of upper respiratory infections (adjusted odds ratio: 4.40 and 3.48) and lower respiratory infections (2.49 and 2.57). Associations with dental caries were relatively weak. Sensitivity analyses supported the respiratory infection findings.

Three distinct allergic comorbidity phenotypes were identified in Chinese children aged 3-14 years, with two adverse phenotypes (rhinitis-dominant and multi-allergic) sharing lifestyle correlates yet differing in early-life exposure associations. Importantly, both phenotypes were independently associated with a higher likelihood of respiratory infections.

Patient-reported outcomes (PROs) have become essential endpoints in clinical trials for bronchiectasis. However, no validated PRO instrument currently exists for the Chinese population. This study aimed to develop and validate a disease-specific Patient-Reported Outcome scale for Bronchiectasis (BE-PRO) tailored to Chinese patients.

A mixed-methods approach was used to develop the BE-PRO. The conceptual framework and initial item pool were developed primarily from semi-structured patient interviews and supplemented by literature and existing-instrument reviews and medical-record analysis. Items were refined through qualitative review by experts and patients. Two field surveys were then conducted, with items selected using classical test theory (CTT), item response theory (IRT), and structural equation modeling (SEM). Finally, a formal validation survey assessed the psychometric properties of the BE-PRO.

The final BE-PRO consists of 16 items organized into five domains: physiology, psychology, environment, society, and treatment satisfaction. The scale demonstrated excellent internal consistency (Cronbach's α = 0.912), split-half reliability (0.856) and satisfactory structural validity (CFI = 0.961; RMSEA = 0.068). Strong correlations with the SF-36 and QOL-B supported criterion validity, while moderate correlations with the BSI and E-FACED supported its clinical relevance. The scale showed high feasibility, with 100% response and completion rates and a mean completion time of 9.07 min.

The 16-item BE-PRO is a reliable, psychometrically validated and feasible instrument for assessing patient-reported outcomes in Chinese patients with bronchiectasis. Its strong psychometric properties support its use in both clinical trials and routine practice.

Cystic fibrosis (CF) newborn screening in Türkiye uses a two-step immunoreactive trypsinogen (IRT/IRT) algorithm with fixed cutoffs. The infants missed by fixed-cutoff screening remain poorly characterized.

In this retrospective single-center cohort (2015-2025), 90 children with confirmed CF were classified as IRT-positive (n = 78; IRT-1 ≥ 90 ng/mL) or IRT-negative (n = 12; IRT-1 < 90 ng/mL). CFTR variants were re-evaluated (ACMG/AMP) and stratified by Welsh-Smith class and residual-function status. Clinical, perinatal, pre-analytical, microbiological and genotype data were compared with standardized effect sizes.

IRT-negative patients were diagnosed later (median 12 vs. 2 months; p < 0.001) and had higher early Pseudomonas aeruginosa colonization (33.3% vs. 9.0%; unadjusted p = 0.037). Height standard deviation score was higher in IRT-negative patients (p = 0.004; Cohen's d = -0.77; not retained after false-discovery-rate adjustment). Mean IRT-1 was four-fold lower (44.5 vs. 189.1 ng/mL; p < 0.001). Class IV-V variants accounted for 33.3% of classified IRT-negative versus 11.1% of IRT-positive alleles; IRT-negative patients were enriched for residual-function and splicing variants, including 2789 + 5 G > A (9.5% vs. 2.0%), R334W and Y1032C. Pre-analytical and perinatal factors did not differ.

In every missed case, the first-tier IRT value fell below the fixed national cutoff, without evidence of pre-analytical or perinatal contributions. Missed cases clustered among carriers of residual-function and splicing CFTR variants, whose attenuated pancreatic injury may keep neonatal IRT below the cutoff. Because the Turkish protocol forgoes second-tier testing in IRT-1-negative infants, this subgroup is invisible to the current algorithm; the fixed cutoff warrants optimization.

An extensive body of clinical and experimental evidence demonstrates that immune checkpoint blockade can invigorate recall immune responses. This phenomenon has previously been highlighted using ex vivo (healthy donor) and in vivo (immunotherapy patients) models of immune checkpoint inhibitor (ICI) administration that demonstrate an enhancement of the T-cell response to concomitant small-molecule drugs. However, the immunological and clinical impact of ICI therapy pre-ceding vaccination, where robust antigen-specific immunogenicity is essential, remains poorly defined. In this study, we utilized an ex vivo assay to evaluate lymphocyte recall responses within peripheral blood mononuclear cells (PBMC) derived from healthy donors and patients pre- and post-immunotherapy following exposure to SARS-CoV-2 derived peptides and ChAdOx1 nCoV-19. In line with the anticipated effects of the primary pharmacology of immune checkpoint inhibitors, we outline an acute increase in proliferation and cytokine and cytolytic molecule secretion following immune checkpoint blockade in response to CEF(T), wild-type SARS-CoV-2 spike pools 1 and 2, and ChAdOx1 nCoV-19. Future studies are needed to evaluate the clinical correlates of the veracity of such responses with protection and incidence of adverse events.