A retrospective analysis was conducted of 29 patients with postoperative bronchopleural fistula. All patients had fistulas ≤5 mm in diameter and underwent bronchoscopic submucosal polidocanol injection. The overall treatment efficacy rate was 86.2%. After treatment, Karnofsky Performance Status and dyspnea scores improved significantly compared with pretreatment values (both P<0.05). Post-procedural complications included fever in 3 patients (10.3%), mild hemoptysis in 4 (13.8%), and worsening pneumothorax in 1 (3.4%); no procedure-related infections or deaths occurred. These findings suggest that bronchoscopic submucosal polidocanol injection is an effective and safe treatment for postoperative bronchopleural fistulas ≤5 mm in diameter.

Objective: To summarize the clinical features, imaging findings, and diagnostic and therapeutic experience of adult patients with congenital pulmonary vein atresia (CPVA), in order to improve clinicians' awareness of this rare disease. Methods: The clinical data of 2 adult patients initially diagnosed with CPVA in our hospital were retrospectively analyzed. In combination with literature retrieved from PubMed and Web of Science up to June 2025, we performed a pooled analysis of CPVA cases diagnosed at age ≥18 years. A total of 30 cases from 27 articles were included; together with 2 cases, a total of 32 cases were analyzed. Their clinical manifestations, imaging characteristics, treatment, and prognosis were summarized. Results: Both of our 2 patients were female, aged 24 and 68 years. Case 1 presented with cough and blood-streaked sputum during pregnancy, with symptom relief after delivery; imaging revealed absence of the right pulmonary veins and a right aortic arch. Case 2 presented with chronic cough and was found to have right upper pulmonary vein atresia with collateral circulation. Among the 32 pooled patients, the median age at diagnosis was 25 years. The main symptoms were hemoptysis (13 cases), dyspnea (11 cases), and cough with sputum (6 cases); 5 cases were asymptomatic. Unilateral involvement occurred in 24 cases (right 16, left 8). Conservative treatment was given in 16 cases, and pneumonectomy in 8 cases. Most patients improved after conservative or surgical treatment, with only 1 death due to postoperative complications. On imaging, CPVA often manifested as non-visualization of the affected pulmonary veins, interstitial lung changes, and systemic-to-pulmonary collaterals, and was easily misdiagnosed as interstitial lung disease or infectious lesions. Conclusion: Although CPVA is rare in adults, some cases can be well compensated and remain undiagnosed until adulthood or even old age. The clinical manifestations are nonspecific, and imaging examinations often provide the first clue to diagnosis; therefore, vascular malformations should be considered in the differential diagnosis of unilateral pulmonary lesions. Treatment should be individualized: conservative follow-up is suitable for asymptomatic or mild cases, whereas surgery or interventional therapy may be considered for those with massive hemoptysis or severe symptoms.

Objective: To investigate the high-resolution CT (HRCT) imaging phenotypes, clinical characteristics and prognostic differences between emphysema-dominant (CPFE-E) and fibrosis-dominant (CPFE-F) subtypes of combined pulmonary fibrosis and emphysema (CPFE). Methods: A retrospective study of 383 CPFE patients was retrospectively enrolled. Based on quantitative HRCT analysis of emphysema and fibrosis proportions, patients were classified into CPFE-E group (emphysema proportion>fibrosis proportion, n=96; 90 men; median age 65 years) and CPFE-F group (fibrosis proportion>emphysema proportion, n=287; 230 men; median age 65 years). Clinical features, treatment regimens, and survival rates (Kaplan-Meier method) were compared, with Cox regression estimating Hazard ratio (HR) and 95%CI of emphysema/fibrosis subtypes on all-cause mortality. Results: The CPFE-E group had higher median emphysema proportion (12% vs. 1%, W=24 101.00, P<0.001), male predominance (93.8% vs. 80.1%, χ²=9.70, P=0.002), smoking index (650 vs. 400 pack-years, W=16 049.50, P=0.014), and bronchodilator use (39.6% vs. 22.0%, χ²=11.52, all P<0.001), but lower diabetes prevalence (6.3% vs. 18.5%, χ²=8.24, P=0.004). Survival analysis revealed lower 2-year survival in CPFE-E (18/96 vs. 51/287); however, the long-term survival trend over the entire follow-up period (median, 390 days) showed no significant difference between the two groups (21/96 vs. 58/287, log-rank P=0.594). Multivariate Cox regression showed that each 1% increase in emphysema proportion was associated with a 6% increase in mortality risk in the CPFE-E group (adjusted HR=1.06, 95%CI: 1.04-1.08, P<0.001), whereas fibrosis proportion significantly increased mortality risk only in CPFE-E (HR=1.24, 95%CI:1.15-1.33, P<0.001). Conclusion: CPFE imaging phenotypes can be classified into CPFE-E and CPFE-F, which show marked heterogeneity. Emphysema proportion is an independent risk factor for prognosis in CPFE-E group. Subtype-oriented individualized management may improve clinical outcomes.

Objective: To preliminarily evaluate the efficacy and safety of sotatercept in patients with pulmonary arterial hypertension (PAH) in China. Methods: This single-center, retrospective case series analysis included seven consecutive PAH patients treated at Ruijin Hainan Hospital, Shanghai Jiao Tong University School of Medicine, who received sotatercept in addition to stable background therapy from May to December 2025. Key efficacy indicators included 6-minute walk distance (6MWD), World Health Organization functional class (WHO FC), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and systolic pulmonary artery pressure (PASP). The core safety indicators were the dynamic changes in hemoglobin (Hgb) and platelet count (PLT). Results: Of the seven patients treated with sotatercept, one received only a single dose and discontinued for personal reasons, and was therefore excluded from subsequent analysis. The remaining six patients completed one-month follow-up, with three completing both one-and three-month follow-ups. At one month, 6MWD significantly improved in five of six patients (5/6), with further improvement in two of three patients (2/3) at three months. At the one-month follow-up, NT-proBNP significantly decreased in five of six patients (5/6) compared to baseline, with further reduction in one of three patients (1/3) at the three-month follow-up. At the three-month follow-up, echocardiographic estimates of pulmonary artery pressure decreased in two of three patients (2/3), and WHO FC improved in two of three patients (2/3). Among the six patients, one (1/6) had a delayed sotatercept dose due to an excessive increase in hemoglobin, and one developed a decrease in platelet count; no other adverse reactions occurred. Conclusions: Sotatercept demonstrated significant short-term improvements in cardiac function and exercise capacity in Chinese PAH patients, with a manageable safety profile. However, due to the small sample size and short follow-up period, these findings require further validation through large-scale, long-term prospective studies.

To compare the risk of moderate or severe exacerbations of chronic obstructive pulmonary disease (COPD) among new users of azithromycin versus roflumilast in a population of patients with active COPD treated in routine clinical practice.

Target trial emulation.

Optum Clinformatics Data Mart Database from 1 March 2011 to 31 August 2024.

Patients aged >40 years with active COPD and at least 183 days of continuous insurance enrolment who initiated a new oral prescription for maintenance azithromycin or roflumilast. Those with evidence of other pulmonary conditions or alternative indications for azithromycin were excluded. Propensity score matching was used between treatment groups.

The primary outcome was time to first moderate or severe COPD exacerbation. Cox proportional hazards models estimated hazard ratios.

A total of 7550 matched pairs of patients initiating azithromycin versus roflumilast were included in the cohort. The mean age of patients was 70 years, and 56% were women. The unadjusted incidence of a first moderate or severe COPD exacerbation among patients in the cohort receiving azithromycin or roflumilast was 1.2 per person year. Compared with roflumilast, azithromycin was associated with a 17% reduction in the hazard of first moderate or severe COPD exacerbation (hazard ratio 0.83, 95% confidence interval (CI) 0.79 to 0.87; number needed to treat 15, 95% CI 12 to 21). These results were robust across a range of prespecified sensitivity and subgroup analyses.

Among patients with active COPD, azithromycin use was associated with a reduced likelihood of moderate or severe COPD exacerbations compared with roflumilast use. Although this study did not assess the comparative safety of these agents, it provides evidence on treatment outcomes that may complement forthcoming data from a large randomised controlled trial.

Centre for Open Science Real-World Evidence Registry https://osf.io/95d2v.

To describe the epidemiological pattern, temporal trends of influenza and SARS-CoV-2, and determinants of severe acute respiratory infection (SARI)-confirmed positivity among patients hospitalised with SARI in Cambodia.

A hospital-based retrospective cross-sectional surveillance data analysis using national sentinel SARI surveillance data collected from 2020 to 2024.

Nine SARI sentinel hospitals are located across Cambodia.

A total of 16 739 hospitalised patients who met the SARI case definition.

SARI-confirmed positivity defines all SARI cases with laboratory-confirmed influenza or SARS-CoV-2 infections as the main outcome measure. Descriptive and bivariate analyses were performed, followed by multivariate logistic regression to identify factors associated with SARI-confirmed positivity.

Among 16 739 SARI cases, median age in years was 16 (IQR=59), with 54.6% being male; 13.5% were laboratory-confirmed for influenza or SARS-CoV-2. High mortality rate in 2021. A(H3N2) dominated in 2020, followed by widespread SARS-CoV-2 circulation in 2021. In 2022, SARS-CoV-2 co-circulated with A(H3N2) and influenza B (Victoria). A(H1N1)pdm became the predominant strain in 2023 as SARS-CoV-2 and A(H3N2) declined. In 2024, A(H3N2) again led circulation, with B(Victoria) and SARS-CoV-2 also detected. Sporadic A(H5N1) cases began appearing in late 2023. Multivariable analysis indicated higher odds of SARI-confirmed positivity among children aged 5-14 years (adjusted OR (aOR)=1.85; 95% CI 1.47 to 2.31) and adults 50-64 years (aOR=1.36; 95% CI 1.15 to 1.60) compared with adults 25-49 years, during the rainy season (aOR=2.09; 95% CI 1.89 to 2.32) and among patients in Phnom Penh compared with other regions (p<0.001). Influenza detection markedly increased from 2022 to 2024 following the decline observed during the COVID-19 pandemic.

These results indicate that there was an increase in SARI trends over the periods and the changing influenza subtypes circulating each year, along with a high mortality rate during the Delta variant COVID-19 pandemic in Cambodia. Age, region, year and season were significant factors associated with SARI-confirmed positivity. Targeted interventions and preventive measures should be prioritised for specific high-risk groups.

Public cord blood (CB) banks face declining inventories worldwide, but the relative contributions of regulatory changes, declining birth rates, and infectious disease outbreaks remain unclear. We performed a retrospective analysis of 73 925 CB units submitted to a Korean public cord blood bank from 2006 to 2025, encompassing two regulatory transitions in total nucleated cell (TNC) criteria and three major outbreaks (H1N1, MERS, and COVID-19), using interrupted time series, correlation, and multivariable analyses. Of 73 925 submissions, 27 684 (37.4%) were banked. The 2011 TNC ≥ 8 × 108 criterion produced a moderate reduction in banking rate from 37.7% to 33.6%, while the 2021 TNC ≥ 11 × 108 revision caused an abrupt decline from 52.6% to 24.4%. H1N1 and MERS had minimal effects, whereas the COVID-19 period showed a sustained decline coinciding with the 2021 TNC revision. Birth decline correlated strongly with submissions (R2 = 0.94). Regulatory criteria changes were the primary driver of banking rate fluctuations, while declining births affected submission volume. Among three outbreaks, only the COVID-19 period overlapped with a sustained decline, likely reflecting concurrent regulatory change rather than the pandemic itself. CB quality and safety were maintained throughout all disruptions. These findings have direct translational implications for sustaining the global CB inventory as a critical source of hematopoietic stem cells for transplantation.

Infectious disease-specific health literacy (IDSHL)-the capacity to obtain, process, and understand basic infectious disease information needed to make appropriate health decisions-is a critical determinant of public health outcomes. The COVID-19 pandemic created an unprecedented global public health education context; yet, its long-term association with population-level IDSHL beyond the pandemic remains unclear. In China, stringent public health measures and digital information campaigns were implemented, yet their lasting impact on IDSHL across different disease domains has not been systematically evaluated over a full pandemic cycle.

This study aimed to evaluate the longitudinal trends in IDSHL among residents of Zhejiang Province, China, from 2019 (prepandemic) to 2024 (postpandemic), and to assess whether the pandemic period was temporally associated with sustained improvements in IDSHL.

Six annual cross-sectional surveys were conducted from 2019 to 2024 across 30 counties in Zhejiang Province using consistent multistage stratified random sampling. A validated 12-item IDSHL questionnaire assessed knowledge, behavior, and skills. Annual sample sizes ranged from 17,131 to 19,257 (N=112,917). Data were weighted to the 2020 census population by age and urban or rural residence. Joinpoint regression identified inflection points in the annual proportion of residents with adequate IDSHL (score≥12). Multivariate logistic regression estimated adjusted odds ratios (ORs) for adequate IDSHL by year, with 2021 as the reference (the peak acute pandemic phase), controlling for sociodemographics. All analyses incorporated sampling weights.

Population-weighted overall IDSHL scores increased from 2019 (mean 10.46 SD 3.09) to 2024 (mean 11.40 SD 2.88; P<.001). All subscale scores (knowledge, behavior, and skills) showed upward trends (all P<.001). Joinpoint regression revealed a rapid annual increase in adequate IDSHL during 2019-2021 (annual percent change 9.42%, 95% CI 6.10-13.45; P<.001), which slowed post-2021 (annual percent change 2.28%, 95% CI -0.38 to 3.73; P=.07). Correct response rates surged for pandemic-salient items (eg, respiratory etiquette from 28.44% to 39.67%), while hepatitis B transmission knowledge fluctuated (63.28% in 2019, 60.71% in 2022, 63.84% in 2024), indicating that not all non-COVID-19 content improved monotonically. Adjusted logistic regression showed the lowest odds of adequate IDSHL in 2019 (OR 0.74, 95% CI 0.71-0.78) and highest in 2024 (OR 1.10, 95% CI 1.05-1.15) compared to 2021.

The COVID-19 pandemic was temporally associated with significant and sustained population-level improvements in IDSHL, particularly for pandemic-relevant knowledge and behaviors. However, gains were time-sensitive and not uniform across all disease domains or demographic groups. These findings underscore the need for postpandemic health strategies that reinforce comprehensive IDSHL through sustained education and address digital divides to bridge persistent equity gaps. Policymakers should prioritize low digital-literacy populations through hybrid (offline+online) educational interventions, and sustain routine surveillance of IDSHL to detect declines in nonpandemic disease knowledge. This study is the first to document six-year population-level IDSHL trends across the full pandemic cycle, providing evidence for future crisis communication and routine health promotion.

Virtual care technologies have rapidly expanded in emergency medicine, particularly following the COVID-19 pandemic. However, comprehensive economic evaluations of their cost-effectiveness remain fragmented across different clinical applications and health care settings, creating uncertainty for policymakers and health care administrators considering implementation.

This study aimed to systematically review and synthesize evidence on the cost-effectiveness of virtual emergency care models compared to traditional in-person emergency care across diverse clinical conditions, populations, and health care settings.

We conducted a systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, searching 8 electronic databases (PubMed, Embase, Scopus, Web of Science, CINAHL, Cochrane Library, MEDLINE, and PsycINFO) from inception to February 2025. We included full economic evaluations comparing virtual emergency care interventions with usual care. Two reviewers independently screened studies, extracted data, and assessed quality using the Drummond checklist and Consensus Health Economic Criteria (CHEC) list. Evidence certainty was evaluated using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Given heterogeneity in interventions and methods, we conducted a narrative synthesis by virtual care modality and clinical application.

From 5817 identified references, 13 studies met inclusion criteria, representing diverse virtual care modalities across 6 countries (United States, Australia, Italy, Canada, Haiti, and Belgium). All included studies reported favorable economic outcomes for virtual emergency care. Video consultation was the most common modality (11/13 studies), achieving 31% to 73% reduction in patient transfers and cost savings of US $73 (AUD $105) to US $5118 per encounter. A total of 6 (46%) studies found virtual care to be dominant (both less costly and more effective). Incremental cost-effectiveness ratios ranged from US $1273 (€990) to US $108,363 per quality-adjusted life year, with most below accepted willingness-to-pay thresholds. Transfer avoidance was the primary economic driver, particularly in rural settings. Quality assessment revealed high methodological rigor (mean Drummond score 92.3%, SD 6.0%; mean CHEC score 95%, SD 4.2%). Using GRADE, evidence certainty was rated high for cost-effectiveness, moderate for transfer reduction and quality of life improvements, and low for emergency department length of stay and mortality benefits.

Virtual emergency care demonstrates strong and consistent cost-effectiveness across diverse clinical conditions, populations, and health care settings. The evidence particularly supports implementation for stroke care, pediatric emergencies, and rural/remote populations where transfer avoidance drives substantial economic benefits. All evaluated modalities achieved favorable economic outcomes, suggesting technology should match context rather than maximize sophistication. These findings provide robust economic justification for expanding virtual emergency care access and removing regulatory barriers. As health care systems face mounting pressures from aging populations, workforce shortages, and budget constraints, virtual emergency care offers a proven strategy for improving access and quality while reducing costs.

PROSPERO CRD42025648218; https://www.crd.york.ac.uk/PROSPERO/view/CRD42025648218.

Recent crises involving zoonotic diseases (Ebola, COVID-19, and Mpox) have highlighted the limitations of fragmented public health systems for the prevention and response to health emergencies at the international and continental level, and particularly in Africa, more specifically in the Democratic Republic of the Congo (DRC). In this context, the One Health (OH) approach and its extension, One Digital Health (ODH), articulated with the findable, accessible, interoperable, reusable (FAIR) principles, offer a framework for rethinking the digital transition in health in the DRC. This study analyzes the reality of this transition in Kinshasa, DRC, and questions the feasibility of ODH in this context.

This study aimed to (1) explore how stakeholders across human, animal, and environmental health sectors perceive and experience digital tool integration and data interoperability in Kinshasa; (2) identify structural, institutional, and technical constraints affecting cross-sectoral data sharing; and (3) analyze the sociotechnical conditions required for the operationalization of ODH in a fragmented digital health (DH) context.

A qualitative study was conducted in Kinshasa, DRC, between November 10, 2025, and November 25, 2025, combining semistructured interviews with key actors (health professionals, administrative officials, digital experts, and engaged citizens) and a document review of strategic and regulatory texts related to DH in the DRC. The data were analyzed using a thematic approach to identify the representations, uses, and constraints related to DH and the operationalization of ODH.

Overall, 22 stakeholders participated (n=9, 40.9% human health; n=8, 36.4% animal health; n=4, 18.2% environmental health; n=1, 4.50% digital sector), predominantly male (n=15, 68.2%) and mainly in operational roles (n=12, 54.5%). Three interrelated topics emerged. First, a dual-track digital ecosystem characterized by the coexistence of formal platforms (eg, District Health Information Software 2 and electronic records) and informal tools (eg, WhatsApp [Meta]), with persistent paper-digital double-entry generating inefficiencies. Second, structural and governance bottlenecks, including electricity instability, limited connectivity, software incompatibility, external data-hosting concerns that affect sovereignty, and institutional silos that privilege human health over animal and environmental sectors. Third, prerequisites for operationalizing ODH emphasize foundational infrastructure (energy and internet), sustainable capacity building beyond one-off training, interoperable "bridges" between fragmented systems, and high-level political leadership. These elements were synthesized into an ODH-FAIR DRC conceptual model structured around three enabling pillars linking sectors for integrated zoonotic surveillance.

Operationalizing ODH in DRC requires addressing foundational enablers beyond tools: synchronized energy-digital policies, decompartmentalized governance, and context-adapted capacity building. These insights inform low- and middle-income countries' DH strategies, urging donors and ministries to prioritize interoperability over isolated pilots to achieve sustainable zoonotic surveillance.