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.

Pediatric obstructive sleep apnea (OSA) is closely linked to the growth and interaction of upper airway soft tissues. The relevance of Scammon's classical growth curves to site-specific oropharyngeal development has been called into question, despite the fact that they have long provided a fundamental framework for comprehending lymphoid tissue maturation.

This narrative review synthesizes current imaging-based and morphometric evidence on the age-related growth of the adenoids, palatine tonsils, lingual tonsils, and tongue, within the context of craniofacial development. Adenoidal tissue undergoes rapid early growth, peaking between 6 and 8 years - earlier than predicted by Scammon's lymphoid curve. Palatine tonsils reach maximum dimensions between 8 and 10 years before gradual involution. Lingual tonsils lack normative developmental data in healthy children and appear largely absent on MRI in asymptomatic subjects, with hypertrophy representing a compensatory or condition-dependent response rather than normal development. The tongue follows a general-type growth trajectory with marked regional differences: the anterior two-thirds attains near-adult size by 8-10 years, while the posterior third continues enlarging into adolescence. These structure-specific trajectories interact with the differential maturation of craniofacial structures - the cranium, maxilla, and mandible - creating a transient "window of vulnerability" between approximately 5 and 10 years of age, during which soft tissue volume disproportionately narrows the upper airway.

Oropharyngeal soft tissue growth is structure-specific and does not conform to a single generalized growth curve. A conceptual, site-specific clinical framework integrating the distinct growth trajectories of each tissue and their proportional relationship to craniofacial development is essential for orthodontic assessment, airway risk stratification, and timely intervention in children with or at risk for sleep-disordered breathing.

Acute respiratory distress syndrome (ARDS) is a life-threatening form of acute respiratory failure characterized by diffuse alveolar injury, severe hypoxemia, and high mortality. Despite advances in supportive care, effective pharmacological interventions remain limited owing to the complex pathophysiology of ARDS, poor pulmonary drug accumulation, systemic adverse effects, and substantial disease heterogeneity. Increasing evidence indicates that distinct clinical and biological subphenotypes of ARDS exhibit differential inflammatory responses, molecular signatures, and therapeutic susceptibilities, underscoring the need for precision medicine approaches. Nanomedicine has emerged as a promising strategy to address these challenges. Through tunable physicochemical properties, surface functionalization, and microenvironment-responsive designs, nanomaterials can enhance drug stability, improve pulmonary targeting, and enable controlled drug release within injured lung tissues. Moreover, nanotherapeutic platforms can exert anti-inflammatory, antioxidant, immunomodulatory, barrier-protective, anticoagulant, and antifibrotic effects through passive and active targeting, biomimetic delivery systems, and stimuli-responsive mechanisms. In this review, we summarize the current understanding of ARDS heterogeneity and its underlying pathophysiological mechanisms, discuss the limitations of existing therapeutic approaches, and comprehensively examine recent advances in nanomaterial-based therapies and targeted drug delivery systems for ARDS. We further highlight key challenges associated with biosafety, large-scale manufacturing, regulatory approval, and clinical translation. Collectively, this review provides a framework for the rational development of precision nanomedicines and outlines future directions for improving therapeutic outcomes in patients with ARDS.

The COVID-19 pandemic exposed profound weaknesses in global infectious disease surveillance yet, in its aftermath, pandemic-prone threats have intensified rather than receded. This narrative review synthesizes contemporary evidence on three converging drivers of pandemic risk zoonotic emergence, antimicrobial resistance, and climate-sensitive disease expansion and examines how structural failures in surveillance and global health governance amplify their impact. Drawing on recent epidemiological analyses, policy reports, and One Health evaluations, the review maps post-COVID surges in zoonotic outbreaks, drug-resistant infections, and vector and water-borne diseases, and links these trends to fragmented laboratory networks, inequitable genomic capacity, and weak integration across human, animal, and environmental systems. It further interrogates the geopolitical and socioeconomic determinants of vulnerability, including conflict-related surveillance collapse, vaccine inequity, and the political economy of pandemic financing. Emerging digital tools from AI-enabled forecasting to wastewater and social media surveillance are assessed not only for their technical promise but also for risks related to data bias, extractives, and governance gaps. The review argues that without redistributive investment in One Health integration, regional genomic platforms, community-based surveillance, and enforceable IHR-based accountability, the world will continue to detect converging threats late and respond inequitably, leaving pandemic preparedness structurally fragile in the post-COVID era.

Lungs are highly affected by brain death, with females showing a higher inflammatory response, linked sex hormones acute reduction. With the aging of world population, the number of older donors is increasing. So, the study of menopause associated changes gain importance. Here we investigated menopause's effects in female brain death rats, previously subjected to transitional follicular depletion and aging. Female Wistar rats were divided in young and menopause groups. After follicular depletion, rats aged for 10 weeks. The animals were submitted to brain death and Sham operated rats served as controls. White blood cell counts, bronchoalveolar lavage were analyzed and inflammatory mediators were quantified. Lung tissue was evaluated for myeloperoxidase, intercellular adhesion molecules, miRNA expression, and protein and gene expression of estradiol receptors. In menopause group, there was increase in systemic and tissue leukocyte infiltration, myeloperoxidase expression, inducible nitric oxide synthase, intercellular adhesion molecule-1, lung edema, and loss of IL-10 regulation. Additionally, we found alterations in estradiol receptors along with changes in the expression of miRNAs associated to inflammation, vascular function and senescence. Menopause increases lung inflammation after brain death, by higher leukocyte infiltration and reduction of IL-10 and may impact the outcome of lung transplantation.

Exposure to fine particulate matter (PM_2.5) is harmful to people, leading to respiratory disease and even death. The association between PM_2.5 pollution and health outcomes has become a key foundation for public health policy development. This study aims to quantify the effects of PM_2.5 on health outcomes (mortality, morbidity) and estimate the benefits of reducing PM_2.5 levels in South Korea.

This study uses an instrumental variable (IV) analysis to estimate the effects of PM_2.5 on health outcomes in South Korea, using mortality data for 2015-2022 and morbidity data for 2016-2019. Local air pollution in South Korea is instrumented using a wind-direction indicator with air pollution levels measured at upwind Chinese monitors to address potential endogeneity concerns. Estimates of PM_2.5-related death and the life-year loss are used to calculate the economic benefits of preventing PM_2.5-related deaths.

The results indicate that a 1 µg/m³ increase in local PM_2.5 levels is associated with a 0.17% rise in older (65+) adult mortality rate and a 5.1% increase in respiratory hospitalizations. Significant rises in mortality and morbidity were observed for disease categories directly associated with PM_2.5 pollution. Considering only the avoided life years lost, the 5.58 µg/m³ reduction in PM_2.5 levels achieved in South Korea from 2015 to 2022 corresponds to an estimated economic benefit of USD 14.14 billion. The study also found that a 1 µg/m³ increase in PM_2.5 raised hospital visits by 1.2% for acute upper respiratory infections and 2.6% for lower respiratory infections.

These findings highlight the magnitude and cost of the health risks posed by air pollution, underscoring the importance of effective policies to manage air quality. This study provides clear evidence of the harmful effects of air pollution on human health, particularly on vulnerable groups and related diseases.

Objective: To determine the threshold for influenza epidemic intensity during the 2024-2025 season in Tianjin using the moving epidemic method (MEM). Methods: Collect weekly data on the percentage of influenza-like illness cases (ILI%), positive detection rate of influenza virus (PR), and PR×ILI% from sentinel hospitals in Tianjin for 2017-2025. Establish an influenza early warning model using MEM, select the optimal value of parameter δ, compare model fitting performance, evaluate the reliability of the three types of data, and determine the threshold for influenza epidemic intensity in Tianjin for 2024-2025. Model selection employs cross-validation, with evaluation metrics including sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, Matthews correlation coefficient, and Youden index. Results: The models based on PR and PR×ILI% showed better fitting effect than those based on ILI% alone, with the PR×ILI%-based model demonstrating the best performance. The MEM model constructed by using PR indicated that with δ set at 3.0, the epidemic start threshold for Tianjin in the 2024-2025 season was 16.05%, the end threshold was 19.68%, and the thresholds for medium, high, and very high epidemic intensity were 51.61%, 66.98%, and 75.16%, respectively. The model based on PR×ILI% showed that with δ set at 3.2, the epidemic start threshold was 105.23%, the end threshold was 128.08%, and the thresholds for medium, high, and very high epidemic intensity were 377.55%, 560.61%, and 667.64%, respectively. Conclusions: The moving epidemic method can be used to determine the influenza epidemic intensity thresholds in Tianjin. The influenza early warning model established based on PR×ILI% data better reflects changes in influenza activity intensity, providing a reliable basis for early warning.

Soft robotic devices may be a useful adjunct for stroke rehabilitation by providing higher intensity training, while allowing comfort and portability compared to rigid exoskeletons. We evaluated the efficacy of a sensor-assisted soft robotic glove (SSR) during inpatient stroke rehabilitation.

This assessor-blinded, randomised controlled trial was conducted in 2 inpatient rehabilitation units. Adults aged 21-90 years old, with ischaemic or haemorrhagic stroke and unilateral upper-limb impairment were recruited between July 2023 and May 2025. Participants were randomised to either [1] SSR or [2] supervised Graded Repetitive Arm Supplementary Programme (GRASP) training for up to 15 sessions, 30-45 min/session; 5 days/week for up to 3 weeks. The primary outcome was Fugl-Meyer Assessment of Upper Extremity (FMA-UE). Secondary outcomes included Stroke Upper Limb Capacity Scale, the DuruÖz Hand Index, and Stroke Impact Scale-16 (SIS-16). Outcomes were assessed at baseline (T1), post-intervention (T2) and follow-up at 3 months (T3).

Recruitment ceased before the planned sample size was reached due to funding constraints. Therefore, the trial was underpowered to detect the prespecified between-group difference. Of 323 screened individuals, 61 were randomised. 3 participants did not complete T2 assessment resulting in a modified intention-to-treat population of 58 (SSR n = 28, control n = 30). Both groups showed improvement across primary and secondary outcomes, with no statistically significant differences observed between them. In a post-hoc exploratory subgroup analysis with baseline FMA-UE < 35 and ≥ 10 sessions (n = 38), a statistically significant difference in FMA-UE distal sub-score at T2 was observed, favouring the SSR group (mean difference 3.06, 95% confidence interval [CI] 0.02 to 6.09, p = 0.049) but not at T3. A numerically higher proportion of participants in the SSR group achieved minimal clinically important difference value for SIS-16 (77.8% vs. 55.0%, adjusted odds ratio 6.52 (95% CI 1.00 to 42.58, absolute risk difference 22.8% [95% CI -7.2% to 47.4%], p = 0.050) at T2, but did not reach statistical significance.

Sensor-assisted soft robotic glove training did not demonstrate superiority over supervised GRASP for upper limb function post-stroke. Exploratory subgroup analyses identified a signal suggesting improved distal hand motor recovery in participants with greater baseline impairment with sufficient therapy exposure.