Tracheoesophageal fistula (TEF) is a rare congenital anomaly commonly associated with esophageal atresia (EA-TEF). Management involves early surgical repair. TEF recurrence is not rare and repeat surgery carries significant complication risks. Endoscopic treatment is an alternative to iterative surgery. This retrospective case series describes the diagnosis, management, and outcomes of children treated with endoscopic chemocauterization for RTEF after EA-TEF surgical repair (RTEF) or isolated congenital TEF in our center.

We reviewed the charts of all patients who underwent endoscopic treatment for TEF at a single pediatric tertiary center from 2016 to 2023. Patients were divided into three groups: isolated congenital TEF, medium-sized or large recurrent RTEF. Chemocauterization was performed via rigid bronchoscopy by applying a trichloroacetic acid (TCA)-soaked cotton swab to the fistula. Postoperative follow-up included clinical assessment and bronchoscopy as indicated by clinical evolution.

Chemocauterization was performed on 13 patients following diagnosis of RTEF. A single chemocauterization procedure was sufficient for 12 patients, while three procedures were required for one patient. This patient developed aspiration pneumonia 1 month after his initial chemocauterization. No complications were observed in other patients. One patient was diagnosed with an isolated congenital TEF and benefited from endoscopic treatment as the primary approach, with a successful single procedure.

Endoscopic chemocauterization using TCA appears to be a safe and effective technique for managing RTEF. This study also presents a successful first-line endoscopic treatment of an isolated congenital TEF using chemocauterization. Further studies are needed to compare its effectiveness with surgery.

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. Most COPD patients have one or more additional chronic diseases (comorbidities), which significantly increase the risk of acute exacerbations-sudden worsening of symptoms that often lead to hospitalization and death.

A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, CNKI, Wanfang, VIP, CBM, Web of Science, and Scopus databases until January 2026. Cohort studies, randomized controlled trials, real-world studies, and high-quality reviews were included for narrative synthesis and descriptive comprehensive analysis. No PROSPERO registration was performed as this is a narrative review, not a systematic review.

Over 70% of COPD patients worldwide have two or more comorbidities, with heart disease, diabetes, and high blood pressure being most common. These comorbidities increase acute exacerbation risk through multiple pathways: direct organ stress (heart failure increases risk 2.3-fold), immune dysfunction (diabetes raises hospitalization 1.8-fold), behavioral changes (depression/anxiety increase risk 1.5-2.1-fold), and self-management breakdown (cognitive impairment affects 32% of patients and drives medication non-adherence). Body-wide inflammation serves as a central biological mechanism linking lung disease to multi-organ damage. New prediction tools using artificial intelligence and dynamic risk scores improve forecasting of exacerbations. Additional about 30 papers were identified through the Snowball Method (citation tracking of included articles and reference list screening), ensuring comprehensive coverage of relevant evidence.

Comorbidities are not merely accompaniments to COPD but active drivers of acute exacerbations through interconnected biological and behavioral pathways. Effective COPD management requires integrated care that addresses heart disease, metabolic disorders, mental health conditions, and cognitive function alongside lung disease, using team-based approaches and locally adapted strategies.

Chronic obstructive pulmonary disease (COPD) represents a significant global health burden with substantial morbidity and mortality worldwide. While smoking remains the predominant associate factor, emerging evidence suggests biomass fuel exposure and other environmental factors contribute significantly to disease development. Large-scale epidemiological studies are essential to identify modifiable associate factors and inform evidence-based prevention strategies.

We conducted a cluster-sampling cross-sectional survey of 65,680 participants aged 35-75 years during Jan 2023 to Dec 2024, to investigate COPD prevalence and associated associate factors in Tianjin, China. COPD diagnosis was established using post-bronchodilator spirometry with FEV1/FVC<70% as the diagnostic criterion. Comprehensive associate factor assessment included demographic variables (age, gender), anthropometric measures (BMI), smoking status (never, current, former), biomass fuel use for cooking or heating, and chronic cough symptoms. Statistical analysis employed univariate comparisons and multivariate logistic regression modeling to identify independent associate factors, calculating odds ratios (OR) with 95% confidence intervals (CI).

The overall COPD prevalence was 7.9% (5,160/65,680 participants) with significant demographic variations. Mean participant age was 54.5±10.9 years, with 41.6% male representation. Multivariate logistic regression identified several independent associate factors: advancing age (OR=1.049, 95% CI: 1.046-1.052, P<0.001), male gender (OR=1.402, 95% CI: 1.312-1.499, P<0.001), current smoking (OR=1.560, 95% CI: 1.445-1.684, P<0.001), former smoking (OR=1.460, 95% CI: 1.306-1.631, P<0.001), and biomass fuel use (OR=1.470, 95% CI: 1.317-1.641, P<0.001). BMI and chronic cough showed no significant associations in the multivariate model.

This large-scale epidemiological study confirms a substantial COPD burden with multiple modifiable associate factors. Beyond traditional smoking risks, biomass fuel exposure emerges as a significant independent predictor, highlighting the importance of environmental interventions. These findings support comprehensive prevention strategies targeting smoking cessation and clean energy initiatives, particularly for high-risk populations including older males and those with environmental exposures.

To evaluate clinical and airway microbiome features of excessive mucus secretion (CMH) in COPD progression and apply machine learning for CMH status identification.

A total of 319 COPD patients from Changzhi People's Hospital (May 2020-March 2024) were consecutively enrolled and divided by sputum volume and characteristics into a high mucus secretion group (n=173) and a non-high mucus secretion group (n=146). Patients were randomly assigned to training (80%) and testing (20%) sets. Airway microbiome structure was analyzed via 16S rRNA sequencing. From clinical and microbiome data, 70 features were extracted. Six machine learning algorithms (SVM, KNN, RF, BN, GBDT, NN) were used to build classification models. Feature selection employed filtering methods, and hyperparameters were optimized by 10-fold cross-validation. Model performance was assessed using sensitivity, specificity, accuracy, and AUC.

The CMH group and the non-CMH group differed significantly in a number of factors, including age, the length of the disease, and pulmonary function indices, according to a comparison of baseline patient data. Analysis of airway microbiome characteristics revealed that the CMH group had significantly lower observed ASVs and Shannon indices (p<0.001), along with significant enrichment of potentially pathogenic bacterial genera such as Haemophilus and Pseudomonas. Following feature selection, disease duration, Haemophilus abundance, history of AECOPD, Pseudomonas abundance, and predicted FEV1% were identified as significant predictive factors. With a sensitivity of 0.867, specificity of 0.789, PPV of 0.805, NPV of 0.855, and AUC of 0.911, the Bayesian Network (BN) model outperformed the other six machine learning models on the testing sets; its generalization ability was significantly superior to other algorithms such as SVM and RF.

CMH in COPD is linked to airway dysbiosis and pathogen enrichment. The BN model effectively identifies this phenotype with strong generalization ability.

To evaluate the association between the timing of maternal magnesium sulfate (MgSO₄) discontinuation before delivery and the risk of apnea of prematurity (AOP) in late-preterm twin infants.

This retrospective cohort study included 161 twin pregnancies (322 infants) delivered between 34 0/7 and 36 6/7 weeks at Yamanashi Prefectural Central Hospital (2017-2025). Infants with major anomalies or intrauterine fetal demise were excluded. The primary exposure was the interval between MgSO₄ cessation and delivery, categorized as: no exposure, < 12, 12-24, and ≥ 24 h. Two multivariable logistic regression models were constructed. Model 1 evaluated the association between any maternal MgSO₄ exposure and AOP. Model 2 further incorporated the timing of MgSO₄ discontinuation as a categorical exposure, adjusting for gestational age, chorionicity, small-for-gestational-age status, sex, and 1-min Apgar score.

Among the 322 infants, 112 (34.8%) developed AOP. In Model 1, maternal MgSO₄ exposure itself was not significantly associated with AOP. However, in Model 2, delivery within 12 h after cessation of MgSO₄ was independently associated with AOP (adjusted odds ratio, 7.44; 95% confidence interval, 1.48-37.4), whereas longer discontinuation intervals (12-24 or ≥ 24 h) were not.

Among late-preterm twin infants, maternal MgSO₄ exposure itself was not independently associated with AOP; however, delivery soon after MgSO₄ discontinuation was associated with an increased risk of AOP. These findings support consideration of MgSO₄ discontinuation timing in perinatal risk assessment and neonatal respiratory monitoring and may help guide future studies.

Respiratory tract infections (RTIs) pose a major diagnostic challenge, complicated by multiple microbial etiologies. Conventional low-throughput methods may underestimate the prevalence and impact of co-infections. This study aimed to evaluate a novel super-multiplex microfluidic qPCR system for comprehensive 49 target pathogens screening and co-infection analysis in patients with influenza-like illness (ILI). Throat swab samples (n = 288) were collected from febrile patients in Beijing during the spring of 2025. All samples were tested using the super-multiplex microfluidic qPCR chip, with a subset (n = 96) validated by conventional qPCR to determine analytical sensitivity, specificity, and Cohen's kappa. The assay demonstrated an overall pathogen detection rate of 66.32%. Influenza A virus (IAV) was the most prevalent pathogen, identified in 50.00% of all samples and constituting 70.69% of single infections, followed by SARS-CoV-2 (14.24%) and Epstein-Barr virus (EBV, 11.81%). Co-infections were frequent (39.27% of positive cases), predominantly dual (23.04%) and triple (10.47%) infections. Notably, IAV was implicated in 84.0% of co-infections. The microfluidic qPCR showed high concordance with conventional qPCR (sensitivity 91.07%, specificity 92.50%, κ = 0.83, indicating almost perfect agreement). This study reveals a complex respiratory pathogen landscape dominated by IAV and marked by frequent polymicrobial co-infections. The super-multiplex microfluidic qPCR chip is a reliable, high-throughput platform that effectively addresses the need for improved detection of co-infections, offering valuable insights for both clinical decision-making and public health surveillance.

Obstructive sleep apnoea (OSA) in children is diagnosed using polysomnography (PSG), but children with neurodisability are >3 times more likely to not tolerate leads and sensors. The diagnostic accuracy of Sunrise, a small sensor applied to the chin, has not been assessed in this special population.

Compare the diagnostic accuracy of Sunrise to simultaneously recorded in-laboratory PSG.

We conducted a prospective, cross-sectional study of children aged 3-18 years with neurodisability, who attended the Queensland Children's Hospital sleep laboratory for diagnostic PSG between February 2024 and September 2025. Sunrise- and PSG-derived measures of sleep disordered breathing were compared, and questionnaire data examining interest in novel sensor technology, and portable, home-based sleep studies were also collected.

There were 48 children with a neurodisability (mean [SD] age = 11.2 [3.6]; 39% female). For 43 children with complete Sunrise data, sensitivity and specificity for identifying moderate-severe obstructive sleep apnoea (OSA) using calibrated MM-ORDI were 0.88 (95% CI: 0.45-1.00) and 0.63 (95% CI: 0.45-0.79), respectively. The concordance correlation coefficient of the obstructive respiratory disturbance index was 0.65 (95% CI: 0.5-0.8) and the median absolute error was 5.7 (IQR: 2.7-13.1) events per hour. Most carers in attendance preferred in-laboratory sleep studies (56%) to home (33%), but the majority preferred Sunrise (50%) to limited-channel (17%) or full PSG (10%).

Sunrise shows excellent ability to exclude moderate-severe OSA in children with neurodisability with moderate specificity. There is substantial appetite among parents and carers for alternative sleep testing modalities.

Hypoxemia is the most common adverse event during sedated gastrointestinal endoscopy. Patients with high obstructive sleep apnea (OSA) risk (STOP-Bang ≥5) are susceptible due to sedation-induced loss of upper airway tone exacerbating airway collapsibility. Although high-flow nasal cannula (HFNC) benefits general at-risk populations, its efficacy in this specific cohort remains uncertain, as its mild positive pressure falls far below therapeutic continuous positive airway pressure levels for moderate-to-severe OSA, questioning its ability to stent the collapsible airway. Our prior proof-of-concept study in this cohort observed a 5% incidence of hypoxemia with HFNC, confirming feasibility and safety and justifying this confirmatory trial.

This prospective, multicenter, randomized controlled single-blind trial will enroll 600 adults (STOP-Bang score ≥5) undergoing elective sedated gastroenteroscopy across three centers. Participants will be 1:1 randomized (stratified by center) to HFNC (30 L/min pre-oxygenation, 60 L/min post-induction) or conventional nasal cannula (6 L/min). Both groups receive standardized propofol-alfentanil sedation. The primary outcome is the proportion of patients with at least one episode of hypoxemia (SpO₂ 75%-90% <60 s). Secondary outcomes include the proportion of patients with at least one episode of severe hypoxemia (SpO₂ <75% or 75%≤SpO₂<90% ≥60 s), the proportion with subclinical respiratory depression (90%≤SpO₂<95%), and the frequency of other adverse events.

This trial will provide definitive evidence on HFNC's efficacy in high-risk OSA patients, addressing whether it can overcome pressure limitations to prevent hypoxemia. Results are expected to inform sedation management guidelines, establish a new standard of care for this subgroup, and enhance procedural safety.

The trial was registered at the ClinicalTrials.gov on 14 December 2025 (NCT07307560).

We estimated the XBB.1.5 vaccine effectiveness (VE) against COVID-19 hospitalization and death in Belgium, Denmark, Italy, Portugal, Spain (Navarre), and Sweden following the 2023-24 fall vaccination campaign among immunocompromised persons (ICPs).

We conducted a multi-country retrospective cohort study using electronic health records. Study sites identified ICPs aged ≥18 years through a common set of immunocompromising conditions and follow-up started the first day of the 2023 vaccination campaign until 12 months later. VE was calculated by time since vaccination (14-59, 60-119, 120-179, 180-365 days after vaccination) for ICPs by pooling study site level confounder adjusted hazard ratios (aHR) of vaccination, estimated with Cox proportional hazards regression models, using a random effect meta-analysis with VE = 100 × (1-pooled aHR).

The XBB.1.5 VE was 52% (95% confidence interval (CI): 41 to 60) and 75% (95%CI: 60 to 84) against hospitalization and death, respectively, 14-59 days after vaccination, and VE decreased with time since vaccination with no remaining protection at 180-365 days after vaccination.

Adapted XBB.1.5 vaccine provided moderate protection within 120 days after vaccination against severe COVID-19 outcomes among ICPs aged ≥18 years during a period with BA.2.86/JN.1 replacing the XBB.1.5 variant.

Objective: To analyze the prevalence of pulmonary tuberculosis (TB) in students in Shaanxi Province from 2015 to 2023 and identify influencing factors of adverse outcomes. Methods: The prevalence data of pulmonary TB in students in Shaanxi from 2015 to 2023 were derived from the TB subsystem of Chinese Disease Prevention and Control Information System. Software Joinpoint 5.4.0 was used to analyze the changing trends of the registration rate of pulmonary TB in students and the composition ratio of the TB patients in different age groups. Multivariate logistic regression model was used to identify influencing factors of adverse outcomes of pulmonary TB in students. Results: From 2015 to 2023, a total of 10 347 pulmonary TB cases were registered in students in Shaanxi, in which the cases in boy students accounted for 61.02% and the cases in students with education level at or above senior high school accounted for 79.06%. The cases were mainly distributed in Yan'an , Ankang, Shangluo and Yulin with average annual registration rates of 26.12/100 000,25.55/100 000,23.33/100 000 and 20.11/100 000 respectively. The registration rate increased from 19.36/100 000 in 2015 to 28.01/100 000 in 2018, and then declined to 9.90/100 000 in 2023 [annual percentage change (APC)=14.90%, 95%CI: 1.34%-30.27%; APC=-20.45%, 95%CI:-24.20% - -16.52%], showing an overall downward trend [average annual percentage change=-8.69%, 95%CI: -12.23% - -5.02%]. The results of multivariate logistic regression analysis showed that the risk factors for adverse outcomes of pulmonary TB in students included being in other ethnic groups (aOR=4.43,95%CI: 2.36-8.30) and living in Southern Shaanxi (aOR=1.51,95%CI: 1.12-2.02), living in Northern Shaanxi (aOR=1.73,95%CI: 1.33-2.24), floating population (aOR=1.58,95%CI: 1.26-1.98), being positive in etiology (aOR=1.28,95%CI: 1.01-1.61), no etiological result (aOR=4.06,95%CI: 2.68-6.17), self-medication or family management (aOR=2.46,95%CI: 1.29-4.71), using no fixed-dose combination (FDC)(aOR=2.21,95%CI: 1.75-2.80). Conclusions: From 2015 to 2023, the registration rate of pulmonary TB in students in Shaanxi showed an overall downward trend. Particular attention should be paid to the impact of factors such as other ethnic groups, the southern and northern regions of Shaanxi, migrant populations, positive bacteriology, no bacteriological results, self-medication or management by family members, and non-use of FDC on the unfavorable outcomes of student pulmonary tuberculosis.