Background and Objectives: COPD is a heterogeneous disease in which conventional clinical classifications may not fully capture the complexity of patient profiles. This exploratory study aimed to examine whether multidimensional COPD phenotypes could be identified using unsupervised cluster analysis integrating clinical, functional, radiological and laboratory features. Materials and Methods: We enrolled 161 patients with confirmed COPD evaluated between January 2020 and January 2024. Demographic, clinical, functional, radiological and laboratory findings were collected. Mixed-type data were analyzed using Gower distance and Partitioning Around Medoids (PAM) clustering. The optimal solution was selected by average silhouette width; stability was assessed by 1000 bootstrap resamples and sensitivity analyses. Results: The two-cluster solution had the highest silhouette width (0.184), although separation was modest. Cluster 1 (n = 78) was characterized by greater symptom and exacerbation burden, worse lung function, greater static hyperinflation, shorter 6-min walking distance and more frequent emphysema than cluster 2 (n = 83). Bootstrap resampling indicated internal stability, although concordance with the primary partition varied across sensitivity analyses. After correction for multiple post hoc comparisons, only LAMA/LABA/ICS use differed between clusters, whereas demographic characteristics, comorbidity burden and blood eosinophil levels were comparable. Conclusions: These exploratory findings suggest multidimensional assessment may complement conventional classifications, but external and longitudinal validation is needed before clinical implementation.

Background and Objectives: COVID-19 restrictions altered population mobility and healthcare use. Most reports describe changes in facial-trauma counts; fewer characterise how injury composition changed or separate policy-associated changes from the secular trend. We examined the volume and structure of maxillofacial trauma around the March 2020 restrictions and the January 2022 easing of restrictions. Materials and Methods: A retrospective study of 3954 patients treated for confirmed facial fractures between 2018 and 2023 at three Slovak tertiary centres. The primary outcome was the monthly count of treated cases (case volume, not incidence, as no catchment denominator was available), modelled by segmented negative binomial regression with level and slope terms at two a priori interruptions and harmonic seasonality. Centre-month panel, centre-specific, and leave-one-centre-out models addressed between-centre heterogeneity. Structural outcomes were modelled by segmented binomial regression at the patient level, adjusting for centre, mechanism, sex, and age. Results: The restrictions were followed by a non-significant reduction in monthly case volume (count ratio 0.84, 95% confidence interval CI 0.67-1.04), and the easing was followed by an increase in the pooled series (1.50, 95% CI 1.22-1.86). This increase was strongly heterogeneous between centres (p < 0.001), was confined to one centre (1.86, 95% CI 1.42-2.43), and was compatible with no change once that centre was excluded (1.15, 95% CI 0.88-1.50). The non-mandibular fracture share fell at the onset of restrictions (odds ratio 0.54, 95% CI 0.38-0.77) and returned thereafter; the post-easing estimate was inconclusive. Electric-scooter injuries rose on a secular trend, with no level shift at either interruption. Conservative management increased at the easing and persisted after adjustment for case mix and centre (aOR 1.44, 95% CI 1.22-1.70). Conclusions: These periods were associated with changes in maxillofacial trauma composition, most consistently a shift toward conservative management. The post-easing volume rise was centre-specific, not a national rebound.

This study compared the outcomes of clear aligner-based expansion screw (CAE) and nickel-titanium palatal expanders in mixed dentition patients with elevated sleep questionnaire scores.

A randomized clinical trial was conducted on 24 UCLP patients presenting with transverse maxillary deficiency and elevated sleep questionnaire scores. Participants were allocated to treatment with either CAE or NiTi palatal expander. Cone-beam computed tomography (CBCT) and polysomnography (PSG) were performed before and after expansion. Changes in airway volume and sleep parameters were assessed. Correlation analyses were conducted to determine associations between expansion characteristics and airway or PSG outcomes.

Pre- and post-expansion Cone-Beam Computed Tomography (CBCT) and polysomnography (PSG) showed that both modalities significantly improved pharyngeal airway volume and sleep parameters. Both groups demonstrated significant improvements in pharyngeal airway volume and PSG parameters. CBCT-based transverse measurements confirmed significant increases in intercanine width, intermolar width, basal bone width, and buccal tipping of molar in both groups, with group1 showing significantly greater gains in intercanine and intermolar width than group 2. Correlation analysis revealed statistically significant positive correlations between the change in intercanine width and increases in nasopharyngeal, oropharyngeal, and total pharyngeal airway volume, and between the change in intermolar width and oropharyngeal airway volume; no significant correlations were observed for J-J' width, basal bone width, or buccal tipping of molar with airway or PSG parameters. A statistically significant negative correlation was observed between skeletal expansion and Δ minimum SpO₂ in the NiTi group.

Both CAE and NiTi palatal expanders significantly improved airway dimensions and sleep parameters in UCLP patients. Anterior transverse widening (intercanine and intermolar width) correlated positively with airway volume gains, whereas basal skeletal widening (J-J' width, basal bone width) and molar inclination did not, suggesting that the overall expansion effect rather than its mechanistic subtype may be the primary driver of functional benefit. Both appliances demonstrated comparable clinical effectiveness.

Depression is one of the world's leading causes of disability, creating significant challenges for individuals and society. Although research in this field has grown rapidly, we still lack a complete understanding of how depression research has evolved globally over the past decade, especially regarding the long-term effects of the Coronavirus disease 2019pandemic.

We collected data from the Web of Science Core Collection as of April 28, 2026. After careful screening, we included 1000 highly cited articles. Using bibliometric methods and visualization tools, we analyzed collaboration networks, keyword patterns, emerging topics, and timeline developments.

Our analysis shows that the United States produces more than half of the world's high-impact depression research. Research focus has shifted from traditional theories to new areas like brain-immune connections and gut bacteria, leading to comprehensive treatment approaches that combine digital technology. The Coronavirus disease 2019 pandemic served as a major turning point, significantly reshaping research priorities and accelerating the integration of medicine and data science.

Over the past decade, depression research has dynamically evolved in response to external challenges. Exploring basic biological mechanisms and combining knowledge from different fields have become central trends. Our comprehensive analysis provides valuable insights for planning future research, developing policies, and understanding the direction toward "multimodal integration" in depression treatment.

Spinal and bulbar muscular atrophy (SBMA, Kennedy disease) is a rare X-linked progressive neurodegenerative disorder. Evidence on the intensive care management of severe SBMA with acute decompensation remains scarce, and superimposed treatable immune-mediated neuropathies are often overlooked in such clinical scenarios.

A 61-year-old man with a 35-year history of progressive limb weakness and 3 months of worsening dysphagia was transferred to our hospital for acute respiratory failure. He had developed progressive dyspnea, ineffective cough, and secretion retention over 15 days, and had been intubated for hypoxemic respiratory failure at the referring facility.

Genetic testing confirmed SBMA as the underlying diagnosis, accounting for the patient's chronic progressive weakness, bulbar dysfunction, and chronic neurogenic electrophysiologic changes. Superimposed probable Guillain-Barré syndrome was suspected based on acute monophasic deterioration, generalized areflexia, sensorimotor axonal neuropathy, and positive anti-ganglioside antibodies, though diagnostic certainty was limited by normal cerebrospinal fluid protein and confounding chronic SBMA pathology. Concurrent conditions included pneumonia, acute segmental pulmonary embolism, and acute respiratory failure.

Multidisciplinary management was delivered, including invasive respiratory support, targeted antimicrobial therapy, therapeutic anticoagulation, aggressive bronchoscopic airway clearance, and structured pulmonary and neuromuscular rehabilitation. Four cycles of therapeutic plasma exchange were administered given ongoing suspicion of immune-mediated polyradiculoneuropathy.

Oxygenation and muscle strength improved gradually with combined interventions, and no single treatment could be identified as the sole contributor. The patient experienced extubation failure on hospital day 18 due to persistent airway protection deficits, and underwent tracheostomy on day 26. He was successfully weaned from invasive ventilation and discharged to a rehabilitation facility on hospital day 44.

Acute neurological deterioration in patients with SBMA should prompt evaluation for superimposed, potentially treatable neuromuscular disorders, rather than being attributed exclusively to baseline disease progression. Integrated multidisciplinary care is essential to optimize outcomes in severe SBMA complicated by acute respiratory decompensation.

Respiratory syncytial virus (RSV) is a leading cause of pediatric respiratory infections, yet the frequency and composition of viral codetections in affected children have not been extensively profiled using unbiased sequencing approaches. Here, we performed viral metagenomic sequencing on nasopharyngeal swabs collected from 42 pediatric patients with confirmed RSV infection to characterize the codetection landscape. RSV was detected and genotyped in all specimens. Beyond RSV, we identified nine additional human respiratory viruses coexisting across the cohort; several of these fall outside the scope of routine diagnostic panels, although their clinical significance remains uncertain. Codetections were the rule rather than the exception: 30 of 42 samples harbored at least three viruses, with up to seven distinct viruses detected in a single case. These findings underscore the taxonomic breadth and polymicrobial complexity of respiratory infections in children. Our results describe the viral codetection landscape in RSV-infected children, revealing a broader spectrum of co-occurring viruses than typically captured by targeted diagnostics, although the clinical significance of most codetections remains uncertain. These findings highlight the polymicrobial complexity of RSV infections and underscore the need for prospective studies to determine which codetections are clinically meaningful.

The VaCoMRI study tracked a cohort of healthcare workers from 2020 through June 2024 to characterize the long-term sustainability of hybrid and vaccine-induced SARS-CoV-2 immunity.

An initial anti-nucleocapsid (N) IgG screening of 4554 health-care workers in early 2020 identified participants who had been infected during the first wave. Anti-N-positive and anti-N-negative individuals then received BNT162b2 through the institutional vaccination program, yielding groups with hybrid and vaccine-induced immunity. Both groups were monitored regularly for nearly four years for breakthrough infections (BTI). Serum collected regularly after vaccination and after BTI was analyzed for anti-N, quantitative anti-spike (anti-S) IgG, and surrogate viral neutralizing antibody (sVNT) titers.

Over a median follow-up of 1180 days, 142 healthcare workers contributed longitudinal samples; 66.2% experienced one BTI and 14.1% a second. In initially seronegative individuals, anti-N titers decreased 2.3-fold between 3 and 6 months after the first BTI, with seropositivity dropping from 82% to 40.4% (median time to seronegativity: 179 days). Prior anti-N seropositivity was associated with 4.5-fold higher anti-N IgG levels after BTI, with elevated levels persisting through 9 months. In both groups, the third vaccine dose significantly enhanced anti-S antibody persistence after 9 months compared to the second dose. In infection-naïve individuals, anti-S IgG titers remained 4.2-fold and sVNT titers 7.2-fold higher. Hybrid immunity was similarly durable: two vaccine doses after prior anti-N seropositivity yielded anti-S IgG and sVNT levels comparable to three-dose vaccination.

This study demonstrates a rapid waning of anti-N IgG that severely limits its reliability for retrospective serosurveillance of SARS-CoV-2 exposure in occupational settings. The combination of vaccination and infection induced robust and durable spike-directed antibody responses. However, these were determined using assays based on the ancestral spike protein. This may limit the prediction of protection from SARS-CoV-2 variants, which usually cause BTIs.

The entry of SARS-CoV-2 via the mucosal surfaces of the upper respiratory tract, including the oral cavity, may be influenced by innate and adaptive immunity. We aimed to determine whether antibodies in secretions might influence the SARS-CoV-2 burden and thus the severity of infection. Blood and stimulated oral fluid (SOF) samples were collected at recruitment (d0) from 173 participants and sequentially at d14, d30 and d90 from 52 participants. Anti-SARS-CoV-2 spike antibodies of the IgG, IgA and SIgA isotypes were detected by ELISA. SARS-CoV-2 RNA copies were quantified by RT-PCR. SARS-CoV-2 RNA copies became negative by d14 in most subjects. At d14, 5/18 SOF samples continued to be RT-PCR-positive. Serum/SOF IgG antibodies were detected in all patients; IgG/IgA/SIgA antibodies increased by d14 and decreased by d90. At d0 and d14, SOF RNA copies were negatively correlated with SOF/serum IgG and with SOF IgA/SIgA antibodies. Higher SOF antibodies were significantly associated with a more rapid decline in SARS-CoV-2 burden. SARS-CoV-2 RNA copies and spike-specific antibodies showed differential trends during the major and minor COVID-19 waves in India. Avidity indices for SOF IgG/IgA antibodies declined by d90. Taken together, our data suggest a potential functional role for SOF anti-SARS-CoV-2 spike antibodies in clearing SARS-CoV-2 from the oral mucosa.

Wastewater-based epidemiology (WBE) has emerged as a supplement to clinical investigations, facilitating the acquisition of timely and non-invasive epidemiological data. In this study, a one-year WBE study was conducted in Perugia (Umbria, Italy) to evaluate respiratory viruses using multiplex assays. Fifty-two wastewater samples were collected weekly between October 2023 and September 2024 and analyzed with the Allplex™ Respiratory Panel 2/3 (for Adenovirus (AdV), Enterovirus (EV), Metapneumovirus (MPV), Parainfluenza virus types 1/2/3/4 (PIV1-4), Bocavirus (BoV), Alphacoronavirus 229E, Alphacoronavirus NL63, Betacoronavirus OC43, and Rhinovirus (RV)) and FTD respiratory pathogens 21 (only for IFV-A and RSV). The results were descriptively compared with clinical data to explore temporal concordance between wastewater and clinical surveillance. Wastewater analysis revealed frequent detection of AdV, EV, and BoV, whereas RV was detected in 67.3% of samples. AdV, EV, and BoV were detected more frequently in wastewater than in clinical samples. RSV showed a seasonal pattern in clinical samples but was only sporadically detected in wastewater, whereas PIVs were detected more frequently in clinical samples than in wastewater. By descriptive comparison, IFV-A, MPV, and non-SARS-CoV-2 coronaviruses showed peaks occurring in similar periods in wastewater and clinical samples. These results support the potential of WBE as a complementary tool to traditional clinical surveillance and suggest that commercial multiplex assays may be useful for broad, exploratory screening of respiratory viral targets in wastewater.

Background and Objectives: The association between SARS-CoV-2 infection, COVID-19 vaccination, and the development of rhabdomyolysis remains unclear. This systematic review aimed to comprehensively synthesize and analyze the available evidence on the occurrence of rhabdomyolysis in the context of SARS-CoV-2 infection and COVID-19 vaccination. Materials and Methods: A literature search was conducted in PubMed, Scopus, EMBASE, and Web of Science. The review followed PRISMA 2020 guidelines, assessing methodological quality. Statistical analyses were performed using STATA v18. Results: A total of 133 patients with rhabdomyolysis associated with SARS-CoV-2 infection were identified from 93 case reports and 7 case series; the median age was 45.5 years (IQR: 24-62), with a predominance of males (72.9%). Additionally, 13 observational studies comprising 818 patients with rhabdomyolysis associated with SARS-CoV-2 infection were included. Among cases associated with SARS-CoV-2 vaccination, 20 patients were identified from 20 case reports; the median age was 52.5 years (IQR: 22.5-76.5), with a predominance of males (75%). These cases were primarily associated with mRNA-based vaccines, particularly Pfizer-BioNTech BNT162b2 (50%) and Moderna (20%), and occurred predominantly after the first and second doses. The most frequent clinical manifestations in both groups were fever, myalgia, and dark urine. Clinical outcomes were favorable in most patients, both among infection-associated cases (72.2%) and vaccination-associated cases (80%). Conclusions: Rhabdomyolysis has been documented during SARS-CoV-2 infection, although its true frequency remains uncertain, whereas cases following COVID-19 vaccination do not establish causality or platform-specific risks.