Search Results (1,714)

Optimal treatment for non-critically ill multisystem inflammatory syndrome in children (MIS-C) remains unclear. We evaluated short-term outcomes in mild to moderately ill hospitalized MIS-C patients fulfilling CDC 2020 and CDC/CTSE 2023 criteria and treated between April 2020 and March 2022 with either intravenous immunoglobulin (IVIG) monotherapy (Group A, n = 17) or IVIG plus corticosteroids (GC) (Group B, n = 22). Cardiovascular clinical parameters, inflammatory markers, and cardiac imaging were compared on days 1, 3, and 5 relative to day 0. The two groups had no significant differences in demographics or illness severity. Group B showed improvement in heart rate (17.8; 95% CI [9.74, 25.8]), mean blood pressure (5.63 [1.61, 9.64]), and body temperature (1.45 [0.94, 1.95]) by day 1, followed by improvement in albumin (0.43 [0.2, 0.84]), CRP (7.56 [3.0, 12.11]), D-dimer (2344 [488.7, 4200.2]), ferritin (1448 [−609.4, 3505.5]), fibrinogen (110 [44.4, 176]), lymphocyte count (1006 [63.5, 1948]), and NT-proBNP (2901 [−349.3, 6153]) by day 3 and left ventricular ejection fraction by day 4–5 (3.84 [0.55, 8.23]). All results were statistically significant (p < 0.05). Group A required more additional therapies, with no difference in hospital stay. Our study concludes that combined IVIG and GC therapy yielded better short-term outcomes than IVIG monotherapy in this patient population, with improvement in cardiovascular clinical parameters preceding changes in inflammatory markers and cardiac imaging. Full article

Limited surveillance and laboratory testing for non-influenza viruses remains a challenge in Uganda. The World Health Organization (WHO) designated National Influenza Center (NIC) tested samples from patients with influenza-like illness (ILI) and severe acute respiratory infections (SARIs) during August 2022–February 2023. We leveraged the influenza sentinel surveillance system to detect other respiratory viruses (ORVs). Samples were tested using the US Centers for Disease Control and Prevention (CDC) influenza and SARS-CoV-2 multiplex and the FTD^TM Respiratory Pathogens 21 assays using real-time reverse transcription polymerase chain reaction (RT-qPCR). A total of 687 (ILI = 471 (68.6%) and SARI = 216 (31.4%) samples were tested. The median age was 2 years (IQR: 1–25) for ILI and 6 years (IQR: 1–18) for SARI case definitions (p-value = 0.045). One or more respiratory pathogens were detected in 38.7% (n = 266) of all samples; 33 (12.4%) were selected for metagenomics sequencing and 8 (3%) for SARS-CoV-2 targeted sequencing. Respiratory pathogens were detected by sequencing in 23 of 33 (69.7%) samples. Our study provides insight into the usefulness of this surveillance system in conducting virological testing for other viruses and provides tools and evidence to monitor patterns and characteristics of viruses causing ILI/SARI, which will guide public health decisions and interventions in Uganda. Full article

Background/Objectives: Prior studies using administrative data have found that antenatal anemia is a risk factor for severe maternal morbidity (SMM). However, administrative definitions, including the commonly used definition from the Centers for Disease Control and Prevention (CDC), have a poor positive predictive value for some SMM components. We tested the relationship between hemoglobin level at delivery admission and SMM, as defined by gold-standard chart review. Methods: This was a retrospective case–control study of deliveries at a high-acuity hospital in Los Angeles, California, from 2016 to 2019. Administrative data were screened to identify patients with CDC SMM. Control-patients were selected at random from screen-negative individuals. Medical records for all individuals were reviewed for gold-standard SMM criteria, and clinical data were abstracted. Confirmed-positive and confirmed-negative patients were compared using bivariate analyses. Multiple logistic regression models were developed to test the relationship between admission hemoglobin level and gold-standard SMM. Results: Of 4202 eligible individuals, 275 (6.5%) screened positive for SMM. Of these, 107 (38.5%) met gold-standard SMM criteria; 285 confirmed-negative controls were retained for analysis. Case-patients were more likely than control-patients to have anemia on delivery admission (43.9% vs. 24.2%, p < 0.01) and had lower admission hemoglobin levels (11.2 ± 1.7 g/dL vs. 11.9 ± 1.3 g/dL, p < 0.01). After controlling for covariates, admission hemoglobin was independently and inversely associated with gold-standard SMM (aOR = 0.76, 95% CI 0.60–0.96, p = 0.02). Conclusions: Lower hemoglobin level at delivery admission was associated with an increased risk of developing gold-standard SMM. Full article

Background/Objective: Pediatric obesity negatively impacts metabolic and musculoskeletal health, particularly muscle quality and function. Ultrasound-derived measures like muscle thickness and echo intensity, combined with body composition data, provide a more comprehensive assessment of muscle status in this population. The purpose of our study was to examine the relationship between anthropometric measurements, muscle strength, and bioelectrical impedance estimations with ultrasound-derived indicators such as subcutaneous fat and quadriceps femoris thickness, as well as muscle quality, through EI. Methods: This cross-sectional study included Hispanic children aged 6 to under 18 years with overweight or obesity (BMI ≥ 85th percentile per CDC standards). Participants were recruited consecutively from outpatient visits. All eligible children were invited for a standardized nutritional assessment, and those who consented were included. Results: The study included 294 children and adolescents (153 boys, 141 girls) with overweight or obesity, showing significant sex differences in anthropometric and body composition variables. Girls had higher intramuscular adipose tissue (IMAT) (p < 0.001), while boys had more lean and musculoskeletal mass. Body fat percentage was significantly correlated with muscle echo intensity (EI corrected: R² = 0.264, p < 0.001; EI uncorrected: R² = 0.242, p < 0.001) and with IMAT (R² = 0.268, p < 0.001). These associations were stronger in girls. Linear models identified body fat and BMI percentile as key predictors of muscle quality indicators (p < 0.001). Conclusions: This study found that higher body fat in children and adolescents with overweight or obesity is linked to poorer muscle quality, and especially increased echo intensity and intramuscular fat. Ultrasound proves useful for early, non-invasive detection of musculoskeletal changes, emphasizing the need to assess both muscle size and quality. Full article

Background: The COVID-19 pandemic magnified long-standing health disparities in the United States, particularly among rural, disadvantaged populations. These communities experience greater barriers to healthcare access, a higher prevalence of chronic illness, and increased vaccine hesitancy factors that collectively contribute to poorer health outcomes. Methods: This narrative review examines rural–urban disparities in COVID-19 vaccine uptake and their impact on mortality, with a focus on cardiovascular disease (CVD) outcomes. We synthesized the peer-reviewed literature, CDC data, and U.S. Census reports to assess factors contributing to vaccine hesitancy, vaccination coverage, COVID-19-related mortality, and CVD mortality trends. Results: Rural residents were less likely to initiate COVID-19 vaccination, showed greater vaccine hesitancy, and experienced higher rates of both COVID-19 and CVD mortality. These disparities were further driven by safety concerns surrounding mRNA technology, misinformation, infrastructural barriers, and sociodemographic factors including political affiliation, education, poverty, and religion. Notably, pre-existing CVD increased vulnerability to severe COVID-19 outcomes in rural communities. Conclusions: Expanding vaccination efforts and improving healthcare infrastructure are essential for addressing these widening health inequities. Future public health strategies should prioritize culturally tailored interventions and rural-specific outreach to reduce vaccine hesitancy and improve mortality outcomes in underserved populations. Full article

The human Poly ADP-ribose Polymerase (PARP) family comprises 17 enzymes responsible for the transfer of ADP-ribose to proteins, forming poly- or mono-ADP-ribosylation. This post-translational modification regulates DNA repair and programmed cell death, processes affecting cancer biology. PARP inhibitors, including the FDA-approved olaparib, are used to treat BRCA-dependent breast and ovarian cancers. Although therapies with use of PARP inhibitors are showing clinical success, their effects on the immune system remain understudied. Prior work has shown that PARP inhibition can modulate inflammatory responses and alter innate immunity. In this study, we evaluated the immunomodulatory effects of olaparib on myeloid cells in vivo, focusing on bone marrow and spleen. Olaparib treatment altered the composition and activation state of dendritic cells, neutrophils, and macrophages. In the bone marrow, olaparib increased the proportion of cDC2 population, mature neutrophils and inflammatory macrophages expressing CD80. In contrast, splenic myeloid cells exhibited enhanced expression of markers associated with tolerogenic phenotypes, including CD206 and CD124 in neutrophils and macrophages. The spleen also showed an increase in immature monocyte-derived dendritic cells (CD206+) and a bias toward the cDC2 subset. These findings indicate that PARP inhibition can induce short-term phenotypic remodeling of myeloid cell populations, promoting a more immunoregulatory profile, especially in the spleen. These changes may contribute to an altered immune landscape with implications for anti-tumor immunity. Full article

Background: COVID-19 vaccination has been a key tool in protecting healthcare workers (HCWs), but breakthrough infections have occurred. The durability of vaccine-induced immunity and its impact on HCWs remain critical for public health strategies. Methods: In this small cohort study (n = 32), we assessed antibody levels and breakthrough infection rates in HCWs over 12 months post-vaccination, providing insights for booster strategies and infection control. A cohort of 32 HCWs was screened for SARS-CoV-2 infection using weekly self-administered swabs and blood samples collected at baseline, 6 months, and 12 months. SARS-CoV-2 antibodies (IgG, IgM) targeting spike proteins and nucleocapsids were analyzed using a multi-antigen serology panel. Pooled nucleic acid testing was employed for infection detection. Results: Nine participants showed breakthrough infections, with nucleocapsid antibodies indicating prior infection. Eight of these cases occurred after the third vaccine dose during the Omicron-dominant period. Anti-spike antibody levels declined significantly in participants without prior infection, while those with breakthrough infections exhibited increased levels. The half-life of S1 and S1 receptor-binding domain (RDB) vaccine-induced antibodies was 144 and 166 days, respectively, which aligns with CDC data. These findings provide valuable insights for determining the optimal timing of booster doses. Conclusions: Our findings highlight the waning antibody levels over time and the occurrence of breakthrough infections. Although based on a small sample, these data support the need for ongoing monitoring and timely boosters. Full article

Background/Objectives: The whole cell pertussis vaccine was introduced in the United States in the 1940s and switched to the acellular pertussis vaccine partially in 1992 and completely in 1997. This study examines the relationship between the resurgence of pertussis in the United States and the change in the type of pertussis vaccines. Methods: Pertussis cases from 1922 to 2024 were obtained from the CDC’s national notifiable disease surveillance system, and vaccination coverage was obtained from the WHO. A trend analysis and Pearson’s correlation test were conducted between the incidence of cases and the coverage of the third and fourth doses of the pertussis vaccine. An ANOVA test and multivariable linear regression were performed to assess the association between the type of vaccine and the number of pertussis cases. Results: The number of cases increased from 4083 in 1992 to 35,435 in 2024, with cyclical outbreaks in 2010, 2012–2014, and 2024. The third and fourth doses of pertussis vaccine coverage had mild and moderate correlations with the number of pertussis cases. The vaccine type had a significant association with the number of pertussis cases and stayed significant after adjusting for vaccination coverage. Conclusions: The switch in pertussis vaccine has impacted the epidemiology of pertussis outbreaks in the United States. A combination of factors, such as different types of immune response to vaccines, waning of immunity, and selection of non-vaccine bacterial strains, may explain the observed results. Further research on newer, improved vaccinations or alternative schedules in children needs to be conducted to address the resurgence of pertussis in this study. Full article

Background: Cervical cancer poses a threat to the health of women globally. Adolescent girls are the primary target population for HPV vaccination, and guardians’ attitude towards the HPV vaccine plays a significant role in determining the vaccination status among adolescent girls. Objectives: This study aimed to explore the factors influencing guardians’ HPV vaccine acceptance for their girls and provide clues for the development of health intervention strategies. Methods: Combining the health belief model as a theoretical framework, a questionnaire-based survey was conducted. A total of 2157 adolescent girls and their guardians were recruited. The multivariable logistic model was applied to explore associated factors. Results: The guardians had a high HPV vaccine acceptance rate (86.7%) for their girls, and they demonstrated a relatively good level of awareness regarding HPV and HPV vaccines. Factors influencing guardians’ HPV vaccine acceptance for girls included guardians’ education background (OR = 0.57, 95%CI = 0.37–0.87), family income (OR = 1.94, 95%CI = 1.14–3.32), risk of HPV infection (OR = 3.15, 95%CI = 1.40–7.10) or importance of the HPV vaccine for their girls (OR = 6.70, 95%CI = 1.61–27.83), vaccination status surrounding them (OR = 2.03, 95%CI = 1.41–2.92), awareness of negative information about HPV vaccines (OR = 0.59, 95%CI = 0.43–0.82), and recommendations from medical staff (OR = 2.32, 95%CI = 1.65–3.25). Also, guardians preferred to get digital information on vaccines via government or CDC platforms, WeChat platforms, and medical knowledge platforms. Conclusions: Though HPV vaccine willingness was high among Chinese guardians, they preferred to vaccinate their daughters at the age of 17–18 years, later than WHO’s recommended optimal age period (9–14 years old), coupled with safety concerns. Future work should be conducted based on these findings to explore digital intervention effects on girls’ vaccination compliance. Full article

To improve collision risk prediction in high-traffic coastal waters and support real-time decision-making in maritime navigation, this study proposes a regional collision risk prediction system integrating the Computed Distance at Collision (CDC) method with an Adaptive Neuro-Fuzzy Inference System (ANFIS). Unlike Distance at Closest Point of Approach (DCPA), which depends on the position of Global Positioning System (GPS) antennas, Computed Distance at Collision (CDC) directly reflects the actual hull shape and potential collision point. This enables a more realistic assessment of collision risk by accounting for the hull geometry and boundary conditions specific to different ship types. The system was designed and validated using ship motion simulations involving bulk and container ships across varying speeds and crossing angles. The CDC method was used to define collision, almost-collision, and near-collision situations based on geometric and hydrodynamic criteria. Subsequently, the FIS–CDC model was constructed using the ANFIS by learning patterns in collision time and distance under each condition. A total of four input variables—ship speed, crossing angle, remaining time, and remaining distance—were used to infer the collision risk index (CRI), allowing for a more nuanced and vessel-specific assessment than traditional CPA-based indicators. Simulation results show that the time to collision decreases with higher speeds and increases with wider crossing angles. The bulk carrier exhibited a wider collision-prone angle range and a greater sensitivity to speed changes than the container ship, highlighting differences in maneuverability and risk response. The proposed system demonstrated real-time applicability and accurate risk differentiation across scenarios. This research contributes to enhancing situational awareness and proactive risk mitigation in Maritime Autonomous Surface Ship (MASS) and Vessel Traffic System (VTS) environments. Future work will focus on real-time CDC optimization and extending the model to accommodate diverse ship types and encounter geometries. Full article

Insecticide resistance monitoring is essential for effective mosquito control. This study compared CDC Bottle Bioassays (BBAs) using technical and formulated insecticides (deltamethrin/Deltagard and malathion/Fyfanon EW) against the Culex pipiens complex (Fogg Rd) and Culex tarsalis Coquillett (Vic Fazio). BBAs indicated resistance to deltamethrin and emerging resistance to malathion in Fogg Rd, as well as resistance to both in Vic Fazio. Field trials, however, showed high efficacy: Deltagard caused 97.7% mortality in Fogg Rd and 99.4% in Vic Fazio. Fyfanon EW produced 100% mortality in Fogg Rd but only 47% in Vic Fazio. Extended BBA endpoints at 120 and 180 min aligned better with field outcomes. Deltagard achieved 100% mortality at 120 min in both populations; technical deltamethrin reached 85.7% (Fogg Rd) and 83.5% (Vic Fazio) at 180 min. Fyfanon EW and malathion showed similar performance: 100% mortality was achieved in Fogg Rd by 120 min but was lower in Vic Fazio; malathion reached 55%; and Fyfanon EW reached 58.6% by 180 min. Statistical analysis confirmed that BBAs using formulated products better reflected field performance, particularly when proprietary ingredients were involved. These findings support the use of formulated products and extended observation times in BBAs to improve operational relevance and resistance interpretation in addition to detecting levels of insecticide resistance. Full article

Background: The candidate therapeutic peptide TnP demonstrates broad, system-level regulatory capacity, revealed through integrated network analysis from transcriptomic data in zebrafish. Our study primarily identifies TnP as a multifaceted modulator of drug metabolism, wound healing, proteolytic activity, and pigmentation pathways. Results: Transcriptomic profiling of TnP-treated larvae following tail fin amputation revealed 558 differentially expressed genes (DEGs), categorized into four functional networks: (1) drug-metabolizing enzymes (cyp3a65, cyp1a) and transporters (SLC/ABC families), where TnP alters xenobiotic processing through Phase I/II modulation; (2) cellular trafficking and immune regulation, with upregulated myosin genes (myhb/mylz3) enhancing wound repair and tlr5-cdc42 signaling fine-tuning inflammation; (3) proteolytic cascades (c6ast4, prss1) coupled to autophagy (ulk1a, atg2a) and metabolic rewiring (g6pca.1-tg axis); and (4) melanogenesis-circadian networks (pmela/dct-fbxl3l) linked to ubiquitin-mediated protein turnover. Key findings highlight TnP’s unique coordination of rapid (protease activation) and sustained (metabolic adaptation) responses, enabled by short network path lengths (1.6–2.1 edges). Hub genes, such as nr1i2 (pxr), ppara, and bcl6aa/b, mediate crosstalk between these systems, while potential risks—including muscle hypercontractility (myhb overexpression) or cardiovascular effects (ace2-ppp3ccb)—underscore the need for targeted delivery. The zebrafish model validated TnP-conserved mechanisms with human relevance, particularly in drug metabolism and tissue repair. TnP’s ability to synchronize extracellular matrix remodeling, immune resolution, and metabolic homeostasis supports its development for the treatment of fibrosis, metabolic disorders, and inflammatory conditions. Conclusions: Future work should focus on optimizing tissue-specific delivery and assessing genetic variability to advance clinical translation. This system-level analysis positions TnP as a model example for next-generation multi-pathway therapeutics. Full article

The 2025 avian influenza A(H5N1) outbreak has highlighted the urgent need for rapidly generated health communication materials during public health emergencies. Artificial intelligence (AI) systems offer transformative potential to accelerate content development pipelines while maintaining scientific accuracy and impact. We evaluated an AI-generated health communication material on bird flu precautions among 100 U.S. adults. The material was developed using ChatGPT for text generation based on CDC guidelines and Leonardo.AI for illustrations. Participants rated perceived message effectiveness, quality, realism, relevance, attractiveness, and visual informativeness. The AI-generated health communication material received favorable ratings across all dimensions: perceived message effectiveness (3.83/5, 77%), perceived message quality (3.84/5, 77%), realism (3.72/5, 74%), relevance (3.68/5, 74%), attractiveness (3.62/5, 74%), and visual informativeness (3.35/5 67%). Linear regression analysis revealed that all features significantly predicted perceived message effectiveness in unadjusted and adjusted models (p < 0.0001), e.g., multivariate analysis of outcome on perceived visual informativeness showed β = 0.51, 95% CI: 0.37–0.66, p < 0.0001. Also, mediation analysis revealed that visual informativeness accounted for 23.8% of the relationship between material attractiveness and perceived effectiveness. AI tools can enable real-time adaptation of prevention guidance during epidemiological emergencies while maintaining effective risk communication. Full article

Background: Broad-spectrum antibiotics are often used for suspected infections in patients with hematologic malignancies due to the risk of severe infections. Although antibiotic use can lead to antimicrobial resistance and microbiome dysbiosis, the effects of antibiotics on the microbiome and resistome in patients with acute myeloid leukemia (AML) undergoing remission induction chemotherapy (RIC) are not well understood. Methods: Various statistical models were utilized to examine the effects of antibiotic administration on the microbiome and resistome over time, as well as differences in AR-infection (ARI) and colonization (ARC) by important CDC-threats in 119 AML patients. Results: A greater number of unique antibiotic classes administered correlated with a loss of unique antibiotic resistance genes (ARGs) (R = −0.39, p = 0.008). Specifically, although a greater number of oxazolidinone administrations was correlated with a greater loss of diversity (R = −0.58, p < 0.001), each additional day of linezolid reduced the risk of ARC by ~30% (HR: 0.663, p = 0.047) and decreased the odds of acquiring genes predicted to confer macrolide (HR: 0.50, p = 0.026) resistance. Conclusions: The number of antibiotic administrations and the types of antibiotics used can influence the risk of antibiotic resistance gene (ARG) expansion and ARC events in AML patients undergoing RIC. While certain antibiotics may reduce microbial diversity, they are not always linked to an increase in ARGs or ARC events. Full article

Background/Objectives: High-risk neuroblastoma patients are treated with approved anti-ganglioside GD2 antibodies of moderate (dinutuximab beta; DB) and higher binding affinity (naxitamab; NAXI). We evaluated the functional potency of DB compared to NAXI and investigated the target-mediated drug disposition (TMDD). Methods: Tumor spheroids were generated from neuroblastoma cells with varying GD2 expression, stably expressing iRFP680 as a viability marker. Antibody-dependent cellular cytotoxicity (ADCC) and complement-dependent cytotoxicity (CDC) were assessed in a long-term life-cell viability assay using serial dilutions of the GD2 antibodies. Binding activity was determined by flow cytometry. Processes involved in TMDD were analyzed, including antibody binding to dead tumor cells and to soluble GD2 (sGD2), antibody internalization into tumor and immune cells and the impact of sGD2 on DB and NAXI-mediated ADCC. Results: DB and NAXI mediated a concentration-dependent ADCC response against GD2-positive spheroids and no response against GD2-negative spheroids. DB showed a significantly higher ADCC potency than NAXI in all GD2-positive spheroid models. Binding activity of DB and NAXI was not significantly different. However, the decrease of anti-GD2 antibody binding to viable GD2-positive tumor cells following co-incubation with dead GD2-positive tumor cells or sGD2 was significantly higher for NAXI than DB. Additionally, we found an increased internalization of NAXI compared to DB by tumor cells and particularly CD64+ monocytes. Finally, sGD2 impaired NAXI-mediated ADCC to a significantly greater extent than DB-mediated ADCC. Conclusions: DB has a higher ADCC potency over NAXI at clinically relevant concentrations, attributed to stronger TMDD effects of NAXI compared to DB. Full article