Acute mountain sickness (AMS) is a common pathological response following rapid ascent to high altitude, and its underlying mechanisms remain incompletely understood. This study focused on investigating the early changes in body composition following acute high-altitude exposure and their association with AMS.

A prospective cohort study was conducted on healthy individuals who flew from plain (500 m) to plateau (3,680 m). Multi-frequency bioelectrical impedance analysis was used to measure body composition indicators within 24 h before and 24 h after ascent. AMS was diagnosed and its severity assessed using the Lake Louise Score System (LLSS). Comparisons of body composition changes before and after high-altitude exposure were performed, and intergroup comparisons were conducted based on the occurrence of AMS. Spearman correlation analysis and multiple linear regression were used to explore the relationships between body composition changes and LLSS score.

A total of 34 participants were included, and the AMS incidence was 61.76%. Compared with the plain baseline, after rapid ascent to high altitude, extracellular-to-intracellular water ratio (ECW/ICW) (t = -2.41, p = 0.022) and phase angle (PhA) (t = -4.78, p < 0.001) decreased significantly, and participants with AMS exhibited greater magnitude decrease in both ΔECW/ICW (Z = -2.14, p = 0.032) and ΔPhA (Z = -3.01, p = 0.003). Spearman correlation analysis showed that both ΔECW/ICW (r = -0.447, p = 0.008) and ΔPhA (r = -0.646, p < 0.001) were negatively correlated with the LLSS score. However, all results of ECW/ICW and ΔECW/ICW shown no statistically significant after Bonferroni correction. Multiple linear regression analysis indicated that only ΔPhA was an independent predictor of the LLSS score (β = -0.507, p = 0.001).

After rapid exposure to high altitude, body water often shifted into cells and pronounced cellular-level dysfunction occurred. Susceptible individuals with AMS exhibited a more pronounced decrease in PhA. The change of PhA (ΔPhA), rather than the change of ECW/ICW (ΔECW/ICW), was an independent predictor of AMS severity. Monitoring ΔPhA may provide an effective, non-invasive method for early risk warning of AMS.

The coronavirus disease 2019 (COVID-19) pandemic has profoundly affected older populations globally. However, limited data are available on the long-term survival and evolving care needs of older patients with COVID-19 in Japan. We evaluated 1-year survival rates and long-term care needs in this vulnerable population.

This population-based cohort study analyzed 2175 hospitalized patients with COVID-19 aged ≥ 65 years using data from the Nara Kokuho Database between February 2020 and August 2022. The database contains administrative claims data from the National Health Insurance and Late Elders' Health Insurance systems, incorporating information on care needs levels. We examined 1-year survival and changes in care needs levels.

The overall 1-year survival rate was 80.9%. Age significantly influenced survival, with rates of 93.6% for patients aged 65-69 years and 56.6% for those ≥ 90 years. Disease severity had a substantial impact: patients not requiring oxygen therapy had a survival rate of 87.5%, compared to 74.0% for those with supplemental oxygen and 49.9% for those receiving invasive mechanical ventilation. Despite a decline in severe cases following the Delta and Omicron-predominant waves, survival among severely ill patients remained lower. While most patients without prior care needs retained independence, approximately 23% developed new care requirements after COVID-19. Higher care needs levels were associated with significantly higher mortality, with patients at care needs level ≥ 2 experiencing mortality rates exceeding 35%.

This study highlights the importance of comprehensive management of the long-term survival and care needs of older patients with COVID-19.

ObjectivesTreatable traits are identifiable and treatable features of disease. The primary objective was to evaluate whether a bronchiectasis clinic in a regional setting, implementing a treatable traits approach, would lead to improvements in quality of life. Secondary objectives were to evaluate clinic implementation outcomes, annual exacerbations and hospitalisation.MethodsAn implementation study. Adults with bronchiectasis attending an outpatient clinic in Rockhampton, Australia between 2021 and 2023 were recruited. Clinical care was implemented by a physiotherapist and nurses according to traits identified. Quality of life (QoL-Bronchiectasis respiratory symptom score (QoL-B rs), Leicester Cough Questionnaire (LCQ) total score) was evaluated at baseline, three and 12-months from first attendance. Implementation outcomes were determined by clinic appointment uptake and attendance and pulmonary rehabilitation uptake and completion at 12-months. Exacerbation frequency and hospitalisation for the 12-months before and after enrolment were compared.Results50 participants were recruited [mean (SD) age 71 (12) years; Bronchiectasis Severity Index (%) mild (22) moderate (44) severe (34)]. There was a significant improvement in QoL at three and 12-months from baseline (mean difference, 95% CI) [3 months: QoL-B rs 9.2 (3.2-15.2), LCQ 1.7 (0.6-2.8); 12-months: QoL-B rs 10.1 (3.9-16.3), LCQ 1.8 (0.8-2.8)]. Clinic uptake (91%), attendance (97%) and pulmonary rehabilitation uptake (74%) and completion (84%) were high. Exacerbation frequency [median (IQR) 1.0 (3.0) to 0.0 (1.0), p = 0.007], and hospitalisation decreased (18% vs 0%, p = 0.005).DiscussionA treatable traits approach improved quality of life, was feasible, including the achievement of high pulmonary rehabilitation uptake and completion, and reduced exacerbation frequency and hospitalisation.

Preeclampsia (PE) is characterized by antenatal hypoxia and inflammation, which may impair neonatal respiratory control. However, its association with apnea of prematurity (AOP) in late preterm infants remains unclear. This study aimed to test the hypothesis that maternal PE is an independent risk factor for AOP in late preterm infants.

This retrospective cohort study was conducted at Yamanashi Central Hospital between January 2017 and June 2025. Singleton pregnancies delivered between 34^ + 0 and 36^ + 6 weeks of gestation were included. Early-onset PE was defined as diagnosis before 34 weeks of gestation, and late-onset PE as diagnosis at or after 34 weeks. Multivariable logistic regression analyses were performed to evaluate the association between PE and AOP, adjusting for potential confounders. In Model 1, PE was analyzed as a binary variable. In Model 2, subjects were categorized into three groups: early-onset, late-onset, and no PE.

A total of 470 mother-infant pairs were analyzed. Among them, 23 women experienced early-onset PE, and 34 experienced late-onset PE. The overall incidence of AOP was 27.9% (131/470). In Model 1, PE was associated with a higher AOP risk (adjusted odds ratio [aOR], 2.44; 95% confidence interval [CI]: 1.21-4.90). In Model 2, early-onset PE was significantly associated with AOP (aOR: 3.42; 95% CI: 1.20-9.72), whereas late-onset PE was not (aOR: 1.88; 95% CI: 0.75-4.73).

PE, particularly early-onset, was significantly associated with AOP. Incorporating maternal PE status into perinatal risk stratification may help identify late preterm infants at elevated AOP risk and guide timely intervention.

Little is known about the mechanisms underlying the link between violence-related distress and asthma, particularly for asthma endotypes.

Cross-sectional analysis of violence-related distress in the previous 6 months (assessed using the Checklist of Children's Distress Symptoms [CCDS] scale) and nasal epithelial gene expression in 3 studies of youth with asthma aged 8-20 years: Stress and Treatment Response in Puerto Rican and African American Children with Asthma (STAR, n = 128), Epigenetic Variation and Childhood Asthma in Puerto Ricans (EVA-PR, n = 228), and Vitamin D Kids Asthma (VDKA, n = 47). We then tested for the association between expression of CCDS-related genes and nasal epithelial transcriptomic profiles corresponding to T2-high and T17-high asthma endotypes.

In a meta-analysis of the CCDS score in the three cohorts, we identified 12 differentially expressed genes (DEGs) with false discovery rate-adjusted p value (FDR-P) < 0.05 and the same direction of association as in the discovery cohort (EVA-PR) in at least one replication cohort. Of these 12 DEGs, 9 (S100A7A, CCL2, CCL8, CXCL9-11, COL15A1, CD300E, and LILRB1) were upregulated and significantly associated with T17-high asthma in a meta-analysis of the three cohorts. Two genes belong to the CC Motif Chemokine Ligand family (CCL2, CCL8) and 3 belong to the CXC Motif Chemokine Ligand family (CXCL9, CXCL10, and CXCL11).

Nine novel genes were associated with violence-related distress and T17-high asthma in three cohorts of predominantly minoritized youth with asthma. Our findings may help uncover biologic processes underlying the violence-asthma link and could represent novel therapeutic targets for T17-high asthma.

ImportanceGlottal competence and cough effectiveness are associated with aspiration. In unilateral vocal fold paralysis (UVFP), injection laryngoplasty (IL) is the mainstay treatment for those with dysphonia and dysphagia. However, few data exist explaining how IL exerts its effects on aspiration prevention.ObjectiveTo evaluate the effect of IL on voluntary cough strength, glottal closure, and swallowing function. Furthermore, the effects were compared between patients with active treatment/disease and those without.Study DesignProspective cohort study.SettingLaryngology clinic of single tertiary hospital.ParticipantAdult patients underwent IL for UVFP between January 2021 and April 2023.Main Outcome MeasuresMaximum volitional cough pressure (MCoughP) was quantified before and after IL, as well as clinical voice outcomes and normalized glottal gap area. For those with a complaint of aspiration, the Eating Assessment Tool (EAT-10) questionnaire and Penetration-Aspiration Scale (PAS) were also evaluated.ResultsForty-one patients were included (26M:15F; age range 32 to 80 years old, mean age 58.7). Clinical voice outcomes and glottal closure were significantly improved in all patients, as well as EAT-10 score (16.22 ± 11.83 at pre-IL and 10.83 ± 11.17 at post-IL, P = .008) and PAS [2 (IQR 1.25, 2) at pre-IL and 1 (IQR 1, 2) at post-IL with 20 mL bolus, P = .02; 2 (IQR 2, 4) at pre-IL and 2 (IQR 1, 2) at post-IL with cup-sipping, P = .007]. Twelve patients had ongoing treatment/systemic diseases, who had significant improvement in voice and glottal closure but not in PAS. MCoughP was significantly increased in ongoing treatment/systemic diseases (-) group [42.90 ± 20.17 cmH₂O at pre-IL, 51.33 ± 21.15 at post-IL, 95% CI (-16.63, -0.23), P = .04] but decreased in ongoing treatment/systemic diseases (+) group [67.98 ± 40.06 cmH₂O at pre-IL, 55.32 ± 31.68 at post-IL, 95% CI (1.37, 23.97), P = .03].Conclusions and RelevanceIL significantly improved glottal competence and voice outcomes. However, increased volitional cough pressure and improved swallowing safety were only demonstrated in patients without ongoing treatment or systemic diseases. Patient's general condition may contribute to the observed effect of IL on dysphagia. Rehabilitation to optimize cough strength and prevent aspiration is beneficial for patients with deteriorating general conditions.

Missing information is common in real-world claims data, particularly on behavioral confounders, for example, smoking. Often one category of the variable, "yes" is partially observed while the other "no" remains completely missing-a pattern we call missing with truncation. A common way to handle these missing values is to naïvely treat missing values as absence of the risk factor, which may lead to substantial misclassification. Standard multiple imputation is impossible as only one level of the variable is observed.

A case study was conducted using data from the NOVELTY study, including 12 224 people with physician diagnosed asthma and/or COPD (NCT02760329). From this cohort, 9733 patients with complete information were included. This dataset was split into two where the first part was used to train an imputation model and the second part was used to evaluate the imputations based on the model (1) when used to impute a truncated and amputated smoking variable against the naïvely classifying missing as "no" (2) when varying the percent smokers retained, q.

The accuracy of approaches (1) and (2) was 0.79 and 0.43, respectively; for q = 90%, the accuracy of approaches (1) and (2) was 0.89 and 0.94, respectively. Transfer learning showed better accuracy than the naïve approach when the percentage of true smokers being recorded as smokers was < 80%.

The added value of transfer learning was greatest when low proportions of true ever-smokers were recorded, with its advantage depending on both the true prevalence of true smokers and the predictive model's performance.

Pulmonary histoplasmosis has traditionally been considered geographically restricted to disease-endemic regions. Taiwan, historically nonendemic, has recently witnessed rising infections. We conducted a retrospective study by reviewing adult patients in Taiwan who had pathologically confirmed pulmonary histoplasmosis during June 1997-December 2024. We analyzed 14 cases with lung involvement. Eight case-patients were male and 6 female; mean age was 56.6 years. Of note, 11 case-patients (78.6%) had no history of travel to histoplasmosis-endemic regions; 10 (71.4%) were immunocompetent. Left upper lobe involvement was most common (n = 4 [28.6%]), with nodular lesions predominating (n = 12 [85.7%]). Most (11 [78.6%]) patients received antifungal therapy, mostly with voriconazole. Outcomes were favorable; 1 (7.1%) patient died. Two additional case-patients without lung involvement exhibited similar demographics and clinical outcomes. Case identification rate has increased since 2015. This 27-year study documents the emergence of pulmonary histoplasmosis in Taiwan, emphasizing the need for heightened clinical suspicion in nonendemic regions.

Sexual and reproductive health (SRH) is essential for public health. COVID-19 led to major disruptions in the provision of essential services including SRH services. Within the context of a multi-country project, this study aimed to explore individual and service-level impacts on contraceptive and sexual health services during the COVID-19 pandemic and recovery phase in England.

A longitudinal, mixed-methods design was implemented, collecting data in two phases, approximately 9 months apart (November 2021 and July 2022). The study comprised in-depth interviews with staff (n = 4) and clients (n = 20) of a sexual health and contraceptive clinical service in the Southeast of England. Over the same timeframe, a quantitative service availability and readiness assessment (SARA) was completed, based on World Health Organization validated tools.

Sexual health and contraceptive services continued to operate throughout the pandemic, however measures taken to prevent COVID-19 transmission and staff capacity issues (due to staff redeployment, staff sickness) impacted on patient choice (e.g. how the service could be accessed, methods of contraception available) and patient experience (e.g. delays in accessing healthcare). Despite disruptions, staff described how in-person provision remained available almost continuously for urgent/vulnerable cases. SARA data confirmed service availability, and qualitative data indicate how this was managed. For example, postal home self-sampling for STIs/HIV was expanded and contraceptive counselling by telephone was introduced to reduce clinic visits, and was retained due to popularity. At Time 2, services were running close to normal.

COVID-19 disrupted sexual health and contraceptive services in England. Compared to pre-pandemic, more elements of these services were delivered remotely. Readiness to adapt was aided by the pre-pandemic direction-of-travel towards greater use of digital and telemedicine services. Innovations require robust evaluation to ensure optimisation for public health benefit both in the pandemic and post-pandemic context.

Obesity is a well-established risk factor for asthma, with genetic factors influencing both conditions. This study investigates the impact of genetic predisposition to increased body mass index (BMI) on adult asthma phenotypes. We recruited 1532 non-asthmatic healthy individuals and 779 adult asthma patients to assess the relationship between BMI-related genetic risk scores (BMI-GRS) and asthma. Among the 85 single nucleotide polymorphisms (SNPs) previously associated with BMI in Japanese populations, significant associations with BMI were confirmed for 6 SNPs in the healthy individuals. Using these, BMI-GRS was calculated for both groups. While asthma patients had higher BMI than healthy individuals (p = 0.004), no significant difference in BMI-GRS was observed between the groups (p = 0.56). A cluster analysis identified six distinct phenotypes of adult asthma patients: two overweight/obese clusters (one with elevated BMI-GRS, one without) and four non-obese clusters (with one showing significantly elevated BMI-GRS). This study demonstrates a genetic heterogeneity in the phenotype of adult asthma among a Japanese population, showing that genetic variants associated with BMI contribute to specific subtypes of asthma. Prospective longitudinal studies are essential to delineate the interactions between genetic predisposition, elevated BMI, subsequent changes in adiposity, and the evolution of asthma phenotypes, which would facilitate the development of mechanism-based therapeutic strategies tailored to genetically-defined patient subgroups.