The effectiveness of coronavirus disease 2019 (COVID-19) vaccines is well established; however, the long-term durability of vaccine-induced immunity remains to be fully elucidated.

This study longitudinally compared humoral and cellular immune responses in two groups: G1, who received two doses of Sinovac-CoronaVac, and G2, who received two doses of AstraZeneca-Oxford, both subsequently boosted with Pfizer.

Immune responses were assessed at five time points: P1 (prior to the second dose), P2 (90-180 days after the second dose), P3 (pre-booster, six-eight months post-second dose), P4 (90-180 days post-booster), and P5 (180-270 days post-booster). Anti-Spike severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG levels were measured by enzyme-linked immunosorbent assay (ELISA), while IFNγ-producing cells in response to Spike peptides were quantified using enzyme-linked immune absorbent spot (ELISPOT). IgG subclasses were analysed in a subset of samples.

Following the first dose, Sinovac-CoronaVac induced lower anti-Spike IgG levels than AstraZeneca-Oxford, though levels equalised after the second dose. After the Pfizer booster, anti-Spike IgG levels remained elevated for up to six months in both groups. IgG1 was predominant in both groups, with occasional expression of IgG2 and IgG4. The mean frequency of IFNγ-producing cells was lower in the Sinovac-CoronaVac group before and up to six months after the second dose, compared to AstraZeneca-Oxford. However, post-Pfizer booster, both means became comparable. Between 90-180 days post-booster, the Sinovac-CoronaVac + Pfizer group exhibited a statistically significant decline in IFNγ-producing cells relative to the AstraZeneca-Oxford + Pfizer group. By P5, over half of individuals in the Sinovac-CoronaVac + Pfizer group demonstrated no detectable cellular response.

High antibody levels were maintained for up to six months following both homologous and heterologous vaccination. However, cellular immunity declined more markedly in the Sinovac-CoronaVac + Pfizer group, resulting in a higher proportion of non-responders. These findings underscore the importance of tailored booster strategies to sustain protective immunity against COVID-19.

Acute-phase viral infections, such as COVID-19, trigger a complex interplay of proinflammatory and regulatory responses, influencing both tissue repair and damage. Intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and platelet endothelial cell adhesion molecule-1 (PECAM-1) play crucial roles in immune activation, regulation, and homeostasis during infection. This study included adult patients hospitalized at the University Hospital in Cracow, Poland, with confirmed SARS-CoV-2 infection between January and June 2021. Blood samples were collected at three time points and categorized based on the time since symptom onset: first, second, or third week of infection. The objective was to assess serum levels of sICAM-1, sVCAM-1, and sPECAM-1 in relation to in-hospital mortality and key biochemical and clinical parameters. Among 276 patients (63% males) with a median age of 62 years, pneumonia was confirmed in 89% of cases, with an in-hospital mortality rate of 12.7%. Mortality was associated with advanced age (71(9) vs. 61(18) years p<0.001) and comorbidities such as hypertension, diabetes, chronic kidney disease, heart failure, and atrial fibrillation. Non-survivors exhibited significantly lower adhesion molecule levels. Median (IQR) concentrations in non-survivors vs. survivors, respectively, were at first week: sICAM-1: 279(114) vs. 399(328) ng/mL (p<0.001); sVCAM-1: 2944(2760) vs. 4670(3331) ng/mL (p<0.001); sPECAM-1: 15(6) vs. 17(7) ng/mL (p<0.05). Results for third week were: sICAM-1: 271(109) vs. 461(296) ng/mL (p<0.01); sVCAM-1: 1875(2034) vs. 1426(1194) ng/mL (p=0.054); sPECAM-1: 18(7) vs. 25(13) ng/mL (p<0.01). Proportionally, sVCAM-1 was highest at symptoms onset, while sICAM-1 and sPECAM-1 rose later. sICAM-1 positively correlated with interleukin-1α, sVCAM-1 was linked to pneumonia and inflammation, and sPECAM-1 negatively correlated with inflammatory markers and D-dimers. These findings highlight the dynamic role of adhesion molecules in COVID-19 and suggest their potential as biomarkers and therapeutic targets for optimizing treatment strategies.

Inflammatory and thrombotic markers play crucial roles in risk stratification for various diseases.

To investigate the relative importance of inflammation, measured by C-reactive protein (CRP), and platelet turnover, indicated by immature platelet fraction (IPF), in predicting outcomes for patients with cardiovascular disease, coronavirus disease 2019 (COVID-19), and bacterial infections.

In this retrospective observational study, we analyzed data from 1473 individuals admitted to the Samson Assuta Ashdod University Hospital between 2018 and 2022. Patients were categorized based on CRP and IPF levels, with a focus on 280 patients in the high CRP/low IPF or high IPF/low CRP tertiles.

The high CRP low IPF group demonstrated significantly higher mortality rates compared to the low CRP high IPF group (13.5% vs. 0.8%, P < 0.001). Logistic regression analysis revealed that the high CRP and low IPF combination was the strongest predictor of mortality (odds ratio 12.951, 95% confidence interval 1.409-119.020, P = 0.024).

The combination of inflammatory (CRP) and thrombotic (IPF) markers provides superior prognostic information compared to individual disease diagnoses in patients with cardiovascular disease, COVID-19, and bacterial infections.

During the early months of the U.S. COVID-19 outbreak, the distribution of morbidity and mortality starkly reflected preexisting social determinants of health. Socially vulnerable racial and ethnic populations endured not only the highest number of cases and death rates, but the earliest age mortality. In addition, early government responses to COVID-19 pandemic varied at the state level, while the federal government failed to take immediate policy action to this public health emergency. Drawing from public-use data, we used statistical and econometric modeling techniques to investigate political, structural, and policy determinants of health outcomes during the pandemic. We also investigated the intersecting impacts of these responses on COVID-19 cases in the context of preexisting social vulnerability. Results indicate that partisanship and political ideologies significantly influenced variation in state-level responses. We also found that preexisting social vulnerabilities shaped the observed effectiveness of governmental interventions. Our findings underscore the need to tackle structural vulnerabilities as a more comprehensive policy approach to mitigating the harms of pandemics. Our results also suggest that state governments that resemble inclusive decision-making processes that prioritize the needs of the most impacted communities are more equipped to respond to pandemics. Our study underscores the complex interplay between political dynamics and social determinants of health during a public health emergency, with implications for future pandemic preparedness.

Remote blood pressure monitoring (RBPM) programs are increasingly utilized to improve hypertension care. Rigorous analysis of program outcomes including clinical effectiveness and participant experience can inform future initiatives.

During year 1 of the COVID-19 pandemic, we implemented a RBPM program for patients who: (1) received primary care in a single academic medical network, (2) were part of an accountable care financial arrangement, and (3) had uncontrolled hypertension. Evaluation combined a 6-month prospective cohort observational study (assessing the program's association with hypertension control and remote blood pressure [RBP] reporting) with surveys (assessing patient and care team experience.)Results:A total of 150 patients (mean age 57 years, 65% male) enrolled across 10 clinics, of whom 121/150 contributed remote blood pressure data. Among the patients who contributed data, we observed an adjusted reduction in systolic blood pressure by 1.08 mm Hg/month (95% CI = -1.24 to -0.91) and diastolic blood pressure by 0.88 mm Hg/month (95% CI = -0.99 to -0.77) associated with our intervention. The number of patients contributing to RBPM data declined from 121 to 22 from inception to the end of the 6-month study. Among the 61 patient survey respondents (40% response rate), 80% reported high program satisfaction and likelihood to recommend. Survey respondents noted improvements in weight loss (14%), medication compliance (16%), diet (29%), and exercise (35%). Qualitative survey analysis identified themes of patient convenience and increased self-efficacy in blood pressure (BP) management. Quantitative and qualitative patient and care team survey analysis showed technology linkage challenges.

Overall, our primary care RPBM program was associated with improved blood pressure control among participants and favorable patient and care team experience but experienced challenges of significant decline in blood pressure reporting over time. For future institutional RBPM implementations, we aim to retain the high quality of blood pressure management guidance that participants received while increasing technology connectivity and longitudinal reporting support.

The financial sustainability of nursing homes is increasingly critical as the aging US population continues to grow. Rural facilities often encounter more significant economic challenges than urban counterparts. This study investigates the disparities in financial performance between rural and urban nursing homes in the United States, emphasizing the influence of organizational and environmental factors. A comprehensive understanding of these differences is necessary for the implementation of effective policy and management interventions.

The study used a longitudinal dataset (2018-2022) comprising 66,056 nursing home-year observations. Data sources included Centers for Medicare and Medicaid Services (CMS) Cost Reports, Payroll-Based Journal, Care Compare, LTCFocus, and the Area Health Resource File. The dependent variable was the operating margin. The primary independent variable, geographic location, was classified using Rural-Urban Commuting Area (RUCA) codes. We conducted multivariable linear regression with facility-level random effects and two-way fixed effects (state and year) to assess rural-urban financial disparities while controlling for organizational and environmental factors and the impact of COVID-19.

Rural nursing homes had lower operating margins than urban facilities in unadjusted models. However, after adjusting for organizational factors such as size, occupancy, and payer mix, the rural-urban difference was no longer significant. Environmental factors, including population demographics and income levels, contributed to financial disparities. COVID-19 exacerbated financial challenges, disproportionately affecting rural facilities.

Financial disparities between rural and urban nursing homes are not solely due to geographical location, but also stem from structural challenges. These insights have significant policy implications suggesting that addressing reimbursement rates, operational efficiency, and resource allocation is crucial to ensure the financial sustainability and quality care for aging populations.

While vitamin D deficiency (VDD) is implicated in both asthma and osteoporosis, the synergistic mechanisms linking these comorbidities remain unexplored. This study introduces a novel murine model of VDD-induced concurrent asthma and osteoporosis, uniquely addressing their bidirectional exacerbation through NLR family pyrin domain containing 3 (NLRP3) inflammasome activation and oxidative stress crosstalk. Female C57 mice were stratified into control, bronchial asthma (BA), osteoporosis (OP), BA+OP, and VDD+BA+OP groups, with therapeutic evaluation of low-dose (LD) and high-dose (HD) vitamin D supplementation. Unlike prior studies, our results demonstrate that VDD amplifies airway resistance and bone microstructural deterioration via NLRP3-driven pyroptosis (elevated cleaved caspase-1, N-terminal gasdermin D and suppressed antioxidant defenses (reduced glutathione peroxidase and catalase, and elevated malondialdehyde). Critically, HD supplementation reversed these effects more robustly than LD, restoring pulmonary compliance, trabecular integrity (bone volume/total volume: 0.0298 vs 0.0356 in VDD+BA+OP), and suppressing inflammasome activity. Mechanistically, we identify a feedforward loop wherein VDD-induced oxidative stress primes NLRP3 activation, which further exacerbates inflammation and bone resorption-a pathway uniquely mitigated by HD vitamin D. These findings provide the first evidence of HD vitamin D's dual therapeutic efficacy in comorbid asthma-osteoporosis, offering a paradigm shift in targeting the NLRP3/oxidative stress axis for managing multifactorial inflammatory diseases.

Mycoplasma pneumoniae pneumonia (MPP) is a prevalent cause of respiratory infections in children, sometimes leading to pleural effusion (PE). This study aimed to identify risk factors and clinical features associated with PE in pediatric MPP patients. We conducted a retrospective case-control study involving 412 children with MPP and 82 with MPP+PE at the Third Affiliated Hospital of Wenzhou Medical University from January 2021 to January 2024. Demographic, clinical, and laboratory data were analyzed using multivariate logistic regression and receiver operating characteristic (ROC) curves. Significant findings included a higher incidence of immunocompromised states in the MPP+PE group (18.29% vs. 8.98%). At admission, children with MPP+PE exhibited higher respiratory rates (29.94 vs. 29.16 breaths/min), lower oxygen saturation (82.33% vs. 83.14%), longer fever duration (5.75 vs. 4.83 days), elevated white blood cell counts (WBC) (11.64×10^9/L vs. 10.12×10^9/L), and increased erythrocyte sedimentation rates (ESR) (20.66 vs. 19.49 mm/h). Patients with PE also experienced longer antibiotic treatment (9.14±4.91 vs. 7.46±3.29 days) and extended hospital stays (13.58±4.18 vs. 12.37±3.52 days). Multivariate analysis identified several significant predictors of PE, and a joint prediction model achieved an area under the curve (AUC) of 0.842, sensitivity of 0.796, and specificity of 0.793. These findings suggest that specific clinical and laboratory factors can help identify children at higher risk for PE, facilitating timely interventions.

Fractional exhaled nitric oxide (FeNO) has emerged as a potential biomarker for differentiating between various causes of non-chronic cough, particularly in conditions associated with airway inflammation, such as asthma. This study aimed to evaluate the diagnostic efficacy of FeNO in pediatric patients with non-chronic cough and its ability to differentiate between asthma exacerbations and respiratory tract infections. Seventy-five pediatric patients aged 10-18 years with non-chronic cough were categorized into three groups: good control asthma (GCA, n=28), acute asthma exacerbation (AAE, n=26), and respiratory tract infection (RTI, n=21). Clinical assessments included FeNO measurement, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, hemoglobin (HB), platelet count (PLT), and immunoglobulin E (IgE) levels. Univariate and multivariate multinomial logistic regression models were applied to assess the predictive value of these variables. FeNO levels were significantly higher in the AAE group (46.58±22.66 ppb) compared to the GCA and RTI groups, indicating elevated eosinophilic airway inflammation in asthma exacerbations. CRP was a significant predictor of both AAE and RTI, with a one-unit increase in CRP increasing the odds of exacerbation or infection by 2.6-fold. Body max index (BMI) was inversely associated with the risk of RTI. Hemoglobin, platelet count, and IgE levels were significantly higher in the AAE group compared to the other groups, while WBC counts, though elevated, were not statistically significant. FeNO associated with other inflammatory markers, including CRP and BMI, could enhance diagnostic accuracy and inform clinical decision-making in managing pediatric respiratory conditions. To confirm these results, future studies with larger sample sizes should be performed.

The pandemic revealed significant gaps in mental health support for educators. This letter emphasizes the need for sustained mental health services, urging governments and institutions to provide resources, integrate mental health education into curricula, and create supportive work environments. Long-term strategies such as regular screenings and normalizing psychological support are essential for educators' well-being.