Numerous clinical studies show that besides respiratory symptoms, COVID-19 patients frequently undergo neurological and neuropsychiatric problems. However, effective treatments for these problems remain insufficient. LW-AFC, derived from traditional Chinese medicine Liuwei Dihuang decoction, is effective in improving cognitive and mental dysfunctions in many animal models. In this study, we aimed to investigate the impact of SARS-CoV-2 spike protein on the mouse nervous system, evaluate the beneficial effects of LW-AFC, and explore its underlying mechanisms. After a single intranasal administration of spike protein, mice showed a significant decline in motor performance from week 1, and this decline persisted until week 32. Three weeks after administration, anxiety-like behaviors and spatial memory deficits appeared but returned to normal by week 32. It is suggested that spike protein causes dynamic neurological and psychiatric impairments in mice, which is consistent with clinical findings. LW-AFC reversed these effects, enhancing motor performance, improving spatial memory, and alleviating anxiety. LW-AFC increased the number of NeuN-positive cells and decreased the number of Iba-1-positive cells. Additionally, LW-AFC reduced the levels of pro-inflammatory cytokines IL-6 and TNF-α, increased ATP levels, and enhanced the activity of mitochondrial respiratory chain complex I. These findings indicate that LW-AFC holds great potential as a therapeutic option for SARS-CoV-2-induced neuropsychiatric impairments.

Covid-19-induced inflammation and edema of the facial skin is a new problem, albeit still somewhat uncommon. To date, there are no published reports on the use of acupuncture for treating facial edema caused by corona virus disease 2019 (COVID-19).

The patient, a young female, developed a fever of 38.7 °C, malaise, and headache, followed by facial edema. After 3 months of conventional treatments (i.e., oral hydroxychloroquine and ebastine) failed, she turned to acupuncture.

Facial edema after COVID-19.

Acupuncture points on the face (ST2, ST3, ST4, LI20, and SI18), facial acupuncture with multiple micro-needles in the affected area, and distal acupuncture points on LI11, LI4, LI6, SP9, ST36, ST40, and LR3. The patient was treated with acupuncture in 20 sessions over 2 months (3 times a week for the first month, 2 times a week for the second month) and instructed not to use any medication during and after the treatment of acupuncture.

After 2 months of acupuncture treatment, the facial edema of the patient subsided.

This case suggests that acupuncture may be an effective alternative therapy for superficial skin inflammation and edema caused by viral infections like COVID-19. Further studies are warranted to explore acupuncture's role in managing post-viral inflammatory conditions.

In recent years, the incidence rate of pertussis in China has been steadily increasing, presenting an increasingly severe challenge for disease prevention and control. To strengthen the immune barrier in the population and effectively curb the spread of pertussis, National Disease Control and Prevention Administration of China and other relevant authorities optimized the immunization procedure for diphtheria-tetanus-pertussis vaccine, with the new procedure implemented in 2025. This adjustment includes three key measures: advancing the initial dose of the vaccine from 3 months to 2 months of age, extending the interval between primary immunization doses from 1 month to 2 months, and adding an extra dose of acellular diphtheria-tetanus-pertussis vaccine at 6 years of age. This article discusses potential changes in the epidemiology and clinical manifestations of pertussis following such adjustments for immunization procedure, and awareness of these changes will facilitate the accurate identification of pertussis cases, which is crucial for evaluating the impact of these adjustments and further optimizing immunization strategies.

Severe persistent air leak is a recognised indication for veno-venous extracorporeal membrane oxygenation (VV ECMO). This case study reports on a toddler-aged girl who presented with respiratory failure, necessitating intubation. The patient subsequently developed bilateral pneumothoraces, pneumomediastinum and pneumoperitoneum, which severely compromised her ability to be oxygenated and ventilated. Despite timely interventions to drain these air leaks, the patient developed progressive subcutaneous emphysema and continued respiratory failure. This situation required the initiation of VV ECMO support via percutaneous cannulation and the cessation of positive pressure ventilation. Invasive mechanical ventilation was recommenced after 2 days, and the patient underwent successful decannulation and extubation on the 4th and 6th days, respectively. This case highlights the following: the beneficial role of early initiation of VV ECMO in cases of severe air leak, the time required for atraumatic air leaks to seal and the favourable prognosis for this demographic of young paediatric patients.

We present a case of collapsing glomerulopathy (CG) and thrombotic microangiopathy (TMA) associated with COVID-19 in an Asian kidney transplant recipient who does not have the APOL1 gene variant, and we conduct a literature review. The patient presented with progressive renal function decline following a negative COVID-19 nucleic acid test, accompanied by TMA manifestations such as thrombocytopenia and peripheral blood schistocytes. The renal biopsy conducted after plasma exchange revealed collapsing focal segmental glomerulosclerosis, along with acute tubulointerstitial nephritis and minor microangiopathic changes. The patient underwent cyclic eculizumab therapy and ultimately died of acute pulmonary embolism. Our findings indicate that kidney transplant recipients still may experience severe renal impairment even after testing negative for COVID-19 nucleic acid. COVID-19 can not only directly damage transplanted kidneys, but also indirectly harm transplanted kidneys by causing the release of cytokines and inflammation. COVID-19-related TMA and CG may be a continuous pathological process, and prolonged TMA may lead to the development of CG with a worse prognosis. It is also possible that CG and TMA coexist when patients present with acute kidney injury (AKI). Therefore, even a mild COVID-19 infection can have serious consequences for kidney transplant recipients. Vigilance for TMA and CG should be maintained in the presence of AKI of unknown cause.

Opportunistic infections caused by viruses, bacteria, fungi, and parasites, are commonly reported in hospitalized human immunodeficiency virus (HIV)-positive patients, but their detrimental contribution to disease severity remains under explored. In this study, we examined the coinfection profiles of 126 HIV-positive patients with suspected respiratory, bloodstream, or neurological infections. Lower respiratory tract (LRT) samples, cerebrospinal fluid, and blood samples collected within the first seven days of admission were subjected to metagenomic next-generation sequencing (mNGS). Additionally, a multiplex polymerase chain reaction (PCR) detection kit to identify ten commonly known respiratory pathogens was applied to the LRT samples. Of 126 HIV-positive patients, 111 (88.1 %) were coinfected with at least one known virus. Epstein-Barr virus (EBV) (71/111, 64.0 %), human cytomegalovirus (HCMV) (64/111, 57.7 %), and torque teno virus (TTV) (63/111, 56.8 %) were the three most prevalent coinfected viruses. Fungal coinfections (58/126, 46.0 %) and bacterial coinfections (47/126, 37.3 %) were less frequent than viral coinfections. Higher viral loads of coinfection were associated with fungal coinfections (odds ratio [OR] = 2.573, 95 % confidence interval [CI]: 1.150-5.757, P = 0.0214) and lower CD4⁺/CD8⁺ T cell ratios (OR = 0.048, 95 % CI: 0.005-0.429, P = 0.0067). Importantly, patients with higher loads of HCMV and TTV, but not EBV, exhibited worse clinical outcomes. Specifically, patients with HCMV reads per million (RPM) > 0 and TTV RPM > 5 exhibited significantly higher risks of poor prognosis and intensive care unit (ICU) admission. In contrast, EBV RPM showed no association with clinical outcomes in this context. In conclusion, HCMV and TTV may serve as prognostic biomarkers linked to poorer outcomes in HIV-positive patients. Detection of HCMV and TTV could predict clinical outcomes and improve patient management strategies.

Although both pre-clinical and clinical studies show promising outcomes, resulting in rapid growth of clinical trials of MSC-based therapies in recent years, the heterogeneity and therapeutic inconsistency of MSCs have severely hampered their clinical applications. Purifying homogenous MSC populations with enhanced specific functions represents one promising approach. We have demonstrated recently that the CD317⁺ MSCs have enhanced anti-inflammatory functions and improved therapeutic efficacy and consistency.

In the current study, we performed both in vitro and in vivo investigations to delineate whether and how CD317 regulates the immune modulation function of MSCs.

Our data here indicate that the CD317 directly contributes to the immune suppression function of MSCs stimulated by TNF-α through up-regulating TSG6 via CD317/lipid-raft/TNFR1 complex. The CD317 stabilizes the TNFR1 complex, resulting in hyper-activation of the NF-κB pathway and up-regulation of TSG6, which confers the therapeutic effects of MSCs on the mouse model of ALI (acute lung injury) and IBD (inflammatory bowel disease).

Thus, the CD317 stabilizes TNFR1 and confers the anti-inflammatory functions of MSCs via NF-κB/TSG6 Pathway.

Despite the importance of human behavior in containing a disease outbreak, formal quantitative analyses examining the relationship between measures of trust and COVID-19 outcomes remain limited. We use data from Wave 7 (2017-2022) of the World Values Survey to assess the country-level relationship between trust and COVID-19 outcomes across 61 countries via clustering and regression. After adjusting for country-level confounders, our findings indicate that countries with low trust have significantly greater numbers of COVID-19 deaths (1200.6 more COVID-19 deaths per million, 95% CI [510.92, 1890.3]), significantly greater excess death (2289.1 more excess deaths per million, 95% CI [971.1, 3607.2]), and a lower vaccination rate (16.6 fewer people vaccinated per 100, 95% CI [-27.7, -5.6]) than high trust countries, suggesting a tangible impact of trust on country-level COVID-19 outcomes. We discuss differences between interpersonal and institutional trust and advocate for incorporating trust in disease modeling to better predict country-level outcomes.

Indeterminate QuantiFERON (QFT) results challenge clinical decision-making and often necessitate repeat testing. This study aimed to assess the prevalence of indeterminate QFT results and identify associated factors.

We compared patients with indeterminate QFT results to a 1:1 randomly selected sample of patients with determinate results from a tertiary care center in Mexico City between March 2020 and December 2022.

Among 4,557 QFT®-Plus tests performed during the study period, 10% yielded indeterminate results. A total of 352 cases with indeterminate results and 352 with determinate results were analyzed. In 96% of cases, indeterminate results were attributed to a low mitogen response. No significant differences were observed in age, sex, or comorbidities between groups. Multiple regression analysis identified the following factors as significantly associated with an indeterminate QFT®-Plus result: severe COVID-19 (OR 3.9, 95% CI 2.5-6.2, p < 0.001), pharmacological immunosuppression (OR 1.7, 95% CI 1.2-2.4, p = 0.004), severe lymphopenia (OR 1.7, 95% CI 1.1-2.7, p = 0.02), anemia (OR 1.9, 95% CI 1.3-2.8, p = 0.001) and hospitalization (non-COVID-19) (OR 3.9, 95% CI 2.6-5.9, p < 0.001).

The prevalence of indeterminate QFT®-Plus test results was 10%, which is significant, particularly among patients with COVID-19. Indeterminate results were linked to immunosuppression and markers of disease severity. These findings suggest that it may be advisable to postpone QFT®-Plus testing until the clinical condition of patients improves.

Hospitals and health care systems may benefit from artificial intelligence (AI) and big data to analyse clinical information combined with external sources. Machine learning, a subset of AI, uses algorithms trained on data to generate predictive models. Air pollution is a known risk factor for various health outcomes, with children being a particularly vulnerable group.

This study developed and validated an AI-based platform to forecast paediatric emergency visits and hospital admissions for respiratory diseases, using clinical and environmental data in the Metropolitan Area of São Paulo, Brazil. We applied XGBoost, a tree-based machine learning algorithm, to predict hospital use at Sabará Children's Hospital, incorporating clinical, pollution, and climatic variables.

We analysed 24 366 emergency department visits and 2973 hospital admissions for respiratory diseases International Classification of Diseases, 10th Revision, Chapter J (ICD-10 J), excluding COVID-19, from January to December 2022. Only geocoded cases within the spatial accuracy thresholds of the study were included. Logistic regression revealed that outpatient visits were associated with higher particulate matter with a diameter of 10 µm or less (PM₁₀) concentrations near children's residences on the day of hospital arrival. In contrast, admissions were linked to lower relative humidity, particularly on drier days. Additional associations were found between admissions and the spring season, as well as male sex.

We developed a platform that integrates clinical and environmental databases within a big data framework to process and analyse information using AI techniques. This tool predicts daily emergency department and hospital admission flows related to paediatric respiratory diseases. The algorithms can distinguish whether a child arriving at the emergency department is likely to be treated and discharged or will require hospital admission. This predictive capability may support hospital planning and resource allocation, particularly in contexts of environmental vulnerability.