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35 pages, 1884 KB  
Review
From Organoids to Organ-on-Chip: Advancing Human-Relevant Models for Viral Pathogenesis and Antiviral Drug Discovery
by Vaibhav Tiwari, Joanna Choe, Aryan Vora, Ishita Kataki, Sara A. L. Roujouleh, Karin Allenspach, Michelle Swanson-Mungerson, Michael V. Volin and Sinju Sundaresan
Cells 2026, 15(17), 1514; https://doi.org/10.3390/cells15171514 (registering DOI) - 22 Aug 2026
Abstract
Organoid and organ-on-chip technologies are rapidly evolving platforms for viral research that integrate stem cell biology, tissue engineering, and microfluidics to recapitulate key structural, mechanical, biochemical, and cellular features of human and animal physiology. By incorporating multicellular organoids into perfused microfluidic systems, these [...] Read more.
Organoid and organ-on-chip technologies are rapidly evolving platforms for viral research that integrate stem cell biology, tissue engineering, and microfluidics to recapitulate key structural, mechanical, biochemical, and cellular features of human and animal physiology. By incorporating multicellular organoids into perfused microfluidic systems, these models can provide complex, dynamic, and physiologically relevant micro-environments for investigating virus–host interactions that are difficult to capture in conventional two-dimensional cultures and static organoids. Controlled flow, shear stress, extracellular matrix organization, tissue–tissue interfaces, and multicellular signaling enable mechanistic investigation of viral infectivity, dissemination, tissue injury and immune activation. Integration of real-time imaging and biosensors further permits longitudinal monitoring of viral replication, host responses, and tissue integrity, expanding the potential of these platforms for antiviral drug discovery. Recent organoid-on-chip studies using brain, skin, vaginal, respiratory, and intestinal models have demonstrated how tissue architecture, mechanical forces, glycocalyx dynamics, and immune–stromal interactions influence viral tropism and pathogenesis. In this review, we provide a mechanistic and translational overview of organoid and organ-on-chip technologies for studying viral infections, with particular emphasis on models of herpes simplex virus (HSV)-mediated disease. We further examine advances in immune integration, multi-organ systems, biosensing, and computational approaches that are expanding the complexity and predictive potential of these models. Importantly, patient-derived organoids and organ-on-chip platforms can capture interindividual differences in viral susceptibility, host responses, and therapeutic efficacy, providing pharmaceutical research with more precise, patient-relevant data to support drug prioritization and precision antiviral medicine. Finally, we discuss key barriers to broader adoption, including organoid maturation, biological and technical variability, reproducibility, scalability, biosafety, cost, standardization, and regulatory validation. Collectively, these advances position organoid and organ-on-chip technologies as powerful human-relevant models that bridge reductionist in vitro systems and human disease, while continued optimization, standardization, and validation will be essential to realize their full potential for mechanistically informed antiviral discovery, therapeutic development, and precision medicine. Full article
17 pages, 2579 KB  
Article
Integrated Cardiopulmonary Profile as an Additive Signal in Patients Evaluated for Suspected Newly Detected Atrial Fibrillation
by Nilima Rajpal Kundnani, Abhinav Sharma, Ciprian Ilie Rosca, Milan Daniel Velimirovici, Ariana Violeta Nicoras, Dana Emilia Velimirovici, Dragos Cozma and Doina Georgescu
Med. Sci. 2026, 14(4), 507; https://doi.org/10.3390/medsci14040507 (registering DOI) - 21 Aug 2026
Viewed by 138
Abstract
Background: Atrial fibrillation (AF) is associated with atrial remodelling, hemodynamic stress, and complex cardiopulmonary interactions. While natriuretic peptides and echocardiographic abnormalities are established markers of AF-related substrate, the contribution of spirometry changes, as a landmark of pulmonary impairment, remains less clearly defined. This [...] Read more.
Background: Atrial fibrillation (AF) is associated with atrial remodelling, hemodynamic stress, and complex cardiopulmonary interactions. While natriuretic peptides and echocardiographic abnormalities are established markers of AF-related substrate, the contribution of spirometry changes, as a landmark of pulmonary impairment, remains less clearly defined. This study evaluated whether AF is associated with an integrated cardiopulmonary profile characterized by altered spirometry, increased NT-proBNP, and conventional echocardiographic markers of left atrial structure and function. Methods: We performed a retrospective, single-center observational study based on an existing clinical database of adult patients referred for 24 h 12-lead Holter ECG monitoring because of palpitations and/or chest pain. None of the included patients had a previously documented diagnosis of atrial fibrillation before Holter monitoring. Because a single 24 h Holter recording cannot establish spontaneous termination or long-term temporal pattern with certainty, AF documented for the first time during this recording is referred to throughout as “newly detected AF” rather than “paroxysmal AF”. During Holter monitoring, no ECG changes suggestive of myocardial ischemia were detected. From 536 records of patients without previously known AF who underwent 24 h 12-lead Holter ECG monitoring for palpitations and/or chest pain, 164 patients were retained for the main comparison, including 48 with newly detected paroxysmal AF and 116 without AF. Demographic, biochemical, spirometric, and echocardiographic variables were analyzed. The main respiratory parameters were forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and peak expiratory flow (PEF). NT-proBNP was the primary biomarker, while conventional left atrial structural and functional variables were used for echocardiographic assessment. Results: NT-proBNP was markedly higher in the AF group (684.5 vs. 62.3 pg/mL, p = 0.001), even when accounting for confounders like age, CKD, or CPD, showing by far the largest between-group difference among the biomarkers assessed (formal discrimination statistics such as ROC/AUC were not computed). The exploratory inflammatory markers assessed (hs-CRP, neutrophil/lymphocyte ratio, homocysteine) showed only modest, non-significant differences. Conventional echocardiographic parameters did not differ significantly between groups. In the strict complete-case comparison, spirometric indices did not reach statistical significance; however, preliminary project-level analysis showed lower FVC, FEV1, and PEF in AF patients, but without supporting the COPD diagnosis, and exploratory correlations suggested a relationship between spirometric performance and left atrial function. Conclusions: In this cohort, AF was most strongly associated with NT-proBNP, while the respiratory signal was weaker but directionally consistent with a broader cardiopulmonary phenotype. These findings do not support spirometry or NT-proBNP as stand-alone diagnostic tools for AF. However, when interpreted alongside traditional AF risk factors and symptoms, elevated NT-proBNP with concordant spirometric impairment may represent a hypothesis-generating additive signal supporting longer or repeated rhythm monitoring beyond 24 h in selected patients with suspected AF; this additive value was not formally tested against clinical models alone and requires prospective confirmation. Full article
(This article belongs to the Section Cardiovascular Disease)
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32 pages, 3661 KB  
Systematic Review
Mechanical Power as a Predictor of Outcomes During Mechanical Ventilation in Coronavirus Disease 2019 (COVID-19): An Updated Systematic Review
by Camila Vantini Capasso Palamim, Tais Mendes Camargo and Fernando Augusto Lima Marson
J. Clin. Med. 2026, 15(16), 6476; https://doi.org/10.3390/jcm15166476 - 21 Aug 2026
Viewed by 88
Abstract
Background/Objectives: Mechanical power (MP) quantifies the energy delivered to the respiratory system during ventilation and serves as a promising marker for ventilator-induced lung injury (VILI). According to its original definition by Gattinoni, MP reflects the energy transferred from the ventilator to the [...] Read more.
Background/Objectives: Mechanical power (MP) quantifies the energy delivered to the respiratory system during ventilation and serves as a promising marker for ventilator-induced lung injury (VILI). According to its original definition by Gattinoni, MP reflects the energy transferred from the ventilator to the respiratory system under conditions of deep sedation, passive breathing, neuromuscular blockade, and volume-controlled ventilation. Its role in coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome (ARDS) remains under investigation. This systematic review aimed to synthesize the available evidence on the association between MP and VILI, complications related to mechanical ventilation (MV), and mortality in adult patients with COVID-19 undergoing invasive mechanical ventilation (IMV). Methods: A systematic review was conducted using PubMed-MEDLINE (Medical Literature Analysis and Retrieval System Online) for studies published in recent years, focusing on adult COVID-19 patients undergoing IMV. Inclusion criteria centered on studies reporting MP and its association with VILI, complications, or mortality. Ten studies met eligibility criteria after screening 356 retrieved articles. Results: Most included studies were retrospective and observational, encompassing critically ill COVID-19 patients. Elevated MP was correlated with more severe outcomes, including increased 28-day mortality, prolonged MV, and weaning failure. Franck et al. demonstrated strong correlations between MP and driving pressure, elastance, and positive end-expiratory pressure, emphasizing the importance of calculation methods. González-Castro et al. identified a threshold of 17 J/min, above which mortality risk increased. Stalla et al. highlighted that dynamic MP reductions during prone positioning were associated with survival. Registry-based analyses confirmed that both magnitude and cumulative exposure above 18 J/min increased intensive care unit mortality. Novel indices combining MP with oxygenation parameters improved prognostic accuracy. While absolute MP at initiation provided limited predictive value, temporal trends and individual components were strongly linked to VILI. Conclusions: Higher MP has been associated with adverse clinical outcomes in patients with COVID-19 receiving invasive mechanical ventilation, supporting its potential role as a prognostic indicator. Its dynamic assessment, thresholds, and integration with ventilatory strategies such as prone positioning enhance risk stratification and may guide individualized, lung-protective ventilation. Continuous monitoring and standardized calculation are recommended to optimize clinical decision-making. Full article
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17 pages, 2833 KB  
Article
Unravelling the Drivers of Early-Life Mortality in Yak Calves: A Retrospective Cohort Study Using Survival Analysis
by Asish Debbarma, Mokhtar Hussain, Martina Pukhrambam, Shubham Loat, Vijay Paul, Dinamani Medhi, Sayed Nabil Abedin and Mihir Sarkar
Animals 2026, 16(16), 2614; https://doi.org/10.3390/ani16162614 - 20 Aug 2026
Viewed by 148
Abstract
Early-life calf mortality is a significant barrier to herd growth and overall productivity in yak husbandry. This retrospective study investigated the survival pattern and potential risk factors linked to yak calf mortality during the first 90 days of life. Analysis was performed on [...] Read more.
Early-life calf mortality is a significant barrier to herd growth and overall productivity in yak husbandry. This retrospective study investigated the survival pattern and potential risk factors linked to yak calf mortality during the first 90 days of life. Analysis was performed on existing farm records from 428 yak calves born between 2013 and 2025 at a semi-intensive yak farm. The Kaplan–Meier method was used to estimate survival probability, and the log-rank test was used to compare survival probabilities; additionally, a multivariate Cox proportional hazards model was employed to identify independent risk factors. Overall, 70 (16.4%) calves died within the first 90 days after birth. The Kaplan–Meier analysis indicated significantly lower survival probability among low-birth-weight calves (≤12 kg; p = 0.0005) and calves born to primiparous dams (p = 0.0003). In contrast, survival did not differ according to calf sex (p = 0.620) and birth season (p = 0.658). In the multivariate Cox proportional hazards model, low birth weight (HR = 2.27, 95% CI: 1.24–4.16; p = 0.008) and primiparous dams (HR = 2.08, 95% CI: 1.28–3.38; p = 0.003) were independently associated with higher mortality risk. As a result, calf sex and birth season were not significant predictors. Diarrhea and respiratory disease were the predominant causes of calf deaths. The current study’s results indicate that maternal and neonatal factors are the major determinants of early-life calf survival. This highlights the need for special care with optimum nutrition and regular monitoring of primiparous dams and low-birth-weight calves in order to lower pre-weaning mortality and improve overall herd productivity. Full article
(This article belongs to the Section Animal System and Management)
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17 pages, 1308 KB  
Article
A Wearable Respiratory Monitor for Home-Based Screening and Stratification of Obstructive Sleep Apnea: A Pilot Study in Participants with Intermediate-to-High STOP-Bang Scores
by Burcu Kolukisa Birgec, Beyza Toprak and Alexander Balfour Mullen
Biosensors 2026, 16(8), 454; https://doi.org/10.3390/bios16080454 - 20 Aug 2026
Viewed by 107
Abstract
Access to in-laboratory polysomnography (PSG) is restricted by prolonged waiting lists, and first-night effects can distort typical sleep architecture. This study evaluates the PneumoWave biosensor as a scalable, unobtrusive alternative for longitudinal single-channel home sleep apnea monitoring. Over three nights in an uncontrolled [...] Read more.
Access to in-laboratory polysomnography (PSG) is restricted by prolonged waiting lists, and first-night effects can distort typical sleep architecture. This study evaluates the PneumoWave biosensor as a scalable, unobtrusive alternative for longitudinal single-channel home sleep apnea monitoring. Over three nights in an uncontrolled home environment, the biosensor’s respiratory rate agreement was evaluated against smartwatch-derived respiratory rate estimates, whilst apnea/hypopnea detection was compared with concurrent pulse oximetry. PneumoWave and smartwatch devices demonstrated good correlation (r = 0.870; p < 0.001). The PneumoWave device showed strong measurement agreement and provided a highly predictive screening pathway for patients with intermediate-to-high obstructive sleep apnea (OSA) risk. Longitudinal analysis confirmed consistent multi-night performance without first-night effect biases (ICC = 0.956, p < 0.001). Furthermore, its intuitive design yielded zero patient-induced setup errors, highlighting its operational robustness for self-administered use. Combining this continuous chest wall monitor with the STOP-Bang clinical questionnaire has the potential to provide an effective predictive screening pathway, improving community OSA screening and assisting clinical triage. Further validation against full polysomnography is warranted before clinical adoption. Full article
(This article belongs to the Section Biosensors and Healthcare)
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20 pages, 6356 KB  
Article
Pandemic-Associated Shifts and Spatial Inequality in Public Attention to Pulmonary Function Testing in China: A 14-Year Baidu Index Study
by Cai Chen, Dedong Ma and Tao Jing
Healthcare 2026, 14(16), 2640; https://doi.org/10.3390/healthcare14162640 - 20 Aug 2026
Viewed by 155
Abstract
Background/Objectives: Pulmonary function tests (PFTs), especially spirometry, are important for chronic respiratory disease diagnosis and management, but Baidu-based online search interest in PFT-related information remains insufficiently characterized. This study examined long-term Baidu search activity for a selected PFT-related keyword in China from 2011 [...] Read more.
Background/Objectives: Pulmonary function tests (PFTs), especially spirometry, are important for chronic respiratory disease diagnosis and management, but Baidu-based online search interest in PFT-related information remains insufficiently characterized. This study examined long-term Baidu search activity for a selected PFT-related keyword in China from 2011 to 2024, with attention to pandemic-period changes, provincial variation, spatial inequality, and associated socioeconomic factors. Methods: We analyzed Baidu Index data from 1 January 2011 to 31 December 2024. The selected PFT-related keyword, “pulmonary function instrument,” was compared with “blood pressure monitor” and “blood glucose meter.” Daily Baidu Index values were aggregated into monthly and annual series. Temporal trends, relative search-intensity ratios, interrupted time-series analysis, inequality indices, fixed-effects regression, subgroup heterogeneity, and convergence dynamics were assessed. Results: PFT-related Baidu search activity remained lower than that for blood pressure and glucose monitoring, with relative search-intensity ratios below 0.35. Descriptively, PFT-related searches increased during 2020–2022; however, the re-specified seasonality-adjusted ITSA using unsmoothed monthly observations did not provide strong statistical evidence for an immediate level change at pandemic onset or a sustained slope change. Provincial differences persisted, with higher values generally observed in several eastern coastal provinces. Inequality indices were lower on average during 2020–2022 but fluctuated over time, and beta-convergence analyses provided limited statistical evidence of systematic catch-up among initially low-index provinces. Urbanization, per capita GDP, and population aging were positively associated with PFT-related Baidu Index values, while subgroup findings were interpreted as exploratory ecological associations. Conclusions: PFT-related Baidu search activity in China remained lower than search activity for blood pressure and glucose monitoring and showed persistent provincial variation. These findings suggest lower visibility of PFT-related information within the Baidu-based online environment. Full article
(This article belongs to the Topic Advances in Chronic Disease Management)
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38 pages, 858 KB  
Review
Healthcare and Psychosocial Needs in Achondroplasia Across the Lifespan: Developmental Functioning, Multidisciplinary Care, and Family-Centered Outcomes
by Rebecca Cristiana Șerban, Andreea Mitut-Veliscu, Alexandra Dumitra, Liana Marica, Cristina Popescu, Andrei Costache, Șerban Teona, Anca-Lelia Riza, Rodica Dirnu, Ion Dorin Pluta, Renata-Maria Varut and Ioana Streata
Healthcare 2026, 14(16), 2623; https://doi.org/10.3390/healthcare14162623 - 19 Aug 2026
Viewed by 526
Abstract
Background/Objectives: Achondroplasia is the most common skeletal dysplasia and the leading genetic cause of disproportionate short stature. Although its biological basis involves gain-of-function variants in the FGFR3 gene, achondroplasia is a lifelong multisystem disorder associated with neurological, respiratory, orthopedic, otolaryngological, cardiovascular, oral, functional, [...] Read more.
Background/Objectives: Achondroplasia is the most common skeletal dysplasia and the leading genetic cause of disproportionate short stature. Although its biological basis involves gain-of-function variants in the FGFR3 gene, achondroplasia is a lifelong multisystem disorder associated with neurological, respiratory, orthopedic, otolaryngological, cardiovascular, oral, functional, and psychosocial complications. This narrative review aims to synthesize the evidence on developmental and adaptive functioning, age-specific healthcare needs, multidisciplinary service delivery, transition to adult care, psychosocial well-being, caregiver burden, and patient- and family-centered outcomes in achondroplasia across the lifespan. Methods: A narrative literature review was conducted using PubMed/MEDLINE, Scopus, Web of Science Core Collection, and CINAHL, with Google Scholar used as a supplementary source. Studies published between January 2010 and July 2026 were considered, together with earlier clinically relevant reports. Evidence addressing prenatal and postnatal diagnosis, age-specific manifestations, neurological and respiratory complications, orthopedic and otolaryngological care, cardiometabolic risk, growth monitoring, multidisciplinary management, transition to adult services, disease-modifying therapy, quality of life, and caregiver burden was evaluated. Results: The clinical priorities of achondroplasia change substantially across the lifespan. Infancy is characterized by an increased risk of foramen magnum stenosis, cervicomedullary compression, hypotonia, and sleep-disordered breathing, whereas orthopedic deformities, chronic pain, reduced mobility, spinal stenosis, hearing impairment, obesity, and cardiovascular risk become increasingly relevant during later childhood, adolescence, and adulthood. Early diagnosis, condition-specific imaging, neurological and respiratory surveillance, growth monitoring, and coordinated specialist care are essential for preventing severe complications. Vosoritide has introduced a disease-modifying therapeutic option, but it does not replace comprehensive clinical surveillance, rehabilitation, orthopedic care, psychosocial support, or shared decision-making. Functional limitations, environmental barriers, treatment burden, and caregiver stress contribute substantially to reduced quality of life. Conclusions: Achondroplasia should be managed as a lifelong multisystem condition rather than solely as a disorder of short stature. Standardized surveillance, multidisciplinary coordination, planned transition to adult care, and patient- and family-centered management are essential for improving function, autonomy, long-term health outcomes, and quality of life. Full article
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17 pages, 8199 KB  
Article
Development of a Porcine Model of Pulmonary Ischemia–Reperfusion Injury Relevant to Post-Esophagectomy Acute Respiratory Distress Syndrome
by Mohammadreza Hafezi, Arash Saffari, Elias Khajeh, Christa Flechtenmacher, Christoph Lichtenstern, Arianeb Mehrabi and Camelia Garoussi
Med. Sci. 2026, 14(4), 490; https://doi.org/10.3390/medsci14040490 - 18 Aug 2026
Viewed by 106
Abstract
Background: Acute respiratory distress syndrome (ARDS) occurs in 20–40% of patients following esophagectomy and is associated with substantial postoperative morbidity and mortality. A major contributor to postoperative ARDS is pulmonary ischemia–reperfusion injury (IRI); however, the role of IRI in ARDS following esophagectomy [...] Read more.
Background: Acute respiratory distress syndrome (ARDS) occurs in 20–40% of patients following esophagectomy and is associated with substantial postoperative morbidity and mortality. A major contributor to postoperative ARDS is pulmonary ischemia–reperfusion injury (IRI); however, the role of IRI in ARDS following esophagectomy is not adequately addressed in current experimental models. In this study, we established a large animal model of pulmonary IRI that reproduces key physiological, inflammatory, and histopathological features of pulmonary ischemia–reperfusion-induced acute lung injury relevant to postoperative ARDS after esophagectomy. Methods: Sequential pulmonary ischemia–reperfusion injury was induced in ten anesthetized Landrace pigs using unilateral hilar inflow occlusion. Right lung ischemia was achieved by clamping the hilar inflow for three hours, followed by reperfusion. Subsequently, the left lung underwent two hours of ischemia. Hemodynamic, respiratory, and inflammatory parameters were continuously monitored throughout the experiment. Blood samples were collected to assess leukocyte counts and circulating inflammatory cytokines, including tumor necrosis factor-α and interleukin-6. Lung tissue samples were obtained for histopathological evaluation. Results: ARDS-like lung injury was successfully induced in all animals, with PaO2/FiO2 ratios falling below 200 mmHg during the predefined reperfusion observation period. Lung compliance decreased by approximately 50% after ischemia and further declined following reperfusion. Progressive leukocyte elevation and elevated tumor necrosis factor-α and interleukin-6 levels were observed, indicating a systemic inflammatory response. Hallmark features of ARDS were histologically confirmed, including intra-alveolar hemorrhage, interstitial and perivascular edema, and neutrophil infiltration. Conclusions: This porcine model reproduces key physiological, inflammatory, and histopathological features consistent with pulmonary ischemia–reperfusion-induced ARDS-like lung injury. Although it does not reproduce the complete clinical syndrome of post-esophagectomy ARDS, it provides a clinically relevant translational platform for investigating pulmonary ischemia–reperfusion injury and evaluating potential preventive and therapeutic strategies. Full article
(This article belongs to the Special Issue Clinical Advances in Perioperative Analgesia and Anesthesia)
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29 pages, 2015 KB  
Review
Lung Ultrasound in Bronchopulmonary Dysplasia: Diagnostic Tool, Prognostic Marker or Monitoring Strategy?
by Ilaria Bucci, Dorina Hoxha, Chiara Rosolia Capasso, Sabrina Di Pillo, Francesco Chiarelli, Marina Attanasi and Paola Di Filippo
Children 2026, 13(8), 1103; https://doi.org/10.3390/children13081103 - 18 Aug 2026
Viewed by 206
Abstract
Bronchopulmonary dysplasia (BPD) remains one of the leading chronic respiratory complications of extreme prematurity despite major advances in neonatal intensive care. Current diagnostic definitions are primarily based on respiratory support requirements and provide limited information on the biological heterogeneity and longitudinal evolution of [...] Read more.
Bronchopulmonary dysplasia (BPD) remains one of the leading chronic respiratory complications of extreme prematurity despite major advances in neonatal intensive care. Current diagnostic definitions are primarily based on respiratory support requirements and provide limited information on the biological heterogeneity and longitudinal evolution of lung injury. Lung ultrasound (LUS) is progressively reshaping the clinical approach to BPD by enabling radiation-free, bedside, and repeatable assessment of peripheral lung abnormalities throughout the neonatal course. This narrative review examines the current role of LUS in BPD, integrating its pathophysiological basis with the available evidence and distinguishing explicitly between its diagnostic, prognostic, monitoring, and treatment-guiding applications, which are supported by markedly different levels of evidence. We discuss how LUS findings reflect the major components of BPD pathophysiology, compare LUS with conventional imaging modalities, and summarize the scanning protocols, semiquantitative scoring systems, examination schedules, and patient populations that have been evaluated to date. We also review the emerging contribution of artificial intelligence to automated image analysis, standardized image acquisition, and personalized risk prediction. Most of the available evidence is prognostic rather than diagnostic: early LUS scores predict BPD subsequently defined at 36 weeks’ postmenstrual age, whereas LUS has not been validated as a diagnostic test for established BPD, and reported cutoffs remain study- and protocol-specific rather than universally applicable. Randomized evidence is confined to LUS-guided surfactant administration, where the demonstrated benefits concern the timing of treatment and the need for invasive ventilation; no trial has yet shown that LUS-guided management reduces the incidence of BPD. Current evidence supports LUS as a complementary imaging modality that extends beyond the assessment of acute neonatal respiratory disease and enables longitudinal bedside monitoring of peripheral lung aeration. Although further multicenter prospective studies are required to harmonize protocols and validate LUS-guided management strategies, the integration of standardized LUS assessment with emerging artificial intelligence technologies has the potential to establish LUS as a key component of precision respiratory care for infants at risk of BPD. Full article
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20 pages, 609 KB  
Article
Using Phenotypic, Biochemical, and Molecular Methods to Identify Candida Species Isolated in a Tertiary Hospital in Mexico
by Karen del Carmen Morales-Ramírez, María Guadalupe Frías-De-León, Esperanza Duarte-Escalante, Teresa Soledad Cid-Pérez, Manuel Huerta-Lara, Raúl Avila-Sosa and Ricardo Munguía-Pérez
Epidemiologia 2026, 7(4), 112; https://doi.org/10.3390/epidemiologia7040112 - 17 Aug 2026
Viewed by 220
Abstract
Background/Objectives: Candida species are among the leading causes of fungal infections, especially in immunosuppressed patients. In recent years, the increase in non-albicans species has altered the epidemiological landscape, requiring updated local surveillance data. Therefore, this study aims to analyze the epidemiological pattern [...] Read more.
Background/Objectives: Candida species are among the leading causes of fungal infections, especially in immunosuppressed patients. In recent years, the increase in non-albicans species has altered the epidemiological landscape, requiring updated local surveillance data. Therefore, this study aims to analyze the epidemiological pattern of Candida spp. involved in various clinical manifestations. Methods: This was a retrospective observational descriptive study of clinical Candida isolates recovered from patients at a single tertiary care hospital in Puebla, Mexico, between 2021 and 2022. Sociodemographic and clinical data were collected from medical records. Candida spp. isolates were recovered from the hospital’s clinical specimen collection and identified using conventional methods and phylogenetic analysis. Results: Ninety isolates were recovered from a total of 88 patients during the study period. The majority of patients were women (60.2%), and among the age groups, the largest proportion corresponded to older adults (≥60 years, 25%). Candida was most frequently isolated from the urinary tract (47.7%), followed by the respiratory tract (19.3%) and the vulvovaginal tract (14.7%). Candida albicans was the predominant species (51.1%), followed by Nakaseomyces glabratus (32.2%) and other species such as Pichia kudriavzevii (5.5%), Candida tropicalis (3.3%), Candida dubliniensis (3.3%), Candida parapsilosis (2.2%), and Candida orthopsilosis (1.1%). The study showed discrepancies between conventional identification methods and molecular analysis. Of the 33 isolates evaluated using culture methods, only 21 matched the identification by PCR and phylogenetic analysis. In the case of the BD Phoenix automated system, 20 matches with and 13 discrepancies from the molecular tests were recorded. Conclusions: Our findings revealed the significant presence of species belonging to the non-albicans family in specific clinical contexts, highlighting the urgent need to monitor the epidemiological profile. The observed discrepancies between phenotypic and molecular identification methods suggest that species identification based solely on phenotypic approaches should be interpreted with caution. Full article
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18 pages, 781 KB  
Article
Impact of Chronic Kidney Disease Severity on COVID-19 Outcomes: A Retrospective Cohort Study
by Laura Garazhayeva, Almagul Kauysheva, Maksat Mamyrkul and Mukhit Kulmaganbetov
Healthcare 2026, 14(16), 2575; https://doi.org/10.3390/healthcare14162575 - 17 Aug 2026
Viewed by 293
Abstract
Background/Objectives: Chronic kidney disease (CKD) is a recognised risk factor for severe COVID-19, but comparative outcomes between conservatively managed CKD patients and those on maintenance haemodialysis (HD) remain incompletely characterised, particularly in Central Asia. This study evaluated the impact of CKD severity on [...] Read more.
Background/Objectives: Chronic kidney disease (CKD) is a recognised risk factor for severe COVID-19, but comparative outcomes between conservatively managed CKD patients and those on maintenance haemodialysis (HD) remain incompletely characterised, particularly in Central Asia. This study evaluated the impact of CKD severity on clinical outcomes, inflammatory profiles, and mortality in hospitalised COVID-19 patients. Methods: This retrospective cohort study reviewed 891 patients hospitalised with COVID-19 at a tertiary infectious disease centre in Almaty, Kazakhstan, between 2020 and 2021. Patients were stratified into three groups: No CKD (n = 598), CKD without HD (n = 116), and CKD on maintenance HD (n = 177). Demographic, laboratory, treatment, and outcome data were extracted from electronic medical records. Multivariate logistic regression was used to identify independent predictors of in-hospital mortality, acute kidney injury (AKI), and intensive care unit (ICU) admission. Model 1 served as the primary prognostic model, while Model 2 explored in-hospital complications. Results: Patients with CKD exhibited significantly higher inflammatory markers, with peak C-reactive protein reaching 168.3 mg/L in the HD group compared to 44.4 mg/L in the No CKD group. In-hospital mortality was highest in the CKD without HD group (34.8%), followed by CKD on HD (21.7%) and No CKD (13.6%). AKI occurred in 35.7% of conservatively managed CKD patients. In multivariate analysis, CKD without HD independently predicted mortality (OR 3.23; 95% CI 1.38–7.63) and AKI (OR 4.12; 95% CI 1.73–10.03). Conversely, established HD status was not a significant independent predictor of mortality after adjusting for age and comorbidities. Conclusions: CKD severity strongly influences COVID-19 prognosis. Paradoxically, conservatively managed CKD patients carry a higher mortality and AKI risk than patients already on maintenance HD, which may be associated with the absence of scheduled volume and metabolic control, although causal inferences cannot be drawn from this observational data. These findings support the need for aggressive monitoring and early nephrological intervention in non-dialysis CKD patients hospitalised with severe viral respiratory infections. Full article
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16 pages, 3957 KB  
Review
The Aeroplastic Exposome: Airborne Microplastics as Interfaces Among Bioaerosol Transport, Aeroallergen Exposure, and Respiratory Immune Response
by Georgios I. Barkas and Garyfallia Perlepe
Aerobiology 2026, 4(3), 15; https://doi.org/10.3390/aerobiology4030015 - 17 Aug 2026
Viewed by 147
Abstract
Airborne microplastics and nanoplastics (MNPs) are increasingly reported in indoor, outdoor, and occupational air, but their aerobiological significance remains incompletely defined. This narrative review proposes the aeroplastic exposome as a cautious, testable framework for evaluating airborne MNPs as interfaces among aerosol transport, biological [...] Read more.
Airborne microplastics and nanoplastics (MNPs) are increasingly reported in indoor, outdoor, and occupational air, but their aerobiological significance remains incompletely defined. This narrative review proposes the aeroplastic exposome as a cautious, testable framework for evaluating airborne MNPs as interfaces among aerosol transport, biological and chemical loading, aeroallergen co-exposure, inhalation, respiratory deposition, clearance, and airway immune response. Evidence from environmental monitoring, indoor and occupational exposure studies, and human respiratory-sample and lung-tissue detection studies supports the occurrence of airborne MNPs, the plausibility of inhalation exposure, reported detection in human respiratory samples, and experimental hazard under selected conditions. However, evidence that airborne plastic particles routinely carry bioaerosols or aeroallergens remains insufficient or model-dependent. The aeroplastic exposome is therefore not proposed as a disease entity, validated exposure metric, or established explanation for asthma, chronic obstructive pulmonary disease, fibrosis, infection, or cancer. Instead, it is a framework for organizing testable questions about polymer identity, aerodynamic fraction, morphology, aging state, biological loading, co-exposure context, deposition, clearance, epithelial–immune responses, and host susceptibility. Priority research needs to include standardized airborne sampling, same-particle polymer–bioaerosol–allergen characterization, exposure-relevant aerosol systems, factorial co-exposure experiments, and prospective human studies with repeated personal exposure assessment. Full article
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58 pages, 5483 KB  
Article
Hierarchical Multimodal Sleep Staging with Optimized EEG, EOG, and PPG Features for Wearable Applications
by Roberto De Fazio, Matteo Paiano, Ramiro Velazquez, Carolina Del-Valle-Soto and Paolo Visconti
Appl. Sci. 2026, 16(16), 8164; https://doi.org/10.3390/app16168164 - 16 Aug 2026
Viewed by 260
Abstract
Automatic sleep staging is fundamental for diagnosing sleep disorders and enabling long-term sleep monitoring with wearable devices. Although Deep Learning has significantly improved classification performance, balancing accuracy with computational efficiency remains challenging, particularly for resource-constrained systems. This paper proposes a lightweight two-stage Deep [...] Read more.
Automatic sleep staging is fundamental for diagnosing sleep disorders and enabling long-term sleep monitoring with wearable devices. Although Deep Learning has significantly improved classification performance, balancing accuracy with computational efficiency remains challenging, particularly for resource-constrained systems. This paper proposes a lightweight two-stage Deep Learning framework for five-class sleep staging based on optimized multimodal physiological features extracted from electroencephalogram (EEG), electrooculogram (EOG), and photoplethysmography (PPG) signals. The framework is trained and tested using the Bitbrain Open Access Sleep (BOAS) database, considering a 31-subject dataset partitioned into training (24 subjects) and independent test (7 subjects) sets. Feature selection is performed using the minimum Redundancy Maximum Relevance (mRMR) algorithm, followed by Principal Component Analysis (PCA) for EEG and EOG features, while respiratory and cardiac features derived from PPG are directly incorporated into the multimodal representation. A hierarchical Long Short-Term Memory (LSTM) architecture first classifies sleep into Wake, REM, and NREM, then further distinguishes the N1, N2, and N3 stages. On an independent test set, the classifier achieves 88.2% five-class accuracy on the multimodal feature set (EEG + EOG + PPG) with a model size of 3.14 MB, and 87.1% accuracy on the EEG-only feature set using only 2.95 MB of memory. Leave-One-Subject-Out (LOSO) cross-validation yields 86.9% accuracy, supporting subject-independent generalization. Inference latency ranged from 2.55 ms (EEG-only) to 4.02 ms (multimodal), with measured energy per inference of 2.88–10.9 mJ across feature sets. Additional validation on the RichSleep and ISRUC datasets demonstrates robustness across different recording conditions, achieving mean accuracies of 78.2% and 77.3%, respectively. The proposed framework provides a favorable trade-off among classification performance, complexity, and memory footprint, suggesting its potential suitability for wearable and edge-based sleep-monitoring systems. Full article
(This article belongs to the Special Issue AI-Based Biomedical Signal Processing—2nd Edition)
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16 pages, 450 KB  
Article
Patient-Reported Health-Related Quality of Life in Romanian Patients with Cystic Fibrosis in the Era of Highly Effective CFTR Modulator Therapy: A National Cross-Sectional Mixed-Methods Survey
by Cristian Phillip Marinău, Cristian Sava, Alin Iuhas, Ioana Mihaiela Ciucă, Liviu Laurențiu Pop, Mihai Craiu, Zsolt Futaki, Ariana Szilagyi, Alexandru Jurca and Claudia Maria Jurca
J. Clin. Med. 2026, 15(16), 6328; https://doi.org/10.3390/jcm15166328 - 16 Aug 2026
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Abstract
Background/Objectives: Highly effective cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy has changed cystic fibrosis (CF) care, but Romanian patient-reported health-related quality of life (HRQoL) data remain limited. This national cross-sectional mixed-methods survey aimed to describe patient- and parent-reported HRQoL in Romanian people [...] Read more.
Background/Objectives: Highly effective cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy has changed cystic fibrosis (CF) care, but Romanian patient-reported health-related quality of life (HRQoL) data remain limited. This national cross-sectional mixed-methods survey aimed to describe patient- and parent-reported HRQoL in Romanian people with CF (pwCF) aged ≥6 years using age-appropriate Cystic Fibrosis Questionnaire-Revised (CFQ-R) versions, with the respiratory domain as the primary outcome. Methods: The online survey was conducted between February and April 2026. Respondents provided demographic and clinical data, including genotype/F508del status, CFTR modulator status, percent predicted forced expiratory volume in 1 s (ppFEV1) category, weight, height, and IV antibiotic-treated pulmonary exacerbations in the previous year. CFQ-R scores were summarized descriptively, and exploratory unadjusted associations were assessed using Mann–Whitney U tests and Spearman correlations. Open-ended responses were analyzed descriptively. Results: Of 67 responses, 61 were included: 43 participants aged 6–13 years and 18 aged ≥14 years. Most respondents were currently receiving CFTR modulators (52/61, 85.2%), predominantly elexacaftor/tezacaftor/ivacaftor. Mean CFQ-R Respiratory scores were 74.5 ± 23.1 in parent-proxy questionnaires for children aged 6–13 years, 83.3 ± 11.8 in self-reported questionnaires for children aged 12–13 years, and 69.8 ± 27.4 among respondents aged ≥14 years. Respiratory scores were higher among currently treated respondents and those with at least one F508del variant, and lower among those reporting IV antibiotic-treated exacerbations. Treatment burden remained among the lower-scoring domains. Qualitative responses described perceived respiratory, nutritional, and functional improvements, alongside residual treatment burden, psychosocial challenges, and access-related expectations. Conclusions: This national Romanian mixed-methods survey provides descriptive, exploratory CFQ-R-based HRQoL data in the CFTR modulator era. The findings suggest more favorable respiratory HRQoL among currently treated respondents, while supporting continued multidimensional patient-reported outcome monitoring in Romanian CF care. Full article
(This article belongs to the Special Issue Cystic Fibrosis: Management Strategies and Patient Outcomes)
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15 pages, 5164 KB  
Article
Whole-Genome Sequencing of RSV and Phylogeographic Assessment of Viral Importations into Russia
by German V. Roev, Ekaterina V. Pimkina, Dmitry V. Svetlichnyy, Arina V. Peresadina, Maksim I. Nadtoka, Kamil F. Khafizov and Vasiliy G. Akimkin
Viruses 2026, 18(8), 901; https://doi.org/10.3390/v18080901 - 15 Aug 2026
Viewed by 403
Abstract
Lower respiratory tract infections caused by the respiratory syncytial virus (RSV) pose a major global public health challenge. The use of next-generation sequencing technologies enables detailed monitoring of viral genetic variability, which is crucial for evaluating the efficacy of immunoprophylactic measures. In this [...] Read more.
Lower respiratory tract infections caused by the respiratory syncytial virus (RSV) pose a major global public health challenge. The use of next-generation sequencing technologies enables detailed monitoring of viral genetic variability, which is crucial for evaluating the efficacy of immunoprophylactic measures. In this study, whole-genome sequencing of RSV was performed on 106 samples collected in the Russian Federation between September 2021 and April 2025. Three NGS platforms were employed: Illumina MiSeq, Oxford Nanopore Technologies MinION, and Qitan Tech QNome-3841. Using discrete phylogeographic methods, we estimated a minimum of 45 introduction events into Russia for RSV-A and 39 for RSV-B among the genomes included in the analysis. Most events were represented by a single Russian genome. These results indicate recurrent introductions of RSV into Russia from abroad. Given the limited genomic sampling available, most of these introductions were not associated with detectable transmission within the country. Full article
(This article belongs to the Special Issue RSV Epidemiological Surveillance: 3rd Edition)
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