Masih Daneshvari Hospital

The high intubation rate due to COVID-19 infection has increased the prevalence of post-intubation tracheal stenosis (PITS). We aimed to compare PITS induced by COVID-19 infection with PITS from non-COVID-19 etiologies. This cohort study utilized PITS data collected prospectively between January 2018 and May 2023. 337 PITS patients were identified and those with direct neck trauma, burn inhalation injuries, and a prior history of tracheal surgery were excluded. Sixty-one COVID-19-related (CR) and 243 non-COVID-19-related (NCR) patients were compared before and after Propensity Score Matching (PSM) including demographics, comorbidities, intubation duration, clinical presentation, stenosis characteristics, the need for resectional airway surgery, and outcomes. Before matching, CR patients were older, more diabetic, less smoker, and they experienced longer intubation durations. After PSM, 59 CR and 59 NCR PITS patients, were included for comparison.Although no statistically significant differences were observed in stenosis, CR PITS patients required significantly more airway resection (81.4%) for definitive management than NCR (42.4%), P-value < 0.001. Postoperative complications, recurrence, and outcomes revealed no significant differences after PSM. Given the increased need for surgical resection in CR PITS patients, thoracic surgeons should consider the increased likelihood of conservative therapy failure in them. Considering this finding and that no statistically significant difference was observed in postoperative outcomes in our study, we recommend a sooner decision for resectional airway surgery in CR than NCR PITS patients.

Bone regeneration remains a significant clinical challenge in conditions such as trauma, osteoporosis, and aging-related bone loss. Recent advances have highlighted the crucial role of extracellular vesicles, especially exosomes, in intercellular signaling pathways that support bone homeostasis and repair. Among their bioactive cargoes, exosomal RNAs—particularly messenger RNAs and microRNAs—have emerged as central regulators of osteogenesis by modulating gene expression, cellular differentiation, and communication within the bone microenvironment. In this review, we provide a comprehensive summary of exosome biology, including their biogenesis, secretion, uptake mechanisms, and RNA cargo characteristics. We critically examine current evidence on how exosomal RNAs influence the molecular mechanisms of bone formation, remodeling, and regeneration under both physiological and pathological conditions such as fractures, diabetes, osteoporosis, and osteoarthritis. Furthermore, we discuss the emerging therapeutic potential of engineered exosomes as RNA delivery systems in bone tissue engineering and regenerative medicine. A better understanding of the functional roles and clinical relevance of exosomal RNAs may pave the way for next-generation, RNA-based therapies in skeletal repair and treatment of bone-related diseases. Impact Statement This review highlights the crucial role of exosomal mRNAs and microRNAs in regulating osteogenesis and bone regeneration. By elucidating the molecular mechanisms and signaling pathways involved, it provides new insights into the potential of exosome-based therapies in bone tissue engineering. This work may accelerate the development of innovative RNA-based regenerative strategies, ultimately improving treatment outcomes for bone diseases and injuries.

and adaptable microbial adversaries. In 2024, the disease claimed an estimated 1.23 million 16 lives, a stark statistic for a condition that is both preventable and curable (Organization 2025).The COVID-19 pandemic further strained diagnostic and treatment services, reversing hard-won 18 progress and highlighting the fragility of our healthcare defenses (Williams 2024). This

Accurate differential diagnosis of major depressive disorder, psychosis, and psychotic depression remains a major challenge in psychiatry due to overlapping clinical symptoms and the reliance on subjective assessment tools. This study aimed to identify objective EEG-based neuromarkers that distinguish between these three diagnostic groups using quantitative EEG features and machine learning. Resting-state EEG was collected from 60 medication-free adult patients clinically diagnosed via DSM-based psychiatric interviews. A total of 26 linear and nonlinear features, including relative power, cordance, alpha peak frequency, Lempel—Ziv complexity, largest Lyapunov exponent, and sample entropy, were extracted across 19 scalp channels. Statistical group comparisons with FDR correction identified significant feature—channel combinations, which were then ranked using the MRMR algorithm. Stepwise feature inclusion and classification with SVM, KNN, and MLP were performed. Results showed that 42 selected features achieved optimal accuracy, with KNN yielding 96.53 ± 0.20% accuracy. These findings highlight the potential of EEG neuromarkers to support precision psychiatry and improve diagnostic specificity.

Asthma and obstructive sleep apnea (OSA) often co‐occur, exacerbating respiratory difficulties and altering airway physiology during sleep. Respiratory obstructions in OSA usually terminate with deep inspiration, and in asthma, deep inspiration may function as a bronchodilator or induce bronchoconstriction. This study investigated deep inspiration patterns using polysomnography data from 202 OSA patients (Apnea‐Hypopnea Index (AHI) > 5) in the Sleep Heart Health Study, including asthma patients and matched controls. Airflow signals were used to calculate the average amplitude of three post‐event deep breaths (PEDB), as overshoots usually peak within these breaths. PEDB curves were compared within and between groups, each including 68 mild, 19 moderate, and 14 severe OSA cases (AHI > 30). In severe OSA, mean PEDB increased from the first to last sleep quartile in controls (p < 0.05) but showed no change in those with asthma (p > 0.05). PEDB values were higher in controls than in asthma patients with moderate and severe OSA. Reduced PEDB intensity in severe OSA with asthma suggests impaired bronchodilator effects of deep inspirations, possibly from chronic inflammation and fluid shifts. These findings enhance understanding of asthma–OSA interactions and the potential role of deep inspirations in mitigating overnight narrowing in lower airways.

Emerging evidence suggests that air pollution may exacerbate obstructive sleep apnoea (OSA) however, findings are conflicting and studies limited to single countries. We aimed to investigate the association between long-term exposure to particulate matter (PM10) and OSA severity in different European cities. ESADA records of OSA patients were integrated with data of PM10 concentrations extracted from Copernicus Atmosphere Monitoring Service. The associations between 1-year daily moving average PM10 concentration and OSA severity indices were evaluated by regression models and adjusted for age, sex, body mass index (BMI), smoking, humidity and temperature, season. 19,325 patients were analysed: age 54.6 (13.2) years, 30% females, BMI 32.1 (6.8) kg/m2, apnoea hypopnea index (AHI) 33.2/h (26.1), oxygen saturation (SpO2) 92.5% (3.3) and time with SpO2 below 90% (T90) 48.2 minutes (79.5). A 1-unit increase in long-term PM10 exposure was associated with a 0.41 increase in AHI (95% Confidence Interval: 0.21 - 0.67), while no association was seen for SpO2 and T90. A centre-specific analysis showed significant regional differences in both intensity and impact of association. <fig><object-id>erj;66/suppl_69/PA5662/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>The findings of the present study support the association between long term PM10 exposure and OSA severity. However, such association does not appear to be homogeneous in the different centres suggesting regional disparities across Europe.

The global challenges posed by COVID-19 vaccinations require careful consideration by decision-makers at both the global and national levels, particularly in developing countries. This study aimed to evaluate the health and economic implications of implementing vaccination programs. Two scenarios, one involving vaccination and the other without, were analyzed using the Markov susceptible-infectious-recovered (SIR) model. For the vaccination scenario, real-world data, such as age-specific vaccination coverage, hospitalization rates, and mortality, were obtained from the Medical Care Monitoring Center (MCMC) and national COVID-19 registry during the Omicron wave in Iran. For the counterfactual non-vaccination scenario, we relied on model-based assumptions using published literature and expert input to estimate infection rates and clinical outcomes in the absence of vaccination. The incremental cost-effectiveness ratio (ICER) of the COVID-19 vaccination program was calculated by comparing the incremental cost per unit of quality-adjusted life year (QALY) generated to a willingness-to-pay (WTP) threshold equivalent to 1 time the gross domestic product (GDP) per capita, approximately US$4091. One-way sensitivity analysis was conducted to ensure the reliability of the results. Overall, 2 098 495 extra QALYs were generated by vaccination, incurring a total extra cost of $853.78 million. The vaccination program resulted in an average of 0.035 incremental QALYs at an additional cost of $14.08 per person. The average ICER for adult vaccination was $406.85 per QALY, indicating that it is a highly cost-effective strategy compared to non-vaccination across all age groups. Vaccinating elderly individuals proved to be the most cost-effective approach among all age categories. The integrated Markov-SIR model used in this study provides valuable insights into both the health and economic impact of the COVID-19 vaccination program in Iran. These findings support the implementation of vaccination strategies and provide a framework for decision-makers to consider when formulating policies.