Major aridification events in Australia during the Pliocene may have had significant impact on the distribution and structure of widespread species. To explore the potential impact of Pliocene and Pleistocene climate oscillations we estimated the timing of population fragmentation and past connectivity of the currently isolated but morphologically similar subspecies of the widespread brushtail possum (Trichosurus vulpecula). We use ecological niche modelling (ENM) with the current fragmented distribution of brushtail possum to estimate the environmental envelope of this marsupial. We projected the ENM on models of past climatic conditions in Australia to infer the potential distribution of brushtail possums over six million years. D-loop haplotypes were used to describe population structure. From shotgun sequencing we assembled whole mitochondrial DNA genomes and estimated timing of intraspecific divergence. Our projections of ENMs suggest current possum populations were unlikely to have been in contact during the Pleistocene. Although lowered sea level during glacial periods enabled colonisation of Tasmania, climate fluctuation during this time would not have facilitated gene flow. The most recent common ancestor of sampled intraspecific diversity dates to the early Pliocene when continental aridification caused significant changes to Australian ecology and Trichosurus vulpecula distribution was likely fragmented. Phylogenetic analysis revealed that the subspecies T. v. hypoleucus (koomal; southwest), T. v. arnhemensis (langkurr; north) and T. v. vulpecula (bilda; southeast) correspond to distinct mitochondrial lineages. Despite little phenotypic differentiation, Trichosurus vulpecula populations probably experienced little gene flow with one another since the Pliocene, supporting the recognition of several subspecies and explaining their adaptations to the regional plant assemblages on which they feed.

Stimulating and harnessing circularly polarized luminescence (CPL) is not only a sine qua non for fundamentally unveiling chirogenesis in physical chemistry, and also a pivotal prerequisite for implementation of such phenomenon in area of chiral optoelectronics and theranostics. Herein, red-emissive carbonized polymer dots (CPDs)-based helical structures were synthesized in this work via biomolecule-tailored organic-inorganic co-assembly strategy. The surface states related chirality exhibited enhanced circular dichroism (CD) and CPL activities with anisotropic factors as high as gCD,max=5.4×10-3 and glum,max=1.5×10-2 respectively. The obtained CPL signals can be further manipulated with an excitation-dependent manner indicating a synergistic-competition phenomenon is existed between configurational chirality and intermolecular energy-transfer dynamics, which is further supported by simulations based on density function theory (DFT). Such tunable CPL behaviors triggers revolutionary designs and applications of these chiral CPDs into the realm of chirality-related biological issues and next generation chiral optoelectronics.

The 3-dimensional structure of habitats is a critical component of species' niches driving coexistence in species-rich ecosystems. However, its influence on structuring and partitioning recruitment niches has not been widely addressed. We developed a new method to combine Species Distribution Modeling and Structure from Motion and characterized three-dimensional recruitment niches of two ecosystem engineers on Caribbean coral reefs, scleractinian corals and gorgonians. Fine-scale roughness was the most important predictor of suitable habitat for both taxa, and their niches largely overlapped, primarily due to scleractinians broader niche breadth. Crevices and holes at mm-scales on calcareous rock with low coral cover were more suitable for octocorals than for scleractinian recruits, suggesting the decline of scleractinian corals is facilitating the recruitment of octocorals on contemporary Caribbean reefs. However, the relative abundances of the taxa were independent of the amount of suitable habitat on the reef, emphasizing niche-processes solely do not predict recruitment rates.

The protein secondary structure (SS) prediction plays an important role in the characterization of general protein structure and function. In recent years, a new generation of algorithms for SS prediction based on embeddings from protein language models (pLMs) is emerging. These algorithms reach state-of-the-art accuracy without the need for time-consuming multiple sequence alignment (MSA) calculations. LSTM-based SPOT-1D-LM and NetSurfP-3.0 are the latest examples of such predictors. We present the ProteinUnetLM model using a convolutional Attention U-Net architecture that provides prediction quality and inference times at least as good as the best LSTM-based models for 8-class SS prediction (SS8). Additionally, we address the issue of the heavily imbalanced nature of the SS8 problem by extending the loss function with the Matthews correlation coefficient (MCC), and by proper assessment using previously introduced adjusted geometric mean metric (AGM). ProteinUnetLM achieved better AGM and sequence overlap score (SOV) than LSTM-based predictors, especially for the rare structures 310-helix (G), beta-bridge (B), and high curvature loop (S). It is also competitive on challenging datasets without homologs, free-modeling targets, and chameleon sequences. Moreover, ProteinUnetLM outperformed its previous MSA-based version ProteinUnet2, and provided better AGM than AlphaFold2 for 1/3 of proteins from the CASP14 dataset, proving its potential for making a significant step forward in the domain. To facilitate the usage of our solution by protein scientists, we provide an easy-to-use web interface under [https://biolib.com/SUT/ProteinUnetLM/](https://biolib.com/SUT/ProteinUnetLM/).

Aim Several cases of ertapenem-related neurotoxicity has been published in the current literature. However, studies evaluating the ertapenem blood concentration as a risk of these adverse events are scarce. We aimed to evaluate the relationship between the ertapenem concentration and the risk of neurological toxicity. Methods Retrospective study, including patients who underwent ertapenem treatment between october 2019 and february 2021. We excluded critical patients and those whose blood sample were not properly took in order to analyze ertapenem trough concentration. We also excluded patients whose clinical follow-up was not properly realized for the entire period of ertapenem treatment. The main outcome was the presence of any suspicious neurological side effect owing to ertapenem administration and its relationship with the plasma concentration. Secondary outcomes were to identify other clinical and analytical data contributing to a higher risk of neurotoxicity. Results Cohort was initially composed by 158 individuals. For the final analysis we evaluated 102 patients, reporting a neurological alteration in 13/102 (12.7%). Mean ertapenem trough plasma concentration was significantly higher in patients showing neurotoxicity in comparison with those who did not (37.8 mcg ml-1 SD±35.7 vs 14.6 mcg ml-1 SD±15.2; p=0.002). In multivariable logistic regression analysis, ertapenem plasma concentration (OR= 1.07; p=0.006), a moderate renal insuficiency (OR= 9.2; p=0.02) and a history of previous neurologic disease (OR=9.9;p=0.02) were identified as risk factors of neurological alteration during ertapenem treatment. Conclusions Identifying properly patients who may accumulate the antibiotic by determining their plasma levels could be helpful to minimize the risk of neurotoxicity.

L-asparaginase (L-ASNase) is an essential component of chemotherapy schemes due to its differential action over normal and leukemic cells. Recently, concerns on the performance of commercial formulations administered in developing countries have been reported. To address this problem, we developed a cell-based protocol to compare the activity of different L-ASNase formulations used in Colombia. We found three statistically different groups, ranging from full to no activity on leukemic cells using 0.05, 0.5 and 5.0 IU/mL concentrations. According to our results, we advise a preclinical evaluation for formulations of L-ASNase distributed in developing countries which could impact the outcome of patients.

We consider the coupled propagation of an optical field and its second harmonic in a quadratic nonlinear medium governed by a coupled system of Schrodinger equations. We prove the existence of ring-profiled optical vortex solitons appearing as solutions to a constrained minimization problem and as solutions to a min-max problem. In the case of the constrained minimization problem solutions are shown to be positive but the wave propagation constants undetermined, but in the min-max approach the wave propagation constants can be prescribed. The quadratic nonlinearity introduces some interesting properties not commonly observed in other coupled systems in the context of nonlinear optics, such as the system not accepting any semi-trivial solutions, meaning, that optical solitons cannot be observed when, say, one of the beams are off. Additionally, the second harmonic always remains positive.

Background: In 2021–22, influenza A viruses dominated in Europe. The I-MOVE primary care network conducted a multicentre test-negative study to measure influenza vaccine effectiveness (VE). Methods: Primary care practitioners collected information on patients presenting with acute respiratory infection. Cases were influenza A(H3N2) or A(H1N1)pdm09 RT-PCR positive and controls were influenza virus negative. We calculated VE using logistic regression, adjusting for study site, age, sex, onset date, and presence of chronic conditions. Results: Between week 40 2021 and week 20 2022, we included over 11,000 patients of whom 253 and 1595 were positive for influenza A(H1N1)pdm09 and A(H3N2), respectively. Overall VE against influenza A(H1N1)pdm09 was 75% (95%CI: 43–89) and 81% (95%CI: 44–93) among those aged 15–64 years. Overall VE against influenza A(H3N2) was 29% (95%CI: 12–42) and 25% (95%CI: -41–61), 33% (95%CI: 14–49) and 26% (95% CI: -22 to 55) among those aged 0–14, 15–64 and over 65 years, respectively. The A(H3N2) VE among the influenza vaccination target group was 20% (95%CI: -6–39). All 53 sequenced A(H1N1)pdm09 viruses belonged to clade 6B.1A.5a.1. Among 410 sequenced influenza A(H3N2) viruses, all but 8 belonged to clade 3C.2a1b.2a.2. Discussion: Despite antigenic mismatch between vaccine and circulating strains for influenza A(H3N2) and A(H1N1)pdm09, 2021–22 VE estimates against circulating influenza A(H1N1)pdm09 were the highest within the I-MOVE network since the 2009 influenza pandemic. VE against A(H3N2) was lower than A(H1N1)pdm09, but at least one in five individuals vaccinated against influenza were protected against presentation to primary care with laboratory-confirmed influenza.

Is Esophageal Temperature Management Needed During Cryoballoon Ablation for Atrial Fibrillation?Bachir Lakkis MD, Marwan M. Refaat, MDDivision of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, LebanonRunning Title: Is Esophageal Temperature Management Needed During CBA for AF?Words: (excluding the title page and references): 462Keywords: Catheter Ablation, Atrial Fibrillation, Heart Diseases, Cardiovascular Diseases, Cardiac ArrhythmiasFunding: NoneDisclosures: NoneCorresponding Author:Marwan M. Refaat, MD, FACC, FAHA, FHRS, FASE, FESC, FACP, FAAMATenured Professor of MedicineDirector, Cardiovascular Fellowship ProgramDepartment of Internal Medicine, Cardiovascular Medicine/Cardiac ElectrophysiologyDepartment of Biochemistry and Molecular GeneticsAmerican University of Beirut Faculty of Medicine and Medical CenterPO Box 11-0236, Riad El-Solh 1107 2020- Beirut, LebanonUS Address: 3 Dag Hammarskjold Plaza, 8th Floor, New York, NY 10017, USAOffice: +961-1-350000/+961-1-374374 Extension 5353 or Extension 5366 (Direct)Atrial fibrillation (AF) is one of the most frequently occurring arrhythmias globally. Risk factors such as aging, hypertension, cardiac and pulmonary diseases, alcohol consumption, smoking, obesity and obstructive sleep apnea play an important role in the development of AF.(1-2) AF is a leading cause of ischemic stroke worldwide and is associated with increased mortality. (3) AF management depends on four pillars: risk factor management, anticoagulation depending on the CHA₂DS₂-VASc score, rate control and rhythm control. (4) The application of thermal energy in ablation, such as in cryoablation, can cause rare complications such as an esophageal injury, esophageal perforation and atrial-esophageal fistula. (5,6). Numerous technologies have been developed to avoid this problem and include esophageal temperature surveillance, using reduced temperatures, real time visualization of the esophagus in addition to making use of an esophageal cooling device. (7-9)In the current issue of the Journal of Cardiovascular Electrophysiology, Sink et al. have conducted a single-center pilot study to assess the utilization of an esophageal warming device to avoid the development of esophageal thermal injury (ETI) while utilizing cryoballoon ablation (CBA). Alternative studies have shown that using a cooling device has been beneficial in reducing the risk of ETI formation for patients undergoing RFA. (10,11) Thus, the authors have enrolled 42 patients undergoing CBA with AF refractory to medical therapy and have randomized them into 2 groups. In the first group, 23 patients undergoing CBA used an esophageal warming device such as esophageal heat-exchange tube (WRM) while the other 19 patients undergoing CBA used traditional luminal esophageal temperature (LET) to monitor the esophageal temperatures. The authors have conducted upper endoscopy monitoring of the esophagus the next day and subsequently, classified ETI into 4 grades. They have observed in the WRM group a paradoxical increase in ETI in comparison to the other group which used LET. Moreover, the authors have perceived a direct link between ETI formation, total freeze time and colder temperature usage. However, this study has several limitations, including the small population size. Furthermore, the study results are based on a single device employment which is EnsoETM® device (Attune Medical, Chicago, IL). Therefore, the effects of using other warming devices are not known.Overall, the authors should be praised on their efforts for conducting the first pilot study to evaluate the effects of using an esophageal warming device for patients undergoing CBA and for providing cardinal insight into the safety of utilizing such a device. In addition, the results of this study have tremendous clinical implications. Certainly, patients undergoing CBA might benefit from using higher temperature (above -51 °) and lower freezing time (<300 seconds) to avert developing ETI. Further studies incorporating more patients should be conducted to elucidate whether using an esophageal warming device is associated with a beneficial or a detrimental effect.References1. Kornej J, Börschel CS, Benjamin EJ, Schnabel RB. Epidemiology of Atrial Fibrillation in the 21st Century. Circulation Research. 2020;127(1):4-20. doi: doi:10.1161/CIRCRESAHA.120.316340.2. Maan A, Mansour M, Anter E, Patel VV, Cheng A, Refaat MM, Ruskin JN, Heist EK. Obstructive Sleep Apnea and Atrial Fibrillation: Pathophysiology and Implications for Treatment. Crit Pathw Cardiol Jun 2015; 14 (2): 81-5.3. Migdady I, Russman A, Buletko AB. Atrial Fibrillation and Ischemic Stroke: A Clinical Review. Semin Neurol. 2021;41(04):348-64.4. Chung MK, Refaat M, Shen WK, Kutyifa V, Cha YM, Di Biase L, Baranchuk A, Lampert R, Natale A, Fisher J, Lakkireddy DR. Atrial Fibrillation: JACC Council Perspectives. J Am Coll Cardiol. Apr 2020; 75 (14): 1689-1713.5. Kapur S, Barbhaiya C, Deneke T, Michaud GF. Esophageal Injury and Atrioesophageal Fistula Caused by Ablation for Atrial Fibrillation. Circulation. 2017;136(13):1247-55. doi: doi:10.1161/CIRCULATIONAHA.117.025827.6. D’Avila A, Ptaszek LM, Yu PB, Walker JD, Wright C, Noseworthy PA, Myers A, Refaat M, Ruskin JN: Left Atrial-Esophageal Fistula After Pulmonary Vein Isolation. Circulation May 2007; 115(17): e432-3.7. Dagres N, Anastasiou-Nana M. Prevention of atrial-esophageal fistula after catheter ablation of atrial fibrillation. Curr Opin Cardiol. 2011 Jan;26(1):1-5. doi: 10.1097/HCO.0b013e328341387d. PMID: 21099683.8. Leung LW, Gallagher MM, Santangeli P, Tschabrunn C, Guerra JM, Campos B, Hayat J, Atem F, Mickelsen S, Kulstad E. Esophageal cooling for protection during left atrial ablation: a systematic review and meta-analysis. J Interv Card Electrophysiol. 2020 Nov;59(2):347-355. doi: 10.1007/s10840-019-00661-5. Epub 2019 Nov 22. PMID: 31758504; PMCID: PMC7591442.9. Arruda, M.S., Armaganijian, L., Base, L.D., Rashidi, R. and Natale, A. (2009), Feasibility and Safety of Using an Esophageal Protective System to Eliminate Esophageal Thermal Injury: Implications on Atrial-Esophageal Fistula Following AF Ablation. Journal of Cardiovascular Electrophysiology, 20: 1272-1278. https://doi.org/10.1111/j.1540-8167.2009.01536.x10. Leung LW, Gallagher MM, Santangeli P, Tschabrunn C, Guerra JM, Campos B, Hayat J, Atem F, Mickelsen S, Kulstad E. Esophageal cooling for protection during left atrial ablation: a systematic review and meta-analysis. J Interv Card Electrophysiol. 2020 Nov;59(2):347-355. doi: 10.1007/s10840-019-00661-5. Epub 2019 Nov 22. PMID: 31758504; PMCID: PMC7591442.11. Tschabrunn CM, Attalla S, Salas J, Frankel DS, Hyman MC, Simon E, Sharkoski T, Callans DJ, Supple GE, Nazarian S, Lin D, Schaller RD, Dixit S, Marchlinski FE, Santangeli P. Active esophageal cooling for the prevention of thermal injury during atrial fibrillation ablation: a randomized controlled pilot study. J Interv Card Electrophysiol. 2022 Jan;63(1):197-205. doi: 10.1007/s10840-021-00960-w. Epub 2021 Feb 23. PMID: 33620619.

In this paper, the leader-follower architecture is constructed by combining intermittent-influence leaders with a signed social network. Unlike a typical network with leaders where leaders are supposed to continuously influence followers, in this article, the leaders intermittently influence followers. Furthermore, the number of influences is limited. We focus on how intermittent-influence leaders impact the evolution of followers' opinions. The relationship between followers' opinions and the number of leader broadcasts is analyzed in detail. Then, the number of broadcasts is regarded as the cost, and the changing trend of the revenue per broadcast is obtained. The results show that as the number of broadcasts increases, the revenue per broadcast decreases gradually. Finally, the concept of assimilation is introduced to weigh the costs and benefits, and the minimum number of broadcasts required for the leader to assimilate the followers is derived. Two examples are given to demonstrate the validity of the main conclusions.

Oxidative polymerization of plant oils and lipids is poorly understood yet widely encountered. Oil oxidation is accelerated at high temperatures, typically above 110°C, where tri-acylglycerides are converted into toxic compounds and viscous deleterious polymers. Polymerization of mono-unsaturated oil (210°C, 3h, open to air) was investigated by comparing four similar sized molecules with different functional groups: oleic acid, methyl oleate, trans-7-tetradecene and stearic acid. Non-volatile products identified by NMR spectroscopy are minor ketones for saturated fatty acid (stearic acid), epoxides for acyl chains without acid groups (methyl oleate, tetradecane) and copious oligomerization, through ester cross-links, for acyl chains with acid and olefinic groups (oleic acid). Long range C-H coupling clearly shows ester (not ether) cross-links, contradicting long held beliefs. Chain fragmentation also occurs as revealed by species with methylene groups bonded to oxygen, -CH2-O-C(=O)-R. Large size (slow diffusion) of the first oligomer (trimer) formed by thermal oxidation of oleic acid, (representing hydrolyzed vegetable oil) was evidenced by DOSY (diffusion ordered spectroscopy). Since the first oligomers formed still have reactive groups (olefin, carboxylic acid), poly-ester formation is inevitable at longer oxidation times. Model oil reactions monitored by NMR spectroscopy are important for resolving the complex chemistry of vegetable oil polymerization.

An individual’s fitness cost associated with environmental change likely depends on the rate of adaptive phenotypic plasticity, and yet our understanding of plasticity rates in an ecological and evolutionary context remains limited. We provide the first quantitative synthesis of existing plasticity rate data, focusing on acclimation of temperature tolerance in ectothermic animals, where we demonstrate applicability of a recently proposed analytical approach. The analyses reveal considerable variation in plasticity rates of this trait among species, with half-times (how long it takes for the initial deviation from the acclimated phenotype to be reduced by 50% when individuals are shifted to a new environment) ranging from 3.7 to 770.2 h. Furthermore, rates differ among higher taxa, being higher for amphibians and reptiles than for crustaceans and fishes, and with insects being intermediate. We argue that a more comprehensive understanding of phenotypic plasticity will be attained through increased focus on the rate parameter.

A novel capacitor voltage-reduced bidirectional (CVRB) PWM DC-DC buck-boost converter is presented in this study. Compared to the conventional bidirectional buck-boost converter, the proposed converter has a lower voltage rating filter capacitor. Accordingly, the given converter has a lower cost and 3.3% higher power density than the conventional buck-boost converter. Additionally, the proposed converter is more efficient due to the direct power transfer feature. Besides, the semiconductor switches have no extra voltage/current stress. The theoretical analysis of the converter is made, and its mathematical analysis is presented. The novel converter is experimentally operated in both the buck and boost modes. The experimental waveforms are shown for both operations. The proposed converter is operated in 100 W output power and 20 kHz switching frequency conditions.

A 55-year-old female patient presented with generalized tonic-clonic seizures. Laboratory evaluation showe low calcium (4.9 mg/dL), low PTH (0.9 pg/mL), & positive activating CaSR antibodies. The condition was diagnosed as autoimmune hypoparathyroidism. Vitamin supplements did not correct the patient’s hypocalcemia and steroids were added to the treatment.

Quantifying space use and segregation, as well as the extrinsic and intrinsic factors affecting them, is crucial to increase our knowledge of species-specific movement ecology and to design effective management and conservation measures. This is particularly relevant in the case of species that are highly mobile and dependent on sparse and unpredictable trophic resources, such as vultures. Here, we used the GPS-tagged data of 127 adult Griffon Vultures Gyps fulvus captured at five different breeding regions in Spain to describe the movement patterns (home-range size and fidelity, and monthly cumulative distance). We also examined how individual sex, season and breeding region determined the cumulative distance travelled and the size and overlap between consecutive monthly home-ranges. Overall, Griffon Vultures exhibited very large annual home-range sizes of 5,027 ± 2,123 km2, mean monthly cumulative distances of 1,776 ± 1,497 km, and showed a monthly home-range fidelity of 67.8 ± 25.5 %. However, individuals from northern breeding regions showed smaller home-ranges and travelled shorter monthly distances than those from southern ones. In all cases, home-ranges were larger in spring and summer than in winter and autumn. Moreover, females showed larger home-ranges and less monthly fidelity than males, indicating that the latter tended to use the similar areas throughout the year. Overall, our results indicate that both extrinsic and intrinsic factors modulate the home-range the social Griffon Vulture and that spatial segregation depend on sex and season at the individual level, without relevant differences between breeding regions in individual site fidelity.

Monoclonal antibodies (mAbs) targeting disialoganglioside 2 (GD2) are an important treatment advance for high-risk neuroblastoma, including in patients with refractory or relapsed disease. Dinutuximab and dinutuximab beta are administered for ≥8 hours (and up to 10 days for dinutuximab beta), whereas naxitamab is administered over 0.5 to 2 hours as tolerated. As acute pain is a class effect of anti-GD2 mAbs, effective pain management is crucial to successful treatment. Here, we provide an overview of current pain-management strategies for anti-GD2 mAb infusions, including discussion of opioid analgesics, ketamine, gabapentin, and other similar agents, and non-pharmacologic approaches. Potential future pain management options are also discussed, in addition to the use of sedatives to reduce the anxiety that may be associated with infusion-related pain. Specific guidance for pain management during naxitamab infusions is provided, as these infusions are administered over 0.5 to 2 hours and may not need overnight hospitalization based on the physician’s assessment, and require rapid-onset analgesia options suitable for potential outpatient administration.

Catheter ablation has become the standard of care for the management of antiarrhythmic drug-refractory atrial fibrillation (AF) in many patients. The cornerstone of AF ablation includes pulmonary vein isolation (PVI) and energy delivery can sometimes extend beyond the atrial myocardium and result in collateral damage to adjacent structures, include the esophagus.[1] While atrial esophageal fistula (AEF) is a generally a rare complication, there have been continued efforts aimed to reduce esophageal thermal injury during AF ablation. While emerging energy sources such as irreversible electroporation show exciting promise for selective, non-thermal targeting of myocardial tissue, safety and efficacy clinical trial evaluation is on-going.[2] Therefore, strategies that can prevent esophageal thermal injury without adversely impacting lesion formation using conventional ablation technologies are still needed.

Objective: SARS-COV-2 pandemic had a profound impact on acute bronchiolitis epidemiology, especially in RSV diffusion and the burden of disease with implications on the management of prophylaxis and health resources. We aimed to compare clinical and epidemiological characteristics of bronchiolitis before and during the SARS-CoV-2 pandemic.   Methods: We conducted an observational study involving children aged 0-2 years with bronchiolitis admitted to a tertiary children’s hospital during the last 5 years. Demographic, clinical, microbiological, and outcome data were collected. Comparison between pre- and post-pandemic period, RSV positive versus non-RSV patients, and SARS-CoV-2 positive vs negative patients were carried out.    Results: A total of 647 patients admitted for bronchiolitis were included (264 female,40.8%, median age 78 days). Molecular diagnostic tests were performed in 617 patients (95.4%) with RSV detected in 62.5% of patients. SARS-CoV-2 was found in 3.9% of hospitalized bronchiolitis (3.9%). We observed a progressive increase in bronchiolitis admissions and a statistically significant increase over the years in the need for respiratory support. Conversely, this was not true for mechanical ventilation, duration of respiratory support, ICU admission, and length of stay. During the pandemic period children with prematurity increased, although only 1 child had an indication for prophylaxis. Discussion: We confirm the stronger impact of bronchiolitis in the 2021-22 season, which is likely explained by the higher prevalence of RSV and the immunity debt theory. However, our findings were conflicting in terms of worsening clinical severity. The increase of children with prematurity and the inter-seasonal spread of RSV highlight the importance of epidemiological surveillance systems that monitor RSV circulation.