Osteoporosis and asthma are prevalent chronic conditions that significantly impact public health. Inflammatory cell merging, leading to reduced bone density, increases the risk of fractures, while asthma is a chronic respiratory disease characterized by airway inflammation and bronchoconstriction. More and more emerging research suggests a potential connection through shared pathways and biological mechanisms. In this study, we aim to investigate the causal effect of anti-osteoporosis drug treatment on chronic disease asthma through the Mendelian randomization (MR) analysis method.

In our study, we employed a two-stage study design, utilizing observational data from the National Health and Nutrition Examination Survey (NHANES) and summary statistics data from genome-wide association studies (GWAS) with a large sample of European adults. Section-cross research was performed using NHANES datasets and analysis of the risk of asthma with bone mineral density (BMD) through a risk proportion regression model. After that, a two-sample MR analysis was performed to investigate the causal effect of anti-osteoporosis drug therapy on asthma. Finally, sensitivity analysis was conducted to evaluate the stability of the results.

Our study revealed a non-linear association between femur BMD and asthma risk, with a critical inflection point at a BMD value of 1.114 g/cm². MR analysis indicated that denosumab did not exert a causal effect on asthma risk (OR = 1.008, 95% CI: 0.994-1.022, P = 0.285) but was associated with improved lung function (β = 0.085, 95% CI: 0.006-0.164, P = 0.035). Conversely, calcitriol exhibited a protective effect against both asthma (OR = 0.931, 95% CI: 0.894-0.969, P < 0.001) and lung function decline (β = 0.294, 95% CI: 0.062-0.525, P = 0.013). These findings suggest a pleiotropic role for these anti-osteoporosis drugs in respiratory health.

This study provides novel insights into the complex relationships between osteoporosis treatments, bone health, and asthma risk. The use of MR analysis enhances the reliability of our findings and highlights the potential benefits of osteoporosis treatments in reducing asthma risk and improving lung function. These results call for further research and may have implications for developing integrated treatment approaches for individuals managing osteoporosis and asthma.

This bidirectional cohort study included 452 patients with pneumonia (modeling cohort) from the Department of Respiratory and Critical Care Medicine at Jinan People's Hospital retrospectively enrolled between January 2021 and December 2023, and 300 patients with newly diagnosed pneumonia (validation cohort) prospectively recruited from January to December 2024. The least absolute shrinkage and selection operator regression (10-fold cross-validation, λ=0.023) was initially applied for dimensionality reduction. Subsequently, Firth-penalized logistic regression was used to construct the predictive model, followed by the development of a P-Sep scoring system. The system was validated using the bootstrap method (500 resamples) and an independent prospective cohort. Multivariate analysis identified four independent predictors of interest: invasive mechanical ventilation (OR=5.12, 95%CI 3.05-8.61); positive blood culture (OR=4.23, 95%CI 2.38-7.51); lactate ≥ 2 mmol/L (OR=3.15, 95%CI 1.92-5.18); and serum amyloid A ≥100 mg/L (OR=2.58, 95%CI 1.52-4.39). The investigators established that the P-Sep score (0-12 points) was an independent predictor denoting low risk (0-5 points), intermediate risk (6-8 points), and high risk (≥9 points). In the modeling cohort, the area under the curve was 0.87 (95%CI 0.83-0.91; sensitivity: 85.2%; specificity: 89.3%). In the validation cohort, the area under the curve was 0.86 (95%CI 0.82-0.89; sensitivity: 84.8%; specificity: 89.1%). In addition, based on data from both cohorts, the predictive performance of the P-Sep score was compared with that of the Quick Sequential Organ Failure Assessment and CURB-65. The results demonstrated that the P-Sep score exhibited favorable predictive efficacy in the warning of secondary sepsis in patients with pneumonia.

Objective: To investigate the clinicopathological features, diagnosis, and prognosis of Erdheim-Chester disease. Methods: The clinical and imaging data of 16 patients with Erdheim-Chester disease diagnosed in the Department of Pathology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China from August 2002 to July 2025 were retrospectively analyzed. A comprehensive evaluation was conducted on histopathology, immunophenotype, molecular characteristics, clinical treatment and follow-up outcomes, supplemented by a review of relevant literature. Results: There were 16 patients with Erdheim-Chester disease, including 7 males and 9 females. The age at onset ranged from 38 to 70 years, with an average age of 48.0 (43.5, 54.5) years. Two of the 16 cases were complicated by Langerhans cell histiocytosis. Isolated skeletal involvement was observed in 5 cases (most commonly affecting the long bones of the lower extremities), while skeletal involvement with extra-skeletal systemic manifestations (including pulmonary, pituitary, urinary system, pericardial, and aortic involvements) was identified in 11 cases. The characteristic imaging presentation consisted of bilateral symmetric, multifocal diffuse osteosclerosis predominantly involving the diaphyses and metaphyses of long bones. Bone scintigraphy revealed symmetrically increased radiotracer uptake. Magnetic resonance imaging showed hypointense signals on T1-weighted images and heterogeneously hyperintense signals on T2-weighted images, with significant enhancement observed after contrast administration. Histopathological examination revealed osteosclerosis accompanied by infiltration of abundant lipid-laden foamy histiocytes or small mononuclear histiocytes within the intertrabecular spaces. These cells exhibited uniformly eosinophilic, pale pink-stained cytoplasm and round to oval nuclei with inconspicuous nucleoli. The lesion was also characterized by variable numbers of Touton giant cells and varying degree of fibrosis. Immunohistochemical analyses demonstrated the expression of CD68, CD163, and PGM1, but no expression of S-100 or Langerin. BRAF V600E gene mutation was detected in five cases. Clinical management regimens encompassed curettage of intraosseous lesions, potentially combined with adjuvant therapies such as hormonal agents, chemotherapy, interferon-alpha, or BRAF V600E inhibitors. At the end of follow-up (ranging from 2 to 18 years), seven patients died of the disease, six survived with it, and three remained disease-free. Conclusions: Erdheim-Chester disease is a rare condition characterized predominantly by multifocal and symmetrical involvement of long bones, with the majority of patients presenting with systemic manifestations. Pathological examination combined with imaging studies aids in distinguishing it from inflammatory disorders and other histiocytic proliferative lesions. The overall prognosis is poor, especially in cases involving multiple bones and systemic involvement.

Sinonasal symptoms occur in up to 80% of patients with granulomatosis with polyangiitis (GPA), affecting quality of life. This study aimed to evaluate the association between self-perceived sinonasal symptoms (SNOT-22 questionnaire), and clinical variables, and to describe discrepancies between self-reported symptoms, ENT findings, and radiographic abnormalities.

A cross-sectional study was conducted at a tertiary center in Mexico City (November 2024-July 2025). Patients with GPA and a paranasal sinus CT scan within two years were included. Data collection comprised demographic, clinical, laboratory, and treatment variables. Assessments included disease activity (BVAS/GPA), cumulative damage (VDI), patient and physician global assessments (PhGA and PtGA), and PROMs (SNOT-22, AAV-PRO). All patients underwent ENT examination with nasal endoscopy.

Fifty patients were included, 64% women, median age 49.5 years, and disease duration 88.5 months. Most were in remission (median BVAS/GPA 0). The median VDI was 3, PtGA 10.7mm, and PhGA 1.8mm. The median SNOT-22 score was 30.5. Common ENT findings were rhinorrhea (64%), hypertrophic turbinates or hyperemic mucosa (36%), nasal crusts (34%), and septal perforation (20%). CT abnormalities included chronic sinusitis (46%) and sinus destruction (32%). Self-reported symptoms showed moderate-to-strong correlations with AAV-PRO domains and global assessments, but no associations with disease activity, damage, or treatment. Discrepancies were observed between SNOT-22 items and ENT or CT findings.

Self-reported sinonasal symptoms correlated with PROMs, whereas associations with disease activity or damage were not evident in this cohort. Discrepancies highlight the need for GPA-specific studies integrating PROMs, standardized ENT assessments, and imaging.

This study aimed to co-design a tailored model of care for older people with long COVID.

Using a human-centred design approach, semistructured interviews were conducted with patients and health professionals from a long COVID service to explore their experiences. Insights were further developed during a co-design workshop involving patients, health professionals and community members who identified as older people and who had experience with chronic illness. Key themes were identified and used to map an ideal patient journey and inform the final model of care.

Long COVID outpatient service in a tertiary hospital in Adelaide, South Australia.

Four patients and four health professionals participated in the interviews. The workshop included four patients, five health professionals and seven community members.

The co-design process identified challenges experienced by people with long COVID, including lack of validation, delayed multidisciplinary care, mental health deterioration and difficulties navigating the healthcare system. These challenges were described as having particular relevance for older adults. In response, a model of care was developed focused on comprehensive assessment, coordinated multidisciplinary care, education for self-management, mental health support and opportunities for research participation.

A comprehensive and adaptable model of care is needed to address the complex and multifaceted nature of long COVID. This human-centred design approach ensured the model was grounded in lived experience, clinically informed and aligned with patient priorities. While not unique to older adults, the findings highlight areas that may require particular attention in this population, including care coordination, validation and support for comorbidities and social vulnerabilities. While developed in a single tertiary service, these principles may inform the design of services for similar populations in other healthcare settings.

Multidrug-resistant tuberculosis (MDR-TB) is a constraining challenge for tuberculosis (TB) control worldwide. The Middle East and North African (MENA) region represents a significant part of the global MDR-TB burden.

To estimate the pooled prevalence of MDR-TB and its determinants in the MENA region.

We searched for studies published in English and French on the subject up to 31 January 2026 on Web of Science, PubMed, Scopus and Cochrane, without time restriction. Original studies reporting data on the prevalence of MDR-TB in individuals living in the MENA region were selected. The meta-analysis was done using the random effects model considering the heterogeneity among the included studies and I ² statistic was used to assess the heterogeneity.

A total of 1239 articles were identified and 25 studies from 6 countries were included in this review. The prevalence of MDR-TB in the MENA region ranged from 0% (95% CI 0% to 4.1%) to 17.1% (95% CI 10.6% to 25.4%). The pooled prevalence was 3.54% (95% CI 2.18% to 5.72%) with a high heterogeneity, I² =95.6%; 95% CI 94.4% to 96.5%. Previous exposition to TB treatment, HIV infection, smoking and the presence of comorbidities were the most reported associated factors.

This review underscores the persistence of MDR-TB in the MENA region, suggesting insufficiency in TB control. Multisectoral interventions integrating strong prevention measures, standardised treatment protocols and measures to enhance treatment adherence should be implemented.

This report details a man in his late 60s who presented with a new right-sided pneumothorax against the background of advanced COPD and a known large apical bulla. Multiple chest drains were inserted to manage the pneumothorax but the patient developed extensive surgical emphysema causing significant distress. Reported here is the management of the extensive surgical emphysema and techniques used to insert a subcutaneous drain and incisional negative pressure wound therapy, ultimately with positive results. This report will briefly explore other techniques to manage subcutaneous emphysema, with the focus then on how negative pressure wound therapy can be implemented and benefit patients who are too frail/comorbid for further invasive interventions.

Obstructive sleep apnea (OSA) affects nearly one billion people globally and poses a substantial public health threat. Effective and accessible methods for OSA risk identification are urgently needed.

This study aims to develop and externally validate a machine learning model derived from multi-parameter pulse oximetry (SpO₂) for OSA screening, and to evaluate its performance, interpretability, and robustness across sex and age subgroups.

Of 4156 screened participants, 2195 underwent polysomnography (internal cohort) and 446 received home sleep apnea testing (external cohort). Eight SpO₂-derived parameters, including oxygen desaturation index (ODI), hypoxic burden (HB), and ST90 (percentage of sleep time with SpO₂ < 90%), were used to construct models. Six machine learning algorithms were trained, with F₁-score as the primary metric and area under the curve as the secondary metric. Model interpretability was assessed using Shapley additive explanations and intrinsic feature importance scores.

Nonlinear parameter-risk relationships were observed between oximetry indices and OSA probability. The 4-parameter ODI-HB-MinSpO₂-ST90 model achieved optimal performance (F₁-score = 0.9516, area under the curve = 0.9879), surpassing all single-parameter models. Shapley additive explanations analysis identified ODI, HB, and MinSpO₂ as key predictors. The ODI-HB-MinSpO₂-MeanSpO₂ configuration demonstrated superior performance in female and younger subgroups, whereas the ODI-HB-MinSpO₂-ST90 model remained optimal for male and older participants. Categorical boosting outperformed other algorithms across multiple metrics and remained robust in both subgroup and external validation analyses.

The multi-parameter oximetry model based on the categorical boosting algorithm provides a simple and accurate tool for OSA screening. Sex- and age-stratified strategies can further enhance its clinical applicability.

Uncertainty about the prior health status of those dying during the pandemic has fuelled debate about its impact. To date, attempts to quantify life years lost during the pandemic have relied on using life tables without taking into account varying levels of vulnerability among those that died.

Using retrospective, linked data from March 2020 to September 2022 for the cohort of all individuals in England alive at outset, we quantified the risk of death, associated with a wide variety of comorbidities, using primary care and hospital data, as well as evidence of vaccination and COVID-19 infection. We then simulated the survival of every individual in the population with a positive COVID-19 test, with and without the assumption that COVID-19 affected their survival, taking account of their personal vulnerability. We used the difference between these simulated survival times to estimate mortality displacement (how long those who died would have lived, had they not tested positive). We used the displacement estimates for those aged 65 and older to revise estimates of excess deaths.

We estimated median mortality displacement of 4.8 (IQR = 1.5 to 16) years for females and 4.4 (IQR = 1.4 to 12.6) years for males at ages 65 and over. We estimate 28% of those dying with COVID-19 aged 65 and over would have survived five years or more without the infection (66% for females aged 65-74).

Life expectancy of those who died with COVID-19 was substantial and, based on our analysis of vulnerability, most of those who died at ages 65 and over are unlikely to have been close to death. In future pandemics, real-time modelling of displacement would be helpful in assessing the mortality impact of the pandemic.

The prevalence of post-COVID-19 symptoms has been reported to decline since the Omicron variant became predominant. However, differences in their long-term course across epidemic periods and between adults and children, including recent Omicron sublineages, remain insufficiently understood.

We extended a previously reported retrospective cohort by conducting follow-up and an additional survey in Hiroshima, Japan. The study included 2,689 individuals diagnosed with COVID-19 between March 2020 and June 2024 (1,524 adults and 1,165 children). A self-administered questionnaire captured the presence and duration of 13 symptoms. Interval-censored survival analysis estimated prevalence over time, and proportional hazards models evaluated factors associated with symptom resolution.

At six months, the estimated prevalence in adults was highest during the Delta period (47%) and lower during Omicron-2022 (23%) and Omicron-2024 (21%). In children, prevalence remained about one-quarter to one-third that of adults, with no notable differences between Omicron sublineages. At two years, persistent symptoms were reported by about 20% of adults infected before Omicron and 10% during Omicron periods, compared with 4.1% and 1.9% of children infected during the Delta and Omicron-2022 periods. Symptoms persisting beyond two years showed little further resolution, though in children they did not interfere with daily activities. In the Cox model, resolution was slower during the Delta period (HR 0.79) and faster during Omicron-2022 (HR 1.24) and Omicron-2024 (HR 1.30). Younger age, particularly ≤12 years, was strongly associated with faster recovery.

The long-term course of post-COVID-19 symptoms differed across epidemic periods and age groups. The risk was highest during Delta and lower among children and those infected during Omicron waves, yet some individuals experienced symptoms for over two years. Long-term follow-up and social support remain crucial to mitigate the burden of post-COVID-19 condition.