Polycystic ovarian syndrome (PCOS) is a prevalent metabolic and neuroendocrine disease affecting females of childbearing age. Irregular ovulation, elevated androgen levels, and the presence of multiple ovarian cysts characterize it. This study aimed to investigate the prolonged impact of RA on female fertility during three oestrus cycles, utilizing biochemical, histopathological, and immunohistochemical analyses. Twelve female mice were classified into two groups of 6 animals each: (1) the negative control group that received DMSO diluted with sunflower oil, and (2) the positive control group that received a 10 mg/kg dose of retinoic acid. For 15 days, intraperitoneal injections were given daily. The animals were physically euthanized by slaughter on day 16 after treatment. Histopathological and immunohistochemical expression of EGFR, as well as hormonal level investigations, including FSH and LH, were performed on day 16. A 10 mg/kg RA daily dose for 15 days significantly induces FSH and reduces LH. In addition, we revealed that exogenous excess RA leads to PCOS, which causes an increase in cystic follicles and a reduction in antral follicles and corpus luteum. Immunohistochemically, excessive RA suppresses the expression of EGFR, which is localized in granulosa cells. Our investigation concluded that inhibition of epidermal growth factor receptor (EGFR) signaling resulting from long-term high-dose treatment with retinoic acid (RA) affects cumulus granulosa cell proliferation and oocyte maturation. So, vitamin A may harm female fertility.

A‑Raf is a serine/threonine protein kinase that belongs to the RAF kinase family. A‑Raf serves key roles in various physiological and pathological processes, including cell cycle regulation, apoptosis, material transport and metabolism, embryonic development, bone mass maintenance and tumor progression. As research has advanced, the functional mechanisms of the A‑Raf gene have attracted increasing attention. To systematically summarize its biological functions, the present review focuses on the effects of A‑Raf on the cell cycle, apoptosis and cell proliferation, its influence on cellular material transport and metabolic processes, its role in organismal development and bone mass maintenance, its impact on tumor progression, the effects of genetic variations on A‑Raf function and the regulation of A‑Raf by upstream factors. The present review therefore aimed to provide a novel perspective for the comprehensive understanding of the function of A‑Raf.

PANoptosis is a novel and unique form of programmed cell death associated with innate immune responses, which is primarily regulated by the aggregation and activation of the PANoptosome, and exhibits characteristics of apoptosis, pyroptosis and necroptosis. Therefore, the PANoptosome complex has become a key target for preventing this type of cell death. PANoptosis is considered to have a role in infectious diseases and cancer; however, to the best of our knowledge, its role in gastric mucosal diseases has not been comprehensively explored. With the advancement of research on the mechanisms underlying gastric mucosal diseases, a shared regulation and crosstalk among pyroptosis, apoptosis and necroptosis has been suggested to exist during the development and progression of these diseases. The present review briefly introduces the relevant mechanisms and features of PANoptosis, with a focus on its role in gastric mucosal diseases (such as acute gastric mucosal injury, infectious gastritis, autoimmune gastritis, spasmolytic polypeptide‑expressing metaplasia, gastric cancer and gastric‑associated lymphomas), with the aim of providing additional targets for the treatment of gastric mucosal diseases.

Obstructive sleep apnea (OSA) and sarcopenia are highly prevalent in aging adults, both contributing to morbidity and diminished quality of life. Despite plausible biological connections through sleep fragmentation, hormonal dysregulation, and chronic inflammation, their clinical relationship remains poorly understood.

This narrative review synthesizes current evidence on pathophysiological links between these conditions.

Population studies consistently demonstrate increased sarcopenia risk in patients with OSA, with NHANES data showing 12% versus 5.5% prevalence. Recent Mendelian randomization studies provide genetic instrumental variable evidence supporting bidirectional causal relationships. Key mechanisms include sleep fragmentation disrupting growth hormone release, chronic inflammation promoting muscle catabolism, and respiratory muscle dysfunction creating vicious cycles. Population variability, comorbidities such as chronic obstructive pulmonary disease (COPD), and lifestyle factors including smoking further shape this relationship. Limited evidence suggests CPAP therapy may partially reverse these effects.

Clinical practice should consider routine sarcopenia screening in patients with OSA and sleep assessment in sarcopenic individuals.

Post-intensive care syndrome includes physical, cognitive and psychological impairments that may persist after discharge from the intensive care unit (ICU), with anxiety and depression among the most commonly reported symptoms. Evidence on these symptoms beyond the first year after discharge remains limited, particularly in patients admitted for COVID-19.

To determine the prevalence and characteristics of anxiety and depression symptoms among patients previously admitted to the ICU for COVID-19 within three years after discharge, and to examine differences according to sociodemographic and clinical variables.

A multicentre, descriptive cross-sectional study was conducted among ICU survivors in Spain using clinical records and structured telephone interviews. Sociodemographic, clinical and patient-reported outcomes were obtained. The Hospital Anxiety and Depression Scale (HADS) was used to assess symptoms of anxiety (HADS-A) and depression (HADS-D).

A total of 106 participants were included. Mean anxiety (HADS-A) and depression (HADS-D) scores were 6.5 (SD ±3.9) and 6.7 (SD ±3.8), respectively. Female sex was linked to higher anxiety (β = 1.73; 95% CI, 0.32-3.13; p = 0.016), while memory problems were associated with higher anxiety (β = 1.49; 95% CI, 0.14-2.83; p = 0.031) and depression (β = 1.65; 95% CI, 0.43-2.86; p = 0.009). Depression was also higher in participants with greater pain (β = 0.50; 95% CI, 0.15-0.84; p = 0.006). Higher quality of life (β = -0.07; 95% CI, -0.11 to -0.03; p < 0.001) was associated with lower depression scores.

Anxiety and depression were common among individuals with a history of ICU admission due to COVID-19 up to three years after discharge. Psychological symptoms should be considered alongside physical and cognitive aspects.

Incorporating psychological assessment into the long-term follow-up may facilitate identifying individuals who may benefit from further support.

Long COVID is an umbrella term for persistent, relapsing, or newly developed health problems after SARS-CoV-2 infection, whereas post-COVID-19 condition (PCC) refers more specifically to the World Health Organization clinical case definition. Reported prevalence varies substantially because of differences in terminology, operational definitions, study populations, follow-up duration, hospitalization status, and symptom ascertainment. This systematic review and meta-analysis synthesized global observational evidence on Long COVID/PCC prevalence and examined major sources of variability.

A systematic review and meta-analysis was conducted according to PRISMA 2020 principles. PubMed/MEDLINE, Scopus, Web of Science, and the WHO COVID-19 Global Literature Database were searched for studies published from 1 January 2020 to 23 February 2026. Observational studies were eligible if they included individuals with confirmed or probable SARS-CoV-2 infection, reported Long COVID/PCC or persistent post-COVID symptoms at least 4 weeks after acute infection, and provided numerator and denominator data. Terminology and operational case definitions were extracted separately. Prevalence estimates were pooled using a random-effects model with logit transformation and back-transformation. Heterogeneity was assessed using Cochran's Q, I², tau², and prediction intervals. Subgroup and sensitivity analyses were performed.

Twenty-two studies contributing 27 prevalence estimates and more than 200,000 participants were included. The primary estimate-level pooled prevalence was 30.8% (95% CI 26.8-35.0). Heterogeneity was extreme: Q = 8031.9, df = 26, p < 0.001; I² = 99.7%; tau² = 0.252 on the logit scale. The prediction interval was 14.0-54.8%. Pooled prevalence was higher among hospitalized cohorts (37.9%, 95% CI 29.5-47.1) than among non-hospitalized, community-based, or mixed cohorts (26.2%, 95% CI 22.0-30.9). WHO-defined PCC yielded lower prevalence (22.8%, 95% CI 14.3-34.4) than broader symptom-based definitions (39.7%, 95% CI 30.5-49.5). Cohort-level sensitivity analysis yielded a similar prevalence of 31.0% (95% CI 26.8-35.4).

Long COVID/PCC represents a substantial post-acute public health burden. However, because heterogeneity was extreme, the pooled prevalence should be interpreted as a descriptive summary of heterogeneous observational evidence rather than as a single precise global rate. Standardized definitions, harmonized surveillance, transparent reporting, rehabilitation pathways, and multidisciplinary care models are needed.

To explore the impact of early enteral nutrition (EN) on clinical prognosis in patients with severe pneumonia via propensity score matching (PSM).

This retrospective cohort study enrolled patients diagnosed with severe pneumonia who received EN treatment in the Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Southwest Medical University, from January 2023 to March 2025. All participants were categorized into the ≤24-hour EN group and the >24-hour EN group based on the timing of EN initiation. PSM was performed to balance baseline characteristics between the two groups. Collected clinical variables included baseline demographic and clinical characteristics, nutritional status indicators [albumin (Alb), prealbumin (PA)], inflammatory markers [C-reactive protein (CRP)], incidence of gastrointestinal complications, pulmonary oxygenation parameters [arterial oxygen saturation (SaO₂), oxygenation index (PaO₂/FiO₂), arterial partial pressure of carbon dioxide (PaCO₂)], body temperature, and Barthel index score. Prognostic outcomes, including mechanical ventilation duration, respiratory intensive care unit (RICU) stay length, total hospital stay, hospitalization costs, and in-hospital mortality, were further compared between the two matched groups.

A total of 237 patients with severe pneumonia who received EN therapy were initially included in this study. After PSM, 203 patients were finally enrolled, including 86 patients in the ≤24-hour EN group and 117 patients in the >24-hour EN group. No significant differences were observed in baseline characteristics between the two matched groups, with all standardized mean differences (SMDs) of covariates less than 0.2. At admission, there were no statistically significant intergroup differences in Alb, PA, CRP, SaO₂, PaO₂/FiO₂, PaCO₂, body temperature, Barthel index score, overall incidence of gastrointestinal complications, hospitalization costs, or in-hospital mortality. Prior to discharge, no significant differences were found in Alb, PA, SaO₂, PaO₂/FiO₂, PaCO₂, body temperature, and Barthel index score between the two groups. However, patients in the ≤24-hour EN group exhibited a significantly lower discharge CRP level [mg/L: 26.74 (9.55, 68.28) vs. 42.56 (13.99, 92.20)], as well as shorter duration of mechanical ventilation [hours: 5 (2, 9) vs. 7 (3, 14)], RICU stay [days: 7 (3, 12) vs. 11 (5, 17)], and total hospital stay [days: 13 (8, 21) vs. 17 (10, 27)], all P<0.05.

Initiation of enteral nutrition within 24 hours after admission is associated with lower inflammatory levels and shorter duration of mechanical ventilation, RICU stay, and total hospital length of stay, which can effectively alleviate inflammation and improve clinical prognosis in patients with severe pneumonia.

To investigate whether the addition of external diaphragmatic pacing (EDP) to standard therapy can effectively improve diaphragmatic dysfunction in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) requiring invasive mechanical ventilation, and increase the likelihood of successful weaning.

A prospective randomized controlled trial (RCT) was conducted. A total of 174 patients with AECOPD undergoing invasive mechanical ventilation who were admitted to the Department of Critical Care Medicine of Hengshui People's Hospital from November 1, 2022 to January 31, 2025 were enrolled. Patients were divided into a control group and an EDP group using a block randomization method, with 87 patients in each group. The control group received conventional therapy; the EDP group received conventional treatment combined with EDP. Baseline characteristics, primary outcome, and secondary outcomes were collected and compared between the two groups. The primary outcome was weaning success rate. Secondary outcomes included respiratory function parameters (peak airway pressure, plateau pressure, airway resistance, and respiratory rate), heart rate, arterial blood gas results [partial pressure of arterial carbon dioxide (PaCO₂), partial pressure of arterial oxygen (PaO₂), and oxygenation index (PaO₂/FiO₂)], diaphragmatic function [diaphragmatic excursion (DE) and diaphragmatic thickening fraction (DTF)], and prognostic indicators [duration of mechanical ventilation, intensive care unit (ICU) length of stay, reintubation rate, ICU mortality, 28-day post-ICU discharge mortality, and overall mortality].

There were no statistically significant differences in baseline characteristics such as gender, age, body mass index (BMI), COPD duration, comorbidities, PaO₂/FiO₂, Acute Physiology and Chronic Health Evaluation II(APACHE II), and Sequential Organ Failure Assessment (SOFA) between the two groups. In terms of the primary outcome, the weaning success rate after treatment in the EDP group was higher than that in the control group [93% (81/87) vs. 61% (53/87), P<0.05]. Regarding secondary outcomes, there were no statistically significant differences in airway peak pressure, plateau pressure, airway resistance, respiratory rate, heart rate, PaCO₂, PaO₂, PaO₂/FiO₂, DE, and DTF between the two groups before treatment. However, after treatment, all these parameters showed improvement, with more pronounced changes in the EDP group compared to the control group [peak airway pressure (cmH₂O, 1 cmH₂O=0.098 kPa): 24.86±7.12 vs. 31.03±8.05, plateau pressure (cmH₂O): 18.05±4.97 vs. 23.08±6.21, airway resistance (cmH₂O×L^-1×s^-1): 28.96±4.85 vs. 34.12±5.61, respiratory rate (breaths/min): 20.13±2.46 vs. 25.52±2.78, heart rate (beats/min): 71.32±3.68 vs. 79.06±3.24, PaCO₂ (mmHg, 1 mmHg=0.133 kPa): 45.36±7.54 vs. 49.81±8.05, PaO₂ (mmHg): 86.07±7.82 vs. 82.18±8.14, PaO₂/FiO₂ (mmHg): 253.57±51.96 vs. 201.83±45.37, DE (mm): 3.49±0.56 vs. 2.82±0.47, DTF: (35.72±4.59)% vs. (29.61±4.81)%, all P<0.05]. In addition, the duration of mechanical ventilation (days: 5.84±1.72 vs. 10.53±2.18) and length of ICU stay (days: 9.74±2.15 vs. 14.38±3.06) in the EDP group were shorter than those in the control group, and the 28-day post-ICU discharge mortality [7% (6/87) vs. 20% (17/87)] and overall mortality [9% (8/87) vs. 29% (25/87)] in the EDP group were lower than those in the control group (all P<0.05). However, there were no statistically significant differences between the two groups in reintubation rate or ICU mortality.

EDP intervention can significantly improve diaphragmatic function, reduce airway pressure and respiratory rate, shorten the duration of mechanical ventilation and length of ICU stay, increase weaning success rate, and reduce mortality. Thus, it provides high-quality, evidence-based support with clinical translational value for this high-risk patient population.

The Bacillus Calmette-Guérin (BCG) vaccine, a live-attenuated derivative of Mycobacterium bovis, has long been central to global tuberculosis prevention. Although it protects well against severe childhood TB, its efficacy against adult pulmonary TB is variable. At the same time, epidemiological and clinical observations suggest that BCG may reduce all-cause mortality and protect against infections beyond TB. Randomised trials have reported lower neonatal all-cause mortality and fewer sepsis-related deaths, supporting the idea of broader immunological benefits. These heterologous effects are proposed to be derived from trained immunity, a form of functional reprogramming of innate immune cells driven by epigenetic and metabolic changes. In some settings, BCG may also induce trained tolerance, leading to a more suppressive immune state, based mainly on animal and in vitro evidence. Clinically, intravesical BCG is an established local immunotherapy for non-muscle-invasive bladder cancer, with current evidence and emerging data suggesting that its effects may extend beyond the bladder through systemic immune training. However, repurposing BCG for other cancers, non-oncological autoimmune diseases, and respiratory tract infections remains established in experimental animal models but is represented with mixed efficacy accompanied by inconclusiveness in human trials and mostly in preclinical or early-phase evidence. Major barriers to translation include strain variability, lack of standardised dosing, uncertain durability, and unresolved long-term safety concerns. Future progress will depend on engineered BCG derivatives, improved delivery systems, rational combination therapies, and well-designed controlled clinical trials.Methodology: Literature was identified through searches of PubMed, Google Scholar, and the Cochrane Library, from database inception to 2026, with a primary focus on studies published between 2011 and 2026.

This letter discusses Costa et al.'s randomized trial of resistance training (RT) combined with photobiomodulation therapy (PBMT) for difficult-to-control asthma (DTCA). The triple-blind study shows RT+PBMT safely improves peripheral muscle strength and exercise capacity better than RT alone. PBMT has dose-dependent effects, but optimal parameters for chronic respiratory patients remain unclear. Some clinicians have proposed standalone PBMT for DTCA patients unable to complete resistance training, but this approach has not been validated in clinical trials. The absence of a PBMT-only group limits assessment for patients unable to tolerate RT. The intervention did not improve lung function or asthma control, acting only peripherally. RT+PBMT is a useful adjuvant therapy; future studies should optimize PBMT dosing, test standalone PBMT, and examine long-term outcomes, and compare different PBMT wavelengths, energy settings and irradiation sites to refine real-world treatment protocols.