The bark, resin, and roots of Commiphora africana (A. Rich.) Engl. have traditionally been used in African medicine to treat fever, stomach disorders, colic, and swelling. However, despite this traditional use, its anti-inflammatory activity and the underlying molecular mechanisms remain poorly characterized.

We evaluated the anti-inflammatory activity of C. africana ethanol extract (Caf-EE) in lipopolysaccharide (LPS)-stimulated macrophages and in murine models of HCl/EtOH-induced acute gastric mucosal injury and LPS-induced acute lung injury. Reporter assays, gene expression analysis, immunoblotting, cellular thermal shift assay (CETSA), gas chromatography-mass spectrometry (GC-MS)-guided compound annotation, network pharmacology, and molecular docking were used to investigate the anti-inflammatory mechanisms of Caf-EE.

Caf-EE inhibited nitrite production without cytotoxicity in LPS-stimulated RAW264.7 macrophages. GC-MS-guided feature annotation identified representative candidate constituents of Caf-EE, and network pharmacology indicated their association with inflammation-related pathways. Mechanistically, Caf-EE suppressed MyD88- and TRIF-mediated NF-κB/Activator protein 1 (AP-1) transcriptional activity and reduced the expression of inflammatory genes. Caf-EE also inhibited phosphorylation of Src/IκB kinase (IKK)/IκB- and Transforming growth factor-β-activated kinase 1 (TAK1)/c-Jun N-terminal kinase (JNK)/c-Jun-associated signaling proteins and increased the thermal stability of Src and TAK1. In vivo, Caf-EE attenuated HCl/EtOH-induced acute gastric mucosal injury and LPS-induced acute lung injury, accompanied by reduced phosphorylation of Src and TAK1 in both tissues. Among the representative GC-MS-annotated compounds, 9,19-cyclolanost-24-en-3-ol exhibited the highest predicted binding affinity for Src and TAK1 in molecular docking analysis.

Collectively, this study provides mechanistic evidence for the anti-inflammatory effects of Caf-EE through modulation of Src/TAK1-associated signaling. Furthermore, the protective effects observed in acute inflammatory disease models support the further development of Caf-EE as a therapeutic candidate for inflammatory disorders.

In the recent years, pregnancy outcomes in the patient with pulmonary hypertension (PH) improved with the development of health monitoring system and applications of pulmonary vascular-targeted drugs. But the maternal mortality is still high. So, the purpose of this study was to describe the maternal and foetal outcomes in pregnant women with PH. The clinical data of 30 pregnant women with PH who were admitted to the department of cardiology, Bangladesh Medical University, Dhaka, Bangladesh from January 2020 to December 2022 were collected and descriptively analyzed. Among the 30 pregnant women with pulmonary hypertension, 5(16.6%) had idiopathic pulmonary hypertension (iPAH), 17(56.6%) had pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD-PAH), 2(6.66%) had PH related to left heart disease (LHD-PH) and 6(20.0%) had PAH due to other diseases (oPAH). The mean systolic pulmonary artery pressure was <30 mmHg in 8(26.6%) patients, 30-40 mmHg was in 8(26.6%) patients and >40 mmHg in 15(50.0%) patients. Four (13.33%) patients were died within 7 days after delivery and CHD-PAH patients had the highest mortality rate (3/17, 17.64%). Three patients (10.0%) were admitted to the intensive care unit (ICU) and the incidence of heart failure during pregnancy was 20.0%. A total of 63.33% of the patients underwent caesarean section; 63.33% had premature infants; 40.0% had low-birth-weight (LBW) infants; 13.33% had very-low-birth-weight (VLBW) infants; 6.66% had extremely-low-birth-weight (ELBW) infants; 56.66% had small for gestational age (SGA) infants and 3.0% experienced neonatal mortality. Though there was difference in the maternal and foetal outcomes I iPAH, CHD-PAH, LHD-PH and oPAH, it was not statistically significant. Maternal mortality was highest in the CHD-PAH. Therefore, CHD-PAH patients should be advised to avoid pregnancy. Standardized and multidiscipline-assisted maternal management is the key to improve maternal and foetal outcome.

Respiratory syncytial virus (RSV) is a common virus causing severe illness in adults. RSV prefusion F protein subunit (RSVpreF) vaccine was approved by the Singapore Health Sciences Authority for adults aged 18-59 years at increased risk and for adults aged ≥ 60 years, to prevent RSV-associated lower respiratory tract disease. This study estimated the clinical and economic impact of RSVpreF vaccination for the prevention of RSV among adults in Singapore.

A Markov model projected clinical and economic outcomes of RSV for the vaccination of adults with RSVpreF compared to no intervention. Analyses were conducted from the healthcare system perspective, with direct costs (2025 Singapore dollars [S$]) and outcomes discounted at 3% annually; scenario/sensitivity analyses tested model robustness.

Compared to no intervention, RSVpreF vaccination would prevent 4,675 hospitalizations, 14,064 emergency department cases, and 37,631 outpatient visits over lifetime, averting S$31.92 million in direct medical costs with a gain of 2,675 quality-adjusted life years (QALYs). The RSVpreF vaccine would be cost-effective up to S$440.79/dose under a threshold of 1 ×gross domestic product per capita per QALY gained (S$122,370).

RSVpreF vaccination would substantially reduce the clinical and economic burden of RSV among adults in Singapore.

Epidemiological data indicate that cardiac arrest is one of the three leading causes of death, and its high case fatality and disability rates pose a major threat to human health. Early after return of spontaneous circulation (ROSC), patients with cardiac arrest frequently develop post-cardiac arrest syndrome (PCAS), which may lead to multiorgan dysfunction. Acute respiratory distress syndrome (ARDS) occurs in 50%-70% of these patients and is an important prognostic factor. This article systematically reviews the pathophysiological mechanisms of post-cardiac arrest ARDS and approaches to its early diagnosis and assessment. It also discusses a multimodal management strategy centered on lung-protective ventilation while incorporating neuroprotective measures, with the aim of helping improve outcomes in this population.

Mycobacterium persicum (M. persicum) is a nontuberculous mycobacterium that predominantly affects the lungs, causing pulmonary lesions, and is readily misdiagnosed as tuberculosis. Here we report a 48-year-old man with AIDS and M. persicum pulmonary disease who was initially misdiagnosed with pulmonary tuberculosis and received standard anti-TB therapy, yet showed no radiological or clinical improvement. Sputum specimens were subsequently subjected to targeted next-generation sequencing (tNGS), which identified M. persicum and established the definitive diagnosis. After switching to an anti-M. persicum regimen, the pulmonary lesions gradually resolved, and the patient was cured. This case highlights that in immunocompromised individuals, M. persicum pulmonary disease closely mimics tuberculosis in both imaging and clinical presentation, and reliance solely on CT and sputum acid-fast staining readily leads to misdiagnosis. Molecular diagnostics are central to precise diagnosis and treatment, and this case offers a valuable clinical reference.

This article reports a 34-year-old man who presented with snoring for more than 1 year, progressive daytime sleepiness for 6 months, and recurrent nocturnal fall-related injuries for 2 weeks. Video-polysomnography (vPSG) captured a typical somnambulism episode during non-rapid eye movement (NREM) sleep and confirmed the diagnosis of severe obstructive sleep apnea (OSA). After continuous positive airway pressure (CPAP) therapy, somnambulism episodes ceased and sleep architecture normalized. Notably, the result of the multiple sleep latency test (MSLT), which had been positive before treatment, also returned to normal after CPAP, suggesting that severe OSA can cause false-positive MSLT results through severe sleep fragmentation and rapid eye movement (REM) sleep rebound. This case suggests that in patients with sleepiness accompanied by abnormal nocturnal behaviors, vPSG should be performed first to screen for OSA, that OSA should be treated adequately and that MSLT should be deffered until adequate treatment of OSA has been achieved.

Radionuclide pulmonary ventilation/perfusion (V/Q) imaging is an important non-invasive tool for diagnosing pulmonary thromboembolism (PTE) and is used for screening, follow-up, and assessment of treatment response of PTE and chronic thromboembolic pulmonary hypertension (CTEPH). Currently, hospitals in China differ in their use of planar and tomographic acquisition methods for V/Q imaging, and interpretation requires a high level of expertise among nuclear medicine physicians. After surveying the nuclear medicine departments of multiple hospitals and holding expert discussions, the working group developed the Expert consensus on the operational protocol for radionuclide pulmonary ventilation/perfusion scintigraphy of pulmonary thromboembolism. This consensus covers examination procedures, diagnostic approaches, and precautions, with the aim of standardizing the clinical application of V/Q imaging procedures and their clinical application in PTE diagnosis. The following recommendations were formulated.Summary of RecommendationsRecommendation 1: For ventilation imaging, ^99mTc-Technegas is recommended as the preferred radiopharmaceutical. During the preparation of Technegas, the working group recommends wetting the crucible with anhydrous ethanol before the addition of the sodium pertechnetate solution to improve the efficiency and quality of Technegas generation. If Technegas is unavailable, ^99mTc-Diethylenetriaminepentaacetic acid (^99mTc-DTPA) aerosol may be used as an alternative (Consensus level: 100%).Recommendation 2: Routine supplemental oxygen is suggested before pulmonary perfusion imaging to prevent false-positive images caused by pulmonary vasospasm. The recommended oxygen flow rate is 2-4 L/min, with an inhalation duration of 5-10 minutes (Consensus level: 83.3%).Recommendation 3: For pulmonary perfusion imaging, 200 000-700 000 radiopharmaceutical particles (mean, approximately 400 000) should be administered, with the recommended activity of 120-240 MBq (3-6 mCi). For patients with severe pulmonary hypertension, conditions with right-to-left heart shunting, or a history of single-lung transplantation, the particle number should be reduced to 100 000-200 000 (Consensus level: 83.3%).Recommendation 4: Gently agitate and homogenize the suspension of ^99mTc-macroaggregated human serum albumin (^99mTc-MAA) prior to injection. With the patient supine and breathing at normal tidal volume, slowly inject the tracer over several respiratory cycles through a patent intravenous line, continuously monitoring for adverse reactions; discontinue immediately if discomfort occurs. Strictly avoid backflow of blood into the syringe, which may cause particulate aggregation and bolus formation, leading to artifactual hot spots (Consensus level: 100%).Recommendation 5: For patients with protein allergies, a routine skin test is recommended before pulmonary perfusion imaging. Inject 0.1 ml of ^99mTc-MAA suspension into the appropriate part of the forearm and observe for 15-20 minutes. If there is no positive reaction, perfusion imaging can be proceeded, with close observation and emergency medications on standby. If the skin test is positive, pulmonary perfusion imaging is not recommended. Routine skin testing is not indicated in patients without a history of allergy (Consensus level: 83.3%).Recommendation 6: For the 2-day acquisition protocol, perform pulmonary perfusion imaging on the first day. If the result is abnormal, perform pulmonary ventilation imaging the following day to aid diagnosis; if the perfusion imaging result is normal, pulmonary ventilation imaging may be omitted (Consensus level: 83.3%).Recommendation 7: For pregnant women with suspected PTE, if V/Q imaging is considered necessary after clinical assessment, a 2-day protocol is recommended. Dose reduction is recommended for lung perfusion imaging, the recommended dose of ^99mTc-MAA is 50 MBq (1.35 mCi) (Consensus level: 100%).Recommendation 8: When the 1-day acquisition protocol is used, perfusion imaging may be performed immediately after completion of ventilation imaging. To ensure the clarity and accuracy of pulmonary perfusion imaging, the perfusion count rate should be 3-4 times the ventilation count rate (Consensus level: 100%).Recommendation 9: Avoid ambiguous phrasing such as "possible pulmonary embolism" in image reports. Interpretations should provide a definitive conclusion, such as "pulmonary embolism present", "pulmonary embolism absent", or another specific conclusion, after excluding other causes of impaired pulmonary perfusion (e.g., Takayasu arteritis, mediastinitis or pulmonary arterial sarcoma). When the diagnosis remains uncertain, the report should state, "pulmonary embolism cannot be excluded; correlation with clinical findings and other imaging examinations is recommended" to support subsequent clinical assessment and therapeutic decision-making (Consensus level: 100%).Recommendation 10: For patients with CTEPH, visual semi-quantitative analysis (Begic/Meyer score) may serve as an adjunctive tool for efficacy assessment after percutaneous pulmonary balloon angioplasty (BPA) or pulmonary endarterectomy (PEA). Where institutional resources permit, structured reporting is encouraged to improve the clarity and reproducibility of segmental impairment documentation (Consensus level: 100%).

Severe pneumonia is one of the critical illness with the highest incidences and mortality rates in the intensive care unit. Its core threat lies not in the pulmonary infection itself, but in the subsequent multiple organ dysfunction syndrome (MODS). This review systematically delineates how severe pneumonia collectively accelerates organ injury through systemic inflammatory responses, type 2 immunity mediated by airway epithelial alarmins, endothelial thrombo-inflammatory pathways, as well as inappropriate oxygen therapy and mechanical ventilation. It further reviews the key points for early identification at the subclinical state, specific early-warning biomarkers, and bedside monitoring techniques applicable to extrapulmonary organs, including the heart, kidney, liver, and gastrointestinal tract, and proposes an integrated organ-protective strategy. This review emphasizes the concept of shifting the diagnostic and therapeutic window earlier, and aims to provide a reference for improving the comprehensive management of severe pneumonia by synthesizing current evidence and clinical practice.