Organotin (IV) compounds are known to induce apoptosis via the intrinsic mitochondrial pathway, which is a key mechanism of effective anticancer therapy. Their ability to selectively promote apoptotic cell death highlights their potential as chemotherapeutic agents. In this study, the in vitro effects of two triorganotin compounds, tributyltin propionate and tributyltin salicylate, on the human breast cancer cell line MDA-MB-231 were evaluated. In addition to their proven antitumor activity, these compounds may act as synthetic ligands for nuclear retinoid X receptors. Protein expression profiles were examined using gel electrophoresis and MALDI-TOF mass spectrometry, with a particular focus on heat shock proteins (HSPs), which are commonly overexpressed in cancer cells and contribute to tumor progression and therapeutic resistance. Both triorganotin derivatives significantly reduced HSP expression, suggesting that HSPs could be a promising target in cancer therapy.

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is generally responsive to immunotherapy, but some patients remain refractory despite treatment escalation. Lymphoplasmapheresis (LPE), a modified apheresis technique that removes both plasma components and circulating lymphocytes, may offer a salvage option in selected cases. We report a 61-year-old woman with refractory anti-NMDAR encephalitis who showed limited improvement after corticosteroids, intravenous immunoglobulin, and ofatumumab. After a prolonged interval following ofatumumab induction, she remained severely impaired with persistent disease activity and elevated cerebrospinal fluid and serum anti-NMDAR IgG titers. Three sessions of LPE were performed over 5 days. Clinical improvement was observed after LPE, accompanied by a decline in antibody titers. At 5-month follow-up after LPE, she maintained sustained recovery, with a Clinical Assessment Scale in Autoimmune Encephalitis score of 6 and a modified Rankin Scale score of 2. This case supports a close temporal association between LPE and clinical and immunological improvement, although causality cannot be definitively established from a single case.

Nursing leadership was pivotal during the acute COVID-19 response, yet less is known about how crisis-era leadership practices persisted, changed, or were replaced by new responsibilities during recovery. This study explored nursing leadership trajectories in Italy from the first pandemic wave to 5 years later.

Two-wave qualitative study with a longitudinal follow-up subsample and a supplementary 2025 refreshment sample, conducted within a descriptive-interpretive orientation.

Semi-structured interviews were conducted with nurse managers and staff nurses in Italian public healthcare settings at two time points: Phase 1 (August-December 2020; n = 22) and Phase 2 (June-September 2025; n = 22). Nine participants were re-interviewed and 13 were newly recruited in 2025, yielding 44 interviews with 35 unique participants. Interviews were transcribed in Italian and analyzed using team-based thematic analysis with a hybrid deductive-inductive strategy. Deductive sensitizing domains were derived from the 2020 dataset and nursing leadership literature, while inductive analysis identified issues newly prominent in 2025. For returning participants, within-case summaries supported longitudinal comparison. Reporting followed COREQ and SRQR guidance.

Findings are reported as patterns of continuity, change, and newly prominent phenomena rather than as uniform within-person change across the full sample. Six themes described leadership trajectories: (1) sustaining emotional support and compassionate leadership; (2) adaptive leadership and system learning; (3) leading digital adoption and technology-enabled care; (4) ethical challenges and moral resilience; (5) coordinating post-COVID pathways across settings; and (6) workforce stewardship, shortages, and retention efforts. Across waves, participants described leadership as shifting from immediate crisis reassurance and improvisation toward institutionalized preparedness, digital change work, cross-sector coordination, and workforce advocacy.

Within this sample, nursing leadership was described as moving from acute crisis containment toward a broader portfolio of organizational, ethical, digital, and workforce-oriented responsibilities in the post-pandemic period.

Health organizations should proactively support nurse leaders' capacity for compassionate leadership and moral resilience, invest in digital competencies, and strengthen retention and preparedness strategies to sustain the nursing workforce beyond crisis periods.

Airway diseases, including asthma and chronic obstructive pulmonary disease (COPD) are global public health burden due to their high prevalence, morbidity, and mortality. Although these conditions are clinically distinct, they share key pathogenic mechanisms, including chronic inflammation, oxidative stress, and airway remodeling. Continuous exposure of the lungs to environmental agents and pathogens increases their susceptibility to injury and dysregulated immune responses, thereby promoting chronic disease progression. Environmental factors, including cigarette smoke and air pollution, can induce epigenetic changes that act as intermediaries between external insults and disease phenotypes. These epigenetic mechanisms, including DNA methylation, histone modifications, and non-coding RNAs, regulate gene expression without altering the DNA sequence. By modulating chromatin structure and transcriptional activity, they influence immune function, lung homeostasis, and disease susceptibility, thereby contributing to persistent inflammation, airway remodeling, and variability in therapeutic responses.

Advances in epigenetics have led to the identification of novel biomarkers and potential therapeutic targets, offering new perspectives for diagnosis and treatment. We provide a comprehensive overview of the most recent advances in this field.

Current evidence and emerging insightsh discussed in this review might facilitate the understanding of how epigenetic alterations contribute to the biological mechanisms of respiratory diseases and help future research priorities.

Chronic respiratory diseases - including asthma, chronic obstructive pulmonary disease (COPD), interstitial lung diseases, lung cancer, and post-COVID conditions - are associated with substantial morbidity and reduced quality of life. In addition to pharmacological therapy, chest physiotherapy and pulmonary rehabilitation play a crucial role in improving functional capacity and patient outcomes. This review aims to summarize contemporary approaches in pulmonary rehabilitation, with particular emphasis on the integration of digital technologies and telerehabilitation strategies. A narrative review of the literature was conducted focusing on the structure of pulmonary rehabilitation programs, training modalities, maintenance strategies, and the clinical applicability of telemedicine-based solutions. Pulmonary rehabilitation, particularly when combined with structured exercise programs, maintenance interventions, and telemonitoring systems, can significantly improve exercise tolerance, symptom control, and health-related quality of life. Modern digital technologies enable real-time monitoring of patient status, facilitate individualized rehabilitation strategies, and support early detection of disease exacerbations. Telemedicine platforms, smart inhalers, and wearable sensors represent promising tools for the management of chronic respiratory diseases. Data generated by these technologies may contribute to improved clinical decision-making and optimization of rehabilitation outcomes. The integration of pulmonary rehabilitation with digital health technologies may play a key role in the future management of chronic respiratory diseases and in maintaining long-term functional stability in affected patients. Orv Hetil. 2026; 167(30): 1199-1206.

Computed tomography of the chest is a cornerstone imaging modality in the diagnosis of pulmonary diseases; however, conventional systems based on energy-integrating detectors have inherent physical limitations, including restricted spatial resolution, electronic noise, and reduced image quality at low radiation doses, which may compromise diagnostic accuracy in certain clinical scenarios. Photon-counting detector computed tomography represents a novel technological approach based on the individual detection and energy discrimination of incoming X-ray photons. This enables improved dose efficiency, reduced image noise, higher spatial resolution, and intrinsic spectral imaging from a single acquisition. The aim of this review is to provide an overview of the role of photon-counting detector computed tomography in pulmonary imaging. Based on the available literature, this technology offers particular advantages in the detection and characterization of small pulmonary nodules, subsolid and ground-glass lesions, as well as in the assessment of fine morphological features of interstitial lung diseases. In addition, it improves the visualization of infectious, vascular, and traumatic pulmonary abnormalities. Spectral imaging capabilities, including virtual monoenergetic reconstructions and iodine maps, provide additional functional information on tissue perfusion, lesion characterization, and treatment response. The technique also shows promise in interventional applications by improving the visualization of target lesions and interventional devices. Photon-counting detector computed tomography represents a significant technological advancement in lung imaging. However, its widespread clinical implementation is currently limited by restricted availability, high costs, and challenges related to inter-system comparability. Nevertheless, current evidence suggests that this technology will play an increasingly important role in pulmonary diagnostics in the future. Orv Hetil. 2026; 167(30): 1186-1198.

This article provides an overview of alcohol exposure and attributable mortality and burden of disease in the World Health Organization Western Pacific Region, and trends in alcohol exposure over the past two decades.

We employed a comparative risk assessment and trend analyses to evaluate alcohol exposure patterns and attributable burden.

In 2019, almost half a million deaths and more than 22 million disability-adjusted life years lost were attributable to the consumption of alcohol in the Western Pacific Region, representing 3.5% (95% uncertainty interval 2.5, 4.8) of all deaths and 4.4% (95% uncertainty interval 3.6, 5.4) of all disability-adjusted life years lost. This was caused by an average consumption of 6.06 litres of pure alcohol per year (APC; 95% confidence interval 4.46-7.84), higher than the global average of 5.45 litres. Trends in APC have varied across subregions: China saw increasing consumption up to 2016, with a marked decrease since then, likely due to an anti-corruption campaign prohibiting consumption in public spaces and during official functions. In other Asian countries, consumption steadily increased until the COVID-19 pandemic, then decreased during it, and has now partially returned to pre-pandemic levels. APC in Oceania including Australasia was relatively stable between 2000 and 2020 and has decreased since.

Overall, alcohol use remains high and normalised in the region, necessitating robust alcohol control policies. Strengthening these efforts is particularly critical in some Asian countries that experienced the largest increases in levels of alcohol consumption between 2000 and 2024.

The mucosal system, which includes the respiratory, gastrointestinal, and urogenital tracts, serves as a primary entry point for pathogens, with a unique immune microenvironment and specialized defense mechanisms. In recent years, especially following the onset of the COVID-19 pandemic, there has been increasing recognition of the importance of mucosal immunity, motivated by an enhanced comprehension of its fundamental mechanisms. Currently, strategies based on mucosal delivery systems to administer antigens and induce strong mucosal protective immunity have become a key focus in the development of mucosal vaccines. Compared with conventional intramuscular delivery, mucosal vaccination can simultaneously elicit a robust local mucosal response, effectively block pathogen entry into the local mucosa, and generate systemic immune responses to prevent symptomatic infections and severe disease. In addition, mucosal delivery offers advantages such as ease of administration and low invasiveness, making it a more widely acceptable approach to vaccination. In the present study, we conducted a systematic review of the mechanisms of mucosal immunity, the technological platforms for mucosal vaccines, and proposed a perspective on the challenges and future directions for the development of next-generation mucosal vaccines, with the goal of enhancing public knowledge and awareness regarding mucosal immunity and its possible effects on global health.

BACKGROUND Dermatomyositis is an idiopathic inflammatory myopathy (IIM) that presents commonly with cutaneous, myopathic, and systemic manifestations. Cardiopulmonary involvement is usually paired with interstitial lung disease (ILD), which when severe can lead to pulmonary hypertension (PH) with heart failure, contributing to morbidity, poor quality of life, and mortality. However, dermatomyositis is rarely associated with PH in the absence of extensive ILD, and is infrequently considered in patients who present PH in the absence of significant lung findings. CASE REPORT We present the case of a 71-year-old woman who was admitted with signs and symptoms of heart failure after months of progressive dysphagia, proximal muscle weakness, and shortness of breath. She was subsequently diagnosed with dermatomyositis, as well as pre-capillary PH, through right-heart catheterization, but had no features of extensive ILD on imaging. She was treated with intravenous diuretics, intravenous methylprednisolone 1 g daily for 3 days, followed by oral prednisone 60 mg, and 2 doses of 75 g of intravenous immunoglobulins (IVIG), resulting in overall clinical improvement. Further IVIG treatment and re-evaluation of the need for vasodilator therapy was planned, but unfortunately the patient died following admission with hyperosmolar hyperglycemia and aspiration pneumonia after declining resuscitation and intubation. CONCLUSIONS PH in the absence of extensive ILD in dermatomyositis may be under-recognized. IIM evaluation should be considered in the rheumatological work-up of pre-capillary and combined pre-/post-capillary PH within the appropriate clinical context. Gaps exist in the understanding of the pathophysiology of PH in IIMs and its management, prognosis, and outcomes.

Our article is testimonios from the perspective of three Black, female MFTs. We explore various results of the intersecting pandemics that we have ourselves experienced and continue to navigate. A recurring narrative that has been amplified during this time is that therapy and therapists should not be political and human. Not only is there an expectation that clinicians should not express or maintain a political stance, but we are also expected to hold space for clients to express their discriminatory or marginalizing views. This notion reflects the repeated pattern of clinicians showing up for clients regardless of any personal turmoil. Clinicians are expected to intentionally consider the context of intersecting pandemics on the populations we serve and give grace to students we teach, yet the same context is disregarded when considering the clinician's wellbeing and expectations regarding productivity. We see this habit manifest in academia as well and it contributes to an internal disconnect and lack of work/life balance. Overall, we have found that clinicians impacted by the ongoing pandemics are unable to find time to reflect on and process what is happening. Our article features our experiences, the lessons we have learned as a result of continuing to survive, and how we intend to use our agency, autonomy, and voices to create change for ourselves and our communities. We hope that readers develop a better understanding of how to recognize and respect the humanity of mental health clinicians.