Aim To synthesise epidemiological and clinical evidence on in-flight barodontalgia in professional aircrew.Methods We searched Scopus, PubMed, Web of Science, and Google Scholar for cross-sectional studies of in-flight barodontalgia. Seven studies (2013-2024) met the inclusion criteria. Data were extracted in duplicate, and risk of bias was assessed with the JBI cross-sectional checklist. Given heterogeneity in case definitions, a narrative synthesis (no meta-analysis) was performed.Results Barodontalgia events occurred predominantly during descent (and also on some ascents). Prevalence varied widely across studies (~6% to 55%). Acute dental pain was the leading symptom, sometimes accompanied by headache or transient concentration loss. Overall study quality was moderate.Conclusions In-flight barodontalgia is a relevant occupational health issue for aircrew. Harmonised case definitions and prospective validation of reports are needed. Preventive measures such as routine pre-flight dental check-ups and appropriate return-to-flight restrictions after recent dental treatment (as determined by aeromedical/occupational policy) may help reduce in-flight occurrences.

Despite being an option for high-risk or inoperable cases, existing neoadjuvant therapies for hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) breast cancer yield suboptimal pathological responses, necessitating novel strategies. This prospective, phase II ACNTBC trial (NCT05558722) investigated the efficacy and safety of combining anlotinib with chemotherapy as a neoadjuvant treatment for HR+/HER2- breast cancer. Enrolled patients received 5 cycles of anlotinib (12 mg qd, d1‒14; q3w) plus 6 cycles of nab-paclitaxel (200 mg/m[2], q3w), pirarubicin (50 mg/m[2], q3w), and cyclophosphamide (500 mg/m[2], q3w). The primary endpoint was the total pathological complete response (tpCR) rate, with the major secondary endpoints including residual cancer burden (RCB) 0/I rate, objective response rate (ORR), and safety. The study enrolled 31 patients, and the ORR was 93.5% (29/31, 95% CI, 78.6-99.2). In the per-protocol set of 28 patients completing treatment and surgery, the tpCR rate was 14.3% (4/28, 95% CI, 4.0-32.7), with RCB 0/I rate of 25.0% (7/28, 95% CI, 10.7-44.9). Grade 3/4 adverse events included hematologic toxicities, hypertension, proteinuria, and headache, all manageable. Post-hoc biomarker analysis showed that high baseline VEGFR2 expression and microvessel density (MVD) were significantly associated with superior efficacy, and the treatment significantly reduced Ki-67 index, VEGFR2 expression, and MVD. Supporting evidence from an exploratory inverse probability of treatment weighting (IPTW) analysis using a real-world cohort receiving chemotherapy alone indicated a potential benefit of the combination over chemotherapy alone. In conclusion, neoadjuvant anlotinib plus chemotherapy demonstrates promising efficacy and manageable safety in HR+/HER2- breast cancer with a high Ki-67 index.

Timely and accurate imaging diagnosis is critical in cases of fever, altered sensorium, seizures, or headaches that do not respond to conventional clinical management. This pictorial essay aims to highlight, through case illustrations, the critical role of imaging in identifying Burkholderia pseudomallei-a rare but significant infectious agent responsible for a characteristic pattern of brain and spinal cord involvement. The condition, known as neuromelioidosis, is endemic in the tropical regions of Southeast Asia and Northern Australia including coastal regions of Tamil Nadu and Karnataka in South India. This review underscores the importance of recognising patterns associated with this disease, with emphasis on the characteristic and specific feature of corticospinal tract involvement. Correct diagnosis is necessary to guide the initiation of targeted antibiotic therapy, which is a critical step in initiating the urgent management required to improve survival outcomes. Furthermore, we provide a discussion of differential diagnoses associated with similar imaging findings, emphasising the need for a nuanced approach to diagnosis and management in such complex cases. By raising awareness of the geographical prevalence and imaging hallmarks of neuromelioidosis, this study aims to enhance clinical decision-making and improve outcomes in affected patients.

The mpox outbreaks observed in 2025 highlighted significant shifts in transmission dynamics, viral clades, and public health responses, particularly in Africa. In contrast, Sierra Leone experienced its largest mpox outbreak that year-Africa's first major Clade IIb epidemic-which ran from 10 January to 17 December 2025. It involved 5,442 confirmed cases among 7,110 suspected cases, a case fatality rate of 1.1%, and 22,536 contacts identified. A public health emergency was declared on 13 January 2025. Transmission peaked in epidemiological week 20 (May 2025) with 654 confirmed cases. The burden was highest in Western Area Urban (55.4%, 3,014 cases), Western Area Rural (19.9%), and Bombali (6.1%). Cases predominantly affected young adults aged 20-39 years (median age 26) and males (52.5%). Key affected groups included sex workers, children under 15 years (6.5%), and pregnant women (1.6%). High population density in Freetown, limited resources, weak coordination, misinformation, and surveillance gaps facilitated spread. Genomic evidence revealed undetected Clade IIb (hMPXV-1 lineage, including G.1) circulating for ~3 months from Nigeria. Environmental contamination affected 13.5% of healthcare surfaces. Symptoms included rash, fever, headache, lymphadenopathy, sore throat, and pain; 28.9% of cases were hospitalized, often delayed by stigma and fear. Among those screened for HIV co-infection (23.6%), 82% of deaths occurred in co-infected individuals. The National Public Health Agency (NPHA) implemented seven response pillars: case management and isolation, infection prevention and control (IPC), risk communication, targeted vaccination (186,470 doses administered from 267,000 received), coordination, surveillance, and research. The outbreak ended after 42 consecutive case-free days, underscoring the importance of early surveillance and genomic monitoring to prevent sustained urban transmission.

The efficacy and safety of maribavir, an oral benzimidazole nucleoside that inhibits viral kinase UL97, were evaluated in hematopoietic stem cell transplant (HSCT) or solid organ transplant (SOT) recipients with cytomegalovirus (CMV) infection. This phase III, multicenter, open-label, single-arm, interventional study (ClinicalTrials.gov: NCT05137717; Japan Registry of Clinical Trials: jRCT2021210056) investigated oral maribavir 400 mg twice daily for 8 weeks. Japanese HSCT/SOT recipients aged ≥ 16 years with symptomatic or asymptomatic CMV infection (including those resistant/refractory to ganciclovir, valganciclovir, or foscarnet) and without central nervous system CMV tissue-invasive disease or CMV retinitis were enrolled. Primary endpoints were confirmed CMV viremia clearance at week 8 for efficacy and treatment-emergent adverse events (TEAEs) for safety. Among 61 patients enrolled across 22 sites, 41 patients (median age 56.0 years; 36/41 [87.8%] were HSCT recipients) received ≥ 1 maribavir dose. At week 8, twenty-eight patients (28/41, 68.3%) achieved confirmed CMV viremia clearance. Overall, 36 patients (36/41, 87.8%) had ≥ 1 TEAE, including nausea (10/41, 24.2%), anemia (7/41, 17.1%), pyrexia (6/41, 14.6%), and headache (6/41, 14.6%). Two deaths were deemed unrelated to maribavir. In conclusion, maribavir was effective in achieving CMV viremia clearance, with an acceptable safety profile and tolerability, in Japanese HSCT or SOT recipients with CMV infection.