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Thoracic radiation therapy (TRT) is commonly used for breast, lung, and lymphoid cancers. While its cardiotoxic effects, particularly coronary artery disease, are well recognized, less is known about its association with arrhythmia-related hospitalizations. A retrospective cohort study using the National Inpatient Sample (2016-2022) was conducted. Hospitalizations for atrial fibrillation or flutter were identified using ICD-10 codes. Documented prior thoracic irradiation was defined using a history of radiation therapy code in combination with thoracic malignancy codes. Propensity score matching followed by post-matching multivariable regression adjustment was used to evaluate outcomes. The primary endpoint was in-hospital mortality; secondary endpoints included length of stay (LOS) and total costs. Among 3,198,304 weighted admissions, 8,570 (0.27%) had prior TRT. After matching, TRT was associated with higher odds of in-hospital mortality (adjusted odds ratio [aOR] 1.97; 95% CI 1.17-3.32; p=0.010) and longer LOS (+0.30 days; 95% CI 0.05-0.55; p=0.019) without increased costs (p=0.202). Hospitalizations with documented prior thoracic irradiation also had higher odds of palliative consultation (aOR 2.60, p<0.001) and DNR status (aOR 1.97, p<0.001), but lower odds of acute kidney injury (aOR 0.66, p<0.001). Documented prior thoracic irradiation identified a clinically complex subgroup of atrial fibrillation or flutter hospitalizations with higher in-hospital mortality, slightly longer length of stay, and greater goals-of-care utilization.

Systematic clinical phenotyping using Human Phenotype Ontology (HPO) is central to rare disease diagnosis. However, current disease prioritization (ranking candidate diseases from HPO for a patient) methods face key challenges: they often fail to account for the hierarchical structure of HPO terms, ignore dependencies among correlated terms, and do not adjust for batch effects arising from systematic differences in phenotype documentation across cohorts, institutions, or clinicians. We aim to develop a scalable and statistically principled framework to address these limitations for rare disease prediction and patient stratification. We developed PhenoSS, a Gaussian copula-based framework that models disease-specific marginal prevalence of HPO terms while capturing their joint dependencies through a multivariate normal distribution. Phenotype frequencies were estimated using external curated resources, including OARD (Open Annotations for Rare Diseases) and HPO annotations. PhenoSS supports both pair-wise phenotype similarity calculation for patient clustering and posterior odds estimation for patient-specific disease prioritization. A batch-effect correction module mitigates systematic phenotyping differences across datasets. Across diverse simulation scenarios, PhenoSS demonstrated robust disease-prediction performance and consistently improved accuracy after batch-effect correction. In real electronic health record data, PhenoSS identified clinically meaningful patient clusters and effectively distinguished patients with different rare diseases. In disease prioritization tasks, PhenoSS achieved competitive performance with existing methods, particularly for patients exhibiting sparse or noisy phenotype annotations. PhenoSS provides a statistically interpretable framework for modeling phenotypic heterogeneity in rare disease research and is adaptable to other structured clinical vocabularies such as SNOMED-CT and ICD codes.

BackgroundNon-tobacco nicotine dependence (NTND) products, such as vaping, nicotine patches/pouches, gum, and lozenges, have become increasingly prevalent. While the negative effects of cigarette smoking on bone healing are well established, the impact of NTND on surgical outcomes remain unclear, particularly in foot and ankle surgery. This study aimed to evaluate the effect of NTND on short- and long-term postoperative complications following midfoot arthrodesis, a procedure commonly performed for arthritis, trauma, and congenital deformities.MethodsThis retrospective cohort study was conducted utilizing the TriNetX database. Patients undergoing midfoot arthrodesis were identified and stratified into NTND (ICD-10: F17, excluding tobacco-specific codes) and nonsmoker cohorts. 1:1 propensity score matching was performed based on demographic and comorbid variables. Postoperative complications were assessed at both 90 days and 2 years utilizing risk ratios (RRs) and 95% confidence intervals (CIs).ResultsAfter matching, 1235 patients were included in each cohort. At 90 days, NTND patients had significantly higher rates of opioid prescriptions (RR 1.18, 95% CI: 1.11-1.26), emergency department visits (RR 1.52, 95% CI: 1.20-1.93), hospitalizations (RR 1.59, 95% CI: 1.28-1.99), postoperative infections (RR 1.95, 95% CI: 1.13-3.37), and wound complications (RR 1.72, 95% CI: 1.14-2.58) (all P < .05). At 2 years, NTND was associated with increased rates of pseudoarthrosis (RR 1.27, 95% CI: 1.06-1.51) and mechanical implant failure (RR 1.39, 95% CI: 1.11-1.75) (both P < .05).ConclusionNon-tobacco nicotine dependence is associated with significantly increased risk of both early and late postoperative complications following midfoot arthrodesis. These findings suggest that vaping may adversely affect bone healing and implant integrity. Surgeons should incorporate NTND screenings and cessation counseling into preoperative planning to optimize patient outcomes.Level of Evidence:III-Retrospective Comparative Study.

AI has become increasingly used in mental health care for applications such as diagnosis, monitoring, and treatment support. These include tools like clinician support systems, large language models, and conversational agents used to augment psychotherapy and clinical decision-making. While prior research suggests potential benefits of and concerns with AI, little is known within the domain of obsessive-compulsive disorder (OCD). Given the expanding role of AI in psychiatry, understanding these perspectives is essential to ensuring AI implementation aligns with patient priorities and values. This study aims to explore the perspectives of individuals with OCD on the use of AI in health care, including perceived benefits, risks, and its role in relation to human clinicians. We conducted semistructured interviews with 24 adults self-reporting OCD, recruited through online communities and advocacy networks. Eligible individuals (&#x2265;18 y with self-reported OCD) completed screening, provided informed consent, and participated in remote Health Insurance Portability and Accountability Act (HIPAA)-compliant Zoom (Zoom Communications, Inc) interviews (May-December 2024). Transcripts were deidentified, open-coded, and used to develop a codebook. Focused codes were applied using a thematic analysis framework in Dedoose (v9.2.22; Sociocultural Research Consultants, LLC). Each transcript was independently coded by 2 reviewers, with discrepancies resolved through consensus. Themes were developed through iterative interpretive analysis of code clusters. Participants' perspectives encompassed concerns and benefits of AI in mental health care. Participants expressed concerns about the accuracy and efficacy of information provided by AI, as well as a limited ability for clinical judgment in psychiatric care. Additionally, participants emphasized the importance of human connection, particularly therapeutic alliance, empathy, and reassurance provided by clinicians, which they felt AI could not replicate. Concerns about data privacy, security, and downstream use of information were also highlighted. Despite concerns, many endorsed the use of AI as an adjunct rather than a replacement for clinicians, noting potential benefits in symptom monitoring, preliminary information gathering, and support for administrative tasks, provided that human oversight is maintained. Individuals with OCD expressed nuanced views on AI in mental health care, balancing cautious optimism with several concerns. While AI may improve efficiency, standardization, and symptom monitoring, participants highlighted risks related to deindividualization, accuracy, and erosion of human connection. These findings underscore the importance of patient-centered, ethically guided AI integration that preserves the therapeutic alliance while leveraging technological benefits.

The experiences foster caregivers have while providing care are linked to important outcomes including placement stability for the child and foster caregiver retention within the child welfare system. Understanding the expectations prospective caregivers have about fostering, and how this compares to their lived experience while fostering, is important for building realistic expectations and addressing unmet needs. The current study used a phenomenological approach through semi-structured qualitative interviews with 45 foster parents (71% female) to assess their recollections of what they had expected fostering to be like, and their thoughts about their fostering experiences to date. Inductive coding revealed positive, negative and neutral expectation and experience themes, as well as a "no expectations" theme, with several subcodes within each. Participants were mixed in terms of whether they agreed their experience had matched their expectations. While a subset of foster caregivers felt their expectations were in alignment with what their lived experience fostering has been, many felt that there were multiple experiences they had not expected, both positive and negative. The themes revealing unmet expectations as well as unforeseen negative experiences have implications for foster care licensing agencies, who can work to assess and develop appropriate expectations for prospective caregivers.

Longstanding racial inequities in maternal mortality require tailored approaches to improving outcomes for Black birthing people. Doulas provide continuous emotional, physical, and informational support and have been shown to improve perinatal outcomes, particularly for Black birthing people. In response, some states have implemented Medicaid doula benefits. In January 2025, Pennsylvania-where &#x223c;35% of births are Medicaid-covered-launched such a policy, allowing certified doulas to enroll as Medicaid providers. As part of a larger mixed-methods study on the effects of Medicaid policies on maternal and child health, the study team examined doulas' experiences participating in Pennsylvania Medicaid. Semi-structured interviews were conducted with 30 doulas statewide from December 2023 to March 2025 to examine the policy's implications for doulas and Black birthing people. Transcripts were analyzed using latent content analysis, applying inductive and deductive coding. Doulas reported persistent racial inequities in health care, including delayed pain management and pressure on Black birthing people to accept unwanted interventions. They described advocating within a system marked by clinician bias and profit-driven hospital models. While some doulas viewed the Medicaid policy as improving credibility and expanding access for Medicaid recipients, concerns emerged regarding administrative burdens, credentialing, enrollment, and scale-up, especially for Black doulas, who play a central role in supporting Black birthing people. This study highlights the need to support doulas in navigating Medicaid processes while also addressing structural barriers within the health care system. Insights from other states can inform implementation efforts in Pennsylvania. These findings underscore that Medicaid doula policy must go beyond reimbursement alone to ensure that community doulas can connect with clients and provide continuous, holistic support both within and outside the health care system-unencumbered by credentialing requirements, enrollment barriers, or payment structures that constrain the scope and reach of their work. Reimagining such policy to center the experiences of both Black doulas and Black birthing people is a necessary step toward dismantling the systemic conditions that drive racial inequities in maternal mortality.

Drug-induced liver injury (DILI) is a common complication of anti-tuberculosis therapy and frequently leads to treatment interruption or modification. In routine clinical practice, liver function abnormalities during tuberculosis treatment are often attributed to DILI. However, isolated indirect hyperbilirubinemia in the presence of persistently normal transaminase levels represents an atypical biochemical pattern that is inconsistent with classical hepatocellular injury and may indicate alternative underlying conditions, posing a diagnostic challenge in tuberculosis management. We report the case of a 22-year-old Han Chinese woman treated for smear-negative pulmonary tuberculosis who developed recurrent elevations in total and indirect bilirubin while alanine aminotransferase and aspartate aminotransferase levels remained persistently within normal ranges. These abnormalities were repeatedly misinterpreted as suspected DILI, resulting in multiple interruptions and modifications of anti-tuberculosis regimens. Bilirubin levels continued to fluctuate despite drug withdrawal, suggesting a non-hepatocellular etiology. Repeated treatment interruption contributed to a delay in effective tuberculosis management exceeding 1 year and was associated with radiological disease progression and cavity formation. Further evaluation, including UGT1A1 genetic testing, identified heterozygous promoter (c.-41_-40dupTA) and coding (c.211G>A, p.Gly71Arg) variants, confirming a diagnosis of Gilbert syndrome. Recognition of this underlying condition prevented further unnecessary cessation of anti-tuberculosis therapy. The patient subsequently resumed an individualized regimen guided by drug susceptibility testing and demonstrated radiological improvement during follow-up. This case highlights an important diagnostic pitfall during tuberculosis treatment. Persistent indirect hyperbilirubinemia with normal transaminases should prompt consideration of Gilbert syndrome rather than DILI. Early recognition and appropriate genetic testing may prevent unwarranted treatment interruption, reduce the risk of disease progression, and improve treatment continuity. To our knowledge, reports describing Gilbert syndrome masquerading as recurrent suspected DILI during tuberculosis treatment remain exceedingly rare.

Treatment Abroad (TA) programs are a key component of healthcare delivery for complex cases requiring highly specialized care. In Qatar, the International Medical Affairs Office (IMAO) manages over 11,000 TA requests annually through multidisciplinary committees and specialized subcommittees to support evidence-based decision-making. Despite advances in committee structures and the adoption of hybrid meeting models, challenges persist in optimizing efficiency, transparency, and committee member satisfaction, highlighting the need for systematic evaluation of committee processes and composition. To identify challenges affecting decision-making and operational effectiveness within IMAO Treatment Abroad committees, define characteristics of optimal committee composition, and develop a reproducible framework to enhance transparency, communication, and committee practices across the IMAO and similar healthcare organizations. Between July and December 2024, a cross-sectional survey was conducted among 162 CMs from main and specialized subcommittees using a home-developed instrument combining Likert-scale, yes/no, and open-ended questions; the tool was pilot-tested for reliability (Cronbach's &#x3b1; = 0.82). Quantitative data were analyzed using non-parametric tests, while qualitative data underwent dual-coded thematic analysis. A total of 87/162 committee members (CMs) responded (53.7%), predominantly male (72.4%) and highly experienced within HMC (&#x2265;9 years, 86.2%), while 50.6% had similar experience within the IMAO committee. Most preferred remote or hybrid meetings (67.8%) and email communication (51.7%), with high satisfaction reported for workflows (93.1%) and IMAO collaboration (65-69%). While 81.6% reported no external influence on decisions, 23% identified the absence of subcommittee input as a barrier, and 52.9% supported anonymized patient requests to enhance transparency. Greater organizational experience was associated with higher satisfaction and increased perception of subcommittee absence as a barrier (36.4% vs. 9.3%; p < 0.05), whereas committee-specific experience showed no significant effect. Key challenges included communication gaps with overseas facilities, interface usability, incomplete medical information, lack of financial compensation (95.4%), and exposure to patient reprisals. Medical committee effectiveness in Treatment Abroad programs is influenced by committee members' organizational experience and perceptions of decision-making processes. Findings underscore the need for structured multidisciplinary input, transparent governance, streamlined communication, and diverse committee representation across gender and experience levels to support equitable and consistent decision-making. The proposed hierarchical framework provides a practical model to standardize processes, enhance transparency, and optimize committee performance within IMAO and comparable healthcare settings.

Protein structure characters have great potential for improving phylogenetic inference, especially for deep nodes where amino acid sequences are highly diverged. The combination of AlphaFold structure predictions and Foldseek's "3Di" structural alphabet makes it relatively easy to conduct model-based phylogenetic inference that includes a partition of slow-evolving 3Di characters. However, we show that even identical amino acid sequences can produce substantially different 3Di characters, depending on the source of structural model and whether inter-chain interactions are considered. We argue that such variability can be addressed with key concepts from traditional organism-based phylogenetic systematics: semaphoront, hypodigm, and character ascertainment method. To illustrate this, we develop an analogy between organismal development, taphonomy, and subsequent description and character coding by a systematist, and the process of protein synthesis, folding, and interaction and subsequent extraction, experimentation, and structural modeling by a biochemist. We conclude that differences in 3Di characters between semaphoronts are not intrinsically a problem, but they do require that the researcher uses the same replicable method on all proteins in the phylogenetic analysis. The guiding principle should be to maximize the chance that character differences in the data matrix are the results of underlying evolutionary changes, rather than artefacts due to differences in the methods used for obtaining semaphoronts and coding characters.

Throughout their youth, non-autistic siblings of autistic individuals may begin considering their involvement in their autistic sibling's life, which may affect their well-being. However, there is little research on how expectations for future involvement differ across cultures. Understanding why and how youth siblings' expectations manifest may inform the design of family interventions that are appropriate for culturally-diverse samples. The present analysis examines how Latino and non-Latino youth siblings perceive their future supportive roles in their autistic sibling's life. Semi-structured qualitative interviews were conducted in English with 12 Latino and 9 non-Latino youth siblings (N&#x202f;=&#x202f;21). Eligible families had at least one child diagnosed with autism and a non-autistic sibling between 8 and 17 years old. Audio-recorded interviews were transcribed verbatim and coded using a coding structure. Data were analyzed using applied thematic analysis and were both analyzed in aggregate and stratified by ethnic background. Two themes were identified: 1) expectations of evolving sibling roles and responsibilities into adulthood shape siblings' visions of their future involvement and 2) without family support, anxiety about the future pushes siblings into action or avoidance. Driven by a sense of duty, Latino siblings were more certain of a support role in their autistic sibling's life. Non-Latino siblings expressed more uncertainty and variability in their expectations for a future support role, feeling conflicted between prioritizing their autistic sibling or future family. These themes are consistent with literature emphasizing how cultural values, such as familism and individualism, shape caregiving attitudes and expectations. These findings may inform the design of culturally-responsive family interventions.

PIWI-interacting RNAs (piRNAs) are a class of non-coding RNAs approximately 24-32 nucleotides (nt) in length. They are well known for silencing transposons and maintaining genomic integrity during germ cell development. Recent studies have detected specific piRNAs in cardiovascular-relevant tissues, including myocardial tissue, circulating samples, and distinct cardiac cell populations, as well as in various disease settings. However, the biogenesis and functions of somatic piRNA/P-element-induced wimpy testis proteins (PIWI) signaling in mammalian cardiovascular tissues remain incompletely understood. The biological functions of piRNAs in cardiac physiology and the pathogenesis of various diseases are still largely unexplored. In this review, we summarize piRNA expression patterns, underlying mechanisms, and potential clinical significance in cardiovascular diseases, providing insights that may facilitate the development of targeted molecular therapies.

Ageing is the strongest risk factor for heart failure, yet the molecular mechanisms underlying cardiomyocyte (CM) ageing remain unclear. We aimed to map the transcriptomic and epigenomic landscape of CM ageing and to test whether DNA hypermethylation is a causal driver of diastolic dysfunction. We performed single-nucleus multiomics (concurrent snRNA-seq and snATAC-seq) on 4- and 28-month-old ventricular myocardium of C57BL/6J mice. Aged CMs showed widespread chromatin remodelling, with 28,324 regions having greater accessibility compared to only 2 with reduced accessibility. 1963 genes were differentially expressed in aged ventricular CMs, with 78.5% neighbouring differentially accessible regions. Promoter accessibility positively associated with expression. Reduced-representation bisulphite sequencing of ventricular CM nuclei identified 1422 regions associated with genes that were hypermethylated in aged CMs, compared to only 167 that were hypomethylated. CpG hypermethylation inversely correlated with differential gene expression. Multi-omic integration revealed ageing signatures shared across cell types, and identified the long non-coding RNA Gm12381 as a CM-selective ageing marker. To test whether DNA hypermethylation is associated with ageing phenotypes, we used cardiotropic MyoAAV to overexpress Dnmt3a in adult hearts. Dnmt3a overexpression induced CM hypermethylation, causing cardiac hypertrophy and diastolic dysfunction, key ageing phenotypes, and altering the transcriptome profile toward that of aged CMs. Gain of chromatin accessibility and CpG hypermethylation associated with transcriptomic reprogramming characterize CM ageing. Experimental elevation of DNA methylation is sufficient to induce diastolic dysfunction and hypertrophy, supporting DNMT3A-mediated hypermethylation as a mechanistic driver. Further work should test whether attenuating methylation prevents or reverses age-related cardiac dysfunction.

Decentralization of antiretroviral therapy (ART) brought treatment to millions of people in Sub-Saharan Africa. However, the implications of such decentralization are still not fully understood. The study included 60 semi-structured interviews with community leaders, healthcare providers, patients, and community members served by a rural mission hospital in Zimbabwe, conducted in January-March 2019. Interviews were transcribed and translated into English and coded using an iterative codebook. Coded extracts were grouped into themes and categories, systematically using QDA Miner qualitative analysis software. The study reveals that treatment-for-all policies and decentralization of ART have indeed improved access to care (as experienced by the study participants). However, the study shows that these policies also had unintended negative consequences. Stigma and complex social relations significantly affect the practices and experiences of ART outreach care, for both patients and healthcare providers, and may hamper attempts to reduce stigma as well as increase physical and social barriers to accessing ART. The study's results highlight the need to understand the consequences of the decentralization of HIV care, as well as the barriers and facilitators associated with ART outreach in order to improve quality of care and provide true accessibility to HIV care for all.

To identify and explain the health system factors influencing private general dental practitioners (GDPs) engagement in state-funded, contracted primary oral healthcare for low-income adults in Ireland, in which circumstances, for which groups, how and why. Nineteen realist interviews were conducted with frontline GDPs, health system actors and academic subject experts from Ireland and elsewhere. Collected data were then transcribed, coded, and analysed to generate context-mechanism-outcome configurations (CMOCs) and develop an overarching realist programme theory to explain causation. Thirteen individual and abstracted CMOCs were crafted and subsequently consolidated into five high level CMOCs. GDPs' engagement with state funded care is influenced by a myriad of complex health system contextual factors. These include low political and resource commitment to oral health; cost containment measures characterised by limited and outdated baskets of care and low remuneration; overtly bureaucratic oversight or contract administrative processes; adversarial communications and the absence of consultative mechanisms between the health system and GDPs. Other factors such as oral healthcare 'market' dynamics, GDPs' professional networks and community ties can also influence engagement in state care. As Ireland looks to reform its primary oral healthcare system to widen population access to care and meet national oral health policy and WHO commitments on oral health, the findings of this study provide health system leaders with evidence to leverage system change and increase or sustain GDPs' engagement in state care. Leveraging such change has the potential to improve access to care for vulnerable populations and reduce oral health inequalities.

GEometry ANd Tracking, version 4 (GEANT4) Dose and Radiation Interaction (G4DARI) is a GEANT4 Application for Tomographic Emission (GATE)/GEANT4 built graphical, Windows-based interface designed to facilitate Monte Carlo dose calculations in computed tomography images of patients, small animals, and phantoms. Developed to remove the programming barrier commonly associated with handling image formats and using GATE and GEANT4 coding, G4DARI integrates Oracle virtual machine (VM) VirtualBox for running the simulation environment and PuTTY for secure communication between the VM and the host system. The interface allows users to perform complete Monte Carlo dose simulations using only mouse interactions, providing a streamlined workflow for clinically relevant simulations, preclinical and research applications, and educational purposes. This manuscript describes the architecture, workflow, and features of G4DARI, from the conversion of Digital Imaging and Communications in Medicine (DICOM) images to dose determination in any region of the digital image. Furthermore, G4DARI is freely available for download, providing users with an accessible platform for running their own dosimetry simulations.

Visit-to-visit blood pressure variability (BPV) may be associated with cognitive decline beyond mean blood pressure (BP), but its relevance across treatment contexts remains uncertain. We pooled individual-participant data from Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes (ACCORD-MIND) and Systolic Blood Pressure Intervention Trial Memory and Cognition in Decreased Hypertension (SPRINT-MIND) (n&#xa0;=&#xa0;11,104). Participants had baseline and follow-up cognitive testing and &#x2265;3 BP measurements from 3 months onwards. The primary exposure was systolic BP variation independent of the mean (SBP-VIM). The primary outcome was annualized change in standardized Digit Symbol Substitution or Coding Test Z-scores. Each 10% increment in SBP-VIM was independently associated with faster annual cognitive decline (&#x3b2;&#xa0;=&#xa0;-0.008 per year; 95% confidence interval [CI]: -0.014 to -0.003) after adjustment including mean SBP. Associations were observed in the intensive but not standard BP treatment arms of both trials, although the pooled interaction was not statistically significant (p&#xa0;=&#xa0;0.054). Higher systolic BPV was associated with accelerated cognitive decline independently of mean BP. The exploratory treatment-context pattern warrants prospective confirmation.

MicroRNAs (miRNAs or miRs) represent conserved non&#x2011;coding RNAs responsible for the regulation of gene expression in a post&#x2011;transcriptional manner. The dysregulation of miRNAs often leads to disease development and progress. In particular, miR&#x2011;200c is one of the miR&#x2011;200 family members, which is found deregulated in various pathologies and involved in the process of cancer progression through its participation in different molecular signaling pathways. Initially, miR&#x2011;200c was regarded as an essential factor in metastases formation. Nevertheless, following the increase in knowledge about cell death signaling pathways, it became clear that miR&#x2011;200c participates in various types of cell death such as apoptosis, autophagy and pyroptosis. The present narrative review primarily discusses the molecular mechanisms through which miR&#x2011;200c regulates apoptosis, pyroptosis and autophagy and explores its potential therapeutic value.

Hepatocellular carcinoma (HCC) is the most prevalent form of primary liver cancer and is characterized by high mortality rates and a lack of effective therapeutic options. HCC cells undergo extensive metabolic reprogramming, including alterations in glycolytic, lipid, and amino acid metabolism, among other processes. These metabolic changes are often accompanied by widespread alterations in the epigenetic landscape, including DNA methylation, post-transcriptional modifications, non-coding RNA dysregulation, and histone modifications. A thorough understanding of how epigenetic modifications and metabolic reprogramming interact in HCC is critical for elucidating the mechanisms underlying hepatocarcinogenesis and developing new treatment approaches against HCC. In this review, we systematically introduce the molecular biological basis of each epigenetic modification and then summarize the latest research progress on the epigenetic regulation of metabolism in HCC, with the goal of linking these two frontier fields to provide novel insights into the treatment of HCC.

To provide an early-stage integrative synthesis of shared and scenario-specific ethical risks of Conversational Artificial Intelligence in nursing triage and patient education, and to synthesize governance directions and limitations discussed in the current literature. A systematic integrative review following the Whittemore-Knafl framework and PRISMA guidelines. Eight databases were searched. Two researchers independently conducted screening, data extraction, and thematic coding, followed by inductive synthesis. Quality appraisal used design-appropriate tools according to article type. Ethical risks were analysed within and across scenarios. Registered in PROSPERO (CRD420251079144). Nine articles were included (four on nursing triage; five on patient education), comprising two empirical studies, four reviews, two randomized controlled trial protocols, and one debate paper. Both scenarios shared six common ethical challenges: data privacy and security, over-reliance and deskilling, training-data bias and stigma reproduction, lack of empathy and emotional interaction capability, algorithmic black box and insufficient interpretability, and blurred accountability and regulatory gaps. Nursing triage presented additional risks including assessment inaccuracy, contextual misunderstanding, lack of personalization, superficially plausible misguidance and insufficient clinician trust. Patient education revealed four distinct issues: misleading information, digital accessibility gaps, cross-cultural and multilingual adaptation, and fairness and health inequality. Six shared governance directions were synthesized-human oversight and manual review, improvement of legal policies and industry standards, enhanced transparency and interpretability, continuous algorithm optimization and scientific validation, the human-machine balance principle, and capacity building for healthcare professionals. The literature also suggested scenario-specific reinforcements for triage and education. Ethical risks of Conversational Artificial Intelligence in nursing show both common and scenario-dependent patterns. Given the limited and heterogeneous evidence base, the identified governance directions should be viewed as preliminary pathways requiring further validation. This review offers evidence-informed ethical insights and scenario-based governance references to support safe, equitable and human-centred application of Conversational Artificial Intelligence in nursing practice. Not applicable.