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This study examines representations of transgenerational trauma and healing strategies in Chika Unigwe's The Middle Daughter. The analysis of the novel pays critical attention to the intergenerational transmission of trauma within the mother-middle daughter relationship. Drawing on the tenets of Trauma Theory, the study reveals how silence, emotional repression, and culturally shaped parenting practices contribute to the psychological distress of the protagonist, Nani. Through a close investigation of characterization and events in the narrative, the paper shows how the often-overlooked role of the middle daughter affects emotional visibility and self-perception within the family, yielding to traumatic flashbacks. The analysis further demonstrates that unresolved maternal trauma and cultural expectations influence Nani's romantic and non-romantic relationships, shaping her vulnerability and internalized guilt. Finally, the study discusses Nani's path to healing, through narration, maternal agency, and personal autonomy, arguing that recovery begins with reclaiming one's story and voice. By closely reading the novel alongside the postulations of trauma scholars such as Judith Herman, Cathy Caruth, Marianne Hirsch, C. N. Van der Merwe, and Pumla Gobodo-Madikizela, the research contributes to trauma studies in African literature by highlighting the psychological cost of inherited silence and the therapeutic import of emotional truth-telling.

The Lathrobium tahirai species group is reviewed and redefined based on detailed morphological examination of the type specimens and newly available materials from Japan. Six previously described species are redescribed and illustrated with additional taxonomically important characters: L. tahirai Y. Watanabe, 2001, L. kanayamaense Y. Watanabe, 2001, L. nikkoense Y. Watanabe, 2001, L. sinense Herman, 2003, L. krilioni Tikhomirova, 1976, and L. riozoi (Y. Watanabe, 1972) comb. nov. Moreover, L. inflatum Assing. 2013 syn. nov. is placed in synonymy with L. nikkoense. In addition, six new species of this species group from Japan are described and illustrated: L. koseii sp. nov. (Kyushu: Nagasaki Prefecture: Tsushima Is.), L. yatsugatakensesp. nov. (Honshu: Nagano Prefecture), L. hashizumeorum sp. nov. (Honshu: Nagano Prefecture), L. undulatumsp. nov. (Honshu: Nagano Prefecture), L. kainum sp. nov. (Honshu: Yamanashi Prefecture), and L. stomachiformesp. nov. (Honshu: Yamanashi Prefecture). A key to species of the L. tahirai group is provided.

While operative treatment of complete distal biceps tendon ruptures yields superior outcomes compared to nonoperative treatment, surgical indications and optimal treatment algorithms remain uncertain for distal biceps tendinopathy and partial tears. The purpose of this systematic review was to summarize the current literature on both operative and nonoperative treatment of distal biceps tendinopathy and partial tears. A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines by searching PubMed, MEDLINE, EMBASE, and the Cochrane Library. Clinical studies reporting outcomes following operative and/or nonoperative treatment of distal biceps tendinopathy and/or partial tears were included. Extracted data included study and patient characteristics, treatment details including postintervention rehabilitation, patient-reported outcomes, and complications. Where possible, comparisons between treatment strategy (operative vs. nonoperative) and tendon pathology (tendinopathy vs. partial tears) were made, albeit meta-analysis was not appropriate as no level I or II comparative studies exist. Thirty studies were included, totaling 614 patients with 500 partial tears (81.4%) and 114 tendinopathies (18.6%). Operative treatment was performed in 20 studies, nonoperative treatment in 5 studies, and both operative and nonoperative treatment in 5 studies. Diagnosis was made by advanced imaging, most commonly magnetic resonance imaging, in 27 of 30 studies, and further aided by variable physical examination maneuvers. Generally, both operative and nonoperative management were reported to be effective in alleviating elbow pain and restoring function, although there was a propensity to treat tendinopathy nonoperatively and partial tears operatively. When reported, there were similar outcomes for full vs. partial tears and tendinopathy vs. partial tears as well as operative vs. nonoperative treatment strategies; however, low-level evidence and study heterogeneity prevented data pooling and statistical comparisons. A systematic review of the current literature on clinical outcomes following treatment of distal biceps tendinopathy and/or partial tears found that both operative and nonoperative strategies can improve elbow pain and restore function. At present, operative treatment is commonly recommended for partial tears, especially in high demand individuals. Nonoperative treatment is the initial strategy for tendinopathy and/or low-demand patients with partial tears. Future studies are needed to define surgical indications and elucidate optimal treatment algorithms.

Acute Care Surgery (ACS) surgeons care for a wide variety of life-threatening surgical conditions and have a high burden of night and weekend calls. Maintaining current knowledge of published literature is increasingly challenging. This study aims to describe motivations and methods used by ACS surgeons to stay current with published literature. We focused on how ACS surgeons acquire new information and apply it in practice, their views on the effectiveness, efficiency, and potential bias of their methods, and their perspectives regarding future knowledge acquisition methods. A prospective qualitative semi-structured interview study was performed. Informed consent was obtained from purposively recruited participants: ACS surgeons practicing in the United States. Interviews continued until theme saturation. Reflexive inductive thematic analysis was used to generate qualitative results. Thirteen interviews were conducted, averaging 27.3 min each. Participant interviews revealed several motivations for remaining current with published literature: problem-based literature review, self-promotion, curiosity, job performance, and job satisfaction. Participants used various strategies to identify and access new literature, including academic and non-academic sources. Barriers included paywalls, time constraints, and information overload. Facilitators included user-friendly interfaces and working at an academic institution. Participants provided insights into their effectiveness, efficiency, and biases and were wary of artificial intelligence processes that may reinforce bias. Participants unanimously desired more efficient methods when asked how literature acquisition may improve in the future. ACS surgeons are motivated to stay current with published literature. Current barriers and facilitators were identified, and participants desired more efficient methods to stay current.

Few medical schools, particularly those without dedicated pathology departments, offer preclinical pathology electives. To address this gap, faculty at Michigan State University College of Osteopathic Medicine and the Michigan State University College of Human Medicine-College of Osteopathic Medicine Pathology Interest Group launched a student-faculty elective in 2025. The elective comprised eight sessions: seven microscope sign-outs and one grossing workshop. Each began with one hour of independent slide preview, followed by a 2-h sign-out led by a practicing pathologist and delivered in person and via Zoom. Across approximately 30 contact hours, students engaged in microscopic and macroscopic pathology. Twenty-three learners attended at least one session. Anonymous pre- and post-class surveys assessed prior exposure, self-rated confidence, specialty interest, and perceptions of curricular adequacy. Thirteen medical students completed the precourse survey, and fourteen completed the postcourse survey; eleven responses were paired. Baseline experience was limited: 54% had never grossed a specimen or attended a sign-out, and no learner reported high confidence in histology, gross pathology, or laboratory report interpretation. Among paired respondents, mean confidence increased by +1.1 to +1.3 points on a five-point scale, with 82% improving across domains. Post-survey data showed 93% reported the elective reshaped their perception of pathology, 93% planned a pathology rotation, and all respondents recommended the course. In the absence of a pathology department, this student-led, faculty-mentored elective provided rare early exposure. Beyond measurable confidence gains, the program offers a scalable model for institutions seeking to strengthen pathology exposure and the specialty pipeline.

Developing countries face limited access to targeted treatments for patients with advanced epithelial ovarian cancer (EOC). The CA-125 ELIMination rate constant K (KELIM), calculated from longitudinal CA-125 measurements during the first 100&#xa0;days of treatment, serves as an early indicator of tumour chemosensitivity. The primary objective of this study was to evaluate the value of the KELIM score in predicting progression-free survival (PFS) and overall survival (OS) in patients with EOC treated with adjuvant or neoadjuvant chemotherapy. The records of patients with EOC (International Federation of Gynecology and Obstetrics stage II-IV) treated at the University Clinical Hospital Mostar (Bosnia and Herzegovina) between 2013 and 2023 were analysed retrospectively. Patient characteristics, outcomes and KELIM score were assessed during the first 100&#xa0;days of treatment. KELIM scores were categorized as favourable (&#x2265;1.0) or unfavourable (<1.0). KELIM scores were assessed in 92 patients: 36 (39&#xa0;%) were classified in the favourable group and 56 (61&#xa0;%) in the unfavourable group. Patients in the favourable KELIM group achieved complete cytoreduction significantly more often (p&#xa0;<&#xa0;0.001) and demonstrated longer platinum-free intervals (PFI), with most having PFI&#xa0;>&#xa0;12&#xa0;months (p&#xa0;=&#xa0;0.005). In contrast to OS (p&#xa0;=&#xa0;0.442), PFS was significantly longer in the favourable KELIM group [29.0&#xa0;months, 95&#xa0;% confidence interval (CI) 8.45-49.55] compared with the unfavourable KELIM group (13.0&#xa0;months, 95&#xa0;% CI 10.56-15.44; p&#xa0;<&#xa0;0.001). In this real-world cohort from a resource-limited setting, a favourable KELIM score was associated with greater early chemosensitivity, longer PFI, improved PFS, and a higher rate of complete cytoreduction in patients with EOC. The KELIM score has been validated in real-world settings and post-hoc analyses of prospective studies, and can be applied easily in routine clinical practice for patients with EOC treated with adjuvant or neoadjuvant chemotherapy, providing a useful prognostic, predictive, pragmatic and cost-effective tool to support risk stratification and inform therapeutic decision-making. Further prospective validation is still required for biomarker-guided treatment selection.

Extended reality (XR) technologies, encompassing augmented reality (AR), virtual reality (VR), and mixed reality (MR), are increasingly used in endodontic education and practice. A gap exists regarding understanding of XR's applications and limitations among endodontic educators and practitioners. This narrative review aims to (A) explain the technical foundations of AR, VR, and MR systems; (B) review current applications of XR in endodontic education and clinical practice; (C) examine limitations and barriers to adoption; and (D) outline future directions. An overview of the technical foundations of XR was provided. A comprehensive electronic search was conducted across PubMed, Scopus, and Web of Science databases to identify papers on applications of XR in endodontics. After screening, 33 articles met the inclusion criteria and were subjected to full-text review. The main features of the studies were extracted, and a narrative summary was prepared. The review shows that XR technologies have been applied in endodontic education for training in visualisation of root canal anatomy, access cavity preparation, and microsurgical procedures, with most studies demonstrating improved comprehension and procedural accuracy. Haptic feedback systems and head-mounted displays enable realistic training that surpasses traditional methods of education. However, most applications remain educational, with few clinical studies involving real patients. Challenges include hardware costs, technical setup complexity, data security concerns and lack of standardisation. When thoughtfully implemented, XR has the potential to improve endodontic education, support clinical workflow and enhance the overall practice of endodontics. Coordinated efforts among clinicians, educators, engineers and regulators are needed to validate these technologies, develop practical implementation standards and integrate XR into routine endodontic education and care.

Type 2 inflammation plays a central role in asthma, but blood eosinophil count (BEC) and fractional exhaled nitric oxide (Feno) levels may reflect different type 2 pathways. Their associations with different asthma characteristics in unselected populations remain unclear. To examine how BEC and Feno, independently and synergistically, are related to lung function, allergy, and nasal polyps in a population-based asthma cohort. Data were analyzed from 1567 participants with physician-diagnosed asthma in the West Sweden Asthma Study. Lung function, bronchodilator responsiveness, and presence of allergy and nasal polyps were evaluated across categories of BEC and Feno labeled as low, medium, or high using various cutoffs. Associations were assessed using linear and logistic regression models in participants who were inhaled corticosteroid (ICS)-naive and ICS-treated separately. Of participants, 49% (n = 767) were on ICS treatment at the time of examination. Among those who were ICS-treated, BEC, independently of Feno, was associated with reduced FEV1 and forced vital capacity percentages, higher nasal polyps and clinical allergy, and together with Feno contributed to bronchodilator responsiveness. Interaction effects between Feno and BEC were observed primarily for FEV1 and forced vital capacity percentages, at high range of cutoff values. In contrast, among participants who were ICS-naive, neither Feno nor BEC showed independent associations with outcomes; instead, their synergistic effect was associated with lower FEV1 and forced vital capacity percentages and a higher prevalence of clinical allergy, with consistent effects across a range of cutoff values. BEC and Feno reflect distinct yet complementary aspects of type 2 inflammation in asthma. These findings support the joint use of BEC and Feno for obstructive airway diseases phenotyping.

The COVID-19 pandemic was a dynamic and often confusing period for clinical and biomedical research. As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread globally, knowledge accumulated rapidly through publications that were frequently based on preliminary or sometimes conflicting evidence, yet these papers played a critical role in shaping evolving medical, research and societal responses. Early in the pandemic, diabetes emerged as one of the strongest predictors of severe COVID-19 outcomes and mortality, placing it at the centre of early risk-stratification and therapeutic frameworks and prompting urgent efforts to understand the biological basis of these associations. As the pandemic progressed, reports of new-onset diabetes following COVID-19 infection raised the possibility of a bidirectional relationship between SARS-CoV-2 infection and diabetes. In this review, we provide a post-pandemic reappraisal of the clinical and experimental literature examining the intersection of COVID-19 and diabetes. We summarise proposed pathophysiological mechanisms, including the effects of SARS-CoV-2 infection in the pancreas and on peripheral insulin-sensitive tissues. We review key meta-analyses assessing the association between COVID-19 and incident type 1 and type 2 diabetes and highlight strengths and weaknesses of the epidemiologic studies underpinning these findings. We highlight the highest-quality evidence from prospective cohorts, as well as relevant clinical trials and registry-based studies that emerged from this collective experience. We discuss emerging relationships between long COVID and diabetes and the effect of vaccination on diabetes risk following SARS-CoV-2 infection. Finally, we identify critical knowledge gaps and outline priorities for ongoing and future studies needed to resolve remaining uncertainties.

Artificial intelligence (AI)-assisted colonoscopy for polyp detection is designed to improve colonoscopy quality. Although surveys have assessed staff gastroenterologists' attitudes toward AI, less is known about the views of gastroenterology (GE) fellows regarding AI during training. We conducted a nationwide survey of GE fellows from August 2024 to November 2024 to assess (1) exposure to and experience with AI in fellowship, (2) perceptions of AI's impact on colonoscopy quality, and (3) attitudes toward implementing AI into training. The survey included Likert scale questions with branching logic to tailor questions based on AI availability at the fellows' institutions. A total of 126 fellows started the survey, and 88 (69.8%) completed it. AI was available at least at 1 training site for 69.3% of respondents. In addition, 81.8% of fellows believed AI should be available during fellowship. Many fellows (43.2%) thought AI should be incorporated in the second year of training. Most fellows (60.7%) believed early exposure to AI-enhanced polyp detection skills. However, 52.5% felt neutral that AI made them better endoscopists overall. Despite this, 62.5% preferred to pursue a job with AI if they had trained with it. Our nationwide survey found that GE fellows are generally supportive of integrating AI into their training, with most advocating for its incorporation in the second year. These results should be considered by fellowship program leadership and GE practices recruiting fellows trained with AI. Further studies are required to assess the impact of training GE fellows with AI on their polyp detection competency.

The electrochemical reduction of nitrate (ERN) to ammonia (NH3) has attracted increasing attention as a sustainable route for nitrogen recovery and green ammonia production, enabled by major advances in electrocatalyst design over the past decade. Two mechanistic pathways are generally well-recognized: direct electron transfer and a hydrogen radical (H*)-mediated mechanism. However, the latter remains difficult to quantify under practical electrochemical conditions, limiting mechanistic comparison across catalyst configurations. Herein, Ni/Co, Ni/Pt, and Ni/Pt/Co electrocatalysts were investigated to elucidate the interplay between direct and indirect ERN pathways. Quantitative electron spin resonance (ESR) measurements of H* under ERN-relevant conditions, combined with bulk electrolysis in the absence and presence of an H* scavenger, enabled direct correlation between H* availability and NH3 production. Ni/Co predominantly follows direct electron transfer, whereas Ni/Pt transitions to an H*-mediated regime above a threshold current density. In contrast, Ni/Pt/Co exhibits synergistic behavior in which both pathways coexist. Moreover, the H* role varies with electrocatalyst chemical composition, facilitating either NO3 - activation or NO2 - hydrogenation. These findings establish a quantitative framework for resolving H*-mediated contribution in ERN and provide mechanistic design principles applicable to other electrocatalytic hydrogenation reactions.

The exchange of biological matter between bacterial cells drives adaptation and evolution. However, whether bacteria can exchange functional proteins remains unclear. In this work, we found that antibiotic treatment can induce vesicle-mediated horizontal protein transfer within and between bacterial species. We developed a genetic system in Escherichia coli to track transfer events and performed single-cell transcriptomic profiling on an isogenic population of bacteria. Antibiotics stimulated the differentiation of this isogenic population into distinct cell states: donor cells that activated a membrane stress response to release protein-containing vesicles and recipient cells that suppressed this response to acquire protein from their neighbors. Protein uptake enhanced the antibiotic persistence of recipient cells, revealing that vesicle exchange promotes bacterial survival during antibiotic treatment.

Obesity is increasingly implicated in hematopoietic malignancies, yet its role in mutation-driven myeloid leukemias remains unclear. Using UK Biobank data from over 440,000 individuals, we found obesity traits including elevated BMI and waist-to-hip ratio were associated with type 2 diabetes, increased plasma IL-17A (interleukin-17A), reduced GLP-1R (glucagon like peptide 1 receptor) expression, and heightened risk of myeloid malignancies. Transplantation of protein tyrosine phosphatase non-receptor type 11, PTPN11 (Shp2E76K/+) mutant hematopoietic stem/progenitors into obese mice demonstrated that metabolic inflammation accelerates leukemogenesis via myeloid cell expansion, lipid metabolic rewiring, IL-17A activation, and accumulation of M2-like tumor-associated macrophages (TAMs), accompanied by T-cell exhaustion and impaired antigen presentation. Notably, dual therapy with an anti-IL-17A antibody and a GLP-1R agonist reversed these effects, by reducing M2-like TAMs, restoring Ciita-dependent antigen presentation, Tyk2-mediated IFN&#x3b3; signaling, reactivated T-cell responses, and reducing leukemic burden. These findings establish IL-17A driven, metabolism-coupled immunosuppression as a mechanistic link between obesity and SHP2-mutant myeloid leukemias, highlighting a tractable therapeutic strategy for high-risk obese patients.

Multidrug-resistant bacteria necessitate innovative antibacterial strategies. Bacteriophages (phages) offer a promising alternative; however, bacterial immune defenses limit their effectiveness. Small-molecule inhibitors of these defenses may facilitate mechanistic studies and serve as adjuvants to enhance phage therapy. Here, we identify inhibitors targeting the bacterial cyclic oligonucleotide-based anti-phage signaling system (CBASS) effector nuclease Cap5. Cap5 is hypothesized to degrade genomic DNA in virally infected cells, leading to cell death through abortive infection. Guided by the crystal structure of the Cap5 SAVED domain bound to its activating ligand, we performed structure-guided virtual screening to identify candidate inhibitors. Biochemical assays revealed &#x223c;16% of the top docking hits inhibited Cap5. Cellular assays revealed one compound could enter E. coli cells and inhibit Cap5 activity. Our integrated approach-combining structure-based virtual screening with biochemical validation-provides a framework for discovering small-molecule inhibitors of bacterial immune defenses to advance adjunctive therapies and deepen our understanding of phage-bacteria interactions.

Listeria monocytogenes is a ubiquitous Gram-positive bacterium responsible for listeriosis, a foodborne zoonotic disease affecting humans and animals. Although infection in immunocompetent individuals is often asymptomatic or limited to mild self-limiting gastroenteritis, Listeria monocytogenes may cause severe invasive disease in vulnerable groups, including pregnant women, neonates, elderly individuals, and immunocompromised patients. Although the incidence of listeriosis is relatively low compared with many other foodborne pathogens, the high hospitalization and mortality rates associated with clinical cases make this bacterium a major concern for food safety and public health. The evolutionary success of L. monocytogenes reflects the interaction between a conserved core genome and a dynamic accessory genome shaped by horizontal gene transfer (HGT), ecological selection, and expansion of specific clones. Transient intestinal carriage in humans and animals, potentially influenced by gut microbiome composition, creates ecological interfaces where plasmids, transposons, prophages, and integrative conjugative elements contribute to the exchange of antimicrobial resistance determinants, virulence factors, and stress tolerance systems. Virulence diversification is further influenced by the differential distribution of pathogenicity islands such as LIPI-1, LIPI-3, and LIPI-4 across specific clonal lineages. These evolutionary processes occur across interconnected farm, food-production, environmental, and clinical ecosystems consistent with the One Health framework. Advances in whole-genome sequencing have clarified lineage-specific gene flow, expansion of specific clones, and the dynamics of the resistome and mobilome in L. monocytogenes populations. This narrative review aims to synthesize current knowledge on the mobile genetic elements and ecological interfaces that shape horizontal gene transfer in L. monocytogenes. Its novelty lies in integrating antimicrobial resistance, virulence-associated genomic islands, stress adaptation, and gut microbiome-mediated selection within a One Health and metapopulation framework. The main message of this review is that HGT should be interpreted as a context-dependent contributor to L. monocytogenes adaptation, acting together with clonal background, ecological selection, and mobile genetic elements.

Systemic lupus erythematosus (SLE) is a progressive antibody-mediated autoimmune disease characterized by systemic immune complex deposition. A subset of SLE patients has elevated CD4+IL-9+ T cells as well as increased levels of secreted interleukin (IL)-9 and IL9 messenger RNA compared with healthy control subjects. However, because IL-9 can have both pro- and anti-inflammatory effects in autoimmune disease, its function in SLE is unclear. We use the MRL/lpr murine model of SLE to demonstrate that IL-9 exhibits protective activity in the early stages of disease. Treatment of these mice with an IL-9 neutralizing antibody from 6 to 12&#x2009;wk of age results in an expansion of immune cells, leading to exacerbation of disease. In contrast, treatment with anti-IL-9 from 6 to 18&#x2009;wk of age does not significantly alter disease course compared with isotype control. Anti-IL-9 antibody treatment of these mice results in reduced systemic IL-2 levels, IL-9+ type 2 innate lymphoid cells, and regulatory T cells in the kidney, suggesting an IL-9-dependent suppressive cellular circuit similar to that observed in rheumatoid arthritis. Importantly, supplementation of IL-2 during IL-9 blockade recovers regulatory T cell numbers and limits disease. Together, these data demonstrate an IL-9-dependent suppressive circuit that is evident early in the development of SLE which may be amenable to manipulation to achieve a therapeutic benefit.

Indolent systemic mastocytosis (ISM) is an under-recognised cause of secondary osteoporosis, and skeletal fragility may be the only presenting feature, delaying diagnosis. We describe four adults referred to a tertiary endocrinology service for unexplained osteoporosis or low-trauma fractures, in whom systemic mastocytosis (SM) was identified during work-up. All had elevated basal serum tryptase (41.4-87.0 &#xb5;g/L), bone-marrow biopsy showing atypical mast cells and the KIT D816V variant; cutaneous lesions were absent in every case. Three patients fulfilled WHO 2022 criteria for ISM. The fourth had coexistent JAK2 V617F-positive post-essential-thrombocythaemia myelofibrosis and was classified as SM with associated haematological neoplasm (SM-AHN); his mast cell clone (tryptase 43.7 &#xb5;g/L; KIT D816V VAF 0.391%) behaved indolently and contributed clinically through osteoporosis alone, illustrating that an indolent mast cell component can be overlooked when a chronic myeloid neoplasm dominates the picture. Presentations ranged from an isolated low-energy L5 fracture in a 55-year-old man, to multiple vertebral compression fractures despite denosumab in a 71-year-old woman with primary hyperparathyroidism, to severe wasp-sting anaphylaxis in a 43-year-old man. After multidisciplinary review, all received intravenous zoledronic acid with vitamin D repletion; KIT-targeted therapy is under consideration in selected patients. Although causal inferences cannot be drawn from four retrospectively identified cases, the series illustrates how ISM may be missed in unexplained or treatment-refractory osteoporosis-particularly in younger men, those with prior severe anaphylaxis, and those fracturing on antiresorptive therapy-and supports combining basal serum tryptase with high-sensitivity peripheral-blood KIT D816V testing, in line with the WHO/ICC/AIM-ECNM 2022-2024 criteria. Prospective studies are needed.

Primary hyperparathyroidism (PHPT) affects 1% of adults, but fewer than one-third of screen-eligible patients are tested. We developed and evaluated two new non-interruptive, clinician-facing alerts to increase appropriate PHPT screening. We designed process changes to facilitate guideline-informed patient identification via electronic phenotyping, laboratory test ordering, result interpretation, and follow-up. The computable phenotype was retrospectively validated. Clinician-facing alerts were built atop existing workflows for health maintenance (HM) and pended orders (PO) and evaluated in separate primary care clinics. Screening laboratory orders were more frequent in PO (81%; n = 30/37; p < 0.001) and HM (57%; n = 51/90; p < 0.001) than in control (19%; n = 373/1945) clinics. Increased screening appeared to yield higher detection of likely PHPT in PO (43%; 16/37; p < 0.001) and HM (8%; 7/90; p = 0.01) than in control (2%; 48/1945) clinics. Non-interruptive alerts demonstrate potential to substantially increase PHPT screening among appropriate patients.

Background/Objectives: Immunonutrition uses dietary bioactive compounds to support immune function while preserving systemic physiological balance. Donkey milk, bovine colostrum, and royal jelly contain complementary antimicrobial, immunoglobulin-rich, and immunoregulatory components, but their combined effects remain insufficiently characterized. Methods: A 6-week controlled study was conducted in female rabbits assigned to four groups (n = 15/group): vaccinated only (G1), immunonutraceutical only (G2), vaccination plus immunonutraceutical (G3), and pre-conditioned immunonutraceutical followed by vaccination and continued supplementation (G4). Serum total immunoglobulins and lysozyme were measured longitudinally. Biochemical indices were monitored throughout the study, and hematological parameters were evaluated at the final time point. Mixed-effects models, generalized estimating equations, principal component analysis, and correlation-based systems analyses were applied. Results: Supplementation significantly modulated both humoral and innate immune responses. The strongest terminal immunoglobulin response was observed in G4 (26.00 &#xb1; 5.80 mg/mL), whereas sustained lysozyme elevation was most pronounced in supplemented groups, particularly G3 (3.13 &#xb1; 0.44 ng/mL). Within-subject analysis demonstrated significant innate-adaptive immune coherence (p = 0.000006). Biochemical analyses showed coordinated metabolic adaptation without evidence of organ toxicity, and hematological findings indicated preserved inflammatory and hematopoietic stability. Conclusions: Multi-component immunonutraceutical supplementation modulated humoral and innate immune dynamics in a timing-dependent manner while maintaining biochemical and hematological safety. These findings support the potential of combined donkey milk, bovine colostrum, and royal jelly as functional ingredients for coordinated immune support.