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Cardiac arrest is a leading cause of sudden death worldwide, and prompt cardiopulmonary resuscitation (CPR) significantly increases survival rates. Assessing the knowledge and awareness of CPR among healthcare students is essential, as they represent future frontline responders in emergency situations. We conducted a cross-sectional study at the University of Kalamoon in Syria, where the survey included 600 students from three medical faculties using a voluntary electronic and paper questionnaire. The questionnaire combined self-efficacy regarding performing CPR and scientific knowledge according to the latest protocols, as well as assessing and studying the most important concerns that prevent students from performing chest compressions for both friends and strangers. SPSS software was used to analyze the data using ANOVA tests and independent t-test, in addition to descriptive analyses. The majority of the sample were females (72.8%), and more than half of the participants had not received any prior training on the principles of basic life support (54.2%). Both the academic major and the academic year showed statistically significant differences, where higher levels were observed among students of the Faculty of Human Medicine and sixth-year students (P-value&#x2009;<&#x2009;0.001), while gender did not show any statistically significant differences (p-value&#x2009;=&#x2009;0.058). 17.2% of the sample strongly agreed to perform chest compressions for a person who needs them. The two most important reasons preventing students from performing chest compressions on a stranger were making a mistake and legal punishment. Integrating CPR courses as a graduation requirement in medical schools in Syria, along with the need to organize interactive workshops and issue certificates as a means of motivating students, are essential means of promoting CPR concepts scientifically and theoretically, given its importance due to the numerous conflicts and wars in recent times. Not applicable.

Caregivers of wounded, ill, or disabled military servicemembers and Veterans play an essential yet underrecognized role in health care delivery. A new cohort of younger spouses, parents, and peers has emerged after the wars in Iraq and Afghanistan, assuming complex clinical, coordination, and advocacy responsibilities while facing substantial health, emotional, and financial risk. This column highlights the role of Nurse Practitioners in recognizing caregivers as secondary patients and advancing caregiver health as integral to patient-centered care. As Nurse Practitioners, we are educated to look beyond diagnoses to the broader context in which health and healing occur. As a Fellow of the American Association of Nurse Practitioners, I believe one of the most pressing-and persistently overlooked-contexts in care today are the health and well-being of caregivers of the wounded, ill, injured, or disabled military servicemembers and Veterans. After the wars in Iraq and Afghanistan, a new cohort of caregivers has emerged. These individuals are central to recovery, rehabilitation, and long-term outcomes for those who have served. Yet caregiver health is too often assumed rather than assessed, and caregiving capacity is taken for granted rather than intentionally supported.

Knowledge of vernacular plant names is fundamental for ethnobotanical research, aiding both in the identification of botanical taxa and the preservation of linguistic and ethnological heritage. This study examines the Ligurian vernacular plant names recorded in botanical publications from the late 19th century to 2020, spanning over 120 years. Beyond contributing to historical Italian ethnobotany, the aim was to describe how communities perceived and utilized plants during this long period, which saw significant socioeconomic shifts and historical events, such as the two World Wars. The main results show that the vernacular flora quotes a total of 9474 citations of dialectal names referring to 950 species, corresponding to 2120 basic vernacular names. Overall, 32.27% of wild taxa were sufficiently well-known to have a vernacular name, highlighting a good conservation of botanical knowledge for the Ligurian flora, characterized by very high biodiversity. However, a comparison between the periods before and after World War II showed a decline in the number of both cited species (30% reduction) and vernacular names recorded (14.48% reduction). These data should be viewed as merely indicative, given that they were collected using methodologies that were not always consistent across the different time periods. Nevertheless, it can be hypothesized that socioeconomic and land use changes-occurring over such a long and complex historical period-have contributed to reducing the population's reliance on wild plants, thereby diminishing knowledge regarding their vernacular names. Ultimately, our survey explored how Liguria's folk botanical knowledge has survived to this day, in an effort to provide a foundation for safeguarding this cultural heritage.

Circulating proteins act as important hormonal signals of nutrient intake. We aimed to systematically characterise the time-resolved proteomic response to glucose ingestion in humans, and to assess its robustness following prolonged complete caloric restriction. We conducted oral glucose tolerance tests (OGTTs) in 11 healthy volunteers before and after 7 days of complete caloric restriction and measured the response of >2900 targets through high-resolution plasma protein profiling. We identified a signature of 44 proteins that changed significantly following glucose ingestion, which was reproducible after 7 days without food, and was strongly (20-fold) enriched for 'stomach-specific' proteins. We report that annexin A10 (ANXA10) shows the most significant post-glucose change observed, similar to the trajectories of secreted hormones. We present observational human evidence from multiple sources suggesting that ANXA10 is secreted upon sensing an increase in gastric pH, with the stomach as the major contributing tissue. Despite a profound metabolic shift after 7 days of complete caloric restriction, characterised by delayed insulin secretion and postprandial hyperglycaemia, only four proteins showed robust evidence for a differential trajectory during both OGTTs. This included plasma levels of tryptophanyl-tRNA synthetase&#xa0;1 (WARS), for which we found a genetic association with glucose homeostasis and coronary artery disease. Our exploratory study identifies the proteomic response to glucose ingestion and demonstrates its reproducibility despite major shifts in glucose homeostasis. We characterise the gastrointestinal origin of these changes, and hypothesise a hitherto under-recognised role for sensing of changes in gastric pH on the plasma proteome.

Crescent formation is a marker of severe kidney injury in lupus nephritis (LN), but data from Saudi Arabia are scarce. We studied how crescents affect clinical features, pathology, and outcomes in Saudi patients. We reviewed 100 adults with biopsy-proven LN (2003-2024), classifying them by the presence and type of crescents (cellular, fibrocellular, fibrous). Crescent burden was calculated as the percentage of glomeruli involved; &#x2265;&#x2009;7.39% was considered high. The composite renal outcome included estimated glomerular filtration rate (eGFR) <&#x2009;20&#x2009;mL/min/1.73&#x2009;m2, &#x2265;&#x2009;20% decline in eGFR, doubling of serum creatinine, or dialysis or transplant. Outcomes were analyzed using Kaplan-Meier curves and multivariable Cox regression. Out of 100 patients with LN, 41 (41%) had crescents. Those with crescents had lower eGFR (71.41 &#xb1; 43.92 vs. 100.12 &#xb1; 45.63&#x2009;mL/min/1.73&#x2009;m2, p = 0.002), lower albumin (25.51 &#xb1; 6.17 vs. 29.81 &#xb1; 7.56&#x2009;g/L, p = 0.004), and higher activity scores (7.93 &#xb1; 3.05 vs. 2.27 &#xb1; 2.33, p < 0.001) than non-crescent patients; chronicity scores were similar. Kaplan-Meier curves suggested that patients with high crescent burden (&#x2265;&#x2009;7.39%) had worse event-free survival, but crescent burden was not an independent predictor. Instead, older age, higher baseline creatinine, elevated CRP, and fibrous crescents were linked to worse outcomes. Treatment response did not differ by crescent burden (p = 0.294). Crescents indicate more active disease and worse kidney function at diagnosis. While a high crescent burden may signal poorer short-term outcomes, long-term prognosis depends more on other clinical and pathological factors. Assessing both clinical presentation and biopsy findings is important for managing LN.

Background/Objectives: Cardiovascular disease increases with ageing and remains the leading cause of death worldwide. Cellular senescence contributes to cardiac dysfunction in the older population by secreting the senescence-associated secretory phenotype (SASP). Cardiac injury models induced by surgery have been shown to induce senescence in young adult rodents. However, surgical models are complex and associated with high mortality. Methods: We established a rat model of injury and senescence using isoproterenol (ISO). Male SD rats received ISO (100 mg/kg) for five days, then hearts were collected on days 10 and 28 after the first ISO dose. Results: ISO administration caused cardiac injury, manifested by inflammatory infiltration, fibrosis, and increased cardiomyocyte cross-sectional area. Cardiac injury was accompanied by an increase in the senescence markers SA-&#x3b2;-gal, p16 and p21, and DNA damage marker &#x3b3;H2AX. Moreover, the mRNA levels of p21 increased on day 10, along with several SASP factors, whereas the mRNA levels of p16 increased on day 28. Fibrosis, hypertrophy, and senescence persisted until day 28, indicating long-lasting cardiac remodeling and senescent cell accumulation. Conclusions: These findings suggest that ISO can provide a simple, cost-effective platform for studying senescence and cardiac injury. This model facilitates the study of timing, dosage, mechanisms and efficacy of senolytic interventions and may contribute to the development of senescence-targeted therapies.

Treatment resistance has become increasingly common in patients with chronic myeloid leukemia. Lack of response to tyrosine kinase inhibitors is associated with mutations in the BCR::ABL1 kinase domain. This study aims to report the frequency and types of BCR::ABL1 kinase domain mutations in Pakistani chronic myeloid leukemia patients. This prospective study was conducted from January to June 2025 at the Armed Forces Institute of Pathology in Pakistan. It included adult patients with chronic myeloid leukemia who were non-responsive to treatment based on molecular, hematological, and clinical criteria. Allele-specific real-time polymerase chain reaction was performed to detect four kinase domain mutations: T315I, E255V, E255K and Y253H. Data was analyzed using IBM SPSS v23. The mean age of the 133 treatment-resistant chronic myeloid leukemia patients included in the study was 47.3 &#xb1; 13.6 years. The majority of cases (62.4%) were male and 79 (59.4%) patients were currently on imatinib therapy. The median BCR::ABL1 level, as measured by quantitative polymerase chain reaction, was 30.73% (range: 1.17-100%) International Scale. BCR::ABL1 kinase domain mutations were detected in 57 (42.9%) patients. E255K was the most common mutation detected in 45 (33.8%) cases, followed by E255V in 11 (8.3%), T315I in 1 (0.8%) and the Y253H mutation in 1 (0.8%) patient. The presence of kinase domain mutations was significantly associated with higher total leucocyte count (p = 0.002), while the E255K mutation was significantly associated with blast crisis (p = 0.048). This study revealed a high prevalence of BCR::ABL1 kinase domain mutations in Pakistani chronic myeloid leukemia patients. E255K, the most frequently detected mutation, was significantly associated with blast crisis. These findings underscore the significance of molecular testing for personalized treatment.

Ovarian aging is a critical factor influencing reproductive capacity and overall health. Granulosa cells (GCs) play essential roles in folliculogenesis; however, the mechanisms by which GC dysfunction contributes to ovarian aging remain incompletely understood. In this study, we identified insulin-like growth factor binding protein 4 (IGFBP4) as a negative regulator of ovarian function that is upregulated in GCs from aged cynomolgus monkey ovaries. Using an Igfbp4-HA tagged mouse model, we found that IGFBP4 expression in GCs increased during follicle development and was further elevated in aged mice. RNA-seq analysis of Igfbp4-deficient GCs revealed activation of the YAP pathway, which supports follicular development. Mechanistically, IGFBP4 reduced YAP nuclear localization in GCs, thereby restraining downstream YAP target gene expression and GC proliferation. In Amhr2-Cre; Igfbp4fl/fl mice, GC-specific deletion of Igfbp4 enhanced folliculogenesis, increased litter size and preserved reproductive performance with age. Elevated IGFBP4 levels were also detected in GCs from aging women and patients with premature ovarian insufficiency (POI). Furthermore, higher concentrations of IGFBP4 were observed in the follicular fluid of POI patients, supporting its potential as a biomarker of ovarian dysfunction. These findings establish IGFBP4 as a GC-derived suppressor of ovarian function and a potential target for preserving ovarian function during aging.

Emotional stress in conflict zones may impact cardiovascular health, particularly acute coronary syndrome incidence. This retrospective study assesses the Israel-Hamas conflict's impact on ST-elevation myocardial infarction (STEMI) by comparing admissions during conflict versus previous years. Using Clalit Israeli data center records, we conducted multi-level STEMI analysis: (1) conflict period (October 2023-October 2024) versus preceding year, (2) outbreak day and subsequent week analysis, (3) comprehensive trend analysis (2013-2024), and (4) geographic distribution across nine hospitals. Sudden cardiac death (SCD) patterns were analyzed throughout 2023. The primary outcome was the comparison of STEMI incidence between conflict and non-conflict periods. Secondary outcomes included risk factors and post-STEMI left ventricular ejection fraction (LVEF). STEMI incidence increased non-significantly from 526.03 to 539.62 per 100,000 during the conflict period compared with the pre-conflict year (P&#x2009;=&#x2009;0.85). No significant increase occurred on October 7, 2023, or during the following week compared to 2022. Geographic analysis revealed stable hospital-specific STEMI proportions (p&#x2009;>&#x2009;0.05). SCD demonstrated minimal variation (October 2023: 6 cases; pre-conflict monthly average: 2.9 cases) and subsequently returned to baseline. Decade-long analysis revealed a gradual increase in STEMI from 377.68 per 100,000 (2013-2014) to 539.62 per 100,000 (2023-2024). LVEF improved from 46.9% to 51.8% despite a non-significant mortality increase (16.29 to 17.96 per 100,000, P&#x2009;=&#x2009;0.2). Acute conflict-related stress did not significantly impact STEMI incidence beyond established progressive trends. These findings are consistent with, though do not prove, population-level attenuation of acute cardiovascular stress responses. The lack of significance should be interpreted with caution, given potential confounders and limited power. Continued surveillance and the inclusion of care-quality metrics in future analyses are warranted.

Schizophrenia is a complex neuropsychiatric disorder associated with genetic variants of the dystrobrevin-binding protein 1 (Dtnbp1) gene. While cognitive deficits in male Dtnbp1 mutant mice are well-documented, the impact of this mutation on female subjects remains underexplored. This study investigated the behavioral and molecular effects of Dtnbp1 deficiency in male and female knockout (Dys-/-) mice, highlighting sex-specific cognitive, social, and molecular signaling impairments relevant to schizophrenia. Female Dys-/- mice exhibited an anxiolytic phenotype with intact threat memory and normal novel object recognition memory. However, they displayed profound deficits in temporal order recognition memory and multiple domains of social behavior. Conversely, male Dys-/- mice largely maintained normal social recognition. Molecular analyses revealed dysregulation of the dopaminergic system specifically in the prefrontal cortex (PFC) of female Dys-/- mice. This dysfunction was characterized by reduced mRNA expression of the dopamine receptors D1 (Drd1) and D2 (Drd2), as well as aberrant activity of canonical (DARPP-32) and noncanonical (GSK3&#x3b2;) signaling pathways. Collectively, these findings demonstrate that dysbindin-1 deficiency drives distinct, female-specific vulnerabilities in behavioral and molecular alterations relevant to neuropsychiatric conditions, providing insight into the sex-dependent pathophysiology of social and cognitive deficits in preclinical models of schizophrenia.

To identify independent predictors of pulmonary hypertension (PH) on echocardiography in chronic obstructive pulmonary disease (COPD) patients during acute exacerbations. We retrospectively enrolled 151 patients hospitalized for acute COPD exacerbation. Patients were divided by echocardiography into COPD with PH (n=75) and COPD without PH (n=76) groups. LASSO regression screened 17 laboratory indicators to identify the optimal variable subset. Multivariate logistic regression determined independent PH predictors, and a nomogram was constructed. The discrimination and calibration of model were assessed. LASSO regression analysis screened out 6 optimal variables (age, albumin, cystatin C, red blood cell distribution width (RDW), pH, and CD4/CD8 ratio). Multivariate logistic regression analysis revealed that serum albumin, cystatin C, RDW, pH, and age were independent predictors of PH. The nomogram constructed using these six variables (age, serum albumin, cystatin C, RDW, CD4/CD8 ratio, and pH) demonstrated a C-index of 0.800 (95&#x202f;% CI: 0.731-0.869). The calibration curve showed that the predicted probability of the model was in good agreement with the actual observed values. The nomogram constructed based on 6 variables has good predictive efficacy for PH on echocardiography in COPD patients during acute exacerbations. It can provide a convenient risk stratification tool for clinical practice.

Armed conflicts can deteriorate environmental conditions, including air quality, yet their short-term health implications remain underexplored. This study assessed the impact of the 2024 Beirut conflict on air pollution and associated respiratory and dermatological risks. Satellite-derived air pollution concentrations for Beirut's Southern Suburbs were compared between the pre-war period (Aug. 1-Sep. 22, 2024) and the war period (Sep. 23-Nov. 29, 2024), using Mann-Whitney U and independent t-tests. Ground-level PM2.5 was measured across 5 sites from October 25 to November 3, 2024. Relative risk (RR) and attributable risk percentage (AR%) for hospital admissions were estimated using exposure-response functions from the Beirut Air Pollution and Health Effects (BAPHE) study. WHO's AirQ+ tool was applied for the validation of respiratory outcomes. Median PM2.5 increased from 15.11 &#x3bc;g/m3 pre-war satellite period to 20.21 &#x3bc;g/m3 during the war. Ground-measured wartime median increased from 19.33 &#x3bc;g/m3 to 22.16 &#x3bc;g/m3 in the direct war zone (DWZ). Wartime respiratory admissions increased modestly (RR = 1.011, AR% = 1.13%) in DWZ, while skin disease admissions were higher in DWZ (RR = 1.032, AR% = 3.10%). AirQ+ estimates were aligned with BAPHE-based findings. The 2024 Beirut conflict elevated air pollution, with measurable short-term health impacts, underscoring the need for environmental monitoring and preparedness during armed conflicts.

The Little Book of Bad Wounds by Yvette Godwin is a concise field manual intended to guide civilian surgeons managing complex traumatic and wartime wounds in resource-limited environments. Written from the perspective of frontline surgical experience rather than tertiary academic practice, the text emphasizes practical wound stabilization strategies over definitive reconstruction and introduces the concept of the "delayed acute wound" (DAW), a wound that may present days after injury yet still requires acute management principles. This editorial evaluates the book's practicality, readability, and consistency with current wound care literature. Godwin work succeeds in presenting a highly accessible framework for the management of blast and ballistic injuries, particularly its "blueprint recipe" structure, which allows for rapid bedside reference. The text appropriately emphasizes repeated debridement, antimicrobial stewardship, preservation of reconstructive options, and the clinical significance of biofilm in delayed traumatic wounds. Additional strengths include pragmatic discussion of austere-resource solutions, realistic commentary on limb salvage versus amputation, and a writing style that remains engaging without sacrificing clinical utility. Several recommendations, however, differ from current guideline-supported practice and warrant contextualization. These include the use of high-concentration povidone-iodine solutions, broad rejection of pulse lavage, omission of negative pressure wound therapy, and selective recommendations regarding topical antimicrobials and antibiotic timing. While many of these viewpoints are grounded in extensive field experience, they should be interpreted as practice-based recommendations rather than universal standards of care. Despite these limitations, The Little Book of Bad Wounds provides a valuable and timely contribution to modern reconstructive and wartime wound literature. As civilian health care systems increasingly encounter injuries associated with armed conflict and mass trauma, this work offers surgeons a practical framework for stabilizing complex wounds in compromised circumstances. When used with appropriate clinical discernment, the book serves as an effective field guide for surgeons managing devastating injuries under austere conditions.

Acute spinal cord injury (ASCI) causes severe dysfunction, with secondary ECM remodelling being more destructive than primary injury. Macrophages regulate neuroinflammation and ECM remodelling in ASCI. Studies shown ECM related gene Lgals3 regulate macrophage polarization across various diseases. However, the role of Lgals3 in ASCI-related ECM remodelling and neuroinflammation remains unclear. We integrated Single-cell RNA Sequencing (ScRNA-seq) analysis with in vitro and in vivo experiments. An ECM-related gene set was constructed for bioinformatic analyses of cell clustering, pseudotime trajectory, cell-cell communication, and transcription factor activity. LPS+IFN-&#x3b3;-induced RAW264.7 macrophages were treated with the Lgals3 inhibitor GB1107, and the Lgals3/NF-&#x3ba;B/p65/Ccl2 axis was further dissected by siRNA-mediated Lgals3 knockdown, pharmacological NF-&#x3ba;B inhibition with QNZ, and TNF-&#x3b1;-mediated NF-&#x3ba;B reactivation rescue. ASCI models in SD rats were assessed via multiplex immunohistochemistry (mIHC), histology, TUNEL, western blot, and qRT-PCR. Seven cell types were identified in the ASCI microenvironment, with macrophages showing the most upregulated ECM-related genes. Four ECM-associated macrophage subtypes were defined; Lgals3high macrophages (Mac-1), characterized by high Lgals3 and Ccl2 expression, dominated early-phase ASCI. Mac-1 exhibited the strongest intercellular communication with prominent CCL signalling pathway activation. Lgals3, Ccl2, and p65 were specifically upregulated in M1 macrophages post-ASCI, with p65 nuclear translocation. GB1107 inhibited NF-&#x3ba;B, promoted M1-to-M2 polarization, reduced inflammatory infiltration and ECM remodelling, and decreased apoptosis. Mechanistically, siRNA-mediated Lgals3 silencing suppressed NF-&#x3ba;B/p65 activation and Ccl2 expression while inducing Arg1; this phenotype was recapitulated by NF-&#x3ba;B inhibition and reversed by TNF-&#x3b1;-driven NF-&#x3ba;B reactivation, validating the Lgals3/NF-&#x3ba;B/p65/Ccl2 axis as the obligate regulatory backbone of macrophage polarization. Lgals3high macrophages are core drivers of ECM remodelling in ASCI via a Lgals3/NF-&#x3ba;B/p65/Ccl2 signalling axis that couples M1 polarization with monocyte recruitment. GB1107 disrupts this axis, reprograms macrophages from M1 to M2, attenuates inflammatory infiltration and ECM remodelling, and reduces apoptosis. GB1107 exerts therapeutic effects by regulating macrophage polarization and ECM remodelling, providing a novel "immune-matrix" dual-targeting strategy.

Female genital cosmetic surgery (FGCS) became popular in recent decades. Many patients worldwide consider these procedures for medical or esthetic reasons. Previous literature indicates a significant gap in public understanding of the risks, benefits, and recovery processes associated with FGCS. This study aims to assess the knowledge and attitudes of healthcare providers in Makkah clusters regarding FGCS. A cross-sectional study was conducted on 142 participants from Makkah cluster facilities, including general practitioners (GPs), gynecologists, surgeons, nurses, medical interns, and medical students, from July to September 2025. Data was analyzed using SPSS software. Descriptive statistics and Chi-square tests were used to measure knowledge and awareness levels, and to assess the associations between cultural beliefs and awareness. Most of the respondents were females and residents. Consultants and specialists showed a lower agreement on having adequate knowledge of FGCS. About 78.2% of workers felt they lacked adequate knowledge of FCGS. Only 26.8% felt confident about labiaplasty, and <10% in other procedures. Nearly half of the participants were not sufficiently aware of the procedures' risks. During GPs' consultations of FGCS, the most used information sources were anatomy books. Relationship difficulties and body dysmorphia were the most common identified psychological issues by GPs. Partners' comments were the most significant social factor influencing women's decisions in these procedures. Furthermore, GPs were often seen as educators. The study reveals a significant gap in knowledge and confidence among healthcare providers in FGCS. Creating accessible materials and educating healthcare providers can raise awareness and the quality of care.

We aimed to explore the critical role of PIK3R3 in pan-cancer, which to facilitate the development of more targeted prognostic markers and therapeutic strategies for these malignancies. In our study, pan-cancer transcriptome datasets were retrieved from Xena database. Subsequently, utilizing the Wilcoxon test, univariate Cox regression analysis as well as Kaplan-Meier (K-M) survival analysis to identify cancer types with high relevance to PIK3R3. Clinical metadata were stratified for correlation analysis, followed by differential expression gene (DEG) identification, overrepresentation analysis, and various functional analysis methods. Lower-grade glioma (LGG), kidney renal clear cell carcinoma (KIRC), liver hepatocellular carcinoma (LIHC), lung adenocarcinoma (LUAD), and uterine corpus endometrial carcinoma (UCEC) exhibited strong associations with PIK3R3. PIK3R3 was closely linked to tumor grade stratification in LGG and UCEC and likely regulated these cancers via pathways such as lipid metabolism. Notably, UCEC showed high-level PIK3R3 mutations, mainly involving mutation and amplification. Compounds including Tetrachlorodibenzodioxin (TCDD), 1-Methyl-4-phenylpyridinium (MPP+), Estradiol, and Valproic Acid were predicted to target PIK3R3. Our results provide novel insights into the molecular mechanisms underlying PIK3R3-associated tumorigenesis and progression, which may contribute to the development of more targeted prognosis markers and therapeutic strategies for these malignancies.

Continuing professional development (CPD) plays a vital role in maintaining the competence of health professionals and ensuring quality health care. Health emergencies such as the coronavirus disease 2019 (COVID-19) pandemic and armed conflicts globally have disrupted traditional educational formats and accelerated the adoption of digital and online learning. This study explores the Armenian experience of CME transformation during recent crises, focusing on the transition to online education, its outcomes, challenges, and opportunities for long-term reform. A descriptive analysis of CME/CPD activities conducted in Armenia during and after the COVID-19 pandemic and the 44-day War in Nagorno-Karabakh in 2020 was performed. Data on the number of online courses and participants were collected, and findings were interpreted in the context of international developments in CME/CPD during health emergencies. Armenia experienced a significant increase in online CME offerings and participation during recent crises, aligning with global trends. The shift ensured continuity of professional education, expanded access to rural areas, and enhanced workforce preparedness. However, challenges emerged, including the absence of a comprehensive regulatory framework, limited quality assurance mechanisms, and concerns regarding sustainability and equity. Armenia's experience reflects global patterns of emergency-driven innovation in CME but also highlights specific national challenges. Lessons from international practice demonstrate the need for stronger regulation, monitoring and integration of CME with workforce planning systems. The Armenian experience demonstrates how a health workforce development system adapted to substantial challenges through the rapid expansion of digitally enabled CME/CPD, regulatory flexibility, and international collaboration. While further research is needed to assess long-term educational and workforce outcomes, the findings suggest that adaptive educational infrastructures may represent an important component of health workforce resilience during periods of crisis and recovery.

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Background and Aims: To develop an inclusive, predictive framework for hepatocellular carcinoma patients, beyond what the Barcelona Clinic Liver Cancer (BCLC) staging system captures alone, non-invasive scores have emerged as potential contributors. Among them, the CRAFITY score (CRP and AFP in ImmunoTherapY), originally developed for immunotherapy-treated HCC populations, and the Platelet-Albumin-Bilirubin (PALBI) score have shown promising prognostic performance in selected cohorts. Likewise, the macrotrabecular-massive (MTM) histological subtype has been identified as a strong independent predictor of tumor recurrence, particularly in surgical series; whether it retains the prognostic significance in a mixed-treatment cohort remains unexplored. We aimed to evaluate the independent prognostic performance of CRAFITY and PALBI across all HCC treatment modalities, determine MTM prevalence and assess whether histological subtyping adds prognostic value beyond these readily available clinical scores. Methods: The study included 500 consecutive, pathologically confirmed HCC patients at a tertiary gastroenterology center in Cluj-Napoca, Romania. MTM subtype was defined as >50% macrotrabecular architectural pattern on histological review by two senior pathologists. Overall survival (OS) and recurrence-free survival (RFS) were assessed by Kaplan-Meier analysis and multivariable Cox regression. A random survival forest (RSF) model was constructed to identify dominant prognostic predictors. Results: MTM was identified in 14 patients (2.8%) and did not independently predict OS (HR 0.94, 95% CI 0.49-1.81, p = 0.85) or recurrence (OR 3.78, p = 0.116). In this heterogeneous cohort spanning multiple treatment modalities, CRAFITY (HR 1.68, 95% CI 1.42-1.98, p < 0.001) and PALBI (HR 1.51, 95% CI 1.22-1.87, p < 0.001) were strong independent predictors of OS after BCLC stage. RSF analysis confirmed this hierarchy with a C-index of 0.734. Conclusions: CRAFITY and PALBI demonstrated strong, independent predictive performance for a large, underrepresented, heterogenous Eastern European HCC cohort. In contrast, MTM subtype showed limited prognostic value in this cohort. The results support the broader applicability of CRAFITY beyond its original immunotherapy context and underline the low prevalence of MTM subtype.