Rooted in "the real human being and their practice", the humanistic thought of Traditional Chinese Medicine (TCM) encompasses four core dimensions: the Theory of Valuing Life and Attaining Sagehood, the Theory of Temperament and Human Nature, the Theory of Subject Mutual Benefit, and the Theory of Body-State Synchronism. It provides crucial support for the mutual learning of Chinese and Western medical humanities. The Theory of Valuing Life and Attaining Sagehood resonates with Western bioethics while adding a unique dimension of spiritual self-cultivation; the Theory of Temperament and Human Nature aligns with the precision medicine paradigm and complements the perspective of cultural ethical examination; the Theory of Subject Mutual Benefit firmly opposes the objectification of patients and theoretically expands the Western concept of "patient-centered care"; the Theory of Body-State Synchronism integrates individual physical and mental health with collective public well-being, aligning with the core values of contemporary global health governance. As an ideological system deeply embedded in Chinese civilization, it takes the Qi ontology and Yin-Yang balance as its profound metaphysical foundation, constructing a holistic medical humanistic paradigm independent of the Western biomedical model. In the contemporary academic context where medical humanities are moving toward pluralistic coexistence, the value of non-Western medical traditions has attracted increasing scholarly attention. It can not only enrich the Western medical humanistic tradition through cross-cultural dialogue but also provide solid ethical support for the global dissemination and clinical practice of TCM, ultimately realizing two-way mutual learning, complementarity and symbiosis between Eastern and Western medical humanities across cultures.
Child and Adolescent Mental Health Services (CAMHS) are currently marked by a paradox: growing public recognition of youth mental health difficulties coincides with increasingly fragile and underresourced services. Beyond organisational strain, the field is shaped by competing narratives about its mission and limits (hopeful progressivism which emphasises innovation, early intervention and developmental plasticity; on the other, defensive pessimism which foregrounds chronicity, clinical realism and institutional constraint. To examine how these competing narratives operate within CAMHS and to articulate an alternative orientation capable of supporting ethical clinical practice. A conceptual and narrative analysis drawing on medical humanities and social sciences perspectives, in particular the concept of moral economy, illustrated by a clinical vignette. Hopeful progressivism and defensive pessimism function as moral postures that distribute responsibility, legitimacy and emotional labour within institutions, with hope and cynicism operating as institutional currencies. Although seemingly opposed, both positions risk obscuring the structural determinants of care and relocating difficulties onto clinicians or families. Rather than choosing between optimism and cynicism, CAMHS may benefit from holding these narratives in productive tension through a dialogical, reflexive approach that re-centres families and re-politicizes the conditions of care. A form of realistic hope, grounded in developmental temporality and attentive to material conditions is essential to ethical and clinically meaningful care.
The study of human anatomy is foundational to education and research in the anatomical and health sciences. In 2012, the International Federation of Associations of Anatomists (IFAA) first published Recommendations to promote ethical practice in the acquisition of human remains for this purpose. In the intervening period, increased awareness of contemporary ethical issues and challenges in the discipline have made revision necessary. These revised Recommendations update and expand prior guidance to reflect evolving sociocultural expectations and technological developments, including revisions that address new concerns such as the international transfer of human remains. The 2026 Recommendations, developed by the Federative International Committee for Ethics and Medical Humanities (FICEM) of the IFAA, provide an updated framework to assist institutions in strengthening or establishing body donation programs to meet contemporary international ethical expectations. They also acknowledge that institutions may acquire human remains through avenues other than body donation programs, incorporating guidance around multiple aspects of good practice where use of human remains occurs. Through the use of these revised Recommendations, it is hoped the global anatomy community can continue to develop and apply ethical practices while promoting and supporting the sustainable use of human remains in anatomical education and research.
The increasing integration of artificial intelligence in clinical decision support systems (AI-CDSS) has fueled expectations of more personalized and effective diagnostics and therapies. By incorporating machine learning methods, AI-CDSS promise enhanced predictive accuracy, improved stratification, and innovative individualized care. However, this technological optimism is accompanied by complex ethical challenges, including issues of explainability, trust, autonomy, and data security. At the core of these debates lies the question of responsibility, which involves both its attribution and diffusion, as well as the underlying normative standards guiding moral action. In the context of healthcare practice, responsibility is further complicated by moral diversity-the coexistence of varying moral values, cultural beliefs, and ethical frameworks among healthcare professionals, patients, and institutional stakeholders. This plurality challenges the establishment of a unified normative standard necessary for ethically sound responsibility attribution. This paper offers an analysis of moral diversity and AI-CDSS as a challenge for responsibility in healthcare environments. Using a relational concept of responsibility the study examines key areas in which moral diversity affects responsibility in AI-mediated decision-making. This includes algorithmic bias, healthcare professional and patient interaction and the role of patients. Through these examples, the paper explains how different normative standards intensify ethical complexity in AI-supported clinical contexts. It argues that greater ethical sensitivity to moral diversity is essential-both in the development of AI-CDSS and in their application within morally value-laden healthcare situations.
Chronic urticaria is a common skin disorder that substantially affects both daily functioning and quality of life. Among its subtypes, chronic inducible urticaria often presents with greater therapeutic challenges than chronic spontaneous urticaria. A comprehensive review of the available evidence indicates that β-blockers may offer a rapid-acting, well-tolerated, and effective treatment option for patients with specific subtypes of chronic inducible urticaria specifically cholinergic urticaria, adrenergic urticaria, and the aquagenic continuum. This approach introduces a readily available, non-parenteral, and cost-efficient therapeutic alternative that could also yield novel insights into the underlying pathophysiology of urticaria. In addition, this manuscript underscores the need to update current clinical guidelines by: (1) recognizing adrenergic urticaria as a distinct chronic inducible urticaria subtype; (2) broadening the conceptual framework for aquagenic-induced symptoms; and (3) standardizing intradermal test concentrations for adrenergic and cholinergic urticaria.
Studies have reported unmet healthcare needs among people with intellectual disability. However, there appears to be a lack of research examining the use of mental health services. The purpose of the present study was to address this knowledge gap and examine characteristics associated with use of the services in Norway. A cross-sectional community-based survey including 199 adult participants (55% men) with intellectual disabilities. Assessment comprised the POMONA-15 health indicators and instruments designed to assess aberrant behavior (The Aberrant Behavior Checklist-Community, ABC-C) and screen for possible mental health problems (Moss Psychiatric Assessment Schedules-Check, MPAS-Check). During the last year, 49% of the participants had received specialist mental healthcare and/or specialized habilitation services. Further, 18% scored above threshold on the MPAS-Check, and the prevalence of challenging behavior in our sample was estimated to be 16% using the ABC-C. The presence of challenging behavior, indicated by the ABC-C, was found to significantly increase the odds of using specialist mental healthcare and/or specialized habilitation services. When developing policies and measures to improve access to mental health care services, it is important to consider factors that serve as barriers and facilitators to access. Our findings indicate that psychotropic medication is primarily managed by general practitioners and suggest a potential gap in follow-up of these medications by specialist mental health and specialized habilitation services.
Preoperative physiotherapy in patients receiving primary total knee arthroplasty (TKA) aims to relieve pain, delay surgery, and improve postoperative recovery. This study investigates the change in PROMs and pain after primary TKA between patients who received preoperative physiotherapy (P) and those who did not (NP). Registry-based cohort study with data from an institutional registry. 1,688 patients followed a standardized fast-track clinical pathway between August 2017 and January 2024 and were grouped in P or NP. Primary outcome was KOOS-PS at 2 months and 1 year postoperatively. Secondary outcomes included pain, the Forgotten Joint Score, and EQ-5d-5L. Two anchor questions related to self-perceived knee function and willingness to have the surgery again at 12 months' follow-up were also evaluated. The model estimate demonstrated no significant between-group difference in KOOS-PS at 2 months (1.12 points; p = 0.079) or 1-year follow-up (1.25 points; p = 0.097). Visual inspection of descriptive plots showed that NP patients had higher KOOS-PS, less pain, and better joint score and quality of life at all time points. At 12 months' follow-up, both groups had similar responses to the anchor questions. After adjustment for baseline differences, no between-group differences in postoperative self-reported physical function were observed; consistently lower scores in the physiotherapy group may reflect systematic preoperative differences between groups.
CLL patients have immune deficiencies and are at high risk of SARS-CoV-2 infection. Limited research exists on risk factors and survival outcomes of SARS-CoV-2 infection in Asian CLL patients during the COVID-19 pandemic. Therefore, this study aims to explore the relationship between SARS-CoV-2 infection and survival in this population. A retrospective analysis was conducted on 119 CLL patients treated at a large tertiary comprehensive hospital in western China from January 2020 to May 2023, coinciding with a surge in the epidemic in the city. (1) During the epidemic, the treatment group had a higher proportion of males, second-line and initial treatment, 11q- chromosome, LDH level, and lower erythrocyte count (P < 0.05). Patients in this group had longer median duration of malaise, more headaches and coughs, longer cough and sputum duration, higher rates of hyposmia, and more patients received antiviral treatment for COVID-19 and suffered weight loss. The treatment group had more CLL patients affected by SARS-CoV-2, and more patients developed secondary COVID-19 infection, and had lower RBC count and hemoglobin levels (P < 0.05). (2) Compared to the non-BTKi treatment group, more patients in BTKi treatment received treatment lasting ≥ 1 month, more had abnormal karyotyping, high-risk cytogenetics, less recent cytotoxic drug and rituximab exposure, lower lymphocyte count, elevated creatinine level, and lower glomerular filtration rate (P < 0.05). (3) Firth's penalised-likelihood logistic regression revealed that male sex increased hospitalization risk, while normal karyotyping decreased this risk. Male sex and recent rituximab exposure (within 6 months) were SARS-CoV-2 infection risk factors. Both frontline and second-or-more line therapies were associated with higher SARS-CoV-2 mortality risk compared to untreated patients (all P < 0.05). Male sex and recent exposure to rituximab within the past six months are risk factors for SARS-CoV-2 infection in CLL patients. Both frontline and second-or-more line therapies are risk factors for mortality (compared to untreated patients). Treatment with BTK inhibitors does not increase the risk of SARS-CoV-2 infection or mortality.
Cell Structure and Function (CSF), the official journal of the Japan Society for Cell Biology (JSCB), celebrates its 50th anniversary in 2025. This essay traces the scientific evolution of CSF from its founding in 1975 to the present, drawing on bibliometric data retrieved from OpenAlex at ten-year intervals. Over five decades, CSF published 1,737 articles, with the Field-Weighted Citation Impact (FWCI) showing a consistent upward trend, even as total output declined following the journal's shift to electronic publication in 2005. A decade-by-decade analysis of the five most-cited articles reveals a clear evolution in research themes: early issues were dominated by plant cell biology and methodological papers in microscopy and biochemistry, while subsequent decades saw increasing focus on autophagy, the unfolded protein response, and intracellular membrane trafficking-fields in which Japanese researchers have played globally recognized pioneering roles. The turn of the millennium marked a peak in absolute citations, with landmark papers on bafilomycin A1, SNARE proteins, and a review of autophagy co-authored by Nobel Prize laureate Yoshinori Ohsumi. Two major milestones-electronic publication in 2005 and gold open-access adoption in 2016-fundamentally transformed the journal's publishing model. Looking ahead, the essay considers the role of artificial intelligence in peer review, arguing that while AI can assist in assessing novelty and reproducibility, the judgment of a manuscript's scientific significance must remain a human responsibility. CSF remains committed to disseminating reliable, foundational cell biology to the international community.Key words: Cell Structure and Function (CSF), bibliometrics, open access, artificial intelligence in peer review.
Financial toxicity (FT), encompassing objective and subjective impacts of cancer care costs, is linked to poorer quality of life, reduced treatment adherence, and higher mortality. While patient-level risk factors have been examined, a system-level perspective incorporating socioeconomic context is needed to understand global variation in FT. MEDLINE, CINAHL, Embase, and Web of Science were searched from inception to 06/27/2025 for peer-reviewed, English-language studies describing self-reported FT outcomes among adults with cancer. Reviewers extracted study characteristics, FT prevalence, predictors, and measurement tools. Financial, physical, and social asset measures from the World Bank were merged with FT data by study country and year of data collection. Focusing on studies reporting Comprehensive Score for Financial Toxicity (COST) scores, multilevel random effects meta-analysis was performed. Univariate and multivariate multilevel meta-regression evaluated relationships between country-level assets and COST. One hundred thirty-two studies from 22 countries were included, with FT prevalence ranging from 4.0% to 100.0%. Three-level meta-analysis of 75 COST-based studies (15 countries; 83,623 patients) yielded a pooled mean COST score of 21.2 (95% CI: 19.1-23.3; 95% prediction interval: 13.3-32.4), though substantial heterogeneity (I2 = 99.2%) and a predominance of studies from the US (55%) limited its standalone interpretability. Variance decomposition showed that 46% of heterogeneity was attributable to between-country differences. Higher log GDP per capita was associated with higher COST (β = 4.44, 95% CI: 2.90-5.98), explaining 43.1% of between-country variance. Higher out-of-pocket health expenditure, population-level financial hardship, and vulnerable employment were associated with worse FT. GDP associations were robust to sensitivity analyses excluding US-based studies. FT among cancer patients is linked to structural conditions governing access to education, employment, and financial systems, although expanded research in low-resource settings is needed. These findings highlight the roles of economic development strategies and investment in human capital in helping to safeguard against population-level FT.
Musicians demonstrate advantages in acquiring motor sequences, showing faster learning and better explicit sequence knowledge than non-musicians. However, it is unclear whether this advantage extends beyond acquisition to the consolidation phase, which is when newly learned skills stabilize and become resistant to interference. Additionally, while interference from executing competing motor tasks is well-established, less is known about whether purely sensory information presented after learning can disrupt consolidation of a bimodal motor sequence. We investigated how post-acquisition sensory interference affects performance of a learned audio-visual sequence, and whether musical training moderates this vulnerability. Participants first learned an explicit sequence in a serial reaction time task using synchronous, informative audio-visual cues. After a brief consolidation period, they were randomly assigned to one of four observational conditions that manipulated the relationship between auditory and visual streams. Motor performance was then reassessed. Post-acquisition sensory interference impaired subsequent motor performance, but this effect was modality-specific: it was driven primarily by manipulations to the task-relevant visual stream, while auditory interference alone had no credible effect. Distributional analysis revealed that learning involved a strategic shift from reactive to anticipatory responding. Critically, participants with musical training showed a consistently higher reliance on anticipatory responses than those without throughout acquisition, indicating stronger predictive motor control. These findings demonstrate that newly formed sensorimotor memories are selectively vulnerable to interference in task-relevant modalities. Furthermore, our work provides a candidate mechanistic account for the musician advantage in sequence learning, linking it to greater reliance on predictive motor strategies during acquisition.
Inherited metabolic diseases are genetic diseases that are individually rare but collectively common. Although they are classically considered as pediatric diseases, many patients are seen in adulthood, either due to a misdiagnosis over several years or a late initial presentation. A diagnosis in adulthood is crucial because it can lead to the implementation of specific treatments that improve patients' quality of life. Once a diagnosis is made, specialized genetic counseling helps identify and potentially treat other at-risk family members. Les maladies héréditaires du métabolisme sont des maladies génétiques rares individuellement, mais fréquentes collectivement dans la population générale. Bien qu’elles soient classiquement considérées comme des maladies pédiatriques, de nombreux patients sont diagnostiqués à l’âge adulte, soit après une errance diagnostique de plusieurs années, soit en raison d’une présentation initiale tardive. Le diagnostic à l’âge adulte est très important, car il peut permettre de mettre en place des traitements spécifiques qui améliorent la qualité de vie des patients. Une fois le diagnostic posé, le conseil génétique spécialisé aide à identifier et, le cas échéant, à traiter d’autres membres de la famille à risque.
Gratitude, a recognized protective factor for mental health state in students with disabilities, has garnered substantial research attention in Western contexts. However, its role among Chinese deaf and hard-of-hearing (DHH) adolescents remains underexplored, particularly regarding mechanisms linking gratitude to psychological well-being beyond psychopathological frameworks. Based on a sample of 102 DHH students across Grades 7-12 (mean age = 17.8 years) from two special education schools, the present study attempted to examine the mediating roles of gratitude, affect balance, and self-esteem in the association between gratitude and mental health outcomes. Results indicated that DHH youths reported a relatively high level of gratitude. Gratitude was positively associated with mental health outcomes through enhanced affect balance. This work deepens understanding of the interaction between gratitude and psychological well-being, paving the way for future intervention focusing on gratitude cultivation and mental health prevention programs within DHH educational frameworks.
Health education plays a critical role in managing congenital anomalies like cleft lip and palate (CL/P). It equips parents with the knowledge and confidence needed for effective care, addressing medical, nutritional, and psychosocial challenges. In Ghana, where CL/P prevalence exceeds the global average and no national health education guidelines exist, initiatives often overlook culturally tailored approaches. To explore health education perceptions and barriers faced by Ghanaian parents of children with CL/P, guided by the social-ecological model at Komfo Anokye Teaching Hospital, Kumasi, Ghana. This qualitative study collected data through face-to-face, in-depth semi-structured interviews. Using criterion-based purposive sampling with maximum variation, parents of children with CL/P who visited the Department of Maxillofacial Surgery at the Komfo Anokye Teaching Hospital in Kumasi, Ghana, were selected. Thematic content analysis was employed to interpret the data and identify themes and subthemes. Three themes were identified from analysis of data from 21 parents: 1) social challenges in educational and community settings; 2) inadequate health education information, characterized by overreliance on hospital-based oral instruction with limited availability of written or visual materials; and 3) lack of support facilities, organizations, and government policies beyond the hospital setting. Findings reveal multilevel barriers to effective CL/P health education in Ghana, including knowledge gaps, community stigma, limited organizational support, and absent national policy guidelines. Addressing multilevel barriers to CL/P health education in Ghana requires culturally appropriate, multilingual materials; community outreach beyond hospitals; and national guidelines to improve outcomes for children with CL/P. Participants, while satisfied with surgical care, highlighted the need for better access to educational materials, stronger support networks, and greater public awareness to improve outcomes for children with CL/P.Knowledge Transfer Statement:This study provides important findings to inform community health education programs for parents, training workshops for clinicians on family-centered care, and policy briefs to inform health care leaders. It highlights the need to develop culturally appropriate educational materials to bridge knowledge gaps. Strengthening collaboration between hospitals, schools, and local governments will ensure that improved health education, psychosocial support, and outreach services are integrated into cleft care initiatives, ultimately enhancing outcomes for children with orofacial clefts.
This study explores community perspectives on operationalizing ethical values in genomic research involving individuals with low grade glioma (LGG) brain tumors - a condition in which genomic characterization is central to diagnosis, prognosis, and treatment. We conducted qualitative directed content analysis of data generated in the course of 11 facilitated engagement discussions conducted via a research advisory council and established brain tumor communities on social media with LGG genomic research community members-including patients, care partners, clinicians, and researchers. This analysis of data from LGG community engagement examines how operationalizing ethical values of autonomy, privacy, ownership, and relevance may guide participant recruitment, communication, and return of results LGG genomic studies. Engagement participants expressed strong support for receiving both individual and aggregate research results, viewing this as a matter of reciprocity and recognition for contributions to research. While engagement participants valued transparency and control over their data and specimens, many held misconceptions about research processes, including the clinical applicability of research findings and the logistics of specimen use. These findings highlight a gap between potential research participant expectations and current LGG genomic research practices, underscoring the need for clear communication and ethically-grounded participant engagement strategies. This analysis informed LGG genomic research participant recruitment and communication practices, including priorities for returning research results and clarifying data and specimen ownership in LGG genomic research.
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Since early modern times, people suffering from venereal diseases have been subject to social stigmatization. In the German Democratic Republic and in other socialist dictatorships, young women who did not conform to the regime's ideology had to undergo medically unnecessary venereological treatments. At the beginning of the Franco Dictatorship in Spain (1939-1975), the Patronato de Protección a la mujer (Patronage for the Protection of Women) was created, aiming to discipline female adolescents. The state Catholic organization had its own medical service. This paper examines the institutions of the Patronato in Catalonia in order to determine if its venereological practice was influenced by Francoist ideology. We analyzed contemporary publications of the Patronato's national board from the National Catalan Archive in Sant Cugat de Vallès as well as unpublished documents of the Patronato's provincial boards in Catalonia from the Archive of the Spanish Government Representation in Barcelona and the Historical Archive of Lleida. To examine these sources, we implemented the historical-critical method. At the headquarters of the provincial board of the Patronato in Barcelona, there was a treatment room where venereological examinations were carried out against the will of the patients. The Patronato cooperated with the Hospital de la Magdalena, a closed venereology ward to which women with venereal diseases were forcibly admitted for inpatient treatment until this institution was closed in 1959. Since 1963, young women who had been handed over to the Patronato were isolated in a so-called Centro de Observación y Clasificación (Observation and Classification Centre), where they had to undergo extensive medical examinations to determine their further treatment. In all three of the institutions examined in this study, examinations were carried out on the basis of questionable medical indications. The patients were young women who had been referred to the Patronato because they had violated the social norms of the Franco regime. This suggests that the examinations were less a part of medical care and more a part of social control mechanisms.
One of the most persistent problems in transplantation in the U.S. is the demand for organs outweighs the supply. Sequential living donation may be one strategy to address this problem, however a reluctance to perform these surgeries exists secondary to the lack of research on the medical outcomes and quality of life of sequential post-donation. A medical record review of 34 sequential liver and kidney living donors and matched controls (by sex, age within 7 years, timing of surgery, and last organ donated) was performed. No significant difference between groups were observed on sociodemographic characteristics with the exception of age [p = 0.030] and marital status [p = 0.010] whereas matched controls were older and more likely to be married. One sequential donor started a chain for both organs which resulted in 7 transplant candidates receiving an organ. No statistically significant differences were observed in the number of complications [p = 0.081], emergency room visits [p = 0.573], 30-day [p = 0.573], 90-day readmissions [p < 0.999], or physical [p = 0.09] or mental health domains of quality of life [p = 0.78] at six or more months post-donation. Sequential donors returned to tobacco use more often than controls [p = 0.03] and matched controls were more likely to gain weight [p = 0.02] post donation. While further research is warranted, this study provides early evidence of the short-term safety of sequential donation.
This service evaluation of a primary care-based specialist weight management service reports data from 1094 patients over 5 years (2014-2019), including weight data at 1-year post-discharge. The results show clinically and statistically significant improvements in weight, diet, physical activity, quality of life, blood pressure and blood glucose control (in people living with type 2 diabetes). Change in weight was statistically significant for all timepoints in all subgroups. At 1-year completers (n = 560) had lost a mean of 8.3 kg (SD 0.3) and 133 patients (23.8%) had lost ≥ 10% of their starting weight. Using baseline observation carried forward analysis on the whole cohort (n = 1094) the mean weight loss at the end of the 1-year programme was 4.5 kg (SD 0.2) and 144 (13.2%) had lost ≥ 10% of their starting weight. A year after discharge completers demonstrated a mean weight loss of 8.3% (SD 10.3 n = 303) and 35.6% (n = 108) of completers had maintained ≥ 10% change in body weight. Analysis showed a mean weight loss of 2.5% (SD 6.8 n = 1094) in the whole cohort using baseline observation carried forward, demonstrating maintenance of weight loss and suggesting that specialist weight management services in primary care may be effective in the longer-term.
Poly(ADP-ribose) polymerase (PARP) inhibitors have made significant advances in the treatment of breast cancer, especially in tumors with homologous recombination deficiency such as BRCA1/2-mutated cancers. Nevertheless, intrinsic and acquired resistance restrict their clinical usefulness in the long term. This review synthesizes existing evidence about the biological roles of PARPs and the molecular aspects of resistance to PARP inhibition in breast cancer. The major mechanisms of resistance are restoration of homologous recombination, loss of 53BP1, stabilization of replication forks, increased drug efflux, loss of PARG and epigenetic changes. We also discuss the interaction of PARP signaling with key therapeutic pathways, including endocrine, HER2-targeted, and PI3K/AKT signaling and contributes to the tumor microenvironment modulation and immune evasion. Notably, the next-generation PARP1-selective inhibitors, rational combination therapies, and biomarker-guided treatment approaches are emerging strategies that can be used to overcome resistance. All of these observations point towards the necessity to combine mechanistic knowledge with clinical innovation to enhance the selection of patients and the sustainability of therapy. The development of biomarker-mediated and combination approaches will play a vital part in increasing the efficacy of PARP inhibitors and the results achieved among patients with breast cancer.