This paper examines Israel's destruction and 'humanitarianisation' of Palestinian health systems, arguing that this should be understood as an instance of 'necropolitics,' as conceived by Achille Mbembe. We review the extensive, long-term destruction of health systems in Palestine before 7 October 2023 and the catastrophic acceleration of that destruction in Gaza in the years since. We show that this process is central to Israel's project of limiting Palestinian life to what Mbembe calls a 'death world', a space where power is exercised through the systematic exposure of a population to death, and that it serves the security and economic agendas of Israel and its allies. By reducing Palestinians to death-like living conditions through the destruction and subsequent humanitarianisation of health infrastructure, Israel optimises its control over the remaining population of Gaza. We argue that necropolitics, and biopolitics more generally, are vital yet underused tools in bioethics, without which situations of extreme oppression cannot be adequately theorised.
As artificial intelligence (AI) is integrated into health care, it is critical for physicians to understand the ethical foundations of its use in medicine so that they can provide just care to patients and use AI technology to effectively support clinical care. This novel ethics session was designed to provide students with the opportunity to discuss ethical principles related to the use of AI in medicine. We designed a case-based small-group session for preclerkship medical students as part of their required bioethics course. Interdisciplinary bioethics faculty facilitated this session. After the session, participants completed a retrospective pre-post survey with questions on a 5-point Likert scale and open-ended questions. One hundred seventy students attended the session, and 94 completed the survey (response rate 55%). Students reported a stronger understanding of the ethical issues surrounding AI use in medicine following the session. Content analysis of narrative responses showed that students valued the opportunity to discuss AI ethics with peers and facilitators. Students valued this innovative session and recommended it be repeated in future years. Data from this session demonstrate a self-reported improvement in understanding of core bioethics concepts related to AI use in medicine. This case-based small-group session offers a timely and effective approach for integrating core domains of AI ethics-bias and inequity, data privacy and patient autonomy, and potential harms of AI-into the undergraduate medical school education curriculum, providing students with a foundational understanding as they prepare to use AI throughout their careers.
Investigators collecting human brain data are under growing pressure to share data widely to accelerate scientific discovery and improve outcomes in neurological and psychiatric disorders, while at the same time facing increasing concerns about potential misuse of brain data and threats to mental privacy. Several commentators have therefore called for clearer ethical guidance on brain data sharing. This article reviews the bioethics and neuroscience literature on the risks of sharing individual-level human brain data and adds to it using insights from a National Institutes of Health (NIH) workshop and normative analysis. The substantial burden of brain disorders creates a strong ethical imperative to share data. We argue that the risks of sharing brain data are not uniform and depend on both the likelihood of re-identification and the range of inferences that can realistically be drawn from the data given scientific capabilities. Certain types of brain data are more likely to be re-identifiable and to enable sensitive inferences-such as those related to current and future health, behaviour, or identity-relevant traits-and thus could be misused to harm individuals or communities. In these cases, brain data may pose greater risks than many, though not all, other forms of biomedical data. At the same time, strategies to mitigate these risks-such as restricting access or reducing data granularity-may limit the scientific value of shared data. We argue that responsible brain data sharing requires calibrating protections to the specific risks associated with sharing a dataset, enabling data sharing that maximizes scientific and clinical value while protecting participants and maintaining trust. To support this, we propose categories of lower-, medium-, and higher-risk data based on inferential sensitivity and the likelihood of re-identification or linkage to harm-relevant groups. We suggest safeguards to consider across these risk levels, including data collection and sharing practices that limit access to data, informed consent approaches, and data-use governance.
Euthanasia and assisted suicide (EAS) in individuals with mental disorders represents a complex and controversial area at the intersection of clinical practice, bioethics, and medico-legal evaluation. While suffering is inherently subjective in both psychiatric and somatic conditions, psychiatric contexts are characterized by greater fluctuation, contextual dependence, and prognostic uncertainty, which complicate the assessment of its severity, persistence, and potential reversibility in medico-legal evaluations. A structured narrative review of the international literature was conducted, focusing on clinical, ethical, and medico-legal aspects of EAS in psychiatric contexts. Regulatory frameworks and empirical contributions were analyzed to identify key domains and areas of ongoing debate. Five interconnected domains emerge as central to psychiatric EAS assessment: decision-making capacity, irremediability of suffering, subjective suffering and voluntariness, and safeguard systems. Across jurisdictions, considerable variability exists in legal models and clinical approaches, although a shared emphasis on repeated, multidisciplinary, and well-documented evaluation processes is evident. Persistent challenges include the absence of standardized criteria for irremediability, inter-rater variability in capacity assessment, and the difficulty of distinguishing between psychopathology-related suicidality and well-considered requests for assisted death. The available literature suggests that psychiatric EAS requires particularly careful and structured evaluation processes, given the inherent complexity and variability of mental disorders. Multidisciplinary approaches involving clinical psychiatry, forensic psychiatry, and legal medicine may contribute to improving consistency, transparency, and medico-legal robustness. Longitudinal assessment and detailed reconstruction of clinical history appear to be key elements in supporting reliable decision-making. Psychiatric EAS remains an evolving and methodologically challenging topic. While uncertainties cannot be fully resolved, structured and multidisciplinary evaluation processes may help enhance the consistency and ethical sustainability of assessments in this context.
Coronary angiography induces oxidative stress through contrast media exposure and ionizing radiation, potentially contributing to vascular and renal injury. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) exert antioxidant and anti-inflammatory effects beyond glycemic control. We investigated whether a single pre-procedural dose of empagliflozin modulates oxidative stress and inflammatory glycosylation patterns in non-diabetic patients undergoing elective coronary angiography. In this prospective, randomized, double-blind study, 60 patients undergoing elective coronary angiography were assigned to standard care or empagliflozin 10 mg administered 2 h before the procedure. Blood samples were collected at baseline, 4 h, and 24 h post-procedure. Total antioxidant capacity (TAC), oxidative DNA damage (alkaline comet assay), and N-glycosylation profiles of immunoglobulin G (IgG) and total plasma proteins were analyzed. Longitudinal changes were assessed using mixed-effects models with correction for multiple testing. Baseline characteristics and procedural variables were comparable between groups. Empagliflozin administration was associated with attenuation of oxidative DNA damage 24 h after angiography and stabilization of antioxidant capacity compared with standard care. Directional shifts in IgG N-glycosylation toward a less pro-inflammatory profile were observed in the intervention group, including reduced agalactosylated and core-fucosylated glycans and relative preservation of galactosylated structures. Similar modulatory trends were detected in total plasma protein glycosylation patterns. Although several glycomic changes did not reach statistical significance after correction for multiple testing, the overall biological signal consistently favored reduced oxidative and inflammatory activation in the empagliflozin group. A single pre-procedural dose of empagliflozin was associated with attenuation of oxidative stress-related DNA damage and modulation of inflammatory glycosylation patterns following coronary angiography. These findings suggest a potential peri-procedural cytoprotective role of SGLT2 inhibition that warrants confirmation in larger studies. ISRCTN11022820. Registered 13 October 2025. Retrospectively registered.
Informed consent is a cornerstone of ethical practice. Eliciting patient questions during informed consent increases patient engagement and understanding, thus enhancing integrity of the consent process. However, a patient in visible pain can add an additional challenge to the informed consent process. The purpose of this research was to examine if and how anesthesiology residents ask for questions from a patient displaying severe pain during an informed consent simulation. Anesthesiology residents recruited from three anesthesia residency programs were video recorded performing an informed consent with a 52-year-old White male simulated patient awaiting urgent repair of a perforated gastric ulcer who was displaying verbal and nonverbal signs of pain. Two independent coders evaluated whether, when and how residents elicited patient questions during the informed consent process. Among a sample of 65 first- and third-year anesthesiology residents, more than 20% of residents did not elicit questions during the informed consent encounter. Those who elicited questions typically did so late in the process, with approximately 10% inviting questions only after the consent form had been signed. Most questions were closed-ended (yes/no questions). Although residents did not typically incorporate the patient's name when eliciting questions, most residents demonstrated eye contact. There were no differences in the number or characteristics of questions elicited based on resident gender or level of training. Our findings suggest there is a need for increased education regarding the purpose and approach to eliciting patient questions during the informed consent process, especially for patients who are experiencing pain. When a patient is about to have surgery, they talk with their doctor about what to expect. Then they must agree to have the surgery and agree to the anesthesia needed for the surgery. This is known as the informed consent process. Patients who are about to have surgery may have a lot of questions for their doctor. It is important for the doctor to ask the patient if they have any questions. This study looked at videos of a training session for anesthesiology residents, who are doctors in advanced training to give anesthesia. In this training session, the anesthesiology residents were asked to get informed consent from a patient. The patient was an actor pretending to be in a lot of pain. This study looked at whether the anesthesiology resident ever asked the patient if he had any questions. Our results show that sometimes the doctors did not ask if the patient had questions. Sometimes the doctors ask after the consent form has been signed. We need to train anesthesiology residents to always ask if the patient has questions before the patient agrees to the surgery and the anesthesia.
The ethical terrain surrounding feeding at the end-of-life is emotionally charged and complex. In the literature, the recently introduced notion of "minimal comfort feeding" (MCF), defined as deliberate limitation of feeding or hydration, given only in response to visible signs of hunger or thirst, for a patient with a longer prognosis, has been proposed as a comfort measure at the end of life and as an alternative to voluntarily stopping eating and drinking (VSED) in advance care planning. However, the same term may be applied to two morally distinct acts: 1) providing comfort in the context of active dying, and 2) a hastening death. In this paper, we argue for conceptual clarity around these two practices and their ethical valence, drawing on an Anscombean-Thomistic virtue ethics framework that deals with moral evaluation of human action and the doctrine of double effect. We present two clinical cases highlighting each of these ethical scenarios. Through the cases, we show how intentionality and some circumstances such as timing critically shape the morality of the act. We propose a new nomenclature with the aim of fostering ethical clarity of the morally distinct acts: "proportionate comfort feeding" (PCF) for MCF where nutrition and hydration is provided for comfort with the understanding that it may hasten death but is its foreseen, unintended outcome, and "minimal feeding to hasten death" (MFHD) for cases where MCF is chosen with the specific intention to hasten death.
Rehabilitation is very crucial for the treatment of chronic illnesses; it is still not widely used in primary healthcare in low-resource countries like Pakistan. Although there is ample evidence of gaps in the health system, behavioural factors that influence provider engagement with rehabilitation services remain poorly understood, especially regarding attitudes, social influences, and a sense of control over service provision. This study investigated how providers' attitudes, societal expectations, and perceived control affected their engagement in a rehabilitative health system-strengthening initiative in Pakistan using the Theory of Planned Behavior (TPB). This qualitative exploratory study was a sub study of ReLAB-HS initiative, which sought to incorporate assistive technology and rehabilitation services into primary care. Data was collected between July and August 2024 from two Networks of Care (Thatta and Swat) from the two provinces Sindh and Khyber Pakhtunkhwa. Participants (n = 61) were among the five cadres and purposefully chosen, including Lady Health Workers, Lady Health Supervisors, Primary Healthcare Providers, Rehabilitation Professionals, and members of Technical Working Group Data were analyzed using a combined inductive-deductive approach guided by the Theory of Planned Behavior (TPB), with coding and theme development conducted in Atlas.ti.24. Interviews revealed that providers' attitudes shifted from initial skepticism to recognizing rehabilitation as a crucial part of primary care, particularly after observing improvements in patient functioning. Subjective norms, reinforced through peer support and digital platforms such as WhatsApp, played a key role in sustaining engagement, although broader uptake was constrained by cultural norms and gender-related stigma. Perceived behavioral control improved with training and job aids, increasing providers' confidence to integrate rehabilitation into practice. However, persistent structural and environmental barriers including time constraints, heavy workloads, and limited access to assistive technology reduced providers perceived behavioral control and restricted sustained implementation. Despite these challenges, many providers adopted adaptive strategies to continue delivering rehabilitation services. Our findings demonstrate that attitudes, subjective norms, and perceived behavioral control collectively shaped provider engagement with rehabilitation services. Peer networks, supportive supervision, and capacity-building initiatives facilitated positive behavioral change; however, these alone were insufficient for long-term integration at the primary care level. Addressing structural barriers including weak referral systems, limited assistive technology, workforce shortages, and sociocultural stigma is essential for sustainable rehabilitation integration.
Nonunion of fractures is a major challenge in orthopedics and traumatology, especially with increasing high-energy injuries. Adipose-derived mesenchymal stem cells (ASCs) are a readily accessible source with strong osteogenic potential. This study compared the bone regenerative efficacy of undifferentiated ASCs versus their osteogenically pre-differentiated derivatives in a critical-size femoral nonunion model. Eighteen male New Zealand White rabbits (n = 18), aged 3 months and weighing 2.94 ± 0.10 kg, were included. MSCs were isolated enzymatically from abdominal adipose tissue of three donor rabbits. At passage 3, cells were cultured either in basal medium (undifferentiated cohort) or osteogenic medium containing β-glycerophosphate, dexamethasone, and ascorbic acid for 4 weeks (differentiated cohort). 5-bromo-2'-deoxyuridine solution (BrdU) labeling was performed. In this randomized controlled in vivo study, a 5-mm mid-femoral defect was created and stabilized with angular-stable plating. In this randomized, controlled in vivo experimental study, on postoperative day 7 the animals were allocated to three groups (n = 5 per group): control (defect alone), undifferentiated mesenchymal stem cells, and differentiated mesenchymal stem cells. Radiographic assessment of bridging callus and cortical thickness index was performed at 4 and 6 weeks; serum total protein, calcium, and alkaline phosphatase were measured. In vitro, osteogenic differentiation induced progressive mineralization (Alizarin Red staining) and a statistically significant 34% reduction in BrdU corrected total cell fluorescence (CTCF) (p = 0.0473). In vivo, both cell-augmented groups accelerated fracture consolidation versus controls. The differentiated cohort achieved 88% bridging callus at 6 weeks (versus 80% in the undifferentiated group), with superior improvements in bridged cortices (+ 9.4%), bridging callus coverage (+ 10.0%), and distal gap closure (-31.0%) at 6 weeks, plus more pronounced cortical remodeling (average CTI decrease - 6.2% at 4 weeks). Serum alkaline phosphatase (ALP) declined by 53.4% (undifferentiated) and 63.6% (differentiated) versus control (both p < 0.001); plasma calcium was 16.8% higher in the undifferentiated group. Immunofluorescence showed 19% higher BrdU-positive cell density and 12% higher CTCF in undifferentiated cells. Osteogenically pre-differentiated ASCs demonstrated enhanced bone regenerative capacity compared with undifferentiated ASCs. These findings indicate that osteogenic pre-differentiation augments the therapeutic potential of ASCs and support their further evaluation in multimodal strategies for fracture nonunion.
The Paleolithic diet (PD) has positive effects on health status and body composition. The Paleo diet has been also used to assess the effects on handball players performance but the association of adherence to PD and resting metabolic rate (RMR) has not been investigated especially in this group. This study aimed to impact of the moderate-carbohydrate diet on RMR among professional handball players. Twenty-five handball players were assigned into two groups: 14 in the experimental group (the Paleo diet; PD) and 11 in the control group (rational diet; CD) for 8-weeks of normoenergetic nutritional intervention. Resting metabolic rate was measured by indirect calorimetry using a Cortex MetaLyzer 3R ergospirometer (Germany), using the breath-by-breath method. Oxygen uptake (VO2), carbon dioxide production (VCO2), respiratory quotient (RQ), RMR, and substrate utilization (carbohydrate, fat, protein) and energy expenditure from each substrate were measured during the measurement. There were no differences in RMR parameters, as well as VO2 (L/min), VCO2 (L/min), RQ, substrate utilization (g/day): CHO, PRO, FAT, and EE (kcal/hour) from each substrate between PD and CD groups. Eight weeks of a normoenergetic Paleo diet did not affect resting metabolic rate.
Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease with progressive bile duct injury, inflammation, and fibrosis. Matrix metalloproteinases (MMPs) contribute to extracellular matrix remodeling but their circulating profile and clinical relevance in early-stage PBC remain incompletely defined. We characterized circulating MMPs in early-stage PBC and related them to non-invasive fibrosis and portal hemodynamics. Forty-six patients with early-stage PBC and 31 healthy controls were studied. Plasma MMP-2, -3, -7, -9, -10, and -26 were quantified by ELISA; liver stiffness was measured by point shear-wave elastography and portal flow indices by Doppler ultrasound. Compared with controls, PBC patients showed higher MMP-7 (p < 0.0001), MMP-2 (p = 0.0007), and MMP-10 (p = 0.046). MMP-7 correlated with liver stiffness (R = 0.68, p < 0.001) and demonstrated the highest discriminatory performance for significant fibrosis defined as LSM > 5.56 kPa (AUC = 0.800, p < 0.001). In exploratory regression analyses, higher MMP-7 concentrations remained associated with significant fibrosis after adjustment for age, whereas APRI and FIB-4 did not show significant discriminatory performance in ROC analysis. Early-stage PBC is therefore associated with a distinct plasma MMP profile, and MMP-7 may serve as a practical biomarker of fibrogenesis, supporting its use for monitoring disease progression.
Community values and preferences should inform risk communication during pregnancy in the context of an epidemic of an emerging pathogen, given the high levels of uncertainty in the diagnosis and the probability of an adverse outcome. We conducted a multicountry qualitative study with 98 women from 7 sites in Brazil, Colombia and Puerto Rico to understand their preferences for learning about Zika virus test results amid high levels of uncertainty in diagnostic testing and related outcomes. We used thematic analysis with a combined deductive and inductive approach to analyse findings from the in-depth interviews. Across sites and time periods, women wanted to learn about their test results, the risk to their pregnancy or infant and the related uncertainty as early as possible. They wanted to separate risk communication from decision-making around the following steps to give them time to consider the test results, related risks and available services. Communication of the risk associated with an emerging pathogen suspected to affect pregnancy and developmental outcomes is a fraught issue. Public health authorities and healthcare providers should work closely together to understand families' preferences for risk communication in the presence of uncertainty and develop a community-informed plan for risk communication as early as possible during an epidemic of an emerging infectious disease.
'Terminal anorexia nervosa' is a controversial diagnosis proposed to facilitate certain practices, such as medically assisted death. This narrative review summarizes reasons given in the literature for and against adopting the term 'terminal anorexia nervosa (T-AN)' for the purpose of examining the nature and extent of engagement between opposing sides in the debate. We sought articles referencing T-AN or a closely related concept that provided reasons for or against T-AN or closely related treatment decision-making. Fifty-seven articles were included, but thematic saturation was reached early. Three themes were found in arguments for adopting T-AN: forgoing 'excessive' or 'futile' treatment, respecting autonomy through heeding patient requests, and harm reduction through facilitating access to resources, including medically assisted death. Four themes were found in arguments against T-AN: difficulty of defining 'terminal' AN, difficulty with assessing capacity in AN, applying the label will cause harm to patients, and effort should instead be focused on improving systemic problems with the quality of and access to AN care. Although both sides raise important issues, there is a lack of shared understanding, especially concerning underlying value judgments embedded in perspectives on T-AN.
Explore Spanish-preferring participants' experiences with and perceptions of communication of genomic results through professional medical interpreters via multiple modes in the Clinical Sequencing Evidence-Generating Research consortium. In this cross-site analysis, we described self-reported data from Spanish-preferring participants (n = 334) who completed a survey after genomic results sessions conducted with a professional medical interpreter present regarding their understanding of results, perceptions of results communication quality, perceived cultural concordance, and satisfaction with and perceptions of interpretation across interpreter modes (in-person, video, phone). Overall, most respondents who had a Spanish interpreter present during their genomic results session reported: understanding the genomic results 'quite a bit' or 'extremely' well (68%), satisfaction with the language interpretation provided (94%), perceiving good quality interpretation (96%), and that the interpreter and clinical team worked well together (98%). Regarding cultural concordance, most respondents reported feeling equal respect (94%), cultural understanding (91%), ease (82%), and personal connection (67%) with both the interpreter and the clinical team. Across all interpreter modes, respondents' satisfaction and perceived quality of genomic results communication and of Spanish interpretation were high, and their perceived cultural concordance with interpreters and clinicians was similar. In open-ended responses, the factors most frequently described as influencing respondents' perceptions of interpretation centered on interpretation understandability and perceived accuracy, interpreters' kind demeanor and attentiveness to respondents' needs, and challenges with remote technology. From the perspectives of Spanish-preferring patients and parents (of minors) across diverse settings, communication of genomic results through professional medical interpreters using in-person and remote (video and phone) modalities was well-received and involved both information exchange and interpersonal facets. Remote interpretation with professional interpreters can promote quality, culturally-concordant communication in genomic settings. Attentiveness to maintaining call quality in remote sessions, along with providing interpreters of any mode with genetics-specific resources, may help facilitate patient satisfaction.
Dietary sugars, particularly sugar rich foods and beverages, have been implicated in the pathogenesis of allergic diseases, but epidemiological evidence in children remains inconsistent. To examine associations between dietary sugar intake from snacks and soft drinks and atopic outcomes across multiple disease definitions in a large pediatric population. A cross-sectional analysis was conducted using data from the Polish arm of the Global Asthma Network (GAN) study (n = 4,647; ages 6-15 years). Dietary exposures, including frequency of sugary snack and soft drink consumption, were assessed using standardized questionnaires. Outcomes were categorized as current symptoms (wheeze, rhinitis, rhinoconjunctivitis, eczema), lifetime ("ever") outcomes, and doctor-diagnosed disease. Overall, 546 participants (12.2%) reported low sugary snack consumption, 1,827 (40.7%) consumed sugary snacks once or twice per week, and 2,113 (47.1%) reported consumption most or all days. For soft drinks, 1,889 participants (41.8%) reported low intake, 1,661 (36.8%) moderate intake, and 969 (21.4%) high intake. Sugary snack intake was not associated with current symptom-based outcomes. However, high sugary snack consumption was associated with increased odds of lifetime hay fever (aOR 1.42, 95% CI 1.12-1.80) and eczema (aOR 1.72, 95% CI 1.20-2.46), with weaker and inconsistent associations for doctor-diagnosed outcomes. In contrast, soft drink intake was inversely associated with allergic outcomes, including hay fever and eczema, but was positively associated with current wheeze (aOR 1.48, 95% CI 1.08-2.02). Female sex and traffic exposure were consistently associated with higher odds of current symptoms. Dietary sugar exposures are differentially associated with pediatric atopic disease depending on outcome definition. Positive associations with lifetime outcomes, alongside null findings for current symptoms and inverse associations for soft drinks, suggest a complex interplay of biological and behavioural factors, including reverse causation. Longitudinal and biomarker-based studies are needed to clarify causal pathways.
Reports suggest increased urinary excretion of Brain-Derived Neurotrophic Factor in patients with Overactive Bladder (OAB). The rs6265 (c.196G > A, p.Val66Met) polymorphism in the BDNF gene was previously associated with impaired secretion of this neurotrophin. The aims of the present study were to analyze the possible association of the BDNF: rs6265 polymorphism with OAB risk and with the response to a single intradetrusor injection of botulinum neurotoxin type A (BoNT/A) in female patients. The study group comprised 160 OAB females, and the control group comprised 359 healthy females. Urodynamic parameters, frequencies of OAB symptoms, and scores from ICIQ-OAB and ICIQ-LUTS-QoL questionnaires were recorded before BoNT/A injection and six months after. Genotyping of BDNF: rs6265 polymorphism was performed using TaqMan real-time polymerase chain reaction. No statistically significant differences in the distribution of BDNF genotypes or alleles between OAB patients and healthy controls were found. No significant differences among OAB subjects regarding BDNF polymorphism were found in terms of clinical symptoms, scores of both questionnaires, and urodynamic parameters. These results do not support the hypothesis that BDNF: rs6265 polymorphism in Polish females with OAB is associated with susceptibility to this condition and with response to BoNT/A treatment.
Triple-negative breast cancer (TNBC) represents the most aggressive breast cancer subtype with limited therapeutic options and poor prognosis, highlighting an urgent need to identify novel metabolic vulnerabilities and prognostic biomarkers to improve patient outcomes. While glutamine metabolism has been implicated in cancer, the specific roles of glutamine metabolism-related genes (GMRGs) in TNBC remain poorly understood. Herein, through an integrating analysis encompassing multi-omics bioinformatics, consensus clustering and tumor microenvironment (TME) analysis, we established a glutamine metabolism-based prognostic classification for TNBC patients, which correlates with distinct survival outcomes and TME features. Furthermore, we identified ALDH18A1, one of the GMRGs that encodes P5CS for proline synthesis, as a novel prognostic biomarker and oncogenic driver. ALDH18A1 is overexpressed in TNBC and associated with larger tumor size, lymph node metastasis and poor survival, as well as an immunosuppressive TME. In vitro experiments confirmed ALDH18A1 activated the AKT/mTOR signaling pathway, promoted the proliferation, migration and invasion of TNBC cells, and increased proline synthesis. Computational drug screening predicted six compounds with potential efficacy against ALDH18A1-high tumors. Collectively, our findings demonstrate that reprogramming of glutamine metabolism plays a crucial role in the malignant progression of TNBC and provide translational insights for precision metabolomic-immunotherapeutic strategies in ALDH18A1-high TNBC.
Choking is a life-threatening paediatric emergency. Despite its importance, public knowledge of first aid remains limited, and data specifically concerning parents are scarce. This study aimed to assess Polish parents' knowledge of paediatric choking first aid and identify factors associated with performance. A cross-sectional online survey was conducted between December 2024 and February 2025. The questionnaire included sociodemographic characteristics and scenario-based open-ended questions assessing the management of foreign body airway obstruction. A total of 156 parents participated. The median score for rescue manoeuvres was 4/12, while the median score for cardiac arrest management was 2/3, indicating generally limited knowledge. In univariate analyses, higher self-reported confidence was associated with better performance, whereas prior training showed a borderline association. In multivariate analysis, previous practical training was the only significant predictor of performance. This exploratory study revealed a discrepancy between parents' self-reported confidence and their actual knowledge of paediatric choking management. Previous practical training may be associated with improved performance; however, the findings should be interpreted cautiously due to limited statistical power. The use of open-ended scenarios enabled a more realistic assessment of functional knowledge. Further large-scale studies are needed to support the development of targeted, skills-based educational interventions.
As standardized metrics in residency selection change, residency program directors increasingly rely on narrative components of the Medical Student Performance Evaluation (MSPE) clerkship summaries. However, wide variability in structure, language, and transparency limits their usefulness for high-stakes decision making. The aims of this study were to explore neurology and child neurology program directors' perspectives on the utility of MSPE neurology clerkship summaries and to identify features that enhance or undermine their value in residency selection. We conducted a qualitative study using semistructured interviews with US neurology and child neurology residency program directors. Participants reviewed and discussed 4 constructed MSPE neurology clerkship summary cases developed from deidentified authentic MSPE excerpts and designed to reflect variation in structure and content. Interviews were audio recorded, transcribed verbatim, and analyzed using reflexive thematic analysis informed by theories of narrative assessment and discourse. Trustworthiness was supported through analytic memos, peer debriefing, and investigator triangulation. Thirteen program directors participated, and 6 themes emerged: (1) Participants valued honest and transparent narratives but perceived candid discussion of limitations as risky for students; (2) institutional variability in grading systems, access to neurology experiences, and evaluator practices limited fair comparison of applicants; (3) narratives were most useful when clearly structured, concise, and transparent about how evaluations were synthesized; (4) comparative information was viewed as essential for decision making, despite its susceptibility to bias; (5) program directors consistently reported that coded language was difficult to interpret and should be avoided; and (6) nonspecific laudatory comments diminished narrative value, whereas brief, concrete behavioral examples enhanced credibility and interpretability. Neurology clerkship summaries in the MSPE remain influential yet imperfect tools for residency selection. Program directors favor narratives that are structured and specific and avoid coded or vague language. Targeted faculty development and adoption of shared narrative frameworks represent actionable strategies to improve fairness, clarity, and trust in narrative assessment within neurology education.