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The purpose of the research was to verify compensatory and protective models of resilience [14, 27] , among adolescents from Poland and war-affected Ukraine. Guided by the socio-ecological model of resilience theory, we examined the relationship between several psychosocial risk and protective factors and suicidal behaviour among adolescents. Data were collected via online self-report questionnaires in Autumn 2024 from 14 to 15 year olds in Western Ukraine (N = 2179) and Warsaw, the capital of Poland (N = 1154). The response rate achieved was 75% in Lviv, 73% in Drohobych and 70% in Warsaw. Suicidal behaviour was measured by a 3-item Suicidal Thoughts and Behaviours scale adapted from the MINI Kid (Sheehan et al. 2010) (α = 0.87 - 0.90). Four groups of risk factors were examined: 1/ exposure to traumatic experiences, with a 9-item index, and victimization measured by two single questions; 2/ mental health problems (symptoms of depression measured by the shortened 4-item CES-D scale, non-suicidal self-injuries measured by a single question, problems of conduct measured with a 12-item index, problematic internet use measured with the Internet Disorder Scale - Short Form (IDS9-SF); 3/ substance use (alcohol, drug, cigarette and tranquiliser use, all measured with single questions); and 4/ personality characteristics that increase vulnerability (impulsiveness, measured by the Barratt Impulsiveness Scale-Brief (BIS-Brief), sensation seeking measured by a 6-item scale). Three groups of protective factors were also measured: 1/ parental/ familial (parental management, family relationships measured using the Brief Family Relationship Scale); 2/ school (school bonding measured with a 6-item scale, sense of safety at school measured by a single question); and 3/ individual (religiosity, measured by two single questions, individual physical activity measured by a single question, positive perception of the future, and five key aspects of positive youth development (connection, confidence, character, caring, competences), measured with the Positive Youth Development (PYD-VSF) scale. Hierarchical linear regression was conducted to test models of resilience. Descriptive analyses showed that significantly more teenagers in Warsaw (Poland) than in Lviv and Drohobych (Ukraine) had suicidal thoughts in the past 12 months (33.6% vs. 14.7%), had at some time planned suicide (35.5% vs. 16.9%), and had at some time attempted suicide (17% vs. 7.2%). In both countries, suicidal behaviours were significantly more prevalent among girls than boys. Further analyses also showed that adolescents in Warsaw were more exposed to significant risk factors than their peers in Lviv and Drohobych and, conversely, that youth in Lviv and Drohobych were more strongly protected against these risks than those in Warsaw. Regression analysis indicated that traumatic experiences, victimization, depressive symptoms, non-suicidal self-injury and the use of tranquilizers were associated with increased suicidal behaviour in both countries, whereas sensation seeking and drug use were associated with increased suicidal behaviour among Ukrainian youth. The results of regression showed also that a positive perception of the future and parental (on the part of the mother) management significantly reduced the risk of suicidal behaviour in both countries; however, a sense of safety at school proved to be a significant protective factor among Ukrainian adolescents, while self-confidence played that role in the Polish group. A block of four protective factors was associated with reduced risk of suicidal behaviour in both countries, supporting a compensatory model of resilience. Sense of safety at school moderated the relationship between traumatic experiences and suicidal behaviour in both countries, supporting a protective model of resilience, whereas self-confidence moderated this relationship in the Polish sample while parental management (on the part of the mother) moderated this relationship in in the Ukrainian sample. Overall, the regression model explained over 50% of the variance in suicidal behaviour in Ukrainian adolescents and 58.5% in Polish adolescents. This study supports the usefulness of resilience models, demonstrating that individual strengths, family resources, and a safe school environment can moderate the negative consequences of traumatic experiences on adolescent suicidal behaviour. A specific implication of these findings is the need for targeted interventions that strengthen family and school support systems to reduce the risk of suicidal thoughts and behaviours among adolescents.

Acute myeloid leukemia (AML) remains a challenging disease with a poor prognosis, necessitating more personalized therapeutic strategies. Retinoic acid receptor (RAR) activation is crucial for myeloid differentiation, but non-APL AML cells resist differentiation induced by the pan-RAR agonist all-trans retinoic acid (ATRA). Am80 (tamibarotene), a specific RARA agonist, has been reported to partially overcome this resistance in AML with high RARA expression. However, its effects on myeloid differentiation, especially in comparison to ATRA, remain understudied. In this study we compared the effects of Am80 and ATRA in non-APL AML samples, focusing on subsets with high RARA and/or RARG expression, using molecular and phenotypic differentiation assessments. In contrast to previous findings, Am80 showed no advantage over ATRA in inducing differentiation in AML cell lines or primary samples, regardless of RARA and RARG expression levels. Cotreatment with inhibitors of the epigenetic modifiers LSD1 and GCN5, which facilitates retinoid-induced myeloid differentiation, enhanced the effects of both Am80 and ATRA to the same extent, with more pronounced responses observed in RARA-high samples. Gene expression analysis revealed identical molecular responses to Am80 and ATRA. The study provides evidence that ATRA can be substituted by the more stable Am80 in retinoid-based AML therapies. It also identifies elevated RARA expression as a potential marker for sensitivity to combination therapy with retinoids and epigenetic inhibitors in AML.

Cohort study. To identify the relationships between health-related quality of life (HRQOL), healthcare utilization, participation, employment, and life satisfaction and longevity after SCI, as defined by surviving to 95% of predicted SCI life expectancy. Medical University in the Southeastern USA. Self-report assessment (SRA) data were collected from 1570 participants in 2003, and survival status was determined as of December 31, 2019. To assess the main outcome, we estimated SCI life expectancy, grouping participants into three groups: 1) those that reached 95% of their predicted life expectancy (RLE), 2) those who died before reaching that milestone (DBR), and 3) those alive, who had not yet reached full life expectancy. Those in group RLE reported more favorable outcomes on nearly all outcomes. Healthwise, they reported fewer days during the past month in poor physical health and poor mental health. They were more likely to be employed at data collection and have been employed since SCI onset. They had higher average scores on each of the three satisfaction domains: home life, vocational, and global satisfaction. They reported spending more hours per day out of bed and more times out of the home during the week. The findings present support that living a successful life, by maintaining good health, regular participation in social activities, and engagement in employment are keys to longevity and reaching full life expectancy.

Radiance is a Monte Carlo-based treatment planning software integrated into the Intrabeam system for 50-kVp X-rays intraoperative radiotherapy (IORT). This study evaluates Radiance accuracy in calculating absorbed dose in IORT of the breast including the effect of tissue heterogeneities. Dose distributions from IORT were calculated in 88 virtual phantoms of different tissue-equivalent materials. Dose was calculated independently using the penEasy code for the PENELOPE Monte Carlo engine and compared to Radiance. Depth dose curves (DDCs) were compared through gamma analysis using 5%/0.5 mm and 3%/0.5 mm criteria. When comparing Radiance vs penEasy all passing rates were above 95%. Notable differences from dose to water emerged for some tissues: cortical bone absorbed about four times more than water, while adipose tissue received about 45% less. These variations were affected by atomic number more than density. Radiance results show strong agreement with penEasy simulations. Furthermore, it was observed that IORT absorbed doses can fluctuate by ± 50% due to heterogeneities surrounding the applicator. This highlights that the prescribed dose and the absorbed dose in the applicator surface do not necessarily coincide in non-water tissues, emphasizing the critical need to account for specific tissue characteristics during treatment planning.

Patients who leave the emergency department (ED) without being seen (LWBS) represent a critical quality and safety metric. Although most LWBS cases involve low-acuity presentations, some may have time-sensitive conditions, leading to delayed diagnoses, adverse outcomes, and increased healthcare utilization. To determine the prevalence, characteristics, and predictors of LWBS over a multi-year period in a high-volume tertiary ED in T&#xfc;rkiye. This retrospective case-control study included all adult ED visits between 1 January 2020, and 30 June 2025, at Taksim Training and Research Hospital. LWBS cases were identified from electronic medical records and compared with controls presenting during the same timeframes. Demographic, triage, temporal, and operational factors were analyzed, and binary logistic regression identified independent predictors. From a total of 1,058,817 adult emergency department (ED) visits during the study period, 9,737 LWBS cases were identified, corresponding to an overall LWBS incidence of 1.0%. Annual LWBS counts ranged from 1,447 (14.9%) in 2020 to a peak of 2,995 (30.8%) in 2022, before declining to 450 (4.6%) in 2024. Patients who left without being seen were younger (mean 36.1&#x2009;&#xb1;&#x2009;15.0&#x2009;years) and predominantly male (61.6%).The highest frequency of LWBS occurred during the evening shift (16:00-00:00) and among green-triage patients, with multivariable analysis confirming increased odds in these groups (evening shift OR&#x2009;=&#x2009;4.99; 95% CI, 3.18-8.09). Night-shift presentations were associated with reduced LWBS risk (OR&#x2009;=&#x2009;0.54; p&#x2009;<&#x2009;0.001). Younger age, evening presentation, and triage category were associated with LWBS in this high-volume tertiary emergency department. However, the predictive performance of the regression model was modest (AUC&#x2009;=&#x2009;0.584), suggesting that additional patient-related, behavioral, and system-level factors may contribute to LWBS. Further studies are needed to better understand the determinants of this phenomenon. Emergency departments can become crowded, leading some patients to leave before being seen by a doctor. This study examined over five years of data from a large hospital in T&#xfc;rkiye to understand which patients are more likely to leave early. We found that younger patients and those with less urgent conditions were more likely to leave, especially during busy evening hours. Although the overall rate was low, these patterns suggest that improving patient flow and reducing waiting times during peak hours may help reduce early departures. These findings may help hospitals design better systems to ensure patients receive timely care.

Internet use has become an essential component of college students' academic and social lives. Students who experience negative emotions such as anxiety, guilt, or shame during rest periods-commonly referred to as rest intolerance-may be more prone to problematic internet use (PIU). This study aimed to examine the relationship between rest intolerance and PIU among college students, focusing on the mediating role of self-compassion and the moderating role of self-control. Participants were 7,163 Chinese college students recruited via convenience sampling, who completed self-report measures assessing demographic characteristics, rest intolerance, PIU, self-compassion, and self-control. A moderated mediation model was conducted to test the hypotheses. Rest intolerance was significantly and positively associated with PIU. Self-compassion was negatively associated with both rest intolerance and PIU, while self-control was negatively associated with rest intolerance. Rest intolerance exerted a significant direct effect on PIU (&#x3b2;&#x2009;=&#x2009;0.08, CI [0.06, 0.10]) and an indirect effect through self-compassion (&#x3b2;&#x2009;=&#x2009;0.14, CI [0.12, 0.15]). Furthermore, self-control moderated both the direct and indirect pathways: high self-control attenuated the negative association of rest intolerance on self-compassion and weakened the association of rest intolerance on PIU. This study reveals that self-compassion mediates the relationship between rest intolerance and PIU, and that self-control moderates both the direct and mediated pathways, offering potential guidance for prevention and intervention strategies aimed at reducing the association of rest intolerance on PIU in college students.

Digital health interventions (DHIs) are increasingly popular as a potential method to address educational and support needs of individuals with long-term conditions, as they are largely accessible to most people, can be highly effective, and delivered at low cost. We have developed a DHI to better support chronic kidney disease (CKD) self-management and demonstrated its efficacy in a UK-based clinical trial. The trial population, however, was fairly homogeneous, and those from underserved populations (including ethnic minority groups), who would have likely benefited from the DHI, were underrepresented. Understanding how ethnic minority communities perceive DHIs is essential for identifying their needs, priorities and challenges, and for ensuring that future DHIs are relevant, acceptable and equitable. Given the potential impact of DHIs, patients should be actively involved in their design and implementation. To support this, patient and public involvement and engagement (PPIE) consultations were conducted to: 1) understand people with CKD from South Asian (SA) backgrounds' perspectives of DHIs; 2) identify factors that require consideration when adapting DHIs to address health inequities; and 3) clarify how best to conduct PPIE projects in adapting DHIs for traditionally underserved groups, particularly ethnic minority groups. PPIE consultation focus groups were conducted in-person with ten individuals (60% male, age: 69&#x2009;&#xb1;&#x2009;7) from SA backgrounds thrice, audio-recorded and transcribed verbatim. Data were analysed using thematic analysis. Participants identified several barriers and facilitators to accessing and using DHIs. Language was reported to be the biggest barrier to accessing and using online health information. Having culturally appropriate information available in their own language would increase the acceptability and uptake of the DHI among SAs. Not making assumptions and being respectful about individual choices, cultural or religious beliefs, was considered key to engaging people. Promotion by a trusted person (doctors, peers, community leaders) was perceived to help alleviate the fear of DHIs and improve uptake and usage. People from SA backgrounds are open to using DHIs, but they need to be available in their own language and be culturally appropriate. The findings will be used to adapt our CKD self-management DHI to better address the needs of those from SA backgrounds. Patients and members of the public were directly involved in the participation of the patient and public involvement and engagement (PPIE) consultations. Community engagement officers from the Centre of Ethnic Health, who were from South Asian backgrounds, were involved in the PPIE consultation, recruitment, development of a semi-structured focus group guide, and facilitation of consultation focus groups. Digital health tools are becoming an important way to help people manage long&#x2010;term health conditions because they are easy to access, cost&#x2010;effective, and can provide useful support. We developed a digital health intervention (DHI) to help people with chronic kidney disease (CKD) manage their condition and showed that it works well in a clinical trial. However, the trial included mostly similar participants, and people from underserved communities, who might benefit the most, were not well represented. This study looked at what makes it easier or harder for people from South Asian backgrounds to use DHIs. We held patient and public involvement and engagement (PPIE) consultation focus groups with 10 participants and analysed their views. The biggest barrier was language, and participants said they would be more likely to use DHIs if information was available in their own language and reflected their cultural needs. They also felt that recommendations from trusted people, such as doctors or community leaders, would help build confidence. These findings will guide changes to make our CKD DHI more inclusive.

Globally, colorectal cancer (CRC) stands as the second most lethal malignancy. Chemotherapeutic drugs have shown some limitations, including systemic toxicity and non-specificity. Nanocarriers such as chitosan/gold nanoparticles (CS/Au NPs) facilitate drug localization at tumor sites, thereby reducing off-target adverse effects. Doxorubicin-loaded CS/Au NPs were synthesized, and their physicochemical properties were analyzed using Fourier transform infrared (FT-IR) spectroscopy and dynamic light scattering (DLS). HCT116 cells were treated with both free doxorubicin and CS/Au-DOX NPs. In vitro cytotoxic effects were evaluated using the MTT assay. Additionally, apoptosis induction, cell cycle arrest, and cellular uptake assay were examined by flow cytometry. The scratch assay used to evaluate the effect of CS/Au-DOX NPs on the cell migration potential of HCT116, and the expression levels of CLMAT3 and ZNRD1-AS1 were determined by qRT-PCR. CS/Au-DOX NPs exhibited high encapsulation efficiency (78%) with favorable nanoscale properties, and were markedly more potent than free doxorubicin against HCT116 cells (IC50 0.5 vs. 3 &#xb5;M). Flow cytometry revealed significant apoptosis induction, G2/M arrest, and enhanced cellular uptake in HCT116 following treatment with CS/Au-DOX NPs. These NPs also reduced the migration potential of CRC cells. In CRC tissues, CLMAT3 and ZNRD1-AS1 were upregulated, with CLMAT3 overexpression associated with lymph node metastasis, while both lncRNAs showed limited diagnostic value. Notably, CS/Au-DOX NPs downregulated CLMAT3 and ZNRD1-AS1 expression in HCT116 cells. CS/Au-DOX NPs substantially enhanced the anticancer efficacy of DOX in the HCT116 cell line. Furthermore, CLMAT3 and ZNRD1-AS1 exhibited only limited utility as diagnostic biomarkers in CRC, suggesting that their clinical applicability in early detection may be restricted.

WD40-repeat (WDR) proteins constitute one of the largest and most functionally diverse scaffold families in eukaryotes. By folding tandem WD repeats into &#x3b2;-propeller domains, they provide modular interaction surfaces that assemble multi-protein complexes governing transcription and epigenetic control, ubiquitin-dependent proteostasis, RNA metabolism, and cell-cycle progression. Despite their pervasive involvement in oncogenic signaling and hallmark cancer phenotypes, the cancer field still lacks an integrated framework that connects WDR structural logic to context-dependent mechanisms and, critically, to actionable biomarkers and therapeutic strategies; existing evidence remains dispersed across tumor types and molecular pathways. This review synthesizes current knowledge to address that gap. We first summarize core structural principles of WD40 &#x3b2;-propellers and explain how multivalent binding and partner selection enable WDR proteins to function as assembly platforms in oncogenic networks. We then consolidate mechanistic evidence showing how representative WDR proteins shape malignant state transitions, including sustained proliferation, survival under stress, epigenetic plasticity, invasion and metastasis, and therapy resistance, by rewiring chromatin programs, ubiquitination circuits, and RNA and translation outputs across cancers. Finally, we highlight translational progress and opportunities. Overall, this review integrates the fragmented WDR research into a clinically oriented framework that clarifies their potential as biomarkers for early detection, stratified diagnosis, and treatment-response prediction, and delineates druggable entry points and rational combination strategies, thereby providing a translational roadmap to enable more precise cancer diagnosis and more effective targeted therapies in the future.

To investigate the role of Nuclear receptor subfamily 5, group A, member 2 (NR5A2) in the seasonal regulation of follicle development in striped hamsters (Cricetulus barabensis), we collected 32 adult females, eight individuals from each season (spring, summer, autumn, and winter). Hematoxylin and eosin (H&E) staining was performed to quantify seasonal variations in follicle numbers across distinct developmental stages. Serum concentrations of gonadotropin-releasing hormone (GnRH), follicle-stimulating hormone (FSH), and luteinizing hormone (LH), as well as fecal concentrations of estradiol (E2) and progesterone (P4), were measured using enzyme-linked immunosorbent assay (ELISA). Ovarian NR5A2 mRNA levels were quantified by real-time quantitative PCR (qPCR). Spearman's correlation analyses were conducted to examine associations between ovarian NR5A2 mRNA levels and follicle counts at each developmental stage, as well as between NR5A2 mRNA levels and serum and fecal reproductive hormone concentrations. The numbers of follicles at different developmental stages and ovarian NR5A2 mRNA levels exhibit pronounced seasonal variation (P&#x2009;<&#x2009;0.01). Specifically, primary follicle counts peak in winter, whereas secondary and antral follicle numbers reach their seasonal minima during this period. Concurrently, ovarian NR5A2 mRNA levels in winter are significantly lower than those in spring, summer, and autumn (P&#x2009;<&#x2009;0.01). Serum concentrations of GnRH, FSH, and LH, as well as fecal concentrations of E2 and P4, also display significant seasonal differences, all five hormones being markedly lower in winter compared with the other three seasons (P&#x2009;<&#x2009;0.01). Furthermore, NR5A2 mRNA levels and fecal E2 and P4 concentrations were negatively correlated with primary follicle number but positively correlated with secondary and antral follicle numbers, suggesting that NR5A2, E2, and P4 collectively facilitate the transition from the primary to more advanced follicle stages. These findings indicate that winter environmental conditions suppress overall follicle development in striped hamsters, and the concomitant downregulation of ovarian NR5A2, correlating significantly with follicle counts, suggests a functionally relevant role for this transcription factor in seasonal follicle development. These results provide a theoretical foundation for ecologically sustainable population management strategies, supporting the rational design of targeted interventions, such as pharmacological agents, that selectively modulate population size in the target species while minimizing off-target effects on non-target organisms.

Ultra-processed foods (UPFs) are becoming increasingly common in diets worldwide, raising growing concerns about their negative impacts on both human health and the environment. To assess the contribution of unprocessed or minimally processed foods (UMPFs), UPFs, processed culinary ingredients (PCIs), and processed foods (PFs) to the daily energy intake among Jordanian adults. A cross-sectional study was conducted involving a convenience sample of 537 Jordanian adults (19-64 years), who were assessed for dietary intake using a validated Arabic food frequency questionnaire (FFQ). Food items were classified according to the NOVA system, and energy contributions from UMPFs, PCIs, PFs, and UPFs were analyzed. Among participants, UPFs were the main source of energy (51.93%), followed by UMPFs (31.05%), PCIs (9.32%), and PFs (7.74%). Males had higher total energy intake and consumed more UPFs and PFs than females, while females consumed more UMPFs. Higher UMPF intake was associated with older age, female sex, and higher BMI, whereas higher UPF intake was linked to younger age, male sex, and lower BMI. No significant differences in PCI or PF intake were found by sex or demographics. These findings highlight clear sex- and age-related differences in dietary patterns, particularly in the consumption of UPF and UMPF. Over half of the energy comes from UPF in the overall sample, especially among males and younger individuals, raising nutritional concerns and underscoring the need for targeted public health strategies to promote healthier food choices.

Physical inactivity and air pollution are significant global health concerns, yet limited evidence examines how residential air pollution is associated with physical activity behaviours among children. Existing research has mainly focused on adults, older adults, or self-reported activity outcomes. This study examined the association between residential carbon monoxide (CO) exposure, objectively measured physical activity, and children's reported preference for outdoor sports and games using data from the Millennium Cohort Study. This study used a cross-sectional secondary analysis of Sweep 4 Millennium Cohort Study data. Physical activity was measured using accelerometer-derived total steps over one week. Residential CO exposure was derived from linked MEDIx air pollution deciles and categorised into relatively lower and higher exposure groups. Linear regression was used to examine the association between CO exposure and total steps. Logistic regression was used to examine the association between CO exposure and preference for outdoor sports and games. Models were adjusted for sex, ethnicity, and socio-economic position, with survey and non-response weights applied. The analytic sample included 6,281 children. In the adjusted linear regression model, children living in areas with higher CO exposure recorded, on average, 356.26 more steps than those living in areas with lower CO exposure. In the adjusted logistic regression model, higher CO exposure was associated with slightly higher odds of reporting a preference for outdoor sports and games. However, the adjusted step-count model explained only a small proportion of variation in total steps. Higher residential CO exposure was modestly associated with higher total steps and greater reported preference for outdoor sports and games. These findings should be interpreted cautiously because the study was cross-sectional, explanatory power was low, and residual confounding by neighbourhood, household, school travel, and built-environment factors is likely. Future studies should examine multiple pollutants alongside more detailed contextual and environmental measures.

Flood risk in semi-arid, snow-fed basins is increasingly influenced by both land-use and climate change, yet their combined future effects remain poorly quantified. This study predicts future flood generation potential (FGP) under combined land-use and climate scenarios in the Gharesou Watershed (Iran) using deep learning. Future land-use (2034-2054) was simulated via Markov chain, and climate variables (temperature, precipitation) under three SSP scenarios were downscaled using the change-factor method. FGP was mapped using CNN, MLP, and DNN algorithms, validated against observed discharge data. By 2054, natural vegetation is projected to decline by 20.9% of the watershed area, while agricultural and residential lands expand. Temperature rises by 3.5-4.5&#xa0;&#xb0;C, and although annual maximum precipitation declines, extreme events become more frequent. Under the optimized CNN model, high- to very-high-risk zones expand from 62% to 87% of the watershed. This study provides the first quantitative attribution of future flood risk in a snow-fed semi-arid basin, identifying land-use change as the dominant driver (about60-70% of increased risk) and climate change as an intensifier (about 30-40%). These results indicate that protecting natural vegetation and restricting land-use conversion in high-risk zones are more urgent than climate adaptation alone. Proactive policies (restoring rangelands/forests, integrating climate scenarios into spatial planning, and enforcing land-use regulations) are essential to enhance watershed resilience.

The Eurasian otter (Lutra lutra Linnaeus, 1758) is an endangered species in Bulgaria and is protected under national legislation. Under harsh environmental conditions, as well as the increasing anthropogenic pressure, knowledge about this species is fundamental for conservation planning. The otter occupies a broad range of freshwater habitats, and the species has also been recorded along the Bulgarian Black Sea coast. The contribution of both components of this complex habitat-freshwater and marine environments-to the otter's diet has been demonstrated. The study confirmed that the otter is primarily piscivorous, consuming predominantly freshwater fish during the cold season, and - marine fish during the warm season. Non-marine arthropods were found as an essential secondary food for the otter with a relative frequency of occurrence (RFO) of 22.2%. Each of the other food categories (birds, anurans, marine-arthropods, rodents and reptiles) accounted for less than 10% RFO in the diet. Seasonality in consumption of reptiles, birds, fish, non-marine arthropods was established. Eurasian coastal otters used both marine and inland habitats for foraging along the Bulgarian Black Sea coast and were predominantly piscivorous overall. Among identifiable fish remains, freshwater fish occurred more frequently during the cold season, whereas marine fish were more frequent during the warm season. However, a substantial proportion of fish remains could not be assigned to either marine or freshwater origin.

Wilson disease (WD) is an inherited disorder of copper metabolism characterized by hepatic copper accumulation, mitochondrial injury, and systemic metabolic dysfunction. Metformin is a widely used antihyperglycemic agent with known effects on mitochondrial metabolism and cellular redox state. We tested whether metformin modifies hepatic mitochondrial abnormalities in a mouse model of WD, stratified by sex. Adult male and female Atp7b-/- mice were treated with metformin in drinking water (500&#xa0;mg/kg/day) or water alone for 2 weeks. Liver mitochondria were evaluated by transmission electron microscopy and quantitative morphometry, respiratory chain enzyme activities, reactive oxygen species production, hepatic and mitochondrial copper and iron content, and targeted glucocorticoid and bile acid profiling. At baseline, female Atp7b-/- mice exhibited greater mitochondrial ultrastructural injury, smaller mitochondrial size, and higher hepatic and mitochondrial copper and iron levels compared with males. Metformin exposure was higher in females and was associated with marked changes in mitochondrial morphology, including increased size and more regularized structural features, along with alterations in respiratory enzyme activities, reduced oxidative stress, and changes in glucocorticoid and bile acid profiles. In contrast, males showed more limited structural and biochemical changes following treatment. These findings identify sex as an important determinant of mitochondrial phenotype and response to metformin in WD and support further investigation of sex-informed therapeutic strategies.

Case-based learning (CBL) requires students to fully engage in class activities, motivates active thinking, and therefore effectively improves the teaching and learning quality. However, CBL method is not commonly used in laboratory courses in medical schools due to the biosafety and the ethical issues of patient samples. Here, we developed a novel method to prepare synthetic sera and doped urine without the need for a patient donor. These materials are safe for both students and teachers and were used in a 3-week biochemistry laboratory CBL course. Fifty-eight second-year undergraduates from Dalian Medical University (China) received the CBL course, while another 56 students in the control group received traditional teaching. In this mode, each biochemical assay was explained and conducted separately without clinical case scenarios. The learning outcomes were assessed via written examinations for all participants, and questionnaires were additionally distributed to students in the CBL group. The results revealed that the CBL course significantly increased their test scores, improved their learning interest, and fostered their self-learning habits and critical thinking with teamwork. As for different genders, more female students endorsed the benefits of the CBL model for skill development, while more male students gave positive feedback on CBL model in terms of stimulating their motivation to study and stated that they preferred CBL model in the future. Notably, this study adopted a quasi-experimental design with grouping based on intact classes and voluntary student participation, which may lead to self-selection bias when interpreting the results.

The link between spirituality and body donation is an important consideration, especially in Nigeria, where there is currently no formal body bequest program for medical education and research purposes. This study delved into students' spiritual perspectives, gauging their impact on their willingness to donate their bodies for educational or research purposes. This cross-sectional study assessed 1158 Nigerian medical and allied health students who have been exposed to cadaver dissection via an online questionnaire developed from interviews and the Spirituality Orientation Inventory, which included questions on spiritual beliefs, willingness, and reasons for body donation. Descriptive analysis and chi-squared tests were used to decide proportions and relationships between the study variables, with statistical significance set at p&#x2009;<&#x2009;0.05. About students' familiarity and attitudes towards body donation, 15.2% were unfamiliar with the concept. In terms of their stance, 35.23% expressed support for body donation, while nearly half, 49.49%, remained neutral on the subject. Most students (63.65%) refused to consider body donation after death. Only a few respondents (17.62%) were open to donating for education or research or if they would benefit from it (10.49%). More than half (56.24%) agreed that they followed their religion's teachings. 76.37% believed in life after death, 40% were uncertain about reincarnation while 54.28% were unaware of their religion's stance on body donation. However, belief in reincarnation is significantly associated with students' willingness to donate their bodies (p&#x2009;=&#x2009;0.026). Awareness of body donation among Nigerian medical students is low, with many expressing neutral attitudes and limited understanding of their religion's stance. Willingness to donate is generally poor, and while spirituality plays a role, specific beliefs such as reincarnation appear more influential than overall religiosity. These findings highlight the need for targeted education and culturally sensitive awareness initiatives.

This paper examines the value of Oller-Vallejo's (2001) ego state model as a framework for understanding emotional dynamics in mental health nursing clinical supervision, and its integration with Proctor's (1986) model of supervision. Mental health nursing is characterised by high emotional demand, relational complexity and exposure to psychological distress. Clinical supervision is increasingly recognised as essential for supporting emotional well-being, professional development and safe practice. However, there remains a need for more psychologically informed frameworks to better understand the emotional processes occurring within supervisory relationships. This paper adopts a conceptual, theory-informed approach, drawing on published literature relating to ego state theory and clinical supervision models. A narrative synthesis is used to explore how these frameworks can be integrated to enhance understanding of emotional processes in supervision. The ego state concepts of caregiving, caregetting and individuating are used to explore emotional roles and relational dynamics within supervision. These are considered alongside Proctor's (1986) restorative, formative and normative functions of supervision. The integration of these models provides a structured way to understand emotional containment, dependency, autonomy and professional development within supervisory relationships in mental health nursing. The paper proposes that combining ego state theory with established supervision models offers a psychologically informed framework for enhancing clinical supervision. This has implications for supporting emotional resilience, improving reflective practice and strengthening workforce well-being and sustainability in mental health nursing.

Despite the widespread use of total knee arthroplasty (TKA), the optimal wound closure technique remains clinically unresolved. Barbed sutures have been proposed as a knotless alternative to traditional sutures, with potential advantages in operative efficiency and wound closure; however, concerns remain regarding postoperative complications. This systematic review and meta-analysis aimed to compare the clinical outcomes and postoperative complications associated with barbed versus traditional sutures in patients undergoing primary TKA. A comprehensive literature search was conducted using MEDLINE/PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), ScienceDirect, Scopus, and Embase from database inception through November 2025. Eligible studies were restricted to randomized controlled trials (RCTs) involving adults undergoing primary TKA that directly compared barbed with traditional (knotted) sutures and reported at least one predefined clinical or wound-related outcome. Primary outcomes included wound closure time, superficial wound infection, postoperative Knee Society Score (KSS), knee range of motion (ROM), and wound-related adverse events. Meta-analysis was performed using RevMan version 5.3. The study was registered in PROSPERO (CRD420251128395) and received Institutional Review Board (IRB) approval from King Abdullah International Medical Research Center (Protocol No. NRJ25/044/8). Five randomized controlled trials involving 1035 patients mettheeligibilitycriteria. Barbed sutures appeared to be associated with shorter wound closure times (MD&#x2009;=&#x2009;-&#x2009;5.39&#xa0;min, 95% CI: - 9.89 to -&#x2009;0.88; P&#x2009;=&#x2009;0.02). However, substantial heterogeneity was observed across studies. Superficial wound infection was significantly more frequent with barbed sutures (OR&#x2009;=&#x2009;2.33, 95% CI: 1.07-5.05; P&#x2009;=&#x2009;0.03). No significant differences were observed in postoperative KSS at 6 weeks and 3 months (MD&#x2009;=&#x2009;0.42, 95% CI: - 0.88 to 1.72; P&#x2009;=&#x2009;0.53). Barbed sutures may reduce wound closure time during TKA but are associated with a higher risk of superficial wound infection. No significant differences were observed in early functional outcomes, and further high-quality studies are needed to clarify long-term safety and efficacy.