搜索结果：bioethics

In healthcare settings, it is crucial to understand the identities of patients receiving services, both for cultural considerations and to identify and prevent disparities in care. Our retrospective observational study analyzed 763 adult bioethics consultations from 2016-2024 at a large urban academic health system and compared the demographics of patients receiving bioethics consultation to the general patient population. We also evaluated demographic differences between patients receiving consults for different categories of ethics issues. We found that Hispanic and Asian patients were underrepresented among those receiving ethics consults, while Black and White patients were overrepresented. Additionally, patients receiving consults were more likely to be male and older. Consults for refusal of medically indicated care were significantly associated with younger age, HIV/AIDS diagnosis, and having diabetes with complications. Initial bivariable associations of consults for refusal of medically indicated care with race and language did not remain significant after adjustment for confounders. The finding that Hispanic and Asian patients were less likely to receive ethics consults may reflect language-related communication barriers or underrecognition of ethics-related concerns. Findings highlight racial and linguistic disparities in ethics service utilization, which may mirror broader structural inequities in care delivery and provider communication. Addressing these gaps is essential for advancing ethical, culturally responsive care. Future efforts should focus on improving access to ethics resources for marginalized groups and investigating how structural racism and communication dynamics influence ethics consult initiation.

Genetic testing, including pharmacogenetic testing, is transforming personalized healthcare by improving risk assessment and treatment decisions. However, these advancements raise ethical, practical, and legal concerns for data privacy and security, as test results are often stored in EHRs. Additional concerns include the use of genetic data in underwriting for policies not covered under the federal Genetic Information Nondiscrimination Act of 2008, including life, disability, and long-term care insurance.These issues affect patients, consumers, and the broader healthcare system by increasing costs when patients delay testing or treatment out of fear of discrimination. They also strain public health programs when individuals are denied coverage because of genetic risks, leading to a "genetic underclass," in which people with certain genetic predispositions are marginalized from the insurance market. Applying a bioethics framework of autonomy, beneficence, nonmaleficence, and justice allows these issues to be examined, and current protections to be evaluated for the purpose of instituting change.

Medical dramas are widely consumed by medical students globally and may constitute an informal or hidden curriculum influencing professional identity, empathy, and ethical reasoning. Palestinian medical students represent an understudied population navigating a resource-constrained and geopolitically complex healthcare context. To investigate the perceptions of Palestinian medical students regarding medical dramas, including viewing habits, assessments of clinical and ethical realism, psychological and behavioural impacts, and the potential role of such media as an informal educational resource. A cross-sectional study was conducted among 638 undergraduate medical students from five universities in the West Bank, Palestine, using convenience and snowball sampling. Data were collected via an online structured questionnaire adapted and culturally validated from the Czarny et al. (2008) instrument, incorporating forward-back translation, pilot testing (n&#x2009;=&#x2009;15), and internal consistency assessment (Cronbach's alpha&#x2009;=&#x2009;0.81). Descriptive statistics and Chi-square tests were applied. Mean age was 21.1&#x2009;&#xb1;&#x2009;1.65 years; 66.8% were female. Most participants (73.4%) had watched medical dramas, primarily via digital streaming platforms. While 77.3% perceived clinical scenes as only slightly or moderately realistic, 41.9% considered ethical content to be moderately accurately depicted. Approximately 46.6% reported increased empathy and 47.2% reported increased study motivation. Drama viewers were significantly more likely to rate informal sources-family (p&#x2009;<&#x2009;0.001), friends (p&#x2009;=&#x2009;0.021), and online news (p&#x2009;=&#x2009;0.037)-as important for ethical guidance, compared with non-viewers. Palestinian medical students engage substantially with medical dramas and appraise their content critically. Associations between drama viewing and increased empathy, study motivation, and reliance on informal ethical guidance sources suggest a potential hidden-curriculum effect. Given the cross-sectional design and convenience sampling, causal inferences cannot be drawn. These findings support cautious integration of medical dramas into bioethics and professionalism curricula as supplementary teaching tools.

BackgroundNeonatal nursing care requires ethical competence alongside technical expertise. Despite progress in Spain, disparities persist in ethical training and professional autonomy in neonatal units.ObjectiveTo examine the ethical dimension of neonatal nursing in Spain, including training, institutional resources, ethical climate, and experiences of ethical conflict and moral distress.Research designA descriptive, observational, and cross-sectional study was conducted, combining quantitative and qualitative analyses to examine the ethical-professional reality of neonatal nurses nationwide. The study was based on an ad hoc questionnaire specifically designed for this research and validated through expert review and content validation procedures.Participants and research contextA total of 307 neonatal nurses in Spain completed an online questionnaire developed by the researcher with 24 structured and semi-structured items. The sample size was determined based on voluntary nationwide participation during the 6-month data collection period, aiming to maximize territorial representation and professional heterogeneity among neonatal nursing staff. The instrument explored sociodemographic, educational, professional, and institutional variables, together with experiences of moral distress and ethical conflict.Ethical considerationThe study followed the Declaration of Helsinki and Spanish and European data protection regulations. The questionnaire was fully anonymous, and no personal data or IP addresses were collected. Informed consent was obtained from all participants. As the study involved anonymous voluntary participation without clinical intervention or sensitive data processing, Ethics Committee approval was not required under regulations.FindingsMost participants had non-formal bioethics training, whereas formal postgraduate education was rare. Moral distress was reported by 85% of respondents, mainly related to treatment limitation, therapeutic obstinacy, and end-of-life care. Bioethics training and professional experience predicted moral distress, while Clinical Ethics Committees showed no predictive value. These findings highlight the need to strengthen ethics education and promote participatory institutional environments to support ethical decision-making and reduce moral distress in neonatal nursing practice.ConclusionThe ethical dimension of neonatal nursing in Spain is shaped by education, experience, and institutional climate. Training was associated with moral distress, but its impact depends on organizational support, underscoring the need for participatory environments to reduce suffering and strengthen ethical care.

Medical futility (MF) remains a complex and debated concept in clinical practice, particularly among patients with terminal illness or limited life expectancy, largely due to inconsistencies in its definition and variability in its application, which complicate clinical decision-making. A scoping review was conducted following the methodologies proposed by Arksey, Levac, the Joanna Briggs Institute, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines to analyze evidence on therapeutic futility in terminally ill adults and the clinical, ethical, and prognostic criteria influencing end-of-life decision-making.&#xa0;A total of 36 published studies were included. Regarding study design, retrospective observational studies predominated (12/36, 33.3%), followed by qualitative studies (9/36, 25.0%), cross-sectional studies (6/36, 16.7%), and, to a lesser extent, prospective or cohort studies (3/36, 8.3%), mixed-methods or case-control studies (2/36, 5.6%), and one case report (1/36, 2.8%). Most studies focused on patients (21/36, 58.3%), primarily in critical care settings or among individuals with advanced disease. A considerable proportion exclusively evaluated healthcare professionals (10/36, 27.8%). Regarding the clinical context, ICUs represented the predominant clinical setting, including general, oncological, surgical, neurological, and medical intensive care units. Other settings included non-critical hospital environments (5/36, 13.9%), oncology-specific settings (3/36, 8.3%), prehospital or emergency care settings (2/36, 5.6%), and additional areas, such as psychiatry, bioethics, or palliative care (3/36, 8.3%). The most frequently identified criterion for MF was the use of treatments without expected clinical benefit (10/36, 27.8%). Ethical and clinical dimensions were addressed across all included studies, with a predominance of multidimensional approaches integrating principles, such as autonomy, beneficence, and justice. Small sample sizes and single-center designs predominated, particularly among qualitative and retrospective studies. MF is a complex and multidimensional concept influenced by clinical, ethical, and sociocultural factors. The heterogeneity in its definition and application complicates the standardization of decision-making, particularly in settings such as ICUs.

BackgroundWorkplace violence (WV) is unfortunately common in healthcare environments and leads to difficult ethical choices for nurses who must decide how to provide for patients' care needs while also navigating a risk of being harmed. When safety takes priority over care, nursing values such as non-abandonment and duty to care cannot be fulfilled, and moral distress results.Research questionThis study examined how moral distress is experienced when nurses encounter WV, to better understand the implications of these ethically fraught situations.Design, Participants & ContextWe conducted a secondary qualitative analysis using conventional inductive content analysis of interview transcripts related to nurses' experiences of WV from 36 nurses working in a range of settings across Canada.Ethical considerationsThe study was approved by the University of Manitoba Fort Garry Campus Research Ethics Board (HE2023-0102).FindingsViolence from patients is a significant moral event, creating moral distress for nurses. We identified three themes: Moral Compromise: angst related to the inability to meet patient needs, the impact of causing trauma to the patient, and being part of dignity-compromising care; Disengagement: decreased tolerance, restrictive boundaries, and leaving the situation; and Structural Influences: watching colleagues suffer, lack of options for violence prevention, and the impact of supervisor support.ConclusionThis study provides critical insights into the ways that nurses experience WV-related moral distress, including the contextuality of the duty to care, opportunities to reframe the concept of abandonment to allow for withdrawal when needed to mitigate risk and moral distress, and the key role of institutions in the production of moral distress. The impact of moral distress experienced by nurses when facing WV and the profound ethical and professional consequences of violent interactions for nurses are a clear call for measures to address both the antecedent behaviors and the resulting distress.

Metabolic syndrome (MetS) represents a well-recognized contributor to cardiovascular risk, and synbiotics have recently gained attention as a potential dietary strategy for its management. The present study aimed to determine whether a novel synbiotic yogurt formulated with Lactobacillus plantarum, Lactobacillus pentosus, and the yeast Kluyveromyces marxianus affects atherogenic markers, cardiometabolic parameters, and insulin resistance surrogates in individuals among individuals diagnosed with MetS. A 12-week double-blind, standard-yogurt-controlled randomized clinical trial was conducted, enrolling 44 adults with MetS who were randomized to either 300&#xa0;g/day of synbiotic yogurt (n&#x2009;=&#x2009;22) or a matched control yogurt (n&#x2009;=&#x2009;22); 41 (22 synbiotic, 19 control yogurt) completed and were analyzed. A comprehensive panel of cardiometabolic outcomes was evaluated at baseline and week 12, encompassing atherogenic indices including the Atherogenic Index of Plasma (AIP), Castelli's Risk Index-I (CRI-I), Castelli's Risk Index-II (CRI-II), Atherogenic Coefficient (AC), and oxidized low-density lipoprotein (ox-LDL); cardiometabolic measures including the Visceral Adiposity Index (VAI), Waist Triglyceride Index (WTI), and Cardiometabolic Index (CMI); body shape and adiposity indices including A Body Shape Index (ABSI), Body Roundness Index (BRI), Body Adiposity Index (BAI), Conicity Index, Abdominal Volume Index (AVI), and Weight-adjusted Waist Index (WWI); and surrogate markers of insulin resistance including the Triglyceride-Glucose Index (TyG), Hepatic Steatosis Index (HSI), triglyceride to high-density lipoprotein ratio (TG/HDL), TyG-Body Mass Index (TyG-BMI), TyG-Waist Circumference (TyG-WC), Metabolic Score for Insulin Resistance (METS-IR), and Lipid Accumulation Product (LAP). At the end of the 12-week period, statistically significant between-group differences were limited to four indices, namely CRI-I (p&#x2009;=&#x2009;0.039), CRI-II (p&#x2009;=&#x2009;0.038), AC (p&#x2009;=&#x2009;0.039), and BAI (p&#x2009;=&#x2009;0.027), all of which favored the control group. Within-group analyses indicated that the control arm experienced significant reductions in AIP, CRI-I, CRI-II, AC, TG/HDL, and METS-IR, whereas participants in the synbiotic arm demonstrated significant decreases only in TyG and TyG-BMI. No significant changes were observed in other indices. According to our findings, 12 weeks of daily synbiotic yogurt consumption did not significantly improve insulin resistance surrogates, atherogenic, and novel anthropometric indices in adults with MetS. Iranian Registry of Clinical Trials (registration ID: IRCT20220426054667N1; registration date: 2022-05-18).

Chromosomal structural variant (CSV)-associated conditions, or genomic disorders (GDs), remain a diagnostic challenge. Our cohort included 26 individuals with severe unselected, phenotypes associated with simple CSVs, as well as two clinically unaffected individuals. Long-insert short-read (LI-SR) and short-insert whole-genome sequencing (SI-WGS) were applied to capture the full spectrum of structural and small sequence variants, complemented by whole-blood transcriptome profiling in 12 individuals. Genome-wide, pathway-stratified, and candidate gene-based phenotype overlap analyses, together with pathway enrichment analysis, were performed to define the spectrum of pathogenic variants and underlying molecular mechanisms, to enable comprehensive phenotype-genotype correlations, and to assess the diagnostic yield and suitability of the applied WGS technologies within a genome-first personalized genomic medicine (PGM) framework. Among disease-causing genes, eight were affected by gene disruption or position effects leading to AD neurodevelopmental GDs; six were identified in individuals with benign simple CSVs with AD conditions caused by small sequence variants; and one case was attributed to a digenic combination of distinct variant types. Candidate disease-associated genes included FLT1 (RASopathies), SSBP3 (chromatinopathies), the ARL14EP-DT/FSHB locus, and position effect-affected genes ZC4H2 and EDA2R, supported by phenotypic, transcriptomic, and pathway enrichment data. This integrative PGM approach-combining WGS, transcriptomic profiling providing orthogonal functional evidence, and detailed phenotyping-improves diagnostic yield, shortens the diagnostic odyssey, facilitates functional genome annotation, and enables the identification of previously unreported disease associations. These findings support SI-WGS as a first-tier diagnostic strategy for structural variant-associated conditions and highlight its potential utility in prenatal diagnosis and personalized medicine.

Peri-implant diseases are characterized by complex host-microbe interactions. This study aimed to investigate the levels of pro-apoptotic Bcl-2 family proteins and their relationship with Porphyromonas gingivalis-gingipain and Treponema denticola-dentilisin in peri-implant tissues. Tissue samples were collected from 72 participants: healthy controls (n&#x2009;=&#x2009;24), peri-implant mucositis (n&#x2009;=&#x2009;23), and peri-implantitis (n&#x2009;=&#x2009;25). Levels of pro-apoptotic proteins (Bax, Bad, Bim, Smac, and Lamin B) quantified via multiplex immunoassays, and proteases were analyzed using western blotting and normalized to total protein content. Regression models adjusted for age and clinical parameters assessed associations between microbial protease levels and apoptotic proteins. Pro-apoptotic protein levels were significantly lower in diseased sites compared to healthy controls (p&#x2009;<&#x2009;0.001). While absolute protease levels did not differ significantly between groups (p&#x2009;>&#x2009;0.05), multivariate regression models, adjusted for clinical parameters, revealed significant associations between gingipain/dentilisin and Bax/Bad levels (p&#x2009;<&#x2009;0.05). The downregulation of pro-apoptotic proteins suggests a suppressed apoptotic response in peri-implant lesions, potentially contributing to disease persistence. The preliminary associations between bacterial proteases and apoptotic markers, independent of clinical severity, highlights these virulence factors as potential modulators of tissue homeostasis and candidates for future diagnostic and therapeutic targets. Bacterial proteases show modest associations with host apoptotic pathways in peri-implant diseases. A better understanding of these relationships may potentially help develop new preventive and therapeutic strategies in the future.

Critical care often unfolds amid uncertainty in diagnosis, therapeutic options and prognosis. Patients frequently lack decision-making capacity, while families confront emotional distress and value conflict in surrogate choices. In this context, time-limited trials (TLTs) have been proposed as a pragmatic mechanism to limit non-beneficial treatment while allowing time for clinical clarification and moral deliberation. Despite growing operational guidance, an inclusive ethical account of TLTs remains underdeveloped. We offer a normative analysis organised across four ethical dimensions and 11 analytic categories, integrating the perspectives of patients, families and healthcare professionals and situating bedside practice within broader considerations of justice and public interest. We examine justificatory foundations, legislative and institutional preparedness, anticipated benefits and recurrent challenges. The analysis identifies pressing knowledge gaps: preference discordance; supports for anticipatory grief and bereavement; ethically coherent approaches for organ donation and systemic barriers to implementation. Addressing these gaps is essential for ethically defensible integration of TLTs across diverse healthcare systems. This framework aims to guide patient-centred, relationally attentive and distributively just decision-making while reducing moral distress and supporting the psychological well-being of families and clinicians at the end of life.

TANGO2 deficiency disorder is an ultra-rare autosomal recessive condition characterized by life-threatening metabolic crises with rhabdomyolysis and cardiac arrhythmias. Patients with 22q11.2 deletion syndrome are at increased risk when a pathogenic variant occurs in the remaining allele, yet this dual diagnosis remains underrecognized as clinicians often attribute all manifestations to the primary genetic condition. We report a case of a child with confirmed 22q11.2 deletion syndrome in whom a coexisting variant in the TANGO2 gene was diagnosed at the age of 5 after first metabolic crisis with rhabdomyolysis. A girl with 22q11.2 deletion syndrome diagnosed in infancy exhibited global developmental delay and chronic excessive sleepiness attributed to her established diagnosis. At age 5, she experienced her first metabolic crisis during pneumonia with severe rhabdomyolysis (creatine kinase >100,000 U/L), features inconsistent with isolated 22q11.2 deletion syndrome. Two additional metabolic crises occurred at age 7 before exome sequencing revealed a hemizygous TANGO2 variant c.536G>A, confirming TANGO2 deficiency. A previously unreported hemizygous missense variant c.536G>A (p.Gly138Glu) in the TANGO2 gene (NM_152906.7) was identified and verified by NGS-based deep amplicon sequencing and Sanger direct sequencing; segregation analysis confirmed paternal inheritance with the maternal allele deleted within the 22q11.2 region. Following diagnosis, B-vitamin supplementation, coenzyme Q10, L-carnitine, and gastrostomy tube placement were initiated to ensure consistent hydration and prevent prolonged periods without nutrition, a known crisis trigger. The patient achieved 4 years of crisis-free stability with reduced daytime sleepiness. At age 11, she remains stable without further crises. This case demonstrates that exome sequencing should be pursued early when atypical features emerge in patients with established genetic diagnoses. The sustained crisis-free period following gastrostomy placement supports proactive nutritional intervention in TANGO2 patients with feeding difficulties. Clinicians must recognize that microdeletion syndrome patients can harbor variants unmasking additional autosomal recessive conditions requiring distinct management.

Practices involving assisted reproductive technologies (ARTs) presuppose the allocation of procreative responsibilities of various types and degrees among clinical embryologists, fertility doctors, and nonmedical individuals such as gamete bank staff and attorneys, while typically exempting them from parental rights and obligations. These individuals are appropriately regarded as third-party participants in assisted reproductive technology (ART) procedures. Surrogates, however, engage in gestational labour which implies a sustained, embodied, and relational form of care fundamentally distinct from the technical or procedural contributions of other third-party participants. This distinction calls into question the adequacy of classifying surrogates as mere third-party contributors. This article rejects that classification and argues that the procreative responsibilities of surrogates are better understood as proto-parental responsibilities grounded on the normative significance of gestation. These responsibilities constitute a prior stage of parenthood, providing the moral basis for subsequent parental rights and obligations. In advancing this view, this article critically engages with the professional model proposed by Ruth Walker and Liezl van Zyl, according to which surrogates' procreative responsibilities should be understood in professional terms. I argue that the professional model undermines the surrogate's reproductive autonomy, trivialises the moral significance of gestation, and obscures the moral importance of the connection between gestation and parenthood. By contrast, the account developed here argues that proto-parental responsibilities arise from gestational proximity and the pregnant woman's capacity to cultivate relationship goods foundational to the parent-child relationship.

Platelets are increasingly recognized as important mediators of cardioprotection during myocardial infarction and ischemia-reperfusion injury. This study investigated whether, under static hypoxia/reoxygenation (H/R) conditions, platelets and platelet-derived extracellular vesicles (PEVs) modulate matrix metalloproteinase (MMP) expression and activity in cardiomyocytes, contributing to myocardial protection effect. Cultured human cardiomyocytes (HCM) were subjected to static H/R either alone (control) or in co-culture with human platelets, and analysed across four hypoxia durations. Static H/R induced platelet activation and a time-dependent increase in CD61 expression on PEVs, accompanied by elevated proMMP-2 and MMP-2 activity in platelets. Co-cultured cardiomyocytes showed increased intracellular proMMP-2 and MMP-2 activity, while extracellular MMP-2 and MMP-9 activity was reduced. A trend toward decreased MMP-2 gene expression was also observed. Cardiomyocytes exposed to platelets demonstrated higher metabolic activity and extracellular lactate dehydrogenase levels, alongside reduced inducible nitric oxide synthase (iNOS) tissue expression compared with controls. Notably, CD61 expression on PEVs positively correlated with cardiomyocyte metabolic activity. These findings suggest that during H/R, platelet activation and PEVs release contribute to cardioprotective signaling pathways activation, potentially through adsorption of cardiomyocyte-derived MMPs, enhancement of cardiomyocyte metabolism, and inhibition of iNOS-associated cytotoxicity.

Cryptorchidism, a major reproductive malformation in dogs, is associated with an increased risk of testicular cancer. In this study, we aimed to compare miRNA expression and 3'UTR length variation in the mRNAs of differentially expressed genes (DEGs) between undescended (UD) and descended (D) canine testes without signs of tumorigenesis. In total, expression of 453 miRNA genes was detected, and over 100 miRNA DEGs were identified in the UD vs. D and UD vs. C (control) comparisons. Predicted target sequences for DEG miRNAs were in silico identified in numerous mRNAs, including 12 of 19 a priori selected genes related to testicular cancer. In silico analysis of miRNA and mRNA DEGs revealed that some of target mRNAs showed significant differences in UD and D/C testes and approximately 50% of miRNA-mRNA pairs exhibited an inverse expression pattern, including cancer-related genes (e.g., AR, IGF1R, KIT, KITLG, SALL4, and SPRY4). Analysis of the 3'UTR length of DEG mRNAs identified 962 transcripts with altered 3'UTR length in both the UD vs. D and UD vs. C comparisons. 3'UTR lengthening (e.g., in cancer-related genes such as LATS2, SRPK2, and AKT3) was the most common alteration observed. Our findings provide a new insight into molecular alterations associated with canine cryptorchidism. We suggest that in undescended canine testes without signs of tumorigenesis dysregulated expression of protein-coding genes, including candidate cancer-associated genes, can be associated with altered expression of specific miRNAs, as well as variations in the 3'UTR length of certain target DEG mRNAs.

Canada's Assisted Human Reproduction Act prohibits nonmedical sex selection to prevent gender discrimination and demographic imbalance. While rooted in the precautionary principle, this ban was shaped by contexts with strong cultural sex bias; however, contemporary Canada exhibits high gender equality and stable sex ratios, necessitating a re-evaluation of this blanket prohibition. This paper examines the ethical justification for Canada's prohibition on nonmedical sex selection, focusing on family balancing, and explores whether a regulated framework could align with reproductive autonomy without compromising gender equality. Demographic data confirm a balanced sex ratio in Canada, with no evidence of systemic gender preference. North American data indicate that nonmedical sex selection requests are balanced between sexes, primarily motivated by "family balancing" the desire for a child of the sex the parents do not already have. In this context, such requests reflect reproductive autonomy and psychosocial well-being rather than discriminatory intent. Ethical principles of autonomy and proportionality support reconsidering whether current legislation remains calibrated to social realities, particularly given the availability of non-invasive prenatal screening (NIPS) and the potential for harm reduction compared to existing "diagnostic termination" pathways. Furthermore, the current prohibition inadvertently fosters cross-border reproductive care and exacerbates socioeconomic inequalities. This article calls for an evidence-based policy review that offers a balanced alternative with robust guardrails, respecting individual reproductive autonomy while upholding Canada's commitment to gender equality.

Triple negative breast cancer (TNBC) is an aggressive malignancy distinguished by resistance to standard breast cancer therapies. The absence of reliable prognostic tools hinders the ability to predict therapeutic response, resulting in some patients receiving treatment that is ineffective yet physically exhausting. miRNAs are small non-coding RNA molecules that regulate gene expression, and their dysregulated profiles in liquid biopsies hold immense potential as minimally invasive biomarkers for monitoring treatment response. In this study, we seek to identify miRNAs that may serve as predictive biomarkers for therapeutic responses in patients diagnosed with triple-negative breast cancer. To achieve this, an in silico analysis of the Cancer Genome Atlas (TCGA) dataset is conducted to narrow the list of candidate miRNAs. miRNAs with potential involvement in TNBC were selected for clinical validation in whole-blood samples of TNBC patients before and after therapy. The RT-qPCR-based expression analysis revealed significant predictive potential of miR-340-5p, miR-1307-3p, miR-185-5p, and miR-30a-3p. Our study identified that dysregulated miRNA signatures can serve as independent indicators for therapeutic monitoring. Notably, the combined multi-miRNA expression panel offers a robust, superior predictive value for stratifying treatment response and tracking disease progression in TNBC patients.

Eduard Pernkopf (1888-1955), a prominent representative of the Viennese Anatomical School, produced one of the most detailed and visually refined anatomical atlases in the history of medicine: Topographische Anatomie des Menschen. Despite its exceptional scientific and artistic value, the Atlas remains deeply controversial because of its association with National Socialist ideology and the probable use of bodies of executed prisoners during its production. This study provides a historical, morphological, and ethical analysis of Pernkopf's life, scientific work, and enduring influence on anatomical education. Special attention is devoted to the morphological and methodological innovations of Pernkopf's topographical dissection technique, including his systematic layer-by-layer anatomical stratification and the unprecedented three-dimensional realism of his anatomical illustrations. Through analysis of the historiographical and bioethical literature, the study examines the epistemological significance of Pernkopf's anatomical method, the historical context of Nazi-era anatomical science, and the ongoing debate regarding the Atlas's contemporary use. Pernkopf's Atlas emerges as both a landmark in morphological representation and a lasting ethical warning for the anatomical sciences. Its legacy underscores both the enduring methodological influence of Pernkopf's topographical anatomical approach and the necessity of integrating scientific excellence with ethical accountability in modern anatomical science.

Large language models (LLMs) have expanded the capabilities of AI and created new opportunities in medicine. To promote the development of safe and innovative digital health tools, there must be public biosignals datasets that encourage research and provide benchmarks. Multiple current examples involve data use agreements that restrict LLM studies. This work presents recommendations to ensure that public releases of biosignals data can ethically facilitate LLM research efforts.