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Hypercholesterolemia and dyslipidemia are associated with an increased risk for many cancer types and with poor outcomes in patients with established disease. Whereas the mechanisms by which this occurs are multifactorial we determine that chronic exposure of cells to 27-hydroxycholesterol (27HC), an abundant circulating cholesterol metabolite, selects for cells that exhibit increased cellular uptake and/or lipid biosynthesis. These cells exhibit substantially increased tumorigenic and metastatic capacity. Notably, the metabolic stress imposed upon cells by the accumulated lipids requires sustained expression of GPX4, a negative regulator of ferroptotic cell death. We show that resistance to ferroptosis is a feature of metastatic cells and further demonstrate that GPX4 knockdown attenuates the enhanced tumorigenic and metastatic activity of 27HC resistant cells. These findings highlight the general importance of ferroptosis in tumor growth and metastasis and suggest that dyslipidemia/hypercholesterolemia impacts cancer pathogenesis by selecting for cells that are resistant to ferroptotic cell death. High cholesterol has been associated with increased risk of cancer but the underlying mechanism is not completely understood. Here, the authors show that a cholesterol metabolite induces metabolic reprogramming that generates ferroptosis-resistant cancer cells leading to increased tumour growth and metastasis.

Conventional nursing courses have solely adopted lecture-based instruction for knowledge delivery, which tends to lack interaction, rehearsal, and personalized feedback. The development of chatbot technologies and their broad application have provided an opportunity to solve the abovementioned problems. Some knowledge-based chatbot systems have been developed; however, it is still a challenging issue for researchers to determine exactly how to effectively apply these chatbot technologies in nursing training courses. Intending to explore the application mode of chatbot technologies and their effectiveness in nursing education, this study integrated a knowledge-based chatbot system into the teaching activities of a physical examination course, using smartphones as the learning devices, and guiding students to practice their anatomy knowledge in addition to analyzing their learning efficacy and pleasure. A quasi-experiment was conducted by recruiting two classes of university students with nursing majors. One class was the experimental group learning with the knowledge-based chatbot system, while the other class was the control group learning with the traditional instruction. Based on the experimental results, the knowledge-based chatbot system effectively enhanced students' academic performance, critical thinking, and learning satisfaction. The results indicate that the application of chatbots has great potential in nursing education.

Obesity and elevated circulating cholesterol are risk factors for breast cancer recurrence, while the use of statins, cholesterol biosynthesis inhibitors widely used for treating hypercholesterolemia, is associated with improved disease-free survival. Here, we show that cholesterol mediates the metastatic effects of a high-fat diet via its oxysterol metabolite, 27-hydroxycholesterol. Ablation or inhibition of CYP27A1, the enzyme responsible for the rate-limiting step in 27-hydroxycholesterol biosynthesis, significantly reduces metastasis in relevant animal models of cancer. The robust effects of 27-hydroxycholesterol on metastasis requires myeloid immune cell function, and it was found that this oxysterol increases the number of polymorphonuclear-neutrophils and γδ-T cells at distal metastatic sites. The pro-metastatic actions of 27-hydroxycholesterol requires both polymorphonuclear-neutrophils and γδ-T cells, and 27-hydroxycholesterol treatment results in a decreased number of cytotoxic CD8 + T lymphocytes. Therefore, through its actions on γδ-T cells and polymorphonuclear-neutrophils, 27-hydroxycholesterol functions as a biochemical mediator of the metastatic effects of hypercholesterolemia. High cholesterol is a risk factor for breast cancer recurrence. Here the authors show that cholesterol promotes breast cancer metastasis via its metabolite 27-hydroxycholesterol (27HC) that acts on immune myeloid cells residing at the distal metastatic sites, thus promoting an immune suppressive environment.

Fostering students’ abilities to deal with practical problems is an important objective of professional training. To enable students to have more practicing time under the supervision of trainers in class, flipped learning has been adopted to shift the lecture time to the before-class stage, and hence more time is available for in-class practicing. Although flipped learning has been recognized by scholars as an effective teaching mode, researchers have also indicated the challenges of implementing it; in particular, many students have difficulty learning before the class on their own. In this research, a self-regulated flipped learning approach was proposed to cope with this problem by guiding students to set their learning goals, and supporting them in monitoring their learning status in five stages, namely, goal setting, flipped learning (including pre-class video-based instruction and in-class discussion), task sharing, self-evaluation, and self-regulation feedback. In addition, an experiment was conducted in a professional training program to examine the effectiveness of the proposed approach. From the experimental results, it was found that the approach significantly improved the students’ learning achievement, self-efficacy, self-regulation, and critical thinking, which could be a good reference for future research related to flipped professional training.

Traditional nursing and health education design courses usually only transfer knowledge via lectures, and lack interaction, drills and personalized feedback. However, the development and widespread adoption of generative artificial intelligence via the ChatGPT system presents an opportunity to address these issues. Some CIDI model-based ChatGPT systems have been developed, but how to effectively apply these technologies in nursing education design courses remains a challenging problem for researchers. In order to explore the application mode and effect of generative artificial intelligence via ChatGPT technology in nursing education, this study integrated generative artificial intelligence via the ChatGPT system into the teaching activities of nursing and health education design courses, and used computers as learning tools to guide learners to learn nursing and health knowledge. At the same time, two classes of nursing undergraduates were recruited to conduct a quasi-experiment. One of the classes was the experimental group, which used the generative artificial intelligence via the ChatGPT system for learning; the other class was the control group, which used traditional teaching methods for learning. By analyzing learners’ learning efficiency and learning satisfaction, we obtained results about the application effect of generative artificial intelligence via ChatGPT technology in a nursing education design course. According to the experimental results, the generative artificial intelligence via ChatGPT system effectively improved learners’ critical thinking ability, problem solving, and learning enjoyment. These results indicate that the generative artificial intelligence via ChatGPT system has great potential in nursing education design courses, and can improve the deficiencies of traditional teaching methods.

Background Assessment of the initial medical history data for pregnant women is an essential component of nursing training. Therefore, understanding clinical patient characteristics is crucial for developing students' ability to independently manage and care for pregnant women and to prepare students for entry into clinical practice. Method This study used a quasiexperimental pre- and posttest design. The generative artificial intelligence-based patient character creation (GAI-PCC) teaching strategy was used for the experimental group, and the conventional creating personas teaching strategy was used for the control group. Results The findings indicated the GAI-PCC teaching strategy significantly improved students' training. Therefore, it is recommended that this teaching strategy be implemented as an innovative scheme in nursing. Conclusion The GAI-PCC teaching strategy has a strong influence on nursing students' maternal care education. Nursing scholars should consciously integrate appropriate generative AI technology and teaching strategies to enhance students' patient care abilities. [J Nurs Educ. 2025;64(6):346–355.]

The Electrocardiogram (ECG) is one of the important tools for diagnosing myocardial infarction. The ECG training course aims to help nurses establish basic competence in interpreting ECG readings. However, in traditional instruction, learners usually have difficulty memorizing the meanings of different ECG wave forms, which could represent clinical symptoms, or even life-threatening conditions/arrhythmia. Some serious problems could cause death if the nursing staff do not make correct judgments in time. This paper reports an explorative study which investigated a novel pedagogy for nursing school students’ ECG learning performance using a contextual game. A 2 week experiment was conducted to compare the learning performances of the nursing students who played the ECG contextual game and those who learned with traditional instruction. The experimental results show that the students learning with the contextual game showed better learning performance, attitude, motivation, and critical thinking tendency than those who received the traditional instruction.

Facilitating the childbirth process is a global issue. Many strategies have been developed to cope with labor pain and improve the delivery experience and satisfaction of pregnant women. The results of different types of medical intervention on women's expectant pain have been varied. Therefore, this systematic review was aimed at summarizing the body of evidence regarding the effects of various non-pharmacological coping strategies for reducing labor pain. The review was conducted according to guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We systematically searched the articles published between 1989 and 2020 in six electronic databases: PubMed, MEDLINE, CINAHL, WOS, PsycARTICLES, and Airiti Library, and the reference lists of the Clinical Trial Registry. Twenty studies were identified, with eight eligible studies included in the Bayesian network meta-analysis. Eight studies with 713 participants were included in the meta-analysis with nine different non-pharmacological strategies for reducing labor pain. The traditional meta-analysis demonstrated that the non-pharmacological coping strategies were effective in reducing labor pain. Of these interventional strategies, the ranking probabilities analysis of the network meta-analysis suggested that the Bonapace Method may be the most effective strategy in reducing labor pain, followed by acupressure. Non-pharmacological coping strategies can reduce labor pain while maintaining an effective and satisfactory delivery experience. This systematic review, by synthesizing the body of evidence, demonstrated that non-pharmacological coping strategies are effective in reducing labor pain. Furthermore, as demonstrated in the network meta-analysis, the Bonapace Method, modulating birth pain by involving the father, is the most effective non-pharmacological intervention for reducing labor pain.

Tumor-associated myeloid cells regulate tumor growth and metastasis, and their accumulation is a negative prognostic factor for breast cancer. Here we find calcium/calmodulin-dependent kinase kinase (CaMKK2) to be highly expressed within intratumoral myeloid cells in mouse models of breast cancer, and demonstrate that its inhibition within myeloid cells suppresses tumor growth by increasing intratumoral accumulation of effector CD8 + T cells and immune-stimulatory myeloid subsets. Tumor-associated macrophages (TAMs) isolated from Camkk2 −/− mice expressed higher levels of chemokines involved in the recruitment of effector T cells compared to WT. Similarly, in vitro generated Camkk2 −/− macrophages recruit more T cells, and have a reduced capability to suppress T cell proliferation, compared to WT. Treatment with CaMKK2 inhibitors blocks tumor growth in a CD8 + T cell-dependent manner, and facilitates a favorable reprogramming of the immune cell microenvironment. These data, credential CaMKK2 as a myeloid-selective checkpoint, the inhibition of which may have utility in the immunotherapy of breast cancer. Calcium/calmodulin-dependent kinase kinase 2 (CaMKK2) is highly expressed in several cancers. Here the authors investigate the role of CaMKK2 expression in the tumour microenvironment and show that CaMKK2 expression in tumour-associated macrophages promotes tumour growth by suppressing T cell anti-tumour activity.

AimsThis study aimed to identify the efficiency of escape room activities in terms of enhancing nursing students’ retention of maternity-related knowledge and their overall learning performance.BackgroundNovel teaching methods have been explored as alternatives to traditional approaches. One such strategy is the implementation of escape-room-based techniques, which have been used as an inventive educational approach in nursing. However, there is limited information available on specific applications, such as in maternity education.DesignThe study conducted a quasi-experimental design during two semesters of an academic year (i.e., the 2021–2022 academic year). The study was conducted at a university, with participants enrolled in a maternity course.MethodsThe experimental group engaged in an online game-based escape room learning activity during the pregnancy assessment session of their maternity course, while the control group learned with a traditional teaching approach. The Mann-Whitney U test was used to compare the performances of the two groups.ResultsFindings from the experimental group suggested that incorporating an online game-based escape room approach into the learning process enhanced students’ learning performance, problem-solving skills and critical thinking skills. Additionally, students expressed a consensus that learning through the online game-based escape room approach added enjoyment to the learning experience.ConclusionsMaternity escape rooms” emerged as an online game-based approach that effectively stimulated nursing students and can serve as a practical resource for engaging in maternity care learning.