Here, we evaluated the expression of CYP24A1, a protein that inactivates vitamin D in tissues. CYP24A1 expression was increased in advanced-stage endometrial tumors compared to normal tissues. Similarly, endometrial cancer cells expressed higher levels of CYP24A1 than immortalized endometrial epithelial cells. RT-PCR and Western blotting were used to examine CYP24A1 mRNA and protein levels in endometrial cancer cells after 8, 24, 72, and 120 h of exposure to progesterone, progestin derivatives and calcitriol, either alone or in combination. Progestins inhibited calcitriol-induced expression of CYP24A1 and splice variant CYP24SV mRNA and protein in cancer cells. Furthermore, actinomycin D, but not cycloheximide, blocked calcitriol-induced CYP24A1 splicing. siRNA-induced knockdown of CYP24A1 expression sensitized endometrial cancer cells to calcitriol-induced growth inhibition. These data suggest that CYP24A1 overexpression reduces the antitumor effects of calcitriol in cancer cells and that progestins may be beneficial for maintaining calcitriol's anti-endometrial cancer activity.
Introduction The ongoing invasion of Ukraine by the Russian Federation represents one of the largest ongoing conventional military engagements in the last 20 years. Since the start of the war, an estimated 210 000 Ukrainian soldiers have been injured or killed as a result of combat. This experience could help prognosticate the nature of large-scale combat operations for modern militaries. The aim of this study was to assess current patterns of injuries among military combatants in Ukraine and identify prevention and mitigation methods.Methods We conducted a series of key informant interviews during the ongoing conflict using an expanded version of the global trauma system evaluation tool. We focused the analysis on injury patterns and prevention of combat-related injuries.Results We interviewed 36 participants from June 2023 to February 2024. Respondents described complex polytrauma as representing the injury norm, with prominent battle injuries, including blast wounds to the extremities, traumatic brain injuries and spinal cord trauma. The primary source of injury prevention on the battlefield remains combat body armour. Military commanders and the Ministry of Defence were identified as principal bodies for the authorising equipment and tactical changes. Most respondents stated there was no formal process for using data to inform injury prevention initiatives.Conclusion The current conflict in Ukraine is characterised by a high prevalence of devastating combat-related injury, with limited measures for battlefield injury prevention. We believe that the provision of additional protective gear could mitigate the severity of some combat-related injuries, while the creation of a trauma registry would provide greater insight into prevention, wounding patterns, treatment and outcomes.
Introduction: This systematic review and meta-analysis evaluates the effectiveness of self-directed learning (SDL) in health professions education (HPE), examining its impact on knowledge, clinical performance, and behavioral outcomes. It investigates whether core SDL components influence educational outcomes, updating and extending the foundational work of Murad et al. (2010). Methods: We searched CINAHL, Embase, OVID Medline, PsycINFO, and Web of Science (2009–2023) for comparative studies evaluating SDL interventions in HPE. From 6,786 screened articles, 125 studies met inclusion criteria, with 48 eligible for meta-analysis. We conducted a three-level random-effects meta-analysis and moderator analyses on profession, outcome type, SDL modality, and facilitator role. Five independent reviewers conducted screening and extraction, resolving discrepancies via consensus. Results: The meta-analysis incorporated 74 effect sizes from 48 studies, revealing a small-to-moderate overall effect (Cohen’s d = 0.34, 95% CI 0.04, 0.64) with significant heterogeneity (I2 = 87%). SDL as intervention showed larger effects (d = 0.54 vs. d = –0.27, p = 0.004). Most studies involved Kirkpatrick Level 2 outcomes (knowledge/skills, 78%), with some Level 3 outcomes (skills/behaviors, 22%) and no Level 4 outcomes (patient/system) reported. Most teachers were absent or acted as facilitators, while learners were less likely to be involved in choosing resources (21%) or in assessments (25%). Conclusions: This updated meta-analysis reaffirms that SDL reliably enhances knowledge acquisition but suggests that it may yield only modest gains in clinical skills and behaviors. The wide variability in how SDL is defined and reported underscores the need for a consensus definition of SDL.
Military sexual trauma (MST) has been a long-standing concern within the U.S. military. Although research has examined risk factors and long-term impacts of MST, there is a gap in research about how the military impacts MST survivors' recovery and understanding mental health specialists' perspectives of MST recovery. This study aimed to identify military factors impacting an MST survivor's recovery journey from mental health specialists' perspectives. Qualitative data were collected through semistructured interviews with civilian and uniformed mental health specialists who have worked with MST survivors. Interviews followed a five-phase MST survivor's recovery model developed for this study (Phase 1: reporting the assault, Phase 2: obtaining medical care, Phase 3: accessing effective mental health care, Phase 4: institutional reintegration, and Phase 5: recovery). Responses were analyzed using reflexive thematic analysis. Seven mental health specialists (85% female and 72% active duty) participated, averaging 11.3 (6.4) years of experience and working with an average of 115.4 (172.04) MST survivors. Findings revealed that each phase of a survivor's recovery journey encounters institutional and treatment-level barriers. Reflexive thematic analysis identified 41 themes, with 19 relevant to the current aims and eight identified as facilitators or barriers to recovery within the survivor's journey to recovery model. Results suggest that military personnel's use of supportive language when an assault is disclosed-shortening wait times between appointments when completing trauma-informed protocols, providing psychoeducation on trauma, defining MST recovery outcomes, and allowing time for recovery in garrison environments-may reduce barriers to recovery. Clinical recommendations are offered to help providers reduce possible MST recovery barriers. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
