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Tenma was a practicing doctor when he first met the (very young) Nina. And with his personality, he'd be fully conscious of the detrimental effect he'd have on her, were he to pursue a relationship with her.
I mean, he met her when she was in a severe emotional state, having just shot her brother in the head. No matter how much time has gone by, their relationship (friends or more) would revolve around that time period. Even in the back of his mind he'd be thinking of her as that little helpless girl, and I don't think any sort of healthy adult male would go for that.
He's always going to be there for her, but that's where it ends with him. But as Shiryuu says, there's a lot of signs that she feels quite differently...
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