Search Results (7,189)

Introduction: Pain is highly prevalent among community-dwelling older adults and can undermine their ability to perform Instrumental Activities of Daily Living (IADL), which are essential for independent living. This systematic review aimed to summarize existing research to clarify the relationship between pain and IADL disability in community-dwelling older adults. Methods: We conducted a search of PubMed on 27 July 2025. Eligible studies met the following criteria: (1) assessed the association between pain and IADL disability; (2) included community-dwelling older adults aged 60 and older; and (3) were published in English. Results: Of the 400 records screened, 29 studies met the inclusion criteria. Of these, 23 studies (18 cross-sectional and 5 cohort studies) reported a significant association between pain and IADL disability, while 6 cross-sectional studies did not. Pain was assessed using diverse instruments across varying recall periods and thresholds, and IADL disability was measured using multiple scales. Such methodological heterogeneity precluded quantitative synthesis. Conclusions: In community-dwelling older adults, pain consistently predicts IADL disability across designs and settings. However, the lack of standardized, multidimensional measures and incomplete adjustment for treatment, multimorbidity, and polypharmacy limits precise effect estimation. Future research should adopt harmonized assessment tools, control comprehensively for relevant confounders, and perform meta-analyses where data permit to clarify pain’s true impact on functional independence. Full article

Background: Children with inflammatory bowel disease (IBD) are at heightened risk for vaccine-preventable infections because of underlying immune dysregulation and long-term immunosuppressive therapy. Despite published guidelines affirming vaccine safety, real-world coverage remains suboptimal. It is a pilot, single-country survey designed to explore baseline knowledge and practices regarding vaccination in paediatric IBD within a specific local healthcare context. Objective: The objective of this study is to evaluate the knowledge, attitudes, and practices of paediatric gastroenterologists (PGs) regarding the immunisation of children with IBD. Methods: We conducted an exploratory pilot, cross-sectional survey of paediatric gastroenterologists in Russia, focusing on immunisation knowledge and practical barriers in routine care. A cross-sectional, anonymous online survey was distributed to PGs nationwide between January 2022 and April 2022. The online questionnaire explored demographic characteristics, awareness of international recommendations, perceptions of vaccine safety at various disease and treatment stages, and routine vaccination practices. Responses were analysed with non-parametric statistics (α = 0.05). In a parallel prospective cohort, the vaccination certificates of 98 paediatric IBD patients (January 2022–April 2023) were audited to quantify real-world coverage. Results: Fifty-one PGs completed the survey. Forty-one per cent agreed that vaccines do not provoke IBD flares, while 17.6% considered live vaccines acceptable during immunosuppressive remission. Nearly one-third (32%) did not personally oversee immunisation, and 18% occasionally discouraged vaccination during therapy. Only 35.3% deemed baseline serology essential before starting immunosuppression; 46.5% supported antibody checks immediately prior to vaccination. The certificate audit revealed a full schedule completion rate of 66.3% for measles–mumps–rubella and 74.2% for hepatitis B, contrasting with parental reports of 82.3% complete coverage. Conclusions: Knowledge gaps, limited guideline awareness, and parental concerns contribute to suboptimal vaccination of paediatric IBD patients. Targeted educational initiatives, clearer shared-care pathways, and routine certificate audits are needed to close the coverage gap and reduce infection-related morbidity. Findings are hypothesis-generating and reflect local practice; as a pilot study, results should be interpreted with caution and may not generalise beyond similar settings. Full article

Background and Objectives: Inflammatory bowel diseases (IBDs) are chronic conditions of the digestive tract, often requiring life-long treatments in order to achieve and maintain remission. However, treatment adherence among patients with IBD can frequently be suboptimal, which can compromise disease control and long-term outcomes. The aim of this study was to analyze the adherence rate and to identify factors that significantly influence treatment adherence in patients with IBD. Materials and Methods: The study employed a cross-sectional design and was conducted at the Fundeni Clinical Institute, a tertiary medical center in Bucharest, Romania. The treatment adherence was assessed using the Medication Adherence Report Scale-5 (MARS-5), with patients scoring greater than 23 considered adherent. Anxiety, depression and perceived stress were assessed using the Depression, Anxiety and Stress Scale-21 (DASS-21). Perceived social support was measured with the Multidimensional Scale of Perceived Social Support (MSPSS), and coping strategies were assessed using the Brief Coping Orientation to Problems Experienced Inventory (Brief COPE Inventory). Results: A total of 188 patients were included in the final analysis. Of these, 99 patients (52.7%) were male and 109 (58.0%) had a diagnosis of Crohn’s disease. The majority of patients (81.9%) were receiving treatment with advanced therapies, including biologics or small molecules. Forty patients were receiving their therapy through more than one route of administration. Optimal adherence was noted in 160 patients (85.1%). Patients treated with advanced therapies (biologics and small molecules) had significantly higher odds of optimal adherence (OR 10.52, 95% CI: 4.3–25.74, p < 0.001), with a rate of adherence of 92.2%. Significantly lower odds of adherence were found for the oral (OR 0.35, 95% CI: 0.14–0.83, p = 0.01) and rectal (OR 0.09, 95% CI: 0.03–0.29, p < 0.001) routes of administration, while the intravenous administration had higher odds of adherence (OR 4.85, 95% CI: 1.02–22.9, p = 0.04) compared to the subcutaneous route. Other factors associated with an improved adherence were being retired (OR 3.5, 95% CI: 1.13–10.8, p = 0.029) and using positive reframing (p = 0.04), planning (p = 0.01) and venting (p = 0.02) as coping strategies; active smoking (OR 0.26, 95% CI: 0.11–0.6, p = 0.002), active disease (OR 0.36, 95% CI: 0.16–0.81, p = 0.014) and behavioral disengagement (p = 0.04) were associated with impaired treatment adherence. No significant differences in adherence were observed between disease phenotypes. Conclusions: The route of administration, smoking status and psychosocial factors, such as perceived stress of social support and coping strategies, may play an important role in influencing treatment adherence in patients with IBD. While the disease phenotype was not associated with differences in adherence, patients with active disease had significantly lower odds of optimal adherence. Full article

Wastewater containing heavy metals can come from a variety of sources and is extremely toxic and hard to break down. Conventional treatment methods can easily result in secondary pollution and are expensive. The research on magnetic chitosan composites, a new adsorbent in the treatment of heavy metal wastewater, is methodically reviewed in this paper. It offers a theoretical foundation for the creation of more environmentally friendly and effective wastewater treatment technology by examining its preparation and modification technology, adsorption mechanism, and application performance. This paper provides a summary of the technology used to prepare and modify magnetic chitosan composites. Both the cross-linking and co-precipitation methods are thoroughly examined. A summary of the fundamental process of heavy metal ion adsorption is provided, along with information on the chemical and physical impacts. Of these, chemical adsorption has been shown to work well with the majority of heavy metal adsorption systems. According to application research, magnetic chitosan exhibits good adaptability in real-world industrial wastewater treatment and has outstanding adsorption performance for various heavy metal ion types and multi-metal coexistence systems (including synergistic/competitive effects). Lastly, the optimization of the material preparation and modification process, the mechanism influencing the various coexisting ion types, and the improvement of regeneration ability should be the main areas of future development. Full article

Taking a typical carburized alloy steel for heavy-duty gears as the research object, this work regulates carburizing–quenching and tempering processes to conduct a layer-by-layer analysis of gradient-distributed microstructures and mechanical properties in the carburized layer. The effects of tempering temperature on martensite evolution, mechanical properties, and wear resistance were specifically investigated. Results demonstrate that carburizing–quenching followed by cryogenic treatment generates high-carbon martensite at the surface, progressively transitioning to lath martensite towards the core. Low-temperature tempering promotes fine carbide precipitation, while elevated temperatures cause carbide coarsening. Specimens tempered at 175 °C achieve surface hardness of 800 HV and near-surface compressive yield strength of 2940 MPa. These samples exhibit 13% lower wear mass loss compared to 240 °C tempered counterparts, demonstrating superior wear resistance characterized by relatively flat wear surfaces, uniform contact stress distribution, and reduced cross-sectional plastic deformation zones. Key strengthening mechanisms at lower tempering temperatures involve solution strengthening, dislocation strengthening, and partial precipitation strengthening from carbides. Coherent carbides formed under these conditions impede fatigue dislocation motion via shearing mechanisms to suppress plastic deformation and fatigue crack initiation under contact fatigue stress, thereby enhancing wear performance. Full article

Early and accurate identification of brain tumors is essential for determining effective treatment strategies and improving patient outcomes. Artificial intelligence (AI) and deep learning (DL) techniques have shown promise in automating diagnostic tasks based on magnetic resonance imaging (MRI). This study evaluates the performance of four pre-trained deep convolutional neural network (CNN) architectures for the automatic multi-class classification of brain tumors into four categories: Glioma, Meningioma, Pituitary, and No Tumor. The proposed approach utilizes the publicly accessible Brain Tumor MRI Msoud dataset, consisting of 7023 images, with 5712 provided for training and 1311 for testing. To assess the impact of data availability, subsets containing 25%, 50%, 75%, and 100% of the training data were used. A stratified five-fold cross-validation technique was applied. The CNN architectures evaluated include DeiT3_base_patch16_224, Xception41, Inception_v4, and Swin_Tiny_Patch4_Window7_224, all fine-tuned using transfer learning. The training pipeline incorporated advanced preprocessing and image data augmentation techniques to enhance robustness and mitigate overfitting. Among the models tested, Swin_Tiny_Patch4_Window7_224 achieved the highest classification Accuracy of 99.24% on the test set using 75% of the training data. This model demonstrated superior generalization across all tumor classes and effectively addressed class imbalance issues. Furthermore, we deployed and benchmarked the best-performing DL model on embedded AI platforms (Jetson AGX Xavier and Orin Nano), demonstrating their capability for real-time inference and highlighting their feasibility for edge-based clinical deployment. The results highlight the strong potential of pre-trained deep CNN and transformer-based architectures in medical image analysis. The proposed approach provides a scalable and energy-efficient solution for automated brain tumor diagnosis, facilitating the integration of AI into clinical workflows. Full article

We previously demonstrated that the activation of FGFR signaling in GIST may be a mechanism of GIST resistance to imatinib mesylate (IM). We show here that IM-resistant GIST cells lacking secondary KIT mutations overexpress claudin-1 on both transcriptional and translational levels. In contrast, a knockdown of CLDN1 or inhibition of its activity by PDS-0330 effectively restored GIST’s sensitivity to IM both in vitro and in vivo. This was evidenced by the increased expression of apoptotic markers (e.g., cleaved PARP and caspase-3) and the decreased proliferation rate of IM-resistant GIST T-1R cells treated with a combination of IM and PDS-0330 (or siRNA CLDN1). In concordance with these findings, a significant synergy was observed between IM and PDS-0330 in GIST T-1R cells. Importantly, decreased tumor size and weight were observed in IM-resistant GIST xenografts treated with a combination of IM and PDS-0330. Furthermore, the combined treatment of IM-resistant tumors induced an increase in intratumoral apoptosis and other changes, as defined by the histopathologic response rate. Based on the co-immunoprecipitation and immunofluorescence microscopy data, we also demonstrated the strong interaction pattern between CLDN1 and FGFR2. Of note, the inhibition or knockdown of CLDN1 effectively decreased the phosphorylation of FGFR2 and FRS-2, a well-known FGFR adaptor protein, thereby illustrating CLDN1’s ability to regulate FGFR-signaling and thereby promote FGFR-mediated survival in KIT-inhibited GIST. Consequently, CLDN1 inhibition in GIST effectively disrupted the FGFR-mediated pathway and re-sensitized tumor cells to IM. In concordance with these data, molecular profiling of CLDN1-inhibited GIST T-1R cells illustrated a significant decrease in the majority of FGFR transcripts, including FGFR2, 3, and 4. Additionally, several FGFR ligands (e.g., FGF14, -19, and -23) were also down-regulated in PDS-0330-treated GIST. Notably, exogenous FGF-2 increased CLDN1 expression in a time-dependent manner. In contrast, pan-FGFR inhibitors effectively reduced CLDN1 levels in IM-resistant GIST T-1R cells, thereby illustrating a cross-talk between CLDN1- and FGFR-mediated pathways in IM-resistant GIST. Based on subcellular fractionation and immunofluorescence microscopy data, we also observed partial relocalization of CLDN1 into the cytoplasm in IM-resistant GIST. Notably, PDS-0330 effectively abrogated this relocalization, suggesting that changes in CLDN1 subcellular distribution might also impact GIST resistance to IM. Lastly, based on our small cohort clinical study (n = 24), we observed the increased expression of CLDN1 in most “high-risk” primary GIST known to be associated with poor prognosis and aggressive behavior, thereby illustrating the prognostic value of increased CLDN1 expression in GIST and providing a further rationale to evaluate the effectiveness of CLDN1 inhibition for GIST therapy. Full article

Invasive candidiasis (IC) in Latin America is undergoing a significant epidemiological shift, increasingly driven by non-albicans strains such as Candida tropicalis, Candida parapsilosis, and Candidozyma auris. These pathogens often exhibit multidrug resistance, which complicates treatment and increases mortality. Diagnostic limitations, particularly in rural and public hospitals, delay detection and hinder the provision of rapid care. Environmental pressures, such as climate change and the widespread use of azoles in agriculture, appear to favor the selection of resistant and thermotolerant strains. Migratory birds may also play a role in the environmental transmission of pathogenic fungi. These factors are amplified by socioeconomic inequalities that restrict access to diagnostics and first-line antifungals. To help mitigate this emerging challenge, a One Health-oriented framework combining integrated environmental surveillance, robust antifungal-stewardship programmers, broader diagnostic access, and coordinated cross-sector public health actions should be developed. Reinforcing these pillars could lessen the regional burden of IC and slow the advance of antifungal resistance. Full article

Background/Objectives: Excessive intake of sugar-sweetened food (SSF) increases obesity risk. Various psychological, physiological, and environmental factors may drive high consumption of SSF. Due to blocking sweet tastes, the herb Gymnema sylvestre (GS) has been shown to reduce SSF consumption, but its impact on motivation to eat SSF is unknown. This research aimed to qualitatively investigate adults’ perceptions regarding effects of GS on their motivation to eat SSF when administered systematically (three times/day in-between meals, i.e., GS-SYS treatment) or ad libitum (up to six times/day at participants’ discretion, i.e., GS-ADLIB) over 14 days, compared to placebo (taste-matched mint; PLAC-SYS). Methods: This study represents the qualitative investigation of a placebo-controlled randomised cross-over trial, conducted as three 14-day phases. The qualitative investigation included interviews at baseline and three post-testing phases. Seven participants (mean age 34.7 ± 13.8 years; two males, five females) agreed to participate. Twenty-eight interviews (across phases) were thematically analysed using NVivo software, identifying themes and highlighting changes in motivation to eat SSFs across the study. Results: The GS-SYS and GS-ADLIB treatments made SSFs unpleasant to eat and increased mindful eating, subsequently increasing motivation to avoid SSFs. External factors could increase or decrease motivation, depending on individual circumstances. Participants preferred GS-SYS and GS-ADLIB over PLAC-SYS, feeling it was more effective at changing behaviours related to SSF intake. Self-control over SSF intake changed during the study, mostly due to external factors, and in part GS-ADLIB. Conclusions: Participants found both GS administrations successful as motivation to avoid SSF; GS-ADLIB was considered most effective. Full article

Background: Gold nanoparticles (AuNPs) have several beneficial properties that make them effective as intracellular drug carriers, and their potential for various diagnostic and therapeutic applications is gaining recognition. Depending on their size and shape, AuNPs can cross the central nervous system (CNS) through the blood–brain barrier (BBB). In the CNS, they can exert a variety of influences on neuronal and glial cells, which can be both supportive—promoting cell health and function—and cytotoxic, potentially leading to cellular damage. The hypothalamus (HT) is the first region where nanoparticles (NPs) interact, as this neuroendocrine center is particularly sensitive to factors in the systemic circulation due to its function and location. This area is affected by systemic factors, including pro-opiomelanocortin (POMC) neurons, which regulate metabolic function and maintain homeostasis. The activity of mitochondria within these cells influences their response to both external factors and the presence of AuNPs, thereby facilitating a complex interplay between nanoparticle interactions and cellular metabolism in this vital brain region. Aims: This study investigates how AuNPs, at different concentrations and exposure times under in vitro conditions, affect the mitochondrial activity of POMC neurons, aiming to provide a comprehensive understanding of the mechanisms in the HT. Methods: The study investigates the effect of varying gold nanoparticle concentrations on the mitochondrial activity of POMC neurons over treatment periods of 1, 15, 24, and 48 h. Mitochondrial activity was measured using a Seahorse XFp Analyzer to provide high-resolution insights. Additionally, mitochondrial functionality was assessed through the detection of reactive oxygen species (ROS) and cell viability. Results: The findings indicated that the effects of gold nanoparticles on mitochondrial activity depend significantly on their concentration and exposure time. Specifically, exposure leads to an increase in early response systems, the citric acid cycle, and proton efflux, ultimately resulting in the inhibition of mitochondrial function and ATP production in POMC cells. This disruption may affect hypothalamic regulation and energy metabolism. Full article

Background: Major geopolitical events and structural shocks are thought to play a significant role in shaping HIV epidemics by influencing individual behaviours, reshaping social networks, and impacting HIV prevention and treatment programs. Here, we describe individual-level measures of estimated time since HIV infection (ETI) from viral next-generation sequencing data among female sex workers and their clients in relation to significant geopolitical events in Ukraine. Methods: The Dynamics Study is a cross-sectional integrated biological and behavioural survey conducted among female sex workers and their clients in Dnipro, Ukraine (December 2017 to March 2018). We were able to successfully sequence a portion of the HIV pol gene on dried blood spot specimens among n = 5/9 clients and n = 5/16 female sex workers who tested positive for HIV (total n = 10/25) using an in-house drug resistance genotyping assay. The “HIV EVO” Intrapatient HIV Evolution web-based tool was used to infer ETI from viral diversity. Results: The median ETIs for female sex workers and their clients were 5.4 years (IQR = 2.9, 6.6) and 6.5 years (IQR = 5.4, 10.8), respectively. Nearly all HIV acquisition events (n = 7/10; 70%) were estimated to have occurred between the Great Recession (2008–2009) and the War in Donbas (May 2014–February 2022). In general, ETI suggests that HIV acquisition occurred earlier among clients (2012 [IQR = 2007, 2013]) compared to sex workers (2013 [IQR = 2012, 2016]). Conclusion: Our findings suggest that most HIV acquisition in this small subset of female sex workers and clients living with HIV occurred during periods of economic decline. Molecular studies on timing of HIV acquisition against timing of major geopolitical events offer a novel way to contextualize how such events may shape transmission patterns. Full article

Background: Cancer remains a leading cause of morbidity and mortality worldwide. In Puerto Rico, patients face additional burdens due to the structural inequalities affecting access to employment, nutritious food, and mental health services. This study examined the associations between employment status, perceived economic hardship, dietary behaviors, and depressive symptoms among 334 adult cancer patients in Puerto Rico. Methods: Using a cross-sectional design, participants provided sociodemographic data, dietary patterns, and self-reports of depression. Results: Statistical analyses revealed that full-time employment was associated with a higher consumption of low-nutritional-value foods (ρ = 0.157, p = 0.015) and significant differences in their consumption having a higher mean against unemployment were observed (mean ranks = 146.09 and 177.08, p = 0.010). A higher employment status also served as a protective factor against depression (p = 0.005). A higher body mass index (BMI) was linked to an increased risk of depression (p = 0.002), and perceived economic hardship was significantly associated with depression (OR= 0.54, p = 0.033). Conclusions: The findings underscore the necessity for comprehensive interventions that account for the synergistic effects of economic perception, employment, nutrition, and psychological well-being in cancer treatment in Puerto Rico. Full article

Background/Objectives: This systematic review addresses the disproportionate impact of the opioid epidemic on American Indian and Alaska Native (AI/AN) populations by examining the socio-ecological and social network factors that influence opioid use and misuse. While previous reviews have largely focused on treatment modalities or structural determinants such as socioeconomic status and rurality, few studies have explored the role of social networks as risk or protective factors, particularly within AI/AN communities. Methods: Applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, the review synthesized findings from three scholarly databases (PubMed, EBSCOhost, ProQuest), six institutional repositories (e.g., Indigenous Studies Portal), and one academic search engine (Google Scholar). Studies that examined the influence of social network domains on opioid misuse in AI/AN populations in the United States, reported quantitative or qualitative data, and were published between 2010 and 2022 were included in this review. Study quality was assessed with the JBI Checklists for Analytical Cross Sectional Studies and Qualitative Research. Of the 817 articles initially identified, 7 met the inclusion criteria, with most studies focusing on AI/AN adolescents and young adults, a demographic shown to be especially susceptible to opioid misuse. Results: The review identified several social network domains that significantly affect opioid use patterns, including familial relationships, peer associations, community dynamics, educational influences, cultural traditions, social media engagement and the effect of historical and intergenerational trauma. These domains can function either as protective buffers or as contributing factors to opioid misuse. Conclusions: The findings underscore the necessity for future longitudinal research to elucidate the causal pathways between these social network factors and opioid behaviors, particularly concerning trauma and digital media exposure. Furthermore, the study highlights the importance of culturally grounded, evidence-based prevention strategies that address the multifaceted social environments of AI/AN individuals. Such approaches are critical to fostering resilience and mitigating the opioid crisis within these historically marginalized populations. Full article

Background: Hospitalized patients’ expectations about their treatment play a key role in therapeutic adherence, satisfaction with care, and clinical outcomes. However, there is a lack of brief, psychometrically validated instruments in Spanish-speaking contexts that adequately assess this construct. Objective: The objective of this study is to culturally adapt and validate the Hospitalized Patients’ Expectations for Treatment Scale-Patient Version (HOPE-P) in a Peruvian population. Methods: A methodological, cross-sectional study was conducted with 277 hospitalized patients aged 18 to 85 years (M = 45.87; SD = 17.09). The adaptation process included translation, back-translation, expert review, and pilot testing. Confirmatory factor analysis (CFA) was performed to assess the factor structure, and reliability and validity indices were calculated. Results: The bifactorial model showed good fit (CFI = 0.97, TLI = 0.94, RMSEA = 0.06). One item with a low factor loading was removed to improve the model. Convergent and discriminant validity were confirmed through acceptable values of Average Variance Extracted (0.60 and 0.55) and inter-factor correlation (φ² = 0.23). Internal consistency was strong for both dimensions (α = 0.76–0.77; ω = 0.76–0.77). Conclusions: The Spanish version of the HOPE-P is a valid, reliable, and culturally appropriate instrument for evaluating treatment expectations in hospitalized Peruvian patients. Its implementation in clinical settings could enhance physician–patient communication, support shared decision-making, and contribute to better therapeutic outcomes, especially in high-demand healthcare environments. Full article

Background/Objectives: Head and neck squamous cell carcinoma (HNSCC) diagnosis and treatment rely heavily on computed tomography (CT) imaging to evaluate tumor characteristics and lymph node (LN) involvement, crucial for staging, prognosis, and therapy planning. Conventional LN evaluation methods based on morphological criteria such as size, shape, and anatomical location often lack sensitivity for early metastasis detection. This study leverages radiomics to extract quantitative features from CT images, addressing the limitations of subjective assessment and aiming to enhance LN classification accuracy while potentially reducing reliance on invasive histopathology. Methods: We analyzed 234 LNs from 27 HNSCC patients, deriving 120 features per node, resulting in over 25,000 data points classified into reactive, pathologic, and pathologic with extracapsular spread classes. Considering the challenges of high dimensionality and limited dataset size, more than 44,000 experiments systematically optimized machine learning models, feature selection methods, and hyperparameters, including ensemble approaches to strengthen classification robustness. A Pareto front strategy was employed to balance diagnostic accuracy with significant feature reduction. Results: The optimal model, validated via 5-fold cross-validation, achieved a balanced accuracy of 0.90, an area under the curve (AUC) of 0.93, and an F1-score of 0.88 using only five radiomics features. Conclusions: This interpretable approach aligns well with clinical radiology practice, demonstrating strong potential for clinical application in noninvasive LN classification in HNSCC. Full article