Search Results (8,275)

Background: Diabetic foot ulcers (DFUs) and lower extremity amputations are major contributors to morbidity and mortality in individuals with diabetes. Among patients undergoing active cancer treatment, the risks are compounded by immunosuppression, peripheral neuropathy, and vascular complications. Even minor foot infections or wounds in these patients can necessitate the suspension of cancer therapy, with potentially lifethreatening consequences. This study evaluated the impaqt of integrating symptom-focused patient education with coordinated podiatric care to reduce DFUs and amputations in this highrisk population with concurrent cancer and diabetes. Methods: A five-year retrospective review was conducted at a National Cancer Institute (NCl)designated comprehensive cancer center as part of the Novel Limb Preservation Initiative. The cohort included patients with Type II diabetes undergoing treatment for prostate, breast, colorectal, lymphoma, leukemia, thyroid, or lung cancers. Patients were assigned targeted educational modules based on self-reported diabetic foot symptoms. Podiatric care was individualized according to each patient's signs and symptoms, including routine diabetic foot examinations and close, timely monitoring when indicated. Results: The intervention yielded a DFU incidence of 2. 8% and an amputation rate of 0. 43%, both lower than national benchmarks. Enhanced patient engagement through diabetic foot symptom-focused education and earlier detection of foot complications-including diabetic foot ssues that may appear minor to laypersons-contributed to these improved outcomes. Conclusion: Integrating diabetic foot symptom-focused education with proactive podiatric monitoring significantly reduced DFUs and amputations in this high-risk population. This model, developed under the Novel Limb Preservation Initiative, offers a scalable strategy for broader implementation, particularly in high-risk communities, including Hispanic, African American, low socioeconomic, and rural populations across the United States. Full article

Cholangiocarcinoma (CCA) is a highly lethal, heterogeneous malignancy arising from the biliary tract. Although the prevalence of CCA is relatively low, its incidence has increased in the last few decades, and the overall prognosis is poor. Surgical resection remains the most efficacious treatment modality for CCA. However, due to its aggressive nature and often asymptomatic presentation, most patients are first diagnosed with advanced disease, precluding them from curative intervention. Moreover, due to its heterogeneity at the molecular, genomic, and epigenetic levels, drug treatment of CCA remains challenging. In this review, we discuss the current standard drug treatment approaches, recent breakthroughs, and promising new therapeutics for CCA. We summarize key clinical data for the standard first-line chemotherapy regimen and its efficacy and resistance mechanisms, along with more recent studies supporting or proposing second-line treatments. We highlight landmark clinical trials, including ABC-02, which established gemcitabine-cisplatin (GC) as the first-line regimen against biliary cancers. Additionally, we discuss recent findings on the susceptibility of CCA against targeted therapies and other immunologic molecules, including results from the KEYNOTE-966 and TOPAZ-1 clinical trials. Finally, we critically analyze new therapeutics in the preclinical and clinical space, such as CAR-T cells and oncolytic viruses that may be effective against CCA. Full article

Background/Objectives: Cancer survivors often experience physical decline, fatigue, and reduced quality of life (QoL) following cancer treatment. Exercise is an important strategy in survivorship care; however, the role of exercise motivation in sustaining exercise behavior and improving QoL remains unclear. This study evaluated the effects of a structured exercise intervention on QoL, fatigue, and exercise motivation among cancer survivors. Methods: This single-arm longitudinal pre–post-intervention study recruited adult cancer survivors (median age: 55 years) with heterogeneous cancer types from E-Da Hospital, Taiwan, between October 2023 and July 2024. Participants completed a 3-month supervised exercise program consisting of weekly 60 min sessions that included aerobic, resistance, balance, and flexibility training. Assessments were conducted at baseline, immediately after the intervention, and at a 3-month follow-up. Outcome measures included physical fitness tests, fatigue scales, and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), and the Relative Autonomy Index for exercise motivation. Results: Thirty-nine participants completed the study. Improvements in several QoL domains were observed at the 3-month follow-up, particularly in physical and emotional functioning. Pain and fatigue symptoms decreased following the intervention, although some fatigue indicators increased again during follow-up. Female participants showed greater improvements in certain physical fitness measures. Intrinsic exercise motivation increased after the intervention, and greater motivation gains were associated with larger improvements in QoL. Conclusions: Participation in a structured exercise program may be associated with improvements in QoL, fatigue symptoms, and exercise motivation among cancer survivors. However, given the single-arm design and small sample size, these findings should be interpreted cautiously. Larger randomized controlled studies are needed to confirm the long-term benefits of exercise interventions in cancer survivorship care. Full article

Honmyōji Temple in Kumamoto preserves copies of four letters exchanged in the early 1620s between a father, Yŏ Ch’ŏn’gap, in Chosŏn, and his son, Yŏ Taenam (Nichiyō), in Japan, although one of the letters was never delivered. Both father and son were abducted to Japan during the Imjin War (1592–1598), but while the father was able to return home, the son was not. In the late 1610s, upon learning that his son, now the abbot of Honmyōji, was alive in Kumamoto, the father sought to contact him by letter. His efforts eventually succeeded, leading to an exchange of correspondence. These four letters, the only known instance of overseas communication between family members separated by Japan’s invasion of Chosŏn, provide valuable insight into the tragic fate of a family divided by war. Drawing on these documents, this article examines how a Korean boy was abducted during the Imjin War and later became the abbot of his captor’s temple. It also explores the father’s efforts to bring his son home and the reasons their hopes for reunion were never realized. Together, the letters bear witness to the dramatic transformation in the life of a young Korean boy who became a victim of war. Full article

Renal cancer is a common malignant tumor in the urinary system. Current research has found that immune escape in kidney cancer can prevent immune system attacks through specific mechanisms, making it difficult for the immune system to effectively kill cancer cells, and promote the progression and metastasis of kidney cancer. Therefore, despite the continuous updating of immunotherapy methods for kidney cancer, the high recurrence rate, high drug resistance, and severe side effects of kidney cancer patients are still difficult to solve. This review systematically summarizes the latest mechanisms of immune escape in the renal cancer immune microenvironment, including abnormal expression of histocompatibility complex (MHC), secretion of immunosuppressive factors, programmed death ligand-1 with abnormal expression, recruiting immunosuppressive cells, and VHL gene deletion. This article also summarizes new treatment strategies proposed for these immune escape mechanisms. We hope this will help future researchers further explore the immune escape mechanism of renal cell carcinoma and propose new immunotherapy strategies. Full article

Background/Objectives: This cross-sectional study aimed to quantify hope levels in adolescents with chronic musculoskeletal pain (CMP) and examine patient-reported outcomes associated with hope. Methods: This was an exploratory, cross-sectional, secondary analysis of baseline data from a prospective, single-center longitudinal study of 60 youth presenting for an initial evaluation at a pediatric subspecialty pain clinic. Subjects were English-speaking 12–17-year-olds with a diagnosis of CMP, primarily female and non-Hispanic White, with diffuse pain, median pain duration of 2 years, and moderate to severe physical dysfunction. Subjects completed surveys measuring hope (Children’s Hope Scale [CHS]) and patient-reported mental, physical, and overall health. Associations between hope scores (total and each subscale) and patient-reported outcomes were evaluated using Spearman rank correlations. Results: The median CHS score was 20.0 (IQR: 16.5–25.0), indicating slight hope. Patient hope was negatively correlated with depression (r = −0.61), anxiety (r = −0.49), psychological distress (r = −0.52), functional disability (r = −0.43), and pain interference (r = −0.37), but not pain intensity. Adolescents’ hope was positively correlated with resilience (r = 0.74) and overall health (r = 0.55; all p < 0.01). Conclusions: Hope is correlated with various patient-reported health measures in youth with CMP. Although causal inferences are not possible due to the cross-sectional nature of this study, the results suggest that hope may be an important coping mechanism in pediatric chronic pain. Future efforts to incorporate existing resilience coaching programs into usual care may improve hope and health-related quality of life in youth with CMP. Full article

Pancreatic ductal adenocarcinoma (PDAC) is a highly lethal malignancy marked by substantial molecular heterogeneity and variable response to gemcitabine-based therapy. While KRAS mutations are nearly universal, the broader RTK-RAS and MAPK signaling architecture and its relationship to treatment response remain incompletely defined. We conducted an integrative clinical-genomic analysis of 184 PDAC tumors stratified by age at diagnosis and gemcitabine exposure, interrogating somatic alterations across curated RTK-RAS/MAPK gene sets. Conversational artificial intelligence agents (AI-HOPE-RTK-RAS and AI-HOPE-MAPK) enabled dynamic cohort construction and pathway-level analyses, with findings validated using standard statistical methods. In late-onset PDAC, ERBB2 and RET mutations were significantly enriched in gemcitabine-treated tumors. Early-onset cases demonstrated differential enrichment of CACNA2D family alterations in non-treated tumors and higher frequencies of FLNB and TP53 mutations in treated disease. Importantly, late-onset patients not treated with gemcitabine who lacked RTK-RAS or MAPK alterations exhibited significantly improved overall survival. These findings reveal age- and treatment-dependent pathway dependencies beyond canonical KRAS status and support a precision oncology framework in PDAC. Conversational AI facilitated rapid, multidimensional clinical–genomic integration to uncover clinically relevant signaling substructures. Full article

Despite widespread corporate endorsement of the Sustainable Development Goals (SDGs), systematic evidence on how top management in emerging economies prioritizes and frames SDG-related issues over time remains limited. Existing studies are often based on manual or single-year analyses, restricting comparability, scalability, and longitudinal insight. This study examines how corporate managerial communication aligns with and emphasizes SDGs across sectors and over time in two major emerging economies, India and South Africa. Using an AI-driven natural language processing (NLP) pipeline, we analyse 2400 annual reports from 600 publicly listed companies covering the period 2020–2023. A fine-tuned SDG-BERT multi-label classification model is applied to extract and classify SDG-related content from top management communications, enabling sectoral, temporal, and cross-country comparison of SDG relevance. The results reveal a strong and persistent emphasis on SDG 12 (Responsible Consumption and Production) across both countries, alongside sector-specific variation and differing patterns of SDG diversity over time. South African firms exhibit greater variation in SDG emphasis across years, while Indian firms display more concentrated and stable SDG framing. Overall, the findings highlight systematic imbalances in SDG-related managerial communication and persistent underrepresentation of several social SDGs. The study contributes methodologically by demonstrating the value of validated AI-assisted longitudinal text analysis for large-scale SDG research and empirically by providing comparative insights into how corporate SDG narratives evolve in emerging market contexts. Full article

Objectives: Prostate cancer is the most frequently diagnosed cancer among men, with Latino patients experiencing higher cancer-specific mortality compared to non-Hispanic populations. We evaluated prostate cancer outcomes across distinct Latino subpopulations. Methods: We retrospectively reviewed a single tertiary comprehensive cancer center database of patients with localized prostate cancer treated with radical prostatectomy from 2003 through 2020. Latino patients were subcategorized as Mexican, South/Central American (SCA), or Caribbean (Puerto Rico and Cuba). Non-Hispanic White (NHW) patients served as the reference group. Results: Overall, 7084 patients were included, of which 78% (n = 5518) were NHW and 10% (n = 679) were Latinos. Compared to NHW, Latino patients were younger at the time of surgery (median 62 vs. 64 years) and had higher median BMI (median 28.8 vs. 27.5 kg/m²), median baseline PSA (6.2 vs. 5.5 ng/mL), and D’Amico intermediate- (44% vs. 42%) and high-risk disease rates (16% vs. 13%) (all p < 0.001). Among Latino patients, Mexican patients had higher median baseline PSA (6.7 vs. 6.1 vs. 6.1 ng/mL, p = 0.005) compared to SCA and Caribbean patients. Survival analysis revealed shorter 5-year (97% vs. 99%) and 10-year (89% vs. 96%) overall survival (OS) rates in Mexican Latinos compared to non-Mexican Latinos (both p < 0.05). The 5-year (77% vs. 80% vs. 95%) and 10-year (63% vs. 65% vs. 86%) biochemical recurrence-free survival rates were shorter for Mexican patients compared to SCA and Caribbean patients. On multivariable analysis, SCA subpopulation status was associated with significantly better OS, and pathologic T stage > T2 was associated with worse biochemical recurrence-free survival. Conclusions: We identified significant differences in prostate cancer outcomes for different Latino subpopulations, underscoring the importance of population disaggregation in this ethnic group. Full article

Education for Sustainable Development (ESD) can support and strengthen responses to the environmental challenges faced today. However, the sustainability knowledge–action gap remains mostly unbridged. This article examines communication as a lever for learning and behavior change in sustainability education and compares the use of communication in conventional delivery and a narrative, dialogic and affective communication mode in secondary, university and community-based learning settings in a mixed-methods experimental study. Quantitative measures (pre-, post-, follow-up) included knowledge, systems thinking, emotional engagement, motivation and self-reported sustainable behaviors. Qualitative data, including interviews, observations and action research projects, were also collected to gain deeper insights into learner engagement with knowledge, systems thinking, emotional engagement and motivation. Results suggest that participants in the catalytic communication condition felt more cognitively and emotionally engaged than the control condition, and displayed more long-term pro-environmental behavior. Mediation analysis suggests that the increase in pro-environmental behavior may be driven by an increase in feelings of empathy and hope associated with the learning experience. This supports the understanding that tailored communication can help to reduce the knowledge–action gap in ESD and provides additional insights into the usefulness of cognitive, affective and behavioral dimensions of sustainability-oriented pedagogical approaches. Full article

Background/Objectives: Research examining the emotional and psychological challenges experienced by couples undergoing in vitro fertilisation (IVF) remains limited. Existing evidence suggests that women undergoing IVF often report elevated levels of depression, anxiety, and emotional distress, whereas men may experience feelings of anger, inadequacy, and self-doubt, especially following unsuccessful treatment cycles. Successful IVF outcomes are commonly associated with intense joy, relief, and fulfilment as couples realise their aspiration to become parents. In light of the limited qualitative research conducted in Greece to date, in the present study, we aimed to explore the lived experiences of couples undergoing IVF treatment, with particular attention to emotional, relational, and systemic dimensions. Methods: A qualitative research design was employed. Semi-structured, in-depth interviews were conducted with six heterosexual couples (aged 18–49 years) residing in Athens and Karditsa, Greece, all of whom had undergone IVF treatment. Interviews were audio-recorded, transcribed verbatim, and analysed using Interpretative Phenomenological Analysis. Results: Our analysis revealed five interrelated superordinate themes with associated subordinate themes: (1) making sense of infertility and IVF, (2) negotiating relationships under the strain of IVF, (3) IVF as an emotionally demanding journey, (4) navigating institutional and systemic barriers, and (5) projecting the future through IVF experience. Lived experiences of infertile couples undergoing IVF treatment highlighted a range of emotions, social pressure, and attitudes towards IVF and related policies. Conclusions: In Greece, where demographic decline has been widely discussed in policy debates, IVF has gained societal and policy attention. For many participants, IVF represented a hopeful pathway towards achieving parenthood despite the emotional and practical challenges involved. Full article

Background/Objectives: The aim of the current study was to investigate the mechanistic hepatoprotective efficacy of selenium (SE) and chitosan-coated selenium nanoparticles (CS-SENPs) using a rat model induced by lipopolysaccharide (LPS). Methods: CS-SENP was prepared and characterized for particle size, polydispersity index (PDI), zeta potential, transmission electron microscope (TEM), and Fourier transform infrared spectroscopy (FTIR). Male albino rats (n = 40) were divided into four groups: control, LPS, SE, and CS-SENP. SE and CS-SENPs (5 mg/kg orally for 14 days) were given before LPS injection. Tissue architecture was assessed using histopathological analysis. HSP-47 and STEAP-3 protein expression levels were measured using ELISA, and oxidative stress markers were quantitatively evaluated. The expression of HO-1, TLR-4, STAT-3, TRAF-6, and IL-17A was measured using immunohistochemical analysis. Furthermore, HSP-90 expression was evaluated by immunofluorescence labeling. Results: CS-SENP characterization revealed uniform (PDI = 0.125 ± 0.04) nanoparticle size (108.54 ± 2.24 nm), with high zeta potential (+63.92 ± 6.287 mV), attributed to the CS layer, which was confirmed by FTIR and TEM as an electron-lucent halo enveloping the individual SENP cores. CS-SENPs significantly reduced lipid peroxidation (MDA) and restored glutathione (GSH) more effectively than SE. CS-SENPs improved redox (upregulated HO-1) and iron balance (downregulated STEAP-3), and also increased the anti-inflammatory effect (suppressed TLR-4, IL-17A, TRAF-6, and STAT-3). CS-SENPs showed superior antifibrotic efficacy (suppresses stress proteins, HSP-47 and HSP-90). Rats treated with CS-SENPs had nearly normal liver structure. Conclusions: The results concluded that CS-SENPs had superior and multi-targeted hepatoprotection against LPS-induced liver damage. Full article

This paper examines how Pakistani popular cinema reproduces a cruelly optimistic attachment to gender identity and thinness, where weight loss is imagined as the key to love, success, and social acceptance. Rather than surveying the entire industry, this study focuses on two emblematic case studies—Jawani Phir Nahi Ani (2015) and Oye Motti (2021)—to show how Lollywood normalises fatphobia through comic ridicule, makeover tropes, and exclusionary casting practices. The analysis reveals how fatness is framed not as an identity but as a flaw to be corrected, rendering overweight characters undesirable despite their talents or personalities. Thus, fatness is usually treated as an obstacle to social acceptance, marriage, and personal happiness; the very hope of inclusion becomes an instrument of exclusion, exemplifying Berlant’s concept of cruel optimism. In Berlant’s terms, cruel optimists always struggle to achieve unattainable fantasies of a better life that promise upward mobility. Full article

Background/Objectives: Adolescent/young adult (AYA) cancer patients experience a variety of challenges, including higher rates of depressive symptoms (D) than healthy controls. Although various forms of social support (SS) seem to be a protective factor against D, AYAs also experience significant disruptions to SS. Snyder’s hope theory involves two interrelated components: agency (the belief in one’s ability to initiate or sustain action toward a desired goal) and pathways (the belief in one’s ability to produce workable routes to desired goals). Because hope, particularly the agency component, has been linked to both SS and D, it may mediate the relationship between the two. Methods: An online questionnaire was completed by AYA cancer patients (N = 205) in which they self-reported levels of perceived social support (PSS), hope, and D, among other scales and demographic variables. A parallel mediation model was conducted to determine if either or both agency and pathways explain the relationship between PSS and D. Results: Agency mediated the relationship between PSS and D in AYA women with cancer, but not men. Pathways did not mediate the relationship between PSS and D. Conclusions: Given the significantly higher prevalence of depression in women with cancer as compared to men, interventions to enhance agency are an important adjunct to methods to promote PSS in AYA women with cancer. Full article

Delayed marriage and non-marriage have become increasingly important issues in Japan, where marriage remains closely related to household formation and well-being. This study examines which sociodemographic characteristics are associated with being married and how marital status correlates with economic conditions, health behaviors, subjective well-being, and COVID-19-related measures. Using annual panel data from 2014 to 2022, we first conducted descriptive comparisons between married and non-married individuals and then estimated a Bayesian panel logit model with respondent-specific effects to account for unobserved heterogeneity. The analysis was designed to identify associations rather than causal effects. The results showed the strongest positive associations with being married for individuals aged 30–49 years, consistent with delayed marriage. Employment attributes such as holding side work and managerial positions were positively associated with marriage, whereas nonprofit employment and self-employment were negatively or imprecisely associated. Financial assets and total debt were positively correlated with marriage, consistent with joint household formation. Higher happiness and life hope were positively associated with being married; regular exercise and longer weekend sleep were negatively associated, whereas longer weekday sleep was positively associated. In addition, respondent-specific effects revealed substantial heterogeneity beyond observed covariates. These findings identify key socioeconomic and behavioral domains associated with marriage in Japan, highlight the importance of unobserved heterogeneity, and provide evidence that may help identify groups prone to delayed marriage under changing social and economic conditions. Full article