Search Results (74)

Background: Gastric cancer (GC) remains a significant health burden in the U.S, particularly among ethnic minorities. We identified patient-level risk factors contributing to advanced-stage (AS) diagnosis and poor survival to guide strategies to address GC-related health disparities. Methods: We conducted a retrospective cohort analysis of 18,396 histologically confirmed GC cases (4102 early-stage (ES) and 14,294 AS) diagnosed between 2000 and 2019, using data from the California Cancer Registry linked to the California Office of Statewide Health Planning and Development. Eligible cases were adults age ≥ 18 with complete diagnostic and follow-up data. Multivariable logistic and Cox regression models were used to identify predictors of AS-GC and five-year disease-specific (DSS) and overall-survival (OS) outcomes. Analyses were further stratified by Asian and Hispanic subgroups. Results: Korean heritage was the strongest predictor of ES-GC [OR 0.58 (95% CI, 0.47–0.71), p < 0.001] and was independently associated with the lowest GC-specific mortality risk [HR 0.73 (95% CI: 0.67–0.80), p < 0.0001]. The youngest age group (18–44 years) had the highest AS-GC rate (91.4%). Asian ethnicity, receipt of care at NCI-designated cancer centers, and prior upper endoscopy were associated with improved OS and DSS. In contrast, comorbidities such as GERD, diabetes, liver disease, smoking and alcohol abuse, and older age ≥ 75, U.S.-birth, and rural residence were linked to worse outcomes. Conclusions: Distinct demographic, clinical, and healthcare access factors contribute to disparities in GC outcomes. These findings support the development of culturally tailored early-detection programs, and risk-based screening for GC care, particularly in vulnerable populations. Full article

Background: Aerobic and resistance training have acute effects on blood pressure (BP) in peripheral arterial disease (PAD). However, the combined effect of both exercises in a single session is still unknown. The aim of this study was to analyze the effects of a single exercise session combining walking and circuit-based training on BP in patients with PAD. Methods: Participants with PAD (n = 13; 65.0 ± 10.2 years; 76.9% male) underwent a supervised exercise therapy (SET) intervention (312 sessions, 24 sessions/patient) that included 15–30 min of walking, followed by 15 min circuit-based training. Clinic systolic (SBP) and diastolic (DBP) were recorded 5 min before and after each exercise session. Longitudinal changes were analyzed using repeated-measures analysis of variance (ANOVA) and categorical changes in blood pressure levels were evaluated with chi-square tests. Results: After each exercise session, clinic SBP decreased 4.87 mmHg (p < 0.001) and clinic DBP decreased 2.11 mmHg (p < 0.001). Furthermore, there were no differences between the initial stage of training (1–10 sessions) and late (14–24 sessions) for each time that SBD or DBP were measured. Conclusions: After an acute exercise session, both clinical SBP and DBP decreased in patients with PAD compared to pre-exercise values. However, no additional reductions in clinical BP were observed when comparing early (sessions 1–10) and late (sessions 14–24) stages of the full SET intervention. Full article

Objective: This study aims to examine activity engagement across stages of cognitive health among older adults. Methods: We used a cross-sectional study analysis of baseline data collected as part of the prospective Microbiome in Aging of Gut and Brain (MiaGB) longitudinal study; the study period was August 2022 to December 2023. Health history and activity engagement questionnaires and the Montreal Cognitive Assessment (MoCA) were used to examine the study objective. One-way ANOVA and chi-squared tests, with Bonferroni post hoc analyses, assessed group differences. Results: The weighted samples reflected 417 participants: 54% females, 70.7% White, with an average age of 72 (±8.7) years, 90% with at least high school education, and 75% self-reported medium income status. Results suggested that individuals who scored ≤17 points on the MoCA had an average age of 84 years, were White, non-Hispanic, female, had less than a high school education, and medium income status (p < 0.001). Significant differences were found in active engagement in all health behaviors (p < 0.05). The frequency of engagement in activities was all statistically significant (p < 0.05), except the frequency of looking after grandchildren (p > 0.05). Older adults who scored ≤17 MoCA points reported higher rates of hypertension, osteoarthritis, and depression compared with individuals who scored higher on the MoCA assessment. Conclusions: Older adults with lower cognitive status report a higher rate of clinical ailments and have less engagement in meaningful activities. We should promote meaningful activities to improve the quality of life in older adults with decreased cognition. We make recommendations for appropriate modifications for activity engagement across cognitive health levels. Full article

Background/Objectives: Pain neuroscience education (PNE) has demonstrated efficacy in adults with chronic pain, but the pediatric evidence is still developing, despite its increasingly frequent use. Evidence for the effectiveness of PNE in pediatrics remains fragmented across settings and outcomes, which justifies a systematic evaluation focused on children and adolescents. Methods: Following PRISMA, two reviewers independently screened records (PubMed, Web of Science, PEDro; through 21 July 2025), extracted data, and assessed risk of bias (RoB 2 for randomized controlled trials; NIH/CASP for non-randomized studies). Given the heterogeneity, we conducted a structured narrative synthesis (SWiM) and rated the certainty of evidence with GRADE. PROSPERO: CRD420251062922. Results: Eleven studies met the inclusion criteria. PNE consistently improved pain-related knowledge, with effects maintained at follow-up (moderate certainty); effects on pain intensity, function, and emotional outcomes were small and inconsistent (low certainty), with more favorable patterns when PNE was combined with exercise and/or booster sessions. Digital and gamified formats proved feasible and engaging; parental outcomes showed small improvements where measured. Conclusions: PNE is a promising, low-cost, and scalable component of pediatric chronic pain care, strengthening self-efficacy and adaptive coping. Integration into biopsychosocial, multidisciplinary programs—particularly alongside exercise and family involvement—may optimize outcomes. Larger, standardized trials with long-term follow-up and systematic adverse-event reporting are needed to solidify guidance for clinical practice. Full article

The matrix metalloproteinase (MMP) family includes several membrane-bound enzymes. Membrane-type 5 matrix metalloproteinase (MT5-MMP) is unique amongst the MMP family in being primarily expressed in the brain and during development. It is proposed to contribute to synaptic plasticity and is implicated in several pathologies, including multiple cancers and Alzheimer’s disease. In cancer, MT5-MMP expression has been correlated to cancer progression, but a distinct mechanistic role has yet to be uncovered. In Alzheimer’s disease, MT5-MMP exhibits pro-amyloidogenic activity, functioning as an η-secretase that cleaves amyloid precursor protein (APP), ultimately generating two synaptotoxic fragments, Aη-α and Aη-β. Several intracellular binding partners for MT5-MMP have been identified, and of these, N4BP2L1, EIG121, BIN1, or TMX3 binding to MT5-MMP results in a significant increase in MT5-MMP η-secretase activity. Beyond direct effects on APP, MT5-MMP may also facilitate APP trafficking to endosomal/lysosomal compartments and enhance proinflammatory responses. Overall, the substrate profile of MT5-MMP has not been well defined, and selective inhibitors of MT5-MMP have not been described. These advances will be needed for further consideration of MT5-MMP as a therapeutic target in Alzheimer’s disease and other pathologies. Full article

Epilepsy remains a major therapeutic challenge, with approximately one-third of patients experiencing drug-resistant epilepsy (DRE) despite the availability of multiple antiseizure medications (ASMs). This review aims to evaluate emerging ASMs—cenobamate, fenfluramine, ganaxolone, ezogabine (retigabine), and perampanel—with a focus on their mechanisms of action, pharmacological profiles, and potential role in precision medicine. A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science to identify preclinical and clinical studies evaluating the pharmacodynamics, pharmacokinetics, efficacy, and safety of the selected ASMs. Relevant trials, reviews, and mechanistic studies were reviewed to synthesize the current understanding of their application in DRE and specific epilepsy syndromes. Each ASM demonstrated unique mechanisms targeting hyperexcitability, including the modulation of γ-aminobutyric acid receptor A (GABA-A) receptors, sodium and potassium channels, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPA receptors), and serotonin systems. These mechanisms correspond with specific pathophysiological features in syndromes such as Dravet and Lennox–Gastaut. Evidence from clinical trials supports their use as adjunctive therapies with generally favorable tolerability, though adverse events and variable efficacy profiles were noted. The mechanistic diversity of these emerging ASMs supports their value in personalized epilepsy management, particularly in treatment-resistant cases. While the promise of precision medicine is evident, further studies are required to address challenges related to long-term safety, cost, and equitable access. Full article

Instead of being waste product of metabolism, lactate, has become a key metabolic and signaling molecule in both exercise physiology and tumor biology. Carcinogenic cells produce huge amounts of lactate through the Warburg effect, which is a hallmark of aggressive tumors, increasing acidity in the environment that can stimulates angiogenesis, immune evasion, and metastasis. Conversely, while exercise acutely elevates blood lactate concentration but it consider helpful for cancer patients. This paradox raises the following question: is exercise-induced lactate a friend or foe in cancer? This study reviews current evidence on the mechanistic, metabolic, immunological, and clinical impacts of exercise-induced lactate in cancer patients, highlighting the context-dependent effects that render lactate either beneficial or detrimental. Tumor-derived lactate seems to be pro-tumorigenic, driving immune suppression and disease progression, whereas short bursts of lactate from exercise can enhance anti-tumor immunity and metabolic reprogramming under the right conditions. Therefore, lactate’s impact on cancer is “all about the context”. Full article

Climbing demands exceptional isometric finger flexor strength and neuromuscular efficiency. This study aimed to compare maximum isometric strength and muscle quality (MQ) between climbers and non-climbers and examine the influence of sex and specific grip types. Methods: 33 climbers (14 women) and 29 non-climbers (15 women) volunteered in this study. Maximum isometric strength was measured for handgrip, three-finger drag, and half-crimp grips, while forearm muscle mass was estimated using DXA. MQ was calculated as the ratio of peak isometric force to forearm muscle mass. Results: Climbers demonstrated significantly higher isometric strength in both the three-finger drag and half-crimp grips compared to non-climbers (p < 0.01); however, non-significant differences were observed in handgrip strength. Despite similar forearm muscle mass, climbers exhibited greater MQ. Notably, female non-climbers showed higher MQ than their male counterparts (p < 0.05), a sex difference that was not evident among climbers. All tests exhibited high repeatability (ICC > 0.93, CV < 5.81%) with low SEM and MDC95 values. Conclusions: The findings underscore the necessity of employing climbing-specific strength assessments to capture the unique neuromuscular adaptations induced by climbing training. Muscle quality emerges as a sex-neutral biomarker for strength performance evaluation, with potential applications in the optimization of training programs. Future research should further explore the predictive value of MQ and strive for standardized testing protocols. Full article

(1) Background: The use of wearable cuffless devices has emerged as an out-of-office blood pressure (BP) monitor device to improve the management of hypertension. We aimed to validate a new, low-cost smartwatch for the measurement of BP and, secondarily, to assess its reliability for the measurement of blood oxygen saturation (SpO₂) and heart rate. (2) Methods: We compared 1000 pairs of measurements (n = 100) acquired by a smartwatch (KC08) with those measured by a reference device. (3) Results: A total of 100 participants (41 ± 18 years) completed the measurements. The values for the systolic and diastolic BP, heart rate and SpO₂ measured with the Smartwatch KC08 and the reference devices differed significantly (p < 0.05). In addition, the Smartwatch KC08 showed a low variability and poor reliability for all the assessed outcomes except for the heart rate. Moreover, no significant heteroscedasticity was observed for the heart rate measured by the Smartwatch KC08 and the reference sphygmomanometer. (4) Conclusions: The main findings of the present study suggest that the Smartwatch KC08 is not yet suitable for daily clinical practice, although it showed low intra-subject variability and reliability for the resting heart rate. Full article

Background/Objectives: Children at Gross Motor Function Classification System (GMFCS) levels IV and V experience severe motor impairments, yet the effects of passive wheelchair rides on their physiological parameters remain unexplored. This study aimed to examine the acute physiological response to passive bike in non-ambulant children with physical disabilities. Methods: This quasi-experimental study included 24 non-ambulant participants with cognitive impairments (6–21 years old, 50% female). After a 10-min rest, participants underwent a 10-min passive wheelchair bike. Muscle activity, oxygen consumption, and heart rate variability were assessed. Results: Passive bike rides significantly increased muscle activity in the right upper (p = 0.050), left upper (p = 0.008), and left lower trapezius (p = 0.038), with increases of 97–112%. However, no significant changes were observed in oxygen consumption or cardiorespiratory parameters. Conclusions: This study suggests that passive wheelchair bike rides increase trapezius muscle activity in children with severe disabilities at GMFCS levels IV and V, offering potential benefits for this population. Full article

Background: Breast cancer survivors (BCS) experience long-term adverse effects, with breast cancer-related lymphedema (BCRL) being one of the most common complications. Exercise is suggested as a safe strategy to improve functionality in BCS with or at risk of developing BCRL. However, the effects of concurrent training in these patients are poorly understood. The aim of the study was to analyze the effects of a 12-week supervised concurrent training program and a 12-week follow-up period without training on molecular, functional, and clinical outcomes in BCS. Methods: A single-arm study was conducted in 11 BCS with or at risk of BCRL to analyze the effects of a 12-week concurrent training and a 12-week follow-up period on molecular (92 inflammation-related proteins), functional (upper- and lower-body strength, handgrip strength, and cardiorespiratory fitness), and clinical (body mass index, arm volume, subcutaneous and muscle thickness, range of motion, physical activity levels and heart rate variability, pain, and quality of life [QoL]) outcomes. Results: The 12-week concurrent training program significantly improved upper-body muscle strength, handgrip strength, pain, emotional well-being, and total QoL. In addition, after the 12-week follow-up period, the increase in row strength was maintained, and a significant decrease in various inflammation-related proteins was observed. Conclusions: A 12-week concurrent training program improved strength, pain, and QoL in BCS without increasing inflammation. After the follow-up period, inflammation-related protein levels decreased, and row strength gains were maintained, supporting the potential effects of concurrent training. Further larger and controlled studies are needed to confirm the results. Full article

Although SARS-CoV-2 reinfections remain a concern for healthcare systems worldwide, the factors driving them are still not fully understood. In this study, we examined data for 3303 individuals who experienced two SARS-CoV-2 infections between March 2020 and May 2022 from both clinical and viral genomics perspectives. Our findings indicate that viral evolution was the primary driver of reinfection. However, chronic conditions were common among reinfected individuals, including those under 26 years old, suggesting that the presence of underlying and/or chronic conditions increases susceptibility to reinfection. The median time elapsed between infections was one year, often coinciding with the emergence of new variants. While vaccination showed only a limited protective effect against reinfection, it drastically decreased the hospitalization rate, underscoring its role in mitigating disease severity. Our findings point to the need for more flexible vaccination strategies, especially for individuals with chronic conditions. Understanding the interactions between host factors and viral evolution is critical to strengthening prevention strategies and reducing the burden of reinfections and their possible long-term complications. Full article

Background: Disparities in neuro-oncological care between high-income and low- and middle-income countries (LMICs) are well documented, yet region-specific data from Latin America remain limited. This review evaluates epidemiologic trends, access to care, and systemic challenges in brain tumor management across Latin American LMICs, using Argentina as a case study. Methods: A systematic review of peer-reviewed literature was conducted focusing on brain tumor incidence, mortality, risk factors, and availability of diagnostics and treatments in Latin America. Socioeconomic, cultural, and systemic barriers were also analyzed. Results: Latin America exhibits some of the highest global brain tumor mortality rates, with Brazil reporting age-standardized rates exceeding 4.5 per 100,000. Glioblastomas are frequently diagnosed at younger ages, often in the fifth decade of life, compared to the global average. Meningioma incidence has increased by 15–20% over the last decade, yet region-wide data remain fragmented. Access to neuroimaging, neurosurgery, radiotherapy, and chemotherapy is limited, with up to 60% of patients relying solely on under-resourced public health systems. Less than 30% of hospitals in rural areas have MRI availability, and continuous professional training is infrequent. Innovative adaptations, such as awake craniotomy, are used in some LMIC centers in response to equipment scarcity. Conclusions: Brain tumor care in Latin America is hindered by limited epidemiological data, restricted access to diagnostics and treatment, and insufficient workforce training. Targeted investments in healthcare infrastructure, international educational collaborations, and policy-level reforms are critical to reducing disparities and improving outcomes in neuro-oncology across the region. Full article

The use of complex human–machine interfaces (HMIs) has grown rapidly over the last few decades in both industrial and personal contexts. Now more than ever, the study of mental workload (MWL) in HMI operators appears essential: when mental demand exceeds task load, cognitive overload arises, increasing the risk of work-related fatigue or accidents. In this paper, we propose a data-driven approach for the continuous estimation of the MWL of professional helicopter pilots in realistic simulated flights. Physiological and operational parameters were used to train a novel machine-learning model of MWL. Our algorithm achieves good performance (ROC AUC score 0.836 ± 0.081, the maximum F1 score 0.842 ± 0.078 and PR AUC score 0.820 ± 0.097) and shows that the operational information outperforms the physiological signals in terms of predictive power for MWL. Our results pave the way towards intelligent systems able to monitor the MWL of HMI operators in real time and question the relevancy of physiology-derived metrics for this task. Full article

Background: Short sessions of isometric exercise have been shown to reduce blood pressure (BP) in normotensive and hypertensive subjects. However, there are few data in hypertensive patients with underlying ischemic heart disease (IHD). In the present study, we compared post-exercise hypotension (PEH) induced by isometric versus combined, aerobic plus dynamic resistance exercise in IHD patients. Methods: Twenty-five stable patients with established IHD and with treated hypertension were enrolled. The study had a cross-over design. All patients performed in a random order and on different days: (1) isometric exercise session (IES) consisting of bilateral knee extension, performed at 20% of maximal voluntary contraction and lasting 20 min; (2) combined exercise session (CES) including moderate-intensity continuous exercise at and dynamic resistance exercise performed at 60% of one repetition maximum, and lasting 60 min and (3) control session (no exercise). BP was measured at rest, immediately after the training and then every 15 min up to 90 min. Results: The repeated measures ANOVA analysis showed that systolic BP significantly decreased after the CES session compared to the control (F = 6.2; p 0.001) and IES (F = 4.4; p 0.004). Systolic BP significantly decreased after IES compared to the control (F = 3.6; p 0.036). Diastolic BP did not show significant changes after CES and IES compared to the control (CES vs. control: F = 2.2; p 0.142; IES vs. control (F = 2.5; p 0.062). There were no significant differences in diastolic BP changes between CES and IES (CES vs. IES: F = 1.8; p 0.156). Conclusions: We observed that CES was more effective than IES in reducing systolic BP; IES was as effective as CES in inducing diastolic PEH in hypertensive patients with underlying IHD. Full article