Search Results (14,645)

Background/Objectives: Peritoneal metastasis represents the most frequent and prognostically unfavorable metastatic pattern in gastric cancer, largely due to limited sensitivity of conventional imaging, delayed diagnosis, and insufficient response assessment. The aim of this review is to provide an overview of the current evidence on the diagnosis and treatment of gastric cancer with peritoneal metastases and to address current treatment limitations and options. Methods: This review was designed as a narrative review and is based on an extensive literature search in established databases. Results: Systemic chemotherapy remains the cornerstone of palliative treatment, improving the survival and quality of life compared with the best supportive care; however, outcomes in peritoneally metastatic disease remain poor. Advances in molecularly targeted and immune-based therapies have extended survival in selected patient populations, yet favorable molecular profiles are mainly unknown in peritoneal metastases. Staging laparoscopy and semi-quantitative assessment using the Peritoneal Cancer Index (PCI) are therefore essential for accurate diagnosis, prognostication, and treatment selection. Growing evidence from retrospective studies, multi-institutional cohorts, and selected randomized trials suggests that a multimodal approach—combining systemic therapy with intraperitoneal or bidirectional chemotherapy—may improve survival and quality of life. In carefully selected patients whose primary gastric tumor and peritoneal lesions respond to systemic treatment, complete cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) may further enhance outcomes and, in rare cases, achieve long-term survival. These potential benefits appear to be limited to highly selected patients with a low peritoneal tumor burden (PCI ≤ 6–7), positive cytology, good performance status, controlled extraperitoneal disease, and a high likelihood of achieving complete macroscopic cytoreduction (CC-0). Conclusions: Although the treatment intent in metastatic gastric cancer remains primarily palliative, carefully selected patients with limited peritoneal metastases may benefit from intensified multimodal treatment strategies when managed in specialized centers. Interdisciplinary evaluation, accurate staging, and individualized treatment planning are essential to optimize outcomes in this challenging disease setting. Full article

Oyster aquaculture offers promising opportunities for diversifying marine production in the Romanian Black Sea, where favorable environmental conditions and recent regulatory developments support shellfish farming. This study aimed to generate baseline data for the cultivation of the Pacific oyster, Magallana gigas, through an in situ experimental trial conducted off Mamaia Bay, Romania. A 50 m experimental long-line system was deployed at 13.5 m depth, and triploid oysters were cultured for one year at two depth horizons (3 m and 6 m). The growth performance, meat yield, Condition Index, microbiological quality, environmental parameters, and epibiotic communities were monitored monthly. Cultivation depth significantly influenced oyster growth, with individuals reared at 6 m consistently achieving a greater wet weight and shell length than those at 3 m. Growth rates peaked during spring, and meat yield values indicated good commercial quality. Environmental monitoring showed strong seasonal variability, with high summer temperatures and reduced dissolved oxygen associated with increased mortality. Microbiological analyses revealed higher bacterial loads during warm months. The Condition Index classified the oysters as generally “fine” to occasionally “special”. Overall, the results demonstrate that Black Sea conditions can support successful cultivation of M. gigas, although seasonal environmental stress and epibiosis require appropriate farm management. Full article

Background: Although pre-exposure prophylaxis (PrEP) has demonstrated strong clinical efficacy in preventing HIV infection among men who have sex with men (MSM), real-world utilization remains suboptimal. In South Korea, MSM constitute a major population within the domestic HIV epidemic; however, PrEP uptake has not increased pro-portionally to awareness. This discrepancy has been conceptualized as the “awareness–uptake gap,” reflecting multi-level barriers beyond individual knowledge. Purpose: This integrative review aimed to compare PrEP awareness, acceptance, and utilization among MSM populations in South Korea and international settings, and to identify structural, institutional, and psychosocial determinants contributing to the awaness, uptake gap. The study further sought to derive practical implications for nursing practice and health policy. Methods: An integrative literature review was conducted following Whittemore and Knafl’s five-step methodology and reported in line with PRISMA guidance. Electronic searches were performed in PubMed, Google Scholar, RISS, ScienceON, and DBpia for peer-reviewed studies published between 2015 and 2025 in English or Korean. The final search was completed on 31 January 2026. A total of 5952 records were identified, and 187 studies met the inclusion criteria after screening and duplicate removal. Quality appraisal was conducted using AXIS, Newcastle-Ottawa Scale, RoB 2.0, CASP, and MMAT according to study design, and the findings were synthesized within an environmental–structural–individual framework. Results: The included studies consistently showed that awareness of PrEP exceeded actual uptake. Across settings, the awareness–uptake gap was shaped by policy environment, service accessibility, stigma, privacy concerns, economic burden, institutional complexity, and provider preparedness. Comparative evidence from China, Thailand, Belgium and France, Brazil, and West Africa further suggested that awareness alone did not ensure uptake when service pathways were fragmented, culturally unsafe, or poorly understood. Conclusions: Closing the awareness–uptake gap requires integrated policy and practice strategies that extend beyond cost reduction. Strengthening confidentiality systems, simplifying service pathways, and enhancing provider competency—particularly through nurse-centered PrEP navigation and counseling models—may support more sustainable PrEP expansion among MSM populations in global settings. Full article

The global aging process has increased the number of older individuals providing care for relatives with severe mental disorders (SMD). This population faces unique health challenges. The present cross-sectional study examined the relationship between self-perceived health (SPH) and clinical, functional, and sociodemographic variables among 71 older caregivers (median age: 65 years) in Bogotá, Colombia. SPH was assessed by answering the question: “How would you describe your overall health status?” and dichotomized into good versus poor perception. Comorbidity was measured as the number of self-reported chronic conditions. Caregiver burden was evaluated using the Zarit Caregiver Burden Interview, and health-related quality of life (HRQoL) was assessed using the SF-36, including dimensions such as physical functioning, emotional well-being, bodily pain, and general health. Descriptive analyses, non-parametric comparisons, and logistic regression models were conducted. The results revealed a marked feminization of caregiving (92.96%) and a high prevalence of good SPH (70.42%), despite a substantial burden of physical comorbidities (mean: 3.21). Dimensions such as physical functioning, emotional well-being, and pain were significant in univariate analyses. However, the multivariate model identified general health as the only independent predictor of good SPH (adjusted odds ratio [OR]: 1.112; 95% confidence interval [CI]: 1.053–1.174; p < 0.001). These findings suggest that subjective health assessment may transcend objective disease counts for older caregivers. Public health policies could prioritize wellness-based interventions and emotional support over traditional disease-centered approaches to improve the quality of life of this growing, active, socially valuable, yet vulnerable population. Full article

Background: Nutrition and sleep are critical determinants of athletic performance and recovery. Direct comparative research between endurance and strength–power athletes remains limited. This study aimed to evaluate and compare nutritional knowledge, dietary habits, sleep quality, and Body Mass Index between ultramarathon runners and American football players, as well as to explore independent predictors of sleep quality. Methods: A cross-sectional study was conducted among 231 male athletes. To address group size disparity and mitigate statistical bias, a random undersampling technique was applied to create a balanced cohort of 86 athletes comprising 43 ultramarathon runners and 43 American football players. Nutritional parameters were assessed using the Kom-PAN questionnaire. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index. Between-group comparisons were performed using the Mann–Whitney U test with False Discovery Rate correction. An integrated multiple regression model was constructed to identify predictors of global sleep quality. Results: Ultramarathon runners demonstrated significantly better overall sleep quality (p = 0.026) and higher nutritional knowledge (p < 0.001) compared to American football players. Differences in adherence to pro-healthy and non-healthy dietary patterns were not statistically significant after False Discovery Rate correction. The integrated multiple regression model revealed that the athletic discipline was the primary independent predictor of global sleep quality (p = 0.001), while dietary variables did not exhibit a significant independent effect. Furthermore, higher Body Mass Index was independently associated with better sleep scores within the multivariate model (p = 0.008). Conclusions: Significant sport-specific differences exist in BMI, nutritional knowledge, and sleep quality. Global sleep quality appears to be primarily associated with the specific physiological and environmental demands of the athletic discipline rather than individual dietary factors, which were not independently significant in the multivariable model. These findings suggest that recovery strategies in strength–power athletes may require a broader, multifactorial approach beyond nutritional education alone. Full article

Background: Testosterone is the most abundant biologically active sex steroid in women, yet the therapeutic implications of its age-related decline remain undercharacterized. Published trials have focused predominantly on sexual function, leaving gaps in understanding how testosterone replacement therapy (TRT) affects broader symptom domains and metabolic biomarkers in women. Objective: To investigate whether individualized, biomarker-guided TRT in women is associated with improvements across multiple symptom domains and favorable hormonal, hematologic, and cardiometabolic biomarker changes, and to examine whether symptomatic benefit varies with treatment duration. Methods: In this retrospective observational study, women (n = 332; ages 27 to 78; mean 45.7 ± 7.1 years) receiving TRT as part of routine clinical care through a telehealth-based platform completed a structured survey at a single post-treatment time point assessing eight symptom domains: energy/fatigue, memory, concentration, irritability, depression, anhedonia, sexual interest, and relationship satisfaction. Respondents were stratified by TRT duration (1 month to >12 months) and a subset (n = 120) underwent paired biomarker assessment at baseline and 12 weeks for total testosterone, free testosterone, SHBG, hemoglobin, and triglycerides. Results: Improvement was reported across all eight domains, with energy/fatigue showing the strongest response (84.3% improved). Depression, irritability, anhedonia, and sexual interest each exceeded 65% improvement. Cognitive domains showed a delayed trajectory, with meaningful gains emerging at 4 to 6 months. Quality of life improvement was reported by 89.7%, with significant improvement rising from 5.4% at 1 month to 51.5% at greater than 12 months. Energy/fatigue (64.2%) and mood (49.7%) ranked above sexual desire (41.3%) as self-identified areas of greatest benefit. All five biomarkers changed favorably: total testosterone +151.8% (d = 3.60), free testosterone +216.7% (d = 3.01), hemoglobin +5.5% (d = 2.03), SHBG −13.3% (d = 1.57), and triglycerides −12.6% (d = 1.28). Conclusions: Individualized TRT in women was associated with broad symptomatic improvement spanning energy/fatigue, depression, irritability, anhedonia, cognitive function, and sexual interest, with duration-dependent gains and favorable biomarker changes across all five markers assessed. These findings suggest that the value of testosterone in women extends beyond sexual function and supports the need for larger controlled trials with extended follow-up. Full article

Background: One of the most debated scientific topics in recent years is the role of non-invasive respiratory support techniques in the treatment of de novo acute hypoxemic respiratory failure. Until pre-COVID-19, the most accredited guidelines did not make recommendations for or against the use of these techniques in this clinical condition, and the increased risk of adverse events for patients who failed the non-invasive approach was widely reported in the literature. The most recent guidelines recommend the use of HFNC as a first-line technique in the treatment of de novo acute hypoxemic respiratory failure to avoid the need for tracheal intubation. However, the strength of these recommendations remains weak, the quality of the underlying evidence is poor, and their usefulness in deciding which technique to apply to an individual patient is questionable. Aim: The aim of this review was to provide the reader with some critical tools to interpret the different indications regarding the choice of the best non-invasive support technique to be used in this setting. Methods: To this end, we analyzed the available literature on this topic, privileging the works that are most useful in correlating the practical indications to the pathophysiological assumptions. Results and Conclusions: The notable heterogeneity of the studies on which the current recommendations are based, as well as the affirmation of the concept of patient self-induced lung injury (P-SILI), highlights the importance of assessing each patient’s risk of developing this complication, individualizing treatment to the patient’s specific needs, and monitoring the patient during treatment. Full article

Research has advanced in the development of precision seed metering devices to ensure proper seed distribution at high speeds. However, little is known about the effect of increasing seeding speed, as well as seeding at different inclinations of the tractor-seeder unit, on the integrity and physiological quality of soybean seeds. This study aimed to identify the effect of travel speeds (5, 7, 9, 11, and 13 km h⁻¹) combined with three longitudinal inclinations of a pneumatic seed metering device (−11°, 0°, and 11°), simulating field conditions, on the distribution and integrity of soybean seeds. We used a 5 × 3 factorial design was used with an additional control treatment in which the seeds did not pass through the metering device. The variables evaluated included the percentage of spacing between individual seeds, germination, mechanical damage (tetrazolium test), and seedling emergence. The results demonstrated that increasing the speed did not prevent the spacing between individual seeds from falling below the minimum limit of 90% for pneumatic seed metering devices. The treatments did not affect germination compared to the control. Sowing on a slope caused the greatest mechanical damage to soybean seeds. All treatments significantly reduced plant emergence, except when the pneumatic metering device operated at an incline of 0° at 9 km h⁻¹. Full article

Coconut milk-based Filipino foods provide a favorable environment for microbial growth and are highly susceptible to spoilage. Traditionally, spoilage in such foods has been assessed through subjective sensory evaluation, a method that often lacks consistency and accuracy. The present study introduces an electronic nose system employing Support Vector Machine (SVM) algorithms to objectively and quantitatively determine spoilage in coconut milk-based Filipino foods, including Bicol Express, Ginataang Langka, Laing, Bilo-bilo, Maja Blanca, and Ginumis. The developed system integrates six MQ gas sensors connected to an Arduino Nano and a Raspberry Pi 4B to detect and process volatile organic compounds emitted from the foods. The SVM algorithm was selected for its effectiveness in high-dimensional spaces and its ability to construct a binary classifier capable of distinguishing between spoiled and fresh samples. Dimensionality reduction in sensor data was achieved using Principal Component Analysis, which further enhanced classifier performance. System evaluation results demonstrated a high classification accuracy of approximately 98.95%, indicating the robustness of the proposed approach. The utilization of this technology offers significant benefits, not only for individuals with impaired olfactory function but also for the food industry, providing a reliable tool for food quality control and safety. Moreover, the outcomes suggest broader applicability to other perishable food products, with potential contributions to improved global food safety and storage practices. Full article

Plant polysaccharides, such as Astragalus polysaccharide (APS) and Glycyrrhiza polysaccharide (GPS), hold potential as feed additives, yet their individual and synergistic effects on squab meat quality remain unclear. In this study, 192 healthy, 15-day-old, early-weaned Silver King squabs were assigned to one of four dietary treatments for 28 days: a control group (CK), an APS group, a GPS group, and a combined APS + GPS group (AG). Slaughter traits, organ indices, liver antioxidant capacity, and meat quality were evaluated across the four groups. Results indicated that supplementation with APS, GPS, and AG enhanced several slaughter traits compared to CK, including live weight, carcass weight, full-eviscerated weight, half-eviscerated weight, and leg muscle weight. GPS and AG supplementation improved color parameters in both breast and leg muscles, with AG showing the most favorable tenderness-related outcomes. Additionally, AG supplementation enhanced liver antioxidant capacity, as evidenced by increased total antioxidant capacity and superoxide dismutase activity. Given AG’s superior overall performance, the ileal metabolomics analysis focused on comparing CK and AG. Metabolomics data revealed clear group separation and significant changes in amino acid-related pathways. In summary, while APS and GPS individually improved certain traits, their combined supplementation yielded the most favorable results, likely through enhanced antioxidant capacity and altered ileal amino acid metabolism. Full article

Background: A substantial discrepancy exists between the prevalence of perceived food allergy and that of food allergy confirmed by objective diagnostic methods. The misperceptions of food-related symptoms in the absence of a confirmed food allergy may be related to maladaptive personality traits, such as neuroticism, which may shape symptom perception, illness experience, and the therapeutic alliance. From an integrative medicine perspective, maladaptive personality traits may be associated with the reporting and interpretation of food-related symptoms. Objective: This pilot exploratory study examined associations between personality traits and perceived food allergy. Methods: Twenty-one adults reporting food allergy symptoms underwent allergological assessment and standardized psychological evaluation. Participants were classified as having confirmed (n = 10) or excluded (n = 11) immune-mediated food allergy. Maladaptive personality traits were assessed using the Personality Inventory for DSM-5 Brief Form (PID-5-BF), and quality of life was measured using the WHOQOL-BREF. Between-group comparisons were performed using Mann–Whitney U tests. Results: Patients without confirmed food allergy demonstrated significantly higher Antagonism scores compared with those with confirmed allergy (p = 0.003; g = 1.03). No significant differences emerged in other personality domains, although moderate-to-large effect sizes were observed for Negative Affectivity, Disinhibition, and Psychoticism. These findings should be interpreted with caution given the small sample size and the exploratory nature of the study and should be considered preliminary and hypothesis-generating. Conclusions: Patients with confirmed food allergy may be primarily burdened by environmental limitations associated with disease management, whereas individuals without confirmed allergy may exhibit higher levels of maladaptive personality traits, particularly antagonism. Integrating psychological assessment into allergy care may support patient-centered, evidence-based integrative approaches in conditions marked by diagnostic uncertainty. Full article

Introduction: Although gait alterations associated with excess body weight have been widely studied, most available evidence comes from laboratory-based analyses, which limit ecological validity and the translation of findings into clinical practice. This study addresses this gap by examining gait biomechanics across BMI categories using portable sensor-based insoles that allow gait assessment in real-world conditions. Methods: A cross-sectional study including 96 adults categorized as normal weight (NW), overweight (OW), or obese (OB) was conducted. Gait biomechanics were recorded using PODOSmart^® intelligent insoles, which capture spatiotemporal and angular parameters during natural walking. Foot health, quality of life and comorbildities were evaluated throught valeted questionnarires. Differences between groups were analyzed using ANOVA and chi-square tests. Age and sex, known to influence gait, were comparable across BMI groups and were considered in the interpretation of the results. Results: Overall, the participants in the OB group exhibited reduced stride length, gait speed, and swing time, increased double-support time, and greater pronation–supination and progression angles than OW and NW participants. Partial eta-squared values (η²p) were predominantly medium to large, reinforcing the robustness of these between-group differences (e.g., double-support time, p > 0.001; η²p = 0.19). Individuals with obesity reported poorer general and foot health and more difficulty finding suitable footwear. BMI was also significantly associated with hypertension, dyslipidemia, arthritis, and depression (all p <0.05), whereas diabetes, cardiopathies, knee pain, and fatigue andwalking or social activity limitations showed no significant differences. Conclusions: By using portable gait analysis technology in ecological conditions, this study provides novel evidence of clinically meaningful gait impairments across BMI groups. Higher BMI is associated with clinically relevant gait impairments, poorer perceptions of foot and general health, and a higher prevalence of several comorbidities. Full article

Apolygus lucorum (Meyer-Dür) is a phytozoophagous crop pest. While the effects of plant-based diets on its development and reproduction have been extensively studied, the combined effects of plant- and prey-based diets on these traits remain poorly understood. This study systematically evaluated the effects of plant-only, prey-only, and mixed plant–prey diets on A. lucorum nymphal survival and development, as well as adult longevity and fecundity, under controlled laboratory conditions. The results demonstrate that diet composition significantly affected nymphal survival and developmental progression. Nymphs fed exclusively on prey (Aphis gossypii Glover or Bemisia tabaci (Gennadius) nymphs) failed to complete juvenile development. Although a diet of Helicoverpa armigera (Hübner) eggs alone enabled some individuals to reach adulthood, survival rates were significantly lower than those in mixed-diet treatments. Mixed feeding markedly improved nymphal survival, with the highest rates observed in groups fed green beans + H. armigera eggs and cotton leaves + B. tabaci nymph combinations (both 64.45%). The developmental duration was also influenced. Mixed diets, particularly green beans + H. armigera eggs, significantly shortened each instar and the total developmental time (11.04 ± 0.17 d), whereas a diet of cotton leaves alone prolonged development (19.45 ± 0.24 d). Adult longevity and reproductive output were likewise diet-dependent. The longest lifespans were recorded in adults fed green beans alone or green beans + H. armigera eggs, while the shortest lifespan was observed for those fed only cotton leaves. Successful oviposition was only achieved following four dietary treatments: green beans alone, green beans + H. armigera eggs, H. armigera eggs alone, and cotton leaves + H. armigera eggs. Among these, the green bean + H. armigera egg diet yielded the best reproductive performance, featuring the shortest pre-oviposition period (5.82 ± 0.60 d), the longest oviposition period (19.41 ± 1.68 d), and the highest mean fecundity per female (238.35 ± 25.51 eggs). This underscores the reproductive advantage of a mixed plant–prey diet. This study clarifies how dietary conditions shape the survival, development, and reproduction of A. lucorum, highlighting its strong reliance on nutritional quality for key life-history traits. These findings offer valuable insights into the ecological adaptations underlying the feeding behavior of this insect. Full article

Background: Stretching exercises are strongly recommended as part of exercise training programs; however, their effects on blood pressure (BP) and other related cardiovascular parameters in adult individuals with elevated BP (pre-hypertension) or hypertension remain unclear. Methods: A systematic search was conducted in PubMed and databases accessed via the EBSCO platform up to 30 September 2025, following the PRISMA guidelines. An additional search of Scopus was performed on 8 April 2026. Studies eligible for inclusion were randomized controlled trials, randomized crossover trials, non-randomized clinical trials and single-arm trials investigating stretching interventions in adults with pre-hypertension and or hypertension. Risk of bias assessment was performed using RoB 2 for randomized trials and ROBINS-I for the non-randomized trials. A random-effect meta-analysis was performed when at least two studies reported sufficiently comparable BP outcomes. The quantitative synthesis was considered exploratory. Results: Eleven records published between 2014 and 2025 met the eligibility criteria and were included. All protocols used static stretching, although only a small number were clearly described as active stretching. The results were heterogeneous across the design, duration of intervention and outcomes. Chronic interventions more often reported favorable changes in indices of arterial stiffness, whereas acute interventions demonstrated more variable immediate BP responses. In the exploratory meta-analysis, the pooled estimate suggested a reduction in systolic blood pressure (SBP) in favor of stretching; however, this effect did not reach statistical significance (mean difference (MD) = −5.39 mmHg, 95% confidence interval (CI): −11.32 to 0.53; I² = 0%). For diastolic blood pressure (DBP), the pooled estimate favored stretching and reached statistical significance (MD = −3.93 mmHg, 95% CI: −7.25 to −0.60; I² = 0%). In sensitivity analyses including a third study, the pooled effects remained in favor of stretching for systolic BP (MD = −6.6 mmHg, 95% CI: −12.2 to −1.0; I² = 56%) and diastolic BP (MD = −5.4 mmHg, 95% CI: −7.1 to −3.7; I² = 8%). These pooled estimates should be interpreted with caution due to the small number of studies, heterogeneity in study design and participant characteristics, and overall limitations in methodological quality. Secondary findings suggested possible improvements in selected vascular parameters, including brachial–ankle pulse wave velocity, augmentation index, and cardio–ankle vascular index, whereas acute responses were more variable and protocol-dependent. Overall, the level of evidence was limited, with most randomized trials judged as having some concerns and non-randomized studies judged as having a critical risk of bias. Conclusions: Stretching interventions may improve BP and selected vascular parameters in adults with pre-hypertension and hypertension and may represent a practical adjunct within the non-pharmacological management of BP. However, the current evidence is limited by methodological heterogeneity, risk of bias, and the small number of studies available for quantitative synthesis. Therefore, the pooled findings should be considered exploratory and hypothesis-generating rather than definitive. Further high-quality randomized controlled trials are required to determine the optimal type, dose, and long-term clinical relevance of stretching interventions in this population. Full article

Sweet peppers (Capsicum annuum L.) are an important dietary source of antioxidants. Optimizing fruit antioxidant quality under reduced inputs is essential to valorize sustainable pepper production. Here, we evaluated seven Spanish genotypes (traditional/local, derived experimental hybrids and commercial hybrids) across six treatments combining two fertilization (100% and 50%) and irrigation (100% and 75%) regimes, with plant growth-promoting rhizobacteria (PGPR) applied under reduced fertilization treatments. Vitamin C and flavonoids were quantified by HPLC at the green-ripe and fully ripe stages, and carotenoids were determined spectrophotometrically at the fully ripe stage. Several genotypes largely maintained antioxidant content under stress treatments, whereas specific genotype × ripening stage combinations showed maximum increases in vitamin C (+102%), flavonoids (+86% for kaempferol) and carotenoids (+67% for yellow-orange carotenoids) under certain low-input treatments compared to the control. The PGPR effects on vitamin C and carotenoids were generally small, with occasional reductions. However, the PGPR increased total and some individual flavonoids by up to 96% (luteolin) in green-ripe Piquillo and 128% (quercetin) in fully ripe Isabel F1 fruits compared to the corresponding non-inoculated treatments. This multi-genotype, two ripening-stage evaluation identifies Spanish traditional germplasm and derived hybrids with stable or improved antioxidant profiles under low-input conditions and provides insight into PGPR effects. These results support the use of traditional genotypes in breeding for sustainable production. Full article