Search Results (5,008)

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

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

Background: Families caring for children with medical complexity (CMC) face sustained psychosocial demands that may impair health-related quality of life (HRQoL) and mental health. A clear map of how these outcomes are assessed and which factors shape them is needed to guide family-centered care. Methods: We conducted a scoping review following the Joanna Briggs Institute guidelines, and reports were prepared according to the PRISMA guidelines. Searches were conducted in PubMed, CINAHL, and EMBASE (January 2011 to December 2023) to find studies reporting on health-related quality of life (HRQoL) and/or mental health outcomes (anxiety, depression, burden) of family members and/or caregivers of CMC, including operationalization based on complex chronic condition (CCC) classifications, technology dependency, or the Pediatric Medical Complexity Algorithm (PMCA). Two reviewers independently screened records and recorded data, and the findings were synthesized narratively and thematically. Results: Sixty-seven studies met the inclusion criteria and spanned cross-sectional, cohort, case–control, pre–post and qualitative designs across conditions such as epilepsy, congenital heart disease, cerebral palsy, technology dependence and cancer. Common measures were PedsQL™ Family Impact Module, SF-36/12, HADS, Beck inventories and Zarit burden scales. Across the included studies, caregivers, predominantly mothers, frequently reported poorer HRQoL and higher levels of anxiety, depressive symptoms, or burden than comparison groups when these were available. Six recurrent themes emerged: (1) gendered caregiving with disproportionate maternal burden; (2) socio-economic gradients and financing models shaping outcomes; (3) culture, religion and spirituality as coping resources; (4) family and social support buffering distress; (5) school participation and coordinated services potentially reducing burden; and (6) interdependence between caregiver and child outcomes. Conclusions: Heterogeneous CMC definitions, outcome measures, and study designs limited comparability across studies. The mapped evidence suggests that family HRQoL and mental health outcomes are shaped by interacting clinical, social, and contextual factors. These findings may inform more family-centered and equity-oriented approaches to care. Future research should harmonize CMC definitions, standardize outcome measures, and prospectively evaluate multicomponent interventions. Full article

(1) Background: The global educational landscape increasingly necessitates pedagogical approaches capable of addressing complex socio-environmental challenges. While STEAM education is widely adopted, its contribution to the 2030 Agenda and Global Competence requires further theoretical consolidation. This study proposes a reconceptualization of STEAM as a Transformative STEAM Framework, explicitly aligned with Sustainable Development Goals (SDGs) 4, 5, and 10, as well as the development of Global Competence. (2) Methods: Guided by PRISMA 2020 principles for study retrieval, a search for peer-reviewed research, literature reviews, and relevant institutional documents conducted in Scopus, Web of Science, and ERIC yielded a final corpus of 32 studies (2014–2024). A multi-layered methodological design was applied, integrating a Critical Interpretive Synthesis (CIS) framework for conceptual evaluation alongside a hybrid thematic synthesis to ensure rigorous data coding. (3) Results: The findings indicate that STEAM bolsters Global Competence by fostering intercultural interaction and critical thinking, demonstrating robust alignment with quality education (SDG 4) and gender equality (SDG 5). However, significant gaps remain concerning broader structural inequalities (SDG 10) and the paucity of validated, multidimensional assessment tools for evaluating Global Competence. (4) Conclusions: This review establishes a conceptual framework that positions STEAM as a catalyst for equity and the 2030 Agenda. To realize its transformative potential, future research must explicitly address the reduction in inequalities and develop robust assessment mechanisms. Full article

Early childhood is a critical period in which religious and moral foundations are established, and the materials used in this process directly influence the quality of learning. In Türkiye, institutional religious education for early childhood is provided through Qur’an courses for children aged 4–6 years, affiliated with the Presidency of Religious Affairs. This study examines the attitudes of instructors working in these courses toward material use and the types of materials preferred in the educational process. Designed within a quantitative research approach using a survey model, the study aimed to collect data from instructors working in Qur’an courses for 4–6-year-old children during the 2023–2024 academic year in Türkiye. Based on voluntary participation, 363 instructors took part in the study. Data were collected through the Material Use Questionnaire and the Attitude Scale Toward Material Use in the Classroom Environment questionnaire and analyzed using SPSS 22.0. Due to the non-normal distribution of the data, the Kruskal–Wallis H test and the Mann–Whitney U test were applied. The findings show that instructors have positive attitudes toward the use of instructional materials and that printed and auditory materials are the most frequently used in the educational process. Full article

This study proposes and analyzes an integrated framework for monitoring potable water quality and laboratory effluent management in universities, with emphasis on its practical application in a Brazilian public institution. Adopting a qualitative and documentary approach, the research was based on high-impact scientific publications, institutional reports, and environmental databases. The results demonstrate that effective water and effluent governance depends on the interaction of three core dimensions: regulatory compliance, technological innovation, and institutional governance. These elements operate synergistically to ensure transparency, risk prevention, and environmental accountability. The proposed University Laboratory Water Monitoring Framework (UL-WMF) illustrates how universities can transform water control into a managerial and educational tool aligned with sustainability goals. The illustrative institutional application revealed potential for integrating Internet of Things (IoT) and Laboratory Information Management System (LIMS) technologies into environmental management routines, reinforcing universities’ strategic role in achieving global sustainability objectives. Despite relying on secondary data, this study provides a scalable foundation for decision support systems and future empirical validation. The novelty of the University Laboratory Water Management Framework (UL-WMF) lies in its integration of potable water monitoring and laboratory effluent governance into a single operational framework, addressing a gap in the existing literature and offering a model specifically tailored to the context of universities in developing countries. The applied component of the study consists of an illustrative institutional case constructed exclusively from publicly available environmental and governance reports. This illustration serves to demonstrate the operational relevance of the proposed framework, without implying field measurements or primary data collection. Full article

Background: Atypical teratoid/rhabdoid tumors (AT/RT) are rare, highly aggressive pediatric central nervous system (CNS) malignancies. AT/RT of the lateral ventricle is an exceptionally rare subgroup, with only 11 reported cases. SMARCB1 inactivation is the primary molecular feature of AT/RT. Current consensus is to classify AT/RT based on methylation and molecular profiles into the following subgroups: AT/RT-TYR, AT/RT-SHH, AT/RT-MYC, and a potentially distinct SMARCA4-deficient subtype. AT/RT-MYC exhibits high levels of CD8⁺ tumor-infiltrating lymphocytes, indicating immunogenic potential. Case presentation: We report three pediatric cases presenting with intracranial hypertension and seizures. Diagnosis was confirmed via histopathology and molecular profiling. Interventions included gross total resection, chemotherapy, radiotherapy, and combined immune checkpoint inhibitors (pembrolizumab and ipilimumab). Outcomes varied from rapid progression to 3-year recurrence-free survival. A cohort of 14 pediatric patients with lateral ventricle AT/RT, comprising 3 institutional cases and 11 cases identified from the PubMed database, was evaluated through a narrative synthesis. Conclusions: These advancements highlight the crucial role of molecular subtyping in tailoring personalized treatments, including epigenetic modifiers and immune-based regimens. However, clinical validation is essential to establish standardized protocols. Integrating genomic, epigenetic, and immune microenvironment profiling may enhance risk assessment and treatment precision, ultimately improving survival and quality of life in pediatric patients. Full article

This study introduces the LESG index, a composite analytical framework designed to assess the structural coherence of national development systems by integrating logistics capability, governance quality, and sustainability performance. Traditional development metrics evaluate these dimensions separately, limiting their ability to capture systemic interactions. Using cross-country data for 123 countries, the LESG index is constructed through normalization procedures and Principal Component Analysis (PCA) to derive a composite indicator reflecting the multivariate structure of the selected dimensions. Cluster analysis is subsequently applied to identify distinct structural development regimes. The results indicate a consistent empirical association between the LESG index and broader development outcomes, while also highlighting heterogeneous configurations of logistics capability, institutional quality, and sustainability performance across countries. These findings suggest that composite indicators can provide useful diagnostic tools for examining the structural alignment of development conditions beyond single-dimension metrics. The LESG framework contributes an integrated perspective for analyzing national development systems and offers a basis for future research on the structural conditions supporting sustainable economic transformation. Full article

Digital trade is reshaping innovation incentives in emerging economies, yet whether digital trade policy can promote a sustainable upgrading of urban innovation structure—one that shifts the composition of innovative activity toward higher quality while contributing to broader societal goals—remains unclear. Exploiting the staggered rollout of China’s Cross-Border E-Commerce (CBEC) Comprehensive Pilot Zones as a quasi-natural experiment, this study examines how the policy is associated with changes in urban innovation composition using city-level panel data from 2010 to 2023. We construct a patent-text-based proxy for the disruptive orientation of urban innovation using TF-IDF analysis of patent abstracts—a methodological approach that captures textual distinctiveness as a dimension of innovation quality—and validate it against invention-patent intensity and highly cited patents. Using both conventional two-way fixed-effects and modern heterogeneity-robust estimators, we find that CBEC pilot-zone adoption is associated with a higher disruptive-innovation proxy share and a lower share of low-quality (strategic) patenting. The estimated increase in the disruptive-innovation proxy share is about 1.3 percentage points, equivalent to 40.6% of the sample mean. The effect is stronger in cities with weaker business environments, consistent with an institutions-as-substitutes interpretation, and is amplified by pre-existing local government attention to digital trade. Exploratory channel tests point to entrepreneurship, digital payment, and digitization as intermediate outcomes that respond to the policy. These findings contribute to the literature on digital trade policy, innovation composition, and sustainable upgrading by showing that a policy-induced compositional reallocation—rather than a simple increase in patent volume—may support a more quality-oriented, inclusive, and potentially more sustainable pattern of urban innovation in emerging economies. Full article

Background: Treatment options for vulvar lichen sclerosus (VLS) remain limited; therefore, therapies that improve quality of life and reduce neoplastic risk are needed. Photodynamic therapy (PDT) is a potential option. This study aimed to evaluate quality of life and sexual function in patients treated according to the protocol used at our institution. Methods: Forty patients with refractory VLS underwent PDT using a 10% 5-aminolevulinic acid nanoemulsion (Ameluz^®) applied to lesions under an occlusive aluminum foil dressing. Patients received 1–6 sessions of 10 min illumination (LED: 37 J/cm², ~77 mW/cm²) at 4–6-week intervals. The Dermatology Life Quality Index (DLQI) and Female Sexual Function Index (FSFI) were used for assessment. Results: Thirty-seven participants answered DLQI, while 20 declared themselves to be sexually active and were included in the analysis. Greater number of PDT sessions was associated with a lower DLQI score (τ = −0.583; adjusted p < 0.001). The number of PDT sessions and the total FSFI score (p = 0.014), as well as desire (p = 0.016), arousal (p = 0.020), orgasm (p = 0.020), and satisfaction (p = 0.016) domains were significantly correlated. Age correlated positively with DLQI scores (p = 0.016), indicating greater disease burden in older patients. Longer disease duration was also associated with poorer quality of life (p = 0.020). Conclusions: PDT can be considered an effective treatment for patients with VLS refractory to standard topical corticosteroid and calcineurin inhibitor therapies when delivered using a refined, patient-centered protocol. This optimized approach used in our institution is based on short irradiation time and precise light delivery, providing a favorable balance between therapeutic efficacy, patient comfort, and treatment feasibility. Our findings also suggest that the cumulative number of PDT sessions is a key factor for clinical response. Further studies should address long-term outcomes. Full article

Background: The Middle East and North Africa (MENA) region faces a high cardiovascular disease (CVD) burden alongside endemic serum 25(OH)D (vitamin D) deficiency. This systematic review examines the relationship between vitamin D deficiency and CVD risk factors in MENA populations. Methods: PubMed, Cochrane Library, and Scopus were searched from inception to 18 October 2024, for observational studies in the MENA region examining vitamin D deficiency and cardiovascular risk factors in adults. Independent data extraction was conducted. Study quality was appraised using the Joanna Briggs Institute tool and the Newcastle–Ottawa Scale, with risk of bias visualized using Robvis. Weighted mean differences in cholesterol, body mass index (BMI), and HbA1c between those with and without vitamin D deficiency were computed with random-effects meta-analysis. The protocol was registered in PROSPERO (ID: CRD42025615188) and funded by the Royal College of Surgeons in Ireland—Medical University of Bahrain. Results: Seventeen studies from nine MENA countries were included, predominantly cross-sectional, involving community-based and disease-specific cohorts. Vitamin D deficiency was highly prevalent and consistently associated with higher adiposity and central obesity. Several studies reported significant links between deficiency and poor glycemic control, particularly in obese and prediabetic groups. Meta-analysis demonstrated significantly higher total cholesterol (MD = 0.32; 95% CI = 0.11 to 0.52, p < 0.001), BMI (MD = 1.81; 95% CI = 0.68 to 2.94, p < 0.001), and HbA1c levels (MD = 0.31; 95% CI = 0.06 to 0.57, p = 0.02) in vitamin D deficient individuals, with notable heterogeneity. Conclusions: Vitamin D deficiency is highly prevalent in the MENA region and consistently associated with adiposity-related risk factors. Despite heterogeneity, findings underscore the need for public health strategies and further research to clarify causal pathways and population-specific interventions. Full article

Background: Eating disorders are among serious psychiatric conditions and are associated with an increased risk of mortality and significant psychological distress. Mind–body therapies are attracting increasing attention as complementary interventions aimed at improving psychological well-being. The aim of this meta-analysis is to examine the effects of mind–body therapies on psychological outcomes in adults diagnosed with an eating disorder or exhibiting clinically significant symptoms associated with it. Methods: Randomized controlled trials published between 2003 and 2026 were identified through a systematic search of the PubMed, CINAHL, Web of Science, Cochrane, and Scopus databases. Studies were included that involved participants aged 18 years and over who had received a diagnosis of an eating disorder according to standard diagnostic criteria (e.g., DSM-IV, DSM-IV-TR, DSM-5) or who exhibited clinically significant symptoms associated with an eating disorder. Mind–body interventions were compared with control conditions. Methodological quality was assessed using the Joanna Briggs Institute assessment tool. Statistical analyses were performed using Stata 16.0 software. Results: Nine randomized controlled trials involving a total of 688 participants were included in the meta-analysis. It was found that mind–body interventions significantly reduced levels of depression (Hedges’ g = −0.44, 95% CI: −0.67 to −0.20). Similarly, significant reductions were observed in levels of inadequate self (g = −0.51, 95% CI: −0.84 to −0.18) and self-hated (g = −0.56, 95% CI: −0.89 to −0.23). Although an effect in the direction of an increase was observed for self-compassion (g = 0.31, 95% CI: 0.07–0.54), this effect was not found to be statistically significant following the correction applied for multiple comparisons. In contrast, anxiety (g = −0.19, 95% CI: −0.39 to 0.02), stress (g = −0.48, 95% CI: −1.05 to 0.09), and self-esteem (g = 0.29, 95% CI: −0.16 to 0.73). Conclusions: Mind–body therapies are associated with improvements in certain psychological outcomes among adults with a diagnosis of an eating disorder or those exhibiting clinically significant symptoms. However, the current findings should be interpreted with caution, as the included studies largely relied on waiting-list or usual-care control groups. Full article

Financial technologies (Fintech) have rapidly reshaped access to financial services, particularly in developing countries where traditional banking remains limited. This study investigates fintech’s role in advancing financial inclusion by analyzing panel data from 89 developing economies gathered from Global Findex reports (2011–2021), complemented by International Monetary Fund (IMF), UNU-WIDER, and PRIO datasets. We applied a random-effects regression model and GMM, incorporating fintech adoption alongside macroeconomic and institutional variables such as education, governance quality, and trade openness. Our results show that fintech is the most significant driver of financial inclusion, especially in expanding account ownership, with education and institutional quality further enhancing outcomes. Conversely, we show that population growth and income disparities constrain progress, while government expenditure and GDP growth display mixed effects. We also find that fintech reduces transaction costs and barriers, yet its impact depends on digital literacy, infrastructure, and governance. In conclusion, our findings highlight that fintech represents a transformative but unevenly utilized tool, capable of fostering broader economic participation and reducing inequality when paired with supportive policies and institutional frameworks. Full article

Governance is often treated as a slow-moving background condition in energy transition research, even though institutional reform and implementation capacity shape outcomes over long horizons. This study adopts a time–frequency perspective to examine how institutional quality aligns with energy-system and carbon-efficiency transition dynamics using multivariate wavelet coherence. Unlike mean-based regression approaches, the multivariate design allows assessment of whether governance aligns with carbon efficiency through three distinct systems—external integration, energy transition with resource rents, and governance coherence—using carbon intensity of GDP (CIGDP) as a common anchor. Using annual data for a comparative sample of GCC economies and non-GCC emerging economies over the period 1996–2022, we examine the evolution of coherence among governance indicators, energy use, renewable energy consumption, external economic exposure, and carbon efficiency, with emissions-related measures explicitly incorporated into the wavelet systems. Environmental implications are therefore interpreted only for systems that directly include carbon-efficiency indicators. The results indicate that institutional quality is most strongly associated with transition dynamics at low frequencies, pointing to persistent long-run alignment rather than short-run adjustment. Across GCC economies, low-frequency coherence is stronger and more continuous, while medium-term weakening appears as time-specific episodes that do not disrupt the underlying long-run structure. In non-GCC emerging economies, long-run coherence remains evident but is less continuous, and medium-horizon fragmentation is more frequent and more prolonged. At high frequencies, coherence is generally weak across countries, suggesting that short-run variation appears more closely associated with external shocks and market conditions than with structural or institutional alignment. Overall, the findings position institutional quality as a stabilising and conditioning factor in energy and carbon-efficiency transitions, operating primarily through long-run coherence and resilience. Systematic differences across governance regimes reflect variation in the continuity and stability of alignment across time horizons, rather than differences in the relevance of governance itself. Full article

Background/Objectives: Pediatric intussusception, a condition where part of the intestine telescopes into an adjacent segment, predominantly affects children aged 6–18 months. Prompt diagnosis and management are crucial to prevent serious complications such as ischemia or necrosis. This systematic review aims to comprehensively evaluate and synthesize existing research on predictive and prognostic biomarkers associated with pediatric intussusception that can aid in early diagnosis, severity assessment, outcome prediction, and treatment. Methods: A comprehensive literature search was conducted across PubMed, Scopus, and Web of Science using specific MeSH and free-text terms related to intussusception, biomarkers, and the pediatric population. The review followed PRISMA guidelines, with independent screening, data extraction, and quality assessment using the Joanna Briggs Institute critical appraisal tools. A total of 47 studies, mostly retrospective cohorts from diverse countries, with over 20,000 patients, were included. Results: The studies identified numerous biomarkers associated with disease severity, including hematological markers and indices (e.g., WBC counts and neutrophil-to-lymphocyte ratio), inflammatory markers (CRP and cytokines), biochemical markers (serum lactate, D-dimer, and electrolytes), and novel molecular markers (I-FABP, MCP-1, and transfer RNA fragments). Elevated inflammatory markers and derived ratios consistently predicted bowel necrosis, ischemia, and need for surgery. Biochemical markers like serum lactate and D-dimer correlated with ischemic severity. Emerging molecular biomarkers show promise for early, non-invasive risk stratification. However, heterogeneity in study designs, assay methods, and cutoff values currently limits immediate clinical application. Conclusions: Biomarker research offers valuable tools for improving pediatric intussusception management, with the potential to enhance early diagnosis and outcome prediction. While traditional markers are useful, novel molecular and protein biomarkers hold promise for more specific and rapid assessment. Validation through multicenter, prospective studies and standardized protocols is essential before routine implementation. Integrating biomarkers with clinical and imaging data could refine decision-making, ultimately reducing morbidity and improving prognosis in affected children. Full article