Peritoneal recurrence is the most common form of recurrence after radical gastrectomy for gastric cancer (GC) and is the main cause of death. The median survival period is 3-6 months, and the 5-year survival rate is almost zero. So far, the treatment methods recommended by various clinical guidelines for peritoneal metastasis (PM) of GC are all palliative systemic chemotherapy (SC). However, the therapeutic effect is not ideal. One possible reason is the existence of the blood-peritoneal barrier, which makes it difficult for drugs to reach the peritoneal metastatic foci fully. Based on this, surgeons have gradually attempted the intraperitoneal administration mode in clinical practice. Hyperthermic intraperitoneal chemotherapy (HIPEC) improves the anti-tumor efficacy through the synergistic effect of heat and chemotherapy drugs and has achieved good therapeutic effects in the treatment of PM of GC. Raltitrexed is mainly used for intravenous administration and intraperitoneal chemotherapy for advanced colorectal cancer. HIPEC with raltitrexed for the treatment of PM after radical gastrectomy for GC is extremely rare. This article introduces a case of advanced GC with peritoneal recurrence and a large amount of ascites 11 months after radical gastrectomy. After 5 cycles of HIPEC with raltitrexed, a favorable therapeutic effect was achieved. The patient experienced significant clinical improvement, characterized by the resolution of ascites, alleviation of symptoms, and prolonged survival, thereby creating an opportunity for subsequent comprehensive treatment. It is hoped that this case can provide a treatment option for patients with peritoneal recurrence after radical gastrectomy for GC.

Eating disorders are complex conditions, with aetiological factors and impacts across multiple domains. Religion and spirituality are areas of individual diversity that may represent a source of strength or struggle for those experiencing mental illness. However, there is limited and mixed evidence regarding the influence of religion and spirituality in eating disorders, and this is not well integrated within healthcare.

To explore the interplay between Christian religion and spirituality and eating disorder development, experience and recovery, from the perspectives of Australians and New Zealanders with lived experience.

Qualitative methodology using reflexive thematic analysis and selected grounded theory techniques. Data is based on semi-structured interviews with 23 participants who had a Christian background and self-identified as having partially or fully recovered from an eating disorder. Trustworthiness was supported by investigator reflexivity and triangulation.

Analysis highlighted an overarching experience of eating disorders and Christian spirituality as two non-linear, interwoven journeys. Three themes and seven subthemes elucidated this dynamic. Themes included (1) "Not enough"-A sense of not being "good enough" and/or "safe enough" in an eating disorder could be exacerbated or alleviated by Christian religion and spirituality; (2) "Wrestling"-Eating disorders often triggered religious and spiritual, which could change spiritual trajectories; and (3) "Help to heal"-Some participants found comfort, hope, and a foundation for eating disorder recovery in their Christian religion and spirituality, often experienced as embracing God's grace (that is, God's unmerited love and favour).

This study highlights previously under-recognised religious and spiritual influences upon protective and predisposing factors for eating disorders, including perfectionism, attachment and identity formation. Results could inform more personalised approaches to caring for Christians experiencing eating disorders. Findings also suggest a need for similar research with other religious and spiritual traditions.

Hearing loss in midlife is an important and potentially modifiable risk factor for the development of dementia. Research examining the association between dementia and hearing loss has expanded rapidly; however, evidence for the mechanisms linking the two conditions is inconclusive, limiting the development of targeted interventions. This review provides a critical overview of current evidence on dementia risk in relation to hearing loss, proposed mechanisms underpinning this association, and emerging evidence on the effectiveness of hearing interventions in modifying trajectories of cognitive decline, dementia risk, and disease progression. Alongside its role as a risk factor, hearing loss commonly co-occurs with dementia, highlighting the need for integrated approaches to care that address the considerable impact of these co-morbid conditions on individuals and communities. Finally, we emphasise the importance of including diverse populations in future research to improve generalisability of findings and help advance equity in dementia prevention and care.

Suicidal thoughts and behaviors (STBs) are a leading cause of death in the United States. Individuals at high-risk for suicide vary greatly in their precedents to STBs, which hinders suicide prevention strategies. Personalized approaches to mapping individualized precedents to suicide ideation might increase the impact and efficiency of treatment.

The present study describes a personalized, blended digital health treatment that uses idiographic network models derived from ecological momentary assessment to inform treatment targets (PeRsonalizEd Clinical Intervention for Suicide Events; PRECISE). PRECISE includes skills from dialectical behavior therapy and safety planning, two existing evidence-based treatments. In this case series, participants (N = 5) at high-risk for suicide and completed a 6-week treatment which included 5×/day ecological momentary assessments as well as weekly coaching sessions. Outcomes were assessed at baseline, post-treatment, and six-weeks post-treatment.

In the intent-to treat sample, three of the five participants (60%) completed the full treatment protocol. Participants attended an average of 4.4 coaching sessions (73.3%), adherence was excellent (98%), and satisfaction was also high (4.2 out of 5). The severity of suicidal thoughts and behaviors were reduced at both post-treatment and the 6-week follow-up (d_zs = -1.33 to -2.00).

PRECISE is an example of a blended digital health interventions that capitalizes on time series data to personalize interventions for suicidal thoughts and behaviors. Incorporating real-time data and idiographic models to inform clinical decision making are promising tools to improve suicide care. Lessons learned and future directions for implementation are discussed.

Major psychiatric disorders are characterized by substantial clinical heterogeneity and high comorbidity, yet their underlying biological mechanisms are not fully uncovered. The microbiota-gut-brain axis (MGBA) offers a cross-system perspective for elucidating the pathophysiology of major psychiatric disorders. The Brain-Gut Health Initiative (BIGHI) was established as the first prospective longitudinal cohort in China dedicated to investigating major psychiatric disorders guided by the framework of MGBA, enabling large-scale, transdiagnostic, and longitudinal analyses of brain-gut interactions. To date, the BIGHI has enrolled over 1,200 participants with schizophrenia, major depressive disorder, bipolar disorder, and healthy controls, with multidimensional data collected including clinical symptomatology, neurocognitive performance, electroencephalography, magnetic resonance imaging, peripheral blood biomarkers, and gut microbiome profiles. The studies within the BIGHI reveal (a) brain-gut physiological alterations in psychiatric disorders; (b) systematic relationships among brain function, peripheral physiological markers, and gut microbiome; and (c) brain-gut network patterns with marked interindividual heterogeneity. In future studies, we will expand the BIGHI into a collaborative network and promote data harmonization and interdisciplinary collaboration to advance computational psychiatry as well as its clinical translation.

We explored the feasibility of integrating a digital mental health intervention (DMHI) for adolescents identified with mild or moderate depressive symptoms during preventive health encounters.

We conducted a quality improvement study at a large integrated health care system in California from August to December 2023. Collaborators included 47 physicians and a nurse practitioner.

Of 1200 health encounters with adolescents, 1143 (95%) documented depression screening. Screening identified depressive symptoms at 106 (9%) encounters, including 41 (3%) with mild to moderate symptoms, 14 (1%) with moderately severe or severe symptoms, and 51 (5%) who screened positive with no information on depression severity. Clinicians documented a DMHI referral offer at 17 encounters with mild to moderate symptoms (41%) and 7 encounters with moderately severe or severe symptoms (50%). Over half of youths with depressive symptoms who were offered the DMHI accepted it (52%), but only one-fifth obtained the download instructions. Clinicians appreciated having a DMHI available, but challenges included difficulty identifying adolescents with depressive symptoms and low adolescent interest. Clinicians recommend facilitating adolescent download of the DMHI at the visit and involving parents/guardians.

A clinician-focused implementation strategy demonstrated limited success in integrating DMHI into adolescent preventive health visits.

This study aimed to evaluate the effectiveness of microvascular decompression (MVD) in improving the quality of life (QoL) of patients with hemifacial spasm (HFS), focusing on both short- and long-term outcomes.

When will patients with HFS benefit from MVD regarding QoL?

A longitudinal, prospective cohort study was conducted, involving 135 patients who underwent MVD at a tertiary referral center between January 2019 and March 2023. Health-related quality of life (HR-QoL) was assessed using the SF-36 questionnaire administered at three intervals: before surgery, three months after surgery, and twelve months after surgery.

Most patients reported complete resolution (63.4%) or at least 90% reduction (13.9%) of spasms after twelve months. Significant improvements were observed in the SF-36 scores, particularly in the domains of Mental Health and Social Functioning, from baseline to twelve months after surgery. Additionally, improvements in Mental Component Summary scores were statistically significant, suggesting substantial importance of patient-reported mental and emotional well-being. Permanent postoperative complications (hearing reduction/loss, mild hoarseness) were seen in 2.9%.

The findings confirm that MVD provides significant and sustained improvements in HR-QoL in patients with HFS. The surgery not only alleviates physical symptoms but also contributes to substantial psychosocial recovery. These outcomes support MVD as a preferred treatment for HFS when a neurovascular conflict is suspected, advocating for its broader application in clinical practice. Continued follow-up and research are recommended to further document the procedure's long-term effectiveness and safety.

The kappa free light chain (κ-FLC) index is a sensitive marker of intrathecal immunoglobulin (Ig) synthesis and is increasingly used in cerebrospinal fluid (CSF) analysis of patients with suspected multiple sclerosis (MS). The relative contribution of the different Ig isotypes to intrathecal κ-FLC production remains unclear.

We retrospectively analysed CSF data from patients with a first demyelinating event suggestive of MS enrolled in studies at the Medical Universities of Innsbruck and Vienna. Of all included patients, results on Ig and κ-FLC concentrations in CSF and serum were available. Linear regression analysis was used to assess the impact of Ig intrathecal fractions (IF) on κ-FLC index.

A total of 188 patients with a median age of 31 (25-39) years and a predominantly female sex distribution (62%) were included. The κ-FLC index was significantly higher in patients with isolated intrathecal IgG synthesis [32.5 (17.7-81.0); n=130] compared to patients without intrathecal immunoglobulin production [3.0 (2.0-5.9); p<0.001; n=18] and was further elevated in patients with both intrathecal IgG and IgM synthesis [68.4 (48.4-120.6); n=29]. Both IgG and IgM IF independently contributed to the κ-FLC index in linear regression analysis, with IgG IF having approximately 3.5 times the effect size of IgM IF. Exploratory analysis of the contribution of IgA IF to κ-FLC index revealed qualitatively the same results.

Increase of κ-FLC index in patients with MS is predominantly due to an intrathecal IgG synthesis, while the contribution of intrathecal IgM is less frequent and quantitatively low.

Polycystic ovarian syndrome (PCOS) is a common endocrine disorder in women, associated with insulin resistance, ovulatory dysfunction, hyperandrogenism, and inflammation. Current treatments often focus on symptoms rather than underlying causes, emphasizing the need for comprehensive strategies. Recently, probiotics have emerged as a safe and cost-effective nutritional option for managing metabolic issues.

This study aims to evaluate the effects of Lactobacillus helveticus and Bifidobacterium longum supplementation on the cardiometabolic profile, hormonal status, oxidative stress, and quality of life in women with PCOS.

We will conduct a double-blind, placebo-controlled, randomized trial involving 90 women with PCOS from Shahid Beheshti hospital, Isfahan, Iran. Recruitment will begin on June 20, 2024, and is expected to be completed by June 20, 2025. Participants will be randomly assigned to receive either a daily probiotic capsule containing Lactobacillus helveticus and Bifidobacterium longum or a placebo. The study will assess the impact of these probiotic strains on cardiometabolic profile, hormonal status, oxidative stress, mental health, quality of life, sleep quality, and clinical symptoms in women with PCOS. All parameters will be evaluated before and after the intervention.

Elevated insulin levels and gut microbiota imbalances significantly contribute to the development of PCOS. Growing evidence suggests that gut dysbiosis is linked to sex hormone levels and estrous cycles. We hypothesize that probiotic supplementation in individuals with PCOS will improve hormonal, metabolic, inflammatory, and antioxidant markers compared to those receiving a placebo.