Survey on hospice care attitude of family members of advanced cancer patients at different ages

BACKGROUND Hospice care plays an important role in improving the quality of life of advanced cancer patients,but controversy remains over whether age affects the attitudes of family members toward hospice care.AIM To investigate the attitudes of family members of advanced cancer patients of different ages toward hospice care.METHODS The study participants were 175 family members of patients with advanced cancer from January 2020 and October 2022.The participants were divided into youth(<40 years,n=65),middle-aged(40–60 years,n=59),and elderly(>60 years,n=51)groups.Researchers investigated and compared the degree of awareness regarding hospice care,attitudes,and whether the family members of patients would choose hospice care.RESULTS Among the family members of 175 patients,approximately 28%(49/175)were aware of hospice care.Awareness of hospice care,the proportion of hospice care acceptance and adaptation attitudes,and the proportion of those who chose hospice care in the youth group were higher in the middle-aged and elderly groups(P<0.05).No statistically significant difference was found in these three indicators between the middle-aged and elderly groups(P>0.05).Hospice care was chosen mainly to relieve pain and reduce unnecessary treatment,whereas the reasons for not choosing hospice care were mainly distrust and ethical concerns.CONCLUSION The family members of patients with advanced cancer had relatively low awareness of hospice care,while youth had a higher awareness of hospice care,acceptance,and adaptation attitudes,and were more willing to choose hospice care.

Present situation and prospect of immunotherapy for unresectable locally advanced esophageal cancer during peri-radiotherapy

Four major studies(Checkmate577,Keynote-590,Checkmate649 and Attraction-4)of locally advanced esophageal cancer published in 2020 have established the importance of immunotherapy,represented by anti-programmed death protein(PD)-1 in postoperative adjuvant treatment and advanced first-line treatment of locally advanced or advanced esophageal cancer and esophagogastric junction cancer,from the aspects of proof of concept,long-term survival,overall survival rate and progression-free survival.For unresectable or inoperable nonmetastatic esophageal cancer,concurrent radiotherapy and chemotherapy is the standard treatment recommended by various guidelines.Because its curative effect is still not ideal,it is necessary to explore radical radiotherapy and chemotherapy in the future,and it is considered to be promising to combine them with immunotherapeutic drugs such as anti-PD-1.This paper mainly discusses how to combine radical concurrent radiotherapy and chemotherapy with immunotherapy for unresectable local advanced esophageal cancer.

Comprehensive analysis of advanced glycation end-products in commonly consumed foods:presenting a database for dietary AGEs and associated exposure assessment

Advanced glycation end-products(AGEs)are a group of heterogeneous compounds formed in heatprocessed foods and are proven to be detrimental to human health.Currently,there is no comprehensive database for AGEs in foods that covers the entire range of food categories,which limits the accurate risk assessment of dietary AGEs in human diseases.In this study,we first established an isotope dilution UHPLCQq Q-MS/MS-based method for simultaneous quantification of 10 major AGEs in foods.The contents of these AGEs were detected in 334 foods covering all main groups consumed in Western and Chinese populations.Nε-Carboxymethyllysine,methylglyoxal-derived hydroimidazolone isomers,and glyoxal-derived hydroimidazolone-1 are predominant AGEs found in most foodstuffs.Total amounts of AGEs were high in processed nuts,bakery products,and certain types of cereals and meats(>150 mg/kg),while low in dairy products,vegetables,fruits,and beverages(<40 mg/kg).Assessment of estimated daily intake implied that the contribution of food groups to daily AGE intake varied a lot under different eating patterns,and selection of high-AGE foods leads to up to a 2.7-fold higher intake of AGEs through daily meals.The presented AGE database allows accurate assessment of dietary exposure to these glycotoxins to explore their physiological impacts on human health.

ATFF: Advanced Transformer with Multiscale Contextual Fusion for Medical Image Segmentation

Deep convolutional neural network (CNN) greatly promotes the automatic segmentation of medical images. However, due to the inherent properties of convolution operations, CNN usually cannot establish long-distance interdependence, which limits the segmentation performance. Transformer has been successfully applied to various computer vision, using self-attention mechanism to simulate long-distance interaction, so as to capture global information. However, self-attention lacks spatial location and high-performance computing. In order to solve the above problems, we develop a new medical transformer, which has a multi-scale context fusion function and can be used for medical image segmentation. The proposed model combines convolution operation and attention mechanism to form a u-shaped framework, which can capture both local and global information. First, the traditional converter module is improved to an advanced converter module, which uses post-layer normalization to obtain mild activation values, and uses scaled cosine attention with a moving window to obtain accurate spatial information. Secondly, we also introduce a deep supervision strategy to guide the model to fuse multi-scale feature information. It further enables the proposed model to effectively propagate feature information across layers, Thanks to this, it can achieve better segmentation performance while being more robust and efficient. The proposed model is evaluated on multiple medical image segmentation datasets. Experimental results demonstrate that the proposed model achieves better performance on a challenging dataset (ETIS) compared to existing methods that rely only on convolutional neural networks, transformers, or a combination of both. The mDice and mIou indicators increased by 2.74% and 3.3% respectively.

Design and analysis of an advanced thermal management system for the solar close observations and proximity experiments spacecraft

In this paper,the mission and the thermal environment of the Solar Close Observations and Proximity Experiments(SCOPE)spacecraft are analyzed,and an advanced thermal management system(ATMS)is designed for it.The relationship and functions of the integrated database,the intelligent thermal control system and the efficient liquid cooling system in the ATMS are elaborated upon.For the complex thermal field regulation system and extreme space thermal environment,a modular simulation and thermal field planning method are proposed,and the feasibility of the planning algorithm is verified by numerical simulation.A solar array liquid cooling system is developed,and the system simulation results indicate that the temperatures of the solar arrays meet the requirements as the spacecraft flies by perihelion and aphelion.The advanced thermal management study supports the development of the SCOPE program and provides a reference for the thermal management in other deep-space exploration programs.

CML、sRAGE、esRAGE对冠心病动脉粥样硬化的诊断价值

目的探讨ε-羧甲基赖氨酸(CML)、可溶性晚期糖基化终产物受体(sRAGE)、内源性可溶性晚期糖基化终产物受体(esRAGE)对冠心病动脉粥样硬化的诊断价值。方法2020年6月至2022年12月,于新疆维吾尔自治区人民医院选取冠心病患者100例作为观察组。同时选取100例在我院体检的正常人作为对照组。比较两组ε-羧甲基赖氨酸(CML)、可溶性晚期糖基化终产物受体(sRAGE)和内源性分泌性晚期糖基化终产物受体(esRAGE)水平。应用受试者操作者特征(ROC)曲线评价CML、sRAGE、esRAGE的诊断水平,并联合检测冠心病动脉粥样硬化。结果与对照组相比,观察组血清CML及sRAGE水平明显升高,而esRAGE水平呈下降趋势。血清CML、sRAGE和esRAGE可准确诊断冠心病动脉粥样硬化,联合检测灵敏度(90.91%)、特异性(68.66%)、准确性(76.00%)、阳性预测值(58.82%)、阴性预测值(93.88%)、ROC曲线下面积(AUC)(0.922)较高。结论CML、sRAGE、esRAGE与冠心病动脉粥样硬化有关,有利于临床诊断和治疗。

Immune-related adverse events associated with immune checkpoint inhibitors for advanced gastric and gastroesophageal junction cancer:A meta-analysis

BACKGROUND Immune checkpoint inhibitors(ICIs)have shown promising efficacy in treatment and clinical management of advanced gastric and gastroesophageal junction cancer.However,the inhibitors also cause immune-related adverse events(irAEs).The current systematic review and meta-analysis study aimed to investigate the incidence and nature of irAEs caused by ICIs.AIM To investigate the incidence and nature of irAEs in advanced gastric and gastroesophageal junction cancer.METHODS This systematic review was registered with PROSPERO(Reg.number:CRD42020152291).Data included in this study were collected from patients diagnosed with advanced gastric cancer or gastroesophageal junction cancer and treated with ICIs.A systematic literature search was conducted using the PubMed,EMBASE,and Cochrane Library databases.Meta-analysis was carried out using the single sample rate method.Synthesis and analysis of the data was conducted using Stata/SE and Review Manager Software.RESULTS The patients enrolled in the present study included 14 patients from 14 case reports,326 patients from 6 case series,and 1249 patients from 8 clinical trials.It was found that the overall incidence of irAEs was 16%[95%confidence interval(CI):11-20]for all grades and 3%(95%CI:2-4)for the severe grade.It was evident that the incidence of irAEs varied with the type of inhibitor and organs.A comparative study of the anti-programmed cell death receptor-1(PD-1)and antiprogrammed death receptor-ligand 1(PD-L1)treatments showed that the antiPD-1 group had a higher overall incidence of irAEs(20%)as compared with that of the anti-PD-L1 group(13%).Results of this study showed that the endocrine system experienced the highest incidence of organ-specific irAEs(7.4%),including hypothyroidism,hyperthyroidism,thyroiditis,diabetes,and adrenal insufficiency,followed by gastroenterology(2.2%),pulmonology(1.8%),neurology(1.4%),dermatology(1.4%),hematology(0.8%),and hepatology(0.7%).In clinical trials,it was found that the incidence of death related to irAEs was 1%(95%CI:0-2.0),whereby colitis and interstitial lung diseases were the leading causes of death.CONCLUSION It was evident that the incidence and nature of irAEs are both organ-and inhibitor-specific.The anti-PD-1 group had the highest incidence of all irAEs grades including the severe grades of irAEs.Early identification and management of irAEs allows clinical oncologists to effectively consider the pros and cons and hence enables them to strike a balance.

Obstetric Outcomes in Advanced Maternal Age among Women at King Abdulaziz University Hospital

Background: Advanced maternal age, over 35 years, is a well-known risk factor for poor pregnancy outcomes. It is commonly associated with various pregnancy complications, such as spontaneous miscarriage, preeclampsia/ toxemia, gestational diabetes mellitus, preterm labor, stillbirth, chromosomal abnormalities, and cesarean delivery. Objectives: This study assessed obstetric and neonatal complications associated with advanced maternal age. Methods: We reviewed the medical records of 199 pregnant women over 35 years old at King Abdulaziz University Hospital in Jeddah, Saudi Arabia, from January to June 2022. We gathered data on age, nationality, number of antenatal visits, results of ultrasound scans for dating and viability, nuchal translucency and anatomy surveys, medications and multivitamins taken during pregnancy, smoking status, pregnancy, and fetal complications, and mode of delivery. Results: The prevalence of obstetric complications was 71.4% (preeclampsia/toxemia, 4.5%;antepartum hemorrhage, 4%;postpartum hemorrhage, 1%;and gestational diabetes, 23.1%). The most frequent complication was preterm labor between 34 and 36 weeks (48%), and only 12.6% of all deliveries were associated with fetal and neonatal complications such as congenital anomalies and neonatal jaundice. The prevalence of anemia during pregnancy was 10.1%, 21.1%, and 28.6% in the first, second, and third trimesters, respectively, and pregnancies complicated with antepartum or postpartum hemorrhage were associated with higher rates of anemia in the second trimester. A significant relationship was found between mean maternal age (38.84 ± 2.75 years) and the development of maternal complications (p < 0.05). Newborns with neonatal complications were much more likely to be born to mothers with a history of antepartum hemorrhage and anemia in the second trimester. Conclusion: Our findings confirm that pregnancy at an advanced maternal age is associated with increased overall maternal complications. The most frequent complication was preterm labor (48%). Other complications, such as preeclampsia/toxemia, antepartum hemorrhage, postpartum hemorrhage, gestational diabetes, and anemia, were less frequent in the sample we reviewed.

基于PLCSIM Advanced和Simulink的自动化生产线仿真实训平台设计

为解决自动化生产线实训线下课程实验硬件套数不足、实验时长和场地受限等问题,提升教学质量,设计了一种基于PLCSIM Advanced和Simulink的自动化生产线仿真实训平台。该仿真平台以实训设备为依托,使用Simulink搭建被控对象仿真模型,在PLCSIM Advanced仿真控制器中编写控制算法,通过应用程序接口(application programming interface,API)通信实现对象模型与控制器间数据的实时交换和仿真。以纸张张力控制设备为例,介绍了仿真实训平台搭建和实施过程。实践教学表明,该仿真平台提高了自动化生产线实训课程的教学成效,激发了学生实践学习的兴趣,提升了学生发现、解决复杂工程问题的能力,让学生深刻体会到团队合作和有效沟通的重要性。

Relevance of Advanced Plant Disease Detection Techniques in Disease and Pest Management for Ensuring Food Security and Their Implication: A Review

Plant diseases and pests present significant challenges to global food security, leading to substantial losses in agricultural productivity and threatening environmental sustainability. As the world’s population grows, ensuring food availability becomes increasingly urgent. This review explores the significance of advanced plant disease detection techniques in disease and pest management for enhancing food security. Traditional plant disease detection methods often rely on visual inspection and are time-consuming and subjective. This leads to delayed interventions and ineffective control measures. However, recent advancements in remote sensing, imaging technologies, and molecular diagnostics offer powerful tools for early and precise disease detection. Big data analytics and machine learning play pivotal roles in analyzing vast and complex datasets, thus accurately identifying plant diseases and predicting disease occurrence and severity. We explore how prompt interventions employing advanced techniques enable more efficient disease control and concurrently minimize the environmental impact of conventional disease and pest management practices. Furthermore, we analyze and make future recommendations to improve the precision and sensitivity of current advanced detection techniques. We propose incorporating eco-evolutionary theories into research to enhance the understanding of pathogen spread in future climates and mitigate the risk of disease outbreaks. We highlight the need for a science-policy interface that works closely with scientists, policymakers, and relevant intergovernmental organizations to ensure coordination and collaboration among them, ultimately developing effective disease monitoring and management strategies needed for securing sustainable food production and environmental well-being.

Securing Transmitted Color Images Using Zero Watermarking and Advanced Encryption Standard on Raspberry Pi

Image authentication techniques have recently received a lot of attention for protecting images against unauthorized access.Due to the wide use of the Internet nowadays,the need to ensure data integrity and authentication increases.Many techniques,such as watermarking and encryption,are used for securing images transmitted via the Internet.The majority of watermarking systems are PC-based,but they are not very portable.Hardwarebased watermarking methods need to be developed to accommodate real-time applications and provide portability.This paper presents hybrid data security techniques using a zero watermarking method to provide copyright protection for the transmitted color images using multi-channel orthogonal Legendre Fourier moments of fractional orders(MFrLFMs)and the advanced encryption standard(AES)algorithm on a low-cost Raspberry Pi.In order to increase embedding robustness,the watermark picture is scrambled using the Arnold method.Zero watermarking is implemented on the Raspberry Pi to produce a real-time ownership verification key.Before sending the ownership verification key and the original image to the monitoring station,we can encrypt the transmitted data with AES for additional security and hide any viewable information.The receiver next verifies the received image’s integrity to confirm its authenticity and that it has not been tampered with.We assessed the suggested algorithm’s resistance to many attacks.The suggested algorithm provides a reasonable degree of robustness while still being perceptible.The proposed method provides improved bit error rate(BER)and normalized correlation(NC)values compared to previous zero watermarking approaches.AES performance analysis is performed to demonstrate its effectiveness.Using a 256×256 image size,it takes only 2 s to apply the zero-watermark algorithm on the Raspberry Pi.

Efficacy and outcome of extensive intraoperative peritoneal lavage plus surgery vs surgery alone with advanced gastric cancer patients

BACKGROUND Gastric cancer(GC)is one of the most common malignant tumors.After resection,one of the major problems is its peritoneal dissemination and recurrence.Some free cancer cells may still exist after resection.In addition,the surgery itself may lead to the dissemination of tumor cells.Therefore,it is necessary to remove residual tumor cells.Recently,some researchers found that extensive intraoperative peritoneal lavage(EIPL)plus intraperitoneal chemotherapy can improve the prognosis of patients and eradicate peritoneal free cancer for GC patients.However,few studies explored the safety and long-term outcome of EIPL after curative gastrectomy.AIM To evaluate the efficacy and long-term outcome of advanced GC patients treated with EIPL.METHODS According to the inclusion and exclusion criteria,a total of 150 patients with advanced GC were enrolled in this study.The patients were randomly allocated to two groups.All patients received laparotomy.For the non-EIPL group,peritoneal lavage was washed using no more than 3 L of warm saline.In the EIPL group,patients received 10 L or more of saline(1 L at a time)before the closure of the abdomen.The surviving rate analysis was compared by the Kaplan-Meier method.The prognostic factors were carried out using the Cox appropriate hazard pattern.RESULTS The basic information in the EIPL group and the non-EIPL group had no significant difference.The median follow-up time was 30 mo(range:0-45 mo).The 1-and 3-year overall survival(OS)rates were 71.0%and 26.5%,respectively.The symptoms of ileus and abdominal abscess appeared more frequently in the non-EIPL group(P<0.05).For the OS of patients,the EIPL,Borrmann classification,tumor size,N stage,T stage and vascular invasion were significant indicators.Then multivariate analysis revealed that EIPL,tumor size,vascular invasion,N stage and T stage were independent prognostic factors.The prognosis of the EIPL group was better than the non-EIPL group(P<0.001).The 3-year survival rate of the EIPL group(38.4%)was higher than the non-EIPL group(21.7%).For the recurrence-free survival(RFS)of patients,the risk factor of RFS included EIPL,N stage,vascular invasion,type of surgery,tumor location,Borrmann classification,and tumor size.EIPL and tumor size were independent risk factors.The RFS curve of the EIPL group was better than the non-EIPL group(P=0.004),and the recurrence rate of the EIPL group(24.7%)was lower than the non-EIPL group(46.4%).The overall recurrence rate and peritoneum recurrence rate in the EIPL group was lower than the non-EIPL group(P<0.05).CONCLUSION EIPL can reduce the possibility of perioperative complications including ileus and abdominal abscess.In addition,the overall survival curve and RFS curve were better in the EIPL group.

Recent Progress in Reinforcement Learning and Adaptive Dynamic Programming for Advanced Control Applications

Reinforcement learning(RL) has roots in dynamic programming and it is called adaptive/approximate dynamic programming(ADP) within the control community. This paper reviews recent developments in ADP along with RL and its applications to various advanced control fields. First, the background of the development of ADP is described, emphasizing the significance of regulation and tracking control problems. Some effective offline and online algorithms for ADP/adaptive critic control are displayed, where the main results towards discrete-time systems and continuous-time systems are surveyed, respectively.Then, the research progress on adaptive critic control based on the event-triggered framework and under uncertain environment is discussed, respectively, where event-based design, robust stabilization, and game design are reviewed. Moreover, the extensions of ADP for addressing control problems under complex environment attract enormous attention. The ADP architecture is revisited under the perspective of data-driven and RL frameworks,showing how they promote ADP formulation significantly.Finally, several typical control applications with respect to RL and ADP are summarized, particularly in the fields of wastewater treatment processes and power systems, followed by some general prospects for future research. Overall, the comprehensive survey on ADP and RL for advanced control applications has d emonstrated its remarkable potential within the artificial intelligence era. In addition, it also plays a vital role in promoting environmental protection and industrial intelligence.

血清AGEs水平联合LIS对老年脓毒症相关性ALI/ARDS患者预后的评估价值

目的探究老年脓毒症相关性急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)患者肺损伤评分(LIS)及晚期糖基化终末产物(AGEs)水平对预后的评估价值。方法选择重庆医科大学附属第一医院第一分院于2019年3月至2021年4月收治的98例老年脓毒症相关性ALI/ARDS患者作为研究组,根据患者入院后30 d内的生存情况将患者分为存活组(55例)和死亡组(43例),另选取51例重庆医科大学附属第一医院第一分院同期收治的非ALI/ARDS脓毒症老年患者作为对照组。患者入院后,记录患者临床资料,检测患者血肌酐、肌钙蛋白Ⅰ、B型脑肽钠(BNP)、C反应蛋白(CRP)、降钙素原(PCT)水平。采用酶联免疫吸附试验测定患者血清中AGEs水平。采用LIS量表计算LIS得分。以患者临床因素作为自变量,患者预后结局作为因变量,采用Logistic回归曲线对老年脓毒症相关性ALI/ARDS患者死亡因素进行多因素分析。结果死亡组、存活组、对照组AGEs水平、LIS得分、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分依次降低(均P<0.05)。死亡组动脉血乳酸、血糖、肌钙蛋白Ⅰ、PCT、BNP、CRP水平均高于存活组和对照组(P<0.05)。结果显示,动脉血乳酸、血糖、肌钙蛋白Ⅰ、PCT、BNP、CRP、AGEs、APACHEⅡ评分、LIS得分均是老年脓毒症相关性ALI/ARDS患者死亡的独立危险因素(P<0.05)。LIS得分预测老年脓毒症相关性ALI/ARDS患者预后的曲线下面积(AUC)为0.857(95%CI:0.821~0.911),血清AGEs的AUC为0.861(95%CI:0.809~0.908),LIS得分和AGEs水平对老年脓毒症相关性ALI/ARDS患者预后均具有一定的预测价值。结论老年脓毒症相关性ALI/ARDS患者LIS得分及AGEs水平均是患者死亡的独立危险因素,对预后有重要的预测价值。

Nε-(carboxymethyl)lysine promotes lipid uptake of macrophage via cluster of differentiation 36 and receptor for advanced glycation end products

BACKGROUND Advanced glycation end products(AGEs)are diabetic metabolic toxic products that cannot be ignored.Nε-(carboxymethyl)lysine(CML),a component of AGEs,could increase macrophage lipid uptake,promote foam cell formation,and thereby accelerate atherosclerosis.The receptor for AGEs(RAGE)and cluster of differentiation 36(CD36)were the receptors of CML.However,it is still unknown whether RAGE and CD36 play key roles in CML-promoted lipid uptake.AIM Our study aimed to explore the role of RAGE and CD36 in CML-induced macrophage lipid uptake.METHODS In this study,we examined the effect of CML on lipid uptake by Raw264.7 macrophages.After adding 10 mmol/L CML,the lipid accumulation in macrophages was confirmed by oil red O staining.Expression changes of CD36 and RAGE were detected with immunoblotting and quantitative real-time polymerase chain reaction.The interaction between CML with CD36 and RAGE was verified by immunoprecipitation.We synthesized a novel N-succinimidyl-4-18Ffluorobenzoate-CML radioactive probe.Radioactive receptor-ligand binding assays were performed to test the binding affinity between CML with CD36 and RAGE.The effects of blocking CD36 or RAGE on CML-promoting lipid uptake were also detected.RESULTS The study revealed that CML significantly promoted lipid uptake by macrophages.Immunoprecipitation and radioactive receptor-ligand binding assays indicated that CML could specifically bind to both CD36 and RAGE.CML had a higher affinity for CD36 than RAGE.ARG82,ASN71,and THR70 were the potential interacting amino acids that CD36 binds to CML Anti-CD36 and anti-RAGE could block the uptake of CML by macrophages.The lipid uptake promotion effect of CML was significantly attenuated after blocking CD36 or RAGE.CONCLUSION Our results suggest that the binding of CML with CD36 and RAGE promotes macrophage lipid uptake.

High glucose reduces Nrf2-dependent cRAGE release and enhances inflammasome-dependent IL-1βproduction in monocytes:the modulatory effects of EGCG

Soluble receptor for advanced glycation end products(sRAGE)acts as a decoy sequestering of RAGE ligands,thus preventing the activation of the ligand-RAGE axis linking human diseases.However,the molecular mechanisms underlying sRAGE remain unclear.In this study,THP-1 monocytes were cultured in normal glucose(NG,5.5 mmol/L)and high glucose(HG,15 mmol/L)to investigate the effects of diabetesrelevant glucose concentrations on sRAGE and interleukin-1β(IL-1β)secretion.The modulatory effects of epigallocatechin gallate(EGCG)in response to HG challenge were also evaluated.HG enhanced intracellular reactive oxygen species(ROS)generation and RAGE expression.The secretion of sRAGE,including esRAGE and cRAGE,was reduced under HG conditions,together with the downregulation of a disintegrin and metallopeptidase 10(ADAM10)and nuclear factor erythroid 2-related factor 2(Nrf2)nuclear translocation.Mechanistically,the HG effects were counteracted by siRAGE and exacerbated by siNrf2.Chromatin immunoprecipitation results showed that Nrf2 binding to the ADAM10 promoter and HG interfered with this binding.Our data reinforce the notion that RAGE and Nrf2 might be sRAGE-regulating factors.Under HG conditions,the treatment of EGCG reduced ROS generation and RAGE activation.EGCG-stimulated cRAGE release was likely caused by the upregulation of the Nrf2-ADAM10 pathway.EGCG inhibited HG-mediated NLRP3 inflammasome activation at least partly by stimulating sRAGE,thereby reducing IL-1βrelease.

Message from Editors

AS with the continuous advancement of the low-carbon energy development, the wind power generation experiences fast growth with 441.3 GW installed capacity by Dec. 2023. The high penetration of renewable energy,together with high penetration of power electronic equipment (namely,“double high”),has been altering the steady-state and transient characteristics of wind power generation in a profound way,resulting in the different risk of instability.These stability issues will seriously affect the consumption of renewable energy and threaten the safe supply of electricity.Along with rapid deployment of wind power generation,together with the solar photovoltaic generation,it is expected to be over 1200 GW by 2030.

Can serum immunoglobulin G4 levels and age serve as reliable predictors of relapse in autoimmune pancreatitis?

We are writing in response to the paper published in the World Journal of Gastroenterology by Zhou et al.The authors identified higher serum immunoglobulin(Ig)G4 levels and age over 55 years as independent risk factors for disease relapse.Despite notable strengths,it is crucial to address potential biases.Firstly,the cohort study included 189 patients with autoimmune pancreatitis(AIP)type 1(with higher IgG4 seropositivity and higher relapse)and 24 with type 2(with lower IgG4 seropositivity and lower relapse).Consequently,most,if not all,AIP type 2 patients were assigned to the normal group,possibly inflating the association of higher serum IgG4 levels with relapse and potentially exaggerating the association of older age with relapse.Secondly,the authors did not provide sufficient details regarding AIP diagnosis,such as the ratio of definitive vs probable cases and the proportion of biopsies.In cases where histological evidence is unavailable or indeterminate,AIP type 2 may be misdiagnosed as definitive type 1,and type 1 may also be misdiagnosed as probable type 2,particularly in cases with normal or mildly elevated serum IgG4 levels.Lastly,in this retrospective study,approximately one-third of the consecutive patients initially collected were excluded for various reasons.Accordingly,the impact of nonrandom exclusion on relapse outcomes should be carefully considered.In conclusion,the paper by Zhou et al offers plausible,though not entirely compelling,evidence suggesting a predictive role of elevated serum IgG4 levels and advanced age in AIP relapse.The foundation for future investigations lies in ensuring a reliable diagnosis and accurate disease subtyping,heavily dependent on obtaining histological specimens.In this regard,endoscopic ultrasound-guided fine-needle biopsy emerges as a pivotal component of the diagnostic process,contributing to mitigating biases in future explorations of the disease.

Age Identity and Elderly Job Participation in China

In the context of rising life expectancy,there is a significant discrepancy between Chinese seniors’self-perceptions of the start of old age and the expectations of society around this age.The traditional paradigm,which forecasts individual economic behavior and formulates economic policies based on societal standards of age,is put to the test by this disparity.This study,which draws from the China Longitudinal Aging Society Survey(CLASS),examines the factors,processes,and improvement strategies that affect how older people choose to work.The following are our conclusions:(i)Chinese elderly believe their old age starts from 70 years on average;delaying perceived old age is a denial of aging and raises the likelihood of finding work.Elders who are youthful at heart have a 2.4%higher chance of remaining employed than elders who are old at heart.(ii)In contrast to old-at-heart elders,young-at-heart elders are more likely to maintain their middle-age lifestyles,continue working,become motivated to engage in social activities,and gain the confidence to face challenges and continue in their career.(iii)If the perceived old age is above 70 years,the milestone event of aging is retirement from work,and there are external pressures,particularly pressures from family intergenerational support,the perception of old age will have a more proactive impact on older workers.(iv)Despite rising pension benefits,older people’s decision to remain in the workforce is still heavily influenced by their perception of their age.However,this effect is notably gender-specific,as older women’s decision to remain in the workforce is not greatly influenced by their own perception of their age.

Clinical evidence of neoadjuvant immunotherapy for resectable locally advanced esophageal carcinoma:A systematic review

Background:Immune checkpoint inhibitors(ICIs)as the neoadjuvant therapy for resectable locally advanced esophageal carcinoma(rlaEC)remains challenging given the poor reports of efficacy and safety.This study aimed to summarize reliable evidence for the preoperative neoadjuvant immunotherapy of rlaEc by analyzing all the published clinical trials on the ICIs as the neoadjuvant therapy for rlaEC.Methods:PubMed,Cochrane Library,Embase and ClinicalTrials.gov were searched from inception until June 1st,2023,for available reports to perform a meta-analysis.The primary endpoints were RO resection,objective response rate(ORR),pathological complete response(pCR)and major pathological response(MPR),as well as treatment-related adverse events(AEs)and postoperative complications.The Stata 14.0 software was employed to estimate pooled effect size.Results:A total of 18 single-arm clinical trials involving 625 patients met the inclusion criteria.Meta-analysis showed that,among these patients with rlaEC,the pooled R0 resection rate was 97.0%(95%CI:94.0%-99.0%),the p0oled ORR was 70.0%(95%CI:64.0%-76.0%),the p0oled pCR and MPR rate were 34.0%(95%CI:29.0%-39.0%)and 56.0%(95%CI:47.0%-65.0%)respectively.The incidence of main treatment-related AEs and postoperative complications was about 6%-45% and 8%-19% respectively.Conclusions:Patients with rlaEC were tolerated to neoadjuvant immunotherapy and it might be beneficial to improve efficacy.But this meta-analysis had limitations and the conclusions still needed to be validated by more rigorous phase II randomized controlled clinical trials.