Clinical efficacy and significance of serum fibroblast growth factor-21 and ghrelin in the treatment of type 2 diabetes complicated with coronary heart disease with integrated traditional Chinese and western medicine

Objective: To treat the patients with type 2 diabetes mellitus complicated with coronary heart disease, to explore the clinical efficacy and mechanism of conventional western medicine combined with Yiqi Yangyin Huoxue herbs, and to detect the level of serum fibroblast growth factor-21 (FGF-21) and Ghrelin. Changes and significance. Methods: A randomized control method was used to collect 100 patients with type 2 diabetes mellitus complicated with coronary heart disease who were diagnosed and treated in our hospital from March 2015 to March 2018.They were randomly divided into two groups according to the random number table method: 50 patients separately. The patients in the control group were treated with conventional western medicine and basic treatment;the observation group was treated with the addition and subtraction of traditional Chinese medicine formulas on the basis of the control group;the clinical curative effect was evaluated after two months of treatment, and the treatment efficiency and scores of traditional Chinese medicine symptoms were observed in the two groups. Basic laboratory indicators were improved, and serum levels of FGF-21 and Ghrelin in patients were measured and the difference between the results of the tests was compared with the condition and efficacy. Results: After treatment, the total effective rate of the observation group (86.0%) was significantly higher than that of the control group (68.0%) (P<0.05), suggesting that the combination of Chinese and Western medicine treatment can significantly improve the clinical efficacy;before treatment,there is no difference between the two groups of Chinese medicine symptom scores (P>0.05). After treatment, the symptom scores of the two groups were significantly improved after treatment (P<0.05). The observation group was better among the two groups (P<0.05).After treatment, the basic biochemical indicators were improved. The observation group was better than the control group (P<0.05);Serum FGF-21 levels were significantly lower in both groups after treatment (P<0.05), and Ghrelin levels were significantly increased. There was a statistically significant difference between the two groups (P<0.05). Conclusion: The use of conventional western medicine in combination with Yiqi Yangyin Huoxue Chinese medicine for the treatment of type 2 diabetes mellitus patients with coronary heart disease can significantly improve the clinical efficacy, effectively promote the improvement of symptoms, and can be used in clinical work through serum FGF-21, Ghrelin levels combined detection of the value of Abnormal changes to predict the severity of type 2 diabetes mellitus with coronary heart disease severity and treatment effect should be widely used in clinical diagnosis and treatment.

21基因复发风险评分在激素受体阳性乳腺癌患者中的应用

近10年来,随着精准医疗的发展,乳腺癌的治疗进入了一个新时代,即在不影响生存结果的前提下,趋向于治疗降级、方案个体化,在给患者带来最大获益的同时尽可能减少医源性毒性暴露。21基因复发风险评分(21-gene recurrence score, RS)能够评估乳腺癌患者复发风险和化疗获益,已被美国临床肿瘤学会、美国国家综合癌症网络及中国抗癌协会推荐用于指导激素受体阳性、人类表皮生长因子受体2阴性的早期乳腺癌患者辅助治疗,但其临床应用尚存有争议。目前的研究主要聚焦于RS的临床优化,以更加准确地识别可从辅助治疗中受益的患者,使乳腺癌患者的治疗方案更加个体化。本文主要就RS在激素受体阳性乳腺癌患者辅助治疗中的应用、RS对临床决策的影响、RS面临的争议与应用前景等方面进行综述,以期指导临床进一步扩展RS的应用范围,使乳腺癌患者的辅助治疗更加精准。

加强体力活动指导对提高民众体质健康之作用研究——基于对“健康日本21”实施效果的考察

2000年,日本政府启动第三次国民健康促进计划——健康日本21,将健康促进的工作重点转向慢性病的早期预防,提高国民的体质健康水平。2010年,日本政府对"健康日本21"第一期(2000—2010)进行了评价,发现其提高国民体质健康水平的成效有限,认为体力活动指导力度不够是造成上述现象的重要原因。因此,日本政府在"健康日本21"第二期(2013—2022)实施过程中,不仅制定并实施了"增进健康的运动基准"及"增进健康的运动指南",从加强日常生活中的体力活动着手提高民众科学锻炼的自我指导与督促能力,而且通过提倡"体医结合"的科学健身模式,加大既有医学知识又能指导运动健身的"健康运动指导员"培养力度,呼吁地方政府、社会团体积极参与等措施提升科学健身的外部指导力,以达到预防慢性病、助力体质健康增进的目的。在解读日本政府"健康日本21"第一期(2000—2010)工作评价及"健康日本21"第二期(2013—2022)工作规划的基础上,从建立"体医结合"的联动管理机制、加强体力活动指导等方面为我国运动防控慢性病的工作提出建议。

21世纪医学面临的难题与挑战

人类已跨入以生命科学为重要标志的21世纪,在对医学科学的突破性进展作前瞻性思考的同时,必须正视医学发展中面临的难题和挑战,才能全面正确地认识21世纪医学发展的趋势。

中西医结合治疗2型糖尿病合并冠心病的临床疗效及对血清成纤维细胞生长因子-21、Ghrelin的影响与意义

目的:通过治疗2型糖尿病合并冠心病患者,探究常规西药联合益气养阴活血中药治疗的临床疗效与机制,并检测观察血清中成纤维细胞生长因子-21(FGF-21)、Ghrelin水平的变化及意义。方法:选取于我院内分泌科诊治的2型糖尿病合并冠心病患者100例,采用随机数表法将其随机分成对照、观察两组,各50例患者。对照组患者采用常规西药联合基础治疗;观察组在对照组治疗基础上联合应用中药方剂加减进行治疗,治疗两个月后进行临床疗效评估,观察两组治疗有效率、中医症状评分、基础实验室指标改善情况,并检测患者外周血清中FGF-21、Ghrelin的水平并比较检测结果的差异情况与病情及疗效的关系。结果:治疗后观察组的总有效率(86.0%)显著高于对照组(68.0%)(P<0.05),提示中西医结合治疗可显著提高临床疗效;治疗前两组中医症状评分比较无差异(P>0.05),治疗后两组中医症状评分有明显改善(P<0.05),组间比较观察组更优(P<0.05);治疗后比较基础生化指标改善情况,观察组优于对照组(P<0.05);两组治疗后血清FGF-21均明显降低(P<0.05),Ghrelin水平均显著升高,组内及组间比较差异均具有统计学意义(P<0.05)。结论:运用常规西药联合益气养阴活血中药治疗2型糖尿病合并冠心病患者可明显提高临床疗效,有效促进症状的改善,并且临床工作中可以通过血清中FGF-21、Ghrelin水平联合检测值的异常变化来预测2型糖尿病合并冠心病的病情严重程度与治疗效果,应在临床诊疗中广泛应用。

胰炎消方对重症急性胰腺炎患者miR21-3p、IL-18及肾功能相关指标的影响

目的观察中药胰炎消方治疗重症急性胰腺炎(SAP)的效果及对微小核糖核酸-21-3p(miR-21-3p)、白细胞介素-18(IL-18)及肾功能相关指标的影响。方法将SAP患者90例按照随机数字表法分为治疗组与对照组各45例。对照组予以胃肠减压、营养支持,维持水/电解质酸碱平衡、静脉补液、抑制胰酶分泌等西医常规治疗,治疗组在此基础上予以中药胰炎消方口服或胃管注入,两组疗程均为7 d。比较两组腹痛、腹胀、发热等主要症状的缓解时间和肠鸣音恢复时间;比较两组治疗前后全身炎症反应综合征(SIRS)评分、改良Marshall评分、血淀粉酶、尿淀粉酶含量及血清肌酐(SCr)、尿素氮(BUN)、胱抑素C(CysC)、miR-21-3p、IL-18含量、24 h尿量。结果治疗组腹痛、腹胀、发热缓解时间及肠鸣音恢复时间均短于对照组(P<0.01);治疗后两组SIRS评分、改良Marshall评分均较治疗前显著降低(P<0.01);两组比较,治疗组SIRS评分、改良Marshall评分均低于对照组(P<0.01)。治疗后两组SCr、BUN、CysC、血淀粉酶、尿淀粉酶均显著降低(P<0.01),24 h尿量增加(P<0.01),两组比较,治疗组各项指标改善均优于对照组(P<0.01);与治疗前比较,治疗后两组血清miR-21-3p、IL-18含量均降低(P<0.01),两组比较,治疗组改善程度优于对照组(P<0.01)。结论中药胰炎消方有利于快速缓解症状,改善全身炎症反应,下调血清miR21-3p、IL-18水平,保护肾脏功能,治疗SAP效果显著。

隔药饼灸对2型糖尿病合并高脂血症患者血清中FGF-21和血脂的影响

目的观察隔药饼灸对2型糖尿病合并高脂血症患者血清中成纤维细胞生长因子(FGF)-21和血脂的影响,探讨隔药饼灸调控血脂的作用机制。方法收集2型糖尿病合并高脂血症患者83例,按随机数字表分为常规组和观察组。常规组在给予降糖药物或胰岛素治疗的基础上加阿托伐他汀治疗,观察组在常规组的基础上加隔药饼灸。检测治疗前和治疗4周后患者血清中血脂水平,采用酶联免疫吸附法检测患者血清中FGF-21浓度。结果治疗前两组FGF-21、TC、TG、LDL-C和HDL-C比较差异均无统计学意义(P>0.05)。治疗后常规组FGF-21和血脂水平与治疗前比较差异均无统计学意义(P>0.05),观察组LDL-C较治疗前降低(P<0.05),FGF-21较治疗前升高(P<0.05)。治疗后两组比较,观察组LDL-C低于常规组(P<0.05),FGF-21高于常规组(P<0.05)。两组FGF-21、TC、TG、LDL-C和HDL-C治疗前后差值比较,差异均有统计学意义(P<0.05)。多元线性逐步回归分析显示LDL-C是FGF-21的独立相关因素。结论隔药饼灸可能通过升高2型糖尿病并高脂血症患者血清中FGF-21浓度,进一步降低LDL-C浓度,改善患者血脂谱,提高临床疗效。

加味桂枝附子汤联合艾灸治疗类风湿关节炎疗效研究

目的:探讨加味桂枝附子汤联合艾灸治疗类风湿关节炎(RA)疗效及对血清白细胞介素-21(IL-21)、Wnt信号通路关键抑制因子Dickkopf-1(DKK-1)的影响。方法:选取80例RA患者随机分为对照组、联合组,各40例。对照组给予加味桂枝附子汤,联合组给予加味桂枝附子汤联合艾灸治疗。比较两组中医证候积分、临床疗效、晨僵时间、压痛关节数(TJC)、肿胀关节数(SJC)、关节功能评分、视觉模拟评分(VAS)、风湿性关节炎活动度评分(DAS28)、血清IL-21、血清DKK-1、不良反应。结果:与治疗前比较,两组治疗后晨僵、关节疼痛、关节肿胀评分、晨僵时间、TJC、SJC、WOMAC评分、VAS评分、DAS28评分、血清IL-21、DKK-1水平均下降,且治疗后联合组上述指标均低于对照组,差异有统计学意义(均P<0.05)。联合组总有效率92.50%高于对照组72.50%,差异有统计学意义(P<0.05)。两组患者便秘、失眠、皮肤瘙痒等不良反应发生率比较,差异无统计学意义(均P>0.05)。结论:加味桂枝附子汤联合艾灸治疗RA可有效改善患者临床症状,提高关节功能,减轻疼痛,降低血清IL-21、DKK-1水平,安全性较高。

还原型谷胱甘肽联合护肝清脂片治疗非酒精性脂肪性肝病患者疗效研究

目的探讨应用还原型谷胱甘肽联合护肝清脂片治疗非酒精性脂肪性肝病(NAFLD)患者的疗效。方法2020年2月~2022年2月我院诊治的61例NAFLD患者,被随机分为对照组30例和观察组31例,分别给予还原型谷胱甘肽治疗或在此基础上联合护肝清脂片治疗6个月。依据文献评估中医症状评分,采用ELISA法检测肿瘤坏死因子(TNF-α)、白介素-6(IL-6)、IL-8、超敏C反应蛋白(hs-CRP)、丝氨酸蛋白酶抑制剂(vaspin)、可溶性白细胞分化抗原163(sCD163)、成纤维细胞生长因子-21(FGF21)、纤溶酶原激活物抑制剂-1(PAI-1)和脂联素(APN)水平。结果在治疗6个月末,观察组神疲乏力、腹胀满、肝区不适、粪便不畅、尿黄、形体偏胖、面色萎黄和口苦口淡评分分别为(0.6±0.1)、(0.9±0.1)、(0.8±0.1)、(0.6±0.1)、(0.8±0.1)、(0.8±0.1)、(0.7±0.1)和(1.2±0.2),均显著低于对照组【分别为(1.2±0.1)、(1.4±0.2)、(1.6±0.2)、(1.1±0.1)、(1.4±0.2)、(1.6±0.2)、(1.1±0.2)和(1.9±0.3),P<0.05】;观察组血清TNF-α、IL-6、IL-8和hs-CRP水平分别为(20.3±4.1)ng/L、(22.9±3.4)mg/L、(132.9±16.6)ng/L和(12.5±2.1)mg/L,均显著低于对照组【分别为(27.9±3.6)ng/L、(27.5±3.1)mg/L、(167.5±18.2)ng/L和(16.5±2.7)mg/L,P<0.05】;观察组血清TC、TG和LDL-C水平分别为(4.2±0.4)mmol/L、(1.5±0.2)mmol/L和(2.3±0.4)mmol/L,均显著低于对照组【分别为(6.3±0.5)mmol/L、(2.9±0.3)mmol/L和(3.1±0.4)mmol/L,P<0.05】;观察组血清vaspin、PAI-1、FGF21水平分别为(1.1±0.2)μg/L、(8.2±1.6)ng/mL和(143.5±16.8)pg/mL,均显著低于对照组【分别为(1.5±0.2)μg/L、(10.4±2.3)ng/mL和(181.6±19.7)pg/mL,P<0.05】,而血清APN和sCD163水平分别为(15.7±2.4)μg/mL和(76.8±9.1)ng/mL,显著高于对照组【分别为(12.1±3.5)μg/mL和(62.3±7.4)ng/mL,P<0.05】。结论应用还原型谷胱甘肽联合护肝清脂片治疗NAFLF患者可显著改善中医症状,降低血脂和炎症因子水平,需要进一步临床验证。

Fuzheng Huayu recipe, a traditional Chinese compound herbal medicine, attenuates renal interstitial fibrosis via targeting the miR-21/PTEN/AKT axis

Objective: MicroRNAs(miRNAs) may be viable targets for treating renal interstitial fibrosis(RIF). Fuzheng Huayu recipe(FZHY), a traditional Chinese compound herbal medicine, is often used in China to treat fibrosis. This study sought to assess the mechanisms through which FZHY influences miRNAs to treat RIF.Methods: RIF was induced in rats by mercury chloride and treated with FZHY. Hydroxyproline content,Masson’s staining and type I collagen expression were used to evaluate renal collagen deposition.Renal miRNA profiles were evaluated using a miRNA microarray. Those miRNAs that were differentially expressed following FZHY treatment were identified and subjected to bioinformatic analyses. The miR-21 target gene phosphatase and tensin homolog(PTEN) expression and AKT phosphorylation in kidney tissues were assessed via Western blotting. In addition, HK-2 human proximal tubule epithelial cells were treated using angiotensin II(Ang-II) to induce epithelial-to-mesenchymal transition(EMT), followed by FZHY exposure. miR-21 and PTEN expressions were evaluated via quantitative reverse transcriptionpolymerase chain reaction(qRT-PCR), while E-cadherin and a-smooth muscle actin(a-SMA) expressions were assessed by immunofluorescent staining and qRT-PCR. Western blotting was used to assess PTEN and AKT phosphorylation.Results: FZHY significantly decreased kidney collagen deposition, hydroxyproline content and type I collagen level. The miRNA microarray identified 20 miRNAs that were differentially expressed in response to FZHY treatment. Subsequent bioinformatic analyses found that miR-21 was the key fibrosis-related miRNA regulated by FZHY. FZHY also decreased PTEN expression and AKT phosphorylation in fibrotic kidneys. Results from in vitro tests also suggested that FZHY promoted E-cadherin upregulation and inhibited a-SMA expression in Ang-II-treated HK-2 cells, effectively reversing Ang-II-mediated EMT. We also determined that FZHY reduced miR-21 expression, increased PTEN expression and decreased AKT phosphorylation in these cells.Conclusion: miR-21 is the key fibrosis-related miRNA regulated by FZHY. The ability of FZHY to modulate miR-21/PTEN/AKT signaling may be a viable approach for treating RIF.

Impacts and risks of“realistic”global warming projections for the 21st century

The IPCC AR6 assessment of the impacts and risks associated with projected climate changes for the 21st century is both alarming and ambiguous.According to computer projections,global surface temperature may warm from 1.3℃to 8.0℃by 2100,depending on the global climate model(GCM)and the shared socioeconomic pathway(SSP)scenario used for the simulations.Actual climate-change hazards are estimated to be high and very high if the global surface temperature rises,respectively,more than 2.0℃and 3.0℃above pre-industrial levels.Recent studies,however,showed that a substantial number of CMIP6 GCMs run“too hot”because they appear to be too sensitive to radiative forcing,and that the high/extreme emission scenarios SSP3-7.0 and SSP5-8.5 are to be rejected because judged to be unlikely and highly unlikely,respectively.Yet,the IPCC AR6 mostly focused on such alarmistic scenarios for risk assessments.This paper examines the impacts and risks of“realistic”climate change projections for the 21st century generated by assessing the theoretical models and integrating them with the existing empirical knowledge on global warming and the various natural cycles of climate change that have been recorded by a variety of scientists and historians.This is achieved by combining the SSP2-4.5 scenario(which is the most likely SSP according to the current policies reported by the International Energy Agency)and empirically optimized climate modeling.According to recent research,the GCM macro-ensemble that best hindcast the global surface warming observed from 1980 to 1990 to 2012–2022 should be made up of models that are characterized by a low equilibrium climate sensitivity(ECS)(1.5℃<ECS≤3.0℃),in contrast to the IPCC AR6 likely and very likely ECS ranges at 2.5–4.0℃and 2.0–5.0℃,respectively.I show that the low-ECS macro-GCM with the SSP2-4.5 scenario projects a global surface temperature warming of 1.68–3.09℃by 2080–2100 instead of 1.98–3.82℃obtained with the GCMs with ECS in the 2.5–4.0℃range.However,if the global surface temperature records are affected by significant non-climatic warm biases—as suggested by satellite-based lower troposphere temperature records and current studies on urban heat island effects—the same climate simulations should be scaled down by about 30%,resulting in a warming of about 1.18–2.16℃by 2080–2100.Furthermore,similar moderate warming estimates(1.15–2.52℃)are also projected by alternative empirically derived models that aim to recreate the decadal-to-millennial natural climatic oscillations,which the GCMs do not reproduce.The proposed methodologies aim to simulate hypothetical models supposed to optimally hindcast the actual available data.The obtained climate projections show that the expected global surface warming for the 21st-century will likely be mild,that is,no more than 2.5–3.0℃and,on average,likely below the 2.0℃threshold.This should allow for the mitigation and management of the most dangerous climate-change related hazards through appropriate low-cost adaptation policies.In conclusion,enforcing expensive decarbonization and net-zero emission scenarios,such as SSP1-2.6,is not required because the Paris Agreement temperature target of keeping global warming<2℃throughout the 21st century should be compatible also with moderate and pragmatic shared socioeconomic pathways such as the SSP2-4.5.

Pien Tze Huang Inhibits Proliferation of Colorectal Cancer Cells through Suppressing PNO1 Expression and Activating p53/p21 Signaling Pathway

ObjectiveTo explore the regulatory effect of Pien Tze Huang (PZH) on targeting partner of NOB1 (PNO1) and it’s down-stream mediators in colorectal cancer (CRC) cells.MethodsQuantitative polymerase chain reaction was performed to determine mRNA levels of PNO1, TP53, and CDKN1A. Western blotting was performed to determine protein levels of PNO1, p53, and p21. HCT-8 cells were transduced with a lentivirus over-expressing PNO1. Colony formation assay was used to detect cell survival in PNO1 overexpression of HCT-8 cells after PZH treatment. Cell-cycle distribution, cell viability and cell apoptosis were performed to identify the effect of PNO1 overexpression on cell proliferation and apoptosis of HCT-8 cells after PZH treatment. Xenograft BALB/c nude mice bearing HCT116 cells transduced with sh-PNO1 or sh-Ctrl lentivirus were evaluated. Western blot assay was performed to detect PNO1, p53, p21 and PCNA expression in tumor sections. Terminal deoxynucleotidyl transferase dUTP nick end labling (TUNEL) assay was used to determine the apoptotic cells in tissues.ResultsPZH treatment decreased cell viability, down-regulated PNO1 expression, and up-regulated p53 and p21 expressions in HCT-8 cells (P<0.05). PNO1 overexpression attenuated the effects of PZH treatment, including the expression of p53 and p21, cell growth, cell viability, cell cycle arrest and cell apoptosis in vitro (P<0.05). PNO1 knockdown eliminated the effects of PZH treatment on tumor growth, inhibiting cell proliferation inhibition and apoptosis induction in vivo (P<0.05). Similarly, PNO1 knockdown attenuated the effects of PZH treatment on the down-regulation of PNO1 and up-regulation of p53 and p21 in vivo (P<0.05).ConclusionThe mechanism by which PZH induces its CRC anti-proliferative effect is at least in part by regulating the expression of PNO1 and its downstream targets p53 and p21.

The 5th Sino-US Symposiums on Medicine in 21st Century

Theme: The 5th Sino-US Symposiums on Medicine in 21 st CenturyDate:12-13 October, 2007Location: Shanghai International Convention Center, Shanghai, ChinaThis symposium is participated by physicians and scientists from American Medical Association (AMA), ChineseAcademy of Sciences (CAS), Chinese Medical Association (CMA), Shanghai Jiaotong University, and Chinese HealthMinistry.

The 5th Sino-US Symposiums on Medicine in 21st Century

Theme:The 5th Sino-US Symposiums on Medicine in 21st CenturyDate:12-13 October,2007Location:Shanghai International Convention Center,Shanghai,ChinaThis symposium is participated by physicians and scientists from American Medical Association(AMA),ChineseAcademy of Sciences(CAS),Chinese Medical Association(CMA),Shanghai Jiaotong University,and Chinese HealthMinistry.Category(1)Frontiers of Medicine-New technologies in clinical application,Diagnostic and Therapeutic Innovation(2)Evidence-based large scale Clinical Study and Clinical Trials-Standardization,Quality Control and Mega-analyses

Using big data to track marine oil transportation along the 21st-century Maritime Silk Road

China's designation of the "21 st-century Maritime Silk Road"(MSR) region is of extraordinary significance to its maritime rights, transportation security, and socio-economic development. We developed a technical framework allowing the use of "big data" derived from the Automatic Identification System(AIS, an automatic ship-tracking network) for two purposes: the accurate mapping of oil tanker trajectories and the creation of heat maps showing the relative use of oil tanker routes and marine shipping chokepoints. We then applied these methods to 1.5 billion AIS records collected within the MSR in 2014 to statistically identify and analyze busy routes, areas, and chokepoints in this strategic region. Our results demonstrate that the proposed framework can provide an effective analysis of oil movements based on large-scale AIS datasets, helping researchers and policy makers better understand the footprint and strategic implications of maritime oil transportation in the MSR region.

中药靶向微小RNA-21防治糖尿病肾病的研究进展

糖尿病肾病(Diabetic nephropathy, DN)是一类由糖尿病(Diabetes mellitus, DM)引起的慢性肾脏疾病,发病机制复杂,受多种因素调控。研究已证实微小RNA(microRNAs, miRNAs)与DN发展密切相关,尤其是微小RNA-21(MicroRNA-21,miR-21)在参与调控DN发病过程中占有重要作用。课题组前期研究也发现,miR-21与细胞自噬和肾纤维化通路存在密切联系,但尚未进行深入研究且目前相关的研究性论文报道相对较少。故本文以miR-21与DN的关系及靶向miR-21的中药为切入点,探讨miR-21在DN中的作用机制,以期为防治DN寻求新靶点,研发新药物,及为后续实验研究提供一定的理论支撑。

Time to Rethink:Educating for a Technology-Transformed World

Purpose:We hope to provoke a conversation about preparing students for an uncertain future that unforeseeable technological innovations will transform in ways we cannot predict.The unprecedented disruption caused by the COVID-19 pandemic makes this an opportune time to reconsiderall dimensions of education.Design/Approach/Methods:We present information on how technology is transforming virtually every aspect of our lives and the threats we face from social media,climate change,and growing inequality.We then analyze the adequacy of proposals for teaching new skills,such as 2Ist-Century Skills,to prepare students for a world of work that is changing at warp speed.Findings:Despite harbingers of a radically different future,most schools continue to operate much as they have for centuries,providing a one-size-fits-all education.Technology now enables an unprecedented degree of personalization.We can tailor learning opportunities to individual students'interests,talents,and potential with teachers serving as guides,resources,and critical friends.The Internet afford a cornucopia of learning opportunities-online courses,international experts,global collaborations,accessible databases,and libraries.Learning can occur virtually anywhere.Originality/Value:The future depends on decisions we are making today about education.The value of this article is that we call for rethinking every component of education rather than considering each element independently.

Lessons Learned as President of the Institute for Systems Biology(2000–2018)

I stepped down as president of the Institute for Systems Biol- ogy （ISB） on Jan 1, 2018. As I think about my 17-year term as President, I am astounded at how much I have learned, not only about science but also about, among other things, what it takes to build a unique world-class institution.