Dear Editor,This letter addresses the impulse game problem for a general scope of deterministic,multi-player,nonzero-sum differential games wherein all participants adopt impulse controls.Our objective is to formulate...Dear Editor,This letter addresses the impulse game problem for a general scope of deterministic,multi-player,nonzero-sum differential games wherein all participants adopt impulse controls.Our objective is to formulate this impulse game problem with the modified objective function including interaction costs among the players in a discontinuous fashion,and subsequently,to derive a verification theorem for identifying the feedback Nash equilibrium strategy.展开更多
Teacher education at the foundational and preparatory stages plays a crucial role in shaping early childhood learning experiences.The National Curriculum Framework for School Education(NCFSE)2023 provides a structured...Teacher education at the foundational and preparatory stages plays a crucial role in shaping early childhood learning experiences.The National Curriculum Framework for School Education(NCFSE)2023 provides a structured pedagogical approach to address challenges in these stages.However,despite these policy frameworks,teachers in Kendriya Vidyalayas(KVs)continue to face numerous pedagogical challenges.This paper aims to explore and analyze the pedagogical challenges encountered by KV teachers in foundational and preparatory stage classrooms and compare them with the challenges addressed in NCFSE 2023.Using qualitative research methods,data were collected through structured online interviews with 10 KV teachers from different campuses.This paper investigated various challenges,including classroom management,language barriers,a lack of inclusive education strategies,insufficient infrastructure,limited parental involvement,and difficulties in integrating technology into teaching practices.The findings highlight the gap between policy recommendations and ground-level implementation.Based on these insights,the study suggests recommendations such as specialized teacher training,recruitment of special educators,improved infrastructure,enhanced parental engagement,and policy-driven interventions to bridge the gap between policy frameworks and real-world classroom experiences.The study concludes that addressing these challenges through targeted reforms can create a more inclusive and effective learning environment,fostering holistic student development at the foundational and preparatory stages.展开更多
Objective The aim of this study was to investigate the value of the 8th American Joint Committee on Cancer(AJCC)anatomic and prognostic stage groups for penile cancer patients and explore whether there is room for imp...Objective The aim of this study was to investigate the value of the 8th American Joint Committee on Cancer(AJCC)anatomic and prognostic stage groups for penile cancer patients and explore whether there is room for improvement.Methods The clinical and histopathologic data from 16 centers between January 2000 and December 2021 were assessed according to the 8th AJCC anatomic and prognostic stage groups.Kaplan–Meier plots were used to estimate the disease-specific survival(DSS)of the patients.The accuracy of the staging systems was investigated using the Harrell's concordance index(C-index).Results According to the 8th AJCC anatomic and prognostic stage groups,the 5-year DSS rates for patients with stages 0is/a,I,IIA,IIB,IIIA,IIIB,and IV disease were 100%,99%,86%,81%,66%,34%,and 23%,respectively(p_(0is/a–I)=0.8,p_(I–IIA)<0.001,p_(IIA–IIB)=0.5,p_(IIB–IIIA)<0.001,p_(IIIA–IIIB)<0.001,p_(IIIB–IV)=0.004,and p_(Total)<0.001).According to the modified model 1 system,the 5-year DSS rates without survivorship overlap for patients with stages 0is/a,I,II,IIIA,IIIB,and IV disease were 100%,99%,88%,66%,34%,and 23%,respectively(p_(0is/a–I)=0.8,p_(I–II)<0.001,p_(II–IIIA)=0.002,p_(IIIA–IIIB)<0.001,p_(IIIB–IV)=0.004,and p_(Total)<0.001).Similarly,according to the modified model 2 system,the 5-year DSS rates without survivorship overlap for patients with stages 0is/a,I,II,IIIA,IIIB,and IV disease were 100%,99%,86%,66%,34%,and 23%,respectively(p_(0is/a–I)=0.8,p_(I–II)<0.001,p_(II–IIIA)=0.008,p_(IIIA–IIIB)<0.001,p_(IIIB–IV)=0.004,and p_(Total)<0.001).The C-index scores of the simple modified staging systems were not inferior to those of the AJCC anatomic and prognostic stage groups.These results were confirmed by the bootstrap internal validation.Conclusion There is still room for improvement about the 8th AJCC anatomic and prognostic stage groups.The improved models,which are more concise and convenient,have similar prediction accuracy.展开更多
This study examines on badminton players following anterior cruciate ligament(ACL)surgery.It analyses the risk factors in badminton that may cause re-injury to the knee joint,such as sports postures and exercise inten...This study examines on badminton players following anterior cruciate ligament(ACL)surgery.It analyses the risk factors in badminton that may cause re-injury to the knee joint,such as sports postures and exercise intensity.Scientific and reasonable sports protection measures and training plans are formulated,including correcting sports postures and reasonably controlling exercise intensity and frequency.Rehabilitation training is carried out in stages,and the training intensity and frequency are gradually adjusted according to the recovery situation.Through scientific protection and training,the risk of re-injury to athletes can be reduced,and they can be helped to restore their best sports conditions.At the same time,future research directions are prospected,covering personalized rehabilitation programs,application of new technologies,and research on psychological factors.展开更多
Background In light of growing concern over eating disorders among young athletes amid cultural and social pressures,this study aimed to assess the prevalence of orthorexia nervosa(ON)risk and evaluate body image perc...Background In light of growing concern over eating disorders among young athletes amid cultural and social pressures,this study aimed to assess the prevalence of orthorexia nervosa(ON)risk and evaluate body image perception and its predictive factors among young football players from Poland and Türkiye.Methods The study involved 171 players aged 15–18 years,recruited from football academies in Poland and Türkiye.The Polish and Turkish versions of the Body-Esteem Scale for Adolescents and Adults(BESAA)were administered to assess body image perception,while the Düsseldorf Orthorexia Scale(DOS)was used to measure ON risk.Anthropometric measurements were taken to calculate Body Mass Index(BMI),which was then referenced to centile charts to determine nutritional status.Results Results indicated that 13%of participants exhibited characteristics of ON,with an additional 26%classified as at elevated risk.Comparative analysis revealed no significant differences in ON prevalence between Polish and Turkish players(p=0.938)and no age-related differences(p=0.694).Among Polish players,a significant positive association emerged between BMI(relative to centile charts)and overall appearance evaluation(BE-Appearance)(p=0.008,partialη^(2)=0.10).This relationship was not observed in Turkish players.Moreover,analysis of ON risk predictors—including age,nationality,nutritional status,and body image—did not identify any single variable as a definitive predictor(all p-values>0.05),with a low predictive capacity(McFadden’s R^(2)=0.03).Conclusion The study revealed a significant risk of ON among young footballers with no clear predictors.展开更多
Group living is widespread across diverse taxa,and the mechanisms underlying collective decision-making in contexts of variable role division are critical for understanding the dynamics of group stability.While studie...Group living is widespread across diverse taxa,and the mechanisms underlying collective decision-making in contexts of variable role division are critical for understanding the dynamics of group stability.While studies on collective behavior in small animals such as fish and insects are well-established,similar research on large wild animals remains challenging due to the limited availability of sufficient and systematic field data.Here,we aimed to explore the collective decision-making pattern and its sexual difference for the dimorphic Tibetan antelopes Pantholops hodgsonii(chiru)in Xizang Autonomous Region,China,by analyzing individual leadership distribution,as well as the joining process,considering factors such as calving stages and joining ranks.The distinct correlations of decision participants’ratio with group size and decision duration underscore the trade-off between accuracy and speed in decision-making.Male antelopes display a more democratic decision-making pattern,while females exhibit more prompt responses after calving at an early stage.This study uncovers a partially shared decision-making strategy among Tibetan antelopes,suggesting flexible self-organization in group decision processes aligned with animal life cycle progression.展开更多
This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias.We retrospectively analyzed the clinical data of patients with severe hypospadi...This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias.We retrospectively analyzed the clinical data of patients with severe hypospadias admitted to the First Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between October 2012 and October 2022.In total,31 patients underwent the conventional Byars procedure(conventional group),and 45 patients underwent the modified Byars staged procedure(modified group).Our modified strategy was built upon the standard Byars procedure by incorporating glansplasty during the first stage and employing a Y-shaped flap in conjunction with a glandular tunnel for urethroplasty during the second stage.Notably,there were no statistically significant differences in the preoperative baseline characteristics,duration of surgery,amount of blood loss,or occurrence of postoperative complications,including urethral fistula,stricture and diverticulum,or penile curvature,between the conventional and modified groups.However,there was a significantly lower incidence of coronal sulcus fistula(0 vs 16.1%,P=0.02)and glans dehiscence(0 vs 12.9%,P=0.02)in the surgical group than that in the conventional group.In addition,the modified group exhibited a notably greater rate of normotopic urethral opening(100.0%vs 83.9%,P=0.01)and a higher mean score on the Hypospadias Objective Penile Evaluation(HOPE;mean±standard error of mean:8.6±0.2 vs 7.9±0.3,P=0.02)than did the conventional group.In conclusion,the modified Byars staged procedure significantly reduced the risks of glans dehiscence and coronal sulcus fistula.Consequently,it offers a promising approach for achieving favorable penile esthetics,thereby providing a reliable therapeutic option for severe hypospadias.展开更多
With the growth of the construction industry,risk management in construction projects has garnered significant attention from the academic community.Effective risk management during the decision-making stage can great...With the growth of the construction industry,risk management in construction projects has garnered significant attention from the academic community.Effective risk management during the decision-making stage can greatly enhance project management efficiency.This paper integrates the AHP-entropy value method and constructs a risk management model based on the DPSIR framework for construction projects.The model is applied to evaluate and analyze the risk level of the decision-making stage in a navigation and electricity hub project in Chongqing Municipality.The results demonstrate the scientific validity and effectiveness of the proposed model.展开更多
The wheat above-ground biomass(AGB)is an important index that shows the life activity of vegetation,which is of great significance for wheat growth monitoring and yield prediction.Traditional biomass estimation method...The wheat above-ground biomass(AGB)is an important index that shows the life activity of vegetation,which is of great significance for wheat growth monitoring and yield prediction.Traditional biomass estimation methods specifically include sample surveys and harvesting statistics.Although these methods have high estimation accuracy,they are time-consuming,destructive,and difficult to implement to monitor the biomass at a large scale.The main objective of this study is to optimize the traditional remote sensing methods to estimate the wheat AGBbased on improved convolutional features(CFs).Low-cost unmanned aerial vehicles(UAV)were used as the main data acquisition equipment.This study acquired image data acquired by RGB camera(RGB)and multi-spectral(MS)image data of the wheat population canopy for two wheat varieties and five key growth stages.Then,field measurements were conducted to obtain the actual wheat biomass data for validation.Based on the remote sensing indices(RSIs),structural features(SFs),and CFs,this study proposed a new feature named AUR-50(multi-source combination based on convolutional feature optimization)to estimate the wheat AGB.The results show that AUR-50 could estimate the wheat AGB more accurately than RSIs and SFs,and the average R^(2) exceeded 0.77.In the overwintering period,AUR-50_(MS)(multi-source combination with convolutional feature optimization using multispectral imagery)had the highest estimation accuracy(R^(2) of 0.88).In addition,AUR-50 reduced the effect of the vegetation index saturation on the biomass estimation accuracy by adding CFs,where the highest R^(2) was 0.69 at the flowering stage.The results of this study provide an effective method to evaluate the AGB in wheat with high throughput and a research reference for the phenotypic parameters of other crops.展开更多
The unavoidable dendrite growth and shuttle effect have long been stranglehold challenges limiting the safety and practicality of lithium-sulfur batteries.Herein,we propose a dual-action strategy to address the lithiu...The unavoidable dendrite growth and shuttle effect have long been stranglehold challenges limiting the safety and practicality of lithium-sulfur batteries.Herein,we propose a dual-action strategy to address the lithium dendrite issue in stages by constructing a multifunctional surface-negatively-charged nanodiamond layer with high ductility and robust puncture resistance on polypropylene (PP) separator.The uniformly loaded compact negative layer can not only significantly enhance electron transmission efficiency and promote uniform lithium deposition,but also reduce the formation of dendrite during early deposition stage.Most importantly,under the strong puncture stress encountered during the deterioration of lithium dendrite growth under limiting current,the high ductility and robust puncture resistance(145.88 MPa) of as-obtained nanodiamond layer can effectively prevent short circuits caused by unavoidable lithium dendrite.The Li||Li symmetrical cells assembled with nanodiamond layer modified PP demonstrated a stable cycle of over 1000 h at 2 mA cm^(-2)with a polarization voltage of only 29.3 mV.Additionally,the negative charged layer serves as a physical barrier blocking lithium polysulfide ions,effectively mitigating capacity attenuation.The improved cells achieved a capacity decay of only 0.042%per cycle after 700 cycles at 3 C,demonstrating effective suppression of dendrite growth and capacity attenuation,showing promising prospect.展开更多
This paper addresses the design problem of an embedded mobile stage location system based on a two-dimensional laser radar.The mobile stage is a piece of important performance equipment in art performances,and the pos...This paper addresses the design problem of an embedded mobile stage location system based on a two-dimensional laser radar.The mobile stage is a piece of important performance equipment in art performances,and the positioning problem is one of the key issues in the control of the mobile stage.Both hardware and software are developed for the mobile stage.The hardware of the location system consists of a laser radar,an embedded control board,a wireless router,and a motion control unit.The software of the location system includes embedded software and human-machine interface(HMI),and they are designed to achieve the functions of real-time positioning and monitoring.First,a novel landmark identification method is presented based on the landmark reflection intensities and shapes.Then,the initial pose of the mobile stage is calculated by using the triangle matching algorithm and the least squares method.A distributed fusion Kalman filtering algorithm is applied to fuse landmark information and odometer information to achieve real-time positioning of the mobile stage.The designed system has been implemented in a practical mobile stage,and the results demonstrate that the location system can achieve a high positioning precision in both the stationary and moving scenarios.展开更多
Pigs have emerged as valuable large-animal models for cardiac xenotransplantation;however,the temporal dynamics of myocardial development in this species remains insufficiently defined.This study analyzed gene express...Pigs have emerged as valuable large-animal models for cardiac xenotransplantation;however,the temporal dynamics of myocardial development in this species remains insufficiently defined.This study analyzed gene expression patterns across four key developmental stages(neonatal,juvenile,sexual maturity,and adulthood)to delineate the molecular mechanisms driving porcine myocardial development.Increases in heart weight were accompanied by proportional expansion of myocardial fiber area and chamber size,reflecting coordinated structural development.Transcriptomic profiling of myocardial tissue by RNA sequencing(RNA-seq)identified 2189 differentially expressed genes(DEGs)across stage comparisons.Short time-series expression miner(STEM)analysis classified these DEGs into four major expression clusters enriched in pathways associated with myocardial development,immune responses,cell proliferation,and metabolic processes.Among 359 DEGs conserved across all developmental stages,six candidate genes were strongly associated with myocardial development.Reverse transcription-quantitative real-time polymerase chain reaction(RT-qPCR)confirmed a significant correlation between the expression of these candidate genes and myocardial development in porcine tissue.These findings establish a transcriptomic framework for porcine myocardial maturation and provide a molecular basis for advancing cardiac xenotransplantation.展开更多
In semiconductor precision packaging and other applications involving alignment of automated equipment,the nonlinear motion caused by structural characteristics and friction effects on torque-type rotating motion stag...In semiconductor precision packaging and other applications involving alignment of automated equipment,the nonlinear motion caused by structural characteristics and friction effects on torque-type rotating motion stages seriously affects output accuracy and stability.To solve this problem,the motion characteristics of a rotating stage and the mechanism by which friction nonlinearity influences accuracy are analyzed in detail.In addition,a compound control strategy based on a kinematic model and the Stribeck friction model is designed.A friction disturbance observer based on output position feedback is improved for simple parameter tuning.Finally,an experimental system is constructed to carry out validation tests,including identification of nonlinear characteristics and performance comparisons.The experimental results show that the linear tracking error of the torque-type rotating stage is less than 1.47µm after adoption of the proposed model-based composite control strategy,and the corresponding rotary angle deviation is less than 0.0153°.The linearity of output motion is increased to 97.59%and the error compensation effect is improved by 51.6%compared with the PID control method.The experimental results confirm that the analysis method adopted here and the proposed compensation strategy can effectively reduce frictional nonlinearity and improve motion accuracy.The proposed method can also be applied to other precision electromechanical systems.展开更多
Objectives A systematic review and network meta-analysis was conducted to evaluate the effectiveness of different childbirth positions in reducing the duration of the second stage of labor,providing evidence-based ins...Objectives A systematic review and network meta-analysis was conducted to evaluate the effectiveness of different childbirth positions in reducing the duration of the second stage of labor,providing evidence-based insights for obstetric institutions to guide interventions related to childbirth positions.Methods A comprehensive literature search was conducted in databases,including PubMed,Web of Science,the Cochrane Library,Embase,Wanfang Databases,China National Knowledge Infrastructure Databases(CNKI),China Science and Technology Journal Database(CSTJ),and China Biology Medicine disc(CBMdisc)to identify studies on the effectiveness of different childbirth positions in reducing the duration of the second stage of labor.The search included randomized controlled trials published from database inception to September 30,2024.The Cochrane risk-of-bias tool was used to assess the quality of the studies.Two independent reviewers screened the literature,extracted data,and evaluated study quality.Subsequently,a network meta-analysis was performed using STATA software.The study protocol has been registered in PROSPERO(CRD42023428217).Results This study analyzed data from 25 randomized controlled trials involving 9,844 women.The findings indicated that in comparison to lithotomy position,free position(MD=20.53,95%CI[11.38,29.68])and upright position(MD=−24.13,95%CI[−42.94,-5.32])were found to be superior in reducing the duration of the second stage of labor.Free position outperformed kneeling position(MD=21.48,95%CI[4.67,38.28])and squatting position(MD=23.43,95%CI[1.88,44.97]);upright position was superior to kneeling position(MD=−25.08,95%CI[−46.93,−3.22]);semirecumbent position surpassed squatting position(MD=19.71,95%CI[2.05,37.38]);and upright position was also superior to squatting position(MD=−27.03,95%CI[−51.48,−2.57]).According to the surface under the cumulative ranking curve(SUCRA),the upright position emerged as the most effective for reducing the duration of the second stage of labor(87.4%),followed by free position(81.1%),semirecumbent position(70.0%),and lateral position(62.3%).Conclusion These findings offer valuable insights for midwifery practice and help inform future research directions.Considering the limitations of this review,more larger-scale,multicenter randomized controlled trials are warranted to further evaluate the relative effectiveness of different childbirth positions in reducing the duration of the second stage of labor.展开更多
The rhizosphere bacteria play crucial roles in plant health and growth as they are involved in assimilating nutrients and resisting adverse conditions such as nutrient stress,drought,and wind erosion.Agriophyllum squa...The rhizosphere bacteria play crucial roles in plant health and growth as they are involved in assimilating nutrients and resisting adverse conditions such as nutrient stress,drought,and wind erosion.Agriophyllum squarrosum(L.)Moq.is a pioneer plant used in sand fixation due to its strong resistance to drought and wind erosion.However,the bacterial community characteristics and ecological function in the rhizosphere of A.squarrosum are poorly understood.In this study,soil samples were collected from different developmental stages(seedling stage,vegetative stage,reproductive stage,and withering stage)of A.squarrosum.Illumina Miseq sequencing was used to detect differences in soil bacterial abundance.The Phylogenetic Investigation of Communities by Reconstruction of Unobserved States(PICRUSt)program was used to predict bacterial functions,and the relationships among bacteria,functional populations,and soil nutrients were examined using a heatmap analysis.The results showed that the Shannon and Sobs indices of rhizosphere bacteria were significantly higher during the reproductive stage than during the other stages.Pantoea sp.(7.03%)was the dominant genus during the seedling stage;Arthrobacter sp.was the dominant genus during the vegetative(13.94%),reproductive(7.57%),and withering(12.30%)stages.The relative abundances of Chloroflexi,Acidobacteria,and Gemmatimonadetes were significantly high during the reproductive stage.According to the PICRUSt analysis,membrane transport,signal transduction,and environmental adaptation of the bacterial functional population occurred during the seedling stage.Carbohydrate metabolism increased during the vegetative stage,while energy metabolism,lipid metabolism,and biosynthesis of other secondary metabolites of the bacterial functional population significantly increased during the reproductive stage.The abundances of bacterial communities,functional genes,and soil nutrients were synergistically altered during various developmental stages.Our findings suggest that the developmental stages of A.squarrosum play a significant role in defining the composition and structure of bacterial communities in the rhizosphere.The results will provide a basis for better prediction and understanding of soil bacterial metabolic potential and functions of A.squarrosum rhizosphere in sandy areas.展开更多
BACKGROUNDColorectal cancer(CRC)typically progresses from benign colorectal polyps,whichrepresent a precursor to malignancy.Identifying the factors influencing thisprogression is crucial for early intervention and pre...BACKGROUNDColorectal cancer(CRC)typically progresses from benign colorectal polyps,whichrepresent a precursor to malignancy.Identifying the factors influencing thisprogression is crucial for early intervention and prevention.Although genetic andenvironmental factors have been widely studied,the role of lifestyle factors suchas physical activity,diet,smoking,sleep,and stress remains underexplored,especially in patients with early stage CRC or polyps.Recent evidence suggeststhat lifestyle behaviors may influence cancer progression by modulating inflammatorypathways,metabolic health,and immune function.For instance,highlevels of physical activity are linked to a reduced risk of CRC development,whereas poor dietary habits,smoking,and inadequate sleep have all beenimplicated in increased cancer risk and progression.Moreover,early-stage CRCpatients,who are often asymptomatic or have minimal symptoms,may particularlybenefit from lifestyle modifications to slow disease progression andimprove overall prognosis.The gap in understanding the specific influence ofthese lifestyle factors on colorectal polyps and early stage cancer progressionunderscores the need for comprehensive studies.By assessing several modifiablelifestyle factors and their association with disease progression,clinicians canidentify practical intervention points.These interventions could ultimately reducethe need for more aggressive treatments and improve the long-term outcomes inaffected patients.AIMTo investigate the association between lifestyle factors and disease progression inpatients with colorectal polyps and early stage cancer.METHODSIn this observational study conducted from January 2022 to December 2023,werecruited 120 patients with colorectal polyps or early stage cancer from Jiangshan People's Hospital.Lifestyle factors,including physical activity,dietary patterns,smoking status,sleep quality,andstress levels,were assessed using validated questionnaires.Disease progression was evaluated using standardizedfollow-up colonoscopies and pathological examinations.Cox proportional hazards models were used to analyzethe association between lifestyle factors and disease progression after adjusting for potential confounders.RESULTSDuring the median follow-up of 18.4 months,42(35.0%)patients experienced disease progression.High levels ofphysical activity were associated with reduced progression risk[adjusted hazard ratio(HR)0.55,95%confidenceinterval(CI):0.38-0.80,P=0.002]compared to low activity levels.High adherence to a healthy dietary patternshowed similar protective effects(adjusted HR 0.62,95%CI:0.43-0.89,P=0.009).Current smoking(adjusted HR1.92,95%CI:1.35-2.73,P<0.001)and poor sleep quality(adjusted HR 1.38,95%CI:1.05-1.82,P=0.021)wereassociated with increased progression risk.The impact of lifestyle factors was particularly pronounced in patientsyounger than 60 years and those with multiple polyps at baseline.CONCLUSIONThis study demonstrated significant associations between lifestyle factors and disease progression in colorectalpolyps and early stage cancer.Physical activity,dietary patterns,smoking status,and sleep quality have emergedas key modifiable factors influencing disease progression.These findings support the integration of lifestyleassessments and modifications in the clinical management of patients with colorectal neoplasia.展开更多
BACKGROUND Rectal cancer is one of the common digestive system malignant tumors around the world.Its early diagnosis and staging are crucial for rectal cancer treatment and prognosis.In recent years,tumor markers have...BACKGROUND Rectal cancer is one of the common digestive system malignant tumors around the world.Its early diagnosis and staging are crucial for rectal cancer treatment and prognosis.In recent years,tumor markers have gradually received attention in early screening,treatment monitoring and prognostic evaluation of cancer,but their predictive role in rectal cancer staging and differentiation is still unclear.AIM To assess the prognostic value of tumor markers alpha-fetoprotein(AFP)cancer antigen 72-4(CA72-4),carbohydrate antigen 19-9(CA19-9),and carcinoembryonic antigen(CEA),alongside multimodal magnetic resonance imaging(MRI),for staging and differentiating rectal cancer in patients.METHODS This study retrospectively analyzed 167 patients with rectal cancer who were treated at our institution from January 2020 to December 2024.Each patient underwent serological testing and multimodal MRI for diagnosis.Histopathological examination after surgical resection or imaging based on follow-up was used as the gold standard.According to the T stage and differentiation degree,patients were divided into low stage group(T1-T2)and high stage group(T3-T4).In addition,they were divided into low-differentiation groups and high-differentiation groups according to their differentiation degree.We compared the accuracy,sensitivity and specificity of tumor marker levels and MRI in rectal cancer stage and differentiation.RESULTS The study's findings indicate that in the context of rectal cancer T staging,there is substantial concordance between MRI and clinicopathological assessments,with a Kappa coefficient of 0.789(P<0.001).Similarly,for various degrees of tumor differentiation,MRI and clinicopathological evaluations demonstrated substantial agreement,with a Kappa coefficient of 0.651(P<0.001).Notably,the concentrations of tumor markers CA19-9,CA72-4,CEA,and AFP were significantly elevated in the T3-T4 stage compared to the T1-T2 stage.Furthermore,these markers were significantly higher in the low-differentiation group compared to the high-differentiation group(P<0.05).The combined use of tumor markers and MRI for preoperative T staging of rectal cancer yielded a diagnostic sensitivity of 93.7%and a specificity of 94.6%,as evidenced by the receiver operating characteristic analysis,with an area under the curve of 0.947.For tumor differentiation,the diagnostic sensitivity and specificity were 93.6%and 97.1%,respectively,with an area under the curve of 0.978(95%confidence interval:0.946-1.000),surpassing the accuracy of individual detection methods.CONCLUSION The CA19-9,CA72-4,CEA and AFP tumor markers combined with multimodal MRI have high sensitivity and specificity in diagnosing rectal cancer stage and differentiation.Their diagnostic efficacy is significantly better than that of single tests,which can effectively improve the predictive ability of rectal cancer stage and differentiation,provide a more reliable diagnostic reference for clinical practice,and have important clinical significance.展开更多
基金supported in part by the National Natural Science Foundation of China(62173051)the Fundamental Research Funds for the Central Universities(2024CDJCGJ012,2023CDJXY-010)+1 种基金the Chongqing Technology Innovation and Application Development Special Key Project(CSTB2022TIADCUX0015,CSTB2022TIAD-KPX0162)the China Postdoctoral Science Foundation(2024M763865)
文摘Dear Editor,This letter addresses the impulse game problem for a general scope of deterministic,multi-player,nonzero-sum differential games wherein all participants adopt impulse controls.Our objective is to formulate this impulse game problem with the modified objective function including interaction costs among the players in a discontinuous fashion,and subsequently,to derive a verification theorem for identifying the feedback Nash equilibrium strategy.
文摘Teacher education at the foundational and preparatory stages plays a crucial role in shaping early childhood learning experiences.The National Curriculum Framework for School Education(NCFSE)2023 provides a structured pedagogical approach to address challenges in these stages.However,despite these policy frameworks,teachers in Kendriya Vidyalayas(KVs)continue to face numerous pedagogical challenges.This paper aims to explore and analyze the pedagogical challenges encountered by KV teachers in foundational and preparatory stage classrooms and compare them with the challenges addressed in NCFSE 2023.Using qualitative research methods,data were collected through structured online interviews with 10 KV teachers from different campuses.This paper investigated various challenges,including classroom management,language barriers,a lack of inclusive education strategies,insufficient infrastructure,limited parental involvement,and difficulties in integrating technology into teaching practices.The findings highlight the gap between policy recommendations and ground-level implementation.Based on these insights,the study suggests recommendations such as specialized teacher training,recruitment of special educators,improved infrastructure,enhanced parental engagement,and policy-driven interventions to bridge the gap between policy frameworks and real-world classroom experiences.The study concludes that addressing these challenges through targeted reforms can create a more inclusive and effective learning environment,fostering holistic student development at the foundational and preparatory stages.
基金supported by the Guangdong Province Nature Foundation of China Project (No. 2022A1515012200 to Li Z)Shenzhen Science and Technology Program (No. RCYX20221008093032008 to Li Z)Shenzhen People's Hospital Clinician Scientist Training Program (No. SYWGSJCYJ202405 to Li Z).
文摘Objective The aim of this study was to investigate the value of the 8th American Joint Committee on Cancer(AJCC)anatomic and prognostic stage groups for penile cancer patients and explore whether there is room for improvement.Methods The clinical and histopathologic data from 16 centers between January 2000 and December 2021 were assessed according to the 8th AJCC anatomic and prognostic stage groups.Kaplan–Meier plots were used to estimate the disease-specific survival(DSS)of the patients.The accuracy of the staging systems was investigated using the Harrell's concordance index(C-index).Results According to the 8th AJCC anatomic and prognostic stage groups,the 5-year DSS rates for patients with stages 0is/a,I,IIA,IIB,IIIA,IIIB,and IV disease were 100%,99%,86%,81%,66%,34%,and 23%,respectively(p_(0is/a–I)=0.8,p_(I–IIA)<0.001,p_(IIA–IIB)=0.5,p_(IIB–IIIA)<0.001,p_(IIIA–IIIB)<0.001,p_(IIIB–IV)=0.004,and p_(Total)<0.001).According to the modified model 1 system,the 5-year DSS rates without survivorship overlap for patients with stages 0is/a,I,II,IIIA,IIIB,and IV disease were 100%,99%,88%,66%,34%,and 23%,respectively(p_(0is/a–I)=0.8,p_(I–II)<0.001,p_(II–IIIA)=0.002,p_(IIIA–IIIB)<0.001,p_(IIIB–IV)=0.004,and p_(Total)<0.001).Similarly,according to the modified model 2 system,the 5-year DSS rates without survivorship overlap for patients with stages 0is/a,I,II,IIIA,IIIB,and IV disease were 100%,99%,86%,66%,34%,and 23%,respectively(p_(0is/a–I)=0.8,p_(I–II)<0.001,p_(II–IIIA)=0.008,p_(IIIA–IIIB)<0.001,p_(IIIB–IV)=0.004,and p_(Total)<0.001).The C-index scores of the simple modified staging systems were not inferior to those of the AJCC anatomic and prognostic stage groups.These results were confirmed by the bootstrap internal validation.Conclusion There is still room for improvement about the 8th AJCC anatomic and prognostic stage groups.The improved models,which are more concise and convenient,have similar prediction accuracy.
文摘This study examines on badminton players following anterior cruciate ligament(ACL)surgery.It analyses the risk factors in badminton that may cause re-injury to the knee joint,such as sports postures and exercise intensity.Scientific and reasonable sports protection measures and training plans are formulated,including correcting sports postures and reasonably controlling exercise intensity and frequency.Rehabilitation training is carried out in stages,and the training intensity and frequency are gradually adjusted according to the recovery situation.Through scientific protection and training,the risk of re-injury to athletes can be reduced,and they can be helped to restore their best sports conditions.At the same time,future research directions are prospected,covering personalized rehabilitation programs,application of new technologies,and research on psychological factors.
文摘Background In light of growing concern over eating disorders among young athletes amid cultural and social pressures,this study aimed to assess the prevalence of orthorexia nervosa(ON)risk and evaluate body image perception and its predictive factors among young football players from Poland and Türkiye.Methods The study involved 171 players aged 15–18 years,recruited from football academies in Poland and Türkiye.The Polish and Turkish versions of the Body-Esteem Scale for Adolescents and Adults(BESAA)were administered to assess body image perception,while the Düsseldorf Orthorexia Scale(DOS)was used to measure ON risk.Anthropometric measurements were taken to calculate Body Mass Index(BMI),which was then referenced to centile charts to determine nutritional status.Results Results indicated that 13%of participants exhibited characteristics of ON,with an additional 26%classified as at elevated risk.Comparative analysis revealed no significant differences in ON prevalence between Polish and Turkish players(p=0.938)and no age-related differences(p=0.694).Among Polish players,a significant positive association emerged between BMI(relative to centile charts)and overall appearance evaluation(BE-Appearance)(p=0.008,partialη^(2)=0.10).This relationship was not observed in Turkish players.Moreover,analysis of ON risk predictors—including age,nationality,nutritional status,and body image—did not identify any single variable as a definitive predictor(all p-values>0.05),with a low predictive capacity(McFadden’s R^(2)=0.03).Conclusion The study revealed a significant risk of ON among young footballers with no clear predictors.
基金supported by the National Natural Science Foundation of China(Grant no.32101237)the China Postdoctoral Science Foundation(Grant no.2021M691522)+1 种基金the National Key Research and Development Program(Grant no.2022YFC3202104)the Tibet Major Science and Technology Project(Grant no.XZ201901-GA-06).
文摘Group living is widespread across diverse taxa,and the mechanisms underlying collective decision-making in contexts of variable role division are critical for understanding the dynamics of group stability.While studies on collective behavior in small animals such as fish and insects are well-established,similar research on large wild animals remains challenging due to the limited availability of sufficient and systematic field data.Here,we aimed to explore the collective decision-making pattern and its sexual difference for the dimorphic Tibetan antelopes Pantholops hodgsonii(chiru)in Xizang Autonomous Region,China,by analyzing individual leadership distribution,as well as the joining process,considering factors such as calving stages and joining ranks.The distinct correlations of decision participants’ratio with group size and decision duration underscore the trade-off between accuracy and speed in decision-making.Male antelopes display a more democratic decision-making pattern,while females exhibit more prompt responses after calving at an early stage.This study uncovers a partially shared decision-making strategy among Tibetan antelopes,suggesting flexible self-organization in group decision processes aligned with animal life cycle progression.
基金supported by funding from the Medical Research Funding of Guangdong(No.A2022499 to QGX)the National Natural Science Foundation of China(No.82301796 to PL)the Guangdong Province Regional Joint Fund-Youth Fund Project of China(No.2022A1515111201 to PL).
文摘This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias.We retrospectively analyzed the clinical data of patients with severe hypospadias admitted to the First Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between October 2012 and October 2022.In total,31 patients underwent the conventional Byars procedure(conventional group),and 45 patients underwent the modified Byars staged procedure(modified group).Our modified strategy was built upon the standard Byars procedure by incorporating glansplasty during the first stage and employing a Y-shaped flap in conjunction with a glandular tunnel for urethroplasty during the second stage.Notably,there were no statistically significant differences in the preoperative baseline characteristics,duration of surgery,amount of blood loss,or occurrence of postoperative complications,including urethral fistula,stricture and diverticulum,or penile curvature,between the conventional and modified groups.However,there was a significantly lower incidence of coronal sulcus fistula(0 vs 16.1%,P=0.02)and glans dehiscence(0 vs 12.9%,P=0.02)in the surgical group than that in the conventional group.In addition,the modified group exhibited a notably greater rate of normotopic urethral opening(100.0%vs 83.9%,P=0.01)and a higher mean score on the Hypospadias Objective Penile Evaluation(HOPE;mean±standard error of mean:8.6±0.2 vs 7.9±0.3,P=0.02)than did the conventional group.In conclusion,the modified Byars staged procedure significantly reduced the risks of glans dehiscence and coronal sulcus fistula.Consequently,it offers a promising approach for achieving favorable penile esthetics,thereby providing a reliable therapeutic option for severe hypospadias.
文摘With the growth of the construction industry,risk management in construction projects has garnered significant attention from the academic community.Effective risk management during the decision-making stage can greatly enhance project management efficiency.This paper integrates the AHP-entropy value method and constructs a risk management model based on the DPSIR framework for construction projects.The model is applied to evaluate and analyze the risk level of the decision-making stage in a navigation and electricity hub project in Chongqing Municipality.The results demonstrate the scientific validity and effectiveness of the proposed model.
基金supported by the Postgraduate Research&Practice Innovation Program of Jiangsu Province,China(SJCX23_1973)the National Natural Science Foundation of China(32172110,32071945)+7 种基金the Key Research and Development Program(Modern Agriculture)of Jiangsu Province,China(BE2022342-2,BE2020319)the Anhui Province Crop Intelligent Planting and Processing Technology Engineering Research Center Open Project,China(ZHKF04)the National Key Research and Development Program of China(2023YFD2300201,2023YFD1202200)the Special Funds for Scientific and Technological Innovation of Jiangsu Province,China(BE2022425)the Priority Academic Program Development of Jiangsu Higher Education Institutions,China(PAPD)the Central Publicinterest Scientific Institution Basal Research Fund,China(JBYW-AII-2023-08)the Science and Technology Innovation Project of the Chinese Academy of Agricultural Sciences(CAAS-CS-202201)the Special Fund for Independent Innovation of Agriculture Science and Technology in Jiangsu Province,China(CX(22)3112)。
文摘The wheat above-ground biomass(AGB)is an important index that shows the life activity of vegetation,which is of great significance for wheat growth monitoring and yield prediction.Traditional biomass estimation methods specifically include sample surveys and harvesting statistics.Although these methods have high estimation accuracy,they are time-consuming,destructive,and difficult to implement to monitor the biomass at a large scale.The main objective of this study is to optimize the traditional remote sensing methods to estimate the wheat AGBbased on improved convolutional features(CFs).Low-cost unmanned aerial vehicles(UAV)were used as the main data acquisition equipment.This study acquired image data acquired by RGB camera(RGB)and multi-spectral(MS)image data of the wheat population canopy for two wheat varieties and five key growth stages.Then,field measurements were conducted to obtain the actual wheat biomass data for validation.Based on the remote sensing indices(RSIs),structural features(SFs),and CFs,this study proposed a new feature named AUR-50(multi-source combination based on convolutional feature optimization)to estimate the wheat AGB.The results show that AUR-50 could estimate the wheat AGB more accurately than RSIs and SFs,and the average R^(2) exceeded 0.77.In the overwintering period,AUR-50_(MS)(multi-source combination with convolutional feature optimization using multispectral imagery)had the highest estimation accuracy(R^(2) of 0.88).In addition,AUR-50 reduced the effect of the vegetation index saturation on the biomass estimation accuracy by adding CFs,where the highest R^(2) was 0.69 at the flowering stage.The results of this study provide an effective method to evaluate the AGB in wheat with high throughput and a research reference for the phenotypic parameters of other crops.
基金National Natural Science Foundation of China (Grant 52372083, 52173255)Opening Project of the Jiangsu Key Laboratory for Chemistry of Low-Dimensional Materials (JSKC24025)+1 种基金Special Funds for the Trans-formation of Scientific and Technological Achievements in Jiangsu Province(BA2023003)Collaborative Innovation Center for Advanced Micro/nanomaterials and Equipment (Co-constructed by Jiangsu Province and Ministry of Education)。
文摘The unavoidable dendrite growth and shuttle effect have long been stranglehold challenges limiting the safety and practicality of lithium-sulfur batteries.Herein,we propose a dual-action strategy to address the lithium dendrite issue in stages by constructing a multifunctional surface-negatively-charged nanodiamond layer with high ductility and robust puncture resistance on polypropylene (PP) separator.The uniformly loaded compact negative layer can not only significantly enhance electron transmission efficiency and promote uniform lithium deposition,but also reduce the formation of dendrite during early deposition stage.Most importantly,under the strong puncture stress encountered during the deterioration of lithium dendrite growth under limiting current,the high ductility and robust puncture resistance(145.88 MPa) of as-obtained nanodiamond layer can effectively prevent short circuits caused by unavoidable lithium dendrite.The Li||Li symmetrical cells assembled with nanodiamond layer modified PP demonstrated a stable cycle of over 1000 h at 2 mA cm^(-2)with a polarization voltage of only 29.3 mV.Additionally,the negative charged layer serves as a physical barrier blocking lithium polysulfide ions,effectively mitigating capacity attenuation.The improved cells achieved a capacity decay of only 0.042%per cycle after 700 cycles at 3 C,demonstrating effective suppression of dendrite growth and capacity attenuation,showing promising prospect.
基金Supported by the Philosophy and Social Sciences Planning Project of Zhejiang Province(No.23NDJC374YB)the Major Humanities and Social Sciences Research Projects in Zhejiang Higher Education Institutions(No.2024QN067).
文摘This paper addresses the design problem of an embedded mobile stage location system based on a two-dimensional laser radar.The mobile stage is a piece of important performance equipment in art performances,and the positioning problem is one of the key issues in the control of the mobile stage.Both hardware and software are developed for the mobile stage.The hardware of the location system consists of a laser radar,an embedded control board,a wireless router,and a motion control unit.The software of the location system includes embedded software and human-machine interface(HMI),and they are designed to achieve the functions of real-time positioning and monitoring.First,a novel landmark identification method is presented based on the landmark reflection intensities and shapes.Then,the initial pose of the mobile stage is calculated by using the triangle matching algorithm and the least squares method.A distributed fusion Kalman filtering algorithm is applied to fuse landmark information and odometer information to achieve real-time positioning of the mobile stage.The designed system has been implemented in a practical mobile stage,and the results demonstrate that the location system can achieve a high positioning precision in both the stationary and moving scenarios.
基金supported by the National Natural Science Foundation of China(32222079 to L.J.and 32202621 to D.D.W.)。
文摘Pigs have emerged as valuable large-animal models for cardiac xenotransplantation;however,the temporal dynamics of myocardial development in this species remains insufficiently defined.This study analyzed gene expression patterns across four key developmental stages(neonatal,juvenile,sexual maturity,and adulthood)to delineate the molecular mechanisms driving porcine myocardial development.Increases in heart weight were accompanied by proportional expansion of myocardial fiber area and chamber size,reflecting coordinated structural development.Transcriptomic profiling of myocardial tissue by RNA sequencing(RNA-seq)identified 2189 differentially expressed genes(DEGs)across stage comparisons.Short time-series expression miner(STEM)analysis classified these DEGs into four major expression clusters enriched in pathways associated with myocardial development,immune responses,cell proliferation,and metabolic processes.Among 359 DEGs conserved across all developmental stages,six candidate genes were strongly associated with myocardial development.Reverse transcription-quantitative real-time polymerase chain reaction(RT-qPCR)confirmed a significant correlation between the expression of these candidate genes and myocardial development in porcine tissue.These findings establish a transcriptomic framework for porcine myocardial maturation and provide a molecular basis for advancing cardiac xenotransplantation.
基金funded by the European Union’s Horizon 2020 Research and Innovation Program under the Marie Sklodowska-Curie Grant Agreement(Grant No.101026104)by the National Natural Science Foundation of China(Grant No.U20A6004)in part by the State Key Laboratory of Precision Electronics Manufacturing Technology and Equipment(Grant No.JMDZ202314).
文摘In semiconductor precision packaging and other applications involving alignment of automated equipment,the nonlinear motion caused by structural characteristics and friction effects on torque-type rotating motion stages seriously affects output accuracy and stability.To solve this problem,the motion characteristics of a rotating stage and the mechanism by which friction nonlinearity influences accuracy are analyzed in detail.In addition,a compound control strategy based on a kinematic model and the Stribeck friction model is designed.A friction disturbance observer based on output position feedback is improved for simple parameter tuning.Finally,an experimental system is constructed to carry out validation tests,including identification of nonlinear characteristics and performance comparisons.The experimental results show that the linear tracking error of the torque-type rotating stage is less than 1.47µm after adoption of the proposed model-based composite control strategy,and the corresponding rotary angle deviation is less than 0.0153°.The linearity of output motion is increased to 97.59%and the error compensation effect is improved by 51.6%compared with the PID control method.The experimental results confirm that the analysis method adopted here and the proposed compensation strategy can effectively reduce frictional nonlinearity and improve motion accuracy.The proposed method can also be applied to other precision electromechanical systems.
基金the Obstetrics and Gynecology Hospital of Fudan University for supporting this project。
文摘Objectives A systematic review and network meta-analysis was conducted to evaluate the effectiveness of different childbirth positions in reducing the duration of the second stage of labor,providing evidence-based insights for obstetric institutions to guide interventions related to childbirth positions.Methods A comprehensive literature search was conducted in databases,including PubMed,Web of Science,the Cochrane Library,Embase,Wanfang Databases,China National Knowledge Infrastructure Databases(CNKI),China Science and Technology Journal Database(CSTJ),and China Biology Medicine disc(CBMdisc)to identify studies on the effectiveness of different childbirth positions in reducing the duration of the second stage of labor.The search included randomized controlled trials published from database inception to September 30,2024.The Cochrane risk-of-bias tool was used to assess the quality of the studies.Two independent reviewers screened the literature,extracted data,and evaluated study quality.Subsequently,a network meta-analysis was performed using STATA software.The study protocol has been registered in PROSPERO(CRD42023428217).Results This study analyzed data from 25 randomized controlled trials involving 9,844 women.The findings indicated that in comparison to lithotomy position,free position(MD=20.53,95%CI[11.38,29.68])and upright position(MD=−24.13,95%CI[−42.94,-5.32])were found to be superior in reducing the duration of the second stage of labor.Free position outperformed kneeling position(MD=21.48,95%CI[4.67,38.28])and squatting position(MD=23.43,95%CI[1.88,44.97]);upright position was superior to kneeling position(MD=−25.08,95%CI[−46.93,−3.22]);semirecumbent position surpassed squatting position(MD=19.71,95%CI[2.05,37.38]);and upright position was also superior to squatting position(MD=−27.03,95%CI[−51.48,−2.57]).According to the surface under the cumulative ranking curve(SUCRA),the upright position emerged as the most effective for reducing the duration of the second stage of labor(87.4%),followed by free position(81.1%),semirecumbent position(70.0%),and lateral position(62.3%).Conclusion These findings offer valuable insights for midwifery practice and help inform future research directions.Considering the limitations of this review,more larger-scale,multicenter randomized controlled trials are warranted to further evaluate the relative effectiveness of different childbirth positions in reducing the duration of the second stage of labor.
基金supported by the Natural Science Foundation Project of Inner Mongolia Autonomous Region(2024LHMS03017)Research Capacity Enhancement“Unveiling and Leading”Project of Inner Mongolia Forestry Science Research Institute(2024NLTS03).
文摘The rhizosphere bacteria play crucial roles in plant health and growth as they are involved in assimilating nutrients and resisting adverse conditions such as nutrient stress,drought,and wind erosion.Agriophyllum squarrosum(L.)Moq.is a pioneer plant used in sand fixation due to its strong resistance to drought and wind erosion.However,the bacterial community characteristics and ecological function in the rhizosphere of A.squarrosum are poorly understood.In this study,soil samples were collected from different developmental stages(seedling stage,vegetative stage,reproductive stage,and withering stage)of A.squarrosum.Illumina Miseq sequencing was used to detect differences in soil bacterial abundance.The Phylogenetic Investigation of Communities by Reconstruction of Unobserved States(PICRUSt)program was used to predict bacterial functions,and the relationships among bacteria,functional populations,and soil nutrients were examined using a heatmap analysis.The results showed that the Shannon and Sobs indices of rhizosphere bacteria were significantly higher during the reproductive stage than during the other stages.Pantoea sp.(7.03%)was the dominant genus during the seedling stage;Arthrobacter sp.was the dominant genus during the vegetative(13.94%),reproductive(7.57%),and withering(12.30%)stages.The relative abundances of Chloroflexi,Acidobacteria,and Gemmatimonadetes were significantly high during the reproductive stage.According to the PICRUSt analysis,membrane transport,signal transduction,and environmental adaptation of the bacterial functional population occurred during the seedling stage.Carbohydrate metabolism increased during the vegetative stage,while energy metabolism,lipid metabolism,and biosynthesis of other secondary metabolites of the bacterial functional population significantly increased during the reproductive stage.The abundances of bacterial communities,functional genes,and soil nutrients were synergistically altered during various developmental stages.Our findings suggest that the developmental stages of A.squarrosum play a significant role in defining the composition and structure of bacterial communities in the rhizosphere.The results will provide a basis for better prediction and understanding of soil bacterial metabolic potential and functions of A.squarrosum rhizosphere in sandy areas.
文摘BACKGROUNDColorectal cancer(CRC)typically progresses from benign colorectal polyps,whichrepresent a precursor to malignancy.Identifying the factors influencing thisprogression is crucial for early intervention and prevention.Although genetic andenvironmental factors have been widely studied,the role of lifestyle factors suchas physical activity,diet,smoking,sleep,and stress remains underexplored,especially in patients with early stage CRC or polyps.Recent evidence suggeststhat lifestyle behaviors may influence cancer progression by modulating inflammatorypathways,metabolic health,and immune function.For instance,highlevels of physical activity are linked to a reduced risk of CRC development,whereas poor dietary habits,smoking,and inadequate sleep have all beenimplicated in increased cancer risk and progression.Moreover,early-stage CRCpatients,who are often asymptomatic or have minimal symptoms,may particularlybenefit from lifestyle modifications to slow disease progression andimprove overall prognosis.The gap in understanding the specific influence ofthese lifestyle factors on colorectal polyps and early stage cancer progressionunderscores the need for comprehensive studies.By assessing several modifiablelifestyle factors and their association with disease progression,clinicians canidentify practical intervention points.These interventions could ultimately reducethe need for more aggressive treatments and improve the long-term outcomes inaffected patients.AIMTo investigate the association between lifestyle factors and disease progression inpatients with colorectal polyps and early stage cancer.METHODSIn this observational study conducted from January 2022 to December 2023,werecruited 120 patients with colorectal polyps or early stage cancer from Jiangshan People's Hospital.Lifestyle factors,including physical activity,dietary patterns,smoking status,sleep quality,andstress levels,were assessed using validated questionnaires.Disease progression was evaluated using standardizedfollow-up colonoscopies and pathological examinations.Cox proportional hazards models were used to analyzethe association between lifestyle factors and disease progression after adjusting for potential confounders.RESULTSDuring the median follow-up of 18.4 months,42(35.0%)patients experienced disease progression.High levels ofphysical activity were associated with reduced progression risk[adjusted hazard ratio(HR)0.55,95%confidenceinterval(CI):0.38-0.80,P=0.002]compared to low activity levels.High adherence to a healthy dietary patternshowed similar protective effects(adjusted HR 0.62,95%CI:0.43-0.89,P=0.009).Current smoking(adjusted HR1.92,95%CI:1.35-2.73,P<0.001)and poor sleep quality(adjusted HR 1.38,95%CI:1.05-1.82,P=0.021)wereassociated with increased progression risk.The impact of lifestyle factors was particularly pronounced in patientsyounger than 60 years and those with multiple polyps at baseline.CONCLUSIONThis study demonstrated significant associations between lifestyle factors and disease progression in colorectalpolyps and early stage cancer.Physical activity,dietary patterns,smoking status,and sleep quality have emergedas key modifiable factors influencing disease progression.These findings support the integration of lifestyleassessments and modifications in the clinical management of patients with colorectal neoplasia.
基金Supported by the Zhejiang Provincial Natural Science Foundation of China,No.LTGY24H160006Jiaxing Medical Key Discipline,No.2023-ZC-015.
文摘BACKGROUND Rectal cancer is one of the common digestive system malignant tumors around the world.Its early diagnosis and staging are crucial for rectal cancer treatment and prognosis.In recent years,tumor markers have gradually received attention in early screening,treatment monitoring and prognostic evaluation of cancer,but their predictive role in rectal cancer staging and differentiation is still unclear.AIM To assess the prognostic value of tumor markers alpha-fetoprotein(AFP)cancer antigen 72-4(CA72-4),carbohydrate antigen 19-9(CA19-9),and carcinoembryonic antigen(CEA),alongside multimodal magnetic resonance imaging(MRI),for staging and differentiating rectal cancer in patients.METHODS This study retrospectively analyzed 167 patients with rectal cancer who were treated at our institution from January 2020 to December 2024.Each patient underwent serological testing and multimodal MRI for diagnosis.Histopathological examination after surgical resection or imaging based on follow-up was used as the gold standard.According to the T stage and differentiation degree,patients were divided into low stage group(T1-T2)and high stage group(T3-T4).In addition,they were divided into low-differentiation groups and high-differentiation groups according to their differentiation degree.We compared the accuracy,sensitivity and specificity of tumor marker levels and MRI in rectal cancer stage and differentiation.RESULTS The study's findings indicate that in the context of rectal cancer T staging,there is substantial concordance between MRI and clinicopathological assessments,with a Kappa coefficient of 0.789(P<0.001).Similarly,for various degrees of tumor differentiation,MRI and clinicopathological evaluations demonstrated substantial agreement,with a Kappa coefficient of 0.651(P<0.001).Notably,the concentrations of tumor markers CA19-9,CA72-4,CEA,and AFP were significantly elevated in the T3-T4 stage compared to the T1-T2 stage.Furthermore,these markers were significantly higher in the low-differentiation group compared to the high-differentiation group(P<0.05).The combined use of tumor markers and MRI for preoperative T staging of rectal cancer yielded a diagnostic sensitivity of 93.7%and a specificity of 94.6%,as evidenced by the receiver operating characteristic analysis,with an area under the curve of 0.947.For tumor differentiation,the diagnostic sensitivity and specificity were 93.6%and 97.1%,respectively,with an area under the curve of 0.978(95%confidence interval:0.946-1.000),surpassing the accuracy of individual detection methods.CONCLUSION The CA19-9,CA72-4,CEA and AFP tumor markers combined with multimodal MRI have high sensitivity and specificity in diagnosing rectal cancer stage and differentiation.Their diagnostic efficacy is significantly better than that of single tests,which can effectively improve the predictive ability of rectal cancer stage and differentiation,provide a more reliable diagnostic reference for clinical practice,and have important clinical significance.
