Long-term Survival, Quality of Life, and Molecular Features of the Patients With Solid Pseudopapillary Neoplasm of the Pancreas: A Retrospective Study of 454 Cases.

OBJECTIVE: To present comprehensive information on the clinicopathological, molecular, survival characteristics, and quality of life (QOL) after surgery for solid pseudopapillary neoplasm (SPN) of the pancreas in a large cohort after long-term follow-up. BACKGROUND: SPN is a rare tumor with an uncertain malignant potential, and solid information on long-term prognosis and QOL remains limited. METHODS: All hospitalized patients with SPNs who underwent surgery between 2001 and 2021 at the Peking Union Medical College Hospital were retrospectively reviewed. The clinicopathological characteristics of the patients were retrieved. A cross-sectional telephone questionnaire was administered to inquire about the QOL. Molecular analyses were performed using whole-exome sequencing. RESULTS: Exactly 454 patients with SPN were enrolled, of whom 18.5% were males and 81.5% were females. The mean patient age was 31 ± 12 years. In total, 61.3% of the patients had no symptoms. The size of the tumors was 5.38 ± 3.70 cm; 83.4% were solid cystic tumors, and 40.1% had calcifications. The proportions of local resection, distal pancreatectomy with or without splenectomy, and pancreaticoduodenectomy with or without pylorus preservation were 29.7%, 28.9% or 22.9%, and 11% or 6.8%, respectively. Over the years, there has been a significant shift from open to minimally invasive surgery. Among all surgical procedures, pylorus-preserving pancreaticoduodenectomy (PPPD) had the highest incidence of grade 2 to 4 complications (up to 32.3%), compared with 6.7% in distal pancreatectomy ( P < 0.001). Regarding histopathology, tissue invasion, perineural invasion, cancerous microvascular emboli, lymph node metastasis, and distant metastasis were present in 16.5%, 2.2%, 0.7%, 2.0%, and 3.1% of patients, respectively. Sixty patients were lost to follow-up. Sixteen of the 390 patients who underwent resection (4.1%) experienced local recurrence or distant metastasis after surgery. In total, 361 patients responded to the telephone survey. Nearly 80% of patients claimed their QOL was not significantly affected after surgery; however, the remaining 20% complained of lower QOL during 3 to 6 years of follow-up after surgery. No clinicopathological factor could reliably predict clinical recurrence or metastasis after resection. A total of 28 driver genes were detected with mutations in at least 2 tumor samples and the top 3 frequently mutated genes were CTNNB1 , ATRNL1 , and MUC16 . CONCLUSIONS: This study presented the largest cohort of patients with SPN after surgery from a single center and reported the QOL of these patients. SPN is associated with extremely favorable long-term survival, even in patients with metastasis, and most patients have a good QOL after surgery.

Revealing Long-Term Indoor Air Quality Prediction: An Intelligent Informer-Based Approach.

Indoor air pollution is an urgent issue, posing a significant threat to the health of indoor workers and residents. Individuals engaged in indoor occupations typically spend an average of around 21 h per day in enclosed spaces, while residents spend approximately 13 h indoors on average. Accurately predicting indoor air quality is crucial for the well-being of indoor workers and frequent home dwellers. Despite the development of numerous methods for indoor air quality prediction, the task remains challenging, especially under constraints of limited air quality data collection points. To address this issue, we propose a neural network capable of capturing time dependencies and correlations among data indicators, which integrates the informer model with a data-correlation feature extractor based on MLP. In the experiments of this study, we employ the Informer model to predict indoor air quality in an industrial park in Changsha, Hunan Province, China. The model utilizes indoor and outdoor temperature, humidity, and outdoor particulate matter (PM) values to forecast future indoor particle levels. Experimental results demonstrate the superiority of the Informer model over other methods for both long-term and short-term indoor air quality predictions. The model we propose holds significant implications for safeguarding personal health and well-being, as well as advancing indoor air quality management practices.

Does Welfare Receipt Change Consumption on Health among Older Families? The Case of China.

Population aging has been occurring rapidly in China. It raises the issue of unmet needs of health-related consumption among older families. Using data from the China Health and Retirement Longitudinal Study and a propensity score matching method, this article examines whether welfare receipt is associated with changed consumption patterns among older families (i.e., main respondent was 60 years old or older or whose spouse was 60 years old or older if married). We found that welfare receipt was significantly associated with increased health expenditures of older families in rural but not in urban China. In neither area did it affect these families' spending to meet daily survival needs such as food and clothing. For rural older families, welfare receipt was associated with increased expenditures on informal health care. It also enabled less vulnerable households to have more self-treatment expenses. However, welfare receipt did not boost expenditures on clinic and hospital visits for either rural or urban families.

Dopamine improves chemotherapeutic efficacy for pancreatic cancer by regulating macrophage-derived inflammations.

Pancreatic cancer is an inflammatory malignancy, and tumor-associated macrophages (TAMs) are the predominant inflammatory cells in tumor tissue. TAMs have complicated interactions with pancreatic cancer cells, however, the details and mechanisms remain largely unknown. In this study, transcriptomics and proteomics analyses were performed to explore the interactions between murine pancreatic cancer cells and TAMs. Dopamine (DA) has been reported to suppress inflammations. However, its roles in TAMs of pancreatic cancer have not been reported. Herein, the roles and mechanisms of DA to affect the chemotherapeutic efficacy for pancreatic cancer were studied. Multi-omics results revealed that there was a tumor-promoting vicious cycle involving murine pancreatic cancer cells and TAMs. DA substantially improved the chemotherapeutic efficacy both in vitro study and in immunocompetent murine pancreatic cancer models by suppression of the M2 characters of TAMs. Further studies found that activation of DRD4 by DA led to the decrease of cAMP, and then inhibited the activation of PKA/p38 signal pathway, which suppressed the tumor-promoting inflammation of TAMs. This study uncovers the reciprocal interactions between TAMs and pancreatic cancer cells using multi-omics techniques and presents that DA has synergistic roles with chemotherapy for pancreatic cancer by suppressing of TAM-derived inflammations.

Upregulated CD58 is associated with clinicopathological characteristics and poor prognosis of patients with pancreatic ductal adenocarcinoma.

BACKGROUND: CD58 has been demonstrated to be abnormally expressed in multiple hematopoietic malignancies and solid tumors and plays an essential role in tumorigenesis and progression; however, its clinical significance and prognostic value in pancreatic ductal adenocarcinoma (PDAC) remain unknown. METHODS: Based on diverse online public databases and 81 PDAC samples of tissue microarray-based immunohistochemistry (IHC), we evaluated CD58 expression in PDAC patients and analyzed its association with clinicopathological characteristics, clinical outcomes, and infiltration of immune cells in PDAC. Furthermore, the correlation between CD58 and the cancer stem cell (CSC)-related, epithelial-mesenchymal transition (EMT)-related, and immune-related markers were detected. Besides, the functional enrichment analysis and related pathways were analyzed and visualized. RESULTS: CD58 expression was elevated in pancreatitis and PDAC tissues than normal pancreas or adjacent nontumor tissues. The positive cases of CD58 (e.g. more than 50% positive cells) in PDAC account for 95.06% (77/81). Upregulated CD58 in cancer tissues was associated with worse histological grade, larger tumor size, and poorer overall survival and disease-free survival in PDAC patients. Furthermore, Cox multivariate regression analysis revealed that CD58 was an independent prognostic factor in PDAC. CD58 expression was correlated with infiltrations of neutrophils, CD8+ T cells, and dendritic cells (DCs). In addition, correlation gene analysis indicated that CD58 expression was strongly correlated with immune-related, EMT-related, and CSC-related markers. Functional enrichment analysis and KEGG pathway manifested that CD58 might be involved in PDAC initiation and progression. CONCLUSIONS: CD58 expression is upregulated in PDAC tissues and its high expression is notably related to poor survival of PDAC. Therefore, CD58 may serve as a novel and effective marker for predicting the prognosis of PDAC patients.

Immune subtyping for pancreatic cancer with implication in clinical outcomes and improving immunotherapy.

BACKGROUND: Emerging evidence has shown that intra-tumor immune features are associated with response to immune checkpoint blockade (ICB) therapy. Accordingly, patient stratification is needed for identifying target patients and designing strategies to improve the efficacy of ICB therapy. We aimed to depict the specific immune features of patients with pancreatic cancer and explore the implication of immune diversity in prognostic prediction and individualized immunotherapy. METHODS: From transcriptional profiles of 383 tumor samples in TCGA, ICGC, and GEO database, robust immune subtypes which had different response immunotherapy, including ICB therapy, were identified by consensus clustering with five gene modules. DEGs analysis and tumor microarray were used to screen and demonstrate potential targets for improving ICB therapy. RESULTS: Three subtypes of pancreatic cancer, namely cluster 1-3 (C1-C3), characterized with distinct immune features and prognosis, were generated. Of that, subtype C1 was an immune-cold type in lack of immune regulators, subtype C2, with an immunosuppression-dominated phenotype characterized by robust TGFß signaling and stromal reaction, showed the worst prognosis, subtype C3 was an immune-hot type, with massive immune cell infiltration and in abundance of immune regulators. The disparity of immune features uncovered the discrepant applicability of anti-PD-1/PD-L1 therapy and potential sensitivity to other alternative immunotherapy for each subtype. Patients in C3 were more suitable for anti-PD-1/PD-L1 therapy, while patients in the other two clusters may need combined strategies targeted on other immune checkpoints or oncogenic pathways. A promising target for improving anti-PD-1/PD-L1 treatment, TGM2, was screened out and its role in the regulation of PD-L1 was investigated for the first time. CONCLUSION: Collectively, immune features of pancreatic cancer contribute to distinct immunosuppressive mechanisms that are responsible for individualized immunotherapy. Despite pancreatic cancer being considered as a poor immunogenic cancer type, the derived immune subtypes may have implications in tailored designing of immunotherapy for the patients. TGM2 has potential synergistic roles with ICB therapy.

Does Participating in New Rural Cooperative Medical Insurance Change Catastrophic Health Expenditure? Evidence from the China Household Income Project.

A primary goal of the New Rural Cooperative Medical Insurance (NRCMI) is to provide financial protection against health care costs and alleviate the financial burdens of rural residents in China. This article examines whether NRCMI participation impacted the incidence of catastrophic health expenditure (CHE) among middle-aged and older adults (45 years old and above). The analysis utilized data from the 2007 China Household Income Project survey in rural areas and an instrumental variable estimation method in Anhui and Sichuan provinces, which exhibited heterogeneity in the NRCMI implementation schedule. The results show that NRCMI participation was not associated with changes in the CHE incidence among families. The finding is consistent with the prior literature using quasi-experimental study designs. This study provides empirical evidence for policymakers, highlighting that the impact of NRCMI participation on financial protections is limited despite its extensive population coverage. The limited effects are probably due to the low reimbursement rate and increased utilization of expensive health care services.

Cryptogenic Multifocal Ulcerating Stenosing Enteropathy: A Rare Case of Small Bowel Stenosis.

BACKGROUND Cryptogenic multifocal ulcerating stenosing enteropathy (CMUSE) is a rare noninfectious chronic inflammatory disease of the digestive tract confined to the small bowel. Chronic inflammatory wasting leads to protein loss and weight reduction, and some patients eventually develop small bowel stenosis. The etiopathogenesis of CMUSE remains unknown. CASE REPORT A thin 62-year-old man was admitted to the hospital with abdominal pain and distension accompanied by bilateral lower-extremity edema for 2 months. After a series of medical tests, rheumatic or immune-related diseases, hyperthyroidism, and tuberculosis were excluded, and common digestive system diseases were also excluded. Abdominal CT showed incomplete obstruction of the small bowel. Enteroscopy showed small-bowel luminal narrowing. The patient subsequently underwent partial resection of the small bowel with end-to-side anastomosis. The small-bowel stricture was about 120 cm from the ileocecal junction, and about 12 cm of small bowel was resected. Postoperative pathology of the resected material revealed multifocal ulceration of the mucosa with massive inflammatory cell infiltration and extensive hyperplastic fibrous tissue, consistent with the characteristics of CMUSE disease. At follow-up 6 months after surgery, he had no abdominal pain or distension, and his anemia and lower-extremity edema were improved. CONCLUSIONS CMUSE diagnosis requires a combination of patient history, imaging, endoscopy, pathology, and exclusion of other digestive disorders, such as Crohn's disease. It is a chronic wasting disease, often accompanied by weight loss, abdominal pain, melena, and hypoproteinemia. Surgery is an important treatment for intestinal strictures caused by CMUSE.

Case Report of Overlapping Pyloric Obstruction Due to Dichlorvos Poisoning and Cholelithiasis with Choledocholithiasis.

BACKGROUND Pyloric obstruction after dichlorvos poisoning causes repeated vomiting and inability to eat. Choledocholithiasis and cholelithiasis are the common digestive diseases, with high morbidity and relapse in elderly patients. However, the complex situation of these diseases' coexistence is a clinically intractable problem, and literature on selecting optimal surgical planning is scarce. CASE REPORT A thin 79-year-old woman took dichlorvos due to family conflicts. She improved after being urgently sent to local hospital for gastric lavage and detoxification. Over the next 3 months, she presented with intermittent nausea, vomiting, epigastric pain, and mental apathy, and was readmitted. Gastroscopy showed extensive scarring in the antrum, pyloric obstruction, and gastric retention. Magnetic resonance cholangiopancreatography revealed gallstones and choledocholithiasis. Also, she presented with gastric retention, hypertension, moderate anemia, hypoproteinemia, and electrolyte disturbances. After hospitalization, conservative treatment was performed, without improving vomiting, followed by surgical treatment. Gastrojejunostomy, Braun anastomosis, and nasojejunal feeding tube placement were performed for pyloric stenosis; cholecystectomy for cholelithiasis; and choledochotomy, intraoperative choledochoscopy examination, basket stone extraction, and primary suture of common bile duct without indwelling T tube for choledocholithiasis. Patient recovered and was discharged 9 days after surgery. She was recovered well, without vomiting, at 2-month follow-up. CONCLUSIONS Gastrojejunostomy plus Braun anastomosis is effective treatment of elderly patients with pyloric obstruction formed after pesticide-induced corrosion. Careful selection of choledocholithotomy with primary suture without indwelling T tube reduced postoperative pain and accelerated recovery. This complex case of pyloric obstruction with gallbladder and bile duct stones provides useful considerations for clinical treatment.

Body Mass and Foot-dominance Disparities in the Foot Plantar Pressure Parameters of Older Women.

OBJECTIVES: To examine the effects of foot dominance and body mass on foot plantar pressures in older women of regular, overweight, and obese weights. METHODS: 96 female adults were divided into regular-weight group (68.30 ± 4.19 yr), overweight group (69.88 ± 3.76 yr), and obesity group (68.47 ± 3.67 yr) based on their body mass index scores. Footscan® plantar pressure test system was used to assess the dynamic plantar pressures, and parameters were collected from risk analysis, foot axis analysis, single foot timing analysis, and pressure analysis. RESULTS: (1) The local risks of lateral forefoot and midfoot, the minimum and maximum subtalar joint angles, the flexibility of subtalar joint, foot flat phase, as well as the average pressures on toes, metatarsals,, midfoot, and lateral heel, with the peak pressures on toe 2-5, metatarsal 2, metatarsal 5, midfoot, and lateral heel had significant within-subject differences. (2) The phases of initial contact and foot flat, the average pressures on toe 2-5, metatarsals, midfoot, and heels, with the peak pressures on metatarsal 1-4, midfoot, and heels exhibited significant between-subjects differences. (3) There was an interaction effect of foot dominance and body mass index on the flexibility of subtalar joint. CONCLUSIONS: The non-dominant foot works better for stability, especially when touching on and off the ground. The dominant foot works better for propulsion but is more susceptible to pain, injury, and falls. For obese older women, the forefoot and midfoot are primarily responsible for maintaining stability, but the lateral midfoot and hindfoot are more prone to pain and discomfort.

Modulating ferroptosis sensitivity: environmental and cellular targets within the tumor microenvironment.

Ferroptosis, a novel form of cell death triggered by iron-dependent phospholipid peroxidation, presents significant therapeutic potential across diverse cancer types. Central to cellular metabolism, the metabolic pathways associated with ferroptosis are discernible in both cancerous and immune cells. This review begins by delving into the intricate reciprocal regulation of ferroptosis between cancer and immune cells. It subsequently details how factors within the tumor microenvironment (TME) such as nutrient scarcity, hypoxia, and cellular density modulate ferroptosis sensitivity. We conclude by offering a comprehensive examination of distinct immunophenotypes and environmental and metabolic targets geared towards enhancing ferroptosis responsiveness within the TME. In sum, tailoring precise ferroptosis interventions and combination strategies to suit the unique TME of specific cancers may herald improved patient outcomes.

Influence of motor capacity of the lower extremity and mobility performance on foot plantar pressures in community-dwelling older women.

Objectives: To investigate the associations of motor capacity of the lower extremity and mobility performance in daily physical activities with peak foot plantar pressures during walking among older women. Methods: Using the data collected among 58 community-dwelling older women (68.66 ± 3.85 years), Pearson correlation and multiple linear regression analyses were performed to analyze the associations of motor capacity of the lower extremity (the 30-s chair stand test, the timed one-leg stance with eyes closed, and the Fugl-Meyer assessment of lower extremity), mobility performance in daily physical activities (the average minutes of moderate to vigorous physical activity every day and the metabolic equivalents), and foot plantar pressures (peak force and peak pressure) with the age and body fat percentage as covariates. Results: (1) The motor capacity of the lower extremity has higher explanatory power for peak foot plantar pressures compared with the mobility performance in daily physical activities. (2) Higher body fat percentage was positively associated with peak force and pressure, while a lower score on the Fugl-Meyer assessment of lower extremity was negatively associated with both of them. (3) The metabolic equivalents were positively associated with the peak force, while the 30-s chair stand test was negatively associated with it. Conclusions: Mobility performance in daily physical activities can be significant predictors for peak foot plantar pressures among older women. The significant predictor variables include the Fugl-Meyer assessment of lower extremity, the 30-s chair stand test, and metabolic equivalents.

Fate and potential ecological risk of rare earth elements in 3000-year reclaimed soil chronosequences.

The introduction of anthropogenic inputs into natural systems may lead to enduring alterations in the innate characteristics of Rare Earth Elements (REEs). Against this backdrop, the evolutionary processes and environmental drivers of REEs in soil remain uncertain. A 3000-year soil chronosequence with uniform parent material was established in reclaimed farmland along the Yangtze River, reconstructing, for the first time, the dynamic processes of REE accumulation and fractionation over a long-time scale. Analysis of 122 soil samples showed REE concentrations ranging from 146.00 to 216.56 µg/g. Based on reclamation duration, three significant stages of REE evolution were identified: natural leaching, rapid accumulation, and stable accumulation with differentiation. Reclaimed soil after 3000 years exhibited a 14.1 % increase in REE concentrations compared to fresh sediments, attributed to anthro -pedogenic processes. Moreover, Heavy Rare Earth Elements (HREEs) accumulated faster than Light Rare Earth Elements (LREEs), particularly in deeper soils (60-100 cm), where HREE concentrations rose by 34.3 %, mainly due to acidic environments promoting HREE fixation. Additionally, the potential ecological risk posed by REEs heightened with reclamation duration, with HREEs exhibiting a sensitivity of 83 % to 94 %. Our findings stress the urgency of carefully monitoring exogenous REEs introduced through anthropogenic activities, particularly HREEs.

[Soil Carbon Pool Allocation Dynamics During Soil Development in the Lower Yangtze River Alluvial Plain].

The allocation dynamics of soil carbon pools during soil development and land use are the key to revealing the carbon cycle process. To clarify the distribution of the soil carbon pool and its change trend, a soil reclamation chronosequence (0 a, 60 a, 160 a, 280 a, 1 000 a, and 1 500 a reclamation) was established in a typical alluvial plain in the Lower Yangtze River, and the content and density of soil organic carbon (SOC), soil inorganic carbon (SIC), particulate organic carbon (POC), and mineral-associated organic carbon (MAOC), along with carbon sequestration potential (CSP) indicators of topsoil under different land use types were measured and analyzed. The results showed that after approximately 1 500 a reclamation, the SOC content developed from the Yangtze River alluvial deposits generally increased by 4.9% after the initial decline, whereas the SIC content decreased to 0.2% from 25.8% of the total carbon content due to its rapid leaching. The MAOC content was normally higher than that of POC, and MAOC was contributing 48.0%-79.7% of the SOC accumulation. In this region, the soil organic carbon density (SOCD) accounted for 57.4%-100% of the total carbon density, the soil carbon sequestration levels (CSL) ranged from 18.6% to 56.1%, and CSP under paddy-dryland rotation increased by 20.8% compared to that under dryland. The C/N ratio and total nitrogen content are key factors in explaining soil carbon accumulation processes, and the reclamation year plays an important role in evaluating soil carbon sequestration levels. After long-term utilization, the cultivated soil in the Yangtze River floodplain must be carefully managed through balanced fertilization to maintain soil productivity, promote the accumulation of SOC, and avoid the decline in soil carbon sequestration capacity.

Pancreatic Cancer Cell-derived Migrasomes Promote Cancer Progression by Fostering an Immunosuppressive Tumor Microenvironment.

Pancreatic cancer is distinguished by an immunosuppressive tumor microenvironment (TME) that facilitates cancer progression. The assembly of the TME involves numerous contributing factors. Migrasomes, recently identified as cellular organelles in migrating cells, play a pivotal role in intercellular signaling. However, research into their involvement in cancers remains nascent. Thus far, whether pancreatic cancer cells generate migrasomes and their potential role in TME formation remains unexplored. In this study, it was found that both murine and human pancreatic cancer cells could indeed generate migrasomes, termed pancreatic cancer cell-derived migrasomes (PCDMs), which actively promote cancer progression. Moreover, utilizing chemokine antibody arrays and quantitative mass spectrometry analysis, we observed significant differences between the chemokines, cytokines, and proteins present in PCDMs compared to their originating cell bodies. Notably, PCDMs exhibited an enrichment of immunosuppression-inducing factors. Furthermore, macrophages could directly uptake PCDMs, leading to the expression of high levels of M2-like markers and secretion of tumor-promoting factors. PCDM-induced macrophages played a pivotal role in inhibiting T cell proliferation and activation partially through ARG-1. In summary, this study provides compelling evidence that pancreatic cancer cells generate migrasomes, which play a crucial role in promoting tumor progression by contributing to an immunosuppressive TME. The exploration of migrasomes as a therapeutic target could pave the way for the development of tailored immunotherapies for pancreatic cancer.

Geochemical behavior and source analysis of rare earth elements in intensive agriculture soils through high-resolution sampling.

Rare Earth Elements (REEs) are crucial for a low-carbon economy but overuse pollutes ecosystems. Studying their behavior and source in agricultural soils provides vital insights for soil management. To address this, we collected an extensive dataset comprising 2901 topsoil and 733 subsoil samples from an agriculturally dominant region in eastern China, characterized by uniform parent material. This comprehensive dataset enabled a thorough examination of the geochemical behavior and sources of REEs in the region. Our findings revealed the feasibility of utilizing La, Ce, and Y to predict ΣREE, LREE, HREE, and LREE/HREE ratios, thereby enhancing the REEs database for eastern China. The average ΣREE concentration in the study area measured 193.0 µg/g, with LREEs constituting 89 % of this total, representing a slight enrichment relative to the Upper Continental Crust. Notably, the electron-donating ability of Ce exhibited a correlation with Mn, indicating its potential as an indicator of redox reactions. The results obtained through structural equation modeling and random forest analysis identified Al, Ti, and K as the most influential environmental factors affecting ΣREE concentrations. Additionally, the indirect impact of K on ΣREE through pH was established. The strong correlation observed between major elements and Heavy Rare Earth Elements (HREEs) shed light on the mechanisms responsible for the notable fractionation of REEs in topsoil. Furthermore, our investigation underscored the substantial influence of pedogenetic processes on the enrichment and leaching of REEs. Source analysis pinpointed significant contributors to REEs, including fertilizers, pesticides, domestic wastewater, coal fly ash, and the native soil parent material. In conclusion, our study emphasizes the pressing need for judicious control of anthropogenic REE inputs. This step is pivotal not only for ensuring the sustainable utilization of soil but also for ultimately safeguarding ecosystems and environmental quality.

Meta-analysis of exercise intervention on health behaviors in middle-aged and older adults.

Objective: To systematically review and analyze the effects of exercise interventions on health behavior among middle-aged and older adults. Methods: A Meta-analysis was performed using NoteExpress software to screen randomized controlled trials (RCTs) published between January 1, 2000, and March 31, 2023, which were identified through databases including CNKI, Web of Science, Pubmed, and 6 more sources, based on predefined literature inclusion criteria. Following the quality assessment, we conducted both the overall and subgroup Meta-analyses of the exercise intervention moderator variables using Review Manager 5.4.1 software, encompassing data among the 18 RCTs. The effect size was measured as the standardized mean difference within its corresponding 95% confidence interval. Heterogeneity was assessed using the I2 metrics. Results: (1) The overall results indicate a significant impact of exercise intervention on health behaviors, characterized by a large effect size [SMD = 1.02 > 0.8, 95% CI (0.73, 1.32), P < 0.001]. (2) The highest degree of heterogeneity in the relationship between exercise interventions and health behaviors was associated with the duration of one exercise session (I2= 71.2%), which was the most influential moderator variable. (3) The aerobic and resistance intervention in group exercise lasting 30-60 min per time a day, 6-7 times per week over a period of 8-12 weeks demonstrated the most substantial effect size. Conclusion: (1) The exercise intervention significantly promotes the health behavior in middle-aged and older adults, emphasizing the importance of carefully considering the duration of individual exercise sessions when designing and implementing exercise intervention. (2) Considering the accessibility for middle-aged and older adults, the optimal exercise intervention should include the means of group practice, the types of aerobic and resistance exercise, with a duration of 30-60 min per time a day, beginning with a lower weekly frequency and gradually increase to 6-7 times per week, and lasting for 8 to 12 weeks. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42024506750.

Cell diversity and immune infiltration in the parathyroid tumour microenvironment.

Tumour microenvironment has been recognized as a crucial factor influencing disease progression. However, relevant features and functions are insufficiently understood in parathyroid neoplasia. Single-cell RNA sequencing was performed to profile the transcriptome of 27,251 cells from 4 parathyroid adenoma (PA) tissue samples. External transcriptomic datasets and immunofluorescence staining of a tissue microarray were set for expression validation. Eight major cell types and various subpopulations were finely identified in PA. We found that a subcluster of tumour endocrine cells with low copy number variation probably presented as a resting state. Diverse infiltrating immune cell subtypes were identified, constructing an immunosuppressive microenvironment. Tumour-associated macrophages, which indicated an anti-inflammatory phenotype, were significantly increased in PA. Inflammatory tumour-associated fibroblasts (iTAFs) were newly verified and highlighted on the role of stromal-immune crosstalk. Positive correlation between iTAFs and increased CD163+ macrophages was uncovered. Moreover, CXCL12 receptor signalling is important for tumour angiogenesis and immune infiltration. Our findings provide a comprehensive landscape interpreting tumour cell heterogeneity, cell diversity, and immune regulation in parathyroid neoplasia. The valuable resources may promote the understanding of parathyroid tumour microenvironment.

Prediction of the Old-Age Dependency Ratio in Chinese Cities Using DMSP/OLS Nighttime Light Data.

The old-age dependency ratio (ODR) is an important indicator reflecting the degree of a regional population's aging. In the context of aging, this study provides a timely and effective method for predicting the ODR in Chinese cities. Using the provincial ODR from the Seventh National Population Census and Defense Meteorological Satellite Program/Operational Linescan System (DMSP/OLS) nighttime light data, this study aims to predict and analyze the spatial correlation of the municipal ODR in Chinese cities. First, the prediction model of the ODR was established with curve regression. Second, the spatial structure of the municipal ODR was investigated using the Moran's I method. The experimental results show the following: (1) the correlation between the sum of the nighttime light and ODR is greater than the mean of nighttime light in the study areas; (2) the Sigmoid model fits better than other regression models using the provincial ODR in the past ten years; and (3) there exists an obvious spatial agglomeration and dependence on the municipal ODR. The findings indicate that it is reasonable to use nighttime light data to predict the municipal ODR in large and medium-sized cities. Our approach can provide support for future regional censuses and spatial simulations.

Comprehensive analysis of mixed neuroendocrine non-neuroendocrine neoplasms (MiNENs): A SEER database analysis of 767 cases.

Background: Mixed neuroendocrine non-neuroendocrine neoplasm (MiNEN) is an extremely rare entity, consisting of neuroendocrine and non-neuroendocrine components. It can occur in various organs throughout the body, with a rising incidence. Its clinical management is a rapidly growing field of interest; however, large-scale patient cohorts are still missing to guide clinical practice. Patients and methods: The demographic, clinicopathological, and survival information of all patients diagnosed with MiNEN in the national Surveillance, Epidemiology, and End Results (SEER) program database (2000-2017) were extracted and further analyzed. The information of the patients before and after 2010 was compared to understand the epidemiological changes of MiNEN. The characteristics of MiNEN originating in different organs were compared. The clinical significance of surgical resection for metastatic MiNENs was also analyzed. Results: A total of 1081 patients were screened, and after applying the exclusion criteria, 767 patients were finally analyzed. There was no obvious sex preference (49.2% vs 50.8%, p>0.05) and the majority of the patients were Caucasians (n=627, 81.7%). A total of 88.3% of the patients were older than 50 years old, and the median age was 60 years. 79.3% of the tumors are located in the distal digestive tract, and 67.7% were grade 3/4. Distant metastasis was presented in 33.9% of the patients at diagnosis. A total of 88% of the patients underwent surgical treatments. The number of patients increased 10-fold between 2000 and 2017. There was no significant difference in sex, race, stage, or surgical treatments among the patients diagnosed before and after 2010. More patients older than 60 years were diagnosed after 2010 (p=0.009). The median survival was 61.0 ± 9.8 months for the whole cohort. After multivariate analysis, older age (>60 years, p<0.01), more advanced stage (p<0.01), grade 3/4 (p<0.01), and non-surgical treatment (p<0.01) were independent risk factors for poorer survival. The appendiceal MiNENs showed the best prognosis. A total of 260 metastatic MiNENs were further analyzed. Only patients with metastatic MiNENs originating from the appendix had a potential benefit from surgical resection, compared to other sites (p=0.05). Conclusion: This study provides the epidemiological, clinicopathological, and survival information of the largest number of MiNEN patients. Although MiNEN is an extremely rare malignant neoplasm, its incidence increases rapidly. The majority of the patients suffered from advanced-stage disease, which highlights the need for improvement of early detection in the future. The appendix is the most common primary site of MiNEN, and surgical resection for selected metastatic MiNEN originating in the appendix has favorable survival outcomes.