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Background: Metastatic colorectal cancer (mCRC) poses a clinical challenge and requires a combination of systemic therapy and conversion surgery. Although first-line chemotherapy and targeted therapy are considered the standard treatments for mCRC, the role of primary tumor resection (PTR) in asymptomatic synchronous mCRC with unresectable metastatic lesion after initial therapy remains relatively underexplored. Materials: A retrospective review was conducted from January 2015 to January 2021, involving 74 patients with synchronous mCRC who received bevacizumab plus FOFIRI as first-line systemic therapy. All 74 patients had unresectable metastatic lesions confirmed through multidisciplinary team discussion. Patient characteristics, PTR data, and radiotherapy (RT) and overall survival (OS) outcomes were analyzed. The patients were categorized into a "PTR" group and a "No PTR" group and then further stratified into "4A," "4B," and "4C" subgroups based on the initial mCRC stage. Additionally, four subgroups—namely "PTR(+)/RT(+)," "PTR(+)/RT(−)," "PTR(−)/RT(+)," and "PTR(−)/RT(−)"—were formed to assess the combined effects of PTR and RT. Results: The median OS for all the patients was 23.8 months (20.5–27.1 months). The "PTR" group exhibited a significantly higher median OS of 25.9 months (21.3–30.5 months) compared with 21.4 months (15.8–27.1 months) in the "No PTR" group (p = 0.048). Subgroup analyses revealed a trend of improved survival with PTR in patients with stage IVA and IVB; however, the results were not statistically significant (p = 0.116 and 0.493, respectively). A subgroup analysis of PTR and RT combinations revealed no significant difference in median OS rates. Conclusion: For asymptomatic mCRC with synchronous unresectable distant metastasis, PTR following first-line therapy with bevacizumab plus FOLFIRI may provide a potential survival benefit, particularly in stage IVA/IVB patients compared with stage IVC patients. Additionally, RT for primary tumor did not provide an additional OS benefit in mCRC with unresectable metastasis. A prospective randomized trial with a larger sample size is essential to further elucidate the role of PTR in this context. [ABSTRACT FROM AUTHOR]

The ultimate goal of energy education is to cultivate citizens with energy literacy, which in turn influences the energy preferences of the general public. Various aspects, such as teaching, practice, publicity, and participation, all profoundly impact the formation of energy literacy. This study reviews the role of energy education in educational policy-making, the operation of educational systems, the design of innovative energy industry environments, and public participation. Through a systematic review, this study integrates empirical research across various contexts and environments. The relevant topics of empirical research include 'energy education', 'energy literacy', 'energy preferences', 'energy education policy', 'operation of energy education systems', 'creation of a renewable energy industry environment', and 'public participation'. These studies indicate that energy education can enhance participants' awareness of energy through knowledge transfer, enabling them to adopt more effective energy solutions and cultivate citizens with energy literacy. Energy education not only shapes the public's energy literacy but also further influences energy preferences, which in turn can have profound effects on social interactions, market outcomes, and political and social systems. Finally, from the perspectives of 'educational shaping' and 'cultural shaping', the research explores the impact of energy education on the energy environment and people's values. The findings reveal that society gradually forms a consensus on energy through long-term interactions, establishing a unique energy culture that subsequently influences the direction and implementation of national energy policies. There exist interactive cycles between energy education and energy policy: energy education influences public energy preferences, while energy culture, in turn, affects policy formulation. [ABSTRACT FROM AUTHOR]

Oral submucous fibrosis (OSF), characterized by excessive collagen deposition by myofibroblasts, is often linked to Areca nuts consumption. Probiotics consumption has shown protective effects against fibrotic diseases, and recently, their metabolic byproducts, known as postbiotics, have demonstrated superior advantages over probiotics. However, studies on the therapeutic impact of postbiotics on OSF have been scarce. Therefore, this study aims to examine the effect of PostBio GK4, a postbiotic derived from Lactobacillus pentosus GK4 , on OSF and explore its underlying mechanisms. The cytotoxicity of GK4 in normal buccal mucosal fibroblasts (BMFs) and fibrotic BMFs (fBMFs) were assessed. Following this, we evaluated the effects of GK4 on collagen contraction, migratory, and wound healing capacities in arecoline-induced fibrotic BMFs. Next, Western blotting and ELISA were employed to assess GK4's impact on fibrosis-related proteins such as COL1A1, and α-SMA, as well as on TGF-β and Smad2/3 signaling pathway. Arecoline was shown to stimulate cell migratory, contractile and wound healing abilities as well as the expression of α-SMA and COL1A1 in BMFs. Treatment with GK4 reduced all arecoline-induced phenomena in BMFs. Moreover, GK4 diminished the increased expression of TGF-β and Smad2/3. Our findings proposed that GK4 may exert a suppressive effect on arecoline-induced myofibroblast activities via the inhibition of TGF-β and Smad2/3 signaling pathway. Therefore, GK4 holds promise as an adjunct therapeutic approach for intervening in OSF. Further in-vivo and clinical studies are warranted to validate these observations. [ABSTRACT FROM AUTHOR]

Regional higher education growth in non-federal states has not attracted much academic attention. This paper is one of the first attempts to explore China's latest higher education expansion and its systematic and regional impact from the perspective of multi-level governance. This article argues that the state had explicitly utilized the Commanding Heights Strategy to diffuse the higher education authority to sub-national level and promote regional growth. The Central authorities allowed the Ministry of Education establishing a vertical elite coalition to command the heights of tertiary institutional hierarchy and key resources for tertiary development. In addition, the state used both financial incentives and sectoral incentives to mobilize resources for regional expansion. The Commanding Heights Strategy shapes China's response to the higher education trilemma of costs, access, and quality. Under this strategy, the unprecedented tertiary expansion has expanded college access, but at the expense of affordability, quality, and a large and increasing regional variation.

Using global citizenship as the framework and guided by a phenomenological approach, this paper examines the experiences of overseas education on Chinese students studying in American high schools, and the mechanisms through which potential growth takes place. The data were collected from interviews with 15 Chinese students studying at American high schools and seven teacher participants who work closely with them. Findings reveal that international sojourning could potentially serve as an effective pathway to global citizenship because it may help international students develop global competencies (knowledge, understanding and skills), and global consciousness (values and attitudes). The paper argues that the process of growing into a global citizen may be viewed as an advanced level of student development, and the mechanisms through which this kind of ideal transformation takes place which were identified in this study include: having non-vanity motives, developing self-authorship, exposure to different perspectives, and experiencing disadvantages and deprivation.