[Outcome indicators in clinical trials on traditional Chinese medicine treatment of microvascular angina].

This study reviewed the current status of the use of outcome indicators in randomized controlled trial(RCT) on traditional Chinese medicine(TCM) treatment of microvascular angina(MVA) and analyzed the existing problems and possible solutions, aiming to provide a basis for the design of high-quality RCT and the establishment of core outcome sets for MVA. CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, Cochrane Library, Web of Science, and 2 clinical trial registries were searched for the RCT on TCM treatment of MVA according to pre-defined criteria. The Cochrane's risk of bias assessment tool was used to evaluate the methodological quality of the included RCT and the use of outcome indicators was summarized. A total of 69 RCTs were included, from which 100 outcome indicators were extracted, with the frequency of 430. The extracted outcome indicators belonged to 8 domains: response rate, symptoms and signs, physical and chemical examinations, TCM efficacy, safety, quality of life, economic evaluation, and long-term prognosis. The indicators of physical and chemical examinations were the most(70 indicators with the frequency of 211), followed by those of response rate(7 indicators with the frequency of 73) and symptoms and signs(7 indicators with the frequency of 54). The outcome indicators with higher frequency were adverse reactions, angina attack frequency, clinical efficacy, endothelin-1, total duration of treadmill exercise, and hypersensitive C-reactive protein. The RCT on TCM treatment of MVA had the following problems: irregular reporting of adverse reactions, diverse indicators with low frequency, lack of attention to the application of endpoint indicators, insufficient use of TCM differentiation and efficacy indicators, non-standard evaluation criteria and failure to reflect the basic characteristics of TCM. A unified MVA syndrome differentiation standard should be established, on the basis of which an MVA treatment efficacy evaluation system and core outcome indicator set that highlights the characteristics of TCM with patient-reported outcomes as the starting point should be established to improve the clinical research and research value.

Coupling coordination of new urbanization in Chinese urban agglomeration-characteristics and driving factors.

The coordinated development of new urbanization (NU) in urban agglomerations (UAs) is key for promoting sustainable urban development and the way to achieve Chinese-style modernization. Based on the mechanisms of coupling and coordination of NU, the internal subsystem coupling coordination of NU was deconstructed into five dimensions-economic, population, land, social, and ecological. Using 200 cities in 19 Chinese UAs areas, the spatio-temporal evolution characteristics of the coupling coordination degree of NU (CCDNU) were analyzed, and the driving factors were analyzed from both spatial spillover effect and stratification heterogeneity. The results are as follows: (1) CCDNU has increased from moderate disorder to barely coordinated, exhibiting a spatial distribution of a higher CCDNU in the east and lower CCDNU in the west with a positive global spatial autocorrelation feature; (2) economic drive, population concentration, spatial carrying capacity, and environmental quality play facilitating roles in the CCDNU of the study region, while the spatial carrying capacity, quality of life, and environmental quality inhibit the CCDNU of neighboring regions. From the decomposition of long- and short-term effects, both direct and indirect effects of driving factors were found to accumulate significantly over time. In addition, the model results were robust after replacing the geographic distance weight matrix and excluding the extreme values; (3) the spatial carrying capacity, population concentration, and economic drive are the dominant factors affecting the CCDNU in China. The dominant driving factors of are different in different regions. Meanwhile, the interaction detection shows that the interaction of each driver exhibits a two-factor enhancement or non-linear enhancement. Based on these results, corresponding policies are recommended.

Influencing factors of self-regulated learning of medical-related students in a traditional Chinese medical university: a cross-sectional study.

BACKGROUND: In recent years, self-regulated learning (SRL) has become a hot topic in medical education. However, the factors that affect the SRL ability of medical-related specialties, such as clinical medicine, traditional Chinese medicine (TCM), and nursing specialty in TCM colleges and universities are unclear. Whether the teaching of learning strategies can help improve students' SRL also needs to be further examined. METHOD: A cross-sectional survey was distributed, and 878 medical-related students who were from a TCM university were recruited for this study. Descriptive statistics illustrated the status quo of SRL and learning strategies, and an independent t-test and analysis of variance were used to analyze the factors associated with SRL. The relationship between SRL and learning strategies was analyzed with multi-linear regression analysis. RESULTS: The scores of SRL on learning motivation, learning setting, self-regulation, and total scores were 34.76 ± 4.62, 41.14 ± 4.30, 39.26 ± 4.74, and 115.16 ± 12.42, respectively. The metacognitive, emotion, cognitive, resource management and total scores of learning strategies were 58.54 ± 12.02, 43.24 ± 8.42, 35.49 ± 7.34, 22.89 ± 4.20, 160.16 ± 29.45, and the mean was all above the midpoint. Learning strategies were positively correlated with SRL (r = 0.421, P < 0.01). Some factors can predict 32% of the variation of SRL, including whether they liked their specialty, educational system, specialty, score ranking, scholarship, whether they were taught by a tutor in middle school, gender, monthly family income, the father's educational background, metacognitive strategy, resource management strategy, and cognitive strategy. CONCLUSIONS: The SRL of medical-related students was better. Learning strategies, as well as personal or social factors, can affect SRL. Educators should pay more attention to the cultivation of learning strategies, exercising learning skills, and monitoring, adjustment, and guidance of learning time. It should adopt various methods to improve the SRL of medical-related students according to the different factors.

Dietary assessment of ochratoxin A in Chinese dark tea and inhibitory effects of tea polyphenols on ochratoxigenic Aspergillus niger.

In recent years, there has been an increasingly heated debate on whether Chinese dark tea is contaminated with mycotoxins and whether it poses health risks to consumers. In this study, a rapid method based on high-performance liquid chromatography was used to detect ochratoxin A (OTA) in Chinese dark tea samples from different regions of China and different years. Of the 228 Chinese dark tea samples tested, 21 were detected for OTA contamination, with a concentration ranging from 2.51 ± 0.16 to 12.62 ± 0.72 µg/kg. Subsequently, a dark tea drinking risk assessment was conducted, and the hazard quotient for each group was far below the acceptable level of 1.0. Of the 12 Aspergillus spp. strains isolated, one strain of Aspergillus niger had the ability to produce OTA. We also found that tea polyphenols and epigallocatechin gallate inhibited the growth of ochratoxin-producing Aspergillus niger and the expression of non-ribosomal peptide synthetase (NRPS), a key gene for ochratoxin synthesis. Thus, OTA contamination of dark tea is at an acceptable risk level, and the inhibition of ochratoxigenic Aspergillus niger by polyphenols provides new insights into the safety of dark tea consumption.

Intermodel comparison for the radiological assessment of the Zapadnoe and Tessenderlo case studies with implications for selection of remediation strategy.

Risk assessment provides a key input for determining the need for and extent of remedial actions necessary for sites contaminated with naturally occurring radioactive material or nuclear legacy sites. The choice of a modelling approach for risk assessment, and the corresponding toolsets should fit the assessment context, taking account of the complexity, and be clearly related to the questions to be addressed in the decision-making process. One of the objectives of Working Group 1 of IAEA Modelling and Data for Radiological Impact Assessments II (MODARIA II) Programme is to perform intermodel comparisons for case studies of selected sites, in particular, to help illustrate the applicability of different models and approaches as inputs to decision-making processes. This intercomparison exercise, which included the analysis of potential consequences on the management strategy for contaminated sites, has been performed for two sites: The former uranium mill tailings facility at Zapadnoe, Ukraine, and the phosphate processing facility at Tessenderlo, Belgium. Several models and computer codes have been used for one or both of these cases: AMBER, GoldSim, NORM And LegacY Site Assessment, Preliminary Remediation Goals (PRG)-dose compliance concentration calculator, and RESRAD-OFFSITE. The assessments explore the implications of using differing assessment frameworks and assumptions, as well as alternative modelling tools, on model outputs and as input for corresponding decisions on remediation strategy. This paper reviews both similarities and differences in the results of assessments performed using these different models. It discusses how different approaches can complement one another to help build confidence in the evidence base underpinning decisions. It also discusses the appropriateness of the different modelling approaches in a given assessment context. In one of the case studies in particular (Tessenderlo case study), the remediation strategy is essentially driven by the contamination of the site with heavy metals, such as cadmium. This has significant consequences on the choice of the most adequate approaches and scenarios for assessing the radiological risk and balancing their relative importance with other impacts. The development of a holistic approach to risk assessment is, therefore, highlighted.

A Chinese Version of the Caring Dimensions Inventory: Reliability and Validity Assessment.

Caring is central to nursing practice. Chinese nurses take care for the health of about 20% of the world's population and their perception of caring is critical. However, until recently, instrument specifically designed to measure the caring of nurses in China was not found. Caring dimensions inventory (CDI) is one of the most frequently used instrument when measuring caring and is applicable to nurses from different cultures. The aim of this study is to test the validity and reliability of the Chinese version of the 25-item CDI. The English version of CDI was translated into Chinese according to the guidelines of the World Health Organization. Content validity was conducted among seven senior nurses from different institutions in different cities in China. A convenience sample of nurses from 11 cities in China was employed. Exploratory factor analysis and confirmatory factor analysis of the CDI was carried out using a sample of 880 nurses. The overall content validity index was 0.98. Three factors (Nurturance, Collaboration, Skill) were identified in exploratory factor analysis and were confirmed by confirmatory factor analysis. The three-factor solution explains 70.15% of the total variance. The Cronbach alpha for overall the CDI was 0.97. This study demonstrated that the Chinese version of the CDI showed satisfactory reliability and validity, indicating that it could be a useful measurement to assess nurses' perception of caring in China.

[Critical quality attribute assessment of big brand traditional Chinese medicine: visualization of blending process for rare medicines in Tongren Niuhuang Qingxin Pills based on spatial distribution uniformity].

The spatial distribution uniformity of valuable medicines is the critical quality attribute in the process control of Tongren Niuhuang Qingxin Pills. With the real world sample of the mixed end-point powder of Tongren Niuhuang Qingxin Pills as the research object, hyperspectral imaging technology was used to collect a total of 32 400 data points with a size of 180 pix×180 pix. Spectral angle matching(SAM), classical least squares and mixed tuned matched filtering(MTMF) were used to identify the spatial distribution of rare medicines. MTMF model showed higher identification accuracy, therefore the spatial distribution of the blended intermediates was identified based on the MTMF model. The histogram method was also used to evaluate the spatial distribution uniformity of rare medicines. The results showed that the standard deviation was 4.78, 6.5, 3.48, 1.96, and 3.00 respectively for artificial bezoar, artificial musk, Borneol, Antelope horn and Buffalo horn; the variance was 22.8, 42.3, 12.1, 3.82, and 9.00, and the skewness was 1.26, 1.71, 0.06,-0.86, and 1.04, respectively. The final results showed that the most even blending was achieved in concentrated powder of Borneol, Antelope horn and Buffalo horn, followed by artificial bezoar, and last artificial musk. A visualization method was established for quality attributes of distribution uniformity in blending process of Tongren Niuhuang Qingxin Pills. It could provide evidences of quality control methods in the mixing process of big brand traditional Chinese medicine.

[Critical quality attribute assessment of big brand traditional Chinese medicine: quality control of Tongren Niuhuang Qingxin Pills in texture and sensory attributes].

Texture sensory attributes are the key items in quality control of Chinese medicinal honeyed pills. The purpose of this study is to develop a quality control method for assessing the texture sensory attributes of Chinese medicinal honeyed pills based on real-world Tongren Niuhuang Qingxin pilular masses and finished products. First, parameters of texture profile analysis(TPA) were optimized through single factor and central composite design(CCD) experiments to establish a detection method for texture sensory attri-butes of Tongren Niuhuang Qingxin Pills. The results showed that the established detection method was stable and reliable, with the optimal parameters set up as follows: deformation percentage of 70%, detection speed at 30 mm·min~(-1), and interval time of 15 s. Furthermore, 540 data points yielded form six texture sensory attributes of pills from 30 batches were subjected to multivariate statistical process control(MSPC) with Hotelling T~2 and squared prediction error(SPE) control charts to establish the quality control method of Tongren Niuhuang Qingxin Pills. This study is expected to provide a reference for improving the quality control system of Chinese medicinal honeyed pills.

[Critical quality attribute assessment of big brand traditional Chinese medicine: quality control method of ginkgo leaves extract material based on powder physical properties].

The physical properties of ginkgo leaves extract(GLE) are the critical quality attributes for the control of the manufacturing process of ginkgo leaves preparations. In this study, 53 batches of GLE with different sources from the real world were used as the objects to carry out the research from 3 levels. First, based on micromeritics evaluation method, a total of 29 physical attribute quality parameters in five dimensions were comprehensively characterized, with a total of 1 537 data points. Further, with use of physical fingerprinting technology combined with similarity evaluation, the powder physical properties of 53 batches of GLE showed obvious differences from an overall perspective, and the similarity of the physical fingerprints was 0.876 to 1.000. Secondly, hierarchical clustering analysis(HCA) and principal component analysis(PCA) models were constructed to realize the reliable identification and differentiation of real-world materials produced by GLE from different sources. Multivariate statistical process control(MSPC) model was used to create GLE material Hotelling T~2 and squared prediction error(SPE) control charts. It was found that the SPE score of B_(21) powder exceeded the 99% confidence control limit by 22.495 9, and the SPE scores of A_1 and C_(10) powder exceeded the 95% confidence control limit by 16.099 2, realizing the determination of abnormal samples in the materials of GLE from the production in real world. Finally, the physical quality control method of GLE in the production process of ginkgo leaves preparations was established in this study, providing a reference for the quality control methods of ginkgo leaves preparations in their manufacturing process.

[Critical quality attribute assessment of big brand traditional Chinese medicine: process quality control method of Suhuang Zhike Capsules intermediate based on physical properties of powder and granules].

The physical properties of powder and granules are the critical quality attributes for the process control of Suhuang Zhike Capsules, a big brand traditional Chinese medicine. This paper took the production of 25 batches of real-world Suhuang Zhike Capsules dry extract powder and granules intermediates as the research object. Firstly, a method for testing the physical properties of Suhuang Zhike Capsules powder and granules with 19 physical indicators was established. The results showed that the granules of dry extract powder after granulation had a smaller particle size, wider particle size distribution range and poor fluidity, which easily caused the problem of over-limit capsule loading. Secondly, correlation analysis, principal component analysis and cluster analysis were used for mathematical statistics. The correlation analysis showed that the density of dry extract powder could affect the chroma and fluidity. At the same time, the particle size in the granules had a stronger effect on the chroma and fluidity than the density. The study also found that the particle size and hygroscopicity of dry extract powder were potentially key physical properties that affected the physical properties of granules. Furthermore, the results of principal component analysis and cluster analysis showed that the consistency of the physical properties between the dry extract powder and intermediate granules was relatively poor. To this end, similarity analysis was carried out, and the quality control method of powder and granules based on physical fingerprint was established. The results showed that the physical fingerprint similarity of 25 batches of dry extract powder was 0.639-0.976, and the physical fingerprint similarity of the gra-nules was 0.716-0.983. With the similarity of 0.85 as the threshold, the batches with abnormal physical properties could be identified. In this study, the process quality control method of Suhuang Zhike Capsules based on the physical properties of powder and granules was established finally, which realized the identification of abnormal batches, and provided a reference for the process quality control of Suhuang Zhike Capsules.

[Critical quality attribute assessment of big brand traditional Chinese medicine: online NIR quality control research on boiling time during extraction process].

Assessment of the status property(boiling time) is a challenge for the quality control of extraction process in pharmaceutical enterprises. In this study, the pilot extraction process of Phellodendron chinense was used as the research carrier to develop an online near-infrared(NIR) quality control method based on the status property(boiling time). First, the NIR spectra of P. chinense were collected during the two pilot-scale extraction processes, and the status property(boiling time) was assessed by observing the state of bubbles in the extraction tank using a transparent window during the extraction process, which was then used as a reference standard. Based on the moving block standard deviation(MBSD) algorithm, the assessment model using online NIR spectra for boiling time during extraction process was established. In addition, the model was optimized as follows: standard normal variable(SNV) for spectral pretreatment, modeling band of 800-2 200 nm, and window size of 4. The results showed that, with 0.002 0 as the MBSD model threshold, the boiling time can be accurately assessed using online NIR spectra during extraction process. Furthermore, the principal component analysis-moving block standard deviation(PCA-MBSD) model was developed by our group to reduce the influence of online NIR spectral noise and background signal on the model, and the number of principal components was optimized into 2 in the PCA-MBSD model. The results showed that, with 0.000 075 as the PCA-MBSD model threshold, the boiling time can be accurately assessed using online NIR spectra during extraction process, with improved reliability. This study can provide a assessment method for boiling time during extraction process using online NIR spectra, which can replace the empirical judgment in manual observation, and realize the digitalization of the extraction process for big brand traditional Chinese medicine.

Pretreatment of rice straw with recycled ionic liquids by phase-separation process for low-cost biorefinery.

An efficient ionic liquids (ILs) recycle technology will increase the economic viability of lignocellulosic biorefinery. The availability of recycling 1-butyl-3-methylimidazolium chloride for rice straw (RS) pretreatment was conducted. The kosmotropic salt K3 PO4 (TKP) solution was used as antisolvent for cellulose precipitation and forming a three-phase system consisting of biomass, ILs-rich, and salt-rich phases. The upper ILs phase and the bottom TKP phase were recycled without additional purification, which significantly simplifies the process for recovering ILs. Subsequently, the RS pretreated with multiple reusing ILs (RPRS) were investigated by components analysis, structure evolution, enzymatic hydrolysis, and fermentation experiments. The results showed that unpurified reusing ILs led to further delignification and improvement of enzyme accessibility of the pretreated RS. The reducing sugar yield of RS pretreated with 8th reusing IL (8th RPRS) could still reach 98.9%, and the ethanol and succinic acid concentrations achieved 91.9 and 29.3 g/L by simultaneous saccharification and cofermentation. The present study demonstrated that the ILs recovered by phase-separation process could be used for RS pretreatment, and achieving high titer ethanol fermentation.

Enrichment, Source Apportionment and Health Risk Assessment of Soil Potentially Harmful Elements Associated with Different Land Use in Coastal Tidelands Reclamation Area, Eastern China.

Coastal tidelands are important ecological habitat resources and valuable resources for agricultural land reclamation. Enrichment of potentially harmful elements (PHEs) in soil caused by anthropogenic activity is an important factor implicated in the ecological deterioration of soil in China. A total of 54 soil sample sites were selected from a 30-year reclaimed tideland and an adjoining coastal wetland. Descriptive and multivariate statistical analyses were performed to describe the enrichment, source, health risk status of eight PHEs (As, Co, Cr, Cu, Mn, Ni, Pb, and Zn) after long-term reclamation. Results indicated that after 30 years of reclamation, most soil PHEs are slightly enriched, whereas no serious threat of environmental pollution was observed. In the reclamation area, the enrichment of PHEs in the aquaculture land, industrial land, and cropland was relatively high compared with other land use types, such as tideland and halophyte land. The source analysis divided the PHEs into five categories: (1) Cu; (2) Co and Mn; (3) Cr; (4) As and Pb; (5) Zn and Ni. Cu was completely derived from natural parent materials and other elements were governed by both weathering of parent rock and human activities, including agricultural activities, industrial production, and transportation emissions. The health risk assessment showed that the soil PHEs potentially had no non-carcinogenic risk to the public, but there was an acceptable probability to have cancer due to Cr and As. Meanwhile, children are more susceptible to harm from the PHEs in soil than adults. According to the economic and social development situation in the coastal region, it is necessary to pay attention to the environmental threats of PHEs enrichment.

Coastal Landscape Vulnerability Analysis in Eastern China-Based on Land-Use Change in Jiangsu Province.

The unreasonable land use in rapid urbanization areas induced by large-scale urban construction activities have caused massive ecological issues. In this study, landscape vulnerability index (LVI) and landscape human interference index (LHAI) were originally addressed and calculated using multi-temporal land-use data from 2000 to 2015. Then, the spatial-temporal relationship assessment model of landscape fragility caused by human activities were constructed for each county of Jiangsu Province, China, so as to analyze the spatial distribution of landscape vulnerability and determine the impacts of artificial disturbance on landscape vulnerability. The results showed: (1) The number of counties with middle and high landscape vulnerability increased from 20 in 2000 to 27 in 2015 with a peak value (33) in 2010. (2) Counties with high-intensity human activities showed an upward trend. (3) Land use generally has a significant and diverse impact on landscape vulnerability. At the county level, the LVI was positively correlated with the LHAI before 2010 and was followed by a negative correlation of them. As concluded from this study, a total of four sub-regions (continuous benefit zones, variable benefit zones, continuous harmful zones, and variable harmful zones) have been identified for sustainable landscape management in the future. (4) The LVI suggests that the landscape vulnerability in Jiangsu did not continue to deteriorate in the study period. Further, accelerated land exploitation has produced a positive impact on regional economic development and ecological protection. This study provided an effective method set for analyzing the environmental impacts caused by human activities and promoting future ecosystem management in coastal areas.

The correlations between socioeconomic status and intrahepatic cholangiocarcinoma in the United States: a population-based study.

BACKGROUND: The incidence and mortality rates of intrahepatic cholangiocarcinoma (ICC) continue to increase in the United States (US). To our knowledge, the associations between socioeconomic factors (SES) and ICC-associated incidence and survival are still unclear. METHODS: We identified patients with ICC in the US Surveillance, Epidemiology, and End Results (SEER) database between 2011 and 2015. ICC incidence rates were calculated by directly age-adjusted to the 2000 US population. Univariate and multivariate Cox regression analyses were performed to find the influence of SES on ICC cause-specific survival (CSS) and overall survival (OS). Using disadvantageous SES, we generated a prognostic score model for risk stratification, then Kaplan-Meier analysis was performed to find the influence of SES on for ICC CSS/OS. RESULTS: A total of 3,456 ICC patients were included. Rates ratios (RR) for ICC incidence rates increased monotonically with ages and decreased with increasing county education levels. From three disadvantageous socioeconomic factors (i.e., unmarried status, uninsured status, median household income

[Assessment of Soil Quality in Coastal Tidal Flat Reclamation Areas Based on MDS-TOPSIS Model].

Investigating the change of soil quality during reclamation can provide scientific guidance for desalinization, fertilization, etc. Soil samples were collected from natural tidal flat areas (0 years) and coastal tidal flat reclamation areas with different reclamation years (5, 30, 38, and 61 years) to assess the changes in soil quality after 60 years of reclamation. Soil quality was evaluated using a soil quality index (SQI), which was calculated by the selected minimum data set (MDS) and TOPSIS method. The ratio of clay content (CLAY), soil salt content (SSC), soil organic carbon (SOC), total potassium (TK), and bulk density (BD) were selected as soil quality indicators involving soil physical and chemical properties based on the MDS. The results showed that soil particle size tended to refine gradually with the continuous decrease of sand content and increase of silt and clay content. Simultaneously, soil water content (SWC) and soil BD decreased gradually during the reclamation period. Additionally, SSC, pH and sodium adsorption ratio (SAR) decreased significantly with increase in reclamation years, whereas the nutrients and available nutrients were accumulated gradually, such as soil organic matter (SOM), total nitrogen (TN), total phosphorus (TP), available nitrogen (AN), and available phosphorus (AP). However, C/N, TK and available potassium (AK) showed a decrease with increasing reclamation years, and the cation exchange capacity (CEC) showed a trend of first decrease and then increase. Finally, SQI values varied from 24.06 in the bare flat soils to 63.08 in the soils after 63 years of reclamation, and showed that bare flat (20.04±11.48) < reclamation for 5 years (29.33±10.65) < reclamation for 30 years (51.52±8.76) ≈ reclamation for 38 years (49.98±10.75) < reclamation for 61 years (58.37±3.15), which has gone through approximately three stages of "initial stability-rapid improvement-relative stability." Soil CLAY content had the highest obstacle degree towards SQI among the selected MDS indicators, followed by SSC, SOM, TK, and SWC, and thereby the lower clay content and higher salt content were the main obstacle factors for promotion of soil quality in reclamation areas.

Modified American Joint Committee on Cancer Tumor-Node-Metastasis Staging System Based on the Node Ratio Can Further Improve the Capacity of Prognosis Assessment for Gastric Cancer Patients.

Background and Objectives: Our aim was to investigate whether the modified American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging system based on the node ratio can further improve the capacity of prognosis assessment for gastric cancer (GC) patients regardless of the number of lymph nodes examined (eLNs). Methods: A total of 17,187 GC patients in the Surveillance, Epidemiology, and End Results (SEER) database were included. On the basis of a training set of 7,660 GC patients, we built the tumor-node ratio-metastasis (TNrM) staging system, which was then externally validated with a validation set of 9,527 GC patients. Results: For the training set, the C-index value of the TNrM staging system was significantly higher than that of the AJCC 8th TNM staging system to predict survival for GC patients (C-index: 0.688 vs. 0.671, P < 0.001). Moreover, the C-index value of the TNrM staging system was significantly higher than that of the 8th TNM staging system to predict survival for GC patients with ≤15 eLNs (C-index: 0.682 vs. 0.673, P < 0.001), as well as for GC patients with >15 eLNs (C-index: 0.700 vs. 0.694, P < 0.001). Similar results were found in the validation set. Conclusions: The TNrM staging system predicted survival more accurately and discriminatively than the AJCC 8th TNM staging system for GC patients regardless of the number of eLNs.

Perfusion-weighted magnetic resonance imaging in the assessment of haemodynamics following stent angioplasty in patients with symptomatic middle cerebral artery plaque stenosis at the M1 segment.

The most effective strategy to assess changes in the brain haemodynamics of stent angioplasty in patients with symptomatic ischemia of the M1 segment of the middle cerebral artery (MCA) remains unknown. The purpose of the present study was to use perfusion-weighted magnetic resonance imaging (PWI) to evaluate the effect of stent angioplasty in treating patients with symptomatic MCA plaque stenosis. Stent angioplasty was performed on 23 patients with reduplicative transient ischaemic attack who were refractory to medical therapy. All patients had MCA plaque stenosis at the M1 segment. Brain PWI was obtained from four major regions of interest (ROIs) at the frontal parietal, temporal, lateral ventricle and basal ganglia lobes prior to and following stent implantation. In addition, cerebral blood flow (CBF), cerebral blood volume, mean transit time (MTT) and time to peak (TTP) parameters derived from PWI were calculated. All patients underwent digital subtraction angiography following surgery to confirm the patency. Computed tomography angiography or PWI was performed 1 week and 3 months post-surgery. According to pre-operative PWI, there was significant hypoperfusion in the symptomatic frontal parietal, temporal, lateral ventricle and basal ganglia lobes. By contrast, the regional CBF and CBF increased in the ROIs of the affected cerebral hemisphere 3 months after stent implantation (P<0.05 vs. pre-operative data). Additionally, post-operative MTT and TTP in the ROIs on the operative side were significantly shorter than pre-operative MTT and TTP (P<0.05). During the follow-up period, the frequency of transient ischaemic attack was reduced or disappeared in all patients during the follow-up. In conclusion, PWI enables an effective and objective assessment of haemodynamics prior to and following stent angioplasty in patients with plaque stenosis of MCA at the M1 segment.

Myrf ER-Bound Transcription Factors Drive C. elegans Synaptic Plasticity via Cleavage-Dependent Nuclear Translocation.

Synaptic refinement is a critical step in nervous system maturation, requiring a carefully timed reorganization and refinement of neuronal connections. We have identified myrf-1 and myrf-2, two C. elegans homologs of Myrf family transcription factors, as key regulators of synaptic rewiring. MYRF-1 and its paralog MYRF-2 are functionally redundant specifically in synaptic rewiring. They co-exist in the same protein complex and act cooperatively to regulate synaptic rewiring. We find that the MYRF proteins localize to the ER membrane and that they are cleaved into active N-terminal fragments, which then translocate into the nucleus to drive synaptic rewiring. Overexpression of active forms of MYRF is sufficient to accelerate synaptic rewiring. MYRF-1 and MYRF-2 are the first genes identified to be indispensable for promoting synaptic rewiring in C. elegans. These findings reveal a molecular mechanism underlying synaptic rewiring and developmental circuit plasticity.