Evolutionary and immune-activating character analyses of NLR genes in algae suggest the ancient origin of plant intracellular immune receptors.

Nucleotide-binding leucine-rich repeat (NLR) proteins are crucial intracellular immune receptors in plants, responsible for detecting invading pathogens and initiating defense responses. While previous studies on the evolution and function of NLR genes were mainly limited to land plants, the evolutionary trajectory and immune-activating character of NLR genes in algae remain less explored. In this study, genome-wide NLR gene analysis was conducted on 44 chlorophyte species across seven classes and seven charophyte species across five classes. A few but variable number of NLR genes, ranging from one to 20, were identified in five chlorophytes and three charophytes, whereas no NLR gene was identified from the remaining algal genomes. Compared with land plants, algal genomes possess fewer or usually no NLR genes, implying that the expansion of NLR genes in land plants can be attributed to their adaptation to the more complex terrestrial pathogen environments. Through phylogenetic analysis, domain composition analysis, and conserved motifs profiling of the NBS domain, we detected shared and lineage-specific features between NLR genes in algae and land plants, supporting the common origin and continuous evolution of green plant NLR genes. Immune-activation assays revealed that both TNL and RNL proteins from green algae can elicit hypersensitive responses in Nicotiana benthamiana, indicating the molecular basis for immune activation has emerged in the early evolutionary stage of different types of NLR proteins. In summary, the results from this study suggest that NLR proteins may have taken a role as intracellular immune receptors in the common ancestor of green plants.

TiCNet: Transformer in Convolutional Neural Network for Pulmonary Nodule Detection on CT Images.

Lung cancer is the leading cause of cancer death. Since lung cancer appears as nodules in the early stage, detecting the pulmonary nodules in an early phase could enhance the treatment efficiency and improve the survival rate of patients. The development of computer-aided analysis technology has made it possible to automatically detect lung nodules in Computed Tomography (CT) screening. In this paper, we propose a novel detection network, TiCNet. It is attempted to embed a transformer module in the 3D Convolutional Neural Network (CNN) for pulmonary nodule detection on CT images. First, we integrate the transformer and CNN in an end-to-end structure to capture both the short- and long-range dependency to provide rich information on the characteristics of nodules. Second, we design the attention block and multi-scale skip pathways for improving the detection of small nodules. Last, we develop a two-head detector to guarantee high sensitivity and specificity. Experimental results on the LUNA16 dataset and PN9 dataset showed that our proposed TiCNet achieved superior performance compared with existing lung nodule detection methods. Moreover, the effectiveness of each module has been proven. The proposed TiCNet model is an effective tool for pulmonary nodule detection. Validation revealed that this model exhibited excellent performance, suggesting its potential usefulness to support lung cancer screening.

Periodontal disease and subsequent risk of cardiovascular outcome and all-cause mortality: A meta-analysis of prospective studies.

Studies reported periodontal disease (PD) periodontal disease is associated with many systemic diseases, including cardiovascular outcomes and all-cause mortality. However, the precise mechanistic link for these relationship remained unclear. We therefore performed a meta-analysis of cohort studies to investigate the association of PD with the risk of cardiovascular outcomes and all-cause mortality. We systematically searched the databases of PubMed, EmBase, and the Cochrane library to identify eligible studies until April 2023. The investigated outcomes included major adverse cardiovascular events (MACEs), coronary heart disease (CHD), myocardial infarction (MI), stroke, cardiac death, and all-cause mortality. The summary relative risk (RR) with 95% confidence interval (CI) were calculated using the random-effects model. Thirty-nine cohort studies with 4,389,263 individuals were selected for final meta-analysis. We noted PD were associated with elevated risk of MACEs (RR: 1.24; 95%CI: 1.15-1.34; P<0.001), CHD (RR: 1.20; 95%CI: 1.12-1.29; P<0.001), MI (RR: 1.14; 95%CI: 1.06-1.22; P = 0.001), stroke (RR: 1.26; 95%CI: 1.15-1.37; P<0.001), cardiac death (RR: 1.42; 95%CI: 1.10-1.84; P = 0.007), and all-cause mortality (RR: 1.31; 95%CI: 1.07-1.61; P = 0.010). Sensitivity analyses indicated the pooled conclusions for cardiovascular outcomes and all-cause mortality are robustness. The associations of PD with the risk of ardiovascular outcomes and all-cause mortality could affected by region, study design, PD definition, follow-up duration, and study quality. This study found the risk of cardiovascular outcomes and all-cause mortality were elevated in PD patients, and the intervention for PD should be applied to prevent the risk of cardiovascular outcomes.

Highly efficient and stable thermally activated delayed fluorescent palladium(II) complexes for organic light-emitting diodes.

Transition metal complexes exhibiting thermally activated delayed fluorescence (TADF) remain underdeveloped for organic light-emitting diodes (OLEDs). Here, we describe a design of TADF Pd(II) complexes featuring metal-perturbed intraligand charge-transfer excited states. Two orange- and red-emitting complexes with efficiencies of 82 and 89% and lifetimes of 2.19 and 0.97 µs have been developed. Combined transient spectroscopic and theoretical studies on one complex reveal a metal-perturbed fast intersystem crossing process. OLEDs using the Pd(II) complexes show maximum external quantum efficiencies of 27.5 to 31.4% and small roll-offs down to 1% at 1000 cd m-2. Moreover, the Pd(II) complexes show exceptional operational stability with LT95 values over 220 hours at 1000 cd m-2, benefiting from the use of strong σ-donating ligands and the presence of multiple intramolecular noncovalent interactions beside their short emission lifetimes. This study demonstrates a promising approach for developing efficient and robust luminescent complexes without using the third-row transition metals.

Evaluation of early liquid drinking after radical gastrectomy in gastric cancer: a Chinese multicenter propensity score matching analysis.

Background: Enhanced recovery after surgery is used in gastrointestinal surgery. This study aimed to access the effects of early liquid drinking (ELD) on gastrointestinal function recovery in patients with gastric cancer (GC) who underwent radical gastrectomy, as high-quality evidence on the outcomes of ELD after gastrectomy is currently lacking. Methods: Clinicopathological data of patients with GC from 11 centers were retrospectively analysed. Clinical outcomes were investigated in 555 patients, including 225 who started drinking liquid within 48 h (ELD group) of surgery and 330 who started drinking liquid after flatus resumption (traditional liquid drinking [TLD] group). Propensity score matching (PSM) analysis was performed using a match ratio of 1:1 and 201 patients were selected from each group for the analysis. Primary outcome was time to first passage of flatus. Secondary outcomes included time to first defecation, post-operative hospitalization days, occurrence of short-term post-operative complications, and hospitalization costs. Results: After PSM, baseline characteristics were not significantly different between the two groups. The time to first flatus (2.72 ± 1.08 vs 3.36 ± 1.39 days), first defecation (4.34 ± 1.85 vs 4.77 ± 1.61 days), and post-operative hospital stay (8.27 ± 4.02 vs 12.94 ± 4.43 days) were shorter in the ELD group than in the TLD group (all P < 0.05). The ELD group had lower hospitalization costs than the TLD group ([7.83 ± 2.44 vs 8.78 ± 3.41] × 104 RMB, P = 0.041). No significant differences were observed in the incidence of post-operative complications. Conclusions: Compared with TLD, post-operative ELD could promote rapid recovery of gastrointestinal function and reduce hospitalization costs; moreover, ELD does not increase the risk of post-operative complications.

Delivery of Engineered Primary Tumor-Derived Exosomes Effectively Suppressed the Colorectal Cancer Chemoresistance and Liver Metastasis.

Liver metastasis is one of the major causes of colorectal cancer (CRC)-related morbidity and mortality. Delivering small interfering RNAs (siRNAs) or noncoding RNAs has been reported as a promising method to target liver metastasis and chemoresistance in CRC. Here, we report a noncoding RNA delivery system using exosomes derived from primary patient cells. Coiled-coil domain-containing protein 80 (CCDC80) was strongly associated with CRC liver metastasis and chemoresistance, a finding validated by bioinformatic analysis and clinical specimens. Silencing CCDC80 significantly increased sensitivity to chemotherapy agents in OXA-resistant cell lines and a mouse model. The primary cell-derived exosome delivery system was designed to simultaneously deliver siRNAs targeting CCDC80 and increase chemotherapy sensitivity in the distant CRC liver metastasis mouse models and patient-derived xenograft mouse models. We further validated the antitumor effect in an ex vivo model of chemoresistant CRC organoids and a patient-derived organoid xenograft model. Tumor-bearing mice treated with the siRNA-delivering exosomes and hepatectomy showed ideal overall survival. Our results provide a therapeutic target and represent a possible therapeutic alternative for patients with CRC and distant metastasis and in cases of chemoresistance.

Understanding the Interfacial Reactions and Band Alignment for Efficient and Stable Perovskite Solar Cells Built on Metal Substrates with Reduced Upscaling Losses.

Conventional perovskite solar cells (PSC) built on transparent conductive oxide (TCO) glass face a fundamental challenge to retain fill factor (FF) for large-area upscaling due to series resistance loss. Building a perovskite solar cell on metal has the potential to reduce this FF loss and is promising for flexible applications. However, their efficiency and stability lag far behind their TCO counterparts. Herein, findings on the complex chemical reactions and degradation-promoting processes at different perovskite/metal (Cu, Au, Ag, and Mo) interfaces, which are closely linked with the inherent stability; and the interlayer engineering for perovskite/metal interface's band alignment, which plays an essential role in achieving high efficiency, are reported. Leveraging these findings, 21% power conversion efficiency (PCE) is achieved for 1 cm2 perovskite solar cells using a p-i-n top-illumination structure on a molybdenum substrate, the highest reported for a PSC built on metal. Notably, the FF and PCE losses due to area upscaling are remarkably reduced by one order of magnitude relative to the counterparts on conventional TCO glass, highlighting an alternative pathway for PSC upscaling and module design.

Reducing nonradiative recombination in perovskite solar cells with a porous insulator contact.

Inserting an ultrathin low-conductivity interlayer between the absorber and transport layer has emerged as an important strategy for reducing surface recombination in the best perovskite solar cells. However, a challenge with this approach is a trade-off between the open-circuit voltage (Voc) and the fill factor (FF). Here, we overcame this challenge by introducing a thick (about 100 nanometers) insulator layer with random nanoscale openings. We performed drift-diffusion simulations for cells with this porous insulator contact (PIC) and realized it using a solution process by controlling the growth mode of alumina nanoplates. Leveraging a PIC with an approximately 25% reduced contact area, we achieved an efficiency of up to 25.5% (certified steady-state efficiency 24.7%) in p-i-n devices. The product of Voc × FF was 87.9% of the Shockley-Queisser limit. The surface recombination velocity at the p-type contact was reduced from 64.2 to 9.2 centimeters per second. The bulk recombination lifetime was increased from 1.2 to 6.0 microseconds because of improvements in the perovskite crystallinity. The improved wettability of the perovskite precursor solution allowed us to demonstrate a 23.3% efficient 1-square-centimeter p-i-n cell. We demonstrate here its broad applicability for different p-type contacts and perovskite compositions.

A Shuttle-Free Solid-State Cu-Li Battery Based on a Sandwich-Structured Electrolyte.

Cu-Li batteries leveraging the two-electron redox property of Cu can offer high energy density and low cost. However, Cu-Li batteries are plagued by limited solubility and a shuttle effect of Cu ions in traditional electrolytes, which leads to low energy density and poor cycling stability. In this work, we rationally design a solid-state sandwich electrolyte for solid-state Cu-Li batteries, in which a deep-eutectic-solvent gel with high Cu-ion solubility is devised as a Cu-ion reservoir while a ceramic Li1.4 Al0.4 Ti1.6 (PO4 )3 interlayer is used to block Cu-ion crossover. Because of the high ionic conductivity (0.55 mS cm-1 at 25 °C), wide electrochemical window (>4.5 V vs. Li+ /Li), and high Cu ion solubility of solid-state sandwich electrolyte, a solid-state Cu-Li battery demonstrates a high energy density of 1 485 Wh kgCu -1 and long-term cyclability with 97 % capacity retention over 120 cycles. The present study lays the groundwork for future research into low-cost solid-state Cu-Li batteries.

The RNAome landscape of tomato during arbuscular mycorrhizal symbiosis reveals an evolving RNA layer symbiotic regulatory network.

Arbuscular mycorrhizal symbiosis (AMS) is an ancient plant-fungus relationship that is widely distributed in terrestrial plants. The formation of symbiotic structures and bidirectional nutrient exchange requires the regulation of numerous genes. However, the landscape of RNAome during plant AMS involving different types of regulatory RNA is poorly understood. In this study, a combinatorial strategy utilizing multiple sequencing approaches was used to decipher the landscape of RNAome in tomato, an emerging AMS model. The annotation of the tomato genome was improved by a multiple-platform sequencing strategy. A total of 3,174 protein-coding genes were upregulated during AMS, 42% of which were alternatively spliced. Comparative-transcriptome analysis revealed that genes from 24 orthogroups were consistently induced by AMS in eight phylogenetically distant angiosperms. Seven additional orthogroups were specifically induced by AMS in all surveyed dicot AMS host plants. However, these orthogroups were absent or not induced in monocots and/or non-AMS hosts, suggesting a continuously evolving AMS-responsive network in addition to a conserved core regulatory module. Additionally, we detected 587 lncRNAs, ten miRNAs, and 146 circRNAs that responded to AMS, which were incorporated to establish a tomato AMS-responsive, competing RNA-responsive endogenous RNA (ceRNA) network. Finally, a tomato symbiotic transcriptome database (TSTD, https://efg.nju.edu.cn/TSTD) was constructed to serve as a resource for deep deciphering of the AMS regulatory network. These results help elucidate the reconfiguration of the tomato RNAome during AMS and suggest a sophisticated and evolving RNA layer responsive network during AMS processes.

Lung nodule false positive reduction using a central attention convolutional neural network on imbalanced data.

Computer-aided detection systems for lung nodules play an important role in the early diagnosis and treatment process. False positive reduction is a significant component in pulmonary nodule detection. To address the visual similarities between nodules and false positives in CT images and the problem of two-class imbalanced learning, we propose a central attention convolutional neural network on imbalanced data (CACNNID) to distinguish nodules from a large number of false positive candidates. To solve the imbalanced data problem, we consider density distribution, data augmentation, noise reduction, and balanced sampling for making the network well-learned. During the network training, we design the model to pay high attention to the central information and minimize the influence of irrelevant edge information for extracting the discriminant features. The proposed model has been evaluated on the public dataset LUNA16 and achieved a mean sensitivity of 92.64%, specificity of 98.71%, accuracy of 98.69%, and AUC of 95.67%. The experimental results indicate that our model can achieve satisfactory performance in false positive reduction.

Prognostic value of final pathological stage in colon adenocarcinoma after neoadjuvant chemotherapy: A propensity score-matched study.

Background: Neoadjuvant chemotherapy (NAC) could improve local tumor control of locally advanced colon cancer (LACC), but the prognostic value of yp stage in colon cancer remains unknown. Here, we aimed to ascertain yp stage as an indicator for LACC prognosis after NAC. Methods: The data of patients diagnosed with colon adenocarcinoma between 2004 and 2015 were extracted from the Surveillance, Epidemiology, and End Results database. After 1:2 propensity score matching, cancer-specific survival (CSS) and overall survival (OS) were compared between the NAC and Non-NAC groups of different stage classifications. The correlation between clinical and pathological factors and CSS was identified. Results: A total of 49, 149, and 81 matched pairs of stage 0-I, II, and III patients, respectively, were generated for analysis. For stage 0-I (p = 0.011) and III (p = 0.015), only CSS in the NAC groups were inferior. Receiving NAC was an independent prognostic risk factor for patients with stage 0-I (hazard ratio, 7.70; 95% confidence interval, 1.820-32.5; p = 0.006) and stage III (hazard ratio, 1.73; 95% confidence interval, 1.11-2.68; p = 0.015). Conclusions: The CSS was poorer among LACC patients who underwent NAC than among those who did not. The yp stage of colon cancer after NAC has distinctive significance, which may contribute to predicting the prognosis and guiding the treatment of LACC patients after NAC.

Influence of Sulfur Atoms on TADF Properties from Through-Space Charge Transfer Excited States.

The harnessing of heavy atom effect of chalcogen elements offers a way for boosting the thermally activated delayed fluorescence (TADF) of purely organic luminescent materials that can harvest triplet excitons. However, the conformational and electronic variations induced by the heavy and large atoms may also have adverse effects on the TADF properties. Herein, the design, synthesis, and structures of a new type of through-space charge transfer (TSCT) emitters containing benzothiazino[2,3,4-kl]phenothiazine (DPTZ) as the donor unit are reported. The influences of S atoms on the emission properties have been systematically investigated by means of theoretical simulations, electrochemical and spectroscopic studies. Although the presence of π-stacking interactions and calculated spin-orbit coupling (SOC) values are beneficial for TSCT-TADF properties, the triplet TSCT states are uplifted to above the locally excited (LE) state of the acceptor moieties. As a result, the new emitters display longer delayed fluorescence lifetimes (τDF ) of 255.0-114.3 µs and lower PLQYs of 45-61 % in comparison with the O-containing congeners (τDF =26.9-6.8 µs; PLQYs=74-71 %). This work highlights that a full consideration of various effects is essential when making use of heavy chalcogen atoms for the design of TADF emitters.

How Job Stress Affect Flow Experience at Work: The Masking and Mediating Effect of Work-Related Rumination.

This study proposes and tests a theoretical model of how two types of stressors (challenge and hindrance stressors) elicit perseverative cognition processes in individuals (as characterized by two types of work-related rumination), and how, through this mechanism, these stressors can further affect individuals' flow experience at work. Our model is largely supported by structural equation modeling analyses of a longitudinal questionnaire-based survey (n = 344). We find that challenge stressors have a significant, positive, direct impact on the experience of flow. Additionally, both challenge and hindrance stressors simultaneously activate problem-solving pondering and affective rumination in employees; affective rumination inhibits flow, while problem-solving pondering promotes flow. The results of a bootstrap sampling analysis further indicate the presence of the masking and mediating effects of work-related rumination in the effects of these stressors on flow experience. The theoretical and practical implications of these findings are discussed.

Low-dose orlistat promotes the therapeutic effect of oxaliplatin in colorectal cancer.

The failure of and resistance to oxaliplatin (OXA)-based chemotherapies may lead to poor prognosis in colorectal cancer (CRC) patients. It has been reported that orlistat (Orli) exhibits potent antitumor effects in several malignant tumors. Here, we identified that OXA in combination with low-dose Orli could sensitize CRC cells to OXA and induce marked synergistic apoptosis in vitro and in vivo. The potential synergistic effects were confirmed and quantified by in silico analysis. Furthermore, we validated the synergistic anti-tumor effects in CRC PDX mice model. A qPCR array was performed to evaluate the changes in 85 apoptosis-related genes to elucidate the possible molecular mechanisms in combination-induced cytotoxicity. To conclude, the antitumor synergistic effects of OXA and Orli make them effective and promising candidates for cancer treatment.

Au⋠⋠⋠H-C Interactions Support a Robust Thermally Activated Delayed Fluorescence (TADF) Gold(I) Complex for OLEDs with Little Efficiency Roll-Off and Good Stability.

The practical use of luminescent mononuclear gold(I) complexes as optoelectronic materials has been limited by their inferior stability. Herein we demonstrate a strategy to improve the stability of gold(I) complexes which display thermally activated delayed fluorescence (TADF). A highly rigid and groove-like σ-donating aryl ligand has been used to form dual Au⋅⋅⋅H-C hydrogen bonds. The secondary metal-ligand interactions have been authenticated by single-crystal structure, NMR spectroscopy and theoretical simulations. The TADF AuI complex exhibits appealing emission properties (photoluminescence quantum yield=76 %; delayed fluorescence lifetime=1.2 µs) and much improved thermal and photo-stability. Vacuum-deposited organic light-emitting diodes (OLEDs) show promising electroluminescence with a maximum external quantum efficiency (EQE) over 23 % and negligible efficiency roll-off even at 10 000 cd m-2 . An estimated LT50 longer than 77 000 h with initial luminance of 100 cd m-2 reveals good operational stability. This work suggests a way for design of stable luminescent gold(I) complexes.

General Synthesis of Tube-like Nanostructured Perovskite Oxides with Tunable Transition Metal-Oxygen Covalency for Efficient Water Electrooxidation in Neutral Media.

Hydrogen production from water electrolysis in neutral-pH electrolytes can not only avoid the corrosion and safety issues and expand the catalyst option but also potentially integrate with artificial photosynthesis and bioelectrocatalysis. However, heterogeneous catalysts that can efficiently negotiate the sluggish oxygen evolution reaction (OER) in neutral solutions are considerably lacking. Herein, we report a template-assisted strategy for the synthesis of 13 kinds of tube-like nanostructured perovskite oxides (TNPOs) with markedly high Brunauer-Emmett-Teller surface areas. By systematic examination of these TNPOs, we found that the OER activity of TNPOs in neutral solution exhibits a volcano shape as a function of the covalency of transition metal-oxygen bonds. Consequently, our designed Sm-doped LaCoO3 catalyst yields a geometric current density of 8.5 mA cm-2 at 1.75 V versus the reversible hydrogen electrode in 1 M phosphate buffer solution (pH 7) due to the optimized covalency of Co 3d and O 2p states, representing the most active noble-metal-free OER catalyst in neutral electrolytes reported as yet.

Effects of Preoperative Radiotherapy on Long-Term Bowel Function in Patients With Rectal Cancer Treated With Anterior Resection: A Systematic Review and Meta-analysis.

Background: Anterior resection is a common surgical approach used in rectal cancer surgery; however, this procedure is known to cause bowel injury and dysfunction. Neoadjuvant therapy is widely used in patients with locally advanced rectal cancer. In this study, we determined the effect of preoperative radiotherapy on long-term bowel function in patients who underwent anterior resection for treatment of rectal cancer. Methods: We performed a comprehensive literature search of the PubMed, Embase, Web of Science, and the Cochrane Library databases. A random-effects model was used in the meta-analysis by the Review Manager software, version 5.3. Results: This systematic review and meta-analysis included 12 studies, which used low anterior resection syndrome score with a total of 2349 patients. Based on them, we concluded that low anterior resection syndrome was significantly more common in the preoperative radiotherapy group (odds ratio 3.59, 95% confidence interval 2.68-4.81, P < .00001) and that major low anterior resection syndrome also occurred significantly more frequently in the preoperative radiotherapy group (odds ratio 3.28, 95% confidence interval 2.05-5.26, P < .00001). Subgroup analyses of long-course radiation, total mesorectal excision, and non-metastatic tumors were performed, and the results met the conclusions of the primary outcomes. Conclusions: Preoperative radiotherapy negatively affects long-term bowel function in patients who undergo anterior resection for rectal cancer.

Health-related quality of life and associated factors in Chinese menstrual migraine patients: a cross-sectional study.

BACKGROUND: Menstrual migraine is a particular form of migraine with a significant impact on the quality of life for women afflicted. Presently, no study has reported the quality of life in menstrual migraine patients. This work aims to assess the health-related quality of life and identify its associated factors among Chinese menstrual migraine patients. METHODS: The cross-sectional study group consisted of 109 patients with menstrual migraine, and the control group consisted of 397 female patients with non-menstrual migraine. In total, 506 patients completed questionnaires for demographic and clinical information, the Self-rating Idea of Suicide Scale, the Hamilton Depression Scale, the Hamilton Anxiety Scale, the Headache Impact Test-6, the Perceived Social Support Scale, the Pittsburgh Sleep Quality Index. Health-related quality of life was measured using the 36-Item Short Form Survey. RESULTS: Compared with non-menstrual migraine patients, five dimensions of health-related quality of life were all found to be significantly impaired in menstrual migraine patients. Headache frequency (ß = - 0.218, P = 0.014), the impact of headache on daily life (ß = - 0.270, P = 0.002), depression symptoms (ß = - 0.345, P < 0.001) were significantly associated with physical component summary, depression symptoms (ß = - 0.379, P < 0.001), social support (ß = 0.270, P < 0.001), suicidal ideation (ß = - 0.344, P < 0.001) were closely related to mental component summary. CONCLUSION: Menstrual migraine patients had a significantly poorer health-related quality of life in many domains than non-menstrual migraine patients. Headache frequency, the impact of headache on daily life, depression symptoms, social support, and suicidal ideation were significantly associated with health-related quality of life in menstrual migraine patients. TRIAL REGISTRATION: ChiCTR1800014343. This study was registered prospectively on 7 January 2018 at Chinese Clinical Trial registry. http://www.chictr.org.cn/showproj.aspx?proj=24526.

Postoperative Adjuvant Imatinib Therapy-Associated Nomogram to Predict Overall Survival of Gastrointestinal Stromal Tumor.

Background: Adjuvant imatinib therapy has been shown to improve overall survival (OS) of gastrointestinal stromal tumor (GIST) significantly. Few nomograms combining the use of adjuvant imatinib and clinicopathological characteristics estimate the outcome of patients. We aimed to establish a more comprehensive nomogram for predicting OS in patients with GIST. Methods: In total, 1310 GIST patients undergoing curative resection at four high-volume medical centers between 2001 and 2015 were enrolled. Independent prognostic factors were identified by multivariate Cox analysis. Eligible patients were randomly assigned in a ratio of 7:3 into a training set (916 cases) and a validation set (394 cases). A nomogram was established by R software and its predictive power compared with that of the modified National Institutes of Health (NIH) classification using time-dependent receiver operating characteristic (ROC) curves and calibration plot. Results: Age, tumor site, tumor size, mitotic index, postoperative imatinib and diagnostic delay were identified as independent prognostic parameters and used to construct a nomogram. Of note, diagnostic delay was for the first time included in a prognostic model for GIST. The calibrated nomogram resulted in predicted survival rates consistent with observed ones. And the decision curve analysis suggested that the nomogram prognostic model was clinically useful. Furthermore, time-dependent ROC curves showed the nomogram exhibited greater discrimination power than the modified NIH classification in 3- and 5-year survival predictions for both training and validation sets (all P < 0.05). Conclusions: Postoperative adjuvant imatinib therapy improved the survival of GIST patients. We developed and validated a more comprehensive prognostic nomogram for GIST patients, and it could have important clinical utility in improving individualized predictions of survival risks and treatment decision-making.