The perception of silence.

Auditory perception is traditionally conceived as the perception of sounds-a friend's voice, a clap of thunder, a minor chord. However, daily life also seems to present us with experiences characterized by the absence of sound-a moment of silence, a gap between thunderclaps, the hush after a musical performance. In these cases, do we positively hear silence? Or do we just fail to hear, and merely judge or infer that it is silent? This longstanding question remains controversial in both the philosophy and science of perception, with prominent theories holding that sounds are the only objects of auditory experience and thus that our encounter with silence is cognitive, not perceptual. However, this debate has largely remained theoretical, without a key empirical test. Here, we introduce an empirical approach to this theoretical dispute, presenting experimental evidence that silence can be genuinely perceived (not just cognitively inferred). We ask whether silences can "substitute" for sounds in event-based auditory illusions-empirical signatures of auditory event representation in which auditory events distort perceived duration. Seven experiments introduce three "silence illusions"-the one-silence-is-more illusion, silence-based warping, and the oddball-silence illusion-each adapted from a prominent perceptual illusion previously thought to arise only from sounds. Subjects were immersed in ambient noise interrupted by silences structurally identical to the sounds in the original illusions. In all cases, silences elicited temporal distortions perfectly analogous to the illusions produced by sounds. Our results suggest that silence is truly heard, not merely inferred, introducing a general approach for studying the perception of absence.

A fungal microRNA-like RNA regulated effector promotes pathogen infection by targeting a host defense-related transcription factor.

Effectors play important roles in facilitating the infection of plant pathogenic fungi. However, the gene expression regulatory mechanism of effector genes, in particular at the post-transcriptional level, is largely unknown. In this study, we uncovered the post-transcriptional regulation of an effector gene VmSP1 by a miRNA-like RNA (Vm-milR16) facilitating the infection of the apple tree Valsa canker pathogen Valsa mali. Genetic and molecular biological assays indicated that the expression of VmSP1 could be suppressed by Vm-milR16-mediated mRNA cleavage in a sequence-specific manner. During V. mali infection, Vm-milR16 was downregulated, whereas VmSP1 was upregulated, which further indicated the regulation relationship. VmSP1 was further demonstrated to be a secreted protein and could suppress plant immunity. Deletion of VmSP1 did not affect the vegetative growth but significantly reduced the virulence of V. mali. Further study indicated that VmSP1 could interact with the transcription factor MdbHLH189 of apple. Transiently overexpression of MdbHLH189 enhanced host resistance to V. mali by enhancing the expression of apple defense-related genes, together with the increased callose deposition. Silencing of MdbHLH189 compromised host resistance to V. mali. Our findings uncovered the novel epigenetic regulation mechanism of a virulence-associated effector gene mediated by a fungal milRNA at the post-transcriptional level, and the results enriched the understanding of the function and action mechanism of effectors in tree pathogenic fungi.

The potential emerging role of piRNA/PIWI complex in virus infection.

P-element-induced wimpy testis-interacting RNAs (piRNAs), a class of small noncoding RNAs with about 24-32 nucleotides, often interact with PIWI proteins to form a piRNA/PIWI complex that could influence spermiogenesis, transposon silencing, epigenetic regulation, etc. PIWI proteins have a highly conserved function in a variety of species and are usually expressed in germ cells. However, increasing evidence has revealed the important role of the piRNA/PIWI complex in the occurrence and prognosis of various human diseases and suggests its potential application in the diagnosis and treatment of related diseases, becoming a prominent marker for these human diseases. Recent studies have confirmed that piRNA/PIWI complexes or piRNAs are abnormally expressed in some viral infections, effecting disease progression and viral replication. In this study, we reviewed the association between the piRNA/PIWI complex and several human disease-associated viruses, including human papillomavirus, human immunodeficiency virus, human rhinovirus, severe acute respiratory syndrome coronavirus 2, respiratory syncytial virus, and herpes simplex virus type 1.

Genetically engineered nanovesicles mobilize synergistic antitumor immunity by ADAR1 silence and PDL1 blockade.

Growing evidence has proved that RNA editing enzyme ADAR1, responsible for detecting endogenous RNA species, was significantly associated with poor response or resistance to immune checkpoint blockade (ICB) therapy. Here, a genetically engineered nanovesicle (siAdar1-LNP@mPD1) was developed as an RNA interference nano-tool to overcome tumor resistance to ICB therapies. Small interfering RNA against ADAR1 (siAdar1) was packaged into a lipid nanoparticle (LNP), which was further coated with plasma membrane extracted from the genetically engineered cells overexpressing PD1. siAdar1-LNP@mPD1 could block the PD1/PDL1 immune inhibitory axis by presenting the PD1 protein on the coating membranes. Furthermore, siAdar1 could be effectively delivered into cancer cells by the designed nanovesicle to silence ADAR1 expression, resulting in an increased type I/II interferon (IFN-ß/γ) production and making the cancer cells more sensitive to secreted effector cytokines such as IFN-γ with significant cell growth arrest. These integrated functions confer siAdar1-LNP@mPD1 with robust and comprehensive antitumor immunity, as evidenced by significant tumor growth regression, abscopal tumor prevention, and effective suppression of lung metastasis, through a global remodeling of the tumor immune microenvironment. Overall, we provided a promising translatable strategy to simultaneously silence ADAR1 and block PDL1 immune checkpoint to boost robust antitumor immunity.

Regulatory focus as a mediator in the relationship between nurses' organizational silence and professional identity.

AIMS: This work aims to analyse the current state of the professional identity of Chinese nurses; examine the relationship amongst regulatory focus, organizational silence and professional identity and determine how regulatory focus affects the relationship between professional identity and organizational silence. DESIGN: This study conducted a cross-sectional survey. METHODS: From June to August 2023, 420 nurses from six hospitals in Hunan Province, China, were selected through convenience sampling and surveyed by using a general information questionnaire, the regulatory focus scale, the organizational silence scale and the professional identity scale. The relationship amongst the regulatory focus, organizational silence and professional identity of nurses was examined by utilizing SPSS 25.0 and the mediating role of regulatory focus between organizational silence and nurses' professional identity was examined by applying AMOS 24.0. RESULTS: Nurses had a moderate level of professional identity. Professional identity was positively correlated with regulatory focus and negatively correlated with organizational silence. Regulatory focus was negatively correlated with organizational silence. Mediation effect studies revealed that organizational silence and professional identity were partially mediated by regulatory focus. CONCLUSION: In accordance with research showing that nurses' organizational silence can indirectly affect professional identity via regulatory focus, clinical nursing managers should concentrate on the interaction amongst these three variables to strengthen professional identity. IMPACT: The results of this study serve as a reminder to nurses to select a preventive or promotive focus based on their career objectives and to effectively express their views to enhance their professional identity. This also reminds nursing managers assess nurse-led regulatory focus, identify their underlying qualities and understand their professional aspirations and career orientation, create a good atmosphere for advice and encourage nurses to express their views, so as to improve nurses 'professional identity. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Silencing or silent transmission? An exploratory study on trauma communication in Kurdish refugee families.

Trauma communication in refugee families is increasingly recognized as an important relational dynamic influencing psychosocial well-being, yet studies exploring interactional dynamics and meaning making at play in intra-family trauma communication remain scarce. This article reports on a qualitative study with Kurdish refugee families including parents (N = 10) and children (N = 17) resettled in Belgium, aiming to explore practices on trauma communication within refugee family relationships. In a multiple-phased qualitative design, semi-structured family interviews and participant observation administered in the homes of the participant families are followed by parental interviews involving a tape-assisted recall procedure to investigate observed intergenerational trauma communication and parent-child interactions. Data analysis shows parents and children seldom explicitly talked about the families' lived experiences of trauma. This silence was especially related to parental wishes to avoid their children's future involvement in violence. However, findings also indicate how the intra-family transmission of memories of collective violence occurs in many subtle ways. Four modes of indirect trauma communication could be distinguished: (1) focusing on the repetition of violence in the present; (2) transmission of the collective trauma history; (3) family storytelling; and (4) interaction with meaningful objects of the past. These findings shed light onto the interwoven nature of personal-familial and collective trauma and loss and illuminate the meanings of silence and disclosure in the context of the Kurdish diaspora. In the final section, we discuss our findings and outline its clinical implications for family therapeutic practices in refugee trauma care.

Silent reflections remain unheard.

OBJECTIVE: To consider the contribution of non-clinical factors in the rising rate of mental health presentations and explore the associated silence within the psychiatric profession. CONCLUSION: Medicalisation, concept creep and group think, alongside societal demand and expectations, have collectively contributed toward a distorted view of mental health and illness. Equitable service provision has been hindered by the silence of important perspectives.

Remaining silent during interrogation.

In many Western jurisdictions, criminal suspects undergoing police interrogations have the right to remain silent. In this experiment, we examined the effects of remaining silent during police questioning on laypersons' perceptions of a suspect. Participants (N = 126) read one of three mock-interview transcripts (i.e. admission, denial or silence) and indicated the extent to which they agreed or disagreed that a male suspect in a missing person case was guilty, cooperative, trustworthy and rational. Participants expressed stronger agreement that the suspect was guilty when he admitted guilt than when he denied involvement or remained silent. When the suspect remained silent, participants viewed the suspect as less cooperative than when the suspect denied or admitted guilt and as less rational than when the suspect denied committing the crime. Our findings provide some support for the notion that remaining silent during police questioning may be viewed unfavourably by external observers.

Online Interaction Turns the Congeniality Bias Into an Uncongeniality Bias.

Online phenomena like echo chambers and polarization are believed to be driven by humans' penchant to selectively expose themselves to attitudinally congenial content. However, if like-minded content were the only predictor of online behavior, heated debate and flaming on the Internet would hardly occur. Research has overlooked how online behavior changes when people are given an opportunity to reply to dissenters. Three experiments (total N = 320; convenience student samples from Germany) and an internal meta-analysis show that in a discussion-forum setting where participants can reply to earlier comments larger cognitive conflict between participant attitude and comment attitude predicts higher likelihood to respond (uncongeniality bias). When the discussion climate was friendly (vs. oppositional) to the views of participants, the uncongeniality bias was more pronounced and was also associated with attitude polarization. These results suggest that belief polarization on social media may not only be driven by congeniality but also by conflict.

Preferences for deinfibulation (opening) surgery and female genital mutilation service provision: A qualitative study.

OBJECTIVE: To explore the views of female genital mutilation (FGM) survivors, men and healthcare professionals (HCPs) on the timing of deinfibulation surgery and NHS service provision. DESIGN: Qualitative study informed by the sound of silence framework. SETTING: Survivors and men were recruited from three FGM prevalent areas of England. HCPs and stakeholders were from across the UK. SAMPLE: Forty-four survivors, 13 men and 44 HCPs. Ten participants at two community workshops and 30 stakeholders at a national workshop. METHODS: Hybrid framework analysis of 101 interviews and three workshops. RESULTS: There was no consensus across groups on the optimal timing of deinfibulation for survivors who wished to be deinfibulated. Within group, survivors expressed a preference for deinfibulation pre-pregnancy and HCPs antenatal deinfibulation. There was no consensus for men. Participants reported that deinfibulation should take place in a hospital setting and be undertaken by a suitable HCP. Decision making around deinfibulation was complex but for those who underwent surgery it helped to mitigate FGM impacts. Although there were examples of good practice, in general, FGM service provision was suboptimal. CONCLUSION: Deinfibulation services need to be widely advertised. Information should highlight that the procedure can be carried out at different time points, according to preference, and in a hospital by suitable HCPs. Future services should ideally be developed with survivors, to ensure that they are clinically and culturally appropriate. Guidelines would benefit from being updated to reflect the needs of survivors and to ensure consistency in provision.

Gold nanoparticles (AuNPs) can rapidly deliver artificial microRNA (AmiRNA)-ATG6 to silence ATG6 expression in Arabidopsis.

KEY MESSAGE: We establish a fast and efficient transient silencing system that facilitates functional studies of some genes, whose knockout leads to plant lethality. In plants, the generation of loss-of-function mutants is crucial for studying gene function. Artificial microRNA (AmiRNA) technology is a more targeted and effective tool for gene silencing. Gold nanoparticles (AuNPs) can bind nucleic acids and deliver them into animal cells. Here, AuNPs are used in combination with AmiRNA technology in plants. We found that AmiRNA-autophagy-related proteins (ATG6) can be delivered to cells by AuNPs to achieve the effect of ATG6 silencing. It is worth noting that on the 10th day there is still a silencing effect. Similar to the atg5 lines, silencing of ATG6 significantly reduced plant resistance to Pseudomonas syringae pv.maculicola (Psm) ES4326/AvrRpt2. Interestingly, ATG6 silencing and ATG5 mutation in NPR1-GFP (nonexpressor of pathogenesis-related genes) lines significantly reduced plant resistance to Psm ES4326/AvrRpt2, suggesting that autophagy is also involved in NPR1-regulated plant immune responses. In summary, we establish a fast and efficient transient silencing system that facilitates functional studies of some genes, whose knockout leads to plant lethality.

A Scalable Distributed Control Algorithm for Bearing-Only Passive UAV Formation Maintenance.

Unmanned Aerial Vehicles (UAVs) can cooperate through formations to perform tasks. Wireless communication allows UAVs to exchange information, but for the situations requiring high security, electromagnetic silence is needed to avoid potential threats. The passive UAV formation maintenance strategies can fulfill the requirement of electromagnetic silence at the cost of heavy real-time computing and precise locations of UAVs. To pursue high real-time performance without the localization of UAVs, this paper proposes a scalable distributed control algorithm for bearing-only passive UAV formation maintenance. By minimizing necessary communication, pure angle information is applied to maintain UAV formations through distributed control, without the knowledge of the UAVs' precise locations. The convergency of the proposed algorithm is proven strictly and the converging radius is derived. Through simulation, the proposed algorithm is proven to be suitable for a general case and demonstrates fast convergence speed, strong anti-interference capability, and high scalability.

Lipoprotein-Inspired Nanoscavenger for the Three-Pronged Modulation of Microglia-Derived Neuroinflammation in Alzheimer's Disease Therapy.

The inflammatory dysfunction of microglia from excess amyloid-ß peptide (Aß) disposal is an overlooked but pathogenic event in Alzheimer's disease (AD). Here, we exploit a native high-density lipoprotein (HDL)-inspired nanoscavenger (pHDL/Cur-siBACE1) that combines the trinity of phosphatidic acid-functionalized HDL (pHDL), curcumin (Cur), and ß-site APP cleavage enzyme 1 targeted siRNA (siBACE1) to modulate microglial dysfunction. By mimicking the natural lipoprotein transport route, pHDL can penetrate the blood-brain barrier and sequentially target Aß plaque, where Aß catabolism is accelerated without microglial dysfunction. The benefit results are from a three-pronged modulation strategy, including promoted Aß clearance with an antibody-like Aß binding affinity, normalized microglial dysfunction by blocking the NF-κB pathway, and reduced Aß production by gene silence (44%). After treatment, the memory deficit and neuroinflammation of APPswe/PSEN 1dE9 mice are reversed. Collectively, this study highlights the double-edged sword role of microglia and provides a promising tactic for modulating microglial dysfunction in AD treatment.

["In God alone my soul can find rest" (Ps 62:2) : Silence and pain in the Psalms and their narrativizations in Taizé]. / "Zu Gott allein ist meine Seele still" (Ps 62,2) : Stille und Schmerz in den Psalmen und deren Narrativierungen in Taizé.

BACKGROUND: A theological perspective on dealing with crises that focuses on modes of endurance and gestalt, is supported by interdisciplinary resilience research. OBJECTIVE: How can silence contribute to a productive coping with crises and pain? MATERIAL AND METHODS: Texts and practices of the Christian tradition are discussed with respect to their ways of dealing with critical and painful situations, namely a) the Psalm texts of the Old Testament, which are examined by means of exegetical methods for historical and cultural aspects of meaning and b) the practice of silence in the prayers of the Taizé community, which are examined from a narrative hermeneutical perspective. RESULTS: By understanding silence as an ambiguous and ambivalent phenomenon, it can contribute to a productive way of dealing with pain that enables perception, confrontation and acceptance. It is crucial not to regard the silence of a sufferer as a mere endurance, but also to have an eye on the creative potentials. Cultural and religious narratives and practices can help to locate oneself in a "space of silence" in such a way that a resilient way of dealing with experiences of pain becomes possible. CONCLUSION: In order for silence to promote resilience, it is necessary to keep an eye on productive as well as destructive processes of silence as an ambivalent phenomenon: These processes occur in an uncontrollable way and are shaped by implicit normative assumptions. Silence can be experienced as loneliness, isolation and the loss of quality of life, or silence can become a place of encounter, of arrival, of security, and in prayer of trust in God.

Data Mining Suggests That CXCL14 Gene Silencing in Colon Cancer Is Due to Promoter Methylation.

CXCL14 is one of the most evolutionarily conserved members of the chemokine family and is constitutionally expressed in multiple organs, suggesting that it is involved in the homeostasis maintenance of the system. CXCL14 is highly expressed in colon epithelial cells and shows obvious gene silencing in clinical colon cancer samples, suggesting that its silencing is related to the immune escape of cancer cells. In this paper, we analyzed the expression profiles of multiple human clinical colon cancer datasets and mouse colon cancer models to reveal the variation trend of CXCL14 expression during colitis, colon polyps, primary colon cancer, and liver metastases. The relationship between CXCL14 gene silencing and promoter hypermethylation was revealed through the colorectal carcinoma methylation database. The results suggest that CXCL14 is a tumor suppressor gene in colorectal carcinoma which is activated first and then silenced during the process of tumor occurrence and deterioration. Promoter hypermethylation is the main cause of CXCL14 silencing. The methylation level of CXCL14 is correlated with the anatomic site of tumor occurrence, positively correlated with patient age, and associated with prognosis. Reversing the hypermethylation of CXCL14 may be an epigenetic therapy for colon cancer.

The relationship between toxic leadership and organizational performance: the mediating effect of nurses' silence.

AIMS: To assess toxic leadership and organizational performance among nurses of a University Hospital, and explore the mediating effect of nurses 'silence. BACKGROUND: Toxic Leadership behaviours are hurtful to feelings, leading to emotive fatigue and nurses silence within the legislative framework. In fact, it is very harmful to all organizations. However, little emphasis has been paid to research on the mediating mechanism and border factors of their connection. METHODS: A cross-sectional design was applied. Data was collected from 750 nurses over the course of three months. The researchers employed structured equation modeling [SEM] to investigate the role of nurses' silence in mediating the association between toxic leadership and organizational performance. RESULTS: The toxic leadership level and Organisational performance level were both high. In addition to, the nurses' silence level was moderate. The SEM revealed that toxic Leadership accounted for the prediction of 65% of the variance of nurses' silence and 87% of the variance of organizational performance. Also, nurses silence as a mediating factor accounted for 73% of the variance of organizational performance. CONCLUSIONS: This study emphasized on the importance of creating a work environment that encourages and promotes open communication, as well as eliminating toxic leadership behaviours from the organizational culture among nurses as it effects on the organizational performance.

Ideological dilemmas of healthcare professionals who do not speak up at interprofessional team meetings.

In healthcare settings, speaking up is considered essential for patient safety. Indeed, voice opportunities are widely available mandatory mechanisms for speaking up at the routine interprofessional team meetings of our study site. Yet, healthcare professionals in team meetings often do not go beyond straightforward reporting of test results and biomedical-functional parameters, suggesting that members with psycho-social information related to the patient are not participating fully in team meetings. Post-meeting interviews with some of the team members revealed the moments of silence and the ideological contradictions underlying team discussions. We explored silences and contradictions as argumentative meanings inherent in naturally occurring speech. The identification of opposing meanings tells of ideological dilemmas that may explain why healthcare practitioners do not speak up vigorously. We identified three such dilemmas: the ideology of working in teams versus the ideology of working solo; the ideology of autonomy versus the ideology of paternalism; and the ideology of collectivism versus the ideology of individuality. The dilemmas made visible the dimensions of silence as well as silencing as an imposition of silence from above. We suggest focussing on mapping disciplinary and interpretive differences and their effects amongst team members may motivate voice. Further studies should explore the affective dimensions of silence in interprofessional team meetings.

Enduring the silence: High silence tolerance and other tools for promoting topic initiations of a man with autism.

Persistent deficits in the ability to initiate social interaction is a core criterion for a diagnosis of autism, and quantitative research shows that children with autism initiate fewer bids for interaction than neurotypical children. This conversation-analytic examination of two interactions between a man with autism, Harry, and two familiar carers will provide insights into the scope of his competences in topic initiation. Analyses of the participants' online management of turn-taking and sequence organisation demonstrate that Harry's topic initiations can be facilitated by a high silence tolerance of the interlocutor in initiation-relevant sequential environments. Specifically, Harry initiates more topics, when his conversational partner endures the long silences after possible sequence closure. The analyses underline that Harry does not lack neither competences nor motivation to successfully execute initiations. Instead, it is proposed that Harry's deficits in initiation should be reconceptualised as a difficulty of initiating interaction on neurotypical terms, where the standard maximum silence between turns is approximately one second. Hereby, the study emphasises that communicative competences of individuals with autism are interactionally managed, emerging in interaction with conversational partners.

What nursing chooses not to know: Practices of epistemic silence/silencing.

Drawing from a keynote panel held at the hybrid 25th International Philosophy of Nursing Conference, this discussion paper examines the question of epistemic silence in nursing from five different perspectives. Contributors include US-based scholar Claire Valderama-Wallace, who meditated on ecosystems of settler colonial logics of nursing; American scholar Lucinda Canty discussed the epistemic silencing of nurses of colour; Canadian scholar Amelie Perron interrogated the use of disobedience and parrhesia in and for nursing; Canada-based scholar Ismalia De Sousa considered what nursing protects in its silences; and Australian scholar Janice Gullick spoke to trans invisibility in nursing.

Construction of a prediction model for postoperative prognosis in patients with resectable cholangiocarcinoma based on silence information regulator 2 expression. / æ²‰é»˜ä¿¡æ¯è°ƒèŠ‚å› å­2åœ¨èƒ†ç®¡ç™Œä¸­çš„è¡¨è¾¾åŠå ¶å¯¹å¯åˆ‡é™¤èƒ†ç®¡ç™Œæ‚£è€ é¢„åŽçš„é¢„æµ‹ä»·å€¼.

OBJECTIVES: To develop a prediction model for postoperative prognosis in patients with cholangiocarcinoma (CCA) based on the expression of silence information regulator 2 (SIRT2). METHODS: The differential expression of SIRT2 between CCA and normal tissues was analyzed using TCGA and GEO databases. Gene set enrichment analysis (GSEA) was used to explore potential mechanisms of SIRT2 in CCA. The expression of SIRT2 protein in CCA tissues and normal tissues (including 44 pairs of specimens) was also detected by immunohistochemistry (IHC) in 89 resectable CCA patients who underwent surgical treatment in the First Affiliated Hospital of Bengbu Medical College between January 2016 and December 2021. The relationship between SIRT2 expression and clinicopathological characteristics and prognosis of CCA patients was analyzed. A survival prediction model for patients with resectable CCA was constructed with COX regression results, the calibration curve and the time-dependent receiver operating characteristic curve (ROC) were used to evaluate the performance of the constructed model, and the predictive power between this model and the American Joint Committee on Cancer (AJCC)/TNM staging system (8th edition) was compared. RESULTS: SIRT2 mRNA was overexpressed in CCA tissues as shown in TCGA and GEO databases. IHC staining showed that SIRT2 protein expression in CCA tissues was significantly higher than that in adjacent non-tumor tissues. GSEA results showed that elevated SIRT2 expression may be involved in multiple metabolism-related signaling pathway, such as fatty acid metabolism, oxidative phosphorylation and amino acid metabolism. SIRT2 expression was related to serum triglycerides level, tumor size and lymph node metastasis (all P<0.05). The survival analysis results showed that patients with higher SIRT2 expression had a significantly lower overall survival (OS) than patients with lower SIRT2 expression (P<0.05). Univariate COX regression analysis suggested that pathological differentiation, clinical stage, postoperative treatment and SIRT2 expression level were associated with the prognosis of CCA patients (all P<0.05). Multivariate regression analysis confirmed that clinical stage and SIRT2 expression level were independent predictors of OS in postoperative CCA patients (both P<0.05). A nomogram based on SIRT2 for prediction of survival in postoperative CCA patients was constructed. The C-index of the model was 0.675, and the area under the time-dependent ROC curve (AUC) for predicting survival in the first, second, and third years was 0.879, 0.778, and 0.953, respectively, which were superior to those of AJCC/TNM staging system (8th Edition). CONCLUSIONS: SIRT2 is highly expressed in CCA tissues, which is associated with poor prognosis in patients with resectable CCA. The nomogram developed based on SIRT2 may have better predictive power than the AJCC/TNM staging system (8th edition) in prediction of survival of postoperative CCA patients.