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Gastric cancer (GC) is a leading cause of cancer-related mortality worldwide, because of the low efficacy of current therapeutic strategies. Estrogen-related receptor γ (ERRγ) was previously showed as a suppressor of GC. However, the mechanism and effective therapeutic method based on ERRγ is yet to be developed. The expression levels of ERRγ, EZH2, and FOXM1 were detected by immunohistochemistry, qRT-PCR, and western blot. The regulatory mechanisms of ERRγ and FOXM1 were analyzed by ChIP, EMSA, and siRNA. The effects of EZH2 inhibitor (GSK126) or/and ERRγ agonist (DY131) on the tumorigenesis of gastric cancer cell lines were examined by cell proliferation, transwell migration, wound healing, and colony formation assays. Meanwhile, the inhibitory effects of GSK126 or/and DY131 on tumor growth were analyzed by xenograft tumor growth assay. The expression of ERRγ was suppressed in tumor tissues of GC patients and positively correlated with prognosis, as opposed to that of EZH2 and FOXM1. EZH2 transcriptionally suppressed ERRγ via H3K27me3, which subsequently activated the expression of master oncogene FOXM1. The combination of GSK126 and DY131 synergistically activated ERRγ expression, which subsequently inhibited the expression of FOXM1 and its regulated pathways. Synergistic combination of GSK126 and DY131 significantly inhibited the tumorigenesis of GC cell lines and suppressed the growth of GC xenograft. The FOXM1 signaling pathway underlying the ERRγ-mediated gastric cancer suppression was identified. Furthermore, combined treatment with EZH2 inhibitor and ERRγ agonist synergistically suppressed GC progression by inhibiting this signaling pathway, suggesting its high potential in treating GC patients.

Chronic stress could induce cancer metastasis by constant activation of the sympathetic nervous system, while cellular mechanism remains obscure. The aim of this research is to explore the metastasis associated negative effect of chronic stress. The analysis of transcriptome sequencing implied that activation of STAT3 signaling pathway by downregulated miR-337-3p might be a potential mechanism to induce epithelial to mesenchymal transition (EMT) of cancer cell and promote metastasis under chronic stress. We also verified this biological process in further experiments. Downregulation of miR-337-3p could downregulate E-cadherin expression and upregulate vimentin expression in vitro and in vivo. STAT3, related signal pathways of which are involved in metastasis regulation, was directly targeted by miR-337-3p. In conclusion, the above results denoted that activation of miR-337-3p/STAT3 axis might be a potential pathway for the increasing metastasis of breast cancer under chronic stress.

Objectives The objective of the study is to develop a novel tool—the Burnout Battery—for briefly screening burnout among oncology professionals in China and assessing its validity. Methods A multicenter study was conducted in doctors and nurses of the oncology departments in China from November 2014 to May 2015. The Burnout Battery was administered with the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and the Doctors' Job Burnout Questionnaire. Results Of 538 oncology doctors and nurses who completed all the survey, using MBI-HSS as the standard tool for measuring burnout, 52% had emotional exhaustion, 39.4% had depersonalization, and 59.3% had a low sense of personal accomplishment. Receiver operating characteristic curve analyses showed that the best cut-off of the Burnout Battery was the battery with 3 bars, which yielded best sensitivity and specificity against all the 3 subscales of MBI-HSS. With this cut-off, nearly half of Chinese oncology professionals (46.8%) had burnout. The Burnout Battery correlated significantly with subscales of the MBI-HSS and the Doctors' Job Burnout Questionnaire. In multiple logistic regression analysis, those who worked more than 60 hours per week and who thought clinical work was the most stressful part of their job were more likely to experience burnout. Conclusion Chinese oncology professionals exhibit high levels of burnout. The Burnout Battery appears to be a simple and useful tool for screening burnout. Working long hours and perceiving clinical work as the most stressful part of the job were the main factors associated with burnout.

Background: Death with dignity (DWD) refers to the refusal of life-prolonging measures for terminally ill patients by “living wills” forms in advance. More and more oncology physicians are receiving DWD requests from advance cancer patients in mainland China. Objective: The study objective was to investigate the attitudes of Chinese oncology physicians toward the legalization and implementation of DWD. Methods: A questionnaire investigating the understanding and attitudes toward DWD was administered to 257 oncology physicians from 11 hospitals in mainland China. Results: The effective response rate was 86.8% (223/257). The majority of oncology physicians (69.1%) had received DWD requests from patients. Half of the participants (52.5%) thought that the most important reason was the patients' unwillingness to maintain survival through machines. One-third of participants (33.0%) attributed the most important reason to suffering from painful symptoms. Most oncology physicians (78.9%) had knowledge about DWD. A fifth of respondents did not know the difference between DWD and euthanasia, and a few even considered DWD as euthanasia. The majority of oncology physicians supported the legalization (88.3%) and implementation (83.9%) of DWD. Conclusions: Many Chinese oncology physicians have received advanced cancer patients' DWD requests and think that DWD should be legalized and implemented. Chinese health management departments should consider the demands of physicians and patients. It is important to inform physicians about the difference between DWD and euthanasia, as one-fifth of them were confused about it.

Denoising nonlinear filter Speech recovery in the presence of very harsh noise is calling for R&D that take approaches different from those established to date, as the conventional systems and algorithms for speech denoising may suffer from serious performance degradation. In this paper, we propose a hybrid nonlinear adaptive noise canceller (ANC) to perform the speech enhancement task using both bone- and air-conducted measurements. In the proposed ANC, the bone-conducted speech serves as a reference signal while the air-conducted measurement with very large additive noise is adopted as a primary noise. A Volterra filter and a functional link artificial neural network (FLANN) are placed in parallel, forming a hybrid nonlinear ANC. Simulations using real bone- and air-conducted speech measurements are provided to demonstrate that the proposed system outperforms ANCs equipped with FIR filter or Volterra filter or FLANN alone.

Wearable electronic systems have been and will continue to be utilized in both civil and military uses. Strong noise environments derived from large vehicles (e.g. ships, aircrafts, or military tanks) seriously affect the quality of speech communications especially for wearable systems without hermetic packaging. Bone conduction technology through the acquisition of skull vibration is able to obtain voice information, which can effectively avoid the interference of acoustic noise on the speech. In this paper, a high-performance wearable bone-conducted speech enhancement system is developed to reduce the distortion of the environment noises. Both bone-conducted and air-conducted voices are used to train the equalization function of bone-conducted speech to air-conducted speech based on the deep neural network, and spectrum coefficients of linear predictive coding is taken as feature information for conversion model.

Sound source location based on General Cross-correlation can be divided into two parts—time delay estimation and location estimation. Considering the cost and calculation speed, the location system based on GCC receives more and more concern from researchers. This paper provides a new approach to improve the accuracy of location estimation using signals from two microphones. For that reverberation carries information of location of acoustic source, we can separate the detail which contains information of sound source under assumption of knowing coordinate of microphones. This method can be applied to many aspects especially for humanoid robot.

High-precision aligned wafer bonding is essential to heterogeneous integration, with the device dimension reduced continuously. To get the alignment more accurately and conveniently, we propose a moir&eacute, based alignment method using centrosymmetric grating marks. This method enables both coarse and fine alignment steps without requiring additional conventional cross-and-box alignment marks. Combined with an aligned wafer bonding system, alignment accuracy better than 300 nm (3&sigma, ) was achieved after bonding. Furthermore, the working principle of the moir&eacute, based alignment for the backside alignment system was proposed to overcome the difficulty in bonding of opaque wafers. We believe this higher alignment accuracy is feasible to satisfy more demanding requirements in wafer-level stacking technologies.

With the development of palliative care, a signed do-not-resuscitate (DNR) order has become increasingly popular worldwide. However, there is no legal guarantee of a signed DNR order for patients with cancer in mainland China. This study aimed to estimate the status of DNR order signing before patient death in the cancer center of a large tertiary affiliated teaching hospital in western China. Patient demographics and disease-related characteristics were also analyzed.This was a retrospective chart analysis. We screened all charts from a large-scale tertiary teaching hospital in China for patients who died of cancer from January 2010 to February 2015. Analysis included a total of 365 records. The details of DNR order forms, patient demographics, and disease-related characteristics were recorded.The DNR order signing rate was 80%. Only 2 patients signed the DNR order themselves, while the majority of DNR orders were signed by patients' surrogates. The median time for signing the DNR order was 1 day before the patients' death. Most DNR decisions were made within the last 3 days before death. The time at which DNR orders were signed was related to disease severity and the rate of disease progression.Our findings indicate that signing a DNR order for patients with terminal cancer has become common in mainland China in recent years. Decisions about a DNR order are usually made by patients' surrogates when patients are severely ill. Palliative care in mainland China still needs to be improved.

Objective We aimed at studying information needs of patients and their families, and their attitude towards the counterparts’ information needs. Factors influencing psychological status of patients were investigated. Methods Self-designed questionnaires for information needs and attitude were delivered to participants. Patient Health Questionnaire 9-item and Generalized Anxiety Disorder 7-item scale were used to evaluate psychological status of patients. Results 183 eligible pairs of patients and families were involved. Except for the patients’ expected life span, most patients and families needed information for all other subscales of disease-related information. Most patients wished families know more information; however, caregivers tended to prevent this. The occurrence of patients’ psychiatric disorders was related to their needs for expected life span (OR 3.06 95%CI 1.36–6.93), as well as the attitude of caregivers about whether to provide more information about treatment outcomes (OR 0.24 95% CI 0.10–0.63). Conclusions Information discordance between cancer patients and their families tended to happen when it came to patients’ prognostic information. The psychological status of cancer patients was found in association with their information needs and families’ attitude towards it. Practice Implications To guide oncology professionals and cancer patients’ families for information provision.

Objective It is widely considered that telemedicine can make positive contributions to dental practice. This study aimed to evaluate a cloud-based telemedicine application for screening for oral diseases. Methods A telemedicine system, based on a store-and-forward method, was developed to work as a platform for data storage. An Android application was developed to facilitate entering demographic details and capturing oral photos. As a proof-of-concept, six volunteers were enrolled in a trial to obtain oral images using smartphone cameras. Following an onsite oral examination, images of participants’ teeth were obtained by a trained dental assistant. Oral images were directly uploaded from the smartphone to a cloud-based server via broadband network. The assessments of oral images by offsite dentists were compared with those carried out via face-to-face oral examinations. Results A complete set of 30 oral images was obtained from all six participants. Out of 192 teeth reviewed, the proportion of ungradable teeth was 8%. Sensitivity and specificity of teledental screening were 57% and 100% respectively. The inter-grader agreement estimated for two examination modalities and between two teledental graders was 70% and 62% respectively. Findings indicate that the proposed system for screening of oral diseases can be implemented to provide a valid and reliable alternative to traditional oral screening. Conclusion This study provided evidence that a robust system for store-and-forward screening for dental problems can be developed, and leads to the need for further testing of its robustness to confirm the accuracy and reliability of the teledentistry system.

e21502Background: In mainland China, euthanasia and death with dignity (DWD, which is equivalent to natural death in USA), don’t have clear legal provisions, so oncology physicians and nurses fall ...

e23005Background: Chronic stress could induce stress-related hormones (SRHs), a known risk factor for cancer. Among the SRHs, norepinephrine (NE) is considered to be one with the highest potential....

e21550Background: Depression and anxiety is prevalent among cancer patients and show serious impact. This study was conducted to investigate the knowledge of and attitude to depression and anxiety ...

e21515Background: Under the influence of Chinese traditional culture, physicians often implement aggressive treatment on patients with terminal cancer although it is of no use in most cases. Recent...