Developing wide-temperature and high-safety lithium-ion batteries(LIBs)presents significant challenges attributed to the absence of suitable solvents possessing broad liquid range and non-flammability properties.γ-Bu...Developing wide-temperature and high-safety lithium-ion batteries(LIBs)presents significant challenges attributed to the absence of suitable solvents possessing broad liquid range and non-flammability properties.γ-Butyrolactone(GBL)has emerged as a promising solvent;however,its incompatibility with graphite anode has hindered its application.This limitation necessitates a comprehensive investigation into the underlying mechanisms and potential solutions.In this study,we achieve a molecular-level understanding of the perplexing interphase formation process by employing in-situ spectroelectrochemical techniques and density function calculations.Our findings reveal that,even at high salt concentrations,GBL consistently occupies the primary Li^(+)solvation sheath,leading to extensive GBL decomposition and the formation of a high-impedance and inorganic-poor solid-electrolyte interphase(SEI)layer.Contrary to manipulating solvation structures,our research demonstrates that the utilization of filmforming additives with higher reduction potential facilitates the pre-establishment of a robust SEI film on the graphite anode.This approach effectively inhibits GBL decomposition and significantly enhances the battery's lifespan.This study provides the first reported intrinsic understanding of the unique GBLgraphite incompatibility and offers valuable insights for the development of wide-temperature and high-safety LIBs.展开更多
Adavosertib(ADA)is a WEE1 inhibitor that exhibits a synthetic lethal effect on p53-mutated gallbladder cancer(GBC).However,drug resistance due to DNA damage response compensation pathways and high toxicity limits furt...Adavosertib(ADA)is a WEE1 inhibitor that exhibits a synthetic lethal effect on p53-mutated gallbladder cancer(GBC).However,drug resistance due to DNA damage response compensation pathways and high toxicity limits further applications.Herein,estrone-targeted ADA-encapsulated metal–organic frameworks(ADA@MOF-EPL)for GBC synthetic lethal treatment by inducing conditional factors are developed.The high expression of estrogen receptors in GBC enables ADA@MOF-EPL to quickly enter and accumulate near the cell nucleus through estrone-mediated endocytosis and release ADA to inhibit WEE1 upon entering the acidic tumor microenvironment.Ultrasound irradiation induces ADA@MOF-EPL to generate reactive oxygen species(ROS),which leads to a further increase in DNA damage,resulting in a higher sensitivity of p53-mutated cancer cells to WEE1 inhibitor and promoting cell death via conditional synthetic lethality.The conditional factor induced by ADA@MOF-EPL further enhances the antitumor efficacy while significantly reducing systemic toxicity.Moreover,ADA@MOF-EPL demonstrates similar antitumor abilities in other p53-mutated solid tumors,revealing its potential as a broad-spectrum antitumor drug.展开更多
In this paper,a kind of Wire Mesh Casing Treatment(WMCT)is proposed to improve the stable operating range of the compressor.In contrast to the traditional circumferential groove,as for WMCT,a layer of wire mesh is lai...In this paper,a kind of Wire Mesh Casing Treatment(WMCT)is proposed to improve the stable operating range of the compressor.In contrast to the traditional circumferential groove,as for WMCT,a layer of wire mesh is laid on the surface of the circumferential groove.Parametric studies were conducted on the low-speed axial flow compressor,including the groove width,axial location,and mesh count.The optimum axial location for WMCT is related to its groove width.A higher wire mesh count results in a smaller compressor stall margin improvement.Steady simulations were carried out to study the effect of WMCT on the flow structure of the compressor.The wire mesh in the WMCT has a certain flow resistance,which restricts the flow into and out of the groove.Due to the WMCT,the flow parameter in the tip region of the rotor is less sensitive to changes in the operating conditions of the compressor.The WMCT causes the rotor tip blade loading to shift backward,inhibiting the formation of spill forward of the leakage flow,and thus improving the stability of the compressor.The flow resistance on the groove surface is a new degree-of-freedom for the casing treatment designer.展开更多
Glioblastoma(GBM)is a malignant brain tumor that grows quickly,spreads widely,and is resistant to treatment.Fibroblast growth factor receptor(FGFR)1 is a receptor tyrosine kinase that regulates cellular processes,incl...Glioblastoma(GBM)is a malignant brain tumor that grows quickly,spreads widely,and is resistant to treatment.Fibroblast growth factor receptor(FGFR)1 is a receptor tyrosine kinase that regulates cellular processes,including proliferation,survival,migration,and dif-ferentiation.FGFR1 was predominantly expressed in GBM tissues,and FGFR1 expression was negatively correlated with overall survival.We rationally designed a novel small molecule CYY292,which exhibited a strong affinity for the FGFR1 protein in GBM cell lines in vitro.CYY292 also exerted an effect on the conserved Ser777 residue of FGFR1.CYY292 dose-depen-dently inhibited cell proliferation,epithelial-mesenchymal transition,stemness,invasion,and migration in vitro by specifically targeting the FGFR1/AKT/Snail pathways in GBM cells,and this effect was prevented by pharmacological inhibitors and critical gene knockdown.In vivo experiments revealed that CYY292 inhibited U87MG tumor growth more effectively than AZD4547.CYY292 also efficiently reduced GBM cell proliferation and increased survival in orthotopic GBM models.This study further elucidates the function of FGFR1 in the GBM and reveals the effect of CYY292,which targets FGFR1,on downstream signaling pathways directly reducing GBM cell growth,invasion,and metastasis and thus impairing the recruitment,activation,and function of immune cells.展开更多
The authors regret that in Figure 3C,the Western Blot(WB)image representing GAPDH levels was mistakenly chosen as the same image for ERK(indicated by the red dotted-line rectangle).We have attached the original WB str...The authors regret that in Figure 3C,the Western Blot(WB)image representing GAPDH levels was mistakenly chosen as the same image for ERK(indicated by the red dotted-line rectangle).We have attached the original WB strip for GAPDH to demonstrate that this was an unintentional error in image selection.Additionally,we noticed that the Transwell images in the two upper panels of the right column in Figure 4J are misleading due to errors in image selection.We have attached the original data to show that this was also an unintentional error.We assure you that these two corrections do not alter the scientificconclusionof thearticle.展开更多
Recently,genetically targeted cancer therapies have been a topic of great interest.Synthetic lethality provides a new approach for the treatment of mutated genes that were previously considered unable to be targeted i...Recently,genetically targeted cancer therapies have been a topic of great interest.Synthetic lethality provides a new approach for the treatment of mutated genes that were previously considered unable to be targeted in traditional genotype-targeted treatments.The increasing researches and applications in the clinical setting made synthetic lethality a promising anticancer treatment option.However,the current understandings on different conditions of synthetic lethality have not been systematically assessed and the application of synthetic lethality in clinical practice still faces many challenges.Here,we propose a novel and systematic classification of synthetic lethality divided into gene level,pathway level,organelle level,and conditional synthetic lethality,according to the degree of specificity into its biological mechanism.Multiple preclinical findings of synthetic lethality in recent years will be reviewed and classified under these different categories.Moreover,synthetic lethality targeted drugs in clinical practice will be briefly discussed.Finally,we will explore the essential implications of this classification as well as its prospects in eliminating existing challenges and the future directions of synthetic lethality.展开更多
Many metal-organic frameworks(MOFs)trapped in water exhibit instability and small-particle agglomeration issues,which unquestionably constrain their potential applications,such as the capture of organic contaminants(O...Many metal-organic frameworks(MOFs)trapped in water exhibit instability and small-particle agglomeration issues,which unquestionably constrain their potential applications,such as the capture of organic contaminants(OCs).In this study,four types of micron-sized MOFs(Zn/Cu-BTC,MOF-5,ZIF-8,and UiO-66)were grown within a zeolite-13X support to form millimeter-sized zeolite-13X@MOF composites for the elimination of benzothiophene,methyl orange,and tetracycline from the liquid phase by dynamic adsorption in a column.We observed that the 13X@Zn/Cu-BTC exhibited extraordinarily high OC capture capacities as a result of the Zn^(2+) and Cu^(2+) combinative effects of the acid-base interaction.Remarkably,the 13X@UiO-66 preserved its structural integrity when immersed in water for 15 days,in contact with boiling water for 12 h,and in both strong acidic and basic aqueous media.Moreover,the OC capture abilities of the 13X@UiO-66 only underwent a slight change after the fifth round.This work provides new method for the design of desirable millimeter-sized zeolite@MOFs,thereby advancing their practical application for OC capture.展开更多
The design of hybrid structure offers an attractive solution to enhance strength and structural stiffness as well as to achieve lightweight effect and cost reduction.The applications of steel-FRP(fiber-reinforced poly...The design of hybrid structure offers an attractive solution to enhance strength and structural stiffness as well as to achieve lightweight effect and cost reduction.The applications of steel-FRP(fiber-reinforced polymer)composites in trans-portation and civil engineering have been comprehensively reviewed.In order to apply hybrid structures to car body parts such as B-pillar,flexural performance of steel-FRP composites is investigated by means of three-point bending test in this study.An analytical model is deduced to calculate the initial stiffness,the bending load and the energy absorption of steel-FRP composites.Steel-CFRP(carbon fiber-reinforced polymer)and steel-AFRP(aramid fiber-reinforced polymer)composites are experimentally studied and discussed.The results demonstrate that the steel-FRP composites exhibit significantly higher load-carrying capabilities and initial stiffnesses along with larger energy absorptions in the bending process compared to the single steel sheet.展开更多
The alarm has been ringing over the gradually increasing drug-resistant bacteria,which calls for the development of safer antibacterial materials.Photosensitive antibacterials are considered as a promising alternative...The alarm has been ringing over the gradually increasing drug-resistant bacteria,which calls for the development of safer antibacterial materials.Photosensitive antibacterials are considered as a promising alternative solution due to their unique light-activated antimicrobial mechanism,which in-situ produces highly reactive oxygen species on the multiple and variable active sites for the inactivation of various microbes.However,there are some factors,including phototoxicity,oxygen consumption and the risk of microbial contamination,greatly limit the efficiency and application of photosensitisers(PSs)in practical biomedical applications.Some studies have explored the synergistic effects of PSs by antibiotics,photothermal agents,antibacterial nanoparticles and biofilm-disrupting enzymes.Moreover,novel synergistic methods for improving the antibacterial ability of PSs under low-energy irradiation,hypoxia conditions and dull conditions,have been rarely reviewed yet.Herein,the authors summarised some synergistic methods and related applications of surface-functionalised photosensitive antimicrobials,which were prepared with organic antimicrobial materials,superhydrophobic surfaces,upconversion nanoparticles and energy storage structures in recent years.Finally,the authors presented the advantages and challenges of these synergistic mechanisms,and further analysed the development trend and application prospects of the surface-functionalised photosensitive antibacterials in biomedical fields.展开更多
Background:To date,no comprehensive analysis of gallbladder cancer(GBC)management has been reported.We aimed to identify the publication characteristics and research trends in managing GBC over the past three decades....Background:To date,no comprehensive analysis of gallbladder cancer(GBC)management has been reported.We aimed to identify the publication characteristics and research trends in managing GBC over the past three decades.Methods:We selected the 100 most cited articles and performed a bibliometric analysis to summarize the publication characteristics,explore research hotspots,and identify research trends in the management of GBC.Results:The total citations of the included articles ranged from 123 to 1822.Period II(2001–2010)yielded the highest number of included articles,whereas the lowest was in Period III(2011–2020).The United States and Japan published the most papers,in which the Memorial Sloan–Kettering Cancer Center and Nagoya University were the leading institutions,respectively.The most influential authors were Blumgart LH and Fong YM from the United States.Cooperation among countries,institutions,and authors was weak.The Annals of Surgery contributed the most articles with the highest number of total citations.The most researched topic was surgery,followed by systemic therapy and adjuvant therapy.Since Period I,the percentage of surgery-related publications continuously decreased(Periods II and III versus Period I,both p<0.001),with a concomitant increase in those of adjuvant therapy(Period III versus Period I,p=0.004)and systemic therapy(Period II versus Period I,p=0.004;Period III versus Period I,p=0.002).Conclusions:Surgery remains the preferred treatment,while there is a tendency toward adjuvant and systemic therapy in GBC management.An increase in local and international collaboration for managing GBC is required.展开更多
基金financially supported by the National Natural Science Foundation of China(21972049,22272175)the National Key R&D Program of China(2022YFA1504002)+3 种基金the“Scientist Studio Funding”from Tianmu Lake Institute of Advanced Energy Storage Technologies Co.,Ltd.Dalian Supports High-Level Talent Innovation and Entrepreneurship Projects(2021RD14)the Dalian Institute of Chemical Physics(DICP I202213)the 21C Innovation Laboratory,Contemporary Ampere Technology Ltd.by project No.21C-OP-202208。
文摘Developing wide-temperature and high-safety lithium-ion batteries(LIBs)presents significant challenges attributed to the absence of suitable solvents possessing broad liquid range and non-flammability properties.γ-Butyrolactone(GBL)has emerged as a promising solvent;however,its incompatibility with graphite anode has hindered its application.This limitation necessitates a comprehensive investigation into the underlying mechanisms and potential solutions.In this study,we achieve a molecular-level understanding of the perplexing interphase formation process by employing in-situ spectroelectrochemical techniques and density function calculations.Our findings reveal that,even at high salt concentrations,GBL consistently occupies the primary Li^(+)solvation sheath,leading to extensive GBL decomposition and the formation of a high-impedance and inorganic-poor solid-electrolyte interphase(SEI)layer.Contrary to manipulating solvation structures,our research demonstrates that the utilization of filmforming additives with higher reduction potential facilitates the pre-establishment of a robust SEI film on the graphite anode.This approach effectively inhibits GBL decomposition and significantly enhances the battery's lifespan.This study provides the first reported intrinsic understanding of the unique GBLgraphite incompatibility and offers valuable insights for the development of wide-temperature and high-safety LIBs.
基金supported by the National Natural Science Foundation of China(82202873,32200566)the Natural Science Foundation of Zhejiang Province(LQ22H160003)the Fundamental Research Funds for the Central Universities(2262022-00141)。
文摘Adavosertib(ADA)is a WEE1 inhibitor that exhibits a synthetic lethal effect on p53-mutated gallbladder cancer(GBC).However,drug resistance due to DNA damage response compensation pathways and high toxicity limits further applications.Herein,estrone-targeted ADA-encapsulated metal–organic frameworks(ADA@MOF-EPL)for GBC synthetic lethal treatment by inducing conditional factors are developed.The high expression of estrogen receptors in GBC enables ADA@MOF-EPL to quickly enter and accumulate near the cell nucleus through estrone-mediated endocytosis and release ADA to inhibit WEE1 upon entering the acidic tumor microenvironment.Ultrasound irradiation induces ADA@MOF-EPL to generate reactive oxygen species(ROS),which leads to a further increase in DNA damage,resulting in a higher sensitivity of p53-mutated cancer cells to WEE1 inhibitor and promoting cell death via conditional synthetic lethality.The conditional factor induced by ADA@MOF-EPL further enhances the antitumor efficacy while significantly reducing systemic toxicity.Moreover,ADA@MOF-EPL demonstrates similar antitumor abilities in other p53-mutated solid tumors,revealing its potential as a broad-spectrum antitumor drug.
基金supported by the National Natural Science Foundation of China(Nos.52325602 and U2241276)the Science Center for Gas Turbine Project,China(Nos.P2022-A-Ⅱ-002-001,P2022-C-Ⅱ-001-001 and P2022-CⅡ-003-001)+1 种基金the National Science and Technology Major Project,China(No.2017-Ⅱ-0005-0018)supported by the Key Laboratory of Pre-Research Management Centre,China(No.6142702200101)。
文摘In this paper,a kind of Wire Mesh Casing Treatment(WMCT)is proposed to improve the stable operating range of the compressor.In contrast to the traditional circumferential groove,as for WMCT,a layer of wire mesh is laid on the surface of the circumferential groove.Parametric studies were conducted on the low-speed axial flow compressor,including the groove width,axial location,and mesh count.The optimum axial location for WMCT is related to its groove width.A higher wire mesh count results in a smaller compressor stall margin improvement.Steady simulations were carried out to study the effect of WMCT on the flow structure of the compressor.The wire mesh in the WMCT has a certain flow resistance,which restricts the flow into and out of the groove.Due to the WMCT,the flow parameter in the tip region of the rotor is less sensitive to changes in the operating conditions of the compressor.The WMCT causes the rotor tip blade loading to shift backward,inhibiting the formation of spill forward of the leakage flow,and thus improving the stability of the compressor.The flow resistance on the groove surface is a new degree-of-freedom for the casing treatment designer.
基金supported by the National Natural Science Foundation of China(No.81971180,81973168 and 82003793)CAMS Innovation Fund for Medical Sciences(No.2019-12M-5-028)+1 种基金the Scientific Research Project of Wenzhou,Zhejiang,China(No.ZY2019001)the National Natural Science Foundation of Zhejiang Province,China(No.LZ22H300002).
文摘Glioblastoma(GBM)is a malignant brain tumor that grows quickly,spreads widely,and is resistant to treatment.Fibroblast growth factor receptor(FGFR)1 is a receptor tyrosine kinase that regulates cellular processes,including proliferation,survival,migration,and dif-ferentiation.FGFR1 was predominantly expressed in GBM tissues,and FGFR1 expression was negatively correlated with overall survival.We rationally designed a novel small molecule CYY292,which exhibited a strong affinity for the FGFR1 protein in GBM cell lines in vitro.CYY292 also exerted an effect on the conserved Ser777 residue of FGFR1.CYY292 dose-depen-dently inhibited cell proliferation,epithelial-mesenchymal transition,stemness,invasion,and migration in vitro by specifically targeting the FGFR1/AKT/Snail pathways in GBM cells,and this effect was prevented by pharmacological inhibitors and critical gene knockdown.In vivo experiments revealed that CYY292 inhibited U87MG tumor growth more effectively than AZD4547.CYY292 also efficiently reduced GBM cell proliferation and increased survival in orthotopic GBM models.This study further elucidates the function of FGFR1 in the GBM and reveals the effect of CYY292,which targets FGFR1,on downstream signaling pathways directly reducing GBM cell growth,invasion,and metastasis and thus impairing the recruitment,activation,and function of immune cells.
文摘The authors regret that in Figure 3C,the Western Blot(WB)image representing GAPDH levels was mistakenly chosen as the same image for ERK(indicated by the red dotted-line rectangle).We have attached the original WB strip for GAPDH to demonstrate that this was an unintentional error in image selection.Additionally,we noticed that the Transwell images in the two upper panels of the right column in Figure 4J are misleading due to errors in image selection.We have attached the original data to show that this was also an unintentional error.We assure you that these two corrections do not alter the scientificconclusionof thearticle.
基金supported by the Opening Fund of Engineering Research Center of Cognitive Healthcare of Zhejiang Province(No.2018KFJJ09)Scientific Research Fund of Zhejiang Provincial Education Department(Y201941406)+2 种基金National Natural Science Foundation of China(Nos.81827804 and 81800540)Zhejiang Clinical Research Center of Minimally Invasive Diagnosis and Treatment of Abdominal Diseases(No.2018E50003)Science and Technology Innovative Activity Plan and New Seedling Talent Plan for College Students in Zhejiang Province(No.2020R401217)。
文摘Recently,genetically targeted cancer therapies have been a topic of great interest.Synthetic lethality provides a new approach for the treatment of mutated genes that were previously considered unable to be targeted in traditional genotype-targeted treatments.The increasing researches and applications in the clinical setting made synthetic lethality a promising anticancer treatment option.However,the current understandings on different conditions of synthetic lethality have not been systematically assessed and the application of synthetic lethality in clinical practice still faces many challenges.Here,we propose a novel and systematic classification of synthetic lethality divided into gene level,pathway level,organelle level,and conditional synthetic lethality,according to the degree of specificity into its biological mechanism.Multiple preclinical findings of synthetic lethality in recent years will be reviewed and classified under these different categories.Moreover,synthetic lethality targeted drugs in clinical practice will be briefly discussed.Finally,we will explore the essential implications of this classification as well as its prospects in eliminating existing challenges and the future directions of synthetic lethality.
基金the Zhejiang Provincial Natural Science Foundation of China under Grant No.LY19B060014the"National Key Research and Development Project(CN)"of China(No.2019YFC1606400).
文摘Many metal-organic frameworks(MOFs)trapped in water exhibit instability and small-particle agglomeration issues,which unquestionably constrain their potential applications,such as the capture of organic contaminants(OCs).In this study,four types of micron-sized MOFs(Zn/Cu-BTC,MOF-5,ZIF-8,and UiO-66)were grown within a zeolite-13X support to form millimeter-sized zeolite-13X@MOF composites for the elimination of benzothiophene,methyl orange,and tetracycline from the liquid phase by dynamic adsorption in a column.We observed that the 13X@Zn/Cu-BTC exhibited extraordinarily high OC capture capacities as a result of the Zn^(2+) and Cu^(2+) combinative effects of the acid-base interaction.Remarkably,the 13X@UiO-66 preserved its structural integrity when immersed in water for 15 days,in contact with boiling water for 12 h,and in both strong acidic and basic aqueous media.Moreover,the OC capture abilities of the 13X@UiO-66 only underwent a slight change after the fifth round.This work provides new method for the design of desirable millimeter-sized zeolite@MOFs,thereby advancing their practical application for OC capture.
文摘The design of hybrid structure offers an attractive solution to enhance strength and structural stiffness as well as to achieve lightweight effect and cost reduction.The applications of steel-FRP(fiber-reinforced polymer)composites in trans-portation and civil engineering have been comprehensively reviewed.In order to apply hybrid structures to car body parts such as B-pillar,flexural performance of steel-FRP composites is investigated by means of three-point bending test in this study.An analytical model is deduced to calculate the initial stiffness,the bending load and the energy absorption of steel-FRP composites.Steel-CFRP(carbon fiber-reinforced polymer)and steel-AFRP(aramid fiber-reinforced polymer)composites are experimentally studied and discussed.The results demonstrate that the steel-FRP composites exhibit significantly higher load-carrying capabilities and initial stiffnesses along with larger energy absorptions in the bending process compared to the single steel sheet.
基金supported by the Open Funding Project of National Key Laboratory of Human Factors Engineering(grant no.SYFD150051805K)the Fundamental Research Funds for the Central Universities(no.2019XJ02)+2 种基金National Natural Science Foundation of China(no.51772251)the National Basic Research Program(grant no.2014CB931804)the Science and Technology Planning Project of Sichuan Province(nos.2017RZ0032,2016GZ0264 and 2018GZ0462).
文摘The alarm has been ringing over the gradually increasing drug-resistant bacteria,which calls for the development of safer antibacterial materials.Photosensitive antibacterials are considered as a promising alternative solution due to their unique light-activated antimicrobial mechanism,which in-situ produces highly reactive oxygen species on the multiple and variable active sites for the inactivation of various microbes.However,there are some factors,including phototoxicity,oxygen consumption and the risk of microbial contamination,greatly limit the efficiency and application of photosensitisers(PSs)in practical biomedical applications.Some studies have explored the synergistic effects of PSs by antibiotics,photothermal agents,antibacterial nanoparticles and biofilm-disrupting enzymes.Moreover,novel synergistic methods for improving the antibacterial ability of PSs under low-energy irradiation,hypoxia conditions and dull conditions,have been rarely reviewed yet.Herein,the authors summarised some synergistic methods and related applications of surface-functionalised photosensitive antimicrobials,which were prepared with organic antimicrobial materials,superhydrophobic surfaces,upconversion nanoparticles and energy storage structures in recent years.Finally,the authors presented the advantages and challenges of these synergistic mechanisms,and further analysed the development trend and application prospects of the surface-functionalised photosensitive antibacterials in biomedical fields.
基金supported by the Scientific Research Fund of Zhejiang Provincial Education Department(grant number:Y202148325)the National Natural Science Foundation of China(grant numbers:81800540,81827804).
文摘Background:To date,no comprehensive analysis of gallbladder cancer(GBC)management has been reported.We aimed to identify the publication characteristics and research trends in managing GBC over the past three decades.Methods:We selected the 100 most cited articles and performed a bibliometric analysis to summarize the publication characteristics,explore research hotspots,and identify research trends in the management of GBC.Results:The total citations of the included articles ranged from 123 to 1822.Period II(2001–2010)yielded the highest number of included articles,whereas the lowest was in Period III(2011–2020).The United States and Japan published the most papers,in which the Memorial Sloan–Kettering Cancer Center and Nagoya University were the leading institutions,respectively.The most influential authors were Blumgart LH and Fong YM from the United States.Cooperation among countries,institutions,and authors was weak.The Annals of Surgery contributed the most articles with the highest number of total citations.The most researched topic was surgery,followed by systemic therapy and adjuvant therapy.Since Period I,the percentage of surgery-related publications continuously decreased(Periods II and III versus Period I,both p<0.001),with a concomitant increase in those of adjuvant therapy(Period III versus Period I,p=0.004)and systemic therapy(Period II versus Period I,p=0.004;Period III versus Period I,p=0.002).Conclusions:Surgery remains the preferred treatment,while there is a tendency toward adjuvant and systemic therapy in GBC management.An increase in local and international collaboration for managing GBC is required.