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Objective To analyze the clinical characteristics of anti-neuronal antibody positive paraneoplastic neurological syndrome related to immune checkpoint inhibitors (ICI-PNS). Methods and Results A total of 5 patients with anti-neuronal antibody positive ICI-PNS in Peking Union Medical College Hospital from January 2012 to March 2024 were included. Tumor types included small cell lung cancer (2 cases), malignant melanoma (one case), Hodgkin lymphoma (one case) and cervical cancer (one case). Immune checkpoint inhibitors (ICIs) included programmed death 1 (PD-1) inhibitors (3 cases), programmed cell death ligand 1 (PD-L1) inhibitors (one case) and bispecific PD-1/cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) inhibitors (one case). All 5 patients presented with high-risk neurologic phenotypes of paraneoplastic neurological syndrome (PNS), of which 4 presented with limbic encephalitis and one presented with rapidly progressive cerebellar syndrome. Anti-neuronal antibodies detected in serum and/or cerebrospinal fluid of patients included anti-Hu, γ-aminobutyric acid receptor type B (GABABR), sex-determining region of Y chromosome-related high mobility group box 1 (SOX1), metabotropic glutamate receptor 5 (mGluR5) and Yo antibodies. Neurological syndromes occurred within 2 weeks after receiving ICIs in 4 patients. The modified Rankin Score (mRS) of 4 patients was 3 at peak of illness, and one patient was 5 at peak of illness. The Common Terminology Criteria for Adverse Events (CTCAE) was grade 3 in all 5 patients. After withdrawal of ICIs and treatment with glucocorticoids and intravenous immunoglobulin (IVIg), the neurological symptoms of the patients were improved. Conclusions High/intermediate-risk anti-neuronal antibodies are diagnostic markers of ICI-PNS. Evaluation of ICI-PNS clinical phenotypes and CTCAE grading are important for immunotherapy. Discontinuation of ICIs, administration of glucocorticoids and IVIg can improve the prognosis of patients. [ABSTRACT FROM AUTHOR]

Summary: Zingiber (Zingiberaceae: Zingibereae) is an economically important but taxonomically difficult genus, with names frequently misapplied. Here, we thoroughly review all names corresponding to the currently recognised 54 species from China including their synonyms, and clarify the status of their types. Lectotypes are designated for 40 names (including one second‐step), neotypes for 3 names, and epitypes for 3 names. Additional and often uncited isotypes have been discovered for numerous names, and such additional records are here provided. Tupistra bambusifolia var. rubromaculosa, Z. simaoense, Z. confine and Z. larsenii are newly treated as synonyms of Z. atrorubens, Z. densissimum, Z. officinale and Z. recurvatum respectively. A new combination, Z. bambusifolium, is proposed, based on Tupistra bambusifolia. This study will form the nomenclatural basis of an ongoing taxonomic revision of the genus in China, and phylogenetic study of the genus. [ABSTRACT FROM AUTHOR]

Background: The use of suboptimal controls in randomized trials of new cancer drugs can produce potentially unreliable clinical efficacy results over the current standard of care and expose patients to substandard therapy. We aim to investigate the proportion of randomized trials of investigational cancer drugs that used a suboptimal control arm and the number of trial participants at risk of exposure to suboptimal treatments in China. The association between the use of a suboptimal control and concluding statistical significance on the primary endpoint was also examined. Methods and findings: This observational study included randomized controlled trials (RCTs) of cancer drugs that were authorized by specific Chinese institutional review boards between 2016 and 2021, supporting investigational new drug applications of these drugs in China. The proportion of trials that used a suboptimal control arm and the total number of trial participants at risk of exposure to suboptimal treatments were calculated. In a randomized trial for a specific condition, a comparator was deemed suboptimal if it was not recommended by clinical guidelines published in priori or if there existed a regimen with a higher level of recommendation for the indication. The final sample included 453 Phase II/III and Phase III randomized oncology trials. Overall, 60 trials (13.2%) adopted a suboptimal control arm. Among them, 58.3% (35/60) used comparators that were not recommended by a prior guideline for the indication. The cumulative number of trial participants at risk of exposure to suboptimal treatments totaled 18,610 by the end of 2021, contributing 15.1% to the total number of enrollees of all sampled RCTs in this study. After adjusting for the year of ethical approval, region of participant recruitment, line of therapy, and cancer site, second-line therapies (adjusted odds ratio [aOR] = 2.7, 95%CI [1.2, 5.9]), adjuvant therapies (aOR = 8.9, 95% CI [3.4, 23.1]), maintenance therapies (aOR = 5.2, 95% CI [1.6, 17.0]), and trials recruiting participants in China only (aOR = 4.1, 95% CI [2.1, 8.0]) were more likely to adopt a suboptimal control. For the 105 trials with publicly available results, no statistically significant difference was observed between the use of a suboptimal control and concluding positive on the primary endpoint (100.0% [12/12] versus 83.9% [78/93], p = 0.208). The main limitation of this study is its reliance on clinical guidelines that could vary across cancer types and time in assessing the quality of the control groups. Conclusions: In this study, over one-eighth of randomized trials of cancer drugs registered to apply for regulatory approval in China used a suboptimal comparator. Our results highlight the necessity to refine the design of randomized trials to generate optimal clinical evidence for new cancer therapies. In this observational study, Yichen Zhang and colleagues explore how comparator arms are used in randomized oncology trials registered in China. Author summary: Why was this study done?: ■ Using inappropriate controls in randomized trials of new cancer drugs can expose patients to harm and produce potentially unreliable results of clinical efficacy. ■ In November 2021, China's Center for Drug Evaluation issued the Guidance on Clinical Value-Oriented Oncology Drug Research and Development. It stated that an active control arm should be selected with consideration of whether it reflects the optimal treatment in current clinical practices. ■ Previous descriptive analysis showed that oncology trials are expanding in China; however, no literature evaluated the quality of their control arms. What did the researchers do and find?: ■ This observational study reports the annual trend and proportion of 453 Phase II/III and Phase III randomized oncology trials registered in China between 2016 and 2021 that adopted a suboptimal control arm. We also calculated the cumulative number of trial participants at risk of exposure to suboptimal treatments. ■ We observed a fluctuating yet overall upward trend in the number of trials and participants that used a suboptimal comparator during our observation period. Overall, 60 trials adopted a suboptimal control arm and the cumulative number of trial participants at risk of exposure to suboptimal treatments totaled 18,610 by the end of 2021. ■ Trials with a suboptimal control reported higher but statistically non-significant proportions of positive results than those using an optimal control. What do these findings mean?: ■ Trial sponsors, ethical review boards, and oncologists should make collaborative efforts to protect patients from unnecessary harm and drugs with uncertain clinical benefits over the existing standard of care. ■ Regulatory agencies should be cautious when reviewing investigational new drug applications whose supporting trial used a suboptimal control and when making subsequent market authorization decisions. ■ A limitation of this study is the reliance on clinical guidelines that could vary across cancer types and time in assessing the quality of the control groups. Hence, though oncologists and clinical pharmacists were consulted when assessing the sample trials, our results may have inherent subjectivity. [ABSTRACT FROM AUTHOR]

The aim of this study is to analyze the clinical characteristics and outcomes of Chinese patients with progressive multifocal leukoencephalopathy (PML) who were treated with programmed cell death protein 1 (PD1) blockade therapies. We retrospectively analyzed patients who were admitted to our hospital between October 1, 2020, and October 1, 2022, diagnosed with PML and treated with PD1 blockade therapies. Four patients with PML who were treated with PD1 blockade therapies were identified. All patients were male, and their ages ranged from 19 to 54 years old. One patient (Case 2) exhibited mild pleocytosis, while three patients (Cases 2–4) had markedly reduced T lymphocyte cell counts prior to treatment. The time interval between symptom onset and treatment initiation ranged from six to 54 weeks. All patients received pembrolizumab treatment, with a total of two to four doses administered. Three patients who responded to pembrolizumab treatment showed clinical improvement starting around 8 weeks after the initiation of therapy. Although one patient did not show clinical improvement, they ultimately survived until the last follow-up. None of the patients in this study exhibited immune-related adverse events or immune reconstitution inflammatory syndrome. PD1 blockade appears to be a promising novel therapeutic option for PML; additional prospective studies are necessary to confirm its efficacy. [ABSTRACT FROM AUTHOR]

Autoimmune cerebellar ataxia (ACA) is an important and potentially treatable cause of sporadic cerebellar syndrome, but studies with large sample size are limited. This study reported a large ACA series in China and described its etiology and clinical characteristics. We reviewed all ACA patients from our hospital (2013–2021) and analyzed their clinical and paraclinical features, treatment, and outcome. ACA subtypes investigated included paraneoplastic cerebellar degeneration (PCD), primary autoimmune cerebellar ataxia (PACA), anti-glutamate decarboxylase (GAD)–associated cerebellar ataxia, opsoclonus-myoclonus syndrome (OMS), Miller Fisher syndrome (MFS), and ACA-associated with autoimmune encephalitis. A total of 127 patients were identified and 40.9% were male. The median onset age was 47.0 years. Gait ataxia was the most prevalent feature followed by limb ataxia, dizziness, and dysarthria/dysphagia. Extracerebellar manifestations included pyramidal signs (28.3%) and peripheral neuropathy/radiculopathy (15.0%). ACA subtypes were PCD (30.7%), PACA (37.8%), ACA associated with autoimmune encephalitis (12.6%), anti-GAD-associated ACA (8.7%), MFS (7.1%), and OMS (3.1%). Neuronal antibodies were positive in 67.7% of patients. Brain magnetic resonance imaging was unremarkable (55.7%) or showed atrophy (18.3%) or abnormal signal intensity (26.1%, most of which was extracerebellar). Although most patients received immunotherapy, the modified Rankin scale at last follow-up was ≤ 2 in only 47.3% patients. Thirteen patients died and 24 relapsed. Compared with PACA, PCD patients were older and had poorer outcome. This study illustrates the heterogeneity in the clinical features of ACA and suggests the importance of neuronal antibody testing in ACA diagnosis. PCD and PACA are the dominant ACA subtypes, and the former has a less favorable prognosis. [ABSTRACT FROM AUTHOR]

Aim: We constructed a multicentre cohort in China to analyse the differences in clinical characteristics, treatment strategies and prognoses between breast neuroendocrine carcinoma (NEC) and invasive ductal carcinoma (IDC) of the breast. Methods: All patients with early‐stage breast cancer who attended three hospitals in Beijing from 2000 to 2018 were included in the study. We used propensity score matching to make a 1:3 match between NEC and IDC. Results: After propensity score matching, 153 patients with IDC and 51 patients with NEC were analysed. Multivariate Cox regression showed that compared to patients with IDC, patients with NEC had a worse disease‐free survival (HR = 2.94, 95% CI: 1.69–5.12, p < 0.001). Conclusion: NEC patients have a worse disease‐free survival than IDC patients. [ABSTRACT FROM AUTHOR]

Background: Tanshinone IIA (TSA), a major lipophilic component extracted from the roots of Salvia miltiorrhiza Bunge, has been widely used in China for its various biological activities. However, its effect on ovarian reserve in aged mice was not studied elsewhere. Objectives: This study aimed to explore the effect of TSA on the ovarian reserve of aged mice as well as young mice. Forty weeks old mice (N = 40) were considered as aged group compared to 4 weeks old mice (N = 40), and these groups were subdivided into four subgroups (N = 10) to receive different doses of TSA (0, 10, 20, and 40 μg/g/day). Methods: The effect of TSA was evaluated by counting follicular number by histological examination. Basal serum levels of FSH, LH, E2, and anti‐Mullerian hormone (AMH) were measured by ELISA. Moreover, the expression levels of antioxidant genes (CAT, Nrf2, GPX1), gap junction (Cx37), ERK1/2, and Smad5 family gene were examined at both mRNA (qPCR) and protein levels (western blot). Results: Follicular number, level of AMH and E2, and the expression of CAT, Nrf2, and GPX1 genes increased significantly (p < 0.05) in aged mice administrated with medium (20 μg/g/day) and high (40 μg/g/day) doses of TSA, whereas FSH and LH levels were significantly low compared to low dose (10 μg/g/day) and control (0 μg/g/day) aged subgroups. However, we did not observe any effect of all doses of TSA on young mice. Conclusions: Administration of TSA with medium and high doses up‐regulates the expression of antioxidative genes, reduces the oxidative injury, increases levels of AMH, and E2 levels that are relatively comparable to those in young mice, and consequently results in a healthy oocyte development. [ABSTRACT FROM AUTHOR]

Background: Primary neuroendocrine breast carcinomas (NEBCs) are an extremely rare and underrecognized subtype of mammalian carcinoma. The prognostic factors for NEBCs remain controversial. Methods: In this multicenter retrospective study, the prognostic factors for patients with primary NEBCs who underwent surgery and had a pathologically confirmed diagnosis of neuroendocrine carcinoma in China and the United States were examined. The endpoints were disease‐free survival (DFS) and overall survival (OS). Results: A total of 51 Chinese patients and 98 US patients were included. In the Chinese cohort, tumor grade and Ki‐67 levels were prognostic factors for DFS in univariate analysis (hazard ratio [HR] = 5.11 [1.67–15.60], p = 0.004; HR = 57.70 [6.36–523.40], p < 0.001, respectively) and multivariate analysis (HR = 100.52 [1.33–7570.21], p = 0.037; HR = 31.47 [1.05–945.82], p = 0.047, respectively). In the US cohort, age was an important prognostic factor for OS in univariate analysis (HR = 1.09 [1.04–1.15], p = 0.001). The random effects model for the combined cohorts revealed age and positive expression of estrogen receptor (ER) as potential prognostic factors for OS (HR = 1.08 [1.01–1.14], p = 0.015; HR = 0.10 [0.02–0.44], p = 0.003, respectively). Conclusions: Tumor grade and Ki‐67 levels are important prognostic factors for DFS of patients with primary NEBCs. Age and ER status are important prognostic factors for OS of patients with primary NEBCs. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyze the effects of 1‐methylcyclopropene (1‐MCP) on ethanol fermentation of Nanguo pears during ripening. Pears were exposed to 1 µl/L 1‐MCP and stored at 20 ± 2°C. Our data indicated that postharvest application of 1‐MCP maintained flesh firmness and reduced ethylene production and respiration rate during storage compared with untreated fruits. 1‐MCP treatment delayed the second glucose peak during fruit ripening. The contents of pyruvate and acetyl‐CoA were generally reduced by 1‐MCP treatment, and at the same time, their peaks were delayed by it during storage compared with controls. The contents of citric acid (CA) and oxaloacetate (OA) were increased by 1‐MCP, whereas the contents of acetaldehyde and ethanol were reduced during the whole storage period compared with controls. Activities of alcohol dehydrogenase (ADH) and pyruvate decarboxylase (PDC) were reduced by application of 1‐MCP during the early stage of storage, and the appearance of their peak activities was also delayed after treatment with 1‐MCP. These data showed that postharvest application of 1‐MCP could effectively delay the production of the "alcohol taste" of Nanguo pears during ripening. Practical applications: Nanguo pear is one of the most common cultivars that widely grow in northeast China. It is preferred by many consumers for its unique "alcohol taste", which is mainly produced through ethanol fermentation during ripening. Until now, the mechanisms for regulating ethanol fermentation in ripening Nanguo pears are still unclear. Our data indicated that postharvest application of the ethylene action inhibitor 1‐MCP could effectively delay the production of the "alcohol taste" of Nanguo pears during ripening. The data from this study can provide reference data for maintaining the quality of postharvest Nanguo pears. [ABSTRACT FROM AUTHOR]

The transfer and fate of methylmercury (MeHg) in typical components, such as sediment, sediment-inhabiting animals, pelagic fish, and three large waterfowls, namely, red-crowned crane (Grus japonensis), mallard (Anas platyrhynchos), and oriental stork (Ciconia boyciana), of the ecosystem in China's Zhalong Wetland were examined using equivalence-based mass balance model. The biomagnification degree of MeHg increased on the species at the high trophic level of the system. Hence, elevated MeHg concentration (3.2 μg g−1, dry weight) was detected in the endangered G. japonensis. The accumulation of the organometal generally followed the decreasing order of oriental stork (carnivore) > mallard (omnivore) > red-crowned crane (omnivore). The predicted results of MeHg at each node of the food web were generally in accordance with the measured values (F = 0.09, P = 0.78), implying that the model is suitable for the prediction of MeHg fate in the inland aquatic system. According to the model, the respiration for the species at low trophic strata was the key input source of MeHg, but ingestion played an important role for MeHg intake in the species at the high trophic position in the food web. Metabolism was a crucial pathway of MeHg loss for the top predators in the ecosystem. [ABSTRACT FROM AUTHOR]

Background: The substitution of generic drugs can effectively alleviate the rapid growth of drug costs; however, the clinical effectiveness and medical costs of originator products and generics were barely studied in China. Objectives: To compare the effectiveness of antihypertensive drugs and hypertension-related medical costs between originator and generic initiators in Yinzhou, China. Methods: We conducted a population-based retrospective cohort study using the Chinese Electronic Health Records Research in Yinzhou (CHERRY), from July 1, 2011, to December 31, 2018. Hypertension patients initiating with originator products were compared with patients initiating with generic counterparts. We used 1:1 propensity score matching to pair the two groups based on sociodemographic, clinical, and health service utilization variables. Cox proportional regression was adopted to compare the rate of hospitalization for hypertension-related cardiovascular disease between matched originator and generic initiators. Wilcoxon matched-pairs signed-rank test was used to compare annual hypertension-related medical costs. Results: Matched pairs (10,535) of patients were included in the comparative study of originator products and generics, corresponding to seven antihypertensive drugs including amlodipine, felodipine, nifedipine, irbesartan, losartan, valsartan, and metoprolol. The average age of patients included in the analysis was around 60 years (originator vs. generics initiators: from 59.0 vs. 59.1 years in losartan to 62.9 vs. 63.6 years in nifedipine). Higher hospitalization rates among originator initiators were observed for three calcium channel blockers (hazard ratio[95% CI]: amlodipine, 3.18[1.43, 7.11]; felodipine, 3.60[1.63, 7.98]; and nifedipine, 3.86[1.26, 11.81]; respectively). The remaining four out of seven drugs of the clinical endpoint estimates showed comparable outcomes between originator products and generics (hazard ratio[95% CI]: irbesartan, 1.19[0.50, 2.84]; losartan, 1.84[0.84, 4.07]; valsartan, 2.04[0.72, 5.78]; and metoprolol, 1.25[0.56, 2.80]; respectively). Higher median annual hypertension-related medical costs were observed in originator initiators (all p < 0.001), except for metoprolol (p = 0.646). Conclusion: We observed comparable or even better clinical outcomes and less medical cost associated with the use of antihypertensive generics compared to originator counterparts. This could help increase patient and provider confidence in the efficacy of generic medicines to manage hypertension diseases. [ABSTRACT FROM AUTHOR]

Background: In China, health technology assessment (HTA) has recently been adopted in pricing negotiation for medicine listing in the National Reimbursement Drug List. At present, how HTA is applied to inform the decision-making process remains underreported. In order to explore how the adoption of HTA was translated into listing and price negotiation results in light of the confidential nature of the negotiating process, this study aimed to compare the negotiated price and the clinical benefit of selected targeted anticancer medicines (TAMs) involved in the 2019 negotiation.Main Text: Among 16 TAMs successfully negotiated, only four TAMs representing four indication groups had appropriate reference medicines for comparison and were, therefore, included in the analysis. The price and clinical benefit of the four TAMs were compared against one or two reference medicines with the same initial indications. The sales prices for nine TAMs before and after the negotiation were extracted from the centralized medication procurement system. Clinical benefits were evaluated based on evidence from published articles and clinical guidelines. The results suggested that, despite the application of HTA, both rational and irrational decisions had been made about the reimbursement of TAMs in the 2019 negotiation, warranting further investigation.Conclusion: While the development and adoption of HTA has seen significant progress in China, actions are needed to ensure that the adoption of HTA is effectively applied in decisions on the reimbursement of medicines. [ABSTRACT FROM AUTHOR]

Background: In terms of medical costs, prostate cancer is on the increase as one of the most costly cancers, posing a tremendous economic burden, but evidence on the health care utilization and medical expenditure of prostate cancer has been absent in China. Objective: This study aimed to analyze health care utilization and direct medical costs of patients with prostate cancer in China. Methods: Health care service data with a national representative sample of basic medical insurance beneficiaries between 2015 and 2017 were obtained from the China Health Insurance Association database. We conducted descriptive and statistical analyses of health care utilization, annual direct medical costs, and composition based on cancer-related medical records. Health care utilization was measured by the number of hospital visits and the length of stay. Results: A total of 3,936 patients with prostate cancer and 24,686 cancer-related visits between 2015 and 2017 were identified in the database. The number of annual outpatient and inpatient visits per patient differed significantly from 2015 to 2017. There was no obvious change in length of stay and annual direct medical costs from 2015 to 2017. The number of annual visits per patient (outpatient: 3.0 vs. 4.0, P < 0.01; inpatient: 1.5 vs. 2.0, P < 0.001) and the annual medical direct costs per patient (US$2,300.1 vs. US$3,543.3, P < 0.001) of patients covered by the Urban Rural Resident Basic Medical Insurance (URRBMI) were both lower than those of patients covered by the Urban Employee Basic Medical Insurance (UEBMI), and the median out-of-pocket expense of URRBMI was higher than that of UEBMI (US$926.6 vs. US$594.0, P < 0.001). The annual direct medical costs of patients with prostate cancer in Western regions were significantly lower than those of patients in Eastern and Central regions (East: US$4011.9; Central: US$3458.6; West: US$2115.5) (P < 0.001). Conclusions: There was an imbalanced distribution of health care utilization among regions in China. The direct medical costs of Chinese patients with prostate cancer remained stable, but the gap in health care utilization and medical costs between two different insurance schemes and among regions still needed to be further addressed. [ABSTRACT FROM AUTHOR]

Keywords: cancer patient; depression; China; healthcare utilization; direct medical cost; Psycho-Oncology EN cancer patient depression China healthcare utilization direct medical cost Psycho-Oncology 979 981 3 06/09/21 20210601 NES 210601 INTRODUCTION Depression can affect cancer treatment adherence and prognosis, worsening the health burden faced by cancer patients and their families.1 Despite previous studies in developed countries showing that depression in patients with cancer would be associated with higher healthcare costs, longer length of hospital stay, and more annual healthcare visits, there appeared to be a gap in the literature on the role of depression in raising healthcare utilization and costs in patients with cancer in developing countries.2 Mental health received insufficient attention in developing countries such as China, where depression was frequently underdiagnosed and undertreated in cancer patients.3 SP , sp 4 This study aimed to explore differences of healthcare utilization and costs between cancer inpatients with and without depression in China. Cancer patients with depression would accrue higher direct medical costs and medication costs, and pay more out-of-pocket for healthcare than those without depression. Second, with no cancer staging information in the database, we were unable to judge whether patients with depression had a more severe health condition contributing to more healthcare utilization and costs compared to other cancer patients. [Extracted from the article]

Background. Incidence rates of breast cancer continue to rise in the People's Republic of China. The purpose of this study was to describe Chinese trends in radical surgical modalities and influential imaging and demographic factors for breast malignancies. Materials and Methods. This study was a hospital-based, multicenter, 10-year (1999-2008), retrospective study. Descriptive statistical tests were used to illustrate information regarding radical surgical trends for the treatment of breast malignancies. Chi-square tests were used to assess effect of demographic factors in addition to imaging and pathological data on the specific surgical method. Results. A total of 4,211 patients were enrolled in the survey. Among them, 3,335 patients with stage 0 to stage III disease undergoing mastectomy or breast-conserving surgery (BCS) were included in the final analysis. The rate of BCS increased from 1.53% in 1999 to 11.88% in 2008. The rate of mastectomy declined over this time period, from 98.47% in 1999 to 88.12% in 2008, with increasing use of diagnostic imaging methods and pathological biopsies. A significantly greater percentage of patients with office work, high education levels, unmarried status, younger age, and early pathological stages preferred BCS compared with mastectomy. Conclusion. Rates of mastectomy in China remain elevated due to diagnosis at higher stages; however, because of increased use of diagnostic imaging, improvement of biopsy methods, and patient education, rates of less invasive lumpectomy are increasing and rates of mastectomy have decreased in China. [ABSTRACT FROM AUTHOR]

Background and Objective. Incidence of and mortality rates for breast cancer continue to rise in the People's Republic of China. The purpose of this study was to analyze differences in characteristics of breast malignancies between China and the U.S. Methods. Data from 384,262 breast cancer patients registered in the U.S. Surveillance, Epidemiology, and End Results (SEER) program from 2000 to 2010 were compared with 4,211 Chinese breast cancer patients registered in a Chinese database from 1999 to 2008. Outcomes included age, race, histology, tumor and node staging, laterality, surgical treatment method, and reconstruction. The Pearson chi-square and Fisher's exact tests were used to compare rates. Results. Infiltrating ductal carcinoma was the most common type of malignancy in the U.S. and China. The mean number of positive lymph nodes was higher in China (2.59 vs. 1.31, p < .001). Stage at diagnosis was higher in China (stage IIA vs. I, p < .001). Mean size of tumor at diagnosis was higher in China (32.63 vs. 21.57 mm). Mean age at diagnosis was lower in China (48.28 vs. 61.29 years, p < .001). Moreover, 2.0% of U.S. women underwent radical mastectomy compared with 12.5% in China, and 0.02% in China underwent reconstructive surgery. Conclusion. Chinese women were diagnosed at younger ages with higher stage and larger tumors and underwent more aggressive surgical treatment. Prospective trials should be conducted to address screening, surgical, and tumor discrepancies between China and the U.S. [ABSTRACT FROM AUTHOR]

Purpose: To perform a short-term and a long-term cost-utility analysis of rhegmatogenous retinal detachment (RRD) surgery in Shanghai, China Methods: A total of 117 patients who underwent RRD surgery at Shanghai First People's Hospital, Affiliated Shanghai Jiaotong University, and then underwent follow-up for at least 1 year, were included in the study. Costs associated with RRD surgery and time trade-off utility values before and after surgery were recorded. Short-term analysis was made for 1 year. Quality-adjusted life years (QALYs) gained by RRD surgery over the lifetime were calculated at a 3% discount rate in the long-term analysis. This study used the bootstrap method in statistical analysis and one-way sensitivity analyses to test robustness of the results. Results: Compared with no treatment, the mean incremental costs of RRD surgery was 11,384 Chinese yuan (CN¥) (US$1751); the mean additional QALYs gained was 0.05 (95% confidence interval [CI] 0.04-0.06) for 1 year and 0.88 (95% CI 0.64-1.13) for life expectancy; the incremental cost effectiveness ratio (ICER) was CN¥224,921 (US$34,603)/QALY for the short-term, and CN¥13,794 (US$2122)/QALY for the long-term. In short-term analysis, the ICER was CN¥150,087 (US$23,090)/QALY for scleral buckling surgery, and CN¥507,727 (US$78,112)/QALY for vitreous surgery. In the long-term analysis, the ICER was CN¥6280 (US$966)/QALY for scleral buckling, and CN¥30,756 (US$4732)/QALY for vitreous surgery. Conclusions: For RRD patients, surgery increases QALYs. In a 1-year analysis, surgery is not a cost-effective treatment, however it is cost-effective over the lifetime. [ABSTRACT FROM AUTHOR]

Background and Purpose: To evaluate the influence of rhegmatogenous retinal detachment (RRD) surgery on elderly patients in terms of visual acuity, vision-related quality of life and its cost-effectiveness. Methods: Elderly patients over 70 years old, who were diagnosed and underwent RRD surgery at Shanghai First People's Hospital, Shanghai Jiao Tong University, China, from January 1, 2009, through January 1, 2013. The participants received scleral buckling surgery and vitreous surgery with or without scleral buckling under retrobulbar anesthesia. We followed the patients for 1 year and collected best-corrected visual acuity (BCVA), vision-related quality of life, and direct medical costs data. Utility values elicited by time-trade-off were analyzed to determine the quality of life. Quality-adjusted life years (QALYs) gained in life expectancy were calculated and discounted at 3% annually. Costs per QALY gained were reported using the bootstrap method. Further analyses were made for two age groups, age 70–79 and age over 80 years. Sensitivity analyses were performed to test stability of the results. Results: 98 patients were included in the study. The BCVA significantly improved by 0.53±0.44 (Logarithm of the Minimum Angle of Resolution (logMAR)) at the 1-year postoperative time point (p<0.001). Utility values increased from 0.77 to 0.84 (p<0.001), and an average of 0.4 QALYs were gained in the life expectancy. Costs per QALY gained from the RRD surgery were 33,186 Chinese Yuan (CNY) (5,276 US dollars (USD))/QALY; 24,535 CNY (3,901 USD)/QALY for the age group of 70–79 years and 71,240 CNY (11,326 USD)/QALY for the age group over 80 years. Conclusions: RRD surgery improved the visual acuity and quality of life in the elderly patients over 70 years old. According to the World Health Organization’s recommendation, at a threshold of willingness to pay of 115,062 CNY (18,293 USD)/QALY, RRD surgery is cost effective in the elderly patients. [ABSTRACT FROM AUTHOR]

Objective Complement component C4 copy number variations are associated with various inflammatory diseases. This study was undertaken to investigate whether copy number variations of C4 are also involved in the pathogenesis of Behçet's disease (BD). Methods Gene expression was examined by enzyme-linked immunosorbent assay (ELISA) or real-time polymerase chain reaction (PCR). Copy number variations of C4 isotypes (C4A and C4B) were detected by real-time PCR in 905 patients with BD, 205 patients with ankylosing spondylitis (AS) and acute anterior uveitis, and 1,238 controls. The activation of CD4+ T cells was analyzed by flow cytometry, and cytokine production was detected by ELISA. Results Protein expression of total C4 in serum was significantly increased in patients with active BD compared with those with inactive BD or controls (Bonferroni corrected P [ Pcorr] = 1.64 × 10−4 and Pcorr = 0.037, respectively), but not in patients with AS and acute anterior uveitis. Copy number variation analysis identified a significantly increased frequency of more than 2 copies of C4A in BD patients ( P = 1.65 × 10−7, odds ratio [OR] 2.84). HLA-B51, which is located on the same chromosome as C4, showed a strong association with BD in the Han Chinese population ( P = 8.90 × 10−65, OR 5.05), but logistic regression showed that C4A copy number variation was an independent risk factor for BD. A significantly increased expression of C4A was observed in the high copy number groups (>2 copies or 2 copies) versus the low copy number group ( Pcorr = 0.019 and Pcorr = 0.044, respectively). Increased production of interleukin-6 (IL-6) was also observed in the high C4A copy number group ( Pcorr = 0.037). No effect of C4 copy number variation on the expression of T cell activation markers was detected. Conclusion Our findings indicate that a high copy number of C4A confers risk for BD by modulating the expression of C4A and enhancing IL-6 production. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To compare iron bioavailability (Fe BV) from ten selected kinds of Chinese wheat flours in order to provide scientific basis for further human trials and enable plant breeding programs to screen biofortified wheat cultivars. Methods: An in vitro digestion/Caco-2 cell model was used to assess Fe BV of ten flour samples from six leading Chinese wheat cultivars and the stability of Fe BV in one cultivar was studied across three growing environments. Results: Significant differences were observed in both Fe BV and Fe bioavailability per gram of food (Fe BVPG) among cultivars (P<0.01) grown at the same location with the same flour extraction rate. Zhongyou 9507 and Jingdong 8 had Fe BV 37%–54% and Fe BVPG 103%–154% higher than the reference control. In the Anyang environment, Zhongyou 9507 had a higher wheat flour-Fe level and Fe BVPG. Differences in Fe BV were detected in cultivars with different flour extraction rates. Conclusion: Zhongyou 9507 and Jingdong 8 were identified as the most promising cultivars for further evaluation of efficacy by using human subjects. The growing environments had no effect on Fe BV, but did have a significant effect on Fe BVPG. Fe bioavailabilities in low-extraction (40%) flours were higher than those in high-extraction (78%) flours. [Copyright &y& Elsevier]

Abstract: In this paper, we present newly obtained molybdenite Re–Os ages for the Chehugou copper–molybdenum deposit and the Yuanbaoshan molybdenum mineral locality from the Chifeng area on the northern margin of the North China block, combined with U–Pb zircon ages of the host granites. The Re–Os isochron age of six molybdenite samples from the Chehugou deposit is 257.5±2.5 Ma and one molybdenite sample from the Yuanbaoshan locality yields a Re–Os model age of 248.0±2.7 Ma. These ages clearly indicate the signature latest Permian to Early Triassic Cu–Mo or Mo mineralization that has not been previously recognized. Zircon LA-ICP-MS U–Pb dating shows that the host granites of the Chehugou deposit and Yuanbaoshan locality formed in the Late Devonian (376±3 Ma) and Late Permian (269±3 Ma), respectively, and is not of Jurassic age, as previously thought. The latest Permian to Early Triassic Cu–Mo mineralization is likely related to extension due to final closure of the Paleo-Asian Ocean and amalgamation of the Mongolian arc terranes with the northern North China block. The establishment of a latest Permian to Early Triassic age for mineralization should encourage renewed exploration aimed at the discovery of new Mo or Cu–Mo resources along the northern margin of the North China block. [Copyright &y& Elsevier]

Microcystin-LR (MC-LR) is prevalent in water and can be translocated into soil-crop ecosystem via irrigation, overflow (pollution accident), and cyanobacterial manure applications, threatening agricultural production and human health. However, the effects of various input pathways on the bioaccumulation and toxicity of MCs in terrestrial plants have been hardly reported so far. In the present study, pot experiments were performed to compare the bioaccumulation, toxicity, and health risk of MC-LR as well as its degradation in soils among various treatments with the same total amount of added MC-LR (150 μg/kg). The treatments included irrigation with polluted water (IPW), cultivation with polluted soil (CPS), and application of cyanobacterial manure (ACM). Three common leaf-vegetables in southern China were used in the pot experiments, including Ipomoea batatas L., Brassica juncea L., and Brassica alboglabra L. All leaf vegetables could bioaccumulate MC-LR under the three treatments, with much higher MC-LR bioaccumulation, especially root bioconcentration observed in ACM treatment than IPW and CPS treatments. An opposite trend in MC-LR degradation in soils of these treatments indicated that ACM could limit MC-LR degradation in soils and thus promote its bioaccumulation in the vegetables. MC-LR bioaccumulation could cause toxicity to the vegetables, with the highest toxic effects observed in ACM treatment. Similarly, bioaccumulation of MC-LR in the edible parts of the leaf-vegetables posed 1.1~4.8 fold higher human health risks in ACM treatment than in IPW and CPS treatments. The findings of this study highlighted a great concern on applications of cyanobacterial manure. [ABSTRACT FROM AUTHOR]

Boesenbergia fallax Loes., previously known as a synonym of B. longiflora (Wall.) Kuntze, is recognized as belonging to the genus Zingiber Mill. Furthermore, it is conspecific with Z. liangshanense Z. Y. Zhu, which was incorrectly treated as a synonym of Z. striolatum in 'Flora of China'. A new combination, Z. fallax (Loes.) L. Bai, Juan Chen & N. H. Xia is proposed here, and Z. liangshanense is treated as its synonym. Lectotypes are designated for B. fallax and Z. liangshanense. Zingiber fallax is now known to occur in southern Sichuan Province and northwestern to central Yunnan Province, China. [ABSTRACT FROM AUTHOR]

• A new silicified microfossilassemblage has been recovered from the terminal Ediacaran Dengying Formation in China. • The preservation status of silicified tubular and spheroidal fossils is compared with that of the phosphatized ones. • The finding indicates that Cloudina, having a worldwide distribution in different paleoecologies and biofacies. A silicified fossil assemblage is newly recovered from the acid-macerated residuals of the siliceous dolomite in the late Ediacaran upper Dengying Formation, Tudimiao Section, Ningqiang, southern Shaanxi Province, China. It consists of a large number of tubular and spheroidal fossils. Of them, Cloudina and Sinotubulites can be well identified by the remaining "cone-in-cone" structure or transverse corrugations and longitudinal ridge and multi-layered outer wall, and several other tubular fossils of unknown affinities can also be recognized. However, most of the tubular fossils are generally preserved as steinkerns lacking detailed surface ornamentation and are difficult to distinguish. Morphologically, spheroidal fossils are highly diversified, comprising one-cell to various aggregated ones including two-cell, three-cell, four-cell, five-cell, or other irregular morphotypes. Therefore, three different preservational styles in the weakly biomineralized organisms may be presented in this area, referring to three tubular fossil assemblages in the Gaojiashan biota, i.e. from the lower to upper, a pyritized Conotubus - Gaojiashania in the siltstone-mudstone and calcified Cloudina in the limestone at the mid-upper Gaojiashan Member, Dengying Formation in the Gaojiashan section and at upper Gaojiashan and lower Beiwan members, Dengying Formation in the Shengchangba section, a phosphatized Cloudina - Sinotubulites association in the lower Beiwan Member, Dengying Formation in the Lijiagou section, and a silicified tubular and spheroidal fossil association at the mid-upper Beiwan Member, Dengying Formation in the Tudimiao section. This finding thus may have some broad implications, it not only opens a new taphonomic window for the late Ediacaran weakly biominerlizing organisms, encourages us to explore more extensively the once neglected cherty dolomite, but also considerably expands the geographical range and species richness of the terminal Ediacaran biosphere. More importantly, the finding also indicates that Cloudina having a worldwide distribution in different paleoecologies and biofacies has the greatest advantage of being the stratigraphic marker for correlation with precision to different paleocontinents. [ABSTRACT FROM AUTHOR]