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Abstract Background The survival outcomes in HER2-low versus HER2-zero breast cancer (BC) after neoadjuvant chemotherapy (NACT) remain unclear. The meta-analysis was conducted to summarize current evidence about the survival outcomes in HER2-low versus HER2-zero BC. Methods We conducted a systematic search in PubMed and EMBASE databases to identify relevant studies. Results A total of 14 studies with 53,714 patients were included. Overall, 34,037 patients (63.37%) were HER2-low, and 19,677 patients (36.63%) were HER2-zero. Patients with HER2-low tumors had a significantly lower pathological complete response (pCR) rate than patients with HER2-zero tumors, regardless of the hormone receptor status. Compared with HER2-zero breast cancer, the overall survival (OS) and disease-free survival (DFS) of HER2-low BC were longer in the overall cohort (HR = 0.72; 95% CI = 0.61–0.85; P

BackgroundThe combination of CDK4/6 inhibitors (CDK4/6i) and endocrine therapy (ET) is currently the standard first-line treatment for patients with metastatic hormone receptor positive (HR+), and HER2-negative (HER2-) breast cancer. However, the impact of HER2 status on the prognosis of patients receiving CDK4/6i and ET remains unclear. The meta-analysis was conducted to evaluate different outcomes between HER2-low and HER2-zero patients in advanced HR+ breast cancer receiving CDK4/6i and ET.MethodsA systematic search was performed in PubMed and EMBASE databases for relevant published literature. Objective response rate (ORR), overall survival (OS), and progression-free survival (PFS) were pooled by fixed or random effects models.ResultsOverall, 12 studies with 3567 patients were eligible for analysis. The pooled analysis suggested that no significant differences were observed in terms of ORR and OS between HER2-low and HER2-zero patients who underwent CDK4/6i and ET. Similarly, no significant difference in PFS was found between HER2-low and HER2-zero patients who underwent post-line CDK4/6i and ET or first-line Palbociclib and ET. However, in patients who received mixed-line (not a single treatment line) or first-line CDK4/6i and ET, the PFS was significantly shorter in the HER2-low subgroup than in the HER2-zero subgroup (mixed-line: HR = 1.36; 95% CI = 1.11–1.65; P = 0.002; first-line: HR = 1.14; 95% CI = 1.01–1.28; P = 0.04). A similar phenomenon was observed in patients who received mixed-line or post-line Palbociclib and ET (mixed-line: HR = 1.60; 95% CI = 1.09–2.34; P = 0.02; post-line: HR = 1.43; 95% CI = 1.03–2.00; P = 0.03).ConclusionThese results indicated that HER2-low status did not have a significant association with ORR and OS, but it may have a worse impact on PFS in patients who received mixed-line or first-line CDK4/6i and ET, as well as mixed-line or post-line palbociclib plus ET.

Introduction: It is controversial whether obesity and periodontitis are related. A representative US population was examined for the relationship between obesity and periodontitis. Methods: In the National Health and Nutrition Examination Survey (NHANES) 2011–2014, participants (n = 6,662) aged 30 years or older and who underwent periodontal examinations were chosen for analysis. An assessment of obesity was based on body mass index (BMI) and waist circumference (WC). Estimates of obesity and periodontal disease were made using univariate and multivariate logistic regression models. Results: According to an adjusted odds ratio (OR) for periodontitis, BMI (OR = 1.01, 95% CI: 1.01∼1.02) and WC (OR = 1.01, 95% CI: 1∼1.01) were significantly associated with periodontitis, respectively. After adjusting for confounding factors, the OR for patients with high WC with periodontitis was 1.18 (1.04∼1.33) compared to normal WC. BMI and WC subgroups showed no significant interaction (p for interaction >0.05), except for the age interaction in BMI. Among young adults aged 30–44 years, obesity was significantly associated with periodontitis in subgroups; the adjusted OR for having periodontal disease was 1.02 (1∼1.03) and 1.01 (1∼1.02) for subjects with BMI and WC, respectively. When all covariates were adjusted, BMI ≥30 kg/m2 was statistically significantly associated with prevalence of periodontal disease among people aged 30–44 years (p < 0.001). Conclusions: BMI and WC are significantly associated with periodontitis, even after adjusting for many variables, and were equally significant in obese (BMI ≥30 kg/m2) young people (30–44 years).

Abstract Ductal carcinoma in situ with microinvasion (DCIS-MI) is a subtype of breast cancer with a good prognosis, for which both breast conserving surgery plus radiotherapy (BCS + RT) and mastectomy are feasible surgical methods, but no clear conclusion has been made on the choice of these treatments. We used the Surveillance, Epidemiology and End Results database to extract 5432 DCIS-MI patients. Participants were divided into the BCS + RT group and the mastectomy group. We compared the overall survival (OS) and breast cancer-specific survival (BCSS) of the two groups using the Kaplan–Meier method and Cox regressions before and after propensity score matching (PSM). Before PSM, both univariate and multivariate analyses showed that BCS + RT group had significantly higher OS and BCSS compared with patients in the mastectomy group (P

Abstract Background Trastuzumab is currently the standard treatment for human epidermal growth factor receptor 2 (HER2)-positive breast cancer. However, it is not recommended for HER2-positive breast cancer patients during pregnancy as it may jeopardize safety of the fetus. Nevertheless, there is evidence that fetuses exposed to trastuzumab in early stages of pregnancy remain healthy Methods To evaluate the possible effects of trastuzumab on fetus and provide evidence on the safety of trastuzumab in early pregnancy in HER2-positive breast cancer patients, we analyzed 22 studies involving 22 pregnant women and 23 fetuses. Results Based on the meta-analysis, the gestational week of exposure to trastuzumab is 0–34 weeks, the average duration of use is 17 weeks, and the average gestational week of delivery is 34.3 weeks. Complications occurred in 77.27% of patients during pregnancy and 56.52% of newborns。The main complication during pregnancy was anhydramnios (68.18%), while the main complications at birth were Respiratory distress or tachypnea (30%). After an average of 25.28 months of follow-up, 17.39% (4/23) of the children died. There was no complication during pregnancy or at birth in patients treated with trastuzumab during early pregnancy (P = 0.043). Patients older than 30 who received trastuzumab during pregnancy were more likely to have neonatal complications (OR = 7.778, 95%CI = 1.2–50.424, P = 0.04). Conclusion These results suggest that trastuzumab use during pregnancy can cause pregnancy,fetal and newborn complications. However, exposed to trastuzumab only in the first trimester are less likely to have pregnancy and fetal complications. Patients with gestational age below 30 years are less likely to have neonatal complications after trastuzumab during pregnancy. Terminating pregnancy should not be the only option for such patients. But more evidence is needed to verify this conclusion.

This study examines, from a comparative standpoint, the contribution of domestic tourism and international tourism to hotel sales revenue (HSR) and its three key revenue sources: room sales revenue (RSR), food and beverage sales revenue (FBR), and other sales income (OSR), using data from 2003 to 2020. The results indicate that domestic tourism has a greater impact on HSR than international tourism. In addition, we discovered that domestic tourism contributes more to OSR than RSR and FBR, but international tourism contributes more to FBR than OSR and RSR. Notably, panel threshold regression test results indicate that the effects of domestic tourist arrivals (DTA) on hotel sales (HSR, RSR and FBR) show different degrees of sensitivity to economic fluctuations. Domestic tourism's impact on hotel sales (HSR, RSR, FBR and OSR) is less sensitive to economic fluctuations than the impact of international tourism. The RSR's response to tourism is the least sensitive to economic cycles, whereas the FBR is the most sensitive. [ABSTRACT FROM AUTHOR]

Abstract Background The survival outcomes of neoadjuvant chemotherapy (NACT) versus adjuvant chemotherapy (ACT) for patients with triple-negative breast cancer (TNBC) remain unclear. Therefore, in this study, a meta-analysis was conducted to analyze current evidence on the survival outcomes of NACT versus ACT in TNBC. Methods A systematic search was performed on the PubMed and Embase databases to identify relevant articles investigating the survival outcomes of NACT versus ACT in TNBC. Results A total of nine studies involving 36,480 patients met the selection criteria. Among them, 10,728 (29.41%) received NACT, and 25,752 (70.59%) received ACT. The pathological complete response (pCR) rate was 35% (95% CI = 0.23–0.48). Compared with ACT, the overall survival (OS) of NACT was poor (HR = 1.59; 95% CI = 1.25–2.02; P = 0.0001), and there was no significant difference in disease-free survival (DFS) between the two treatments (HR = 0.85; 95% CI = 0.54–1.34; P = 0.49). NACT with pCR significantly improved the OS (HR = 0.53; 95% CI = 0.29–0.98; P = 0.04) and DFS (HR = 0.52; 95% CI = 0.29–0.94; P = 0.03), while the OS (HR = 1.18; 95% CI = 1.09–1.28; P < 0.0001) and DFS (HR = 2.36; 95% CI = 1.42–3.89; P = 0.0008) of patients with residual disease (RD) following NACT were worse compared to those receiving ACT. Conclusion These findings suggest that, for TNBC, NACT with pCR is superior to ACT in improving OS and DFS, and it turns to be opposite when patients are receiving NACT with RD.

BackgroundThe effect of postmastectomy radiotherapy (PMRT) on T1-2N1M0 triple-negative breast cancers (TNBC) remains unclear. The population-based study aimed to investigate the survival outcomes of T1-2N1M0 TNBC patients who underwent PMRT or not.MethodsWe selected 1743 patients with T1-2N1M0 TNBC who underwent mastectomy between 2010 and 2015 through the Surveillance, Epidemiology and End Results (SEER) database. After propensity score matching (PSM), the PMRT and no-PMRT groups consisted of 586 matched patients, respectively. The Kaplan-Meier method was applied to calculate breast cancer-specific survival (BCSS) and cox proportional hazard model was used to determine the prognostic factors of T1-2N1M0 TNBC.ResultsThe 5-year BCSS for the PMRT and no-PMRT groups was 79.1% and 74.7%, respectively. Analysis showed that in patients with three nodes positive, radiotherapy could significantly improve BCSS (HR = 0.396, 95% CI = 0.175-0.900, P = 0.027), but it brought no significant advantage in BCSS in patients with one or two nodes positive (HR = 1.061, 95% CI = 0.725-1.552, P = 0.761; HR = 0.657, 95% CI = 0.405-1.065, P = 0.088). In addition, PMRT improves the BCSS in TNBC patients with T2 tumor concomitant with three positive lymph nodes (HR = 0.343, 95% CI = 0.132-0.890, P = 0.028).ConclusionTNBC patients with T2 tumor concomitant with three positive lymph nodes can benefit from PMRT.

BackgroundTo evaluate the efficacy and safety of radiofrequency ablation (RFA) of breast cancer smaller than 2 cm.MethodsA systematic search was conducted in the PubMed and EMBASE databases to identify published studies investigating the efficacy and safety of RFA for breast cancer smaller than 2 cm. The main outcomes were technical success rate of the ablation, complete ablation rate, complications and local recurrence. Secondary considerations were mode of anesthesia, pain tolerance, mean ablation time and surgical excision after ablation.ResultsSeventeen studies involving 399 patients and 401 lesions met the inclusion criteria. Nearly 99%(95%CI=0.98-1.00) of lesions achieved good technical success rate.Notably, 83.88% of the patients received RFA under general anesthesia (333/397) whereas 15.87% received RFA under local anesthesia (63/397). Of the 63, 98.41% tolerated the pain associated with the procedure. Majority of patients (65.74%, 261/397) underwent surgical excision of the tumor after ablation whereas in a few patients (34.26%, 136/397), the tumor tissue was retained in the breast after ablation. Complete ablation was achieved in 96% of patients for a mean time of 15.8 minutes (95%CI=0.93-0.99). Overall, only 2% (95%CI=0.01-0.04) of the individuals developed complications. Skin burns (2.02%, 8/397) were the most common complications. There was no local recurrence after a median follow-up of 27.29 months, whether or not they underwent surgical resection following RFA.ConclusionThe results show that RFA for breast cancer smaller than 2 cm is safe and effective. However, prospective studies are needed to validate this conclusion.

BackgroundMetaplastic breast cancer (MBC) are rare. The survival outcomes of MBC patients after breast conserving surgery plus radiotherapy (BCS+RT) or mastectomy have not been established. The study aimed to compare survival outcomes of MBC patients subjected to BCS+RT or mastectomy therapeutic options.MethodsPatients who were subjected to BCS+RT or mastectomy between 2004 and 2014 were enrolled in this study through the Surveillance, Epidemiology and End Results (SEER) database. Breast cancer-specific survival (BCSS) and the overall survival (OS) of the participants were determined. Cox proportional hazard model and the Kaplan Meier method were used to determine the correlation between the two surgical methods and survival outcomes.ResultsA total of 1197 patients were enrolled in this study. Among them, 439 patients were subjected to BCS+RT, while 758 patients were subjected to mastectomy. After propensity score matching (PSM), the BCS+RT and mastectomy groups consisted of 321 patients, respectively. The univariate and multivariate analysis with a 6-month landmark all indicate that patients receiving BCS+RT has higher OS than patients receiving mastectomy (HR = 0.701,95% CI = 0.496-0.990, P = 0.044; HR = 0.684,95% CI = 0.479-0.977, P = 0.037) while the BCSS was no difference between the two groups (HR = 0.739,95% CI = 0.474-1.153, P = 0.183; HR = 0.741,95% CI = 0.468-1.173, P = 0.200).ConclusionThe BCS+RT therapeutic option exhibits a higher OS in MBC patients compared to the mastectomy approach.

It is impossible to overstate the importance of culture and literature in tourism. Most studies have relied on qualitative evidence to the exclusion of precise secondary data to show a direct link between literature and tourism. Using a novel and unique index of Tang poems ranks as a proxy for cultural status and heritage accumulation to quantify the effects of Tang poetry on the expansion of domestic and international tourism, this research adds significantly to the body of knowledge on literary tourism. Based on ordinary least squares and bias-corrected propensity score matching regression analysis, the top 100 Tang poetry rankings are favorably associated with domestic tourist growth but not with international tourism expansion. These findings are crucial for the development of literary tourism. [ABSTRACT FROM AUTHOR]

Travel has long been recognized as a beneficial method for rejuvenating individuals who are feeling exhausted. Drawing inspiration from theories of restorative environments, this study utilizes semi-structured interviews to explore the mechanisms through which tourism contributes to restorative outcomes. The findings reveal that tourism plays a significant role in restoring individuals across various dimensions, including physiological, psychological, spiritual, and social aspects. By adopting an environmental change perspective, six key mechanisms of the restorative process have been identified: being physically and psychologically away from the everyday environment, environmental stimulation from tourist destinations, emotional regulation, mental adjustment, physiological improvement, and negative factors. [ABSTRACT FROM AUTHOR]

This study adopts semi-structured interviews in Grand Teton National Park (GRTE) in the United States and aims to understand Chinese tourists' decision-making processes and experiences. The results reveal that geographic distances, China's unique technical infrastructure and policies influence Chinese tourists' information sources and reasons for visiting GRTE. Their information sources are unique, and their decisions for visiting GRTE are ad-hoc in nature. Chinese tourists' expectations and experiences, such as planned places to visit and activities to participate in, are influenced by a cultural dimension of a high level of collectivism. The study also shows that Chinese tourists' sense of complacency, respect for nature, comfort with detachment from nature, and beliefs in fate and destiny affect their satisfaction with their experiences, compared to domestic American tourists. The study then provides a conceptual model of how these national differences affect Chinese tourists' information source choices, decision-making, expectations, satisfaction, and intentions to return in the future. The model may overthrow the classic linear process of consumer decision making framework in a cross-country context. [ABSTRACT FROM AUTHOR]

Using data from 31 provinces/municipalities in China from 2003 to 2018, this article examines the impact of international tourism on hotel sales revenue (HSR). Specifically, this study lays a theoretical foundation for investigations of the nonlinear and state-dependent effects of international tourist arrivals (ITAs) on HSR. Results of both traditional and dynamic panel regression test models reveal the following interesting results. First, the positive relationship between ITA and hotel performance is not unique to Taiwan but is also found in Mainland China. Second, based on the theory of economies of agglomeration, the impact of ITA on HSR is found to be inverse U-shaped. Third, the effects of ITA on HSR are economic state-dependent, relying to a great extent on economic conditions. Furthermore, ITA has a stronger impact on HSR during periods of economic expansion. Important policy implications are provided based on the empirical results. [ABSTRACT FROM AUTHOR]

This study complements the tourism literature by proposing an asymmetrical effect of the tourism-led growth hypothesis on the city-level economy using panel data from 331 cities in China from 2004 to 2015 (3,972 observations). The results, based on an augmented Solow model and the system-generalized method of moments (GMM), reveal that the impact of tourism on city-level economic growth is indeed asymmetric and heterogeneous, depending on the presence of top-level attractions (TL), which are proxied by the World Heritage Sites or AAAAA (5A) scenic spots. The dynamic panel threshold model's results also corroborate the asymmetric threshold effect of tourism on city-level economic growth. Tourism, in particular, has facilitated positive and significant economic growth in cities with TL but has had an uncertain and statistically insignificant impact on cities without it. The findings indicate that the validity of tourism-led growth depends on the availability and number of TL in each city, which serve as a moderator. As a result, we confirm tourism's asymmetric effect and spatial heterogeneity on urban economic growth. [ABSTRACT FROM AUTHOR]

A combination of dielectric and thermal properties is the prime factor for developing glass–ceramics for practical aspects in low-temperature co-fired ceramic technology. In this work, we report the low melting-point compositions of BaO–Al2O3–SiO2–B2O3 and BaAl2Si2O8 ceramics at 900 °C. The phase evolutions, microstructure, dielectric, and thermal expansion properties corresponding to the partial replacement of Ba2+ with alkaline earth metal ions R2+, i.e., Sr2+, Ca2+, and Mg2+ were investigated. The results indicated that, because the lattice distortion of hexacelsian structure was caused by solid solutions of substitution ions to BaAl2Si2O8 ceramics, the phase transition of hexacelsian can be gradually inhabited with the decrease of the substitution ion radius. Notably, the partial substitution of Mg2+ in the Ba2+ can completely inhibit the phase transition and promote the formation of orthorhombic celsian. By the substitution of 40 mol% of Ba2+ to Mg2+, physical properties, i.e., density of 2.22 g⋅cm−3, εr of 4.08 at 12 GHz, and tanδ of 2.7 × 10−3, are obtained. Importantly, the coefficient of thermal expansion (CTE) of 4.02 × 10−6/°C close to that of monocrystalline silicon is also successfully achieved. The new BaAl2Si2O8 ceramics with low CTE and reliable thermal stability demonstrated the potential for application in chip packaging. [ABSTRACT FROM AUTHOR]

Using domestic tourism data (1999–2014) and inbound tourism data (1999–2016), this research applies linear and nonlinear models to investigate the impact of World Heritage Sites (WHS) on inbound and domestic tourism expansion (TE) in terms of tourist arrivals and tourism receipts and then tests whether or not the impact of WHS on TE is instant. The results show a notable influence of WHS on tourist arrivals and tourism receipts and identify several differences between the impacts of WHS on inbound and on domestic TE. Moreover, the relationship between WHS and TE exhibits an inverted U-shaped curve. The optimal number of WHS for TE is four, and there is a significant instantaneous effect of WHS on domestic TE. Differently, the impact of WHS on inbound tourism shows a 1-year lag. Lastly, we perform dynamic regressions as a robustness check and discussion and implications are provided. [ABSTRACT FROM AUTHOR]

This study uses dynamic panel data to investigate the effects of Cultural World Heritage Site (CWHS) and Natural World Heritage Site (NWHS) on China's domestic tourism receipts (DTR) and inbound tourism receipts (ITR). The results show evidence of a positive asymmetrical relationship between World Heritage Site (NWHS and CWHS) and both kinds of tourism receipts. The impact of NWHS on DTR follows scale effects, while that of NWHS on ITR obeys the law of decreasing marginal utility. The link between CWHS and inbound and domestic tourism receipts follows an inverse U-shaped pattern. The optimal numbers of NWHS and CWHS obtained from those non-linear models vary, while the effect of NWHS and CWHS on DTR can be strengthened by the presence of each other, but only the impact of CWHS on ITR is influenced by NWHS. Furthermore, we describe the implications of the research results. [ABSTRACT FROM AUTHOR]