Jiajian Chen

Son preference, use of maternal health care, and infant mortality in rural China, 1989-2000

This study assesses the effects of socio-economic conditions and the interaction between son preference and Chinas one-child family planning policy on the use of maternal health care services and their effects on infant mortality in rural China, using nationally representative data from the 2001 National Family Planning and Reproductive Health Survey. The results show that while the use of maternal health care services has continued to increase over time, large gaps still exist in the use of these services and in infant survival by mothers education, community income, and parity. Further improvements in the reproductive health of all women and in infant survival will require effective reduction of the obstacles to the use of maternal health care among those women in rural China who are less educated, poor, and of higher parity.

Province-level variation in the achievement of below-replacement fertility in China.

The first part of this paper describes, for China, province-level variation in the year in which below-replacement fertility was achieved. The second part, also based on province-level data, is a multivariate analysis of the effects of (1) fertility policy, and (2) economic and social development on fertility in the year 2000. In 1975, only two provinces—Beijing and Shanghai—had below-replacement fertility, but by 2000, 29 out of 31 provinces had below-replacement fertility. Among these 29 provinces, 22 had a total fertility rate (TFR) below 1.7, and 20 provinces had a TFR below 1.5. The main findings from the cross-sectional multivariate analysis of province-level variation in the TFR are that (1) depending on the measure of economic and social development used, between 33 and 42 percent of the effect of the one-child policy on the TFR, as measured by policy TFR, is actually due to development, and (2) the effect of policy TFR on TFR, after development is controlled for, is 38 to 50 percent less than the effect of development.

Effects of population policy and economic reform on the trend in fertility in Guangdong province, China, 1975–2005

An analysis of data mainly from Chinas 1990 and 2000 censuses and 2005 mini-census shows how fertility decline between 1975 and 2005 in the province of Guangdong has been influenced by both fertility policy and economic and social development. Guangdongs development since 1975 has been very rapid and has attracted huge numbers of migrants from other provinces. The analysis of the provinces fertility trend from 1975 shows clearly the influence of fertility policy on the trend. The analysis also shows that economic development has brought about large changes in population composition by urban/rural residence, education, occupation, and migration status, which, together with large fertility differentials by these characteristics, have contributed substantially to Guangdongs fertility decline, in large part through changes in proportions currently married.

Utility of one-step nucleic acid amplification (OSNA) assay in detecting breast cancer metastases of sentinel lymph nodes in a Chinese population

BackgroundThe one-step nucleic acid amplification (OSNA) assay is an innovative method for the diagnosis of sentinel lymph node (SLN) metastases in breast cancer patients. The aim of the present study was to clinically validate the OSNA assay and compare its results with postoperative serial sectioning in a Chinese breast cancer population.MethodsA prospective study of 370 consecutive SLNs from 115 patients was conducted at our institution. A total of 311 SLNs underwent OSNA assay analysis. All SLNs were sectioned in approximately 2-mm pieces. OSNA assay and postoperative serial sectioning were performed on alternate divided node samples. The postoperative serial sectioning histology diagnosis was used as the standard.ResultsThe overall rate of agreement between OSNA assay and the postoperative serial sectioning was 95.2xa0% [95xa0% confidence interval (CI) 91.6–96.9xa0%], with a sensitivity of 83.3xa0% (95xa0% CI 66.5–93.0xa0%), a specificity of 96.7xa0% (95xa0% CI 93.7–98.4xa0%), a positive predictive value of 76.9xa0% (95xa0% CI 60.3–88.3xa0%), and a negative predictive value of 97.8xa0% (95xa0% CI 95.0–99.1xa0%) based on the number of SLNs sampled before the discordant cases analyses. Eleven out of 15 discordant cases can be explained by tissue allocation bias.ConclusionsOur study shows that the OSNA assay is more standardized, objective, and reproducible and can utilize more lymphoid tissue than the traditional pathological examination methods. OSNA can also distinguish between micrometastasis and macrometastasis, thereby enabling us to further study the significance of micrometastasis. Since there is a lack of standardization and reproducibility of pathological examination and diagnostic criteria of the SLNs, we recommend that the OSNA assay can be used in daily clinical diagnostic work.

Adjuvant chemotherapy increases the prevalence of fat necrosis in immediate free abdominal flap breast reconstruction

BACKGROUNDnFat necrosis is one of the most common complications following free flap breast reconstruction. Although a minor complication, fat necrosis can compromise esthetic results and confuse with cancer recurrence. Perfusion-related factors and post-operative radiotherapy are the known risks. However, the influence of adjuvant chemotherapy on fat necrosis prevalence remains unknown.nnnMETHODSnOur initial experience of 88 consecutive breast reconstructions with free abdominal flaps was reviewed. The prevalence of fat necrosis was recorded and the risk factors were analyzed using univariate and multivariate logistic regression models.nnnRESULTSnThe overall prevalence of fat necrosis was 36.4% in this series. In a multivariate logistic regression model, adjuvant chemotherapy significantly increased the risk of fat necrosis. The relative risk was 4.762 (95% confidence interval (CI), 1.767-12.831; p = 0.002). There was no evidence of a specific chemotherapeutic agent causing fat necrosis. The first cycle of adjuvant chemotherapy was frequently delivered earlier in patients with fat necrosis than those without fat necrosis, although this tendency was not statistically significant.nnnCONCLUSIONSnOur initial experience with free flap breast reconstruction seems to suggest that chemotherapy may increase the risk of fat necrosis following immediate breast reconstruction. Patients should be fully informed, and the initiation of post-operative chemotherapy may be adjusted accordingly.

Breast Sclerosing Adenosis and Accompanying Malignancies: A Clinicopathological and Imaging Study in a Chinese Population.

AbstractSclerosing adenosis (SA) is a less common histopathological lesion of the breast that can coexist with proliferative lesions as well as malignancies. We aimed to analyze the clinicopathological characteristics of SA and to investigate the radiological features of SA.Patients who underwent breast surgery at our institute from 2007 to 2013 were retrospectively reviewed. A total of 815 breasts (722 patients) were included in the final analysis. Synchronous bilateral SA was defined as the detection of another SA arising in the contralateral breast within 1 month after surgery for the initial breast lesion. Baseline characteristics, imaging records (ultrasonography, mammography, and magnetic resonance imaging [MRI]), and pathology were included in the analysis.The median age at diagnosis was 47 years old. The majority of patients had unilateral non-Bc-SA (457/722). Among 102 patients with bilateral SA, 78.4% were diagnosed synchronously. In total, 26 patients suffered from synchronous bilateral breast cancer. Upon final pathological investigation, 226 cases were SA involving breast cancer (Bc-SA), most (56.2%) of which were ductal carcinoma in situ (DCIS). In addition, lobular carcinoma in situ (LCIS) and diseases that involved LCIS also comprised up to 11.1% of cases. The majority of SA cases (405; 49.7%) had no obvious symptoms except for imaging changes in mammography or ultrasound. Compared with non-Bc-SA cases, Bc-SA cases were more likely to exhibit features of mass (32.8% vs. 28.6%) and architectural distortion (20.4% vs. 13.0%) on mammography. Ultrasonography, mammography, and MRI revealed unsatisfactory sensitivity and specificity to differentiate Bc-SA from non-Bc-SA. MRI exhibited the highest sensitivity and lowest specificity, whereas the specificity of mammography was as low as 50.0%.A tendency for synchronous bilaterality in both Bc-SA and non-Bc-SA was noted. DCIS was the most commonly observed malignancy involved in Bc-SA. Although most patients with SA were asymptomatic, the ability of imaging studies to accurately differentiate non-Bc-SA from Bc-SA remained unsatisfactory.

Comparative Study of Water-Leaching and Acid-Leaching Pretreatment on the Thermal Stability and Reactivity of Biomass Silica for Viability as a Pozzolanic Additive in Cement

The present work aims to introduce a novel and eco-friendly method, i.e., a water-leaching pretreatment for extracting highly reactive biomass silica from rice husk (RH), for viability as a pozzolanic additive in cement. For comparison, the traditional acid pretreatment method was also employed throughout the experimental study. The silica from RH was extracted using boiled deionized water and acid solution as leaching agents to remove the alkali metal impurities, and then dried and submitted to pyrolysis treatment. The results indicated that potassium was found to be the major contaminant metal inducing the formation of undesirable black carbon particles and the decrease in crystallization temperature of amorphous RHA silica. The boiling-water-leaching pretreatment and acid-leaching pretreatment on RHs significantly removed the metallic impurities and reduced the crystallization sensitivity of RHA silica to calcination temperature. A highly reactive amorphous silica with purity of 96% was obtained from RH via 1 N hydrochloric acid leaching followed by controlled calcination at 600 °C for 2 h. The acid treatments increased the crystallization temperature of silica to 1200 °C and retained the amorphous state of silica for 2.5 h. In the case of water-leaching pretreatment, leaching duration for 2.5 h could yield an amorphous silica with purity of 94% and render the silica amorphous at 900 °C for 7 h. The RHA silica yielded by water-leaching pretreatment presented a comparable enhancing effect to that of acid leaching on hydration and improved the strength of cement. Furthermore, compared with the acid-leaching method, the water-leaching pretreatment method is more environmentally friendly and easier to operate, and hence more widely available.

Trends and clinicopathological predictors of axillary evaluation in ductal carcinoma in situ patients treated with breast-conserving therapy

The aim of this study was to investigate the trends of axillary lymph node evaluation in ductal carcinoma in situ (DCIS) patients treated with breast‐conserving therapy (BCT) and to identify the clinicopathological predictors of axillary evaluation. DCIS patients treated with BCT in 2006–2015 at our institute were retrospectively included in the analysis. Patients were categorized into three groups: sentinel lymph node biopsy (SLNB), axillary lymph node dissection (ALND), and non‐evaluation. Univariate and multivariate logistic regression analyses were performed to identify factors that predicted axillary evaluation. A total of 315 patients were identified, among whom 135 underwent SLNB, and 15 underwent ALND. The proportion of patients who underwent axillary evaluation increased from 33.0% in 2006–2010 to 53.8% in 2011–2015 (P < 0.001), however, no patients had lymph node metastasis based on final pathology. In multivariate analysis, high‐grade tumor favored axillary evaluation (OR = 4.376, 95% CI:1.410–13.586, P = 0.011); while excision biopsy favored no axillary evaluation compared with other biopsy methods (OR = 0.418, 95% CI: 0.192–0.909, P = 0.028). Subgroup analysis of patients treated in 2011–2015 revealed that high‐grade tumor (OR = 5.898, 95% CI: 1.626–21.390, P = 0.007) and palpable breast lump (OR = 2.497, 95% CI: 1.037–6.011, P = 0.041) were independent predictors of axillary lymph node evaluation. Despite the significant decrease in ALND and a concerning overuse of SLNB, we identified no axillary lymph node metastasis, which justified omitting axillary evaluation in these patients. High‐grade tumor, palpable lump, and biopsy method were independent predictors of axillary evaluations. Excision biopsy of suspicious DCIS lesions may potentially preclude the invasive component of the disease and help to avoid axillary surgery

Long non-coding RNA00544 serves as a potential novel predictive and prognostic marker for HR+ HER2− subtype breast cancer

Luminal breast cancers (BC) account for majority of breast cancer. Due to its heterogeneity and the development of treatment resistance, luminal BC patients can vary substantially. Long noncoding RNAs (lncRNAs), as we known, is involved in breast cancer progression. Here, we aim to identify the lncRNAs which are involved in the particular type luminal BC progression. By Gene Chips analysis, we found a novel lncRNA00544, which was highly expressed in the metastatic axillary nodes compared with corresponding luminal BC tissues (fold changeu2009=u20092.26, Pu2009=u20090.043). This result was confirmed in luminal BC cell lines (pu2009=u20090.0113) and 49 paired breast cancer samples compared with in corresponding controls (pu2009=u20090.011). Furthermore, Kaplan–Meier survival curves of 373 breast cancer patients indicated that disease-free survival was significantly poor in breast cancer patients with high lncRNA00544 expression (pu2009<u20090.001). Univariate and multivariate Cox regression analyses showed that lncRNA00544 was a significant independent prognostic biomarker in luminal BC patients. Further analysis showed that the prognosis of high lncRNA00544 expression in breast cancer patients was actually related to HRu2009+u2009HER2− subtype. Together, our studies indicate that lncRNA00544 may represent a novel predictive and prognostic indicator in luminal BC patients.

A prospective study of breast anthropomorphic measurements, volume and ptosis in 605 Asian patients with breast cancer or benign breast disease

Objectives The current study aims to summarize breast anthropomorphic measurement features in Chinese patients with breast diseases and to investigate their potential correlations with demographic factors. Materials and methods Fifteen breast anthropomorphic parameters of 605 Chinese female patients were collected prospectively. Breast ptosis status was scaled by two methods and breast volume was calculated according to a modified formula of BREAST-V. Results Among 1210 breasts, the average breast volume was 340.0±109.1 ml (91.8–919.2 ml). The distance from the nipple to the inframammary fold was 7.5±1.6 cm in the standing position. The width of the breast base was 14.3±1.4 cm (8.5–23.5 cm). The incidence of breast ptosis was 22.8% (274/1204), of which 37 (23.5%) and 79 (31.7%) women had severe ptosis assessed by different criteria. Increased height (OR[odds ratio] = 1.500, P<0.001), post-menopausal status (OR = 1.463, P = 0.02), increased BMI, breastfeeding for 7–12 months (OR = 1.882, P = 0.008) and more than one year (OR = 2.367, P = 0.001) were risk factors for an increased breast volume. Post-menopausal status (OR = 2.390, P<0.001 and OR = 2.621, P<0.001 for different scales), BMI≥24.7 kg/m2 (OR = 3.149, P<0.001 and OR = 2.495, P = 0.002), breastfeeding for 7–12 months (OR = 4.136, P = 0.004 and OR = 4.010, P = 0.002), and breastfeeding for more than one year (OR = 6.934, P<0.001 and OR = 6.707, P<0.001) were independent risk factors for breast ptosis. Conclusions The current study provides anthropomorphic measurements data of Chinese women with breast diseases, which are useful for cosmetic and reconstructive breast surgery decisions. Post-menopausal status, increased BMI, and breastfeeding for more than six months were independent risk factors for both increased breast volume and breast ptosis.