Insurance Reimbursement for Special Foods and Phenylalanine Levels in Patients With PKU in China.

Importance: Recent changes in China's social medical insurance reimbursement policy have impacted the financial burden of patients with phenylketonuria (PKU) for special foods. However, whether this policy change is associated with their blood phenylalanine (PHE) concentration is unclear. Objective: To investigate the association between the reimbursement policy and blood PHE concentration in patients with PKU. Design, Setting, and Participants: This cohort study measured the blood PHE concentrations of 167 patients with PKU across 4 newborn screening centers in China from January 2018 to December 2021. The reimbursement policy for special foods for patients with PKU at 2 centers was canceled in 2019 and restored from 2020 onwards. In contrast, the other 2 centers consistently implemented the policy. Data were analyzed from September 10 to December 6, 2023. Exposures: The implementation and cancelation of the reimbursement policy for special foods of patients with PKU. Main Outcomes and Measures: The blood PHE concentration was regularly measured from 2018 to 2021. A 1-sided Z test was used to compare the mean of the blood PHE concentration between different years. Results: Among 167 patients with PKU (mean [SD] age, 84.4 [48.3] months; 87 males [52.1%]), a total of 4285 measurements of their blood PHE concentration were collected from 2018 to 2021. For patients at the center that canceled the reimbursement policy in 2019, the mean (SD) of the blood PHE concentrations in 2019 was 5.95 (5.73) mg/dL, significantly higher than 4.84 (4.11) mg/dL in 2018 (P < .001), 5.06 (5.21) mg/dL in 2020 (P = .006), and 4.77 (4.04) mg/dL in 2021 (P < .001). Similarly, for patients at the other center that canceled the policy in 2019, the mean (SD) of the blood PHE concentrations in 2019 was 5.95 (3.43) mg/dL, significantly higher than 5.34 (3.45) mg/dL in 2018 (P = .03), 5.13 (3.15) mg/dL in 2020 (P = .003), and 5.39 (3.46) mg/dL in 2021 (P = .03). On the contrary, no significant difference was observed between any of the years for patients at the 2 centers that consistently implemented the policy. Conclusions and Relevance: In this cohort study of patients with PKU from multiple centers, the implementation of the reimbursement policy for special foods was associated with controlling the blood PHE concentration. Special foods expenditure for patients with PKU should be included in the scope of long-term social medical insurance reimbursement.

Assessment of the Reliability and Clinical Applicability of ChatGPT's Responses to Patients' Common Queries About Rosacea.

Objective: Artificial intelligence chatbot, particularly ChatGPT (Chat Generative Pre-trained Transformer), is capable of analyzing human input and generating human-like responses, which shows its potential application in healthcare. People with rosacea often have questions about alleviating symptoms and daily skin-care, which is suitable for ChatGPT to response. This study aims to assess the reliability and clinical applicability of ChatGPT 3.5 in responding to patients' common queries about rosacea and to evaluate the extent of ChatGPT's coverage in dermatology resources. Methods: Based on a qualitative analysis of the literature on the queries from rosacea patients, we have extracted 20 questions of patients' greatest concerns, covering four main categories: treatment, triggers and diet, skincare, and special manifestations of rosacea. Each question was inputted into ChatGPT separately for three rounds of question-and-answer conversations. The generated answers will be evaluated by three experienced dermatologists with postgraduate degrees and over five years of clinical experience in dermatology, to assess their reliability and applicability for clinical practice. Results: The analysis results indicate that the reviewers unanimously agreed that ChatGPT achieved a high reliability of 92.22% to 97.78% in responding to patients' common queries about rosacea. Additionally, almost all answers were applicable for supporting rosacea patient education, with a clinical applicability ranging from 98.61% to 100.00%. The consistency of the expert ratings was excellent (all significance levels were less than 0.05), with a consistency coefficient of 0.404 for content reliability and 0.456 for clinical practicality, indicating significant consistency in the results and a high level of agreement among the expert ratings. Conclusion: ChatGPT 3.5 exhibits excellent reliability and clinical applicability in responding to patients' common queries about rosacea. This artificial intelligence tool is applicable for supporting rosacea patient education.

Physiological cost of Ulva lactuca under combined pressure of nutrient-oxytetracycline: One potential formation and maintenance mechanism of Ulva sp. green tide.

Environmental pollution is considered to lead to Ulva sp. green tides. Nevertheless, nutrients with high concentrations inhibit algae which may be damaged by antibiotics, such as OTC (oxytetracycline). Thus, Ulva sp. algae might pay a physiological cost under nutrient-OTC combined pressures. If this hypothesis is confirmed, Ulva sp. algae cannot easily form green tides, or green tides are difficult to maintain. To test this hypothesis, an uniform design experiment during which OTC, ammonia (NH4-N) and phosphate (PO4-P) were factors was set to simulate nutrient-OTC combined pressures, and Ulva lactuca was exposed to the pressures for 96 h. The TN (total nitrogen, CTN) or TP (total phosphorus, CTP) content in U. lactuca increased with increasing nutrient concentrations, as CTN = 21.206±1.000+ 1.227±0.418NH4-N × PO4-P (R2 = 0.282, p < 0.05) and CTP = 1.886±0.266+ 0.877±0.126PO4-P (R2 = 0.689, p < 0.05), respectively. The increase in dry weight of U. lactuca (Wdry) had a relationship with combined pressures, Wdry = 0.011±0.029 - 0.036±0.014PO4-P (R2 = 0.243, p < 0.05), i.e., the algal growth was inhibited by increasing PO4-P concentration. The SOD (Superoxide dismutase) activity (ASOD) was stimulated by OTC, as ASOD = 127.868±8.741+9.587±4.179 OTC (R2 = 0.193, p < 0.05). The contents of Chl a and b (Ca and Cb) were negatively affected by OTC or PO4-P with high concentration, as Ca = 0.566±0.042 - 0.024±0.022 OTC × PO4-P (R2 = 0.179, p < 0.05) and Cb = 0.512±0.043-0.044±0.020PO4-P (R2 = 0.180, p < 0.05). Thus, too high concentrations of PO4-P or OTC may hinder the formation and maintenance of Ulva sp. green tides.

The impact of green finance on carbon emission efficiency.

Green finance plays a pivotal role in guiding and incentivizing private capital to invest in low-carbon industries and initiatives. This study utilizes data of Chinese cities from 2006 to 2022 to investigate the influence of green finance on carbon emission efficiency. The results show that green finance significantly contributes to enhancing carbon emission efficiency. The impact of green finance on carbon emission efficiency is subject to a dual threshold effect, which depends on the level of regional economic development. Regional innovation emerges as a vital channel through which green finance influences carbon emission efficacy. Moreover, the sensitivity of carbon emission efficiency to the green finance index shows an inverted U-shaped trend. Green support is most significant in green finance sub-dimensions. These findings provide valuable theoretical support for the role of green finance in fostering carbon efficiency improvement and provide essential insights for formulating effective policy strategies.

Assessment of tree-ring mercury radial translocation and age effect in Masson pine: Implications for historical atmospheric mercury reconstruction.

The tree ring has been regarded as an emerging archive to reconstruct historical atmospheric mercury (Hg) trends, but with the large knowledge gaps in the reliability. In this study, we comprehensively evaluated the Hg source, radial translocation and age effect of Masson pine (Pinus massoniana) tree ring at Mt. Jinyun in Chongqing, to assess the suitability of such tree ring as the archive of atmospheric Hg. Results showed that distinct variabilities among Masson pine tree-ring Hg concentration profiles. The Hg concentration significantly increased along with stem height (P < 0.05), indicating the Hg in tree rings mainly derived from foliage uptake atmospheric Hg. We found a distinct age effect that the tree ring of young trees had the higher Hg concentration. Besides, we used the advection-diffusion model to demonstrate how Hg concentration shifted by the advection or/and diffusion in tree rings. The modeling results showed that the advection induced radial translocation during the young growth period of tree was a plausible mechanism to result in the tree-ring Hg record largely different from the trend of anthropogenic Hg emissions in Chongqing. We finally suggest that in further Hg dendrochemistry, better discarding the tree-ring Hg profile of the young growth period to reduce impacts of the radial translocation and age effect.

Effects of osseous structure based on three-dimensional reconstructive imaging evaluation in the assessment of temporomandibular joint disc position.

OBJECTIVES: This pilot morphological study aimed to investigate the association between anterior disc displacement (ADD) and the status of the mandibular condyle and articular fossa. MATERIALS AND METHODS: Thirty-four patients were divided into a normal articular disc position group and an ADD with and without reduction group. Images reconstructed were used to determine multiple group comparisons of these three different types of disc position, and the diagnostic efficacy for the morphological parameters with significant group difference was analyzed to assess. RESULTS: The condylar volume (CV), condylar superficial area (CSA), superior joint space (SJS), and medial joint space (MJS) all exhibited obvious changes (P < 0.05). Additionally, they all had a reliable diagnostic accuracy in differentiating between normal disc position and ADD with an AUC value from 0.723 to 0.858. Among them, the CV, SJS, and MJS (P < 0.05) had a significantly positive impact on the groups by analysis of multivariate logistic ordinal regression model. CONCLUSIONS: The CV, CSA, SJS, and MJS are significantly associated with different disc displacement types. The condyle in ADD exhibited altered dimensions. These could be promising biometric markers for assessing ADD. CLINICAL RELEVANCE: The morphological changes of mandibular condyle and glenoid fossa were significantly influenced by the status of disc displacement, and condyles with disc displacement had three-dimensionally altered condylar dimensions, irrespective of age and sex.

Assessing Spatial Accessibility of Community Hospitals for the Elderly in Beijing, China.

Accessibility of health services signifies the quality and equitability of universal health provision. The hierarchical medical system recently implemented in China offers the policy instruments to improve medical services to the elderly in an aging society. As the critical primary care gateway, accessibility to community hospitals has significant impacts on people's health. However, current research has paid little attention to spatial accessibility within walking distance of community hospitals, especially for the elderly. This study selected four districts with different urbanization levels in the rapidly developing Beijing metropolis. The spatial interaction model was applied to measure the accessibility of community hospitals for the elderly at the community level. An attractiveness index was computed based on key hospital traits. The results showed that: (1) community hospitals could cover 82.66% of elderly residents, and 77.63% of the communities were within walking distance. The served elderly proportion was relatively high in central urban areas and low in the suburbs. (2) The attractiveness indices of hospitals varied notably between districts, with higher values in more urbanized areas. (3) The spatial accessibility for the elderly of hospitals differed significantly between the four districts, with a descending gradient from central to suburban and rural areas, as indicated by the Gini coefficients and Lorenz curves. (4) The accessibility index was strongly related to the served elderly population and the hospital-residence distance. The findings provide policy directions to the government, including providing more primary-care resources to suburban and rural areas, building new community hospitals in identified provision gaps, upgrading some clinics to hospitals in rural areas, and planning hospitals according to the projected trend of the elderly population in terms of quantity and distribution. The considerable provision disparity between core urban, suburban and rural areas can be addressed by refined spatial health planning informed by research.

Decomposition analysis of health inequalities between the urban and rural oldest-old populations in China: Evidence from a national survey.

The number of Chinese oldest-old (aged 80+) is growing rapidly and some studies have shown that the health status is unequal among older persons in different regions. However, to the best of our knowledge, no study to date has analyzed health inequalities among the oldest-old in urban and rural areas in China. This study therefore aimed to examine the correlation between health inequalities among the oldest-old in urban and rural areas of China. From the 8th wave of the Chinese Longitudinal Health Longevity Survey (CLHLS), we selected 8124 oldest-old participants who met the requirements of the study. Chi-square tests were used to analyze the distribution characteristics of indicators and a logistic model was performed to determine the factors associated with different self-rated health (SRH). The Fairlie model was adopted to decompose the causes and related contributions to health inequality. Our results found that of the Chinese oldest-old, 46.57% were in good health. Urban residents reported significantly better SRH than rural residents (50.17% vs. 45.13%). Variables associated with good and poor SRH had different distribution characteristics. The logistic model suggested that marital status, alcohol consumption, and annual income were important factors underlying the SRH differences. Our decomposition analysis indicated that 76.64% of the SRH differences were caused by observational factors, and validated that the difference in SRH between urban and rural areas was significantly (P<0.05) associated with exercise status (45.44%), annual income (37.64%), social activity status (3.75%), age (-5.27%), and alcohol consumption (-2.66%). Therefore, socioeconomic status and individual lifestyle status were the main factors underlying the health inequality between urban and rural Chinese oldest-old.

[Characteristics and Risk Assessment of Heavy Metals in the Soil Around Copper Smelting Sites].

Copper smelting can cause heavy metal pollution in surrounding soil and threaten human health. This study examined the characteristics, distribution, and health risk of heavy metals in soil with different land uses around 40 copper smelting sites at home and abroad by collecting published literature data. The results showed that the mean values of ω(As), ω(Cd), ω(Cu), ω(Pb), and ω(Zn) in the soil around the copper smelting sites were 196, 10.5, 1948, 604, and 853 mg·kg-1, respectively. The order of Igeo was Cd(5.63)>Cu(3.88)>As(2.96)>Pb(2.30)>Zn(1.27), and the accumulation of Cd and Cu was the most serious. High Nemero index (NIPI) values were found in the soil around smelting sites with a long history of smelting, outdated process, and insufficient environmental protection measures. Significant correlations were found between the concentrations of heavy metals in the soil, which decreased with the sampling distance. The heavy metals mainly accumulated within 2-3 km from the smelting sites. Compared with the smelting history, scale, and process, land use type had a lower effect on soil heavy metal concentrations. The heavy metals in the soil around copper smelters may pose carcinogenic and non-carcinogenic risks on residents. The high health risks were mainly caused by As and Pb in smelting production areas, and Pb in woodland. These results may guide the risk prevention of heavy metal pollution in the soil around smelting sites.

Development and assessment of the Quality of Life Instruments for Chronic Diseases-Gout (QLICD-GO) (V2.0).

OBJECTIVE: To develop and assess the Quality of Life Instruments for Chronic Diseases-Gout QLICD-GO (V2.0). METHODS: The instrument was developed using a programmatic decision-making method to combine the general module of the Quality of Life Instruments for Chronic Diseases and a new specific module. The instrument was assessed by measuring the quality of life of 116 patients with gout. RESULTS: The QLICD-GO (V2.0) included 28 items from the general module of chronic diseases and 12 items in three facets from the specific module. In addition to the field of physiological function, the internal consistency reliability of other fields and dimensions of the instrument was > 0.7, and the split-half reliability was > 0.5. Three common factors were extracted from the specific module, with a cumulative variance contribution rate of 57.54%. The standardized response means of the specific module and the whole instrument were 0.94 and 1.20, respectively. CONCLUSIONS: The QLICD-GO (V2.0) has good reliability, validity, and responsiveness. The instrument comprehensively and objectively reflects the quality of life of patients with gout, and it can be used to assess treatment regimens developed by medical staff. Key Points • The QLICD-GO (V2.0) has been developed for patients with gout based upon the foundation of the QLICD-GM. • The QLICD-GO reflects the clinical signs and symptoms, drug-related side effects, and psychological changes specific to patients with gout. • Based on the assessment results, the QLICD-GO (V2.0) has good reliability, validity, and responsiveness. • QLICD-GO (V2.0) can objectively and comprehensively reflect the QOL of patients with gout and can be used by clinical staff to assess treatment regimens.

Halomonas spp., as chassis for low-cost production of chemicals.

Halomonas spp. are the well-studied platform organisms or chassis for next-generation industrial biotechnology (NGIB) due to their contamination-resistant nature combined with their fast growth property. Several Halomonas spp. have been studied regarding their genomic information and molecular engineering approaches. Halomonas spp., especially Halomonas bluephagenesis, have been engineered to produce various biopolyesters such as polyhydroxyalkanoates (PHA), proteins including surfactants and enzymes, small molecular compounds including amino acids and derivates, as well as organic acids. This paper reviews all the progress reported in the last 10 years regarding this robust microbial cell factory. KEY POINTS: • Halomonas spp. are robust chassis for low-cost production of chemicals • Genomic information of some Halomonas spp. has been revealed • Molecular tools and approaches for Halomonas spp. have been developed • Halomonas spp. are becoming more and more important for biotechnology.

Impact of financial support on the prognosis of HER2-positive breast cancer from 2002 to 2020: a prospective cohort from western China.

Background: Trastuzumab has significantly improved the outcomes of human epidermal growth factor receptor 2 (HER2)-positive breast cancer over 20 years, and remains a cornerstone of treatment for this subtype today. Higher mortality was reported in underinsured breast cancer, but the mechanism remains unclear. Financial support for trastuzumab has transitioned from no support, to the Breast Cancer Assistant Program (BCAP), and finally, health insurance. Exploring the association between survival outcomes and different financial supports is necessary to further improve the outcomes of HER2-positive breast cancer in resource-limited regions. Methods: A prospective cohort of primary early unilateral HER2-positive breast cancer patients registered between January 2002 and December 2020 was used. Patients were divided into the following 3 groups, based on when they were diagnosed with breast cancer: (I) before 2011 (no financial support); (II) 2011-2017 (BCAP support); and (III) 2018 onwards (health insurance support). Overall survival and invasive disease-free survival (iDFS) were the primary outcomes. The follow-up was performed according the standard procedure. Cox proportional hazards regression was used to explore the association between financial support and prognosis with adjustment of demographic and clinicopathological characteristics, and treatments. Results: A total of 2,972 patients were finally identified. During the median follow-up period of 3.9 years, there were 153 breast cancer-related deaths. When fully adjusted potential covariates, patients supported by the BCAP had a 37% [hazard ratio (HR): 0.63, 95% CI: 0.41-0.96] decreased risk of overall mortality and that of patients covered by health insurance had a 64% decreased of overall mortality (HR: 0.36, 95% CI: 0.17-0.74) when compared with those who did not receive any financial support. Lower overall mortality was observed in patients covered by a higher reimbursement rate (HR: 0.68, 95% CI: 0.49-0.94) or the urban scheme (HR: 0.61, 95% CI: 0.43-0.86) than those covered by a lower reimbursement rate or the rural scheme. The same trends were also observed for iDFS and breast cancer-specific survival. Conclusions: Our findings revealed the independent role of financial support in improving the survival outcomes of the HER2-positive breast cancer in resource-limited regions and the underneath mechanism.

Assessment of the Characteristics of Waxy Rice Mutants Generated by CRISPR/Cas9.

The cooking and eating quality of rice grains is a major focus from a consumer's perspective and is mainly determined by the apparent amylose content (AAC) of the starch. Waxy rice, a type of rice with an AAC of less than 2%, is an important goal for the breeding of high-quality rice. In recent years, the cloning of the Waxy (Wx) gene has revealed the molecular mechanism of the formation of waxy traits in rice. However, there have been limited studies on the physicochemical properties, such as gelatinization temperature, rapid viscosity analyzer profile, and amylopectin fine structure of wx mutants. In the current study, a rapid and highly efficient strategy was developed through the CRISPR/Cas9 gene-editing system for generating wx mutants in the background of five different rice varieties. The wx mutation significantly reduced the AAC and starch viscosity but did not affect the major agronomic traits (such as plant height, panicle number per plant, grain number per panicle, and seed-setting frequency). Incorporation of the wx mutation into varieties with low initial AAC levels resulted in further reduction in AAC, but without significantly affecting the original, desirable gelatinization traits and amylopectin structure types, suggesting that parents with low initial AAC should be preferred in breeding programs.

Needs assessment and expectations regarding evidence-based practice knowledge acquisition and training activities: A cross-sectional study of healthcare personnel in China.

OBJECTIVES: Evidence-based healthcare contributes to the improvement of healthcare quality and informs healthcare decision-making. The provision of timely high-quality evidence is always required to fulfil the ever-changing needs and expectations of healthcare personnel. This study aimed to assess the needs and expectations of healthcare personnel regarding evidence-based healthcare in China. METHODS: We conducted a cross-sectional online survey from December 8, 2020 to January 15, 2021 involving 901 participants across China. Healthcare providers, policy makers, researchers and educators, and full-time postgraduate medical and nursing students working/living in China were eligible to participate. A self-developed questionnaire was used. RESULTS: Participants generally agreed that health-related research evidence was beneficial. Evidence-based resources, such as Cochrane resources, were only known or used by about half of the respondents due to difficulties related to availability and accessibility. Various types of resources, topics of evidence, and themes of workshops were of particular interest to most of the participants. CONCLUSIONS: The dissemination and translation of evidence, provision of more support in evidence availability, offering evidence-based training, and determining the most in-demand research areas have been identified as priority areas of work which could fulfil the needs and expectations of healthcare personnel in China.

Understanding the influencing mechanism of users' participation in live streaming shopping: A socio-technical perspective.

Introduction: In live streaming shopping, exploring the influencing mechanism of consumers' participation is an important prerequi site for understanding consumer behavior in social commerce activities. The purpose of this study is to explore the relationship betw een technological and social factors (visibility, media richness, guidance shopping and real-time interactivity) in live streaming shop ping and consumers' purchase intention. The mediating roles of attraction and cognitive assimilation were also examined. Methods: This study collected 425 pieces of data through questionnaire survey. The structural equation model is established based on S-O-R frame. The hypothesis is tested by structural equation model. Results: Our study found that that real-time interactive and media richness positively affect attraction; visibility, guidance shopping and media richness positive affect cognitive assimilation; cognitive assimilation and attraction positive affect consumers' purchase intention; cognitive assimilation and attraction play a partial mediating role in the influence of technology and social factors on cons umers' purchase intention of live streaming shopping. Discussion: From the perspective of socio-technical, this study explores the influence mechanism of different influencing factors on consumers' purchase intention in live streaming shopping. This study expands the application of IT affordance theory in the context of live streaming shopping, and reveals the mediating role of attraction and cognitive assimilation between social, technological factors and consumers' purchase intention.

Advanced Flexible Skin-Like Pressure and Strain Sensors for Human Health Monitoring.

Recently, owing to their excellent flexibility and adaptability, skin-like pressure and strain sensors integrated with the human body have the potential for great prospects in healthcare. This review mainly focuses on the representative advances of the flexible pressure and strain sensors for health monitoring in recent years. The review consists of five sections. Firstly, we give a brief introduction of flexible skin-like sensors and their primary demands, and we comprehensively outline the two categories of design strategies for flexible sensors. Secondly, combining the typical sensor structures and their applications in human body monitoring, we summarize the recent development of flexible pressure sensors based on perceptual mechanism, the sensing component, elastic substrate, sensitivity and detection range. Thirdly, the main structure principles and performance characteristic parameters of noteworthy flexible strain sensors are summed up, namely the sensing mechanism, sensitive element, substrate, gauge factor, stretchability, and representative applications for human monitoring. Furthermore, the representations of flexible sensors with the favorable biocompatibility and self-driven properties are introduced. Finally, in conclusion, besides continuously researching how to enhance the flexibility and sensitivity of flexible sensors, their biocompatibility, versatility and durability should also be given sufficient attention, especially for implantable bioelectronics. In addition, the discussion emphasizes the challenges and opportunities of the above highlighted characteristics of novel flexible skin-like sensors.

Soil Threshold Values for Zn Based on Soil-Rice System and Health Risk Assessment in a Typical Carbonate Area of Guangxi.

Zinc (Zn) is enriched in carbonate area related to geological genesis. To ensure safety of rice, soil threshold values of Zn in soil-rice systems were assessed based on analysis of soil-rice Zn concentration in relation to human health risk. Models for the prediction of Zn concentration of early-season and late-season rice grain were accurately established on the basis of significant partial correlations between log10 (BAFs) and log10 (soil properties). The rice threshold value ranged from 10.67 to 37.90 mg/kg, which might not suitable for male and urban residents. The soil safety threshold of early-season rice and late-season rice in carbonate area ranged from 148-200 mg/kg, 119-200 mg/kg with pH below 6.5, 148-250 mg/kg, 119-250 mg/kg with pH ranging from 6.5 to 7.5; 148-300 mg/kg, 119-300 mg/kg with pH above 7.5, respectively.

Combining tumor response and personalized risk assessment: Potential for adaptation of concurrent chemotherapy in locoregionally advanced nasopharyngeal carcinoma in the intensity-modulated radiotherapy era.

BACKGROUND AND PURPOSE: In the intensity-modulated radiotherapy (IMRT) era, the role of concurrent chemoradiotherapy (CCRT) after induction chemotherapy (IC) in locoregionally advanced nasopharyngeal carcinoma (LANPC) is undetermined, while concerns exist about CCRT-associated excessive toxicity. We aimed to combine tumor response and risk assessment to guide decisions about concurrent chemotherapy. MATERIALS AND METHODS: From April 2009 to December 2015, 744 LANPC patients treated with CCRT/IMRT after IC were included. Matching techniques were performed for treatment effect evaluation. Tumor response to IC was used for patient stratification. A nomogram was built based on multivariable Cox regression analysis to predict overall survival (OS). RESULTS: After IC, 508 patients (68.3%) had favorable tumor response (complete or partial response), among whom IC + CCRT achieved significantly superior 5-year disease-free survival and OS than IC + IMRT (82.2% vs. 72.5%, P = 0.025; 89.2% vs. 79.9%, P = 0.025). However, no significant difference was found in patients with unfavorable response (both P > 0.05). For favorable responders, a nomogram was built integrating age, smoking, T category, N category, pretreatment Epstein-Barr virus DNA and treatment modality. The concordance index was 0.713 and calibration was good. The nomogram determined three risk groups with distinct OS. High-risk patients benefited from CCRT after IC regarding disease-free survival, OS and distant metastasis-free survival, whereas low- and intermediate-risk patients did not. CONCLUSIONS: For LANPC patients with unfavorable response to IC, subsequent CCRT seems inadequate, rendering intensification necessary. For favorable responders with low risk, IC + IMRT represents a reasonable de-intensification approach, although confirmation by prospective data is needed.

The highly rearranged mitochondrial genomes of three economically important scale insects and the mitochondrial phylogeny of Coccoidea (Hemiptera: Sternorrhyncha).

The mitochondrial genomes (mitogenomes) of scale insects are less known in comparison to other insects, which hinders the phylogenetic and evolutionary studies of Coccoidea and higher taxa. Herein, the complete mitogenomes of Unaspis yanonensis, Planococcus citri and Ceroplastes rubens were sequenced for Coccoidea. The 15,220-bp long mitogenome of U. yanonensis contained the typical set of 37 genes including 13 PCGs, 22 tRNA genes and two rRNA genes; the 15,549-bp long mitogenome of P. citri lacked the tRNA gene trnV; the 15,387-bp long mitogenome of C. rubens exhibited several shortened PCGs and lacked five tRNA genes. The mitochondrial gene arrangement of the three mitogenomes was different from other scale insects and Drosophila yakuba. Most PCGs used standard ATN (ATA, ATT, ATC and ATG) start codons and complete TAN (TAA or TAG) termination codons. The ND4L had the highest evolutionary rate but COX1 and CYTB were the lowest. Most tRNA genes had cloverleaf secondary structures, whereas the reduction of dihydrouridine (DHU) arms and TψC arms were detected. Tandem repeats, stem-loop (SL) structures and poly-[TA]n stretch were found in the control regions (CRs) of the three mitogenomes. The phylogenetic analyses using Bayesian inference (BI) and maximum likelihood methods (ML) showed identical results, both supporting the inner relationship of Coccoidea as Coccidae + (Pseudococcidae + Diaspididae).