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Tea is one of the most heavily consumed beverages in the world. The relationship between tea drinking and human health is becoming a subject of intense study by scientists throughout the world. In this paper, we first provide a comprehensive analysis of the medical literature on tea published in China during the past 20 years, and then highlight some recent studies in China on the relationship between tea and several human diseases. During the period 1982–2002, 691 research papers related to tea and health have been published in 290 Chinese journals. These studies showed that tea and tea constituents have various biological activities and suggested that tea drinking might be beneficial to human health. Tea has potential in the prevention or adjuvant treatment of several diseases including cancer, cardiovascular diseases and obesity. The trend and future direction in medical research on tea in China are also briefly discussed. [ABSTRACT FROM AUTHOR]

Aim. This paper describes a study identifying the impact of key aspects of Chinese culture on the responses of mid-aged Chinese-Australians to their advanced cancer in order to make recommendations about their care within the health system. Background. Studies conducted in the 1960s and 1970s focused on understanding people's psychological responses to their experiences of terminal illness, but the issue of culture was not addressed. In recent years, a few studies have been conducted with Chinese-Australians, but were limited to issues related to their information needs and the disclosure of a cancer diagnosis. There is a lack of understanding of the impact of Chinese culture on the experiences of these patients. Method. A grounded theory approach was used to generate a substantive theory to explain how mid-aged Chinese-Australians respond to advancing cancer. Eleven participants were recruited and data were collected from face-to-face interviews, telephone contacts, observation and researcher fieldnotes. Data generation occurred between 1997 and 1999. Findings. Four modes of response to advanced cancer were identified: acute crisis, combat, despondency and waiting for death. This paper deals particularly with the combat mode which incorporated five culturally specific strategies used by participants in their struggle against advanced cancer. These were traditional Chinese medicine, traditional Chinese beliefs on the use of food for health maintenance, qi gong (a form of exercise), feng shui (which involves paying attention to spatial organization) and the worship of ancestors and gods. Deeply entrenched within these responses is the influence of Chinese culture, rooted in the beliefs and practices of traditional Chinese medicine and the philosophy of harmony and balance of yin and yang and qi. Conclusion. Healthcare professionals need to be aware of the cultural practices and beliefs of the different ethnic groups for whom they care, and of the importance of accommodation to and negotiation about these cultural practices. [ABSTRACT FROM AUTHOR]

Purpose: Distress screening using measures of patient-reported outcomes (PRO) has been introduced in China and is increasingly recognized as contributing to whole-patient care. We carried out a multi-centered cross-sectional survey of Chinese cancer inpatients to explore the symptom burden, symptom clusters, and risk factors of distress.Method: Patients were recruited from five hospitals in four provinces. The Distress Assessment and Response Tool (DART) was used as the screening tool. Demographic and medical information was collected. Descriptive analysis, the chi-square test, logistics regression analysis, and hierarchical clustering analysis were used.Results: Totally 1045 valid questionnaires were collected (83.6% validity ratio). Low well-being (39.4%), lack of appetite (35.4%), tiredness (32.9%), pain (21.1%), and anxiety (19.8%) were the top five symptoms. Patients in Ci County had a heavier symptom burden than patients at other sites. Depression, anxiety, nausea, drowsiness, and pain were considered pain-illness symptoms; lack of appetite, low well-being, tiredness, and shortness of breath were considered fatigue-illness symptoms. Social difficulty was a risk factor for all symptoms. A high proportion of suicide ideation (38.8%) and suicide intention (10.5%) was identified among patients with potential depression.Conclusion: The high symptom burden of Chinese cancer inpatients indicates the necessity of distress screening; well-designed screening programs such as the multidimensional DART and its acceptability in China should be further explored. Social difficulty has a universal impact on patients' well-being, and psychosocial care should be integrated into holistic symptoms management. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to develop and psychologically test the mobile health information‐seeking behaviour (MHISB) questionnaire in people with cancer. Design: Instrument development. Methods: The study was conducted in three phases in a southeastern city of China from May 2017 to April 2018. In phase one, an item pool was constructed based on a literature review and semistructured interviews. In phase two, expert evaluation and cognitive interviews were used to evaluate the content validity of the questionnaire. In phase three, a cross‐sectional study was conducted with people with cancer. Cronbach's α was calculated for reliability analysis. Validity evaluation included content validity and construct validity. Results: The developed MHISB questionnaire has four dimensions (information‐seeking frequency, information‐seeking self‐efficacy, health information evaluation and information‐seeking willingness) and 25 items. Psychometric findings were satisfactory and supported the questionnaire's reliability. Conclusions: The construction process of the MHISB questionnaire was scientific and feasible. The MHISB questionnaire had acceptable validity and reliability, and it requires further improvement in future studies. [ABSTRACT FROM AUTHOR]

Objective: This study aims to systematically examine Chinese cancer patients' and families' preferences for information disclosure to the patient, patient awareness, and predictors of patient awareness. Methods: The Preferred Reporting Items for Systematic reviews and Meta‐Analyses guidelines were followed. Web of Science, Scopus, Proquest, Taylor & Francis Online, and China National Knowledge Infrastructure were searched in April 2022 and Chinese Biomedical Literature Database in July 2022 for quantitative studies. The Mixed Methods Appraisal Tool was used for quality assessment. Results: A total of 22 studies were included, and the average quality score was 0.65/1. Meta‐analyses showed that 89.6% and 81.8% of cancer patients wanted to know their diagnosis and prognosis, respectively. Meanwhile, 50.0% and 32.4% of families prefer diagnosis disclosure and prognosis disclosure to the patient, respectively. Significantly more patients than families favored disclosure to the patient. In reality, only 59.3% of cancer patients know their diagnosis, and 19.9% know their prognosis. For predictors, while patients' gender, cancer type (breast cancer or not), treatment method (operation or other), or complications (yes or no) do not influence diagnosis awareness, being younger, being married, having higher educational attainment, having early‐stage rather than late‐stage cancer, and being in a higher‐grade hospital all predict better chances of knowing a diagnosis. No study explored predictors of patients' prognosis awareness. The findings did not vary according to publication time or sample size. Conclusions: Chinese cancer patients are eager to know their diagnosis and prognosis, but families are hesitant about disclosure to the patient, and patients' awareness is low. While cultural, legal, and medical backgrounds lay the foundation for information disclosure in Mainland China, case‐by‐case practical factors also make a difference. [ABSTRACT FROM AUTHOR]

Objective: The present study was aimed to comprehensively characterize the epidemiological, clinicopathological characteristics, treatments, and prognosis of intraoral spindle cell carcinoma (SpCC). Materials and Methods: Patients diagnosed with intraoral SpCC at our institution in the past 15 years (2005–2019) were screened from inpatient disease registry. All relevant data concerning patients with intraoral SpCC were retrieved. Previous reports about intraoral SpCC with adequate clinicopathological data in both English literature and Chinese literature were collected. Eligible cases were further reviewed and pooled for statistical analyses. Results: Six patients (5 females and 1 male; average age: 59 years) with intraoral SpCC were histopathologically diagnosed and surgically treated at our institution. The literature review identified another 63 published cases from 34 articles. Most cases were presented in the fifth to seventh decade of life with a male preponderance. Gingiva (23/69, 33.3%) was the most common site followed by the tongue (19/69, 27.5%) and buccal mucosa (8/69, 11.6%). Complete surgical ablation remains the primary treatment option. Tumor size, pathological grades, cervical node metastasis, and distant metastasis were significantly associated with reduced survival. Conclusions: Intraoral SpCC is an uncommon and aggressive malignancy with dismal prognosis. Much attention and effort are needed to characterize this rare entity and improve its clinical outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Major depressive disorder (MDD) is associated with an increased risk of suicide and suicide attempt among cancer patients. However, we do not know how many cancer patients without MDD have suicidal ideation (SI). Objectives: This study aimed to investigate the prevalence, characteristics and correlated factors of SI among advanced cancer patients without MDD. Methods: This is a multi‐center, cross‐sectional study based on an electronic patient‐reported outcome systems in patients who were diagnosed with advanced lung, liver, gastric, esophageal, colorectal or breast cancer, the top six prevalent cancers in China. A total of 2930 advanced cancer patients were recruited from 10 regional representative cancer centers across China from August 2019 to December 2020. Patients completed the Patient Health Questionnaire‐9 regarding if they had thoughts of being better off dead or of hurting themselves in some way in the previous 2 weeks. Patients also completed the symptom inventory and quality of life assessment. Generalized estimating equation model was performed to explore the correlated factors associated with SI among the patients without MDD. Results: The overall prevalence of SI among advanced cancer patients without MDD was 13.1%. The prevalence was higher in older patients. After adjusted for existing conditions, patients with vomiting symptom (p < 0.001), poorer life quality (p < 0.001), and middle education level (p = 0.031) were correlated factors of SI. Conclusions: The suicidal ideation is common in advanced cancer patients without MDD. Patients with vomiting, poor quality of life, and middle education level should be screened and monitored for suicidal ideation even without MDD. Clinical Trial Information: ChiCTR1900024957. [ABSTRACT FROM AUTHOR]

Two genetic variants that alter alcohol metabolism, ALDH2‐rs671 and ADH1B‐rs1229984, can modify oesophageal cancer risk associated with alcohol consumption in East Asians, but their associations with other cancers remain uncertain. ALDH2‐rs671 G>A and ADH1B‐rs1229984 G>A were genotyped in 150 722 adults, enrolled from 10 areas in China during 2004 to 2008. After 11 years' follow‐up, 9339 individuals developed cancer. Cox regression was used to estimate hazard ratios (HRs) for site‐specific cancers associated with these genotypes, and their potential interactions with alcohol consumption. Overall, the A‐allele frequency was 0.21 for ALDH2‐rs671 and 0.69 for ADH1B‐rs1229984, with A‐alleles strongly associated with lower alcohol consumption. Among men, ALDH2‐rs671 AA genotype was associated with HR of 0.69 (95% confidence interval: 0.53‐0.90) for IARC alcohol‐related cancers (n = 1900), compared to GG genotype. For ADH1B‐rs1229984, the HRs of AG and AA vs GG genotype were 0.80 (0.69‐0.93) and 0.75 (0.64‐0.87) for IARC alcohol‐related cancers, 0.61 (0.39‐0.96) and 0.61 (0.39‐0.94) for head and neck cancer (n = 196) and 0.68 (0.53‐0.88) and 0.60 (0.46‐0.78) for oesophageal cancer (n = 546). There were no significant associations of these genotypes with risks of liver (n = 651), colorectal (n = 556), stomach (n = 725) or lung (n = 1135) cancers. Among male drinkers, the risks associated with higher alcohol consumption were greater among ALDH2‐rs671 AG than GG carriers for head and neck, oesophageal and lung cancers (Pinteraction <.02). Among women, only 2% drank alcohol regularly, with no comparable associations observed between genotype and cancer. These findings support the causal effects of alcohol consumption on upper aerodigestive tract cancers, with ALDH2‐rs671 AG genotype further exacerbating the risks. [ABSTRACT FROM AUTHOR]

Background: Leukemia can create a significant economic burden on the patients and their families. The objective of this study is to assess the medical expenditure and compensation of pediatric leukemia, and to explore the incidence and determinants of catastrophic health expenditure (CHE) among households with pediatric leukemia patients in China. Methods: A cross‐sectional interview was conducted among households living with pediatric leukemia using a questionnaire in two tertiary hospitals. CHE was defined as out‐of‐pocket (OOP) payments that were greater than or equal to 40% of a household's capacity to pay (CTP). Chi‐square tests and logistic regression analysis were performed to identify the determinants of CHE. Results: Among 242 households living with pediatric leukemia, the mean OOP payment for pediatric leukemia healthcare was $9860, which accounted for approximately 35.7% of the mean household's CTP. The overall incidence of CHE was 43.4% and showed a downward trend with the lowest income group at 69.0% to the highest income group at 16.1%. The logistic regression model found that medical insurance, frequency of hospital admissions, charity assistance, and income level were significant predictors of CHE. Conclusion: The results revealed that pediatric leukemia had a significant catastrophic effect on families, especially those with lower economic status. The occurrence of CHE in households living with pediatric leukemia could be reduced by addressing income disparity. In addition, extending coverage and improving compensation from medical insurance could also alleviate CHE. Some other measures that can be implemented are to address the barriers of charity assistance for vulnerable groups. [ABSTRACT FROM AUTHOR]

Background: Immune checkpoint inhibitors (ICIs) have significant clinical efficacy in the treatment of non‐small cell lung cancer (NSCLC); however, the incidence of immune‐related adverse events (irAEs) of up to 50% has prevented their widespread use. With the increase in the use of ICIs alone or as combination therapy, clinicians are required to have a better understanding of irAEs and be able to manage them systematically. In this study, we aimed to assess the incidence of irAEs associated with ICIs. Methods: We searched PubMed, Embase, and the Web of Science databases, and also included relevant literature references to widen our search. The relevant data with inclusion criteria were performed using RevMan 3.6.0 for meta‐analysis. We undertook a systematic literature search which included published data up to December 2019. Results: Overall, 147 articles and 23 761 cancer patients with 11 different ICI treatment‐related (grade 1–5 and 3–5) irAEs were included in the study. There were 46 articles on pembrolizumab (6598 patients), 27 on nivolumab (3576 patients), 13 on atezolizumab (2787 patients), 12 on avelumab (3213 patients), 10 on durvalumab (1780 patients), 22 on ipilimumab (4067 patients), eight on tremelimumab (1158 patients), three on JS001 (223 patients), four on camrelizumab (SHR‐1210) (178 patients), one on sintilimab (96 patients), and one on cemiplimab (85 patients). Grade 1–5 irAEs were: cytotoxic T lymphocyte antigen 4 (CTLA‐4) (82.87%), programmed cell death 1 (PD‐1) (71.89%), and programmed cell death ligand‐1 (PD‐L1) (58.95%). Subgroup analysis was: Avelumab (44.53%), durvalumab (66.63%), pembrolizumab (67.25%), atezolizumab (68.77%), nivolumab (76.25%), Ipilimumab (82.18%), and tremelimumab (86.78%). Grade 3–5 irAEs were: CTLA‐4 (27.22%), PD‐1(17.29%), and PD‐L1(17.29%). Subgroup analysis was: Avelumab (5.86%), durvalumab (13.43%), atezolizumab (14.45%), nivolumab (15.72%), pembrolizumab (16.58%), tremelimumab (22.04%), and ipilimumab (28.27%). Conclusions: This meta‐analysis confirmed that anti‐PD‐1 and anti‐PD‐L1 inhibitors had a lower incidence of irAEs compared with anti‐CTLA‐4 inhibitors. [ABSTRACT FROM AUTHOR]

Colorectal neoplasms are a type of malignant digestive system tumor that has become the third‐highest morbidity tumor in China and the fourth leading cause of cancer‐related death worldwide. The role of the gastrointestinal (GI) microbiome in bile acid metabolism, inflammation, and insulin resistance and its strong correlation with the occurrence and development of colorectal neoplasms have gradually led to it becoming a target area of tumor research. Fibroblast growth factor (FGF) 19 is a hormone that is secreted in mainly the ileum and can regulate bile acid biosynthesis, improve inflammation, and regulate insulin resistance. The relationship of the GI microbiome, FGF19 and its carcinogenic activities in colorectal neoplasms enticed us to search for potential targets and research ideas for the clinical diagnosis and treatment of colorectal neoplasms. [ABSTRACT FROM AUTHOR]

Background: With the rapid development of the socioeconomic status, the mortality of several cancers has been changed in China during the past 30 years. We aimed to estimate the trends of mortality and years of life lost (YLLs) of various cancers in urban and rural areas of China from 1990 to 2017. Methods: The mortality data were collected from Chinese yearbooks and the age structure of population from the Chinese sixth population census were used as reference to calculate age‐standardized mortality rates (ASMRs) and YLLs rates. Joinpoint regression analysis was implemented to calculate the annual percent change (APC) of mortality rates and YLL rates for cancers. YLLs owing to premature death were calculated as age‐specific cancer deaths multiplied by the reference life expectancy at birth of 80 years for male and 82.5 years for female. Results: The ASMRs of all cancers showed significant decreasing trends for urban residents from 1990 to 2017, such downward trend without significance was also observed among rural residents. Interestingly, ASMRs of lung cancer and breast cancer have raised continuously in rural areas since 1990. The age‐standardized YYL rates for urban and rural residents decreased with 1.02% and 0.85% per year, respectively. YLLs in rural areas were higher than those in urban areas, whereas YLLs of urban outstripped those of rural finally with the increasing in YLLs of urban areas (216.71% for men and 207.87% for women). Conclusion: The ASMRs and YLL rates of all cancers have declined in urban and rural areas from 1990 to 2017. YLLs increased in urban areas and remained higher level in rural areas after 2014 year. Preventive measures should be strengthened to against cancer, especially for lung cancer. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the characteristics of colonic neuroendocrine neoplasms (NENs) and to validate the prognostic value of the European Neuroendocrine Tumor Society (ENETS) and American Joint Committee on Cancer (AJCC) 8th staging systems. Methods: A total of 167 and 1248 patients with colonic NENs from 12 medical centers across China and from the Surveillance, Epidemiology, and End Results (SEER) cancer registry in the United States, respectively, were reviewed. Patients were staged according to the ENETS and AJCC 8th staging systems. Results: Clinicopathological features of colonic NENs in the Chinese cohort and SEER cohort were significantly distinct. In both the Chinese cohort and the SEER cohort, colonic neuroendocrine carcinoma (NEC) and mixed adeno‐neuroendocrine carcinoma (MANEC) were more frequent in the midgut than in the hindgut. Tumors originating from the midgut tended to be larger and at a more advanced stage than those from the hindgut. The AJCC 8th staging system and the ENETS system appeared to have similar prognostic ability for colonic NEC/MANEC. Conclusions: Our study revealed that tumors originating from the midgut and the hindgut shared different clinicopathological features. The AJCC 8th staging system and the ENETS system appeared to have similar prognostic ability for colonic NEC/MANEC. [ABSTRACT FROM AUTHOR]

Background: China accounts for approximately 27% of global cancer deaths. However, to the authors' knowledge, the lasting effects of cancer and cancer treatments on patients have not been investigated in China. The authors developed a questionnaire, the China Survey of Experiences with Cancer, for Chinese cancer survivors. This article introduces the study design and domains covered in the questionnaire.Methods: The Cancer Survivorship Supplement of the Medical Expenditure Panel Survey (MEPS) was used as a reference to develop the questionnaire. The final in-person surveys were conducted in 2015 and 2016. Samples were chosen through multistage sampling. The authors described the characteristics of the study participants and their cancer experiences.Results: At the time of last follow-up, a total of 1166 patients had completed at least 1 component of the survey. Approximately 59% of the cancer survivors were aged ≥60 years. Greater than one-half of the participants had an elementary education level or less (51%) and a yearly family income of <$3174. Chinese cancer survivors were more likely to retire earlier than planned compared with American cancer survivors (37% vs 9%). The majority of Chinese cancer survivors (84%) reported that their work abilities were hindered by their cancer or cancer treatments. Approximately one-half of patients in China had to incur debt because of cancer, whereas <10% of patients in the United States reported having incurred debt.Conclusions: The survey provides information regarding the burden of cancer in China that to the authors' knowledge currently is unavailable from other sources, including medical care use, financial impacts, employment patterns, and life experience after a cancer diagnosis for survivors and their families. [ABSTRACT FROM AUTHOR]

Background: Post-traumatic stress disorder (PTSD) is a disorder that can affect people following the experience of a traumatic event. Few studies have researched on PTSD symptoms of patients with central nervous system tumors. In this study, we aim to examine the association between social support and PTSD symptoms and to explore the mediating effect of self-efficacy in this relationship among patients with central nervous system tumors in China. Methods: Questionnaires consisting of the Post-traumatic Stress Checklist-Civilian Version, the Duke-UNC Functional Social Support Questionnaire, the General Self-Efficacy Scale, as well as demographic and clinical factors were used to collect information of patients with central nervous system tumors in Liaoning Province, China. A total of 222 patients (effective response rate of 66.1%) became our subjects. Hierarchical linear regression analyses were performed to explore the association between social support and PTSD symptoms and the mediating effect of self-efficacy. Results: After adjusting for demographic characteristics and tumor type, social support was negatively associated with the total score of PTSD symptoms (β = -0.342, P < 0.01). Social support explained 8.8% of the variance in PTSD symptoms. Self-efficacy was found to partially mediate the relationship between social support and PTSD symptoms. Conclusions: Self-efficacy partially mediated the relationship between social support and PTSD symptoms. Interventions focusing on both social support and self-efficacy might be more useful than interventions only targeting either of them. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study was to test the psychometric properties of a Chinese version of the Sense of Coherence Scale (C-SOC-13) in women with cervical cancer in Mainland China. Methods The C-SOC-13 and Health-related Quality of Life scale (Functional Assessment of Cancer Therapy-Cervix) were administered to 238 women with cervical cancer. Validity was assessed in terms of factor validity, predictive validity, divergent validity and stability, whereas reliability was evaluated using Cronbach's alpha coefficient. Results This study showed that in confirmatory factor analysis, the first-order interrelated three-factor model and second-order model were performed based on Antonovsky's theoretical structure of Sense of Coherence (SOC). Both models fitted the data satisfactorily when the largest modification index was released. The chi-square value/degrees of freedom was 2.120, the goodness-of-fit index was 0.919, the root mean square error of approximation was 0.069, and the comparative fit index was 0.911. The Pearson correlation coefficient between SOC and Functional Assessment of Cancer Therapy-Cervix was 0.611. Enter multiple regression with SOC as a dependent variable and medical and socio-economic variables as independent variables showed no statistically significant partial coefficient of any independent variable in regression equation except for age. The Cronbach's alpha coefficient for the scale was 0.824. Conclusion The factor validity, predictive validity and divergent validity of C-SOC-13 were reasonable, as well as the internal consistency. In general, C-SOC-13 showed to be suitable as an SOC measurement for women with cervical cancer in Mainland China. However, SOC may have a different meaning to Chinese people because of the philosophy and culture that shape the context of their lives. Generalizing the findings to other populations requires further psychometric evaluation of C-SOC-13. Further longitudinal studies are also needed to explore the stability. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The concept of offspring provides a symbolic shield against the fear of death. The existential function of offspring was examined in two studies conducted in China employing real-life dependent measures. In Study 1, reminders of death through a word-completion task increased the disapproval of a birth-control policy in China. In Study 2, hospitalized patients generally preferred young family members more than other family members. Cancer patients showed this preference to a greater extent than non-cancer patients. Taken together, the findings showed that the death-anxiety-buffering function of offspring affects people's judgments and desires in real-life settings. [ABSTRACT FROM AUTHOR]

A previous study investigated metal contamination in farmland and the air in a typical mining town of Guangxi, South China. In this study, the health risks associated with exposure to this contamination that were evaluated for the following routes of exposure are reported: inhalation, dermal contact, ingestion of dust, and ingestion of homegrown vegetables. The findings demonstrated that the inhabitants were at high risk for noncancer effects posed by some of the metals. The total hazard index (THI) of all the pathways was 145 for adults and 560 for children, which were far higher than the normative level 1. The noncancer risk mainly came from air PM10 pollution through inhalation and ingestion routes of exposure. However, vegetable ingestion also made a noticeable contribution to HI of about 7 for adults and 22 for children. The metals that posed the greatest noncancer risks were Mn for inhalation, and ingestion of dust and vegetables. The total cancer risks of the inhabitants were 1 × 10−1 (adult) and 3 × 10−1 (child), which far exceeded the acceptable carcinogen risk of 10−4∼10−6 for regulatory purposes. The cancer risk in the village is mainly (97%) associated with As exposure by inhalation and ingestion of dust. However, consumption of vegetables is also associated with a significant cancer risk of up to 2 × 10−3 for adults and 8 × 10−3 for children. The cancers associated with this exposure are estimated to be lung cancer and skin cancer. Air particulate-matter pollution was the main source of noncancer risk and cancer risk and originated from vehicular transport of ore through the community. The risk could be tested by a specifically designed epidemiological study. [ABSTRACT FROM AUTHOR]

Of 12 patients with adult dermatomyositis studied, 5 (41 %) had associated malignancies, of which 3 were nasopharyngeal carcinomas. The youngest was a 23-year-old woman. In view of the high incidence of cancer and the predominance of nasopharyngeal carcinoma, malignancy evaluation in Chinese patients from the Far East, 20 years of age or older with dermatomyosit is should have extended workups for postnasal cancer. Two patients who had positive antinuclear not have associated cancers. Three patients died of acute myocardial infarction. [ABSTRACT FROM AUTHOR]