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Background Villoglandular adenocarcinoma is a rare sub- type of cervical adenocarcinoma. Objective To analyze the clinicopathological features and evaluate the prognosis of patients with villoglandular adenocarcinoma of the cervix. Methods Patient characteristics, procedure, pathology, and surgical outcomes were retrospectively reviewed in patients with villoglandular adenocarcinoma between November 2006 and June 2019 from multiple centers in China. In order to explore the difference between villoglandular adenocarcinoma and routine adenocarcinoma, patients (FIGO 2009 stage IA1-IB2) who had complete data during the same time period were included. Results A total of 60 patients with villoglandular adenocarcinoma and 104 with standard adenocarcinoma were included. The median age of the patients with villoglandular adenocarcinoma was 42 years (range 27--68). The most common 2009 FIGO stage was IB1 in 39 (65%) patients with villoglandular adenocarcinoma. A total of 23 patients underwent laparoscopic surgery (two total hysterectomies, 21 radical hysterectomies) and the other 37 patients underwent laparotomy (three total hysterectomies, 34 radical hysterectomies). A total of 56 patients underwent lymphadenectomy and three (5.4%) had positive lymph nodes. Fifteen (25%) patients had one or both ovaries preserved. Seven patients were lost to follow- up. The median follow- up time for the entire group was 50.2 months (range 5.1--154.6). No deaths or recurrences occurred. Excluding six patients with FIGO 2009 stage II, the 5- year disease- free survival of the 47 patients with villoglandular adenocarcinoma with FIGO 2009 stage I for whom there was follow- up, was significantly higher than that of the 104 patients with standard cervical adenocarcinoma (100% vs 92.2%, logrank p=0.039). However, the 5- year overall survival of the two groups did not differ (100% vs 95.7%, log- rank p=0.11). Conclusion Villoglandular adenocarcinoma has a favorable prognosis. Further studies are needed to provide more details of treatment strategies and prognosis. [ABSTRACT FROM AUTHOR]

Background: Health inequity is an important issue all around the world. The Chinese basic medical security system comprises three major insurance schemes, namely the Urban Employee Basic Medical Insurance (UEBMI), the Urban Resident Basic Medical Insurance (URBMI), and the New Cooperative Medical Scheme (NCMS). Little research has been conducted to look into the disparity in payments among the health insurance schemes in China. In this study, we aimed to evaluate the disparity in reimbursements for tuberculosis (TB) care among the abovementioned health insurance schemes. Methods: This study uses a World Health Organization (WHO) framework to analyze the disparities and equity relating to the three dimensions of health insurance: population coverage, the range of services covered, and the extent to which costs are covered. Each of the health insurance scheme's policies were categorized and analyzed. An analysis of the claims database of all hospitalizations reimbursed from 2010 to 2012 in three counties of Yichang city (YC), which included 1506 discharges, was conducted to identify the differences in reimbursement rates and out-of-pocket (OOP) expenses among the health insurance schemes. Results: Tuberculosis patients had various inpatient expenses depending on which scheme they were covered by (TB patients covered by the NCMS have less inpatient expenses than those who were covered by the URBMI, who have less inpatient expenses than those covered by the UEBMI). We found a significant horizontal inequity of healthcare utilization among the lower socioeconomic groups. In terms of financial inequity, TB patients who earned less paid more. The NCMS provides modest financial protection, based on income. Overall, TB patients from lower socioeconomic groups were the most vulnerable. Conclusion: There are large disparities in reimbursement for TB care among the three health insurance schemes and this, in turn, hampers TB control. Reducing the gap in health outcomes between the three health insurance schemes in China should be a focus of TB care and control. Achieving equity through integrated policies that avoid discrimination is likely to be effective. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) patients in China still face a number of barriers in seeking diagnosis and treatment. There is evidence that the economic burden on TB patients and their households discourages treatment compliance. Methods: A cross-sectional study was conducted in three cities of China. Patients were selected using probability proportional to size (PPS) cluster sampling of rural townships or urban streets, followed by list sampling from a patient register. Data were collected using a questionnaire survey, key informant interviews and focus group discussions with TB patients to gain an understanding of the economic burden of TB and implications of this burden for treatment compliance. Results: A total of 797 TB patients were surveyed, of which 60 were interviewed in-depth following the survey. More than half had catastrophic health expenditure. TB patients with higher household incomes were less likely to report non-compliance (OR 0.355, 95% CI 0.140-0.830) and patients who felt that the economic burden relating to TB treatment was high more likely to report non-compliance (OR 3.650, 95% CI 1.278-12.346). Those who had high costs for transportation, lodging and food were also more likely to report non-compliance (OR 4.150, 95% CI 1.804-21.999). The findings from the qualitative studies supported those from the survey. Conclusion: The economic burden associated with seeking diagnosis and treatment remains a barrier for TB patients in China. Reducing the cost of treatment and giving patients subsidies for transportation, lodging and food is likely to improve treatment compliance. Improving doctors' salary system to cut off the revenue-oriented incentive, and expanding current insurance's coverage can be helpful to reduce patients' actual burden or anticipated burden. Future research on this issue is needed. [ABSTRACT FROM AUTHOR]

Driven by climate change, periods of dominating glacial and fluvial erosion have both sculpted mountain ranges during the Quaternary. To understand the evolution of mountain landforms, there is considerable interest in knowing which erosion agent leads to more incision, how glacial thermal regime impacts erosion and landscape development, and whether glacial erosion can result in increased relief. To investigate the relative efficiency of glacial and fluvial erosion, and the influence of glacial thermal regime on topography, we compare two different mountain ranges–the Qionglai Shan (monsoonal temperate glaciation) and Lenglongling (subcontinental glaciation) in western China. We use a 1-D model to construct presumptive fluvial longitudinal profiles if glaciation had not occurred, and compare these with the actual glacial profiles to obtain relative incision rates of fluvial and glacial erosion. Results demonstrate that glacial incision is smaller than fluvial incision in Lenglongling and larger than fluvial incision in the Qionglai Shan, which may be influenced by different tectonics and glacier types. Topographic analysis of glacial and fluvial valleys with similar drainage areas show that glacial erosion results in valley widening, local valley relief increase induced by isostatic uplift, and slope gradient increase in Lenglongling. However, there is no local valley relief and slope increase observed in the Qionglai Shan, which may reflect slope process responses to threshold hillslope limiting the height above valley bottoms. • Different relative efficiency of glacial and fluvial incision on the Tibetan Plateau. • Relief increase is influenced by isostatic uplift and threshold hillslope angles. • Tectonic uplift and glacier types control incision rate variations for rivers and glaciers. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to articles about publication pressure on physicians in China.

Objective: The criteria for the diagnosis of metastatic retropharyngeal lymph nodes (RLNs) have not yet been resolved and are not included in the current edition of the American Joint Committee on Cancer (AJCC) staging system (seventh edition) for the staging of nasopharyngeal carcinoma (NPC). The aim of this study was to use MRI to identify an RLN size criterion that can accurately predict prognosis in patients with NPC., Materials and Methods: Eight hundred seventeen patients with newly diagnosed localized NPC were identified. All of the patients underwent MRI before treatment with definitive radiation therapy. All the MRI studies and medical records were reviewed retrospectively. Overall survival (OS), distant metastasis-free survival (DMFS), and local relapse-free survival (LRFS) were assessed using SPSS software (version 17.0)., Results: RLN size cutoffs of ≥ 5 mm and of ≥ 6 mm were used. There was no significant difference in OS (p = 0.216), DMFS (p = 0.081), or LRFS (p = 0.067) in patients with RLNs ≥ 5 mm and in those with RLNs < 5 mm. When 6 mm was used as a size cutoff, significant differences in OS (p = 0.000) and DMFS (p = 0.001) were identified; there was no significant difference observed for LRFS (p = 0.380)., Conclusion: A minimum axial RLN diameter of 6 mm was a more accurate prognostic predictor in NPC patients with RLN metastases than 5 mm.

Purpose: To evaluate patterns of skull base invasion and its possible impact on tumor (T)-staging in nasopharyngeal carcinoma (NPC) using magnetic resonance imaging (MRI)., Materials and Methods: 838 consecutive newly diagnosed by biopsy proven and untreated patients with NPC underwent MRI. The skull-base invasion of NPC was classified according to their incidence from proximal sites to more distant sites surrounding the nasopharynx as: high (≥35%), medium (≥5-35%), and low (<5%) groups. A retrospective analysis of data consisting of a 5-year follow-up was carried out. The skull base invasion was related to their tumor (T) staging and prognosis at the 5-year follow-up after treatment with definitive radiation therapy. In addition, a survival health-related quality of life (QOL), overall survival (OS), local relapse-free survival (LRFS) and distant metastasis-free survival (DMFS) were also assessed among the three groups., Results: The total incidence of skull-base invasion was 65.51% (549/838). The differences in T-stage distribution, and the total survival health-related QOL, among the three groups were statistically significant (χ(2)=160.45, p<0.005; χ(2)=38.43, p<0.005, respectively). The differences between any two of the three groups were also significant, except when the medium grade was compared to the low grade. Significant differences were observed with regard to 5-year OS (83.2%, 74.7%, 59.2%, p=0.000) and DMFS (95.0%, 88.0%, 88.0%, p=0.016); no significant difference was observed in LRFS (95.3%, 95.6%, 91.23%, p=0.450)., Conclusions: The results indicate that medium and low group displayed similar findings of skull base invasion, and survival status. We, therefore, propose that patients in these two groups be grouped under T4 in the TNM classification that might have a bearing in implementing optimum treatment., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)