PLA Navy Research Articles

Development and validation of a prediction model for postoperative pneumonia in patients who received spinal surgery: A retrospective study

ObjectivesTo develop and validate a risk prediction model by identifying the preoperative factors associated with an increased risk of pneumonia after spinal surgery. MethodsThis study included patients with spinal disease from two hospitals between January 2021 and June 2023. The patients were divided into the training and validation sets, which were categorized as postoperative pneumonia (POP) or non-POP, respectively. This study identified the independent risk variables for POP using a multivariate logistic regression analysis. A nomogram prediction model was developed and validated using risk factors, receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) to assess predictive performance. ResultsFollowing exclusion, 2223 patients from Changzheng Hospital were enrolled in the training set and 357 patients from the No. 905 Hospital of PLA Navy were enrolled in the validation set. Univariate and multivariate logistic regression analyses revealed that operation time, American Society of Anesthesiologists (ASA) grade, smoking, non-wearing of medical masks, lack of preoperative respiratory training, chronic obstructive pulmonary disease (COPD), underlying diseases, and spinal section were risk factors for POP development in patients with spinal diseases. The area under the ROC curve of the training set was 0.950, whereas that of the validation set was 0.879. The model calibration curves demonstrated good agreement, and the DCA indicated a high expected net benefit value. ConclusionThe POP risk prediction model has high accuracy and efficiency in predicting POP in patients with spinal diseases. POP development is influenced by factors such as operation length, ASA grade, smoking, non-wearing of medical masks, lack of preoperative respiratory training, COPD, underlying diseases, and lumbar surgery.

The Rise of Wargaming Competitions in the Chinese Navy

In recent years, the People’s Liberation Army Navy (PLAN) has embraced competitive conflict simulation as an approach to train and educate the officer corps for future high-end naval combat. The PLAN regards these wargaming competitions as a useful means to popularise wargaming across the service, thereby allowing more personnel to benefit from conflict simulation. These benefits include increased understanding of the challenges the PLAN would face in a high-end naval conflict and opportunities to hone command leadership skills. Ryan D Martinson argues that although large-scale adoption of wargaming methodologies may achieve some of these anticipated benefits, there are also several likely drawbacks to this approach. ■

Preparing for a two-front conflict: The role of the Indian Navy and the Indian Air Force

This article argues that while India is preparing for the contingency of a two-front war against China and Pakistan, its procurement and arms production policies make it problematic for the Indian Air Force (IAF) and Indian Navy (IN) to meet these challenges. IAF doctrine is not aligned to its current capabilities and is, therefore, largely speculative. Further, due to budgetary shortfalls in its modernization efforts, the IAF will find it difficult to fulfill its stated doctrinal role against China or Pakistan. On the other hand, the Indian Navy’s doctrine is better aligned with its objectives and capabilities. The IN can carry out its doctrine of sea control against the Pakistani Navy, but will have to adopt a sea denial posture against China because of the rapid growth of the PLA Navy’s force and capabilities. Given their slow pace of modernization, neither service will be able to decisively counter the Chinese military.

Effect of FOLFOX regimen combined with cetuximab treatment on the efficacy and tumor markers of advanced colon cancer patients.

To evaluate the efficacy of FOLFOX regimen combined with cetuximab in the treatment of advanced colon cancer. This retrospective study involved 60 patients with primary colon cancer who were treated in the PLA Navy Anqing Hospital from January 2022 to February 2023. According to their treatment regimen, the patients were divided into a treatment group that received FOLFOX4 combined with cetuximab (n=30), and a control group treated with cetuximab alone (n=30). The general data of the two groups were compared, and the short-term response rate was assessed by comparing the proportions of complete remission (CR), partial remission (PR), stable disease (SD) and progressive disease (PD) between the two groups. In addition, the progression free survival (PFS) and overall survival (OS) were compared between the two groups, along with the adverse reactions and changes in serum tumor marker (CEA and CA19-9) levels. The observation group showed a significantly higher short-term effective rate (CR+PR) compared to the control group (56.67% vs. 23.33%). The PFS and OS of the observation group were markedly longer compared to the control group. In terms of adverse reactions, the incidence of neutropenia, thrombocytopenia, nausea, vomiting, and diarrhea was similar between the two groups; however, the incidence of rash in the observation group was higher. After the treatment, the serum CEA and CA19-9 levels decreased markedly in both groups, and the observation group demonstrated obviously lower levels than the control group (P<0.001). Similarly, the decreases in VEGF-A and VEGFR2 levels in the observation group were more significant than those in the control group (all P<0.001). Despite inducing rash, which is controllable, the combined therapy of FOLFOX and cetuximab significantly improves short-term efficacy, reduces the levels of CEA, CA19-9, VEGF-A and VEGFR2, and extends the PFS and OS of patients, which can be served as an effective treatment strategy for advanced colon cancer.

Correspondence: Debating China's Use of Overseas Ports

Correspondence: Debating China's Use of Overseas Ports

Соперничество в Индо-Пацифике и военно-морское планирование США

The U.S.-China maritime rivalry in recent years has taken on the character of a naval race where the pretender PLA Navy is rapidly increasing its capabilities and already possesses numerical superiority over the U.S. Navy. To some extent, the present situation is similar to previous naval races of the 19th and 20th centuries, between Britain and Germany, between the United States and Japan, and between the United States and the Soviet Union. However, in the past, British and American command of the seas was also confirmed by their advantage in shipbuilding, including commercial one. Now, this advantage has been lost. China, while challenging for sea control, has already gained superiority in shipbuilding. This causes the U.S. to seek means to compensate for the lack of material forces. Nevertheless, the possibility of maintaining sea control in the face of growing numerical superiority of the adversary is questionable. The capability for effective deterrence without an equivalent material basis is also questionable. This situation forces U.S. analysts to search for other solutions, including the change of the naval posture and ship`s classification, which has been established over the decades. So far, these visions have not been incorporated into official strategic guidance. The paper examines the impact of this race on American military planning and its reflection in official strategic guidance. The U.S. strategic guidance hierarchy and the interrelationship of the keystone provisions of its documents as related to military and naval planning are reviewed, as well as the evolution of naval planning in the preceding period. The article considers the key provisions and priorities of the U.S. naval strategy and the criticism of this strategy from the U.S. researchers. It analyses possible further U.S. actions for implementation of the adopted maritime strategy and the limitations on this path.

Questioning China’s Peaceful Development: A Mahanian Sea Power Analysis of Blue Water Navy Accumulation

China has been rapidly accumulating naval capabilities for nearly 4 decades with the ambition of pursuing blue-water-navy forces through its People’s Liberation Army Navy (PLAN). With its peaceful development policy, the acquisition of such powers has been interpreted as an anomaly and therefore resulted in an increase of security dilemmas between states. In the quest for explanations behind China’s actions, multiple scholars have examined this phenomenon by utilizing offensive realism, defensive realism, and Tirpitzian non-hegemonic naval theory. Thus, this paper brings another perspective by applying the Mahanian Sea Power approach. Consequently, the analysis established that China’s pursuit of blue-water-navy is driven by its interest in economic supremacy. In addition, the intention is also influenced by its wide coastline, large population, competitive nationals, and independent decisive government. The paper concludes that a blue-water-navy is a necessity for China in order to access markets, secure territorial interests, and obtain command of the sea for economic purposes.

Oncocytic papillary renal cell carcinoma: a clinicopathological analysis of nineteen cases

Objective: To investigate the clinicopathological characteristics, immunophenotype, and molecular signatures of oncocytic papillary renal cell carcinoma (OPRCC), and to compare these findings with those in type 1 papillary renal cell carcinoma (PRCC 1). Methods: The clinicopathologic data of 19 patients with OPRCC from the Affiliated Hospital of Qingdao University (16 patients) and the 971 Hospital of People's Liberation Army Navy (3 patients) from October 2003 to February 2021 were collected. Histologic, immunohistochemical (IHC) and molecular analyses, together with a control group of 15 cases of PRCC I diagnosed in the same period, were assessed. Results: The cohort included 15 males and 4 females, with a median age of 61 years (range, 47-78 years). In 13 patients the tumors were found at physical examination; four presented with painless gross hematuria and two with low back pain. As for the pathologic stage, 14 patients were pT1, one patient was pT2a, three patients were pT3a and one patient was pT4. The tumor size ranged from 1.7-14.0 cm, with clear boundary and soft texture. The cut surface was grayish-yellow and grayish-red. Microscopically, the tumor cells were mainly arranged in papillary (10%-100%) and acinar (tubular) patterns, with strongly eosinophilic cytoplasm, round or irregular nuclei, and prominent nucleoli (WHO/ISUP grade Ⅲ). Two cases showed sarcomatoid differentiation. Stromal foamy macrophages were visible in all cases. IHC staining showed diffuse strong positivity for AMACR in all cases. RCC (18/19), CD10 (17/19), vimentin (16/19) and PAX8 (17/19) were positive in most tumors. CK7 was expressed in about 50% of cases. Fluorescence in situ hybridization identified trisomy 7 in eight patients, trisomy 17 in seven patients, and the two aberrations occurred simultaneously in seven cases. Eight of 13 men had Y chromosome deletion. All patients were followed up for 8-120 months. Three patients died of metastases at 8, 62 and 82 months postoperatively, respectively, and one patient relapsed 36 months after surgery. Compared with PRCC1, OPRCC tended to have higher nuclear grade, and stromal foam cell aggregation was more commonly found (P<0.05). The expression of CD10 and EMA were different (P<0.01). There was no significant difference in the survival rate between the two groups (P=0.239). Conclusions: OPRCC has unique morphologic features, and its immunophenotype overlaps but differs from PRCC1. The molecular results support that it belongs to a morphologic variation of PRCC. This tumor has similar biologic behavior to PRCC1, and has a poor prognosis when sarcomatoid differentiation occurs.

Strategic Posturing of China in IOR

China has been working on a modernization plan for its military. Particularly, the People’s Liberation Army-Navy (PLAN) has been the focus of modernization due to China’s seaward economic growth and development for protecting its maritime economic interests. China’s Belt and Road Initiative (BRI) is an example of strategic envisioning which has multiple facades besides dividends. Since China has a massive trade volume transiting Indian Ocean Region, PLAN has increased engagement in this region. Its modernization including its naval capabilities, surface and underwater vessels, unmanned maritime vehicles (UMVs), acoustic systems for information, and other technological advancements has made China’s strategic posture in IOR dynamic and is threatening India’s intrinsic naval supremacy in the region with certain implications over regional peace and stability. This is exploratory research conducted to determine the nature of naval competition and the resulting balance of power to identify implications for regional peace and stability.

Protecting Chinese Interests Abroad or Planning for PRC Primacy?

Protecting Chinese Interests Abroad or Planning for PRC Primacy? Andrew Scobell (bio) Andrea Ghiselli's meticulously researched and lucidly written tome, Protecting China's Interests Overseas: Securitization and Foreign Policy, explores the drivers of China's increasing global military activism and is well worth the read. He has done exceptional research in primary Chinese language sources and solidly grounded his scholarship in the relevant international relations literature. The topic is one that has grabbed the attention of the United States and other countries—the growing global activism of the armed forces of the People's Republic of China (PRC). While still modest and tentative compared to the security activities and overseas military postures of other great powers, the 21st-century activities of China's armed forces go well beyond the PRC's borders and immediate periphery. The People's Liberation Army (PLA) Navy now routinely transits the Indian Ocean to the Gulf of Aden, and PLA Navy vessels regularly appear in more distant bodies of water. China joined the club of great powers that possess overseas military bases with its first official military facility beyond PRC borders formally established in Djibouti in 2017. And for twenty years the PLA has regularly conducted ground, air, and maritime exercises with other militaries in locales both within China and around the globe. China has also been dispatching soldiers to serve in UN peacekeeping missions far afield since the 1990s. But China's increased military activism during the past decade or so signals a sea change in Beijing's disposition and thinking. China long proclaimed that it did not station a single soldier overseas or occupy an inch of foreign soil. But with a military base abroad, Beijing can no longer say this. What accounts for this dramatic change? The book describes the 2011 unraveling of Muammar Gaddafi's regime in Libya as the watershed event. Beijing was caught by surprise and had to scramble to evacuate some 36,000 Chinese workers from the chaos (p. 1). The operation was coordinated by China's Ministry of Foreign Affairs mostly using chartered commercial shipping via the Mediterranean to remove PRC citizens from harm's way. The involvement of the military in this operation was almost [End Page 160] a sideshow—limited to four PLA Air Force Ilyushin Il-76s flying out 1,655 Chinese (p. 229) and a single PLA Navy vessel, the frigate Xuzhou, serving as an escort for an armada of civilian ships ferrying the evacuees out of Libya (pp. 223–24). According to Ghiselli, "a crisis in a third country had never impacted Chinese interests abroad as much as this one" (p. 1). In an era where great-power competition is the dominant rubric and the myth of Chinese omnipotence seems pervasive in the policy community, two key findings of Protecting China's Interests Overseas merit special attention. First, Ghiselli finds that China's greater security presence beyond its own immediate Asia-Pacific neighborhood is defensive—driven by a "powerful" impulse (p. 1) to protect its burgeoning interests overseas—rather than propelled by an offensive strategy to wrest global supremacy from the United States. The author concludes that the "deployment of Chinese soldiers in critical regions like the Middle East or North Africa…has not been motivated by a desire to erode American supremacy in those regions" (p. 241). Ghiselli's point is that not everything Beijing does is about great-power competition with Washington. Of course, the United States looms large for China's leaders and factors into almost every decision they make. But the PRC is pursuing its own destiny and advancing its own interests, not all of which involve the United States. A policy implication of this finding is that there is potential for cooperation, or at least coexistence, with the PRC on the global stage. However, China's "interest frontiers" are expanding and, when combined with Beijing's own zero-sum thinking, notwithstanding China's "win-win" propaganda rhetoric, there is no guarantee that this potential will be realized. Second, Ghiselli's research reveals that most "events related to China's interest frontiers were hardly the result of a well-thought-out plan" (p. 242). This finding calls...

Caught Between Appeasement and Limited Hard Balancing: The Philippines’ Changing Relations With the Eagle and the Dragon

After five years of pursuing a policy of appeasement towards China, the Philippines is incrementally and reluctantly shifting to “limited hard balancing.” The goal is to constrain China's revisionist agenda in the South China Sea. This strategy entails building up the Philippine military's territorial defence capabilities, maintaining its alliance with the U.S., and forging security partnerships with other middle power like South Korean, Japan, and Australia. During his six-year term, the late President Benigno Aquino III stood up to China's expansive claim in the South China Sea. When Rodrigo Roa Duterte assumed the presidency in June 2016, he unravelled his predecessor's balancing policy towards China. Nonetheless, recent developments such as the People's Liberation Army Navy's hostile moves against the Armed Forces of the Philippines units on Philippine-occupied islands in the South China Sea and the delays in the promised Chinese public investments in the country prompted the Duterte Administration to review the appeasement approach and to mull over on a limited hard balancing policy. In conclusion, this article contends that the Duterte Administration is at the crossroads, figuring out if it will continue its appeasement stance or adopt a limited hard balancing policy towards China.

China’s Oceanic Aspirations: New Insights from the Experts

The People’s Liberation Army Navy (PLAN) is rapidly building a blue-water force structure, but little is known about how the service intends to use these new platforms in operations outside of East Asia. This article answers key questions about the future trajectory of the PLAN by examining the service’s strategy of “Far Sea Protection.” It argues that Far Seas Protection is predicated on two desires: (1) to strengthen China’s ability to protect the homeland from attack from the sea and (2) to safeguard the country’s expanding overseas interests. Ultimately, the PLAN intends to do so through the conduct of “far seas mobile operations” with aircraft carrier strike groups, amphibious assault ships, and nuclear-powered submarines. If conflict occurs before these platforms are available to the fleet, the PLAN would conduct asymmetric warfare east of the first island chain, using an approach described as “far seas sabotage guerilla operations.”

Getting synergized? PLAN-CCG cooperation in the maritime gray zone

ABSTRACT China is pursuing a “gray zone” strategy to advance its maritime claims in the East and South China Seas. That is, it is gradually expanding its control and influence over disputed maritime space by leveraging nontraditional tools of sea power—its coast guard and maritime militia—backed up by the People’s Liberation Army Navy (PLAN). Each of these forces plays a role in this strategy, but roles overlap and are mutually-supporting. Thus, the effectiveness of this strategy depends in part on the ability of the coast guard, navy, and militia to synergize their efforts. This article examines China’s efforts to improve jointness between the China Coast Guard (CCG) and the PLAN. In particular, it assesses recent developments in operational coordination, joint training and exercises, and intelligence sharing. It argues that despite widespread recognition in China of the importance of the CCG-PLAN relationship, the two services still fall short in all three areas.

Keeping China Out, the United States In, and Pakistan Down: India's Strategy for the Indian Ocean Region

Keeping China Out, the United States In, and Pakistan Down:India's Strategy for the Indian Ocean Region Rohan Mukherjee (bio) India is a rising power with significant gaps in the translation of its economic potential into military power—gaps that may considerably widen due to the severe damage being wrought by the Covid-19 pandemic on India's economy and society. At a time when military spending relative to GDP has been declining for over a decade and personnel costs have until recently been rising at the expense of capital expenditures, the three scenarios in this exercise starkly demonstrate some of the external challenges that Indian policymakers might face in coming years. These challenges are all the more dangerous in a period when India, weakened by the pandemic, may be seen as an easier target and may itself respond aggressively to provocations for reasons of domestic or international reputation. Given these parameters, the scenarios highlight three important dimensions in which Indian thinking about the future of the Indian Ocean region will need to be flexible and sometimes run counter to dominant assumptions in New Delhi: capabilities, resolve, and partnerships. If India faced a benign security environment, its domestic weaknesses would be less pernicious and the state would have a longer runway to build itself into a major world power. In fact, the opposite is true. The scenarios highlight two major external trends that must factor into India's strategic calculus: the relative decline in U.S. capabilities and interests in the Indian Ocean, and the relative increase in Chinese capabilities and interests in this region. Both of these factors eliminate the luxury of time and increase the pressure on India to make resource allocations and political choices suited to a range of near-term potential crises and geopolitical ruptures. On the one hand, India will need to enlarge its naval footprint in the Indian Ocean region to make up for a longer-term decline in U.S. presence. On the other hand, India will need to prepare for the full spectrum of challenges from China's expansion into this region, including adventurism along the Sino-Indian border, an increased People's Liberation Army (PLA) Navy presence in the Indian Ocean, deepening relationships between [End Page 29] China and Indian Ocean states, and even cyber intrusions and attacks on Indian infrastructure. India's Capabilities First, India's own capabilities will make a crucial difference to regional outcomes. This is not simply a matter of expenditure, which of course will matter, but also one of allocation. It is in China's interest to keep India tied down on its land frontiers and obsessed with the possibility of a two-front war. The working assumption of most Indian policy and defense planners is that India's major military engagements in the coming decades will be along the contested borders with Pakistan and China, respectively—an assumption further validated by the ongoing Sino-Indian standoff in Ladakh. The scenarios suggest, however, that ignoring sea power would be a grave mistake. In the extreme case of India continuing with its current naval strength without augmentation, the best the Indian Navy can do is provide coastal defense. Its existing resources are radically inadequate for sea denial—which the Indian Navy views as "an offensive measure, to reduce the adversary's freedom of action and to degrade his operations"—let alone sea control.1 India has hitherto benefited from the U.S. Navy's command of the seas in the Indian Ocean region. The U.S. Navy's ability to ensure freedom of navigation, protect maritime chokepoints, and slow the pace of China's maritime expansion into the region has allowed India to gradually develop its own naval capabilities and doctrine while devoting sufficient resources to countering land-based threats. A future scenario in which the United States withdraws from Diego Garcia or China takes hostile action against regional countries such as Indonesia would place considerable demands on the Indian Navy to assume a substantial share of the tasks fulfilled by the U.S. Navy today. To plan for such a role, Indian decision-makers will need to rethink the dominance of the army among the...

Sino-American Tensions and Their Effects on Counter-terrorism Operations in Djibouti

This research note examines the tensions between the United States and the People’s Republic of China in Djibouti. Djibouti has become a battleground of interests between the US and China with both building military bases on its territory. The People’s Liberation Army Navy (PLAN) utilises its base to conduct naval operations and to implement the Belt and Road Initiative (BRI), often conflicting with US operations and interests. The research note relies on primary documents to investigate the interaction between the two states over Djibouti and to assess whether and how China’s presence is an obstacle to US counterterrorism operations. This analysis indicates that a conflict of interests between the US and China is inevitable, but the US’ counterterrorism operation in Djibouti can be protected from the diplomatic conflict.

Clinicopathological features of hybrid oncocytic/chromophobe renal cell tumor

Objective: To investigate the clinicopathological features and immunohistochemical phenotypes of hybrid oncocytic/chromophobe tumor (HOCT) of the kidney and its associations with renal oncocytoma (RO) and eosinophilic chromophobe renal cell carcinoma (eChRCC). Methods: A total of 8 HOCT cases were collected from 2008 to 2019 at the Affiliated Hospital of Qingdao University (5 cases) and 971 Hospital of PLA Navy (3 cases), Qingdao, China for morphological studies, immunohistochemical staining and follow-up. The immunohistochemical results of HOCT were compared with those of 27 typical RO and 17 eChRCC. Results: Among the 8 patients, 3 were male and 5 were female. Their ages ranged from 39 to 75 years (median: 56 years). All cases were sporadic. Seven patients were asymptomatic and one suffered from lumbago. During a mean follow-up of 37 months in 7 patients, none of them developed tumor recurrence or metastasis. Seven cases were solitary and one was multiple. The tumor size ranged from 1.4 to 5.7 cm (mean, 3.6 cm). The cut surface of the tumors was dark red or yellowish. Histologically, the tumors were well-defined. Six cases were directly adjacent to the surrounding renal tissue, 2 cases had pseudocapsule, 3 cases showed entrapped renal tubules at the edge of tumor tissue, and one circumscribed with focal infiltrating borders. There were two types of histological morphology: one type (4 cases) was composed of mixed areas of otherwise typical RO and areas resembling chromophobe renal cell carcinoma; another type (4 cases) showed the morphological characteristics of both RO and eChRCC. Three second-type tumors showed nest-like, trabecular, and solid growth patterns with conspicuous edematous stroma. The cell border was conspicuous and the cytoplasm showed an eosinophilic appearance. The nuclei were small and round with clear perinuclear halo. One tumor showed a multi-nodular and solid growth pattern, and the cytoplasm was eosinophilic, hypochromatic or transparent. The nuclei were small and round, and some of them had obvious perinuclear halo. Immunohistochemically, the tumor cells in all 8 cases were positive for Ksp-cad but negative for vimentin. CD117 was diffusely positive in 6/8 cases. CK7 staining showed patchy positivity in 6/8 cases. S-100A1, cyclin D1 and claudin7 showed variable positivity in 4/8, 6/8 and 5/8 cases, respectively, but the range and intensity were narrower and weaker than those in RO and eChRCC. Conclusions: HOCT is a low-grade eosinophilic renal tumor with morphological characteristics resembling RO and eChRCC. The combined application of immunohistochemical stains of CK7, CD117, Ksp-cad, cyclin D1, claudin7 and S-100A1 may play an auxiliary role in the differentiation of the three tumors. HOCT has a good prognosis after surgical resection and can be regarded as a tumor with uncertain malignant potential.

The Incalculable: Thoughts on the Collapse of the Biosecurity Regime

Liu offers insights about the collapse of the biosecurity regime It makes a world of difference where the novel coronavirus travels Sirens wail day and night on the streets as doctors and nurses struggle to keep critically ill patients alive while exposing themselves to the deadly pathogen To the astonishment of the world, American society has not prepared itself for a disaster of this magnitude;and worse, many in Europe and America had initially been led to believe that the novel coronavirus might be one of those isolated, regional affairs Recent genomic analyses suggest that the vast majority of coronavirus cases in New York came from Europe, not from Asia Blindsided by its own racism, the political calculus of the US biosecurity regime has misfired

Necessity of Maritime Security in Gwadar Port Complex

In the changing global scenario of international politics, the growing attention following the end of the Cold War, has been directed towards oceans. Indian Ocean and its region has gained immense attention in the past few years. Due to the presence of strategic Sea Lines of Communications (SLOCs) and choke points-Indian Ocean has crucial importance to drive international politics. The level of competition in the region has increased. With China’s rise as a global economic power, the hegemonic status of USis beingchallenged. In this regard, China’s String of Pearls strategy comes to light with special reference to the One Belt, One Road (BRI). The China-Pakistan Economic Corridor (CPEC) is the most potent part of the Belt-Road Initiative. Thesurmounting attention owes to the geostrategic location of Gwadar. Connecting Gwadar with Xinjiang-it would provide China with an alternate route to reach the Middle Eastern and North African markets, ending its Malacca Dilemma. CPEC in this regard, requires a diverse map for maritime security which sees the interplay of four major navies in the region-US, PLA Navy, Pakistan and the Indian Navy.

Clinicopathological features and differential diagnosis of eosionphilic chromophobe renal cell carcinoma

Objective: To investigate the clinicopathological characteristics of eosionphilic Chromophobe renal cell carcinoma (eChRCC), and differences in morphology, immunophenotype and clinical prognosis betweeneChRCC, renal oncocytoma(RO) and classic Chromophobe renal cell carcinoma (cChRCC). Methods: The clinicopathologic data of 17 patients diagnosed as eChRCC from the Affiliated Hospital of Qingdao University (13 cases) and 971 Hospital of PLA Navy (4 cases) from October 2006 to February 2019 were collected. Immunohistochemical analysis was carried out to compare the immunophenotypes between 17 cases with ChRCC, 27 cases with RO and 30 cases with cChRCC. Resuls: Among the 17 patients, seven were males and ten were females, and the age ranged from 40 to 75 years (median 54 years). Clinically, 15 cases of 17 were found accidentally by physical examination. The tumor size ranged from 1.8 cm to 10.0 cm (average 5.7 cm) and the cut surface of 15 cases were solid, one case was solicl and cystic, and one was cystic. Most showed gray to red, and partially soft, gray to yellow appearances. Microscopically, most tumors presented solid growth pattern with vary number of alveolar structures (12 cases). Some were predominately characterized by cystic structure (3 cases), alveolar structure(1 case) and microcapsule structure (1 case). There were boundaries with varying degrees of clarity between tumor cells in 16 cases. The cytoplasm of tumor cells was eosinophilic and the nuclei were small round or irregular with focal perinuclear haloes in 14 cases. Large polygonal cells with light-stained cytoplasm appeared focally in 9 cases, and edematous areas with scarce tumor cells were found in 4 cases. Among 7 cases, 4 cases focally invaded peripheral renal parenchyma, 2 cases invaded adipose tissues outside the renal capsule, and 1 case presented invasion of renal sinus. Immunohistochemically, all cases were moderate to strong positive for EMA and claudin-7. CK7, CD117 and Ksp-cad were highly expressed with the expression rates of 12/17, 15/17, 14/17, respectively. Cyclin D1, AMACR, CD10, S100A1, and RCC were rarely expressed with the expression rates of 4/17, 3/17, 4/17, 1/17 and 1/17, respectively. On the contrary, all cases were negative for vimentin, CAⅨ, HMB45 and Melan A. The Ki-67 proliferation index of the 17 cases was 1%‒5%. Follow-up data were available for all 17 patients from 7 to 154 months. Among them, 15 patients were alive without tumor recurrence or metastasis, one patient died of pulmonary metastasis after 31 months of surgery and one patient died of hepatic metastasis after 38 months of surgery. Conclusion: eChRCC has overlapping morphology and immunophenotype with RO. eChRCC is characterized by solid nest or alveolar structure, distinct border between tumor cells, perinuclear halos and lacking of interstitial looseness and edema. Scattered large polygonal cells with light-stained cytoplasm in tumor tissue play a significant role in the diagnosis of eChRCC. The positive expression of CK7, CD117, claudin-7 and Ksp-cad, and negative expression of cyclin D1, S100A1 are helpful to the diagnosis and differential diagnosis of eChRCC. The prognosis of eChRCC after complete surgical resection is excellent and few cases may have long-term metastasis. There is no significant difference in prognosis between eChRCC and cChRCC, but eChRCC shows better outcome than RO.

Counter-intervention in Chinese naval strategy

ABSTRACT The prospect of U.S. military involvement in a regional war looms large in Chinese naval strategy. This article examines the Chinese Navy’s evolving role in countering U.S. military intervention in a conflict over Chinese-claimed offshore islands. This role has both wartime and peacetime aspects. In peacetime, the PLA Navy serves a deterrence function, demonstrating China’s ability and resolve to fight the U.S. military if the U.S. were to intervene. In wartime, the operations of the PLA Navy would sit at the heart of any maritime campaign, helping to achieve China’s territorial objectives in spite of U.S. involvement.