PLA Navy Research Articles

China’s rising naval ambitions in the Indian Ocean: aligning ends, ways and means

ABSTRACT China’s naval footprint in the Indian Ocean has expanded considerably over the last decade. This growing presence has led to significant debates about China’s goals and capabilities in the region. This article argues that China’s trajectory over the last ten years reflects an alignment of ends, ways and means in the Indian Ocean. The main driver behind China’s ambitions in the region is the need for Beijing to secure pivotal maritime lines of communications that carry a large share of Chinese oil imports and a sizable part of Chinese exports. Fulfilling this mission has required a significant adjustment of China’s naval strategy, and the addition of ‘open seas protection’ to the core missions of the PLA Navy. This strategy has, in turn, been supported by the development of a navy with increased sea control capabilities and overseas basing plans that have started to materialize in Djibouti.

Renal cell carcinoma in patients with end-stage renal disease: a clinicopathological analysis

Objective: To investigate the clinicopathological characteristics and prognosis of renal cell carcinoma (RCC) in patients with end-stage renal disease (ESRD). Methods: The clinicopathological data of patients of renal cell carcinoma arising in end-stage renal disease were collected from the Affiliated Hospital of Qingdao University (ten cases) and 971 Hospital of PLA Navy (five cases) from January 2009 to August 2018. Results: Among 15 patients, 14 were male and 1 was female, and the age ranged from 38 to 78 years (mean 51 years, median 49 years). All patients had history of chronic renal failure (7-192 months), including 9 patients treated with hemodialysis for 6 to 132 months. In 12 cases the tumor border was distinct and the tumor size ranged from 1.8 to 11.0 cm. Two cases were multifocal and one case showed extensive renal hemorrhage with an inconspicuous tumor mass. Microscopically, 9 cases were clear cell reanl cell carcinoma including one with sarcomatoid differentiation, 4 were acquired cystic kidney disease-associated(ACKD-RCC) and two were papillary renal cell carcinoma. All patients had a follow-up of 3 to 120 months. Four patients died during a follow-up of 6 to 60 months (mean 30 months) as a result of extensive distant metastases (two cases) and renal failure (two cases), while other eleven patients were alive without tumor recurrence or metastasis (median 40.8 months of follow-up ranging from 3 to 120 months). Conclusions: ESRD-RCC is more often seen in younger male patients. The time intervals from the onset of chronic renal failure to the diagnosis of renal cell carcinoma differ and tumors are frequently incidental findings. The histological types can be sporadic renal cell carcinoma or unique ACKD-RCC. Tumors are often hemorrhagic and necrotic. Routine physical examination and early detection could benefit ESRD-RCC patients. ESRD-RCC may have a favorable prognosis despite of a large tumor size or the presence of sarcomatoid differentiation.

Forecast of Chinese SSBN force levels

ABSTRACTNuclear-powered Ballistic Missile Submarines (SSBNs) remain the mainstay of credible nuclear deterrence. Owing to the limited information emerging from China, even the number of SSBNs in service with the PLA Navy at present remains an estimate. Projections or forecasts of Chinese SSBN force levels in the next 10–20 years are therefore speculative and widely deviating. Based on the analysis of China’s professed nuclear policy, possible SSBN deployment patterns, and developing shipyard infrastructure, this paper assesses the capacity as well as perceived requirement of Chinese SSBNs. Accordingly, the author offers forecasts for SSBN force levels by 2030 and by 2040. Likely technological developments and characteristics of the next-generation Type 096 SSBN are also predicted.

Wading tiger, swimming dragon: A study on comparative Indo-Sino naval development

In this article, I study the newly commissioned ships and ships in development in the Chinese and Indian navies to analyze how the Chinese People’s Liberation Army–Navy (PLA-N) and the Indian Navy view the other’s modernization. I argue that the Chinese and Indian navies’ development can be explained by defensive realism and that they will take steps according to this view. I predict that the Indians will focus on developing a navy that can defeat the PLA-N in Indian-dominated waters, while the PLA-N will develop anti-submarine assets to counter the Indian nuclear triad.

Clinicopathological characteristics of fumarate hydratase-deficient renal cell carcinoma

Objective: To investigate the clinicopathologic characteristics, molecular and genetic features, differential diagnoses and prognosis of fumarate hydratase-deficient renal cell carcinoma (FH-RCC). Methods: The immunohistochemical (IHC) expression of FH in 391 renal neoplasms in tissue chips collected from the Affiliated Hospital of Qingdao University and 971 Hospital of PLA Navy from January 2011 to December 2017 was evaluated. The clinicopathologic data of eight FH negative cases were collected.Polymerase chain reaction (PCR) and sequencing were used to detect the changes in FH gene in three cases. Interphase FISH with a dual color and break-apart probe was applied to detect the TFE3 gene alteration in the cases showing TFE3 protein expression. Results: Among the eight patients, seven were male and one was female, and age ranged from 28 to 50 years (mean 39 years). Tumor size ranged from 3.5 cm to 12.0 cm (mean 7.9 cm). Renal pelvis invasion was identified in six cases, and the tumor emboli in renal vein and inferior vena cava were found in four patients. The cut surface of most tumors was solid, colorful, grayish white or yellow with no clear border showing invasive growth pattern. Microscopically, the tumors showed different proportions of papillary, tubular cystic, cribriform and solid structures. The tumor cells were rounded or polygonal with eosinophilic or amphotropic cytoplasm, round or oval nuclei, and focal large and prominent nucleoli (WHO/ISUP grade 3-4). Two cases had sarcomatoid or rhabdoid components. Intravascular tumor emboli were found in five cases. IHC staining showed most tumors expressed PAX8(7/8), CK19(7/8), vimentin (6/8) and P504s(8/8). However, other immunomarkers including CK7, CD10, CD117, RCC, 34βE12, HMB45 and Melan A were all negative. Sequencing showed all three cases had FH gene mutations in exon 1. FISH revealed no TFE3 gene translocation or amplification in the two cases with TFE3 IHC expression. Follow-up data were available in seven patients with the follow-up period from 11 to 66 months. Among them, five patients died between 11 to 31 months after the surgery because of extensive distant metastases of the tumor to the lung, liver and lymph nodes. The other two patients were alive at the 36th and 66th month after the surgery. Conclusions: Morphologically, FH-RCC overlaps with papillary RCC, collecting duct carcinoma and tubular-cystic RCC, showing a mixture of papillary, tubular cystic, cribriform or tubular papillary structures with at least focal large and prominent nucleoli. The negative expression of FH and the detection of FH gene mutation could facilitate the diagnosis of the tumor. FH-RCC is a high aggressive tumor, prone to metastasize, and is associated with poor prognosis. The timely diagnosis of FH-RCC could benefit the patients and their relatives as well.

Understanding China’s naval ship building industry – lessons India can learn

ABSTRACTThis article examines the major shipbuilding programmes of the PLA Navy (PLAN) with the purpose of assessing the capabilities of the shipyards engaged in their construction. It analyses the reasons underpinning the Chinese Navy’s ability to convert capital into assets in an efficient, time-bound, and cost-effective manner. It also examines the PLAN’s organisation, structure, scale and best practices, with the aim of identifying those tenets that could be adopted by Indian shipyards to boost efficiency. The piece concludes by making recommendations on these issues.

Securing the Maritime Silk Road in South Asia and the Indian Ocean

Securing the Maritime Silk Road in South Asia and the Indian Ocean Nilanthi Samaranayake (bio) For roughly fifteen years, China's commercial and military activities in South Asia and the wider Indian Ocean have caused increasing concern about its intentions in the region. China specialists have examined the country's energy interests and naval planning along its sea lines of communication.1 The proliferation of commercial infrastructure projects now branded under the Belt and Road Initiative (BRI) has heightened these concerns about China's presence in the Indian Ocean region. Prominent infrastructure efforts include port development in Pakistan, Sri Lanka, and Myanmar, while lower-profile efforts include tunnel and bridge construction in Bangladesh and Maldives. These developments have raised questions about how China is attempting to secure the 21st Century Maritime Silk Road (MSR)—the waterway "road" component of BRI—in South Asia and across the Indian Ocean region more broadly. Because Pakistan will be examined by another essay in this roundtable and the China-Pakistan relationship is long-standing and predates BRI activities, this essay focuses on what China's activities look like elsewhere in maritime South Asia and out to critical Indian Ocean chokepoints. Despite notable changes in the country's presence in the Indian Ocean over the last decade, to what extent is China securing its commercial interests using naval and maritime forces? If it indeed aims to do this in a comprehensive way, then the results are modest at present. The first section of this essay examines the evidence that China is working to secure its interests in the region. The next section describes challenges to China's efforts to do so and the galvanizing effects of its activities thus far. The essay will conclude by emphasizing the importance of monitoring potential indicators of a substantive shift in the Indian Ocean and South Asian order, [End Page 21] despite the limited scope of China's activities to secure the MSR to date, and by considering the implications for U.S. interests in the region. Is China Securing the MSR? The clearest examples of China acting to secure the MSR are the counterpiracy and noncombatant evacuation operations (NEOs) conducted by the People's Liberation Army (PLA) Navy and the establishment of a base in the far fringes of the Indian Ocean at the chokepoint in Djibouti. Since 2008, Beijing has sent a PLA Navy task force to the Gulf of Aden. Originating out of UN resolutions to combat piracy,2 China's military vessels have transited the Indian Ocean for the past decade, providing escort activity that aims to secure the safe passage of shipping, including for Chinese commercial vessels. China has used this mission to justify the deployment of submarines. These were clearly not in support of counterpiracy but instead appeared to be aimed at gaining operational experience far from home for this platform.3 As Admiral (ret.) Michael McDevitt observes, at any given time the PLA Navy has four to five surface ships and two support ships transiting the Indian Ocean, plus occasionally a submarine.4 India's chief of naval staff Admiral Sunil Lanba estimates a similar number (six to eight ships).5 Second, China conducted NEOs in response to domestic instability in Libya in 2011 and Yemen in 2015. In total, roughly 35,000 Chinese nationals were evacuated from Libya using Chinese civilian and military aircraft and ships,6 and nearly 1,000 Chinese and foreign nationals were evacuated from Yemen.7 Through such operations, China secured an important MSR asset—its citizens working in these countries. [End Page 22] Third, China established a military base in Djibouti in 2017. Although China had stated for decades that it had no intention of developing overseas bases, its counterpiracy operations as well as NEOs pointed to the potential benefits of having logistical support in place.8 The base leverages Djibouti's location at the Bab el-Mandeb Strait chokepoint, where the Red Sea meets the Gulf of Aden. China's presence at this far corner of the Indian Ocean shows the expanse of its operational reach across the region. Challenges to China Securing the MSR Through conducting counterpiracy operations and NEOs and establishing a base...

Japan and Taiwan – a Strategic Convergence?

<p>Artykuł dotyczy współzależności strategicznych Japonii i Tajwanu. Są one konsekwencją z jednej strony wzrostu Chin, z drugiej coraz większej militarnej aktywności Japonii w regionie. Tajwan chcąc ochronić swój obecny status potrzebuje zbudowania silnej koalicji w regonie. Zachowanie status quo Tajwanu leży również w interesie Japonii, ze względu na jego położenie geopolityczne. Tajwan pełni rolę bariery pomiędzy Chinami a otwartym Pacyfikiem, będąc częścią tzw. pierwszego łańcuch wysp. Zatem przejęcie Tajwanu przez Chiny miałoby katastrofalne skutki dla Japonii, oraz zachwiałoby poważnie równowagę w regionie Azji i Pacyfiku.</p>

The Rise of the Chinese Navy: A Tirpitzian Perspective of Sea Power and International Relations

Western commentators often view the emergence of a modernizing Chinese People's Liberation Army Navy (PLAN) through the theoretical lens of Alfred Thayer Mahan, an influential 19th century American naval theorist who advocated an imperialistic brand of sea power modeled on the British example. This approach, however, risks painting a misleading picture of China's naval ambitions because it is based on a hegemonic theory of naval power that most regional powers cannot realistically follow. Instead, this article turns to the writings of Alfred von Tirpitz, the architect of the short‐lived German battle fleet that unsuccessfully challenged British naval dominance during World War I. Applying his ideas about naval power and hegemony to East Asia's strategic context is a useful heuristic device for revealing key logics behind three facets of US–Chinese naval rivalry: (i) China's anxieties over access to markets; (ii) the importance of alliance value; and (iii) the fiscal, operational, and technological dynamics that shape naval arms races between a hegemon and its weaker regional contender. In all three cases, the application of non‐hegemonic naval theory raises important questions about the sustainability and justice of current US naval strategy in the Western Pacific while simultaneously laying bare the major pitfalls of China's current trajectory.

China’s Naval Leadership Reshuffle, Evolving Maritime Strategy and Professionalisation

Appointing a naval officer to command the Southern Theatre indicates the relative importance of the South China Sea to the People’s Liberation Army (PLA), mainly in terms of its strategic location and its deep depth, immense space and unfettered transit to the Western Pacific for operating PLA Navy’s strategic nuclear submarines and major surface ships. For the reshuffling of naval leadership, functional and technical expertise-based, or professional criteria may play a primary role.

Růst čínské námořní moci: Nové politicko-vojenské ambice v regionu?

With an effort to further develop the economic output of China and preserve her social stability, the Government of the People's Republic of China is strongly motivated to secure the on-going inflow of crucial raw materials concurrently with the continuing outflow of Chinese products outside the Mainland China. Regarding the fact that almost three quarters of the overall volume of transported resources as well as exported production is done by maritime routes, the PRC faces a strategic challenge to control these routes in order to prevent their interruption. This corresponds with the continuous growth of Chinese military expenditures and focus on the further PLA Navy development.

Medical resource preparation and allocation for humanitarian assistance based on module organization

This research aims to associate the allocation of medical resources with the function of the modular organization and the possible needs for humanitarian assistance missions. The overseas humanitarian medical assistance mission, which was sent after a disaster on the hospital ship Peace Ark, part of China's People's Liberation Army (PLA) Navy, was considered as study model. The cases used for clustering and matching sample formation were randomly selected from the existing information related to Peace Ark's mission. Categories of the reusable resources clustered by this research met the requirement of the actual consumption almost completely (more than 95%) and the categories of non-reusable resources met the requirement by more than 80%. In the mission's original resource preparing plan, more than 30% of the non-reusable resource categories remained unused during the mission. In the original resource preparing plan, some key non-reusable resources inventories were completely exhausted at the end of the mission, while 5% to 30% of non-reusable resources remained in the resource allocation plan generated by this research at the end of the mission. The medical resource allocation plan generated here can enhance the supporting level for the humanitarian assistance mission. This research could lay the foundation for an assistant decision-making system for humanitarian assistance mission.

Воздействие рaзвития китaйских МЛК в трендaх междунaродной безопaсности

Geopolitical ascendancy of China as a growing superpower entails to the development of new tendencies in the area of the international security. Chinese policy on sustaining of the energy security and active search of various crudes led to the development not only a transport and logistical strategy, but also to the shifts within strategic environment, especially in area of the India Ocean. Chinese SLOCs (Sea Lines of Communication) in the contemporary period play a crucial role under shaping and development of tendencies in the sphere of regional security. The theme and nature itself of Chinese SLOCs have a complex character and cover such areas like a transportation and logistics, foreign policy and strategy, development of military forces and PLAN capabilities.Key words: logistics and transportation, ports, tankers, PLAN (People`s Liberation Army Navy), strategy, energy.

China’s Emerging Indo-Pacific Naval Strategy

Although China has not formally put forward an Indo-Pacific naval strategy, the new national defense strategy of the People's Liberation Army (PLA), Fighting Regional Informatized War, has changed the strategy of the PLA Navy (PLAN) from focusing on one ocean (the Pacific) to focusing on two oceans (the Pacific and Indian). As part of its mission in the far seas, the PLAN will require new blue water capabilities in the medium to long term. In short, the Indian Ocean is becoming a linchpin for China's new global naval reach. This essay argues that China is developing its military strategy for the Indian Ocean to protect and defend its economic and security interests in those waters. As a result, China's maritime presence there will only increase over time.The Indian Ocean and the Nexus of PLA and PLAN StrategiesChina's national defense strategy assists the nav y in setting service missions, development goals, and combat engagement rules. This paper includes just one conceptual guideline to shed light on PLAN activities in the Indian Ocean.1China's sixth national defense strategy, first adopted in 2004 and updated in 2015, introduced a new concept of defense, which enriched the original strategy and has immediate relevance to PLAN expansion. This does not refer merely to defense of China's geographic boundaries but also to protection of its new open-ended frontiers of national and economic security interests. It heavily factors in potential hostile scenarios against China's sea lines of communication (SLOC) through the Indian Ocean. Frontier defense entails efforts to both establish a forward naval presence and develop the long-range power-projection capabilities to sustain such a presence. This concept departs from the PLA's time-honored continental mentality in planning that had dominated previous defense strategies and favored the role of the army in the overall force structure. Although the PLA continues to maintain its homeland-based defense posture, frontier defense requires it to extend warfighting into the global commons as a way to enlarge China's strategic space. This requires the projection of new play Go posturing and the establishment of multidimensional zones, including outer space and cyberspace.2 A primary pillar for frontier defense involves the PLAN's capabilities for far-sea operations against a major sea power, and increasing the PLAN's effective combat reach into the Indian Ocean has been set as a capability criterion and medium-term objective. This is a consequence of Xi Jinping's One Belt, One Road initiative to increase connectivity to Europe through a northern land route and to Africa through a southern maritime corridor connecting China with the Middle East, which places a greater onus on the PLAN to protect China's SLOCs.Another important nexus between China's national defense strategy and naval strategy is the PLA's two war doctrines. With the prospect of a land disappearing, the country's security gravity has shifted from the western and northern land borders to the eastern coastal flank. If the PLA is dragged into a full maritime conflict in the East and South China Seas with the United States and Japan, India may take advantage by encroaching farther across the disputed Sino-Indian land borders. This is the first 1.5 scenario.3 The second scenario also involves India. If a sizeable maritime erupts in East Asia, the Indian Navy may be called on to disrupt China's SLOCs in the Indian Ocean in order to both strengthen India's position in the Sino-Indian border dispute and help U.S. operations in the Pacific. Both scenarios regard India as a potential threat. In response, the PLA's frontier defense would inevitably require the PLAN to expand its one-ocean strategy into a two-ocean strategy (the western Pacific Ocean plus the northern Indian Ocean) and thus extend its naval combat reach into the Indian Ocean rim.The Indian Ocean in the PLAN's Naval War ScenarioThe PLAN's doctrinal evolution has seen several major adjustments since 1987, each expanding its range of activities toward the far seas. …

Japan’s Perceptions of and Interests in the South China Sea

China's assertive and high-handed activities in Asian waters-especially in the East and South China Seas-are generating serious security concerns within the international community. In particular, China's unique, unilateral positions on maritime issues, which it claims are supported by its wider, and sometimes self-centered, interpretation of the United Nations Convention on the Law of the Sea (UNCLOS) and other established international rules, have puzzled regional states and stakeholders such as the United States. At the same time, disputes in the South China Sea risk escalating into military clashes between the United States and China.Thus, for Japan, the South China Sea does not simply involve territorial disputes among coastal nations but rather raises a grand issue that could cause a direct military collision, undermining existing stability and potentially leading the region and the world into an unprecedented chaotic situation. This essay examines Japan's perceptions of and interests in the South China Sea. Japan's primary concerns in the region are twofold: First, China's reclamation activities and military buildup could eventually give it strategic control of the sea lines of communication. Second, the potential escalation of tensions between China and the United States, Japan's key ally, poses a threat to regional stability. The essay then examines Japanese security policy and assesses what actions Japan could take to help stabilize the situation.An Overview of Japan's Key ConcernsChina's reclamation and island-building activities. Stretching approximately 1,750 miles from the Bashi Channel/Luzon Strait to Singapore and 1,250 miles from Hong Kong to Brunei, the South China Sea is roughly 9.5 times as large as Japan and includes around two hundred islands, rocks, shoals, and reefs. There are several prominent archipelagos, such as the Paracel Islands and the Spratly Islands, and each has its own strategic significance.Since 2013, China has started reclamation at seven lagoons and engaged in the construction of artificial islands. Fiery Cross Reef seems to be a core spot that includes full military facilities, most notably a runway and a deep port. Subi and Mischief Reefs, which are about 125 miles apart, are the other artificial islands with runways and port facilities. Japan fears that four other artificial islands with various support facilities could function as outer guard posts for the three main islands with airfields and air-surveillance sites that could enable a potential Chinese air defense identification zone in the South China Sea. These man-made islands, when fully completed, would provide China with strong footholds in the Spratly Islands for controlling most of the sea lines of communication and for monitoring foreign naval and air activities. Moreover, if China in the future ever successfully builds an artificial island at the Scarborough Shoal, there would be a strategic triangle connecting Woody Island, the Spratlys, and Scarborough Shoal that would cover most of the South China Sea. The impact of this strategic triangle would be tremendous for the United States' and Japan's strategic planning and could be a game changer in regional power relations.As a major global power, China has a national objective to be a nuclear power comparable with the United States. However, China lacks longrange bombers and, as a result, naturally depends on its strategic missile forces, including its maritime strategic nuclear capabilities, as a major element. In this context, the People's Liberation Army (PLA) Navy must maintain a robust nuclear-powered ballistic missile submarine (SSBN) force and protect this force against the antisubmarine warfare capabilities of potential adversaries-especially the U.S. Navy's nuclear-powered attack submarine (SSN) force. The PLA Navy has completed a new naval base at Sanya on Hainan Island, which is ideal for deploying its SSBN force to patrol in the Indian and the Pacific Oceans. …

India’s Response to China’s Naval Presence in the Indian Ocean

The dominance of the marshals in the Chinese Central Military Commission was for years assumed to ensure that the People's Liberation Army (PLA) would overall follow a continental strategy in which maritime strategy is subordinated to continental defense. But in recent years pressure has increased to develop a new maritime strategy in keeping with the Politburo's ambitions for to become a world power. This trend began to build up from 2012 onward, but it is in the 2015 white paper China's Military Strategy that we see the first overt signal of becoming a maritime power:The seas and oceans bear on the enduring peace, lasting stability and sustainable development of China. The traditional mentality that land outweighs the sea must be abandoned, and great importance has to be attached to managing the seas and oceans and protecting maritime rights and interests. It is necessary for to develop a modern maritime military force....for building itself into a maritime power. The traditional mentality that land outweighs the sea must be abandoned, and great importance has to be attached to managing the seas and oceans and protecting maritime rights and interests.1The 2015 white paper may be said to give political clearance to the following goals:* the funding of the PLA Navy (PLAN) to become a world-class navy* the protection of China's prime sea lines of communication (SLOC), including those in the Indian Ocean* the eventual deployment of the PLAN wherever Chinese interests existThe 2015 white paper goes on to talk of joining other naval forces to protect international SLOCs; the importance of Chinese SLOCs in the Indian is of such magnitude that a permanent Chinese presence in the ocean is certain.This essay examines China's maritime strategy in the Indian and possible Indian responses. It first considers why is interested in the Indian Ocean, before turning to analyze PLAN operating requirements there. The essay then concludes by assessing the implications and options for India.China's Interests in the Indian OceanAccording to one estimate, China imports 82 per cent of its energy requirements, in the form of oil and gas, through the Indian Ocean and, more importantly, via the Strait.2 Without these imports, the Chinese economy would shut down. This percentage is slated to increase as China's economy grows. The Malacca dilemma, as described by Hu Jintao, is real and is a true reflection of Beijing's thinking. Bypassing the Indonesian archipelago via pipelines across Myanmar and Pakistan is not a viable option for resolving the dilemma. All signs point toward a consensus having been reached within the Chinese leadership that becoming a world power necessarily means becoming a maritime power that is capable of defending its interests in the far seas.A move toward the Indian to protect Chinese SLOCs would require the creation of supporting infrastructure for the PLAN to operate in the far seas. This maneuver would be well thought out and follow a long-standing progressive plan created over a couple of decades, including the following steps:* offering investment of capital to boost trade* offering to build infrastructure and special economic zones* obtaining an economic toehold in the Indian littoral* creating a perception of as a benefactor* making regional states indebted to China* convincing these states to provide a base for Chinese operations in the Indian OceanIn short, will use its surplus cash and economic diplomacy to create geopolitical conditions in the Indian that are favorable to pro-Beijing decisions being made.To protect Chinese SLOCs, the PLAN will require more than one base in the Indian Ocean. already has footholds in Djibouti and Gwadar covering the northwest Indian and SLOCs through the Strait of Hormuz and the Bab-el-Mandeb Strait. …

A Global People’s Liberation Army: Possibilities, Challenges, and Opportunities

For more than a decade, China has been developing the necessary expeditionary military capabilities to protect its interests beyond the East Asia region.1 As China assumes a larger role in world affairs, these interests have expanded substantially and increasingly require the capacity to secure investments and business ventures around the globe, including the millions of People's Republic of China (PRC) citizens living abroad, access to energy and other natural resources, and continued access to critical shipping lanes. To this end, the People's Liberation Army (PLA) has begun to engage in missions far beyond its borders, including humanitarian assistance and disaster relief (HADR), noncombatant evacuation operations, counterpiracy operations, and the protection of sea lines of communication (SLOC).While hardly surprising given China's global interests, the development of military expeditionary capabilities has raised concerns both in the United States and abroad about what role the PLA will play in global affairs and how that role may affect or constrain other countries. Examples include wariness about China's intentions following the announcement of a PLA logistics base in Djibouti, anxiety in New Delhi after PLA Navy (PLAN) submarines unexpectedly surfaced in the Indian Ocean, and challenges from the United States and others to Chinese naval patrols, conducted with some of the PLAN's most advanced combatants and submarines, in the farthest reaches of the South China Sea and associated disputed waters.2 Increasingly, China is able to shape the international security environment overseas with its military capabilities, posing both opportunities and challenges for U.S. leaders.Under what conditions will China decide to employ military capabilities abroad, and will this development be positive or negative for the United States and the international order?3 Current research fails to answer this question adequately because of a narrow focus on related but fundamentally different classes of behavior. For example, there is a strong scholarly tradition that evaluates Chinese thinking on the use of force but focuses exclusively on regional and border-related disputes and mainly nontraditional operations overseas.4 Another research agenda focuses on China's evolving participation in UN peacekeeping operations, but these are cases in which Chinese national interests are not directly at stake and therefore may not be a valid comparison.5 Last, scholars and practitioners often focus on how China employs its military in specific territorial disputes, such as the South China Sea-but again, how and when China utilizes its military to promote claims close to its shores provides little insight into the leadership's willingness and ability to use these military tools far from China's shores in sovereignty issues.6The topic may be understudied because Chinese involvement abroad outside the confines of UN peacekeeping operations is a nascent phenomenon and presents methodological challenges. There are few cases of Chinese expeditionary operations from which to derive causal and descriptive inferences, with the Gulf of Aden deployments and select noncombatant evacuation operations being the exceptions. A recent volume brainstormed what operational capabilities China is likely to develop for its expeditionary force by 2025 but stopped short of determining the factors that would shape its deployment.7This article seeks to better understand China's preferences, its strategies to achieve preferred outcomes, and the strategic setting in which Chinese leaders will be making real-time decisions. To do this, the article evaluates five main drivers of Chinese security behavior: (1) the leadership's agenda, (2) domestic expectations for intervention, (3) the power-projection model China adopts, (4) the nature of the situation and impact on the country's security interests, and (5) global and U.S. receptivity to a larger Chinese role. …

India and China at Sea: A Contest of Status and Legitimacy in the Indian Ocean

Strategic competition between India and China in the Indian Ocean has the potential to profoundly affect the stability and security of the region. This essay examines Indian and Chinese views on the status and legitimacy of their roles in the Indian Ocean and argues that fundamental differences in perceptions could exacerbate an already highly competitive security dynamic in the maritime domain. Delhi tends to have a somewhat proprietary attitude toward the region, questioning the legitimacy of any extraregional naval presence, particularly China. But Indian strategists also see China as having strategic vulnerabilities in the Indian Ocean. For its part, Beijing refuses to recognize claims to great-power status or special prerogatives in the Indian Ocean region (IOR).This essay first summarizes China's growing strategic imperatives in the Indian Ocean. It then considers aspirations to take a leading role in the IOR and Indian perspectives on China's presence in the region. Next, the essay discusses Chinese perspectives on India and its role in the Indian Ocean and considers the potential consequences for China of the failure to take sensitivities into account. In short, I argue that China's failure to try to co-opt India as a partner or address some of its concerns is a mistake. Beijing will find it difficult to create a favorable geostrategic environment in the Indian Ocean in opposition to India.China's Imperatives in the Indian OceanChina's primary strategic imperative in the IOR is the protection of its sea lines of communication (SLOC) across the Indian Ocean. Beijing is keenly aware that its SLOCs are highly vulnerable to threats from state and nonstate actors, especially at the narrow chokepoints through which most trade must pass. Chinese strategists are concerned that an adversary may use these vulnerabilities as a bargaining chip in the context of a wider dispute. China also has other developing interests in the IOR, including a growing population of Chinese nationals and greater investment in the region. These issues are likely to become increasingly important in the country's strategic thinking.An additional factor is that China's military expansion program will significantly enhance its ability to project military power into the IOR in the long term. Its capabilities already exceed by a considerable and growing margin. China's naval presence has grown in connection with the People's Liberation Army (PLA) Navy's antipiracy deployments in the western Indian Ocean, which Beijing is now making more permanent, including by developing logistical support facilities in Djibouti. China's One Belt, One Road initiative will also involve the development of a swathe of maritime infrastructure across the IOR.India's Aspirations in the Indian OceanIndia considers itself as the leading Indian Ocean state and as destined to be the natural leader of the region. It thus takes a somewhat proprietorial attitude toward the IOR and perceives the presence of extraregional naval powers, particularly China, as essentially illegitimate.India has long harbored ambitions to become the dominant power in the Indian Ocean. Though few Indian officials might care to publicly admit it, many in Delhi see the Indian Ocean as more or less India's ocean. 1 As Donald Berlin has commented, New Delhi regards the Indian Ocean as its backyard and deems it both natural and desirable that India function as, eventually, the leader and the predominant influence in this region-the world's only region and ocean named after a single state. 2India's views on the Indian Ocean are partly defensive: the country's colonial experience is used to justify the exclusion of extraregional powers from the Indian Ocean, an approach that is sometimes labeled India's Monroe Doctrine. The idea involves an assertion, at least unofficially, that the military presence of outside powers in neighborhood is essentially illegitimate and that neighboring countries should rely exclusively on India as the predominant regional manager and security provider. …

Painful neuropathy in a diabetic patient resulting from lung cancer and not diabetes: A case report.

The current study reports the case of a 61-year-old man with diabetes who was suffering from generalized pain over the whole body and gradually progressive numbness. The patient was initially diagnosed with diabetic peripheral neuropathy and received treatment, however, the symptoms persisted. In October 2010, the patient was admitted to the Chinese People's Liberation Army Navy General Hospital (Beijing, China) for the treatment of diabetes, however, a full-body sharp pain was also described, which was relieved upon massaging the area. Causes, other than diabetes, were investigated for these symptoms. Chest computed tomography and positron emission tomography-computed tomography scans revealed a mass shadow in the right lower lobe of the lung, with multiple lymphatic metastases. Lung cancer was diagnosed with a tumor-node-metastasis stage of T1N3Mx. Following treatment of the cancer with chemotherapy and radiotherapy, the patient's symptoms were significantly improved. The present study reports a rare case of a paraneoplastic neurological syndrome (PNS) that presented as painful neuropathy resulting from lung cancer, which mimicked diabetic peripheral neuropathy.

Radiology on Board the PLA(N) Peace Ark Hospital Ship During a Humanitarian Medical Relief Mission to the Philippines.

From November 24 to December 10, 2013, the Chinese People's Liberation Army Navy [PLA(N)] hospital ship Peace Ark was deployed to the Leyte Gulf in the Philippines to provide humanitarian medical relief in Tacloban after Typhoon Haiyan. The purpose of this study was to assess the radiological services aboard the ship to provide guidance for future missions. A retrospective review was performed on a cohort of 109 patients who underwent digital radiography (DR) and 59 patients who underwent computed tomography (CT) scans during a 16-day period during a humanitarian medical relief mission to the Philippines. Patient demographics, DR findings, and CT findings were analyzed. The mean age of the 109 DR patients was 39.7 years for the 64 males and 43.7 years for the 45 females. A total of 148 DR examinations were performed of the chest (n=109), extremities (n=35), and spine (n=4). The mean age of the 59 CT patients was 43.8 years for the 32 males and 49.1 years for the 27 females. A total of 72 CT scans were performed of the head and neck (n=36), thorax (n=24), abdomen (n=5), spine (n=4), and extremities (n=3). The imaging findings mainly included disaster-related and non-disaster-related fractures, pulmonary tuberculosis, pulmonary infection, acute brain infarction, intracranial hematoma, and occupying lesions. Analysis of radiological services during a humanitarian medical relief mission to the Philippines provided meaningful information for future humanitarian medical relief missions.