BackgroundBreast cancer is one of the most commonly diagnosed cancers, and the fourth leading cause of cancer deaths in females worldwide. Sarcopenia is related to adverse clinical outcomes in patients with malignancies. Muscle index is a key parameter in evaluating sarcopenia. However, there is no data investigating the association between muscle index and distant metastasis in breast cancer. The aim of this study was to explore whether muscle index can effectively predict distant metastasis and death outcomes in breast cancer patients.Study DesignThe clinical data of 493 breast cancer patients at the Harbin Medical University Cancer Hospital between January 2014 and December 2015 were retrospectively analyzed. Quantitative measurements of pectoralis muscle area and skeletal muscle area were performed at the level of the fourth thoracic vertebra (T4) and the eleventh thoracic vertebra (T11) of the chest computed tomography image, respectively. The pectoralis muscle index (PMI) and skeletal muscle index (SMI) were assessed by the normalized muscle area (area/the square of height). Survival analysis was performed using the log-rank test and Cox proportional hazards regression analysis.ResultThe patients with metastases had lower PMI at T4 level (PMI/T4) and SMI at T11 level (SMI/T11) compared with the patients without metastases. Moreover, there were significant correlations between PMI/T4 and lymphovascular invasion, Ki67 expression, multifocal disease, and molecular subtype. In addition, multivariate analysis revealed that PMI/T4, not SMI/T11, was an independent prognostic factor for distant metastasis-free survival (DMFS) and overall survival (OS) in breast cancer patients.ConclusionsLow PMI/T4 is associated with worse DMFS and OS in breast cancer patients. Future prospective studies are needed.

With the rapid development of the electronic information industry in recent years, electronic products are being updated faster and faster, and e-waste recycling has become a common problem around the world. Firstly, this article contrasts recycling at home and abroad using the predicament of Midea Corp. Based on a closed-loop supply chain with the system dynamics method, a model is constructed and simulated. In this model, the collection point coverage rate is introduced to adjust the e-waste recycling rate dynamically. Aiming at a recycling mode dominated by the third party of the closed-loop supply chain, the article mainly discusses the impact on the sales rate and market share of the recycling model by third-party enterprises and compares the total revenue of all supply chains. Simulation results show that the model is more effective and optimal than the traditional recycling model.

“O2O” (online to offline) classification recycling is a new recycling mode. It is premised on the double lines of online service platform and offline recycling service system, thus forming a pattern of online disposal and offline trading. This mode is capable of integrating upstream and downstream resources on the network platform, creating a recycling and processing mode for the entire industry chain of waste sorting, and developing a circular development mode featuring “resources-products-waste-renewable resources” to realize the recycling of resources. In this paper, the abovementioned recycling mode is constructed using the dynamic method. Taking the recycling of electronic waste (e-waste) as an example, on the basis of the original recycling, an online recycling mode is added and the e-waste is reprocessed by means of classification. Besides, the final process of manufacturing is put into the market for new products. By comparing the efficiency of different classification processing channels and the efficiency of O2O recycling, it was found out that the higher the product quality, the higher the recycling efficiency, and the efficiency of online recycling was concluded due to offline recycling. The system effect is evaluated according to the environmental index. In addition, this paper demonstrates the applicability of the mode by introducing Gree Corp. The results of this research are believed as contributory to improving the efficiency of recycling and remanufacturing at corporate level. It also provides a valuable reference for the improvement of e-waste management work for governments both in China and other countries.

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Abstract:The fast-growing accumulation of electronic waste (e-waste) around the world is resulting in environmental pollution and adverse human health and, thus, has become a global area of concern. As the world's second largest producer of e-waste, China suffers significant pollution from e-waste because of inefficient recycling and management. This paper is a comparative systems dynamics study of two big home appliance manufacturers in China: Haier (Haier Group of Qingdao, China) and Gree (Gree Electric Appliances Inc. of Zhuhai, China). We used systems dynamics modeling to examine and compare the impact of closed-loop supply chain recycling and remanufacturing strategies on the total revenue of the supply chain and market shares of both manufacturers. Results show that an increase in third party service coverage and increased environmental awareness enhanced the total revenue of supply chain. Retailers showed more enthusiasm for recycling through contract development with manufacturers, thus resulting in reduced time of payment in closed-loop supply chains. We also found that an improvement of the recycling mechanism of retailers results in an increase in the share of the supply chain market. Hence, we propose a better supply chain mode.