Journal articles on the topic 'Ji shu xue xiao'

Traditional Chinese medicine (TCM) divides fracture treatment into three stages. Many TCM herbs and formulas have been used to treat fractures for thousands of years. However, research regarding the Chinese herbal products (CHPs) that should be used at different periods of treatment is still lacking. This study aims to identify the CHPs that should be used at different periods of treatment as well as confirm the TCM theory of fracture periods medicine. We used prescriptions of TCM outpatients with fracture diagnoses analyzed using the Chang Gung Research Database (CGRD) from 2000 to 2015. According to the number of days between the date of the fracture and the clinic visit date, all patients were assigned to one of three groups. Patients with a date gap of 0-13 days were assigned to the early period group; those with a date gap of 14-82 days were assigned to the middle period group; and those with a date gap of 83-182 days were assigned to the late period group. We observed the average number of herbal formulas prescribed by the TCM doctor at each visit was 2.78, and the average number of single herbs prescribed was 6.47. The top three prescriptions in the early fracture period were Zheng-gu-zi-jin-dang, Shu-jing-huo-xue-tang, and Wu-ling-san. In the middle fracture period, the top three formulas were Zheng-gu-zi-jin-dang, Shu-jing-huo-xue-tang, and Zhi-bai-di-huang-wan. In the late fracture period, the top three formulas were Shu-jing-huo-xue-tang, Gui-lu-er-xian-jiao, and Du-huo-ji-sheng-tang. The main single herbs used in the early fracture period were Yan-hu-suo, Gu-sui-bu, and Dan-shen. From the middle to the late period, the most prescribed single herbs were Xu-duan, Gu-sui-bu, and Yan-hu-suo. We concluded that the results showed that the CGRD utilization pattern roughly meets the TCM theory at different fracture periods.

ObjectivesPatients with type 2 diabetes have a higher risk of colorectal cancer (CRC), but whether Chinese herbal medicines (CHMs) can reduce this risk is unknown. This study investigated the effect that CHMs have on CRC risk in patients with type 2 diabetes.Research design and methodsThis cohort study used the Taiwanese National Health Insurance Research Database to identify 54 744 patients, newly diagnosed with type 2 diabetes, aged 20–70 years, who were receiving treatment between 1998 and 2007. From this sample, we randomly selected 14 940 CHMs users and 14 940 non-CHMs users, using propensity scores matching. All were followed through 2012 to record CRC incidence. Cox proportional hazards regression was used to compute the hazard ratio (HR) of CRC by CHMs use.ResultsDuring follow-up, 235 CHMs users and 375 non-CHMs users developed CRC, incidence rates of 1.73% and 2.47% per 1000 person-years, respectively. CHM users had a significantly reduced risk of CRC compared with non-CHM users (adjusted HR=0.71; 95% CI 0.60 to 0.84). The greatest effect was in those receiving CHMs for more than 1 year. Huang-Qin, Xue-Fu-Zhu-Yu-Tang, Shu-Jing-Huo-Xue-Tang, Liu-Wei-Di-Huang-Wan, Ji-Sheng-Shen-Qi-Wan, Gan-Lu-Yin, Shao-Yao-Gan-Cao-Tang and Ban-Xia-Xie-Xin-Tang were significantly associated with lower risk of CRC.ConclusionIntegrating CHMs into the clinical management of patients with type 2 diabetes may be beneficial in reducing the risk of CRC.

Recently, sulfonamides have been shown to be promising electrolyte components due to their high chemical and electrochemical stability in lithium batteries [1, 2]. The electrolyte stability becomes critical when applying high voltage and/or utilizing Ni-rich layered oxides in high energy density lithium-ion batteries. Another approach to successful Ni-rich cathode performance is to develop a stable and effective cathode electrolyte interphase (CEI). Given the success of sultones and sulfates in this regard [3, 4], it is hypothesized that nitrogen analogs, like sulfonamides, could be tailored to provide a similar benefit. Indeed, Yim et al. [5, 6] have shown that N,N,N’,N’-tetraethylsulfamide (TES) forms a CEI on NMC811 that imparts high voltage cycling stability and less cathode corrosion. Our earlier studies of TES with Ni-rich NCA also formed a favorable CEI and these results are the topic of this presentation. Herein, we examine the performance of 0 - 4 wt.% TES in our commercially available, high power INR18650-P28A. These cells contain a composite SiO/graphite anode in addition to a Ni-rich cathode. As shown in Fig 1, TES significantly decreased the impedance of the cathode interface after conditioning compared to the control electrolyte. Thereafter, cells containing up to 2%TES show improved capacity retention during long-term high-rate cycling (+1C/-80W). Part of this success was due to a suppression of resistance growth during cycling by TES. Fast charge cycling (+3C/-2C), however, was moderately impaired with increased TES. Considering the largely reduced impedance of the cathode, fast-charge performance may have suffered due to anode rate limitations. These results will be discussed as well as gas generation, storage performance, and additional rate and cycling tests. [1] Shuting Feng, Mingjun Huang, Jessica R. Lamb, Wenxu Zhang, Ryoichi Tatara, Yirui Zhang, Yun Guang Zhu, Collin F. Perkinson, Jeremiah A. Johnson, Yang Shao-Horn. Chem, 5, 2630-2641 (2019) [2] Weijiang Xue, Mingjun Huang, Yutao Li, Yun Guang Zhu, Rui Gao, Xianghui Xiao, Wenxu Zhang, Sipei Li, Guiyin Xu, Yang Yu, Peng Li, Jeffrey Lopez, Daiwei Yu, Yanhao Dong, Weiwei Fan, Zhe Shi, Rui Xiong, Cheng-Jun Sun, Inhui Hwang, Wah-Keat Lee, Yang Shao-Horn, Jeremiah A. Johnson, Ju Li. Nature Energy, 6, 495-505 (2021) [3] Koji Abe, Manuel Colera, Kei Shimamoto, Masahide Kondo, Kazuhiro Miyoshi. Journal of Electrochemical Society, 161 (6) A863-A870 (2014) [4] Jian Xia, N. N. Sinha, L. P. Chen, J. R. Dahn. Journal of Electrochemical Society, 161 (3) A264-A274 (2014) [5] Kwangeun Jung, Taeeun Yim. Journal of Alloys and Compounds, 834,155155 (2020) [6] Ji Won Kim, Kwangeun Jung, Taeeun Yim. Journal of Mater. Sci & Tech. 86, 70-76 (2021) Figure 1

??? Yehang Chuan ‘Night Ferry’ is an encyclopaedic masterpiece and the chef-d’oeuvre of ?? Zhang Dai (circa 1597-1689), an illustrious historian, poet, dramatist, essayist, aesthete, musician and gastronomist in late Ming and early Qing China. Night Ferry cumulates more than four thousand entries and encompasses a veritable cornucopia of topics in an elephantine range. In this research, I investigate Chapter Twenty ?? Fang Shu ‘Alchemy and Sorcery’ of Night Ferry, which comprises Section ?? Fu Zhou ‘Amulets and Incantations’ and Section ?? Fang Fa ‘Prescriptions and Practices’. Both sections abound with depictions pertaining to occult acts and paranormal forces, the vast majority of which embody cultural allusions concerning religion, divination and patriarchy. Furthermore, Chapter ‘Alchemy and Sorcery’ is featured by humorousness, though Night Ferry is not a dedicated jestbook. The humorous effect in Night Ferry is not attained via sarcasm or homo-/hetero-erotism, as manifested by derisive and prurient jokes compiled in a renowned pre-modern jestbook entitled ????Xiao Lin Guang Ji ‘A Collection of Classic Chinese Jokes’.

In the article, the author justifies the necessity to work out the principles of the approach, which would underline the principles of the commented translation of the Lun Yu (The Analects) from Chinese into Russian. The prospective authors of this translations must take into consideration both the existent translations as well as the existing comments This approach would enable to select the relevant parts from the Lun Yu, which are difficult for understanding due to The Analects which are difficult to understand due to the use of polysemantic expressions and vocabulary. The article comprises a brief textual review of the earlier versions of Lun Yu and offers a new commented translation of the two well-known fragments of the text. They are fragment 6.22 (on self-sufficiency, guided by a sense of duty) and fragment 7.17 (“on adding years”). The author suggests a new understanding of the well-known expressions, such as yan zhi 遠之 (6.22) as “Keeping distance [from ghosts and spirits]”, and xue yi 學易 (7.17) as “Study the [book of] Changes”. Likely, in the first case, it suggests “not to depend depending on the ghosts and spirits because everyone should rely primarily on himself. In the second case, it implies the act of teaching as such. The author’s results are based upon the commentaries, viz. Lun yu ji jie yi shu and Lun yu ji zhu. The yan zhi 遠之 was interpreted as “do not disturb”. And the second one is based on the found in 1973 the earliest known commentary for Lun Yu, where “Changes” yi 易 is only a homophonic auxiliary expression with the attached word yi 亦. These examples show that even the well-known and thoroughly researched text can receive new interpretation by putting it into a new boarder textual context

Background: Acute ischemic stroke (AIS) is characterized by high morbidity, disability, mortality, recurrence, and economic burden. Clinical trials have demonstrated that the clinical efficacy of combining oral Chinese patent medicines (CPMs) with chemical drugs (CDs) is better than that of CDs alone. In this study, we performed a network meta-analysis (NMA) of RCTs to assess the efficacy of different CPMs in combination with CDs in the treatment of AIS. Methods: Search 6 databases from the beginning to January 10, 2023. The Cochrane Risk of Bias tool assessed the methodological quality of the included studies. The NMA was then performed using the STATA 13.0 program. The surface under the cumulative ranking curve (SUCRA) probability values were applied to rank the studied treatments, and cluster analysis was used to compare the effects of CPMs between 2 different outcomes. Results: A total of 94 eligible RCTs, involving 9581 participants, were included in this analysis. Nine CPMs, including Nao-mai-li granule (NML), Nao-mai-tai granule (NMT), Qi-long granule (QL), Long-sheng-zhi capsule (LSZ), Nao-xin-tong capsule (NXT), Nao-xue-shu oral liquid (NXS), Tong-xin-luo capsule (TXL), Xiao-shuan-chang-rong capsule (XSCR), and Xue-shuan-xin-mai-ning capsule (XSXMN) were included. Regarding the clinical effective rate, all types of CPMs + CDs treatments were significantly better than CDs treatments alone, with significant differences among the 9 selected CPMs. Compared with CDs, results showed that NXS + CDs performed best in improving clinical effective rate [OR = 4.73; 95% CI: 1.26–17.78; (SUCRA: 76.1%)]. TXL + CDs showed the most effective effect in alleviating National Institutes of Health Stroke Scale (NIHSS) [MD = −3.84; 95% CI: −5.23, −2.45; (SUCRA: 81.6%)]; NXT + CDs were most effective in improving Barthel index [MD = 13.05; 95% CI: 3.98–22.12; (SUCRA: 63.5%)]. Combined with other outcome indicators and the results of cluster analysis, NXS + CDs may assist in the potential optimal treatment regimen for AIS. Conclusion: In conclusion, CPMs were found to be beneficial as adjuvant therapy in patients with AIS. Taking into account the clinical effective rate and other outcomes, NXS + CDs may be the most effective option to improve the condition of AIS patients.

Purpose. Acute myeloid leukemia (AML) is the most deadly subtype of leukemia, and many patients with this disease seek other complementary therapies, one of which is Chinese medicine. We set out to provide reliable data regarding the benefit of Chinese herbal medicine (CHM) for AML patients, using mortality as the main outcome measure. We also characterized the herbal prescriptions of patients. Methods. Using the Taiwanese National Health Insurance Research Database, we performed a nationwide population-based cohort study among AML patients from 1997 to 2010. The Cox regression model was used to adjust for comorbidities and other variables, and the hazard ratios (HRs) of CHM users and non–CHM users were compared. Results. After 1:1 matching, 498 patients were included into the study. The HR of the CHM group was 0.41 (95% CI = 0.26-0.65; P = .0001) compared with the non-CHM group. This decrease in HR was also shown to be dose dependent ( P < .001). The 3 single-herbs most commonly prescribed were Salvia miltiorrhiza (Dan Shen), Astragalus membranaceus (Huang Qi), and Spatholobus suberectus (Ji Xue Teng). The 3 mutli-herb products most commonly prescribed were Jia Wei Xiao Yao San, Gui Pi Tang, and Qi Ju Di Huang Wan. Conclusion. Prospective controlled clinical data is still needed, however, this study provides real-world data regarding the benefit AML patients may have from CHM. This study suggests that all AML patients, regardless of age or other prognostic factors, may achieve longer survival times when receiving CHM in addition to standard therapy.

Background This retrospective cohort study investigated the risk of major bleeding events during the concurrent use of Chinese herbal medicine (CHM) and anticoagulants in clinical practice. Methods A total of 4,470 patients receiving anticoagulant drugs were selected from Taiwan’s National Health Insurance Research Database (NHIRD). Half (n = 2,235) were also using CHMs (CHM cohort); the other half were not (non-CHM cohort). Each cohort was matched 1:1 using the propensity score. Chi-square testing and the Student’s t-test were used to examine differences between two cohorts. Cox proportional hazard regression analysis assessed the risks for major bleeding events in each cohort, as well as bleeding risks associated with specific CHM formulas and herbs. Cumulative incidence curves for major bleeding events were calculated using Kaplan-Meier analysis. Results Compared with the non-CHM cohort, the CHM cohort had a lower risk of overall bleeding events (p < 0.001) including hemorrhagic stroke (p = 0.008), gastrointestinal (GI) bleeding (p < 0.001), urogenital bleeding (p ≤ 0.001) and nasal/ear/eye bleeding (p = 0.004). Single herbs, such as Glycyrrhiza uralensis et Rhizoma, Panax notoginseng, Panax ginseng, Platycodon grandiflorum, Eucommia ulmoides Oliver and formulas, such as Shu Jing Huo Xue Tang, Shao Yao Gan Cao Tang and Ji Sheng Shen Qi Wan were associated with a lower risk of major bleeding events. Conclusion Using CHMs with anticoagulants appeared to decrease the risk of major bleeding, especially CHMs products containing Glycyrrhiza uralensis et Rhizoma, Panax notoginseng, Panax ginseng, Platycodon grandiflorum and Eucommia ulmoides Oliver. Further investigations are needed to determine whether CHM can maintain the therapeutic efficacy of anticoagulants while simultaneously reducing potential side effects.

Abstract Background: The etiology of lung cancer among never-smokers is unclear despite 15% of cases in men and 53% in women worldwide are not smoking-related. Metabolomics provides a snapshot of dynamic biochemical activities, including those found to be driving tumor formation and progression. This study used untargeted metabolomics with network analysis to agnostically identify network modules and independent metabolites in pre-diagnostic blood samples among never-smokers to further understand the pathogenesis of lung cancer. Methods: Within the prospective Shanghai Women’s Health Study, we conducted a nested case-control study of 395 never-smoking incident lung cancer cases and 395 never-smoking controls matched on age. We performed liquid chromatography high-resolution mass spectrometry to quantify 20,348 unique metabolic features in plasma. Because metabolic features are expected to be highly correlated and more likely to be involved in biological processes as a network of intertwined features than individually, we agnostically constructed 28 network modules using a weighted correlation network analysis approach. The associations between metabolite network modules and individual metabolites with lung cancer were assessed using conditional logistic regression models, adjusting for age, body mass index, and exposure to environmental tobacco smoke. We accounted for multiple testing using a false discovery rate (FDR) &lt; 0.20. Results: We identified a network module of 122 metabolic features enriched in lysophosphatidylethanolamines that was associated with all lung cancer combined (p = 0.001, FDR = 0.028) and lung adenocarcinoma (p = 0.002, FDR = 0.056) and another network module of 440 metabolic features that was associated with lung adenocarcinoma (p = 0.014, FDR = 0.196). Metabolic features were enriched in pathways associated with cell growth and proliferation, including oxidative stress, bile acid biosynthesis, and metabolism of nucleic acids, carbohydrates, and amino acids, including 1-carbon compounds. Conclusions: Our prospective study suggests that untargeted plasma metabolomics in pre-diagnostic samples could provide new insights into the etiology of lung cancer in never-smokers. Replication and further characterization of these associations are warranted. Citation Format: Mohammad L. Rahman, Xiao-Ou Shu, Douglas Walker, Dean P. Jones, Wei Hu, Bu-tian Ji, Batel Blechter, Jason YY Wong, Qiuyin Cai, Gong Yang, Tu-Tang Gao, Wei Zheng, Nathaniel Rothman, Qing Lan. A nested case-control study of untargeted plasma metabolomics and lung cancer risk among never-smoking women in the prospective Shanghai Women’s Health Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6056.

Aqueous rocking chair batteries have attracted attention as highly safe and inexpensive secondary batteries. Lithium and sodium ions have mostly been used as the mobile ions, whereas proton systems with potentially the highest mobility have rarely been reported. Recently, research on proton batteries has been conducted using concentrated sulfuric acid solutions as the electrolyte that can assist high-rate performance.[1] Stability under concentrated acidic conditions is required for the electrode materials, as well as the capability of proton accommodation. MoO3 has been reported as a stable negative electrode material for aqueous proton batteries,[2] while few positive electrode materials are known except for bulky organic[3] and Prussian-blue materials[4]. For achieving high energy density and long life, oxide positive electrode materials are desirable. Here we propose the application of MoO3 as the positive electrode material by optimizing the operating composition range. The potential values shown below are all shown versus SHE (actually measured with Ag/AgCl). MoO3 showed a discharge profile at around 0.5 V with the maximum capacity of ca. 100 mAh g-1, as shown in the figure. This potential is sufficiently more positive than the redox potential of protonated MoO3 of around -0.3 V as the negative electrode. With the aid of operando X-ray diffraction analysis, it turned out that the discharge regions at 0.5 V and 0.4 V are respectively associated with a biphasic transition of MoO3/phase I (ca. 0 < x < 0.3 in H x MoO3) and a single-phase reaction of phase I (ca. 0.3 < x < 0.5 in H x MoO3). Deep discharging beyond this range results in the coexistence of phase I and phase III (ca. 0.5 < x < 1.5 in H x MoO3) and the proton extraction from phase III leads to the formation of phase II or phase IIa with its discharging potential of 0.0 V. Structural calculation based on the density function theory is employed to clarify the origin of this irreversible phase transition behavior. Different proton sites between these phases seem to be responsible. An aqueous proton battery with a 7 mol dm–3 sulfuric acid electrolyte was constructed with H-inserted MoO3 and MoO3as the negative and positive electrodes, respectively, and was successfully discharged and charged repeatedly, with the operating voltage of ca. 0.6 V, indicating the launch of aqueous proton battery composed of oxide active materials. Reference s : [1] J. Li, H. Yan, C. Xu, Y. Liu, X. Zhang, M. Xia, L. Zhang, J. Shu, Nano Energy, 89 (2021) 106400. [2] X. Wang, Y. Xie, K. Tang, C. Wang, C. Yan, Angew. Chem. Int. Ed., 57 (2018) 11569. [3] X. Wang, J. Zhou, W. Tang, Energy Storage Mater., 36 (2021) 1. [4] X. Wu, J. J. Hong, W. Shin, L. Ma, T. Liu, X. Bi, Y. Yuan, Y. Qi, T. W. Surta, W. Huang, J. Neuefeind, T. Wu, P. A. Greaney, J. Lu, X. Ji, Nat. Energy, 4 (2019) 123. Figure 1

BackgroundIxekizumab, a high-affinity monoclonal antibody that selectively targets interleukin-17A, has demonstrated efficacy in global clinical trials in patients with active radiographic axial spondyloarthritis (r-axSpA)/ankylosing spondylitis (AS)[1,2].Rapid onset of clinical improvement is one of the most important needs of treatment for r-axSpA patients.ObjectivesTo evaluate the onset time of ixekizumab in Chinese patients with r-axSpA.MethodsThis report evaluated efficacy onset time of r-axSpA patients treated with ixekizumab compared with placebo based on data from a phase 3 study in China.The major secondary efficacy measures in this report included Assessment of Spondyloarthritis International Society (ASAS) 40 response, ASAS 20 response, change from baseline in Ankylosing Spondylitis Disease Activity Score (ASDAS), change from baseline in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), change from baseline in Bath Ankylosing Spondylitis Functional Index (BASFI), and ASDAS <2.1 response.Other secondary efficacy measures in this report included change from baseline of ASAS individual components (like patient global, Spinal pain, Inflammation, high sensitivity C-reactive protein [hsCRP]), proportion of patients who experience clinically important improvement (change of ASDAS from baseline ≥1.1), major improvement (change of ASDAS from baseline ≥2.0), and BASDAI 50 response. All efficacy measures were evaluated from week 0 through week 52.A logistic regression model and mixed-effects model of repeated measures (MMRM) were used to analyze categorical and continuous measures from week 0 to 16 (placebo-controlled period), and categorical missing data were imputed using non-responder imputation (NRI).ResultsMore patients achieved ASAS40 and ASAS20 response as early as week 1 (p = 0.042 and p < 0.001) in the ixekizumab-treated group compared with placebo.In addition, statistically significant (p < 0.05) improvements were observed as early as week 1 for the ixekizumab group compared to placebo in almost all efficacy measures mentioned above.For other outcomes including proportion of patients who experience major improvement and BASDAI 50 response, differences were evident (p < 0.05) by week 2 in the ixekizumab group compared with placebo.Furthermore, ixekizumab sustained high efficacy in all efficacy measures through 52 weeks.ConclusionIxekizumab demonstrated a rapid onset of efficacy improvements on ASAS response, ASAS core set values, disease activity and function in Chinese patients with r-axSpA.References[1]Désirée van der Heijde, James Cheng-Chung Wei, Maxime Dougados, et al. Ixekizumab, an interleukin-17A antagonist in the treatment of ankylosing spondylitis or radiographic axial spondyloarthritis in patients previously untreated with biological disease modifying anti-rheumatic drugs (COAST-V): 16 week results of a phase 3 randomised, double-blind, active-controlled and placebo-controlled trial.Lancet2018; 392: 2441–51.[2]Deodhar A, Poddubnyy D, Pacheco-Tena C, et al. Efficacy and safety of ixekizumab in the treatment of radiographic axial spondyloarthritis: sixteen-week results from a phase III randomized, double-blind, placebo-controlled trial in patients with prior inadequate response to or intolerance of tumor necrosis factor inhibitors.Arthritis Rheumatol2019; 71:599–611.AcknowledgementsThe author would like to thank Zipei Xiao for medical assistance and Fei Ji for peer review (both of Eli Lilly and Company employees), and all study participants.Disclosure of InterestsYU XUE Consultant of: Yu Xue has been investigator of Eli Lilly and Company, Jiankang Hu Consultant of: Jiankang Hu has been investigator of Eli Lilly and Company, Dongzhou Liu Consultant of: DongZhou Liu has been investigator of Eli Lilly and Company, Jingyang Li Consultant of: Jingyang Li has been investigator of Eli Lilly and Company, Huaxiang Wu Consultant of: Huaxiang Wu has been investigator of Eli Lilly and Company, Chunyu Tan Consultant of: Chunyu Tan has been investigator of Eli Lilly and Company, Lie Dai Consultant of: Lie Dai has been investigator of Eli Lilly and Company, Yan Yan Employee of: Yan Yan is employee of Eli Lilly and Company, Hongying Li Shareholder of: HongYing Li is minor stockholder of Eli lilly and Company, Employee of: HongYing Li is employee of Eli Lilly and Company, Hejian Zou Consultant of: Hejian Zou has been investigator of Eli Lilly and Company.

Abstract Background: The etiology of lung cancer among never-smokers has not been adequately elucidated despite that globally15% of lung cancer cases in men and 53% in women are not smoking-related. Epigenetic modifications, including changes in DNA methylation (DNAm), have been suggested as possible underlying mechanisms. However, only a few prospective epigenome-wide association studies (EWAS) of lung cancer incidence have been conducted, all exclusively focused on DNAm in peripheral blood cells and included a minimal number of never-smokers. We aimed to investigate genome-wide DNAm associations and epigenetic age acceleration with future risk of lung cancer among never-smokers using pre-diagnostic oral rinse samples. Methods: We conducted a case-control study of 80 never-smoking incident lung cancer cases and 83 comparable never-smoking controls nested in two large prospective cohorts: the Shanghai Women’s Health Study and Shanghai Men’s Health Study. DNAm was measured using the Illumina EPIC array. The top 50 differentially methylated positions (DMPs) were identified from a discovery sample and tested for replication in a validation sample using robust linear regression models. We also conducted an EWAS in the pooled sample. We examined functional overlap enrichment across chromatin states and histone mark broadPeaks for the top 1000 DMPs using eFORGE and constructed enrichment biological pathways analyses. Results: Across discovery and pooled EWAS, we identified four DMPs associated with lung cancer at the epigenome-wide significance level of P&lt;8.0x10-8 (cg01411366: SLC9A10, P=7.23x10-08; cg00811020: NAA30, P=3.95x10-08; cg05658193: EIF2A, SERP1, P=5.02x10-08; and cg09198866: unannotated, P=5.39x10-09). The top 1000 DMPs were significantly enriched in epithelial regulatory regions and were associated with small GTPase-mediated signal transduction pathways. Furthermore, epigenetic age acceleration, measured by the GrimAge clock was prospectively associated with an increased risk of lung cancer (OR=1.19 per year of acceleration; 95% CI: 1.06-1.34) in logistic regression models. Conclusions: To our knowledge, this is the first prospective EWAS of lung cancer among never-smokers using oral rinse samples. Our results show that DNAm in pre-diagnostic oral rinse samples can provide new insights into lung cancer etiology and risk factors. Citation Format: Mohammad L. Rahman, Charles E. Breeze, Xiao-Ou Shu, Jason YY Wong, Andres Cardenas, Xuting Wang, Bu-Tian Ji, Wei Hu, Batel Blechter, Qiuyin Cai, H Dean Hosgood, Gong Yang, Jianxin Shi, Jirong Long, Yu-Tang Gao, Douglas Bell, Wei Zheng, Qing Lan, Nathaniel Rothman. Epigenome-wide association study of lung cancer among never-smokers in two prospective cohorts in Shanghai [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3483.

Abstract Background: Previous studies have investigated the association between reproductive factors and lung cancer risk; however, findings have been inconsistent. This study aims to assess the association between reproductive factors with lung cancer incidence and mortality among Asian women. Methods: A total of 308,949 female participants with a mean age of 55.13 from 11 prospective cohorts and four Asian countries (Japan, Korea, China, and Singapore) in the Asia Cohort Consortium (ACC) were included. Cox proportional hazards regression models were used to estimate the hazard ratios (HR) and 95% confidence intervals (CIs). Results: A total of 3,119 primary lung cancer cases and 2,247 lung cancer deaths were identified with a mean follow-up of 16.4 years. Parous women had a lower risk of lung cancer incidence and mortality as compared with nulliparous women, with HRs of 0.82 (95% CI = 0.70 - 0.96) and 0.78 (95% CI = 0.65 - 0.94). Corresponding HRs were lowest among women with 1-2 children, with HRs of 0.78 (95% CI = 0.66 - 0.93) and 0.72 (95% CI = 0.59 - 0.87) for lung cancer incidence and mortality. The protective association of parity and lung cancer incidence was greater among ever-smokers (HR=0.66, 95% CI = 0.49 - 0.87) than in never-smokers (HR=0.90, 95% CI = 0.74 - 1.09) (P-interaction = 0.029). Compared with age at first delivery ≤20 years, older age at first delivery (≥26 years) was associated with a lower risk of lung cancer incidence and mortality. Compared with age at menopause &lt;45 years, older age at menopause (≥55 years) was associated with a decreased risk of lung cancer mortality (HR=0.75, 95% CI = 0.58 - 0.96). Women who ever used hormone replacements had a higher likelihood of developing non-small cell lung cancer (HR = 1.30, 95% CI = 1.01 - 1.67), compared to those who never used hormone replacements. Conclusions: Distinct from Western women, Asian parous women, especially those who have 1-2 children had a lower risk of lung cancer incidence and mortality compared with nulliparous women. Future studies are needed to assess the underlying mechanisms, the relationships within these female reproductive factors, and the potential changes in smoking habits over time. Citation Format: Xin Yin, Rie Kishida, Sarah Krull Abe, Md. Rashedul Islam, Md. Shafiur Rahman, Eiko Saito, Qing Lan, Batel Bletcher, Melissa Merritt, Ji-Yeob Choi, Aesun Shin, Ryoko Katagiri, Xiao-Ou Shu, Norie Sawada, Akiko Tamakoshi, Woon-Puay Koh, Ichiro Tsuji, Chisato Nagata, Sue K. Park, Sun-Seog Kweon, Yu-Tang Gao, Shoichiro Tsugane, Takashi Kimura, Jian-Min Yuan, Yukai Lu, Seiki Kanemura, Yumi Sugawara, Keiko Wada, Min-Ho Shin, Habibul Ahsan, Paolo Boffetta, Kee Seng Chia, Keitaro Matsuo, You-Lin Qiao, Nathaniel Rothman, Wei Zheng, Manami Inoue, Daehee Kang, Wei Jie Seow. Association between reproductive factors with lung cancer incidence and mortality: A pooled analysis of over 308,000 females in the Asia Cohort Consortium. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4200.

Abstract Background: The majority of female lung cancer cases in Asia are never-smokers with distinct risk factor profiles. Given the high burden of disease in this population, there is an increasing need to improve the understanding of lung cancer. Current risk models for lung cancer focus on active smokers and individuals of European ancestry. Therefore, we developed statistical models by integrating genetic and environmental risk factors to estimate absolute and population attribute risk of lung cancer among never-smoking women in Asia. Methods: We built absolute risk models for lung cancer among never-smoking women using data from 71,300 women (760 incident cases) in the Shanghai Women’s Health Study (SWHS), a population-based prospective cohort study. Relative risks were estimated using a multivariable Cox regression model with questionnaire-based risk factors. To account for missing genetic data for some subjects, we simulated genotypes for 10 common single nucleotide polymorphisms (SNP) using information on minor allele frequencies (MAF) and odds ratio estimates from previous genome-wide association studies (GWAS), conditional on family history of lung cancer. We used the iCARE tool to build two models for predicting lifetime (40 years) and 6-year absolute risk of lung cancer using age-specific lung cancer incidence rates, age-specific competing mortality rates, and risk factor distribution with: 1) questionnaire-based risk factors only and 2) questionnaire and genetic data. We then used the full absolute risk model to estimate the population attributable risk (PAR) due to modifiable risk factors, namely coal use and exposure to environmental tobacco smoke (ETS). Results: The questionnaire-based only model included family history of lung cancer, coal use, exposure to ETS, and body mass index (BMI). The full model also included data on 10 lung cancer related SNPs from our previous GWAS and had a wider spread in distribution of absolute lifetime risk (median=2.41%; range=0.43-12.36) compared to the questionnaire-based only model (median=2.72%; range=1.93-4.87). We used the full model to estimate the PAR and found that 1.74% and 6.33% of lung cancer cases could be prevented if never-smoking women in Shanghai did not use coal and were not exposed to ETS, respectively. Furthermore, we found that the full model estimated that 2.5% of the study population had a 6-year absolute risk of lung cancer higher than 1.51%, which is the suggested risk threshold for screening by existing risk models. Conclusion: We built risk models for never-smoking Asian women and estimated the contribution of coal use and ETS to the burden of lung cancer in Shanghai. This initial work shows promise for expanding and validating risk models in this population with potential translational implications, such as providing insight to identifying high risk individuals that may be eligible for lung cancer screening and primary prevention efforts. Citation Format: Batel Blechter, Parichoy Pal Choudhury, Xiao-ou Shu, Wei Zheng, Qiuyin Cai, Gong Yang, Jason Y.Y. Wong, Bu-Tian Ji, Wei Hu, Anne Rositch, Nilanjan Chatterjee, Nathaniel Rothman, Qing Lan. Risk models for lung cancer in never-smoking women in Shanghai with implications for screening [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2254.

Objectives: Patients with rheumatoid arthritis (RA) are at a higher risk of extra-articular manifestations, especially hearing loss (HL). Although Chinese herbal medicines (CHM) are proven safe and effective treatments for inflammatory conditions, the effect of CHM use on HL in RA patients is unknown. This cohort study aims to determine the relationship between CHM use and the subsequent risk of HL among RA patients.Methods: From health insurance claims data in Taiwan, a total of 6,905 persons aged 20–80 years with newly-diagnosed RA in 2000–2009 were identified. Of these, we recruited 2,765 CHM users and randomly selected 2,765 non-CHM users who matched with the users by the propensity score. Both cohorts were followed up until the end of 2012 to estimate the incidence of HL. Cox proportional hazards regression was used to estimate the adjusted hazard ratio (HR) for HL.Results: The incidence of HL was lower in the CHM users than in the comparison cohort (8.06 vs. 10.54 per 1,000 person-years) (adjusted HR, 0.77; 95% CI, 0.63–0.94). Those who received CHM for more than 2 years had the greatest benefit against the onset of HL, with over 50% risk reduction. Prescriptions of Hai Piao Xiao, Yan Hu Suo, San-Qi, Huang Qin, Dang Shen, Jia-Wei-Xiao-Yao-San, Shu-Jing-Huo-Xue-Tang, and Dang-Gui-Nian-Tong-Tang were found to be associated with a reduced risk of HL.Conclusions: Our findings suggest that adding CHM to conventional therapy may reduce the subsequent risk of HL in RA patients. Prospective randomized trials are recommended to further clarify whether the association revealed in this study supports such a causal relationship.

Ethnopharmacology relevance: Yunnan Baiyao (YNBY), a traditional Chinese medicine formulae, has some significant properties including activating blood circulation to dissipate blood stasis (Huo-Xue-Hua-Yu), eliminating swelling and alleviating pain (Xiao-Zhong-Zhi-Tong), and eliminating necrotic tissues and promoting granulation (Qu-Fu-Sheng-Ji).Aim of this study: This paper intends to provide a comprehensive and critical analysis of studies on YNBY, proposing new possible therapeutic directions of this formula.Materials and methods: Relevant data on YNBY were retrieved from available databases and a hand-search by searching the keywords such as “Yunnan Baiyao,” “pharmacology,” “toxicity,” and “clinical applications.”Results: Traditionally, YNBY has been used to cure hemorrhage, bruises, swelling, and pain caused by injuries in the Chinese folk. Modern pharmacological studies show that YNBY possesses pharmacological activities including hemostasis, invigorating the circulation of blood, wound healing, anti-inflammation, analgesia, antibiosis, infection prevention, and other effects. Toxicological studies demonstrate that YNBY has a certain toxicology, which is mainly caused by Aconitum alkaloids from Cao-wu (CW, Aconiti Kusnezoffii Radix). The developmental non-toxic reaction dose (NOAEL) of YNBY for embryos and fetuses is 0.5 g/kg in rats. In addition, the NOAEL for fertility and early embryo development toxicity is 4.0 g/kg in rats. Clinical trials have confirmed the safety of YNBY in a large number of patients, and adverse drug reactions (ADRs) such as abdominal pain, diarrhea, allergy, and others in very few people. YNBY is routinely used in clinic to cure bleeding, pain, swelling, upper digestive tract ulcer, postoperative wound, arthritis, mouth ulcers, ulcerative colitis, etc.Conclusions: Hemostasis is a conspicuous effect of YNBY. Except for this effect, analgesia and anti-infection may be new research directions of this formula. In addition, the in vitro and in vivo pharmacology and mechanisms of action of YNBY are encouraged as well as the pharmacokinetics of this formulae. Furthermore, the material basis of the pharmacological effects of YNBY also needs clear identification.

IntroductionIn this article, I set out to accomplish two tasks. The first is to map coffee and cafés in Mainland China in different historical periods. The second is to focus on coffee and cafés in the socio-cultural milieu of contemporary China in order to understand the symbolic value of the emerging coffee/café-scape. Cafés, rather than coffee, are at the centre of this current trend in contemporary Chinese cities. With instant coffee dominating as a drink, the Chinese have developed a cultural and social demand for cafés, but have not yet developed coffee palates. Historical Coffee Map In 1901, coffee was served in a restaurant in the city of Tianjin. This restaurant, named Kiessling, was run by a German chef, a former solider who came to China with the eight-nation alliance. At that time, coffee was reserved mostly for foreign politicians and military officials as well as wealthy businessmen—very few ordinary Chinese drank it. (For more history of Kiessling, including pictures and videos, see Kiessling). Another group of coffee consumers were from the cultural elites—the young revolutionary intellectuals and writers with overseas experience. It was almost a fashion among the literary elite to spend time in cafés. However, this was negatively judged as “Western” and “bourgeois.” For example, in 1932, Lu Xun, one of the most important twentieth century Chinese writers, commented on the café fashion during 1920s (133-36), and listed the reasons why he would not visit one. He did not drink coffee because it was “foreigners’ food”, and he was too busy writing for the kind of leisure enjoyed in cafés. Moreover, he did not, he wrote, have the nerve to go to a café, and particularly not the Revolutionary Café that was popular among cultural celebrities at that time. He claimed that the “paradise” of the café was for genius, and for handsome revolutionary writers (who he described as having red lips and white teeth, whereas his teeth were yellow). His final complaint was that even if he went to the Revolutionary Café, he would hesitate going in (Lu Xun 133-36). From Lu Xun’s list, we can recognise his nationalism and resistance to what were identified as Western foods and lifestyles. It is easy to also feel his dissatisfaction with those dilettante revolutionary intellectuals who spent time in cafés, talking and enjoying Western food, rather than working. In contrast to Lu Xun’s resistance to coffee and café culture, another well-known writer, Zhang Ailing, frequented cafés when she lived in Shanghai from the 1920s to 1950s. She wrote about the smell of cakes and bread sold in Kiessling’s branch store located right next to her parents’ house (Yuyue). Born into a wealthy family, exposed to Western culture and food at a very young age, Zhang Ailing liked to spend her social and writing time in cafés, ordering her favourite cakes, hot chocolate, and coffee. When she left Shanghai and immigrated to the USA, coffee was an important part of her writing life: the smell and taste reminding her of old friends and Shanghai (Chunzi). However, during Zhang’s time, it was still a privileged and elite practice to patronise a café when these were located in foreign settlements with foreign chefs, and served mainly foreigners, wealthy businessmen, and cultural celebrities. After 1949, when the Chinese Communist Party established the People’s Republic of China, until the late 1970s, there were no coffee shops in Mainland China. It was only when Deng Xiaoping suggested neo-liberalism as a so-called “reform-and-open-up” economic policy that foreign commerce and products were again seen in China. In 1988, ten years after the implementation of Deng Xiaoping’s policy, the Nestlé coffee company made the first inroads into the mainland market, featuring homegrown coffee beans in Yunnan province (China Beverage News; Dong; ITC). Nestlé’s bottled instant coffee found its way into the Chinese market, avoiding a direct challenge to the tea culture. Nestlé packaged its coffee to resemble health food products and marketed it as a holiday gift suitable for friends and relatives. As a symbol of modernity and “the West”, coffee-as-gift meshed with the traditional Chinese cultural custom that values gift giving. It also satisfied a collective desire for foreign products (and contact with foreign cultures) during the economic reform era. Even today, with its competitively low price, instant coffee dominates coffee consumption at home, in the workplace, and on Chinese airlines. While Nestlé aimed their product at native Chinese consumers, the multinational companies who later entered China’s coffee market, such as Sara Lee, mainly targeted international hotels such as IHG, Marriott, and Hyatt. The multinationals also favoured coffee shops like Kommune in Shanghai that offered more sophisticated kinds of coffee to foreign consumers and China’s upper class (Byers). If Nestlé introduced coffee to ordinary Chinese families, it was Starbucks who introduced the coffee-based “third space” to urban life in contemporary China on a signficant scale. Differing from the cafés before 1949, Starbucks stores are accessible to ordinary Chinese citizens. The first in Mainland China opened in Beijing’s China World Trade Center in January 1999, targeting mainly white-collar workers and foreigners. Starbucks coffee shops provide a space for informal business meetings, chatting with friends, and relaxing and, with its 500th store opened in 2011, dominate the field in China. Starbucks are located mainly in the central business districts and airports, and the company plans to have 1,500 sites by 2015 (Starbucks). Despite this massive presence, Starbucks constitutes only part of the café-scape in contemporary Chinese cities. There are two other kinds of cafés. One type is usually located in universities or residential areas and is frequented mainly by students or locals working in cultural professions. A representative of this kind is Sculpting in Time Café. In November 1997, two years before the opening of the first Starbucks in Beijing, two newlywed college graduates opened the first small Sculpting in Time Café near Beijing University’s East Gate. This has been expanded into a chain, and boasts 18 branches on the Mainland. (For more about its history, see Sculpting in Time Café). Interestingly, both Starbucks and Sculpting in Time Café acquired their names from literature, Starbucks from Moby Dick, and Sculpting in Time from the Russian filmmaker Andrei Tarkovsky’s film diary of the same name. For Chinese students of literature and the arts, drinking coffee is less about acquiring more energy to accomplish their work, and more about entering a sensual world, where the aroma of coffee mixes with the sounds from the coffee machine and music, as well as the lighting of the space. More importantly, cafés with this ambience become, in themselves, cultural sites associated with literature, films, and music. Owners of this kind of café are often lovers of foreign literatures, films, and cultures, and their cafés host various cultural events, including forums, book clubs, movie screenings, and music clubs. Generally speaking, coffee served in this kind of café is simpler than in the kind discussed below. This third type of café includes those located in tourist and entertainment sites such as art districts, bar areas, and historical sites, and which are frequented by foreign and native tourists, artists and other cultural workers. If Starbucks cultivates a fast-paced business/professional atmosphere, and Sculpting in Time Cafés an artsy and literary atmosphere, this third kind of café is more like an upscale “bar” with trained baristas serving complicated coffees and emphasising their flavour. These coffee shops are more expensive than the other kinds, with an average price three times that of Starbucks. Currently, cafés of this type are found only in “first-tier” cities and usually located in art districts and tourist areas—such as Beijing’s 798 Art District and Nanluo Guxiang, Shanghai’s Tai Kang Road (a.k.a. “the art street”), and Hangzhou’s Westlake area. While Nestlé and Starbucks use coffee beans grown in Yunnan provinces, these “art cafés” are more inclined to use imported coffee beans from suppliers like Sara Lee. Coffee and Cafés in Contemporary China After just ten years, there are hundreds of cafés in Chinese cities. Why has there been such a demand for coffee or, more accurately, cafés, in such a short period of time? The first reason is the lack of “third space” environments in Mainland China. Before cafés appeared in the late 1990s, stores like KFC (which opened its first store in 1987) and McDonald’s (with its first store opened in 1990) filled this role for urban residents, providing locations where customers could experience Western food, meet friends, work, or read. In fact, KFC and McDonald’s were once very popular with college students looking for a place to study. Both stores had relatively clean food environments and good lighting. They also had air conditioning in the summer and heating in the winter, which are not provided in most Chinese university dormitories. However, since neither chain was set up to be a café and customers occupying seats for long periods while ordering minimal amounts of food or drink affected profits, staff members began to indirectly ask customers to leave after dining. At the same time, as more people were able to afford to eat at KFC and McDonald’s, their fast foods were also becoming more and more popular, especially among young people. As a consequence, both types of chain restaurant were becoming noisy and crowded and, thus, no longer ideal for reading, studying, or meeting with friends. Although tea has been a traditional drink in Chinese culture, traditional teahouses were expensive places more suitable for business meetings or for the cultural or intellectual elite. Since almost every family owns a tea set and can readily purchase tea, friends and family would usually make and consume tea at home. In recent years, however, new kinds of teahouses have emerged, similar in style to cafés, targeting the younger generation with more affordable prices and a wider range of choices, so the lack of a “third space” does not fully explain the café boom. Another factor affecting the popularity of cafés has been the development and uptake of Internet technology, including the increasing use of laptops and wireless Internet in recent years. The Internet has been available in China since the late 1990s, while computers and then laptops entered ordinary Chinese homes in the early twenty-first century. The IT industry has created not only a new field of research and production, but has also fostered new professions and demands. Particularly, in recent years in Mainland China, a new socially acceptable profession—freelancing in such areas as graphic design, photography, writing, film, music, and the fashion industry—has emerged. Most freelancers’ work is computer- and Internet-based. Cafés provide suitable working space, with wireless service, and the bonus of coffee that is, first of all, somatically stimulating. In addition, the emergence of the creative and cultural industries (which are supported by the Chinese government) has created work for these freelancers and, arguably, an increasing demand for café-based third spaces where such people can meet, talk and work. Furthermore, the flourishing of cafés in first-tier cities is part of the “aesthetic economy” (Lloyd 24) that caters to the making and selling of lifestyle experience. Alongside foreign restaurants, bars, galleries, and design firms, cafés contribute to city branding, and link a city to the global urban network. Cafés, like restaurants, galleries and bars, provide a space for the flow of global commodities, as well as for the human flow of tourists, travelling artists, freelancers, and cultural specialists. Finally, cafés provide a type of service that contributes to friendly owner/waiter-customer relations. During the planned-economy era, most stores and hotels in China were State-owned, staff salaries were not related to individual performance, and indifferent (and even unfriendly) service was common. During the economic reform era, privately owned stores and shops began to replace State-owned ones. At the same time, a large number of people from the countryside flowed into the cities seeking opportunities. Most had little if any professional training and so could only find work in factories or in the service industry. However, most café employees are urban, with better educational backgrounds, and many were already familiar with coffee culture. In addition, café owners, particularly those of places like Sculpting in Time Cafe, often invest in creating a positive, community atmosphere, learning about their customers and sharing personal experiences with their regular clients. This leads to my next point—the generation of the 1980s’ need for a social community. Cafés’ Symbolic Value—Community A demand for a sense of community among the generation of the 1980s is a unique socio-cultural phenomenon in China, which paradoxically co-exists with their desire for individualism. Mao Zedong started the “One Child Policy” in 1979 to slow the rapid population growth in China, and the generations born under this policy are often called “the lonely generations,” with both parents working full-time. At the same time, they are “the generation of me,” labelled as spoiled, self-centred, and obsessed with consumption (de Kloet; Liu; Rofel; Wang). The individuals of this generation, now aged in their 20s and 30s, constitute the primary consumers of coffee in China. Whereas individualism is an important value to them, a sense of community is also desirable in order to compensate for their lack of siblings. Furthermore, the 1980s’ generation has also benefitted from the university expansion policy implemented in 1999. Since then, China has witnessed a surge of university students and graduates who not only received scientific and other course-based knowledge, but also had a better chance to be exposed to foreign cultures through their books, music, and movies. With this interesting tension between individualism and collectivism, the atmosphere provided by cafés has fostered a series of curious temporary communities built on cultural and culinary taste. Interestingly, it has become an aspiration of many young college students and graduates to open a community-space style café in a city. One of the best examples is the new Henduoren’s (Many People’s) Café. This was a project initiated by Wen Erniu, a recent college graduate who wanted to open a café in Beijing but did not have sufficient funds to do so. She posted a message on the Internet, asking people to invest a minimum of US$316 to open a café with her. With 78 investors, the café opened in September 2011 in Beijing (see pictures of Henduoren’s Café). In an interview with the China Daily, Wen Erniu stated that, “To open a cafe was a dream of mine, but I could not afford it […] We thought opening a cafe might be many people’s dream […] and we could get together via the Internet to make it come true” (quoted in Liu 2011). Conclusion: Café Culture and (Instant) Coffee in China There is a Chinese saying that, if you hate someone—just persuade him or her to open a coffee shop. Since cafés provide spaces where one can spend a relatively long time for little financial outlay, owners have to increase prices to cover their expenses. This can result in fewer customers. In retaliation, cafés—particularly those with cultural and literary ambience—host cultural events to attract people, and/or they offer food and wine along with coffee. The high prices, however, remain. In fact, the average price of coffee in China is often higher than in Europe and North America. For example, a medium Starbucks’ caffè latte in China averaged around US$4.40 in 2010, according to the price list of a Starbucks outlet in Shanghai—and the prices has recently increased again (Xinhua 2012). This partially explains why instant coffee is still so popular in China. A bag of instant Nestlé coffee cost only some US$0.25 in a Beijing supermarket in 2010, and requires only hot water, which is accessible free almost everywhere in China, in any restaurant, office building, or household. As an habitual, addictive treat, however, coffee has not yet become a customary, let alone necessary, drink for most Chinese. Moreover, while many, especially those of the older generations, could discern the quality and varieties of tea, very few can judge the quality of the coffee served in cafés. As a result, few Mainland Chinese coffee consumers have a purely somatic demand for coffee—craving its smell or taste—and the highly sweetened and creamed instant coffee offered by companies like Nestlé or Maxwell has largely shaped the current Chinese palate for coffee. Ben Highmore has proposed that “food spaces (shops, restaurants and so on) can be seen, for some social agents, as a potential space where new ‘not-me’ worlds are encountered” (396) He continues to expand that “how these potential spaces are negotiated—the various affective registers of experience (joy, aggression, fear)—reflect the multicultural shapes of a culture (its racism, its openness, its acceptance of difference)” (396). Cafés in contemporary China provide spaces where one encounters and constructs new “not-me” worlds, and more importantly, new “with-me” worlds. While café-going communicates an appreciation and desire for new lifestyles and new selves, it can be hoped that in the near future, coffee will also be appreciated for its smell, taste, and other benefits. Of course, it is also necessary that future Chinese coffee consumers also recognise the rich and complex cultural, political, and social issues behind the coffee economy in the era of globalisation. 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The curtain rose. The howling of desert wind filled the performance hall in the Shanghai Grand Theatre. Into the center stage, where a scenic construction of a mountain cliff and a desert landscape was dimly lit, entered the character of the Daoist priest Wang Yuanlu (1849–1931), performed by Chen Yizong. Dressed in a worn and dusty outfit of dark blue cotton, characteristic of Daoist priests, Wang began to sweep the floor. After a few moments, he discovered a hidden chambre sealed inside one of the rock sanctuaries carved into the cliff.Signaled by the quick, crystalline, stirring wave of sound from the chimes, a melodious Chinese ocarina solo joined in slowly from the background. Astonished by thousands of Buddhist sūtra scrolls, wall paintings, and sculptures he had just accidentally discovered in the caves, Priest Wang set his broom aside and began to examine these treasures. Dawn had not yet arrived, and the desert sky was pitch-black. Priest Wang held his oil lamp high, strode rhythmically in excitement, sat crossed-legged in a meditative pose, and unfolded a scroll. The sound of the ocarina became fuller and richer and the texture of the music more complex, as several other instruments joined in.Below is the opening scene of the award-winning, theatrical dance-drama Dunhuang, My Dreamland, created by China’s state-sponsored Lanzhou Song and Dance Theatre in 2000. Figure 1a: Poster Side A of Dunhuang, My Dreamland Figure 1b: Poster Side B of Dunhuang, My DreamlandThe scene locates the dance-drama in the rock sanctuaries that today are known as the Dunhuang Mogao Caves, housing Buddhist art accumulated over a period of a thousand years, one of the best well-known UNESCO heritages on the Silk Road. Historically a frontier metropolis, Dunhuang was a strategic site along the Silk Road in northwestern China, a crossroads of trade, and a locus for religious, cultural, and intellectual influences since the Han dynasty (206 B.C.E.–220 C.E.). Travellers, especially Buddhist monks from India and central Asia, passing through Dunhuang on their way to Chang’an (present day Xi’an), China’s ancient capital, would stop to meditate in the Mogao Caves and consult manuscripts in the monastery's library. At the same time, Chinese pilgrims would travel by foot from China through central Asia to Pakistan, India, Nepal, Bangladesh, and Sri Lanka, playing a key role in the exchanges between ancient China and the outside world. Travellers from China would stop to acquire provisions at Dunhuang before crossing the Gobi Desert to continue on their long journey abroad. Figure 2: Dunhuang Mogao CavesThis article approaches the idea of “abroad” by examining the present-day imagination of journeys along the Silk Road—specifically, staged performances of the various Silk Road journey-themed dance-dramas sponsored by the Chinese state for enhancing its cultural and foreign policies since the 1970s (Kuang).As ethnomusicologists have demonstrated, musicians, choreographers, and playwrights often utilise historical materials in their performances to construct connections between the past and the present (Bohlman; Herzfeld; Lam; Rees; Shelemay; Tuohy; Wade; Yung: Rawski; Watson). The ancient Silk Road, which linked the Mediterranean coast with central China and beyond, via oasis towns such as Samarkand, has long been associated with the concept of “journeying abroad.” Journeys to distant, foreign lands and encounters of unknown, mysterious cultures along the Silk Road have been documented in historical records, such as A Record of Buddhist Kingdoms (Faxian) and The Great Tang Records on the Western Regions (Xuanzang), and illustrated in classical literature, such as The Travels of Marco Polo (Polo) and the 16th century Chinese novel Journey to the West (Wu). These journeys—coming and going from multiple directions and to different destinations—have inspired contemporary staged performance for audiences around the globe.Home and Abroad: Dunhuang and the Silk RoadDunhuang, My Dreamland (2000), the contemporary dance-drama, staged the journey of a young pilgrim painter travelling from Chang’an to a land of the unfamiliar and beyond borders, in search for the arts that have inspired him. Figure 3: A scene from Dunhuang, My Dreamland showing the young pilgrim painter in the Gobi Desert on the ancient Silk RoadFar from his home, he ended his journey in Dunhuang, historically considered the northwestern periphery of China, well beyond Yangguan and Yumenguan, the bordering passes that separate China and foreign lands. Later scenes in Dunhuang, My Dreamland, portrayed through multiethnic music and dances, the dynamic interactions among merchants, cultural and religious envoys, warriors, and politicians that were making their own journey from abroad to China. The theatrical dance-drama presents a historically inspired, re-imagined vision of both “home” and “abroad” to its audiences as they watch the young painter travel along the Silk Road, across the Gobi Desert, arriving at his own ideal, artistic “homeland”, the Dunhuang Mogao Caves. Since his journey is ultimately a spiritual one, the conceptualisation of travelling “abroad” could also be perceived as “a journey home.”Staged more than four hundred times since it premiered in Beijing in April 2000, Dunhuang, My Dreamland is one of the top ten titles in China’s National Stage Project and one of the most successful theatrical dance-dramas ever produced in China. With revenue of more than thirty million renminbi (RMB), it ranks as the most profitable theatrical dance-drama ever produced in China, with a preproduction cost of six million RMB. The production team receives financial support from China’s Ministry of Culture for its “distinctive ethnic features,” and its “aim to promote traditional Chinese culture,” according to Xu Rong, an official in the Cultural Industry Department of the Ministry. Labeled an outstanding dance-drama of the Chinese nation, it aims to present domestic and international audiences with a vision of China as a historically multifaceted and cosmopolitan nation that has been in close contact with the outside world through the ancient Silk Road. Its production company has been on tour in selected cities throughout China and in countries abroad, including Austria, Spain, and France, literarily making the young pilgrim painter’s “journey along the Silk Road” a new journey abroad, off stage and in reality.Dunhuang, My Dreamland was not the first, nor is it the last, staged performances that portrays the Chinese re-imagination of “journeying abroad” along the ancient Silk Road. It was created as one of many versions of Dunhuang bihua yuewu, a genre of music, dance, and dramatic performances created in the early twentieth century and based primarily on artifacts excavated from the Mogao Caves (Kuang). “The Mogao Caves are the greatest repository of early Chinese art,” states Mimi Gates, who works to increase public awareness of the UNESCO site and raise funds toward its conservation. “Located on the Chinese end of the Silk Road, it also is the place where many cultures of the world intersected with one another, so you have Greek and Roman, Persian and Middle Eastern, Indian and Chinese cultures, all interacting. Given the nature of our world today, it is all very relevant” (Pollack). As an expressive art form, this genre has been thriving since the late 1970s contributing to the global imagination of China’s “Silk Road journeys abroad” long before Dunhuang, My Dreamland achieved its domestic and international fame. For instance, in 2004, The Thousand-Handed and Thousand-Eyed Avalokiteśvara—one of the most representative (and well-known) Dunhuang bihua yuewu programs—was staged as a part of the cultural program during the Paralympic Games in Athens, Greece. This performance, as well as other Dunhuang bihua yuewu dance programs was the perfect embodiment of a foreign religion that arrived in China from abroad and became Sinicized (Kuang). Figure 4: Mural from Dunhuang Mogao Cave No. 45A Brief History of Staging the Silk Road JourneysThe staging of the Silk Road journeys abroad began in the late 1970s. Historically, the Silk Road signifies a multiethnic, cosmopolitan frontier, which underwent incessant conflicts between Chinese sovereigns and nomadic peoples (as well as between other groups), but was strongly imbued with the customs and institutions of central China (Duan, Mair, Shi, Sima). In the twentieth century, when China was no longer an empire, but had become what the early 20th-century reformer Liang Qichao (1873–1929) called “a nation among nations,” the long history of the Silk Road and the colourful, legendary journeys abroad became instrumental in the formation of a modern Chinese nation of unified diversity rooted in an ancient cosmopolitan past. The staged Silk Road theme dance-dramas thus participate in this formation of the Chinese imagination of “nation” and “abroad,” as they aestheticise Chinese history and geography. History and geography—aspects commonly considered constituents of a nation as well as our conceptualisations of “abroad”—are “invariably aestheticized to a certain degree” (Bakhtin 208). Diverse historical and cultural elements from along the Silk Road come together in this performance genre, which can be considered the most representative of various possible stagings of the history and culture of the Silk Road journeys.In 1979, the Chinese state officials in Gansu Province commissioned the benchmark dance-drama Rain of Flowers along the Silk Road, a spectacular theatrical dance-drama praising the pure and noble friendship which existed between the peoples of China and other countries in the Tang dynasty (618-907 C.E.). While its plot also revolves around the Dunhuang Caves and the life of a painter, staged at one of the most critical turning points in modern Chinese history, the work as a whole aims to present the state’s intention of re-establishing diplomatic ties with the outside world after the Cultural Revolution. Unlike Dunhuang, My Dreamland, it presents a nation’s journey abroad and home. To accomplish this goal, Rain of Flowers along the Silk Road introduces the fictional character Yunus, a wealthy Persian merchant who provides the audiences a vision of the historical figure of Peroz III, the last Sassanian prince, who after the Arab conquest of Iran in 651 C.E., found refuge in China. By incorporating scenes of ethnic and folk dances, the drama then stages the journey of painter Zhang’s daughter Yingniang to Persia (present-day Iran) and later, Yunus’s journey abroad to the Tang dynasty imperial court as the Persian Empire’s envoy.Rain of Flowers along the Silk Road, since its debut at Beijing’s Great Hall of the People on the first of October 1979 and shortly after at the Theatre La Scala in Milan, has been staged in more than twenty countries and districts, including France, Italy, Japan, Thailand, Russia, Latvia, Hong Kong, Macao, Taiwan, and recently, in 2013, at the Lincoln Center for the Performing Arts in New York.“The Road”: Staging the Journey TodayWithin the contemporary context of global interdependencies, performing arts have been used as strategic devices for social mobilisation and as a means to represent and perform modern national histories and foreign policies (Davis, Rees, Tian, Tuohy, Wong, David Y. H. Wu). The Silk Road has been chosen as the basis for these state-sponsored, extravagantly produced, and internationally staged contemporary dance programs. In 2008, the welcoming ceremony and artistic presentation at the Olympic Games in Beijing featured twenty apsara dancers and a Dunhuang bihua yuewu dancer with long ribbons, whose body was suspended in mid-air on a rectangular LED extension held by hundreds of performers; on the giant LED screen was a depiction of the ancient Silk Road.In March 2013, Chinese president Xi Jinping introduced the initiatives “Silk Road Economic Belt” and “21st Century Maritime Silk Road” during his journeys abroad in Kazakhstan and Indonesia. These initiatives are now referred to as “One Belt, One Road.” The State Council lists in details the policies and implementation plans for this initiative on its official web page, www.gov.cn. In April 2013, the China Institute in New York launched a yearlong celebration, starting with "Dunhuang: Buddhist Art and the Gateway of the Silk Road" with a re-creation of one of the caves and a selection of artifacts from the site. In March 2015, the National Development and Reform Commission (NDRC), China’s top economic planning agency, released a new action plan outlining key details of the “One Belt, One Road” initiative. Xi Jinping has made the program a centrepiece of both his foreign and domestic economic policies. One of the central economic strategies is to promote cultural industry that could enhance trades along the Silk Road.Encouraged by the “One Belt, One Road” policies, in March 2016, The Silk Princess premiered in Xi’an and was staged at the National Centre for the Performing Arts in Beijing the following July. While Dunhuang, My Dreamland and Rain of Flowers along the Silk Road were inspired by the Buddhist art found in Dunhuang, The Silk Princess, based on a story about a princess bringing silk and silkworm-breeding skills to the western regions of China in the Tang Dynasty (618-907) has a different historical origin. The princess's story was portrayed in a woodblock from the Tang Dynasty discovered by Sir Marc Aurel Stein, a British archaeologist during his expedition to Xinjiang (now Xinjiang Uygur autonomous region) in the early 19th century, and in a temple mural discovered during a 2002 Chinese-Japanese expedition in the Dandanwulike region. Figure 5: Poster of The Silk PrincessIn January 2016, the Shannxi Provincial Song and Dance Troupe staged The Silk Road, a new theatrical dance-drama. Unlike Dunhuang, My Dreamland, the newly staged dance-drama “centers around the ‘road’ and the deepening relationship merchants and travellers developed with it as they traveled along its course,” said Director Yang Wei during an interview with the author. According to her, the show uses seven archetypes—a traveler, a guard, a messenger, and so on—to present the stories that took place along this historic route. Unbounded by specific space or time, each of these archetypes embodies the foreign-travel experience of a different group of individuals, in a manner that may well be related to the social actors of globalised culture and of transnationalism today. Figure 6: Poster of The Silk RoadConclusionAs seen in Rain of Flowers along the Silk Road and Dunhuang, My Dreamland, staging the processes of Silk Road journeys has become a way of connecting the Chinese imagination of “home” with the Chinese imagination of “abroad.” Staging a nation’s heritage abroad on contemporary stages invites a new imagination of homeland, borders, and transnationalism. Once aestheticised through staged performances, such as that of the Dunhuang bihua yuewu, the historical and topological landscape of Dunhuang becomes a performed narrative, embodying the national heritage.The staging of Silk Road journeys continues, and is being developed into various forms, from theatrical dance-drama to digital exhibitions such as the Smithsonian’s Pure Land: Inside the Mogao Grottes at Dunhuang (Stromberg) and the Getty’s Cave Temples of Dunhuang: Buddhist Art on China's Silk Road (Sivak and Hood). 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