‘Half-Match’ Bone Marrow Transplants Cure Sickle Cell in Trial

In her mid-20s, Yetunde Felix-Ukwu wore a Fentanyl patch that delivered enough narcotic to knock most adults out cold. Yet it barely kept her pain, caused by sickle cell disease, tolerable.

Even with the patch, she was hospitalized almost every month for the pain, which she said was “like being hit with a hammer, searing, throbbing, you name it.”

A debilitating genetic disorder, sickle-cell disease causes blood cells to be shaped like sickles, or crescents, and to be rigid, not pliable. Rather than squeezing in and out of capillaries and blood vessels as normal cells do, the sickle cells jam up, depriving tissues throughout the body of blood and oxygen. That can cause severe organ damage, stroke, blindness and unimaginable pain.

“Imagine heart attack pain all over the body,” said Dr. Robert A. Brodsky, director of the division of hematology at Johns Hopkins University School of Medicine. Many patients don’t live past 50.

A bone marrow transplant could help. The problem is, most patients, including Ms. Felix-Ukwu, cannot get a bone marrow transplant because they don’t have a perfect genetic match. Like a vast majority of others who have sickle cell disease, Ms. Felix-Ukwu is African-American, and the chance of an African-American finding a donor in bone marrow registries is about 10 percent, compared with a 60 to 70 percent chance for Caucasians, Dr. Brodsky said.

Dr. Brodsky and his colleagues at Johns Hopkins, however, began a bone marrow transplant trial using so-called half-match donors. The trial has found that the procedure can cure sickle cell, replacing defective stem cells that produce sickle-shaped cells with normal stem cells that churn out plump, pliable blood cells.

Since almost everyone with a sibling, a parent or a child has a genetic half match, the procedure could make bone marrow transplants available to more than 90 percent of candidates.

“It opens the opportunity for a cure for thousands of adults with the disease who previously had not had any hope of a cure,” said Dr. Michael DeBaun, director of the Center for Excellence in Sickle Cell Disease at Vanderbilt University School of Medicine. Dr. DeBaun was not involved with the half-match trial.

Beginning in high school, Ms. Felix-Ukwu, now 30, had undergone regular transfusions to dilute and temporarily replace the sickle cells in her blood, but the transfusions stopped helping. Half-match donors have been used for about a decade in bone marrow transplants for leukemia and lymphoma patients, and the doctors believed it was now safe enough to use in sickle cell patients.

Ms. Felix-Ukwu, who lives in Lanham, Md., enrolled in the Johns Hopkins study, and her younger sister, Woma Felix-Ukwu, became her half-matched bone marrow donor.

Ms. Felix-Ukwu had to undergo a grueling course of chemotherapy, radiation and immunosuppresants before receiving the transplant.

“Those three days of chemo were the hardest days of my life, including all the pain I had been through with sickle cell,” she said. But it worked. Her body started producing normal blood cells. She continued to have some pain for another 18 months or so, for reasons that are not entirely clear, but now, three years after the transplant, Ms. Felix-Ukwu is disease-free and off all of her pain medications.

“It’s absolutely amazing,” says Dr. Brodsky, who published the study this month in Blood, the journal of the American Society of Hematology. Of the 14 patients in the study who received half-matched transplants, six were cured, meaning that their bone marrow is made up entirely of the donor’s and they are no longer producing sickle cells.

Two additional patients are still taking immunosuppressive drugs, meaning that the donor’s bone marrow took, but they still have some of their own marrow. They still have a chance of being cured.

In a half-match transplant, known medically as haploidentical transplant, only 50 percent of the pertinent genes have to match up. Testing for a bone marrow match entails looking for genes in the human leukocyte antigen, or H.L.A., system, the part of the immune system that recognizes self and not self.

In a full match, 8 to 10 H.L.A. genes need to match between donor and recipient.

“If you have disparities in the H.L.A. system and you transplant stem cells that recognize the patient as foreign, the new immune system will start attacking the patient,” said Dr. Brodsky. In half-match transplants, only half of these H.L.A. genes need to match.

But half-match transplants carry the risk that the donor’s immune cells will attack the host, a potentially deadly complication called graft-versus-host disease.

To reduce this risk, patients receive the chemotherapeutic drug cyclophosphamide after the bone marrow is transplanted. This drug kills the donor’s lymphocytes that would normally attack the recipient, but it spares the donor stem cells, which have an enzyme that makes them immune to it. The stem cells then produce new lymphocytes.

“What happens is that the new cells that are generated become tolerant to the host and will not attack it,” says Dr. Javier Bolaños-Meade, the lead author on the study and associate professor of oncology at Johns Hopkins.

“The biggest paradigm shift was the post-treatment chemo,” added Dr. Brodsky.

The other shift was the trend toward a gentler pre-treatment. In a traditional bone marrow transplant to treat cancer, patients receive high-dose chemotherapy and radiation before the transplant, not only to suppress the immune system but to kill off every last cancer cell in the body. But in sickle cell, the chemotherapy just has to suppress the immune system, so doctors can use a less intense regimen.

This could potentially open it up to many more adults. Bone marrow transplants have largely been offered to children with sickle cell, not adults, who were often too weak or debilitated to endure the more intense pre-treatments.

The half-match transplant is still experimental, and because of its toxicity, it is recommended only for those with advanced disease. It was successful in only about 50 percent of patients.

“You’re putting people through a lot, and to have half of the transplants not take must be heartbreaking,” said Dr. Jane Little, director of the adult sickle cell program at Case Western Reserve University in Cleveland. “It’s exposing patients to risk you can’t take away. But it also really expands the pool of potential recipients.”

The team at Johns Hopkins is tweaking the procedure to improve the success rate without increasing the toxicity, said Dr. Bolaños-Meade. “We are working on transplanting with a higher number of stem cells to help overcome rejection,” he said.

“Clearly it doesn’t cure everyone, but in those patients in which it works, it’s a huge, huge thing,” Dr. Bolaños-Meade said.

This August, Ms. Felix-Ukwu celebrated a year without being in the hospital. She plans to go back to law school next September.

“When I look back, I wonder how I ever made it through all that pain,” she said. “Now I feel like I’m on vacation. I finally have the freedom to be able to live my life.”

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Syrian Jet Strikes Close to Border With Turkey

GAZIANTEP, Turkey — Syria pulled both Turkey and Israel closer to military entanglements in its civil war on Monday, bombing a rebel-held Syrian village a few yards from the Turkish border in a deadly aerial assault and provoking Israeli tank commanders in the disputed Golan Heights into blasting mobile Syrian artillery units across their own armistice line.

The escalations, which threatened once again to draw in two of Syria’s most powerful neighbors, came hours after the fractious Syrian opposition announced a broad new unity pact that elicited praise from the big foreign powers backing their effort to topple President Bashar al-Assad.

“It is a big day for the Syrian opposition,” wrote Joshua Landis, an expert on Syrian political history and the author of the widely followed Syria Comment blog. Mr. Landis, director of the Center for Middle East Studies at the University of Oklahoma, wrote that the “Assad regime must be worried, as it has survived for 42 years thanks to Syria’s fragmentation.”

There has been speculation that Mr. Assad, feeling increasingly threatened, may deliberately seek to widen the conflict that has consumed much of his own country for the past 20 months and left roughly 40,000 people dead. Although there is no indication that Mr. Assad has decided to try to lure Israel into the fight, any Israeli involvement could rally his failing support and frustrate the efforts of his Arab adversaries.

The attack on the Turkish border, by what Syrian witnesses identified as a Syrian MIG-25 warplane, demolished at least 15 buildings and killed at least 20 people in the town of Ras al-Ain, the scene of heavy fighting for days and an impromptu crossing point for thousands of Syrian refugees clambering for safety into Turkey.

“The plane appeared in seconds, dropped a bomb and killed children,” said Nezir Alan, a doctor who witnessed the bombing. “Here is total chaos.” In a telephone interview from Ras al-Ain, he said the bombing wounded at least 70 people, 50 of them critically. Turkish television stations reported that ambulances were rushing victims into Ceylanpinar, Turkey, just across the border.

Windows of shops and houses in Ceylanpinar were shattered by the force of the bombing, and Turkish television showed people on both sides of the border running in panic, while military vehicles raced down streets as a huge cloud of smoke hung over the area.

There were no immediate reports of deaths or injuries in Ceylanpinar. But the Turkish authorities, increasingly angered by what they view as Syrian provocations, have deployed troops and artillery units along the 550-mile border with Syria and have raised the idea of installing Patriot missile batteries that could deter Syrian military aircraft.

Turkey’s foreign minister, Ahmet Davutoglu, sent a diplomatic note to Syria on Monday to protest the Ras al-Ain bombing, the semiofficial Anatolian News Agency reported.

Civilians in southern Turkey’s provinces of Hatay, Sanliurfa and Gaziantep, where the government has erected camps for Syrian refugees, have been advised not to travel close to the border.

In Israel, the military said Israeli tanks that are deployed in the Golan Heights, which the Israelis seized from Syria in the 1967 war, had made a direct hit on Syrian artillery units on Monday after consecutive days of erratic mortar fire coming from the Syrian side of the armistice line. The Syrian mortar shells caused no damage or casualties, the military said.

Military officials and analysts in Israel said that they viewed the Syrian shelling as unintentional spillover from the civil war and that Israel has no desire to get involved in the Syria conflict. But the Israelis have expressed increasing concern that after four decades of relative stability in the Golan area, the Assad government may be trying to push them into a fight that could galvanize Arab hostility toward Israel and distract attention from its own problems.

If an errant Syrian shell hit a school filled with children on the Israeli side, said Prof. Moshe Maoz at the Hebrew University of Jerusalem, a strong Israeli response would be all but guaranteed. “Assad knows very well that Israel does not have a sense of humor here and can retaliate very heavily.”

The United Nations, which monitors an armistice agreement between Israel and Syria in force since the 1973 war, has said it fears that Golan violence could jeopardize the cease-fire.

In Doha, Qatar, where Syrian opposition figures had been meeting since last week, the agreement reached Sunday on forming a new umbrella organization, which could become the basis for a provisional government, was welcomed by participants and the effort’s foreign backers, including Turkey, the United States, the European Union and the Arab League. There were expectations that the new group, called the National Coalition of Syrian Revolutionary and Opposition Forces, would be permitted to take Syria’s seat at the Arab League, which had expelled Mr. Assad’s representative.

Turkey’s Foreign Ministry released a statement saying that the agreement “would add momentum to efforts in completing the democratic transition process in line with the legitimate expectations of the people.”

In the northern Syrian city of Aleppo, a focal point of the conflict since this summer, civilians who have been living under the threat of constant shelling by the Syrian Army welcomed the opposition unity agreement and expressed hope that it signaled a turning point.

“We have been waiting for this for a very very long time,” said Abu al-Hasan, an anti-Assad activist in Aleppo who was reached by telephone. “Even if it is not perfect yet, it will save us.” But he also warned that “people do not believe this will stop the shelling like a miracle.”

There was no sign that the violence was abating elsewhere inside Syria. Activist groups said warplanes were dropping bombs in Damascus suburbs and that army snipers had taken up positions in areas where bombs had been dropped. The mayhem surrounding central Damascus made residents in that part of the capital feel increasingly isolated.

“The inside of the city is like a big prison now,” said Alexia Jade, a media activist contacted inside Damascus. “The checkpoints have increased and the lines of cars waiting to be searched are getting longer.”

Sebnem Arsu reported from Gaziantep, Turkey, and Rick Gladstone from New York. Reporting was contributed by Isabel Kershner and Jodi Rudoren from Jerusalem, and Hania Mourtada from Beirut, Lebanon.

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Lakers hire Mike D'Antoni as new coach

LOS ANGELES (AP) — The Los Angeles Lakers hired Mike D'Antoni late Sunday night, signing the former coach of the Suns and Knicks to replace Mike Brown.

The Lakers and D'Antoni's agent, Warren LeGarie, confirmed the deal two days after the Lakers fired Brown five games into the season.

D'Antoni agreed to a three-year deal worth $12 million, with a team option for a fourth season.

D'Antoni got the high-profile job running the 16-time NBA champions only after the club's top brass extensively discussed the job with former Lakers coach Phil Jackson.

The 11-time NBA champion coach met with Lakers owners Jerry and Jim Buss and general manager Mitch Kupchak on Saturday to weigh a return for a third stint on Los Angeles' bench.

The Lakers instead went with D'Antoni, a respected offensive strategist who coached Lakers point guard Steve Nash in Phoenix during the best years of their respective careers. D'Antoni was less successful during four seasons in New York, but at least restored the once-moribund Knicks to competence before resigning last March.

"Dr. (Jerry) Buss, Jim Buss and Mitch Kupchak unanimously agreed that Mike was the best coach for this roster at this time," Lakers spokesman John Black said.

The 61-year-old D'Antoni underwent knee replacement surgery earlier this month, and could be physically limited early in his tenure. Black said the Lakers aren't certain when D'Antoni will travel to Los Angeles to begin work.

Interim coach Bernie Bickerstaff will continue running the Lakers until D'Antoni arrives. Los Angeles beat Sacramento 103-90 on Sunday night, improving to 2-0 under Bickerstaff after a 1-4 start under Brown.

The Lakers' next game is Tuesday night against San Antonio at Staples Center.

After Brown's dismissal, Nash and Kobe Bryant both expressed enthusiasm about the prospect of playing for D'Antoni, although Bryant also campaigned eagerly for Jackson.

Bryant idolized D'Antoni while growing up in Italy, where D'Antoni was a star player for Olimpia Milano in the Italian pro league. D'Antoni also has been an assistant coach on various U.S. national teams featuring Bryant, including the gold medal-winning squad at the London Olympics.

Nash won two MVP awards while running D'Antoni's signature up-tempo offense for the final four seasons of the coach's five-year tenure with the Suns.

Nash and D'Antoni won at least 54 games each season and reached two Western Conference finals — and they eliminated Bryant's Lakers from the first round of the playoffs in 2006 and 2007, still the only first-round exits of Kobe's 17-year career.

D'Antoni then coached New York to just one playoff appearance and no postseason victories. He also coached the Denver Nuggets during the lockout-shortened 1998-99 season.

But his NBA accomplishments can't measure up to Jackson, who won five titles and reached seven NBA finals during two stints totaling 11 seasons with Los Angeles.

Jackson walked away from the club 18 months ago after a second-round playoff sweep by Dallas, and Brown led Los Angeles to a 41-25 mark followed by another second-round playoff defeat last summer.

The Lakers then traded for Nash and Dwight Howard, setting up a season of enormous expectations for Brown — but the Lakers struggled to learn his new, Princeton-influenced offense while playing mediocre defense.

After the Lakers stumbled out of the gate while Howard and Bryant missed preseason games to preserve their health, Nash incurred a small fracture in his leg during the Lakers' second regular-season game, keeping him out of the lineup for their past five games and for at least another week.

The Lakers have improved to 3-4 under Bickerstaff after following up their winless preseason with four losses in their first five regular-season games, the club's worst start since 1993.

Despite his reputation for offensive acumen, D'Antoni's NBA teams typically have played fairly solid defense, statistically speaking — and they never had the imposing Howard or defensive stopper Metta World Peace in their lineups.

Nash had his best NBA seasons as the versatile quarterback of the Suns' offense under D'Antoni, and point guard Jeremy Lin became a star on the Knicks last season while filling much the same role.

D'Antoni resigned late last season following a six-game losing streak, surprising many observers, and former assistant coach Mike Woodson led the Knicks to the playoffs.

Phoenix visits Staples Center on Friday.

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Global Update: A Solar Device to Help Sterilize Instruments

Solar power can steam-sterilize surgical instruments, according to a new study — but the contraption needed to do so is not pocket-size.

Sterilizing instruments needed in surgical emergencies like Caesarean births or appendectomies can be a problem in rural clinics in Africa: There may be no electricity, jugs of bleach or tanks of propane.

So a Rice University team recently modified a prototype of an old solar stove to power a simple autoclave, which is a pressure-cooker for instruments, and tested it in the Texas sun.

On all 27 attempts, it reached United States government sterilization standards.

How practical it is awaits African trials; it is nearly 12 feet long and 6 feet tall and has bright curved mirrors to focus sunlight on a water-filled pipe. On sunny days, it can make steam at 150 degrees Celsius (302 degrees Fahrenheit) from about 9 a.m. to 3 p.m.

Douglas A. Schuler, above, a Rice business professor and lead author of the study, published in The American Journal of Tropical Medicine and Hygiene, said he “married into the project.” His French father-in-law designed the solar stove years ago after a student trip to West Africa. But women in Haiti, where they tested it, “just hated cooking on it,” Dr. Schuler said, so they found a different use for it.

The initial setup costs about $2,100. But sunlight costs nothing, making five years of operation about $2,000 cheaper than using propane.

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Report Sees U.S. as Top Oil Producer, Overtaking Saudi Arabia, in 5 Years

Charlie Riedel/Associated Press

A pump jack near Greensburg, Kan. Increased oil production and new policies to improve energy efficiency mean that the United States will become “all but self-sufficient” in energy in about two decades, the International Energy Agency predicted.

The United States will overtake Saudi Arabia as the world’s leading oil producer by about 2017 and will become a net oil exporter by 2030, according to a new report released on Monday by the International Energy Agency.

That increased oil production, combined with new American policies to improve energy efficiency, means that the United States will become “all but self-sufficient” in meeting its energy needs in about two decades — a “dramatic reversal of the trend” in most developed countries, the report says.

“The foundations of the global energy systems are shifting,” said Fatih Birol, chief economist at the Paris-based organization, which produces the annual World Energy Outlook, in an interview before the release. The agency, which advises industrialized nations on energy issues, had previously predicted that Saudi Arabia would be the leading producer until 2035.

The report also predicted that global energy demand would grow by 35 percent to 46 percent between 2010 and 2035, depending on whether policies that have been proposed are actually put in place. Most of that growth will come from China, India and the Middle East, where the consuming class is growing rapidly. The consequences are “potentially far reaching” for global energy markets and trade, the report said.

Dr. Birol noted, for example, that Middle Eastern oil once bound for the United States would probably be rerouted to China. American-mined coal, facing declining demand in its home market, is already heading to Europe and China instead.

There are several components of the sudden shift in the world’s energy supply, but the prime mover is a resurgence of oil and gas production in the United States, particularly the unlocking of new reserves of oil and gas found in shale rock. The widespread adoption of techniques such as hydraulic fracturing and horizontal drilling has made those reserves much more accessible, and in the case of natural gas, resulted in a vast glut that has sent prices plunging.

The report predicted that the United States would overtake Russia as the leading producer of natural gas in 2015.

The strong statements and specific predictions by the energy agency lend new weight to trends that have become increasingly apparent in the last year.

“This striking conclusion confirms a lot of recent projections,” said Michael Levi, senior fellow for energy and environment at the Council on Foreign Relations.

Formed in 1974 after the oil crisis by a group of oil-importing nations, including the United States, the International Energy Agency monitors and analyzes global energy trends to insure safe and sustainable supply.

Mr. Levi said that the I.E.A. report was generally “good news” for the United States because it highlights the nation’s new sources of energy. But he cautioned that being self-sufficient did not mean that the country would be insulated from seesawing energy prices, since those oil prices are set by global markets.

“You may be somewhat less vulnerable to price shocks and the U.S. may be slightly more protected, but it doesn’t give you the energy independence some people claim,” he said.

Also, he noted, the agency’s projection of United States self-sufficiency assumed that the country would push ahead with improving gas mileage in cars and energy efficiency in homes and appliances. “It’s supply and demand together that adds up to this striking conclusion,” Mr. Levi said.

Dr. Birol said the agency’s prediction of increasing American self-sufficiency was 55 percent a reflection of more oil production and 45 percent a reflection of improving energy efficiency in the United States, primarily from the Obama administration’s new fuel economy standards for cars. He added that even stronger policies to promote energy efficiency were needed in the United States and many other countries.

The report said that several other factors could also have a large impact on world energy markets over the next few years. These include the recovery of the Iraqi oil industry, which would lead to new supply, and the decision by some countries, notably Germany and Japan, to move away from nuclear energy in the wake of the Fukushima disaster.

The new energy sources will help the United States economy, Dr. Birol said, providing continued cheap energy relative to the rest of the world. The I.E.A. estimates that electricity prices will be about 50 percent cheaper in the United States than in Europe, largely because of a rise in the number of power plants fueled by cheap natural gas, helping American industries and consumers.

But the message is more sobering for the planet, in terms of climate change. Although natural gas is frequently promoted for being relatively low in carbon emissions compared to oil or coal, the new global energy market could make it even harder to prevent dangerous levels of warming.

The United States’ reduced reliance on coal will just mean that coal moves to other places, the report says. And the use of coal, now the dirtiest fuel, continues to rise elsewhere. China’s coal demand will peak around 2020 and then stay steady until 2035, the report predicted, and in 2025, India will overtake the United States as the world’s second-largest coal user.

The report warns that no more than one-third of the proven reserves of fossil fuels should be used by 2050 to limit global warming to 2 degrees Celsius, as many scientists recommend.

Such restraint is extremely unlikely without a binding international treaty by 2017 that requires countries to limit the growth of their emissions, Dr. Birol said. He added that pushing ahead with technologies that could capture and store carbon dioxide was also crucial.

“The report confirms that, given the current policies, we will blow past every safe target for emissions,” Mr. Levi said. “This should put to rest the idea that the boom in natural gas will save us from that.”

This article has been revised to reflect the following correction:

Correction: November 12, 2012

An earlier version of a photo caption with this article incorrectly identified the equipment used in an oil field in Greensburg, Kan. It is a pump jack, not an oil rig.

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Changing of the Guard: Chinese Communist Party Faces Calls for Democracy

BEIJING — As the Communist Party’s 18th Congress approached, Li Weidong, a scholar of politics, made plans to observe a historic leadership battle in one of the world’s great nations.

Instead of staying in Beijing to monitor China’s once-a-decade transfer of power, Mr. Li boarded a plane.

“I’m going to the United States to study the elections,” Mr. Li said in a telephone interview during a stopover in Paris. After witnessing the American presidential election on Tuesday, Mr. Li went on the radio for another interview. “I still think China’s politics remain prehistoric,” he said. “I often joke that the Chinese civilization is the last prehistoric civilization left in the world.”

With China at a critical juncture, there is a rising chorus within the elite expressing doubt that the 91-year-old Communist Party’s authoritarian system can deal with the stresses bearing down on the nation and its 1.3 billion people. Policies introduced after 1978 by Deng Xiaoping lifted hundreds of millions out of poverty and transformed the country into the world’s second-largest economy. But the way party leaders have managed decades of growth has created towering problems that critics say can no longer be avoided.

Many of those critics have benefited from China’s stunning economic gains, and their ranks include billionaires, intellectuals and children of the party’s revolutionary founders. But they say the party’s agenda, as it stands today, is not visionary enough to set China on the path to stability. What is needed, they say, is a comprehensive strategy to gradually extricate the Communist Party, which has more than 80 million members, from its heavy-handed control of the economy, the courts, the news media, the military, educational institutions, civic life and just the plain day-to-day affairs of citizens.

Only then, the critics argue, can the government start to address the array of issues facing China, including rampant corruption, environmental degradation, and an aging population whose demographics have been skewed because of the one-child policy.

“In order to build a real market economy, we have to have real political reform,” said Yang Jisheng, a veteran journalist and a leading historian of the Mao era. “In the next years, we should have a constitutional democracy plus a market economy.”

For now, however, party leaders have given no indication that they intend to curb their role in government in a meaningful way.

“We will never copy a Western political system,” Hu Jintao, the departing party chief, said in a speech on Thursday opening the weeklong congress.

The party’s public agenda, which Mr. Hu described in detail in his 100-minute address, was laid out in a 64-page report that is in part intended to highlight priorities for the new leaders, who will be announced later this month. Much of the document had retrograde language that emphasized ideology stretching back to Mao and had little in the way of bold or creative thinking, said Qian Gang, the director of the China Media Project at the University of Hong Kong.

Most telling, there was no language signaling that the incoming Politburo Standing Committee, the group that rules China by consensus, would support major changes in the political system, whose perversions many now say are driving the nation toward crisis.

While Chinese who are critical of the current system generally do not expect a wholesale adoption of a Western model, they do favor at least an openness to bolder experimentation.

“To break one-party rule right now is probably not realistic, but we can have factions within the party made public and legalized, so they can campaign against each other,” said Mr. Yang, who added that there was no other way at the moment to ensure political accountability.

Only in the last few years has the idea of liberalizing the political system gained currency, and urgency, among a broad cross-section of elites. Before that, as the West foundered at the onset of the global financial crisis, many here pointed to the triumph of a “China model” or “Beijing consensus” — a mix of authoritarian politics, a command economy and quasi-market policies.

But the way in which China weathered the crisis — with the injection of $588 billion of stimulus money into the economy and an explosion of lending from state banks — led to a spate of large infrastructure projects that may never justify their cost. As a result, many economists now say that China’s investment-driven, export-oriented economic model is unsustainable and needs to shift toward greater reliance on Chinese consumers.

Constant lip-service is paid to that goal, and on Saturday, Zhang Ping, a senior official, reiterated that stance. But it will not be easy for the new leaders to carry it out. At the root of the current economic model is the political system, in which party officials and state-owned enterprises work closely together, reaping enormous profits from the party’s control of the economy. Under Mr. Hu’s decade-long tenure, these relationships and the dominance of state enterprises have only strengthened.

“What happens in this kind of economy is that wealth concentrates where power is,” said Mr. Yang, the journalist.

The 400 or so incoming members of the party’s Central Committee, Politburo and Politburo Standing Committee, as well as their friends and families, have close ties to the most powerful of China’s 145,000 state-owned enterprises. The growing presence of princelings — the children of notable Communist officials — in the party, the government and corporations could mean an even more closely meshed web of nepotism. It is a system that Xi Jinping, anointed to be the next party chief and president and himself a member of the “red nobility,” would find hard to unravel, even if he wanted to.

Mia Li contributed research.

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Oregon is No. 1 in AP Top 25; K-St 2, Notre Dame 3

NEW YORK (AP) — Oregon is No. 1 in The Associated Press college football poll after Alabama gave up the top spot following a loss to Texas A&M.

The Ducks have 45 of 60 first-place votes. Kansas State is No. 2 with 14 first-place votes. Notre Dame is third and received one first-place vote.

The Crimson Tide, which had been No. 1 for 10 straight weeks, dropped to fourth after a 29-24 loss to the Aggies in Tuscaloosa, Ala., on Saturday.

Texas A&M moved up six spots to No. 9.

The Ducks were last No. 1 in 2010. That was the first season in the history of the program that Oregon reached No. 1, and the Ducks spent seven weeks there and reached the BCS championship game, which they lost to Auburn.

No. 25 Kent State is ranked for first time since Nov. 5, 1973.

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Mind Faded, Darrell Royal’s Wisdom and Humor Intact Till End

Three days before his death last week at 88, Darrell Royal told his wife, Edith: “We need to go back to Hollis” — in Oklahoma. “Uncle Otis died.”

“Oh, Darrell,” she said, “Uncle Otis didn’t die.”

Royal, a former University of Texas football coach, chuckled and said, “Well, Uncle Otis will be glad to hear that.”

The Royal humor never faded, even as he sank deeper into Alzheimer’s disease. The last three years, I came to understand this as well as anyone. We had known each other for more than 40 years. In the 1970s, Royal was a virile, driven, demanding man with a chip on his shoulder bigger than Bevo, the Longhorns mascot. He rarely raised his voice to players. “But we were scared to death of him,” the former quarterback Bill Bradley said.

Royal won 3 national championships and 167 games before retiring at 52. He was a giant in college football, having stood shoulder to shoulder with the Alabama coach Bear Bryant. Royal’s Longhorns defeated one of Bryant’s greatest teams, with Joe Namath at quarterback, in the 1965 Orange Bowl. Royal went 3-0-1 in games against Bryant.

Royal and I were reunited in the spring of 2010. I barely recognized him. The swagger was gone. His mind had faded. Often he stared aimlessly across the room. I scheduled an interview with him for my book “Courage Beyond the Game: The Freddie Steinmark Story.” Still, I worried that his withering mind could no longer conjure up images of Steinmark, the undersize safety who started 21 straight winning games for the Longhorns in the late 1960s. Steinmark later developed bone cancer that robbed him of his left leg.

When I met with Royal and his wife, I quickly learned that his long-term memory was as clear as a church bell. For two hours, Royal took me back to Steinmark’s recruiting trip to Austin in 1967, through the Big Shootout against Arkansas in 1969, to the moment President Richard M. Nixon handed him the national championship trophy in the cramped locker room in Fayetteville. He recalled the day at M. D. Anderson Hospital in Houston the next week when doctors informed Steinmark that his leg would be amputated if a biopsy revealed cancer. Royal never forgot the determined expression on Steinmark’s face, nor the bravery in his heart.

The next morning, Royal paced the crowded waiting room floor and said: “This just can’t be happening to a good kid like Freddie Steinmark. This just can’t be happening.”

With the love of his coach, Steinmark rose to meet the misfortune. Nineteen days after the amputation, he stood with crutches on the sideline at the Cotton Bowl for the Notre Dame game. After the Longhorns defeated the Fighting Irish, Royal tearfully presented the game ball to Steinmark.

Four decades later, while researching the Steinmark book, I became close to Royal again. As I was leaving his condominium the day of the interview, I said, “Coach, do you still remember me?” He smiled and said, “Now, Jim Dent, how could I ever forget you?” My sense of self-importance lasted about three seconds. Royal chuckled. He pointed across the room to the message board next to the front door that read, “Jim Dent appt. at 10 a.m.”

Edith and his assistant, Colleen Kieke, read parts of my book to him. One day, Royal told me, “It’s really a great book.” But I can’t be certain how much he knew of the story.

Like others, I was troubled to see Royal’s memory loss. He didn’t speak for long stretches. He smiled and posed for photographs. He seemed the happiest around his former players. He would call his longtime friend Tom Campbell, an all-Southwest Conference defensive back from the 1960s, and say, “What are you up to?” That always meant, “Let’s go drink a beer.”

As her husband’s memory wore thin, Edith did not hide him. Instead, she organized his 85th birthday party and invited all of his former players. Quarterback James Street, who engineered the famous 15-14 comeback against Arkansas in 1969, sat by Royal’s side and helped him remember faces and names. The players hugged their coach, then turned away to hide the tears.

In the spring of 2010, I was invited to the annual Mexican lunch for Royal attended by about 75 of his former players. A handful of them were designated to stand up and tell Royal what he meant to them. Royal smiled through each speech as his eyes twinkled. I was mesmerized by a story the former defensive tackle Jerrel Bolton told. He recalled that Royal had supported him after the murder of his wife some 30 year earlier.

“Coach, you told me it was like a big cut on my arm, that the scab would heal, but that the wound would always come back,” Bolton said. “It always did.”

Royal seemed to drink it all in. But everyone knew his mind would soon dim.

The last time I saw him was June 20 at the County Line, a barbecue restaurant next to Bull Creek in Austin. Because Royal hated wheelchairs and walkers, the former Longhorn Mike Campbell, Tom’s twin, and I helped him down the stairs by wrapping our arms around his waist and gripping the back of his belt. I ordered his lunch, fed him his sandwich and cleaned his face with a napkin. He looked at me and said, “Was I a college player in the 1960s?”

“No, Coach,” I said. “But you were a great player for the Oklahoma Sooners in the late 1940s. You quarterbacked Oklahoma to an 11-0 record and the Sooners’ first national championship in 1949.”

He smiled and said, “Well, I’ll be doggone.”

After lunch, Mike Campbell and I carried him up the stairs. We sat him on a bench outside as Tom Campbell fetched the car. In that moment, the lunch crowd began to spill out of the restaurant. About 20 customers recognized Royal. They took his photograph with camera phones. Royal smiled and welcomed the hugs.

“He didn’t remember a thing about it,” Tom Campbell said later. “But it did his heart a whole lot of good.”

Jim Dent is the author of “The Junction Boys” and eight other books.

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Chinese Official Reaffirms ‘Rebalancing’ of Economy

BEIJING — A senior Chinese official reaffirmed on Saturday a national goal of shifting China’s economy away from its dependence on investment and exports and toward a more sustainable emphasis on consumption spending.

In doing so, the official, Zhang Ping, the chairman of the National Development and Reform Commission, glossed over recent data that suggested the reverse might be happening.

Mr. Zhang, whose agency oversees economic planning and coordinates the country’s economic ministries, said in a news conference held in conjunction with the 18th Party Congress that the Chinese economy was growing again, crediting government policies aimed at moving China away from its reliance on capturing an ever greater share of overseas markets for its exports. He also claimed success in easing the economy’s dependence on enormous investment, which has become less efficient and less productive as many industries struggle with overcapacity.

“Starting from August, the turn toward a slower economy has been effectively curbed,” Mr. Zhang said. “From the October economic data, we can see that the trend toward a rebalancing of the Chinese economy is all the more obvious.”

But independent economists question whether any such conclusion is justified. China’s General Administration of Customs announced on Saturday morning that the country’s trade surplus in October had soared to $32 billion, the highest level in nearly four years. Exports surged 11.6 percent from a year earlier, while imports rose 2.4 percent.

Chinese officials are acutely conscious of the frictions that their trade surpluses create with importer nations like the United States, and have argued for many years that the surpluses are temporary and should not be an issue because they might soon disappear. President Obama and Mitt Romney, the Republican nominee, vied during the presidential election campaign over who could be tougher in trade and currency disputes with China over the next four years.

Commerce Minister Chen Deming tried again on Saturday to allay foreign concerns about rising Chinese exports, describing the surge as unlikely to last. He said exports would probably not remain strong because of economic troubles in overseas markets and because of what Mr. Chen described as an international rise in protectionism.

“The trade situation will be relatively grim in the next few months,” he said, “and there will be many difficulties next year.”

Investment has also surged rapidly this autumn, government statistics released on Friday showed, as state-owned banks have lent heavily to state-owned enterprises.

A series of news conferences on economic policy — a third was held on Saturday evening on efforts to encourage industrial innovation — came as the 2,268 delegates to the Party Congress attended closed-door meetings on the third day of the gathering, which is held every five years. The Congress is scheduled to choose a new Central Committee of the Chinese Communist Party this coming week, and that committee will approve a list of leaders who are expected to run the country for the next decade.

Mr. Zhang said in his news conference that the economy was becoming less reliant on exports and investment spending. He omitted October in citing data from 2012’s first nine months that he described as showing that consumption had been playing a bigger role than investment in economic growth. He also said exports had been a drag on growth.

But investment, which had slumped early this year as the government limited bank lending and restricted real estate sales to pop a housing bubble, has been bouncing back as the restrictions have been eased. Exports were also very weak early this year because of Europe’s difficulties, but are strengthening as American demand rebounds.

Wang Tao, a China economist at UBS in Hong Kong, said short-term changes in various sectors of the economy made it hard to draw any reliable conclusions about whether policy makers had been able to shift the foundations of the Chinese economy onto a firmer and more sustainable footing.

But she expressed skepticism that any fundamental shift had taken place so far, saying: “These are cyclical moves. Rebalancing happens very slowly.”

At the news conference on innovation, corporate executives expressed concern about China’s ability to create its own inventions. But Liang Wengen, the president of Sany Heavy Industry, a big construction equipment manufacturer, answered a last question on American investment policies.

Mr. Liang is widely viewed as a well-connected industrialist with the best chance of becoming the first business tycoon to join the Central Committee, possibly this coming week. He bitterly criticized the Obama administration on Saturday evening for its decision not to allow an American company owned by Sany executives to install Sany-made wind turbines in or near restricted airspace next to a United States Navy site where drones are developed.

Mr. Liang promised a long legal battle against the decision, saying: “We will fight to the end. We hope we will achieve final victory, because we believe in the justice of U.S. law, the courage of the American people and the justice of the world.”

Patrick Zuo contributed research.

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