This study aimed to comprehensively examine the association of gallstones, cholecystectomy, and cancer risk. Multivariable logistic regressions were performed to estimate the observational associations of gallstones and cholecystectomy with cancer risk, using data from a nationwide cohort involving 239 799 participants. General and gender-specific two-sample Mendelian randomization (MR) analysis was further conducted to assess the causalities of the observed associations. Observationally, a history of gallstones without cholecystectomy was associated with a high risk of stomach cancer (adjusted odds ratio (aOR)=2.54, 95% confidence interval (CI) 1.50-4.28), liver and bile duct cancer (aOR=2.46, 95% CI 1.17-5.16), kidney cancer (aOR=2.04, 95% CI 1.05-3.94), and bladder cancer (aOR=2.23, 95% CI 1.01-5.13) in the general population, as well as cervical cancer (aOR=1.69, 95% CI 1.12-2.56) in women. Moreover, cholecystectomy was associated with high odds of stomach cancer (aOR=2.41, 95% CI 1.29-4.49), colorectal cancer (aOR=1.83, 95% CI 1.18-2.85), and cancer of liver and bile duct (aOR=2.58, 95% CI 1.11-6.02). MR analysis only supported the causal effect of gallstones on stomach, liver and bile duct, kidney, and bladder cancer. This study added evidence to the causal effect of gallstones on stomach, liver and bile duct, kidney, and bladder cancer, highlighting the importance of cancer screening in individuals with gallstones.
Humans ; Mendelian Randomization Analysis ; Gallstones/complications* ; Female ; Male ; Cholecystectomy/statistics & numerical data* ; Middle Aged ; Risk Factors ; Aged ; Adult ; Neoplasms/etiology* ; Stomach Neoplasms/epidemiology*

This study aims to describe the population and regional distribution characteristics of smoking behavior among adult twins in the China Twin Registry (CNTR), as well as the concordance rates for smoking behavior in monozygotic and dizygotic twins, and estimate the heritability. The study population included adult twins in CNTR who had smoking questionnaire data. A random-effects regression model was used to describe the distribution of smoking behavior among different subgroups based on various characteristics. The concordance of smoking behavior between different zygosity groups was calculated, and heritability was estimated. A total of 28 444 twin pairs were included in this study, with an average age of (36.6±12.0) years. Among male twins, 41.2% were current smokers, while only 1.2% of females smoked. Higher smoking rates were observed among male smokers in the 50-59 age group ( z=23.0, P<0.001), northern regions ( z=2.9, P<0.01), rural areas ( z=-5.2, P<0.001), those who were divorced/widowed ( z=3.8, P<0.001), and first-born twins ( z=-4.3, P<0.001), while lower smoking rates were found in those with higher education ( z=-16.1, P<0.001) and unmarried individuals ( z=-16.0, P<0.001). The smoking concordance rate for male monozygotic twins was 69.6%, significantly higher than the 57.3% concordance rate for dizygotic twins ( χ 2=105.0, P<0.05). The heritability of smoking behavior in male twins was estimated at 28.9% (95% CI: 24.3%-33.4%). Stratified analyses showed differences in heritability across regions and age groups: the heritability in northern regions was 32.6% (95% CI: 27.3%-38.0%), higher than the 21.0% (95% CI: 12.4%-29.5%) observed in southern regions; the highest heritability of 35.1% (95% CI: 26.3%-43.9%) was found in the 18-29 age group, with heritability decreasing with age. In conclusion, the smoking rate and influencing factors in the twin population are similar to those in the general population, with unique characteristics, such as higher smoking rates in first-born twins. Genetic factors have a significant impact on smoking behavior.

Objective To explore the feasibility, safety, and efficacy of transesophageal endoscopic surgery for mediastinal tumors. Methods A retrospective analysis was conducted on the clinical data of 17 patients who underwent transesophageal endoscopic resection for benign mediastinal tumors at the Endoscopy Center of Zhongshan Hospital, Fudan University, between January 1, 2016 and December 31, 2024. Epidemiological characteristics, surgical parameters, adverse events, and follow-up outcomes were analyzed. Results Among the 17 patients, there were 9 males and 8 females, with an average age of (42.4±14.5) years and an average tumor size of (2.6±1.6) cm. Pathological types included esophageal duplication cysts (6 cases, 35.3%), bronchogenic cysts (5 cases, 29.4%), gastroenteric cysts (3 cases, 17.6%), schwannomas (2 cases, 11.8%), and lymphangioma (1 case, 5.9%). Fourteen patients (82.4%) underwent submucosal tunneling endoscopic resection (STER), 3 patients (17.6%) underwent natural orifice transluminal endoscopic mediastinal surgery. All surgeries were successfully completed without conversion to open surgery. En bloc resection was achieved in 11 patients (64.7%), with an average operative time of (60.9±32.6) min. No intraoperative bleeding or mucosal injury occurred, and 4 patients (23.5%) experienced minor complications (pneumothorax, fever, recurrent laryngeal nerve injury), all of which resolved with conservative treatment. The average postoperative hospital stay was (3.2±1.5) days, and no recurrence was observed during the follow-up period. Conclusions Transesophageal endoscopic resection of benign mediastinal tumors is a safe, effective, and minimally invasive treatment method. Further validation of its efficacy and safety through large-scale prospective studies is warranted.

Objective:Endoscopic resection of giant submucosal tumors (SMTs) in the esophagus and gastric cardia is challenging. The aim of this study was to investigate the safety and efficacy of various endoscopic procedures for resection of esophageal or gastric cardia SMTs with longitudinal diameter ≥7 cm and/or transverse diameter ≥3.5 cm.Methods:In this retrospective cohort study, we analyzed data of 109 patients with giant esophageal/cardia SMTs originating in the muscularis propria who had undergone endoscopic resection in Zhongshan Hospital from July 2017 to February 2022. Inclusion criteria were as follows: (1) SMT diameter ≥7 cm longitudinally or ≥3.5 cm transversely; (2) presence of symptoms requiring intervention; and (3) tumor originating in the muscularis propria. Exclusion criteria included severe comorbidities, coagulation disorders, prior surgery, or tumor adjacent to vital organs precluding endoscopic treatment. The primary outcomes were en bloc and piecemeal resection rates, whereas secondary outcomes comprised adverse events and long-term survival.Results:Among the 109 patients who had successfully undergone endoscopic resection, the median tumor diameters were 7.5 (4.0-15.0) cm, and 4.5 (1.5-7.0) cm. Submucosal tunneling endoscopic resection, endoscopic full-thickness resection, and endoscopic submucosal excavation were performed on 77, 22, and 10 patients, respectively. The median duration of the procedures was 90 (30-300) minutes. The overall en bloc resection rate was 78.9% (86/109), and piecemeal resection rate 21.1% (23/109). Major adverse events occurred in 12.8% of patients (14/109), comprising pneumothorax or pleural effusion ( n=12), esophageal-pleural fistula ( n=3), severe delayed bleeding ( n=1), tunnel infection with abdominal abscess ( n=1), pulmonary abscess ( n=1), abdominal abscess ( n=1), and postoperative esophageal stricture ( n=1). During a median follow-up period of 33.6 (15.4-70.4) months, no tumor recurrences or metastases were detected. Multivariate analysis revealed that transverse diameter ≥4.5 cm was an independent risk factor for piecemeal resection (OR=6.016, 95%CI: 2.180-16.597, P<0.001); longitudinal diameter ≥9.0 cm (OR=2.728, 95%CI: 1.005-7.405, P=0.049) and transverse diameter ≥4.5 cm (OR=2.942, 95%CI: 1.099-7.874, P=0.032) were independent risk factors for prolonged operation time; and longitudinal diameter ≥9.0 cm (OR=5.040, 95%CI: 1.425-17.828, P=0.012) and piecemeal resection (OR=6.280, 95%CI: 1.741-22.656, P=0.005) were independent risk factors for major adverse events. Conclusion:Endoscopic resection is a safe and effective treatment modality for giant esophageal or gastric cardia SMTs of longitudinal diameter ≥9.0 cm and transverse diameter ≥4.5 cm.

Objective To observe the value of pituitary radiomics and MRI features combined model for predicting growth hormone(GH)status in pediatric short stature.Methods Totally 300 children with short stature were enrolled as training set,while other 73 cases were taken as external validation set.Based on growth hormone stimulation test,the children were divided into GH deficiency(GHD)group(n=228)and non-GHD group(n=145).The training set included 196 cases in GHD subgroup and 104 cases in non-GHD subgroup,while the validation set included 32 cases in GHD subgroup and 41 cases in non-GHD subgroup.Radiomics features of pituitary were extracted from T1WI.The key features were selected using least absolute shrinkage and selection operator(LASSO)regression,and machine learning models were subsequently constructed using support vector machine(SVM),logistic regression(LR),naive Bayes(NB)and K-nearest neighbor(KNN),respectively.Then combined models were constructed combining with MRI features,and the efficacy of each model was evaluated.Results The area under the curve(AUC)of SVM,LR,NB,and KNN radiomics model for predicting GH status in pediatric short stature was 0.860,0.831,0.838 and 0.901 in training set,0.788,0.829,0.823 and 0.770 in validation set,while of the relative combined SVM,LR,NB and KNN model was 0.924,0.903,0.859 and 0.920 in training set,and 0.827,0.881,0.836 and 0.718 in validation set.LRcombined model had the best overall performance,with sensitivity of 84.94％,specificity of 80.56％and accuracy of 83.61％in training set,and 80.95％,72.22％and 80.00％in validation set,respectively.Conclusion Pituitary radiomics and MRI features combined model could effectively predict GH status in pediatric short stature.

This study aims to describe the population and regional distribution characteristics of smoking behavior among adult twins in the China Twin Registry (CNTR), as well as the concordance rates for smoking behavior in monozygotic and dizygotic twins, and estimate the heritability. The study population included adult twins in CNTR who had smoking questionnaire data. A random-effects regression model was used to describe the distribution of smoking behavior among different subgroups based on various characteristics. The concordance of smoking behavior between different zygosity groups was calculated, and heritability was estimated. A total of 28 444 twin pairs were included in this study, with an average age of (36.6±12.0) years. Among male twins, 41.2% were current smokers, while only 1.2% of females smoked. Higher smoking rates were observed among male smokers in the 50-59 age group ( z=23.0, P<0.001), northern regions ( z=2.9, P<0.01), rural areas ( z=-5.2, P<0.001), those who were divorced/widowed ( z=3.8, P<0.001), and first-born twins ( z=-4.3, P<0.001), while lower smoking rates were found in those with higher education ( z=-16.1, P<0.001) and unmarried individuals ( z=-16.0, P<0.001). The smoking concordance rate for male monozygotic twins was 69.6%, significantly higher than the 57.3% concordance rate for dizygotic twins ( χ 2=105.0, P<0.05). The heritability of smoking behavior in male twins was estimated at 28.9% (95% CI: 24.3%-33.4%). Stratified analyses showed differences in heritability across regions and age groups: the heritability in northern regions was 32.6% (95% CI: 27.3%-38.0%), higher than the 21.0% (95% CI: 12.4%-29.5%) observed in southern regions; the highest heritability of 35.1% (95% CI: 26.3%-43.9%) was found in the 18-29 age group, with heritability decreasing with age. In conclusion, the smoking rate and influencing factors in the twin population are similar to those in the general population, with unique characteristics, such as higher smoking rates in first-born twins. Genetic factors have a significant impact on smoking behavior.

Objective:Endoscopic resection of giant submucosal tumors (SMTs) in the esophagus and gastric cardia is challenging. The aim of this study was to investigate the safety and efficacy of various endoscopic procedures for resection of esophageal or gastric cardia SMTs with longitudinal diameter ≥7 cm and/or transverse diameter ≥3.5 cm.Methods:In this retrospective cohort study, we analyzed data of 109 patients with giant esophageal/cardia SMTs originating in the muscularis propria who had undergone endoscopic resection in Zhongshan Hospital from July 2017 to February 2022. Inclusion criteria were as follows: (1) SMT diameter ≥7 cm longitudinally or ≥3.5 cm transversely; (2) presence of symptoms requiring intervention; and (3) tumor originating in the muscularis propria. Exclusion criteria included severe comorbidities, coagulation disorders, prior surgery, or tumor adjacent to vital organs precluding endoscopic treatment. The primary outcomes were en bloc and piecemeal resection rates, whereas secondary outcomes comprised adverse events and long-term survival.Results:Among the 109 patients who had successfully undergone endoscopic resection, the median tumor diameters were 7.5 (4.0-15.0) cm, and 4.5 (1.5-7.0) cm. Submucosal tunneling endoscopic resection, endoscopic full-thickness resection, and endoscopic submucosal excavation were performed on 77, 22, and 10 patients, respectively. The median duration of the procedures was 90 (30-300) minutes. The overall en bloc resection rate was 78.9% (86/109), and piecemeal resection rate 21.1% (23/109). Major adverse events occurred in 12.8% of patients (14/109), comprising pneumothorax or pleural effusion ( n=12), esophageal-pleural fistula ( n=3), severe delayed bleeding ( n=1), tunnel infection with abdominal abscess ( n=1), pulmonary abscess ( n=1), abdominal abscess ( n=1), and postoperative esophageal stricture ( n=1). During a median follow-up period of 33.6 (15.4-70.4) months, no tumor recurrences or metastases were detected. Multivariate analysis revealed that transverse diameter ≥4.5 cm was an independent risk factor for piecemeal resection (OR=6.016, 95%CI: 2.180-16.597, P<0.001); longitudinal diameter ≥9.0 cm (OR=2.728, 95%CI: 1.005-7.405, P=0.049) and transverse diameter ≥4.5 cm (OR=2.942, 95%CI: 1.099-7.874, P=0.032) were independent risk factors for prolonged operation time; and longitudinal diameter ≥9.0 cm (OR=5.040, 95%CI: 1.425-17.828, P=0.012) and piecemeal resection (OR=6.280, 95%CI: 1.741-22.656, P=0.005) were independent risk factors for major adverse events. Conclusion:Endoscopic resection is a safe and effective treatment modality for giant esophageal or gastric cardia SMTs of longitudinal diameter ≥9.0 cm and transverse diameter ≥4.5 cm.

Objective:To describe the distribution characteristics of alcohol consumption in adult twins in the Chinese National Twin Registry (CNTR), and further explore the influence of genetic factors on alcohol consumption in adult twins.Methods:The subjects of the study were twins registered by CNTR in 11 project areas across China from 2010 to 2018. A total of 56 966 twins (28 483 pairs) aged 18 years and above who answered questions about drinking behavior were included, and the random effect model was used to describe the population and regional distribution characteristics of alcohol consumption. Intra-pair analysis was performed to calculate the concordance rate and heritability of their alcohol consumption.Results:The age of all subjects was (36.6±12.0) years, and current drinkers accounted for 16.6% (9 461/56 966) of all subjects. In men, those aged 50-59 years, those in northern China, those living in rural area, those with low education level and those with high BMI, the proportions of current drinkers were higher. After excluding 468 pairs of twins who had stopped alcohol use and 21 764 pairs of twins who had no drink or had small amount drink, an intra-pair analysis was conducted in 4 929 pairs of same-sex twins, and found that the concordance rate of alcohol consumption was 64.0% (2 059/3 215) in monozygotic twins, and 52.6% (902/1 714) in dizygotic twins, the difference was significant ( P<0.001), and the heritability of alcohol consumption was 24.1% (95% CI: 18.9%- 29.3%). The further stratified analysis found that in southern men, the heritability was highest in those aged 40-49 years (36.1%, 95% CI: 21.6%-50.7%), while in northern men, the heritability was highest in those aged 50-59 years (34.2%, 95% CI: 18.1%-50.3%). Conclusions:In adult twins in China, there were population and regional differences in the distribution of alcohol consumption behavior, and alcohol consumption was influenced by genetic factors, and gender, age and region had potential modifying effects.

Objective:To explore the efficacy and safety of camrelizumab combined with chemotherapy in treatment of advanced esophageal carcinoma.Methods:A retrospective cohort study was conducted. A total of 84 patients with advanced esophageal carcinoma admitted to the First Affiliated Hospital of Xi'an Medical University from June 2020 to May 2022 were selected, and all patients were divided into the observation group and the control group according to the different treatment methods, 42 cases in each group. The control group was given albumin-bound paclitaxel combined with cisplatin chemotherapy, and the observation group was given camrelizumab based on the control group. The clinical efficacy, survival, tumor markers levels, T lymphocyte subsets levels, quality of life and adverse reactions were compared in both groups.Results:There were no statistically significant differences in age, gender, body mass index, clinical stage and tumor site between the 2 groups (all P > 0.05). There were 9 cases of partial remission (PR), 15 cases of stable disease (SD) and 18 cases of progression of the disease (PD) in the control group; and 15 cases of PR, 18 cases of SD, 9 cases of PD in the observation group. There was no statistically significant difference in objective remission rate between the control group and observation group [21.4% (9/42) vs. 35.7% (15/42), χ2 = 2.10, P = 0.147]. The disease control rate in the observation group was higher than that in the control group [78.6% (33/42) vs. 57.1% (24/42)], and the difference was statistically significant ( χ2 = 4.42, P = 0.035). The median overall survival time was 12 months (95% CI: 10.7-13.3 months) and 9 months (95% CI: 7.6-10.4 months), respectively in the observation group and the control group, and the difference in overall survival was statistically significant ( χ2 = 9.45, P = 0.002). The levels of carbohydrate antigen 125 (CA125), carcinoembryonic antigen (CEA) and squamous cell carcinoma antigen (SCC) in both groups after treatment were lower than those before treatment, and the levels of these tumor markers in the observation group [CA125: (54±6) IU/ml, CEA: (9.2±1.1) μg/L, SCC: (0.72±0.19) μg/L] were lower than those in the control group [CA125: (61±7) IU/ml, CEA: (11.3±1.5) μg/L, SCC: (1.26±0.30) μg/L] (all P < 0.001). After treatment, the T lymphocyte proportions of CD3 +, CD4 + and the level of CD4 +/CD8 + in the observation group were higher than those before treatment; and T lymphocyte proportions of CD3 +, CD4 + and the level of CD4 +/CD8 + in the observation group were higher than those in the control group (all P < 0.05). The scores of quality of life scale in both groups after treatment were higher than those before treatment (all P < 0.001), and the score in the observation group was higher than that in the control group [(64±5) points vs. (60±4) points], and the difference was statistically significant ( t = 4.05, P < 0.001). There were no statistically significant differences in the incidence of gastrointestinal reactions, liver dysfunction and rash between the 2 groups (all P > 0.05). The incidence of cutaneouscapillary endothelial proliferation in the observation group was higher than that in the control group [14.29% (6/42) vs. 0 (0/42) ], and the difference was statistically significant ( P = 0.026). Conclusions:Camrelizumab combined with chemotherapy can improve the disease condition, prolong the survival time, improve the quality of life and regulate the disorder of T lymphocytes in patients with advanced esophageal carcinoma, and its safety is controllable.

Objective To observe the value of pituitary radiomics and MRI features combined model for predicting growth hormone(GH)status in pediatric short stature.Methods Totally 300 children with short stature were enrolled as training set,while other 73 cases were taken as external validation set.Based on growth hormone stimulation test,the children were divided into GH deficiency(GHD)group(n=228)and non-GHD group(n=145).The training set included 196 cases in GHD subgroup and 104 cases in non-GHD subgroup,while the validation set included 32 cases in GHD subgroup and 41 cases in non-GHD subgroup.Radiomics features of pituitary were extracted from T1WI.The key features were selected using least absolute shrinkage and selection operator(LASSO)regression,and machine learning models were subsequently constructed using support vector machine(SVM),logistic regression(LR),naive Bayes(NB)and K-nearest neighbor(KNN),respectively.Then combined models were constructed combining with MRI features,and the efficacy of each model was evaluated.Results The area under the curve(AUC)of SVM,LR,NB,and KNN radiomics model for predicting GH status in pediatric short stature was 0.860,0.831,0.838 and 0.901 in training set,0.788,0.829,0.823 and 0.770 in validation set,while of the relative combined SVM,LR,NB and KNN model was 0.924,0.903,0.859 and 0.920 in training set,and 0.827,0.881,0.836 and 0.718 in validation set.LRcombined model had the best overall performance,with sensitivity of 84.94％,specificity of 80.56％and accuracy of 83.61％in training set,and 80.95％,72.22％and 80.00％in validation set,respectively.Conclusion Pituitary radiomics and MRI features combined model could effectively predict GH status in pediatric short stature.