Objective To explore the potential causal relationship between 91 inflammatory factors and the risk of lung cancer (LC). Methods By extracting related data of inflammatory factors and LC and its subtypes from public databases of Genome-wide Association Studies (GWAS), bidirectional, repeated, multivariable Mendelian randomization (MR) and subgroup MR methods were used for analysis. The inverse variance weighted method was mainly used for causal inference, and a series of sensitivity analyses were applied to verify the strength of the results. Results Higher levels of CD5, interleukin-18 (IL-18), and oncostatin-M (OSM) were causally associated with a lower risk of LC, while nerve growth factor-β (NGF-β) and S100 calcium-binding protein A12 (S100A12) were associated with an increased risk of LC. Subgroup MR analysis results showed that IL-18 had a causal relationship with a reduced risk of lung adenocarcinoma, while NGF-β and S100A12 had a causal relationship with an increased risk of lung adenocarcinoma; CD5 and OSM had a causal relationship with a reduced risk of lung squamous cell carcinoma; NGF-β had a causal relationship with an increased risk of small cell lung cancer. Conclusion Five inflammatory factors, including CD5, IL-18, OSM, NGF-β, and S100A12 have a causal correlation with the risk of LC, providing potential targets for early screening of LC patients and development of therapeutic drugs.

Definitive chemoradiotherapy (dCRT) has become a cornerstone in the treatment of locally advanced esophageal cancer; however, local control remains suboptimal, and persistent lesions or locoregional recurrences after treatment are not uncommon. For patients without distant metastases but with local failure, whether surgical intervention can still offer curative potential remains a major clinical dilemma. Salvage esophagectomy (SE) offers potential long-term survival for selected patients, but this procedure is performed in the context of severe fibrosis, impaired local blood supply, and obscured anatomical planes following chemoradiotherapy, resulting in significantly higher perioperative risk compared to primary esophagectomy. Consequently, controversies exist regarding patient selection, preoperative restaging, choice of surgical approach, extent of lymphadenectomy, gastrointestinal reconstruction, and perioperative management. In recent years, with the refinement of restaging modalities such as PET/CT, the accumulation of experience in high-volume centers, and emerging evidence from clinical studies, the clinical role of SE has gradually shifted from a "high-risk salvage measure" to a "selective curative strategy aimed at achieving long-term survival in carefully selected patients". Nevertheless, standardized guidelines for patient selection, technical approaches, and perioperative management are still lacking. Based on current evidence and clinical experience, experts organized by the Integrated Esophageal Cancer Committee of Chinese Anti-Cancer Association systematically reviewed key issues regarding SE, including its definition, indications, preoperative evaluation, choice of surgical approach, lymphadenectomy, gastrointestinal reconstruction, and perioperative management, and formulated a Chinese expert consensus. This consensus aims to provide guidance for standardized assessment, appropriate referral, individualized surgical decision-making, and optimized perioperative management of patients with locoregional failure after dCRT. Ultimately, this will increase the likelihood of R0 resection, reduce the risk of severe complications, and promote the safer, more judicious, and standardized implementation of SE in high-risk scenarios.

Objective Jejunal interposition is an important option for restoring gastrointestinal continuity in patients with complex esophageal cancer in whom the stomach is unavailable for reconstruction due to previous gastrectomy, tumor involvement, failed gastric conduit, or other constraints. Although the jejunum offers a caliber similar to the esophagus, a rich blood supply, and preserved peristaltic function, anatomical variations in mesenteric length and vascular arcades render long-segment and high-level reconstruction susceptible to excessive tension, mesenteric torsion, venous congestion, and inadequate distal perfusion. This consensus aims to provide standardized recommendations for the application of jejunal interposition in this specific patient population. Methods This consensus was developed in accordance with the WHO Handbook for Guideline Development and Chinese national guideline development standards, with reference to the Appraisal of Guidelines for Research & Evaluation Ⅱ(AGREE Ⅱ), Reporting Items for Practice Guidelines in Healthcare (RIGHT), and Scientific, Transparent and Applicable Rankings (STAR) checklists. The project was registered on the international practice guidelines registry platform (PREPARE-2026CN1384). The working group systematically searched Chinese and English evidence addressing 12 clinical questions. Evidence was graded using the Oxford Centre for Evidence-Based Medicine (OCEBM) 2009 system, with structured appraisal of risk of bias, inconsistency, indirectness, and imprecision. Recommendations were formulated through two rounds of Delphi surveys and a face-to-face consensus meeting, with an agreement threshold of ≥75%. Results The consensus generated 12 recommendations covering indications, selection between jejunum and colon, preoperative assessment, surgical approach and reconstruction route, pedicled jejunal interposition (PJI), supercharged pedicled jejunal interposition (SPJ), indocyanine green (ICG) perfusion assessment, perioperative nutrition, management of anastomotic leakage, long-term follow-up, and special treatment scenarios. Given that the available direct evidence is predominantly derived from single-center retrospective cohorts and case series, recommendations extrapolated from general esophagectomy or other gastrointestinal surgical evidence are deliberately phrased with caution. Conclusion Jejunal interposition is a safe and effective approach for digestive tract reconstruction in patients with complex esophageal cancer in whom the stomach is unavailable. This consensus emphasizes that clinical decision-making should be individualized based on the patient's prior treatment history, reconstruction height, vascular anatomy, technical availability, and institutional experience in the Chinese context.

Combined small cell lung cancer (CSCLC) is a cancer that mixes small cell lung cancer (SCLC) with non-small cell lung cancer (NSCLC) components according to the World Health Organization's 2015 New Pathologic Classification of Lung Cancer. Composed of a mixture of SCLC and NSCLC components, CSCLC is classified as a subtype of SCLC in neuroendocrine tumors. Currently, research on SCLC mainly focuses on single-component pure SCLC, with relatively few studies on CSCLC, which is clinically rare and has no standardized treatment protocols and lacks a unified perception of the clinicopathological features and prognostic predictive indexes of CSCLC. Further observation of efficacy and prognosis is needed. We report the treatment course of a case of CSCLC and provide a literature review of the current status of research on CSCLC.
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Humans ; Small Cell Lung Carcinoma/diagnostic imaging* ; Lung Neoplasms/diagnostic imaging* ; Male ; Middle Aged

Esophageal scar stenosis following chemical burns is a common and complex clinical issue.According to the Zargar classification,approximately 90％of patients with third-degree burns and 15％-30％of those with second-degree burns will develop esophageal or pyloric stenosis.Personalized treatment strategies tailored to the specifics of esophageal stenosis are particularly important.This review focuses on the selection of anastomotic sites during esophageal reconstruction following chemical burns and summarizes perioperative evaluations and timing of surgery.Overall,the treatment strategy for esophageal scar stenosis emphasizes personalized medicine,taking into account the characteristics of the stenosis and carefully selecting the most suitable surgical approach to achieve optimal therapeutic outcomes.

Esophageal scar stenosis following chemical burns is a common and complex clinical issue.According to the Zargar classification,approximately 90％of patients with third-degree burns and 15％-30％of those with second-degree burns will develop esophageal or pyloric stenosis.Personalized treatment strategies tailored to the specifics of esophageal stenosis are particularly important.This review focuses on the selection of anastomotic sites during esophageal reconstruction following chemical burns and summarizes perioperative evaluations and timing of surgery.Overall,the treatment strategy for esophageal scar stenosis emphasizes personalized medicine,taking into account the characteristics of the stenosis and carefully selecting the most suitable surgical approach to achieve optimal therapeutic outcomes.

Objective:To compare the accuracy of 11 ultrasound parameters prediction formulas for fetal body mass,and to explore the effect of gestational weight gain(GWG)on the accuracy of ultrasound prediction of fetal body mass.Methods:A total of 502 single and full-term postpartum women who gave birth from August 2020 to December 2020 at Jinshan Hospital,Fudan University were collected.The gestational weight gain,fetal ultrasound measurement indicators within 7 days before delivery,and newborn birth weight were calculated and analyzed.The accuracy of multiple ultrasound prediction formulas were calculated and analyzed.According to the criteria for weight gain during pregnancy,the reasonable weight gain during pregnancy was 12.5-18.0 kg for singleton pregnancies with pre-pregnancy(body mass index)BMI<18.5 kg/m2,11.5-16.0 kg for those with BMI 18.5-24.9 kg/m2,7.0-11.5 kg for those with BMI 25.0-29.9 kg/m2,and 5.0-9.0 kg for those with BMI≥30.0 kg/m2.The cases were divided into the group with insufficient GWG(125 cases),the normal group(202 cases),and the group with too much GWG(175 cases)to analyze the effect of different GWG on the accuracy of ultrasound pre-diction of fetal body mass.Results:Among the 11 ultrasound parameter formulas for predicting fetal body mass,the HadlockⅢformula predicted fetal body mass with an absolute error of 186.64±149.28 g and a relative error of(5.52±4.18)%,which was the smallest error among 11 prediction formulas,with a statistically significant difference(P<0.05).The absolute and relative error compliance rates were 72.31%,86.25%,respectively,both of which were the highest,and the difference was statistically significant(P<0.05).When the HadlockⅢformula was used to predict birth weight in the insufficient GWG group,the normal group,and the group with too much GWG,the absolute errors were 190.23±136.69 g,148.12±99.39 g,228.54±189.57 g,and the relative errors were(5.95±4.25)%,(4.40±2.78)%,(6.49±5.09)%,respectively,and the differences were statistically significant(P<0.05).Conclusions:The accuracy of Hadlock Ⅲ formula in predicting fetal body mass is better than that of other formulas,but its accuracy can be affected by GWG,and it is necessary to consider multiple as-pects when estimating fetal body mass in clinical practice.

Objective:To investigate the significance of menstrual abnormalities in polycystic ovary syndrome (PCOS) for the prediction of future combined metabolic syndrome (MS) and compare the differences in intestinal flora structure between patients with MS and those without.Methods:A case-control study was used to select 111 patients with PCOS who attended the outpatient clinic of the Department of Obstetrics and Gynecology of Jinshan Hospital affiliated to Fudan University between February 2021 and December 2023, and they were divided into the group of PCOS not combined with MS ( n=74, recorded as the NMS group) and the group of PCOS combined with MS ( n=37, recorded as the MS group). The menstrual-related information and stool specimens of all cases were collected to analyze the menstrual characteristics of the two groups and their predictive significance for PCOS combined with MS; and the intestinal flora of the two groups were analyzed by 16S rDNA high-throughput sequencing. Results:The age of menstrual changes [(23.47±4.73) years], time of menstrual changes occurring after menarche [(9.85±5.11) years], and duration of menstrual changes [(3.43±2.78) years] in the NMS group were statistically significantly different when compared with those in the MS group [(20.71±3.61) years, P=0.020; (7.04±3.34) years, P=0.025; (7.63±3.47) years, P<0.001]. The rate of menstrual abnormality, scanty menstruation and amenorrhea were higher in the MS group than in the NMS group, and the difference in the ratio of the composition of the menstrual pattern between the two groups was statistically significant ( P=0.036). The differences in the rates of menstrual abnormalities 8 years later after menarche between the two groups were statistically significant (all P<0.05), and the ORs from 8 to 13 years after menarche were 2.76 (95% CI: 1.07-7.11), 3.68 (95% CI: 1.28-10.56), 3.27 (95% CI: 1.13-9.41), 3.07 (95% CI: 1.06-8.87), 4.20 (95% CI: 1.16-15.21), 11.57 (95% CI: 1.48-90.49), respectively; the difference in the rate of menstrual abnormality between the two groups with menstrual alteration duration of more than 4 years was also statistically significant (all P<0.05), and the ORs for menstrual alteration duration of 4-9 years were 8.89 (95% CI: 2.14-36.99), 11.88 (95% CI: 3.07-46.02), 16.56 (95% CI: 4.15-66.13), 11.25 (95% CI: 2.88-32.95), 7.80 (95% CI: 2.04-29.84), and 10.00 (95% CI: 1.91-52.48), respectively. The α-diversity index of intestinal flora was lower in the MS group than in the NMS group, but the difference was not statistically significant ( P>0.05). At the phylum level, there was a statistically significant difference in the abundance of intestinal flora between the two groups ( P<0.001), the abundance of Bacteroidetes was lower in the MS group than in the NMS group, and the abundance of the Firmicutes was similar in the two groups. At the genus level, there was a statistically significant difference in the abundance of intestinal flora between the two groups ( P<0.001), the abundance of Bifidobacterium decreased and the abundance of Streptococcus and Escherichia increased in the MS group compared with those in the NMS group. Conclusion:Abnormal menstruation 8 years later after menarche in patients with PCOS is predictive of future MS, and its predictive effect increases with age, but does not change significantly with the duration of disease in abnormal menstruation. The structure of the intestinal flora of patients with MS in PCOS is indeed significantly different from that of those without MS.

Objective:To investigate the significance of menstrual abnormalities in polycystic ovary syndrome (PCOS) for the prediction of future combined metabolic syndrome (MS) and compare the differences in intestinal flora structure between patients with MS and those without.Methods:A case-control study was used to select 111 patients with PCOS who attended the outpatient clinic of the Department of Obstetrics and Gynecology of Jinshan Hospital affiliated to Fudan University between February 2021 and December 2023, and they were divided into the group of PCOS not combined with MS ( n=74, recorded as the NMS group) and the group of PCOS combined with MS ( n=37, recorded as the MS group). The menstrual-related information and stool specimens of all cases were collected to analyze the menstrual characteristics of the two groups and their predictive significance for PCOS combined with MS; and the intestinal flora of the two groups were analyzed by 16S rDNA high-throughput sequencing. Results:The age of menstrual changes [(23.47±4.73) years], time of menstrual changes occurring after menarche [(9.85±5.11) years], and duration of menstrual changes [(3.43±2.78) years] in the NMS group were statistically significantly different when compared with those in the MS group [(20.71±3.61) years, P=0.020; (7.04±3.34) years, P=0.025; (7.63±3.47) years, P<0.001]. The rate of menstrual abnormality, scanty menstruation and amenorrhea were higher in the MS group than in the NMS group, and the difference in the ratio of the composition of the menstrual pattern between the two groups was statistically significant ( P=0.036). The differences in the rates of menstrual abnormalities 8 years later after menarche between the two groups were statistically significant (all P<0.05), and the ORs from 8 to 13 years after menarche were 2.76 (95% CI: 1.07-7.11), 3.68 (95% CI: 1.28-10.56), 3.27 (95% CI: 1.13-9.41), 3.07 (95% CI: 1.06-8.87), 4.20 (95% CI: 1.16-15.21), 11.57 (95% CI: 1.48-90.49), respectively; the difference in the rate of menstrual abnormality between the two groups with menstrual alteration duration of more than 4 years was also statistically significant (all P<0.05), and the ORs for menstrual alteration duration of 4-9 years were 8.89 (95% CI: 2.14-36.99), 11.88 (95% CI: 3.07-46.02), 16.56 (95% CI: 4.15-66.13), 11.25 (95% CI: 2.88-32.95), 7.80 (95% CI: 2.04-29.84), and 10.00 (95% CI: 1.91-52.48), respectively. The α-diversity index of intestinal flora was lower in the MS group than in the NMS group, but the difference was not statistically significant ( P>0.05). At the phylum level, there was a statistically significant difference in the abundance of intestinal flora between the two groups ( P<0.001), the abundance of Bacteroidetes was lower in the MS group than in the NMS group, and the abundance of the Firmicutes was similar in the two groups. At the genus level, there was a statistically significant difference in the abundance of intestinal flora between the two groups ( P<0.001), the abundance of Bifidobacterium decreased and the abundance of Streptococcus and Escherichia increased in the MS group compared with those in the NMS group. Conclusion:Abnormal menstruation 8 years later after menarche in patients with PCOS is predictive of future MS, and its predictive effect increases with age, but does not change significantly with the duration of disease in abnormal menstruation. The structure of the intestinal flora of patients with MS in PCOS is indeed significantly different from that of those without MS.

Objective To explore the safety and efficiency of sequential operation of Tirelizumab combined with chemotherapy in neoadjuvant therapy for locally advanced esophageal cancer.Methods A retrospective analysis was conducted on 60 patients with locally advanced esophageal cancer admitted to Renmin Hospital of Wuhan University from August 2018 to June 2022.The immunotherapy combined with chemotherapy sequential surgery patients were selected as the observation group(29 cases)and the chemotherapy sequential surgery patients were selected as the control group(31 cases)according to the treatment method.The study aimed to analyze whether there were differences in efficacy and safety between the two groups.Results There are 28 patients with R0 resection in the observation group,and 14 case reached ORR.In the control group,29 cases were resected with R0,and 7 cases reached ORR.The proportion of ORR patients in the observation group was significantly higher than that in the control group,which was statistically significant(P＜0.05).There were 9 patients with pCR in the observation group and 2 patients with pCR in the control group,and the proportion of pCR patients in the two groups was significantly different(P＜0.05).There were no significant differences between the two groups for preoperative and postoperative adverse events.Conclusion Immune checkpoint inhibitors combined with chemotherapy sequential surgery are safe and reliable in patients with locally advanced esophageal cancer,with significant short-term efficacy,and long-term efficacy remains to be observed.