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*

Objective To review the research of safe injection protocols for peripheral norepinephrine(pNE),to make clear the main contents of safe injection protocols and the compliance of clinical implementation protocols,and to provide reference for clinical nurses to use drugs safely.Methods Systematic searches were conducted in the PubMed database,the Embase database from the Netherlands,the Web of Science,the Cochrane library,CNKI,Wanfang database,VIP,and the China biomedical literature database for studies related to safe injection protocols for pNE.The search period extended from the establishment of the databases to April 30,2024.Two researchers conducted data extraction and summary analysis of the included literature.Results A total of 10 articles were incorporated,including 2 guidelines,4 observational retrospective cohort studies,2 observational prospective cohort studies,2 ambispective cohort study.All documents provide a complete safe injection scheme of pNE,and its main contents were as follows:the drug concentration should be diluted to 8～64 mg/L;the injection dose should be small,and the maximum dose should not exceed 0.5 μg·kg-1·min-1 or 25 μg/min;a short infusion time was appropriate,among which 4 schemes require≤24 hours;intravenous catheters should be large-bore models,mainly 16,18 and 20 G;selection of infusion sites with favorable venous conditions of upper limb should be selected for injection;during infusion,regular and effective monitoring was required,and the frequency of monitoring should be once an hour,not exceeding a maximum of 2 hours;observation of the puncture site,and must assess whether there was blood return to the venous pathway,develop an emergency plan for drug extravasation.Several studies provided the compliance analysis of the protocol.The items with the highest compliance were using the drug concentration specified in the protocol,with the highest implementation rate of 100.0%.The items with low compliance were:using ultrasonic catheterization or evaluation,with minimum 26.6%;monitor according to the specified time frequency,with a minimum of 36.0%;selection of infusion sites,with a minimum of 65.0%.Conclusion The pNE is safe and feasible in emergency situations,but it comes with numerous risks and limitations.Norepinephrine(NE)should be administered at low concentrations and small doses,using large-caliber venous indwelling needles,and choosing optimal injection sites.Ultrasound assessment and localization can be used if conditions permit.Short-term infusion is preferred,and effective monitoring should be conducted at regular intervals during the infusion.Emergency plans for drug extravasation should be established.Developing safe injection protocols can reduce the incidence of adverse events such as extravasation.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective To review the research of safe injection protocols for peripheral norepinephrine(pNE),to make clear the main contents of safe injection protocols and the compliance of clinical implementation protocols,and to provide reference for clinical nurses to use drugs safely.Methods Systematic searches were conducted in the PubMed database,the Embase database from the Netherlands,the Web of Science,the Cochrane library,CNKI,Wanfang database,VIP,and the China biomedical literature database for studies related to safe injection protocols for pNE.The search period extended from the establishment of the databases to April 30,2024.Two researchers conducted data extraction and summary analysis of the included literature.Results A total of 10 articles were incorporated,including 2 guidelines,4 observational retrospective cohort studies,2 observational prospective cohort studies,2 ambispective cohort study.All documents provide a complete safe injection scheme of pNE,and its main contents were as follows:the drug concentration should be diluted to 8～64 mg/L;the injection dose should be small,and the maximum dose should not exceed 0.5 μg·kg-1·min-1 or 25 μg/min;a short infusion time was appropriate,among which 4 schemes require≤24 hours;intravenous catheters should be large-bore models,mainly 16,18 and 20 G;selection of infusion sites with favorable venous conditions of upper limb should be selected for injection;during infusion,regular and effective monitoring was required,and the frequency of monitoring should be once an hour,not exceeding a maximum of 2 hours;observation of the puncture site,and must assess whether there was blood return to the venous pathway,develop an emergency plan for drug extravasation.Several studies provided the compliance analysis of the protocol.The items with the highest compliance were using the drug concentration specified in the protocol,with the highest implementation rate of 100.0%.The items with low compliance were:using ultrasonic catheterization or evaluation,with minimum 26.6%;monitor according to the specified time frequency,with a minimum of 36.0%;selection of infusion sites,with a minimum of 65.0%.Conclusion The pNE is safe and feasible in emergency situations,but it comes with numerous risks and limitations.Norepinephrine(NE)should be administered at low concentrations and small doses,using large-caliber venous indwelling needles,and choosing optimal injection sites.Ultrasound assessment and localization can be used if conditions permit.Short-term infusion is preferred,and effective monitoring should be conducted at regular intervals during the infusion.Emergency plans for drug extravasation should be established.Developing safe injection protocols can reduce the incidence of adverse events such as extravasation.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Background/Aims: Low educational attainment is a well-established risk factor for nonalcoholic fatty liver disease (NAFLD) in developed areas. However, the association between educational attainment and the risk of NAFLD is less clear in China. Methods: A cross-sectional study including over 200,000 Chinese adults across mainland China was conducted. Information on education level and lifestyle factors were obtained through standard questionnaires, while NAFLD and advanced fibrosis were diagnosed using validated formulas. Outcomes included the risk of NAFLD in the general population and high probability of fibrosis among patients with NAFLD. Logistic regression analysis was employed to estimate the risk of NAFLD and fibrosis across education levels. A causal mediation model was used to explore the potential mediators. Results: Comparing with those receiving primary school education, the multi-adjusted odds ratios (95% confidence intervals) for NAFLD were 1.28 (1.16 to 1.41) for men and 0.94 (0.89 to 0.99) for women with college education after accounting for body mass index. When considering waist circumference, the odds ratios (95% CIs) were 0.94 (0.86 to 1.04) for men and 0.88 (0.80 to 0.97) for women, respectively. The proportions mediated by general and central obesity were 51.00% and 68.04% for men, while for women the proportions were 48.58% and 32.58%, respectively. Furthermore, NAFLD patients with lower educational attainment showed an incremental increased risk of advanced fibrosis in both genders. Conclusions In China, a low education level was associated with a higher risk of prevalent NAFLD in women, as well as high probability of fibrosis in both genders.

Diabetes, hypertension, and dyslipidemia, collectively referred to the " Three Highs, " represent increasingly prevalent metabolic risk factors in China. Many individuals experience all three conditions concurrently, significantly heightening the risk of cardiovascular disease and mortality. Although the National Metabolic Management Center(MMC) has been established for over eight years and has its unique features, the awareness, treatment, and control rates of these diseases in China remain low, and the efficiency of community management is insufficient. According to the previous two editions of management guidelines and the most recent domestic and international diagnostic and treatment guidelines, this paper conducts an in-depth analysis of the operational experience and management strategies of the MMC. Its aim is to improve the efficiency of grassroots MMC mode management for " Three Highs" patients and ensure that patients receive more standardized management.

Diabetes, hypertension, and dyslipidemia, collectively referred to the " Three Highs, " represent increasingly prevalent metabolic risk factors in China. Many individuals experience all three conditions concurrently, significantly heightening the risk of cardiovascular disease and mortality. Although the National Metabolic Management Center(MMC) has been established for over eight years and has its unique features, the awareness, treatment, and control rates of these diseases in China remain low, and the efficiency of community management is insufficient. According to the previous two editions of management guidelines and the most recent domestic and international diagnostic and treatment guidelines, this paper conducts an in-depth analysis of the operational experience and management strategies of the MMC. Its aim is to improve the efficiency of grassroots MMC mode management for " Three Highs" patients and ensure that patients receive more standardized management.

Objective:To analyze the distribution characteristics of special types of diabetes in China, in order to provide a theoretical basis for the diagnosis and treatment of special types of diabetes.Methods:Pubmed, CNKI, and WanFang Data were searched for the case reports and clinical studies of special types of diabetes in China from 2011 to 2021. After independent literature screening by 2 researchers according to the inclusion and exclusion criteria, diseases and the number of corresponding cases included were extracted for statistics. The etiological composition and disease characteristics of three subtypes of special type diabetes were analyzed.Results:A total of 613 articles(7 377 patients)were included and roughly divided into eight subtypes of special type diabetes according to etiological classification for disease composition analysis. The results by ratio in descending order were as follows: mono-genetic gene defects in islet β-cell function, pancreatogenic diabetes, diabetes induced by drugs or chemicals, endocrine disease, mono-genetic gene defects in insulin action, other genetic syndromes associated with diabetes, infection, and uncommon immune-mediated diabetes. The disease composition of the three subtypes of special types of diabetes that we focused on were mono-genetic gene defects in islet β-cell function(50.21%), pancreatogenic diabetes(35.65%), and mono-genetic gene defects in insulin action(1.56%). The composition analysis of the special types of diabetes in each subtype showed that neonatal diabetes mellitus(NDM, n=1 749, 23.71%)and maturity onset diabetes in young(MODY, n=1 554, 21.07%)accounted for the largest proportions. According to the composition analysis of each subtype of MODY patients, the top three subtypes were MODY2(50.89%), MODY3(16.03%), and MODYX(8.91%). In addition, taking MODY as an example, patients with de novo mutations(DNMs)and(or)new mutation sites were summarized and analyzed. The results revealed 31 MODY patients with DNMs(1.99%) and 339 MODY patients with new mutation sites(21.81%). Conclusions:According to the literature analysis, NDM and MODY represent the largest proportion of patients with special type diabetes in China. MODY2 patients make up the largest proportion of MODY patients. In addition, diabetic patients carrying DNMs and(or)new mutation sites should be taken seriously.