Objective:This study analyzes the clinicopathological features and prognostic factors of early-stage gastric mixed adenoneuroendocrine carcinoma (G-MANEC), which is an exceedingly rare malignancy, in an effort to provide evidence-based insights for clinical decision-making.Methods:A retrospective observational study was conducted using the clinical data of 36 patients with early-stage G-MANEC who underwent surgical resection at Zhongshan Hospital, Fudan University, from July 2014 to May 2022. The observed indicators included clinicopathological data and follow-up information on recurrence, metastasis, and overall survival (OS).Results:Among the 36 patients there were 21 males and 15 females, aged 32-84 (65±11) years. The most common initial symptoms were abdominal pain and distension (19/36, 52.8%), followed by incidental findings during physical examinations (7/36, 19.4%). Tumors were located in the proximal stomach in 13 cases (36.1%), the middle stomach in 4 cases (11.1%), and the distal stomach in 19 cases (52.8%). Average tumor diameter was (2.48±1.18) cm. Gross morphology included elevated type in 12 cases (33.3%), flat type in 20 cases (55.6%), and depressed type in 4 cases (11.1%). Ulceration was present in 12 cases (33.3%). There were 11 cases (30.6%) at T1a stage and 25 cases (69.4%) at T1b stage. Lymph node metastasis was positive in 10 cases (27.8%), and the differentiation grades of the adenocarcinoma component were Grade I, II, and III in 3 (8.3%), 10 (27.8%), and 23 (63.9%) cases, respectively. Furthermore, the proportion of neuroendocrine carcinoma component was ≥50% in 18 cases (50.0%) and <50% in 18 cases (50.0%). Lymphovascular or perineural invasion was present in 18 cases (50.0%). Lauren classification included mixed type in 10 cases (27.8%), intestinal type in 19 cases (52.8%), and diffuse type in 7 cases (19.4%), and chromogranin A (CgA) positivity was found in 20 cases (55.6%). Additionally, the Ki-67 index positivity was found in 26 cases (72.2%). Total gastrectomy was performed in 12 cases (33.3%) and partial gastrectomy in 24 cases (66.7%), with a median follow-up duration of 77.5 months. The 3-year and 5-year OS rates were 88.89% and 79.67%, respectively. Univariate analysis revealed that age, gross morphology, ulceration, proportion of neuroendocrine carcinoma component, lymphovascular or perineural invasion, and chromogranin A (CgA) positivity showed statistical significance in their association with OS ( P<0.10). Multivariate Cox regression analysis further identified ulceration (HR=7.74, 95%CI: 1.24-48.30, P=0.028) and CgA positivity (HR=21.76, 95%CI: 1.86-53.97, P=0.014) as independent risk factors of OS. Conclusions:Patients with early-stage G-MANEC are typically asymptomatic, and those with ulceration or positive CgA immunohistochemical staining tend to have a poor prognosis.

Objectives:To investigate the clinical efficacy of the distal tension-offloading cosmetic suture technique in reducing hypertrophic scar formation following open thyroidectomy.Methods:Clinical data and postoperative incision appearance of 138 patients undergoing open thyroidectomy at the Department of Thyroid and Neck Oncology of Tianjin Medical University Cancer Institute and Hospital, as well as the Department of Head and Neck Oncology of Tianjin Cancer Hospital Airport Hospital, from Aug 2023 to Jan 2024 was enrolled. Patients were devided into two groups based on the incision closure method: the distal tension-offloading cosmetic suture group (tension reduction group, 37 cases) and ordinary intradermal suture group (control group A, 55 cases evaluated 3 months post-surgery; control group B, 46 cases evaluated 6 months post-surgery). The Vancouver Scar Scale (VSS) was employed to assess the appearance of the wounds at 3 and 6 months post-surgery .Results:On 3 and 6 months post-surgery, the total VSS scores for patients in the tension reduction group were 2.8 ± 2.3 and 2.5 ± 2.5, respectively,while that in control group A on 3 months was 5.2 ± 3.0, and in group B on 6 months was 5.3 ± 3.4. The differences were statistically significant (all P<0.001). On 3 and 6 months post-surgery, the proportions of hypertrophic scars in the tension reduction group were 14% (5/37) and 11% (4/37), respectively , while in control group A it was 35% (19/55) , and in control group B was 35% (16/46) at 6 months, with differences being statistically significant ( P=0.024, 0.011 ). On 6 months post-surgery, 51 % (19/37) of patients in the tension reduction group achieved 'socially invisible aesthetic incisions', while only 15% (7/46) of patients in control group B achieved the same outcome ( P<0.01). Conclusion:Distal tension-offloading cosmetic suture significantly reduces the incidence of incision hypertrophic scars in open thyroid surgery.

Objective:To investigate whether the levels of 15 micronutrients could influence the risk of HER2-positive and negative breast cancer using Mendelian randomization (MR) .Methods:In this study, multivariate Mendelian randomization analysis was used to obtain the data of 15 micronutrients (copper, calcium, carotene, folate, iron, magnesium, potassium, selenium, zinc, vitamin A, vitamin B12, vitamin B6, vitamin C, vitamin D and vitamin E) and HER2 (+/-) breast cancer in the Genome-Wide Association Study (GWAS) database. Analyses were performed using R software and the TwoSampleMR package. This study used the inverse variance weighting (IVW) method as the main method to analyze the causal relationship between micronutrients and HER2 (+/-) breast cancer, combined with MR-Egger regression, weighted median (WM) , Simple mode, and Weighted mode as complementary methods. Heterogeneity and horizontal pleiotropy of our results were detected by the Cochran Q test, MR-Egger regression test, MR-PRESSO composite test, and MR Egger intercept to enhance the reliability and stability of the results. Reverse MR analysis was performed as HER2 (+/-) breast cancer exposure factors. The micronutrients screened by the MR above analysis were used as outcome variables for effect and sensitivity analyses. Multivariate Mendelian randomization analysis was performed on the relevant trace elements screened by MR to avoid interference between variables. The independent effects of trace elements were analyzed to improve the reliability of our results.Results:The results of MR analysis showed that micronutrient vitamin B6 was negatively associated with the risk of developing HER2-negative breast cancer (IVM: OR=0.69,95% CI:0.45-0.96, P=0.029) . The results of the Cochran Q test, MR-Egger regression test, MR-PRESSO composite test, and MR Egger intercept test showed that there was no heterogeneity and horizontal pleiotropy among the instrumental variables. At the same time, the analysis of leave-one-out test confirmed that a single SNP had no significant effect on the overall results, which further enhanced the reliability and stability of the results. Conclusions:Among the 15 micronutrients, our results suggested that vitamin B6 may be a protective factor for HER-negative breast cancer. Our study provided a reference for the pathogenesis of HER-negative breast cancer and its early prevention and treatment.

Objective To analyze the clinicopathological characteristics and survival prognosis of young female patients with gastric adenocarcinoma. Methods A retrospective analysis was conducted on female patients who underwent radical gastrectomy at Zhongshan Hospital, Fudan University between January 2014 and December 2020, with postoperative pathological confirmation of gastric adenocarcinoma. Those aged ≤45 years were defined as the young group (n＝287), and were matched in a 1∶2 ratio by pTNM stage with female patients aged ≥60 years (elderly group, n＝574). Clinicopathological characteristics were compared between the two groups. Survival curves were plotted using the Kaplan-Meier method, and overall survival (OS) rates were assessed by log-rank test. Prognostic factors in the young group were analyzed using Cox regression models. Results Compared to elderly patients, young female gastric cancer patients exhibited a higher prevalence of tumors in the middle third of the stomach and a lower proportion in the upper third of the stomach. Molecular profiling revealed a higher frequency of HER2-low expression and elevated Ki-67 index. Pathologically, these patients were more frequently diagnosed with poorly differentiated or undifferentiated adenocarcinoma and signet ring cell carcinoma, while Lauren classification showed a predominance of the diffuse type with a lower proportion of the intestinal type (P＜0.05). Stratified analysis showed no significant difference in OS rates between the two groups for stage Ⅱ and Ⅲ patients; however, among stage Ⅰ patients, the young group had significantly better OS rates than the elderly group (P＝0.037). Multivariate Cox analysis and log-rank test confirmed that pN₃ stage (HR＝3.576, 95%CI 1.652–7.740), stage Ⅲ (HR＝3.581, 95%CI 1.059–12.106), and diffuse type (HR＝2.711, 95%CI 1.316–5.585) were risk factors for poor prognosis in young female gastric cancer patients. Conclusions Young female patients with gastric adenocarcinoma typically present with clinicopathological features such as the diffuse type, poor differentiation, and high proliferation. Moreover, pN₃ stage, stage Ⅲ cancer, and the diffuse type histology are correlated with a poor prognosis in this demographic.

Objective:This study analyzes the clinicopathological features and prognostic factors of early-stage gastric mixed adenoneuroendocrine carcinoma (G-MANEC), which is an exceedingly rare malignancy, in an effort to provide evidence-based insights for clinical decision-making.Methods:A retrospective observational study was conducted using the clinical data of 36 patients with early-stage G-MANEC who underwent surgical resection at Zhongshan Hospital, Fudan University, from July 2014 to May 2022. The observed indicators included clinicopathological data and follow-up information on recurrence, metastasis, and overall survival (OS).Results:Among the 36 patients there were 21 males and 15 females, aged 32-84 (65±11) years. The most common initial symptoms were abdominal pain and distension (19/36, 52.8%), followed by incidental findings during physical examinations (7/36, 19.4%). Tumors were located in the proximal stomach in 13 cases (36.1%), the middle stomach in 4 cases (11.1%), and the distal stomach in 19 cases (52.8%). Average tumor diameter was (2.48±1.18) cm. Gross morphology included elevated type in 12 cases (33.3%), flat type in 20 cases (55.6%), and depressed type in 4 cases (11.1%). Ulceration was present in 12 cases (33.3%). There were 11 cases (30.6%) at T1a stage and 25 cases (69.4%) at T1b stage. Lymph node metastasis was positive in 10 cases (27.8%), and the differentiation grades of the adenocarcinoma component were Grade I, II, and III in 3 (8.3%), 10 (27.8%), and 23 (63.9%) cases, respectively. Furthermore, the proportion of neuroendocrine carcinoma component was ≥50% in 18 cases (50.0%) and <50% in 18 cases (50.0%). Lymphovascular or perineural invasion was present in 18 cases (50.0%). Lauren classification included mixed type in 10 cases (27.8%), intestinal type in 19 cases (52.8%), and diffuse type in 7 cases (19.4%), and chromogranin A (CgA) positivity was found in 20 cases (55.6%). Additionally, the Ki-67 index positivity was found in 26 cases (72.2%). Total gastrectomy was performed in 12 cases (33.3%) and partial gastrectomy in 24 cases (66.7%), with a median follow-up duration of 77.5 months. The 3-year and 5-year OS rates were 88.89% and 79.67%, respectively. Univariate analysis revealed that age, gross morphology, ulceration, proportion of neuroendocrine carcinoma component, lymphovascular or perineural invasion, and chromogranin A (CgA) positivity showed statistical significance in their association with OS ( P<0.10). Multivariate Cox regression analysis further identified ulceration (HR=7.74, 95%CI: 1.24-48.30, P=0.028) and CgA positivity (HR=21.76, 95%CI: 1.86-53.97, P=0.014) as independent risk factors of OS. Conclusions:Patients with early-stage G-MANEC are typically asymptomatic, and those with ulceration or positive CgA immunohistochemical staining tend to have a poor prognosis.

Objective:To investigate whether the levels of 15 micronutrients could influence the risk of HER2-positive and negative breast cancer using Mendelian randomization (MR) .Methods:In this study, multivariate Mendelian randomization analysis was used to obtain the data of 15 micronutrients (copper, calcium, carotene, folate, iron, magnesium, potassium, selenium, zinc, vitamin A, vitamin B12, vitamin B6, vitamin C, vitamin D and vitamin E) and HER2 (+/-) breast cancer in the Genome-Wide Association Study (GWAS) database. Analyses were performed using R software and the TwoSampleMR package. This study used the inverse variance weighting (IVW) method as the main method to analyze the causal relationship between micronutrients and HER2 (+/-) breast cancer, combined with MR-Egger regression, weighted median (WM) , Simple mode, and Weighted mode as complementary methods. Heterogeneity and horizontal pleiotropy of our results were detected by the Cochran Q test, MR-Egger regression test, MR-PRESSO composite test, and MR Egger intercept to enhance the reliability and stability of the results. Reverse MR analysis was performed as HER2 (+/-) breast cancer exposure factors. The micronutrients screened by the MR above analysis were used as outcome variables for effect and sensitivity analyses. Multivariate Mendelian randomization analysis was performed on the relevant trace elements screened by MR to avoid interference between variables. The independent effects of trace elements were analyzed to improve the reliability of our results.Results:The results of MR analysis showed that micronutrient vitamin B6 was negatively associated with the risk of developing HER2-negative breast cancer (IVM: OR=0.69,95% CI:0.45-0.96, P=0.029) . The results of the Cochran Q test, MR-Egger regression test, MR-PRESSO composite test, and MR Egger intercept test showed that there was no heterogeneity and horizontal pleiotropy among the instrumental variables. At the same time, the analysis of leave-one-out test confirmed that a single SNP had no significant effect on the overall results, which further enhanced the reliability and stability of the results. Conclusions:Among the 15 micronutrients, our results suggested that vitamin B6 may be a protective factor for HER-negative breast cancer. Our study provided a reference for the pathogenesis of HER-negative breast cancer and its early prevention and treatment.

Objectives:To investigate the clinical efficacy of the distal tension-offloading cosmetic suture technique in reducing hypertrophic scar formation following open thyroidectomy.Methods:Clinical data and postoperative incision appearance of 138 patients undergoing open thyroidectomy at the Department of Thyroid and Neck Oncology of Tianjin Medical University Cancer Institute and Hospital, as well as the Department of Head and Neck Oncology of Tianjin Cancer Hospital Airport Hospital, from Aug 2023 to Jan 2024 was enrolled. Patients were devided into two groups based on the incision closure method: the distal tension-offloading cosmetic suture group (tension reduction group, 37 cases) and ordinary intradermal suture group (control group A, 55 cases evaluated 3 months post-surgery; control group B, 46 cases evaluated 6 months post-surgery). The Vancouver Scar Scale (VSS) was employed to assess the appearance of the wounds at 3 and 6 months post-surgery .Results:On 3 and 6 months post-surgery, the total VSS scores for patients in the tension reduction group were 2.8 ± 2.3 and 2.5 ± 2.5, respectively,while that in control group A on 3 months was 5.2 ± 3.0, and in group B on 6 months was 5.3 ± 3.4. The differences were statistically significant (all P<0.001). On 3 and 6 months post-surgery, the proportions of hypertrophic scars in the tension reduction group were 14% (5/37) and 11% (4/37), respectively , while in control group A it was 35% (19/55) , and in control group B was 35% (16/46) at 6 months, with differences being statistically significant ( P=0.024, 0.011 ). On 6 months post-surgery, 51 % (19/37) of patients in the tension reduction group achieved 'socially invisible aesthetic incisions', while only 15% (7/46) of patients in control group B achieved the same outcome ( P<0.01). Conclusion:Distal tension-offloading cosmetic suture significantly reduces the incidence of incision hypertrophic scars in open thyroid surgery.

Objective To investigate the prevalence and molecular characteristics of Anaplasma infections in sheep and goats in Anhui Province in 2020, so as to provide insights into ovine anaplasmosis prevention and control. Methods A total of 355 fresh blood samples were collected from 7 sheep and goat farms in Linquan County of Fuyang City, Lixin County of Bozhou City, Yu'an District of Lu'an City, Wangjiang County of Anqing City, Nanling County of Wuhu City, and Tianchang City and Fengyang County of Chuzhou City in Anhui Province from June to December 2020. A. bovis and A. phagocytophilum 16S ribosomal RNA (16S rRNA) gene, A. ovis major surface protein 4 (MSP4) gene and A. capra citric acid synthase (gltA) gene were amplified using PCR assay in all blood samples, and the prevalence of A. bovis, A. phagocytophilum, A. ovis and A. capra infections was calculated in sheep and goats. In addition, the positive amplification products were sequenced and subjected to genetic evolutionary analysis. Results The overall prevalence of Anaplasma infections was 17.5% (62/355) in sheep and goats in Anhui Province, and the prevalence of A. bovis, A. phagocytophilum, A. ovis and A. capra infections was 2.8% (10/355), 2.5% (9/355), 2.5% (9/355), and 7.0% (25/355), while the prevalence of A. bovis and A. phagocytophilum, A. phagocytophilum and A. ovis, A. phagocytophilum and A. capra and A. bovis, A. phagocytophilum and A. ovis co-infections was 0.8% (3/355), 1.1% (4/355), 0.3% (1/355) and 0.3% (1/355), respectively. No Anaplasma was detected in the sheep and goat farms in Fengyang County, while at least three Anaplasma species were detected in other sheep and goat farms, with co-infections of multiple Anaplasma species identified. The prevalence of Anaplasma infections was 14.7% (24/163) in goats and 19.8% (38/192) in sheep, and the prevalence of Anaplasma infections was 31.0% (31/100) in goats and sheep under 6 months of age, and 12.2% (31/255) in goats and sheep at ages of 6 months and older, respectively. A. bovis, A. phagocytophilum, A. ovis and A. capra were identified in sheep and goats of different breeds and ages. Conclusions Multiple Anaplasma species infections were commonly prevalent in goats and sheep in Anhui Province in 2020, notably A. phagocytophilum, A. ovis and A. capra, which have zoonotic risks. Improved surveillance and prevention and control of Anaplasma infections are required in sheep and goats in Anhui Province.

Objective:To investigate the risk factors for lymph node metastasis in patients with early gastric cancer and establish a model for prediction of risk.Methods:The cohort of this retrospective observational study comprised 1096 patients who had undergone radical gastric cancer surgery combined with standard D1 lymphadenectomy and been diagnosed with early gastric cancer by postoperative pathology in Zhongshan Hospital affiliated with Fudan University from January 2016 to July 2022. The patients were allocated to groups with and without lymph node metastases. Clinicopathological characteristics were compared between the two groups and multi-factor logistic regression analysis used to identify independent risk factors for lymph node metastasis in patients with early gastric cancer. Indications for endoscopic resection in the Japanese Gastric Cancer Association (JGCA) guideline were also incorporated into construction of the model. The patient cohort was divided into training and validation sets in a 6:4 ratio. The identified independent risk factors were used to construct a predictive nomogram. Receiver operating characteristic curves were plotted separately and the difference between them in predictive efficacy was compared using the area under the curve (AUC).Results:A total of 1,096 patients with early gastric cancer were included, with 750 males and 346 females. Their average age was (61.4±10.9) years old, and the mean tumor diameter was (23.8±11.4) mm. Among them, 188 patients (17.2%) had positive lymph node metastasis, with 109 cases in N1 stage, 42 cases in N2 stage, and 37 cases in N3 stage. Additionally, 462 patients were in T1a stage, while 634 patients were in T1b stage. Univariate analysis showed that tumor diameter, location, Lauren classification, gross morphology, histological type, intravascular invasion, ulceration, differentiation type and tumor T stage were associated with lymph node metastasis after radical gastrectomy for early gastric cancer (all P<0.05). Multifactorial analysis showed that the presence of intravascular invasion (OR=14.822, 95%CI: 9.323–23.572, P<0.001), undifferentiated type (OR=3.095, 95%CI: 1.649–5.811, P<0.001), tumor T1b (OR=1.798, 95%CI: 1.053–3.079, P=0.032), and tumor diameter ≥2 cm (OR=1.229, 95%CI: 1.031–1.469, P=0.022) were independent risk factors for lymph node metastasis. The baseline data of the training set and validation set were consistent in terms of balance (all P>0.05). We used the above variables to establish a predictive nomogram for lymph node metastasis in patients with early gastric cancer. The AUC values obtained from the validation of the model in the training and validation sets were 0.880 (95%CI: 0.849–0.911) and 0.881 (95%CI: 0.841–0.921), respectively, and were significantly better than the predictive efficacy based on the JGCA guideline (AUC=0.777, 95%CI: 0.746–0.809, P<0.001). Conclusions:Patients with early gastric cancer and intravascular invasion, undifferentiated tumors, tumor T1b, and diameter ≥2 cm are at higher risk of postoperative lymph node metastasis than other patients. The predictive model developed in this study more accurately predicts lymph node metastasis in patients with early gastric cancer than previously proposed methods.

Objective:To investigate the risk factors for lymph node metastasis in patients with early gastric cancer and establish a model for prediction of risk.Methods:The cohort of this retrospective observational study comprised 1096 patients who had undergone radical gastric cancer surgery combined with standard D1 lymphadenectomy and been diagnosed with early gastric cancer by postoperative pathology in Zhongshan Hospital affiliated with Fudan University from January 2016 to July 2022. The patients were allocated to groups with and without lymph node metastases. Clinicopathological characteristics were compared between the two groups and multi-factor logistic regression analysis used to identify independent risk factors for lymph node metastasis in patients with early gastric cancer. Indications for endoscopic resection in the Japanese Gastric Cancer Association (JGCA) guideline were also incorporated into construction of the model. The patient cohort was divided into training and validation sets in a 6:4 ratio. The identified independent risk factors were used to construct a predictive nomogram. Receiver operating characteristic curves were plotted separately and the difference between them in predictive efficacy was compared using the area under the curve (AUC).Results:A total of 1,096 patients with early gastric cancer were included, with 750 males and 346 females. Their average age was (61.4±10.9) years old, and the mean tumor diameter was (23.8±11.4) mm. Among them, 188 patients (17.2%) had positive lymph node metastasis, with 109 cases in N1 stage, 42 cases in N2 stage, and 37 cases in N3 stage. Additionally, 462 patients were in T1a stage, while 634 patients were in T1b stage. Univariate analysis showed that tumor diameter, location, Lauren classification, gross morphology, histological type, intravascular invasion, ulceration, differentiation type and tumor T stage were associated with lymph node metastasis after radical gastrectomy for early gastric cancer (all P<0.05). Multifactorial analysis showed that the presence of intravascular invasion (OR=14.822, 95%CI: 9.323–23.572, P<0.001), undifferentiated type (OR=3.095, 95%CI: 1.649–5.811, P<0.001), tumor T1b (OR=1.798, 95%CI: 1.053–3.079, P=0.032), and tumor diameter ≥2 cm (OR=1.229, 95%CI: 1.031–1.469, P=0.022) were independent risk factors for lymph node metastasis. The baseline data of the training set and validation set were consistent in terms of balance (all P>0.05). We used the above variables to establish a predictive nomogram for lymph node metastasis in patients with early gastric cancer. The AUC values obtained from the validation of the model in the training and validation sets were 0.880 (95%CI: 0.849–0.911) and 0.881 (95%CI: 0.841–0.921), respectively, and were significantly better than the predictive efficacy based on the JGCA guideline (AUC=0.777, 95%CI: 0.746–0.809, P<0.001). Conclusions:Patients with early gastric cancer and intravascular invasion, undifferentiated tumors, tumor T1b, and diameter ≥2 cm are at higher risk of postoperative lymph node metastasis than other patients. The predictive model developed in this study more accurately predicts lymph node metastasis in patients with early gastric cancer than previously proposed methods.