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*

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.

Objective:To study the correlation between serum uric acid (SUA) and vascular calcification in middle-aged and elderly men.Methods:Using the Yiduyun electronic medical record retrieval system, a cross-sectional study was conducted on the clinical data of 2 786 male patients aged ≥40 years who underwent lung CT examinations in Dalian Central Hospital, Dalian University of Technology from January 2010 to October 2022. According to the degree of pulmonary CT vascular calcification, they were divided into vascular calcification group (1 296 cases)and non vascular calcification group (1 490 cases). The clinical data were collected and the correlation between SUA and vascular calcification were analyzed.Results:The levels os SUA in the vascular calcification group was higher than that in the non vascular calcification group: 311.50(270.25, 359.00) μmol/L vs. 284.00(251.00, 318.00) μmol/L, there was statistical difference ( F = 14.16, P<0.01). The constituent ratio of hyperuricemia in vascular calcification group was higher than that in non vascular calcification group : 25.62%(332/1 296) vs. 11.68%(174/1 490), there was statistical difference ( χ2 = 20.15, P<0.01). Spearman correlation analysis found a positive correlation between SUA level and vascular calcification in middle-aged and elderly men ( r = 0.489, P<0.01). Binary Logistic regression analysis results showed that SUA, body mass index (BMI), diastolic blood pressure(DBP), fasting plasma glucose(FPG) were positively correlated with vascular calcification ( P<0.01); after adjusting the influence of BMI, DBP and FPG on male vascular calcification, SUA was still a risk factor for vascular calcification. Conclusions:In the middle-aged and elderly male population, with the increase of blood uric acid, vascular calcification increase, and the elevated blood uric acid level is an independent risk factor for vascular calcification.

Objective To explore the influence of family history of diabetes and central obesity on prediabetes(Pre-DM)and their interaction.Methods Based on the REACTION studyduring August December 2011 in Dalian,2587 individuals aged≥40 with normal blood glucose(BG)were divided into newly diagnosed Pre-DM(n=522)and BG normal group(NC,n=2065)during follow-up.The influence of family history of DM and central obesity on prediabetes and their interaction were analyzed.Results The age,SBP,DBP,BMI,WC,HDL-C,LDL-C,TG,ALT,GGT,FPG,2 hPG,HbA1c,FIns,HOMA-IR,SUA and the incidence of hypertension,fatty liver disease,dyslipidemia,overweight/obesity and central obesity in Pre-DM group were all higher than those in NC group(P＜0.05).Multivariate logistic regression analysis showed that family history of diabetes and central obesity were risk factors for Pre-DM.After adjustment,no significant multiplicative interaction was shown between diabetes family history and central obesity on the risk of Pre-DM(P=0.764).Quantitative analysis of interaction showed that RERI=0.110,S=1.112 and AP=0.053,suggesting that DM family history and central obesity have no significant additive interaction on the risk of Pre-DM.Conclusion The family history of DM and central obesity are both associated with the occurrence of Pre-DM,but there is no significant interaction.

Objective:To investigate the influence of Covid-19 epidemic on the number of acute ischemic stroke patients with intravenous thrombolytic therapy in Dalian in 2020, the way to hospital, onset to door time (ODT), door to needle time(DNT), onset to needle time(ONT), and the National Institute of Health Stroke Scale (NIHSS) before and after intravenous thrombolytic therapy.Methods:This was a retrospective descriptive study on 13 map-participating hospitals in Dalian from August 2020 to December 2020. The number of acute ischemic stroke patients with intravenous thrombolytic therapy, ODT, DNT, ONT, modes of transport to hospital, the NIHSS score before and after intravenous thrombolytic therapy, etc were analyzed. Data were collected from August 1, 2020 to December 31, 2020, and compared with the baseline data from the same period in 2019.Results:SPSS 22.0 statistical software and Data Analysis ToolPak were used for statistical analysis of the obtained data, and T tests statistic was used for data analysis. In 2020,the number of acute ischemic stroke patients with intravenous thrombolytic therapy increased (681 cases vs 416 cases), and DNT increased [50 minutes vs 45 minutes P = 0.01]. In 2020, 83.55% of patients indicated self-visit as their main mode of transport to the hospital. In 2020, among the self-visit patients with NIHSS score<15 scores,the number of the patients with the NHISS score unchanged or decreased after intravenous thrombolytic therapy was more (562 scores vs. 535 scores, P<0.001), and the patients with NIHSS score ≥15 scores were more willing to call ambulances to hospital. Conclusions:During the Covid-19 epidemic period of 2020, the number of acute ischemic stroke patients receiving intravenous thrombolytic therapy increased, DNT increase; the patients withNIHSS score<15 scores are more willing to choose to visit the hospital using their own transportation and benefit from intravenous thrombolytic therapy. The patients with NIHSS ≥15 scores prefer to call ambulances to hospital.

Objective:To observe the changes of skeletal muscle indexes in elderly patients with type 2 diabetes complicated with sarcopenia treated with sitagliptin and acarbose.Methods:A total of 60 patients over 60 years old with type 2 diabetes complicated with sarcopenia in Dalian Municipal Central Hospital from January 2019 to January 2020 were selected and divided into two groups by random number table method.One group received sitagliptin and metformin,and the other group received acarbose and metformin. The changes of skeletal muscle indexes, glucagon-like peptides-1 (GLP-1), insulin resistance index (HOMA-IR) and inflammatory indexes were compared between the two groups at baseline and 36 weeks after treatment.Results:After treatment, the skeletal muscle index (SMI) of sitagliptin group was increased (5.94 ± 1.52 vs. 5.99 ± 1.52), and the difference was statistically significant ( P<0.05). Muscle strength and SMI decreased in acarbosse group (18.75 ± 4.64 vs. 17.72 ± 4.44, 6.09 ± 1.74 vs. 6.00 ± 1.71), with statistical significance ( P<0.05). GLP-1 increased in sitagliptin group, 0 min: (10.65 ± 1.68) pmol/L vs. (12.41 ± 1.88) pmol/L; 60 min: (22.79 ± 2.85) pmol/L vs. (25.51 ± 2.79) pmol/L; 120 min: (24.26 ± 2.94) pmol/L vs. (29.49 ± 2.91) pmol/L; 180 min: (11.68 ± 1.84) pmol/L vs. (12.88 ± 1.83) pmol/L. There were significant differences ( P<0.05). HOMA-IR and CRP decreased: 4.73 ± 3.04 vs. 3.16 ± 2.41, (2.39 ± 0.50) mg/L vs. (2.33 ± 0.43) mg/L, and the differences were statistically significant ( P<0.05). HOMA-IR in acarbose group decreased after treatment (5.80 ± 3.94 vs. 4.00 ± 1.63), and the difference was statistically significant ( P<0.05). Comparison between the two groups after treatment, the decreased value of muscle strength in sitagliptin group was less than that in acarbose group, and the difference was statistically significant ( P<0.05). GLP-1 and overall GLP-1 area under the curve in sitagliptin group were higher than those in acarbose group (67.64 ± 6.81 vs. 58.98 ± 6.72), with statistical significance ( P<0.05). HOMA-IR and CRP in sitagliptin group were lower than those in acarborose group: 3.16 ± 2.42 vs. 4.00 ± 1.63, (2.33 ± 0.43) mg/L vs. (2.41 ± 0.70) mg/L, with statistical significances ( P<0.05). Conclusions:Sitagliptin therapy improves muscle mass and protects muscle strength in elderly patients with type 2 diabetes mellitus and sarcopenia.

Objective: To investigate the relationship between neck circumference and metabolic syndrome (MS) in ≥ 40 years old community residents. Methods: A total of 5 017 Dalian community residents who participated in "the risk evaluation of cancers in Chinese diabetic individuals: a longitudinal study" from July to December 2014 were selected, with 1 256 male cases and 3 761 female cases, aged ≥ 40 years old. The basic information was selected by questionnaire. The neck circumference, waist circumference (WC), body height, weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting plasma glucose (FPG), 2 h-postprandial plasma glucose (2 h PG), glycosylated hemoglobin (HbA₁c) and blood fat were measured; the body mass index (BMI) was calculated. Results: The age, neck circumference, WC, FPG, 2 h PG, SBP, DBP, incidence of obesity, incidence of hypertension and incidence of type 2 diabetes mellitus in male were significantly higher than those in female: (63.5 ± 8.4) years vs. (60.8 ± 8.0) years, (38.6 ± 3.0) cm vs. (34.4 ± 2.6) cm, (92.3 ± 9.1) cm vs. (87.3 ± 9.6) cm, 5.59 (5.20, 6.42) mmol/L vs. 5.43 (5.09, 5.99) mmol/L, 7.67 (6.06, 11.08) mmol/L vs. 7.20 (5.97, 9.64) mmol/L, (135.3 ± 18.8) mmHg (1 mmHg = 0.133 kPa) vs. (129.8 ± 19.5) mmHg, (79.8 ± 10.7) mmHg vs. (74.8 ± 10.0) mmHg, 53.0% (666/1 256) vs. 48.9% (1 841/3 761), 49.9% (627/1 256) vs. 40.6% (1 528/3 761) and 29.8% (374/1 256) vs. 22.5% (846/3 761); the total cholesterol, triacylglycerol, high density lipoprotein cholesterol, low density lipoprotein cholesterol and incidence of central obesity in male were significantly lower than those in female: (5.04 ± 0.94) mmol/L vs. (5.58 ± 1.03) mmol/L, 1.35 (0.97, 1.95) mmol/L vs. 1.45 (1.06, 2.04) mmol/L, (1.18 ± 0.27) mmol/L vs. (1.32 ± 0.29) mmol/L, (2.99 ± 0.78) mmol/L vs. (3.27 ± 0.85) mmol/L and 63.7% (800/1 256) vs. 79.7% (2 998/3 761), and there were statistical differences (P<0.01 or <0.05). There were no statistical differences in BMI, HbA₁c and incidence of MS between male and female (P>0.05). After adjustment for age, smoking, drinking, menopausal status (female), BMI and WC, Logistic regression analysis result showed that increased neck circumference in male increased the risk of type 2 diabetes mellitus (OR = 1.075, 95% CI 1.012 to 1.142, P = 0.019); increased neck circumference in female increased the risks of type 2 diabetes mellitus (OR = 1.143, 95% CI 1.096 to 1.192, P = 0.000), hypertension (OR = 1.112, 95% CI 1.071 to 1.156, P = 0.000), hypertriacylglyceremia (OR = 1.099, 95% CI 1.060 to 1.139, P = 0.000), low HDL-C (OR = 1.104, 95% CI 1.064 to 1.144, P = 0.000) and MS (OR = 1.167, 95% CI 1.120 to 1.217, P = 0.000). Taking neck circumference as detection variable and MS as outcome variable, the receiver operating characteristic curve was analyzed. In male, the area under curve was 0.733, the optimal cut-off value of neck circumference was 37.9 cm, with a sensitivity of 77.9%, and a specificity of 55.9%. In female, the area under curve was 0.720, the optimal cut-off value of neck circumference 33.3 cm, with a sensitivity of 76.7%, and a specificity of 56.0%. Conclusions Neck circumference is associated with MS in ≥ 40 years old community residents. Male neck circumference >37.9 cm and female neck circumference>33.3 cm are the optimal cut-off value for forecasting MS.

To investigate the effect of lipid accumulation index on islet βcell function in middle-aged and elderly people.A total of 10 109 subjects were enrolled in the community residents of Dalian City,aged≥40 years, from July to December 2011, according to enrollment and exclusion criteria.The relationship between lipid accumulation index(LAP)and homeostasis model assessment for βcell function(HOMA-β)was described by curve fitting model, and the effect of LAP on HOMA-βwas proved by correlation and linear regression analysis.The relationship between LAP and HOMA-βshowed an inverted U trend.With the increase of LAP,HOMA-βincreased gradually, following then entered the plateau, and then decreased slowly.According to the LAP quartile classification,each category was analyzed separately as a separate data.Spearman correlation results showed that HOMA-βwas positively correlated with LAP in Q1 group, not in Q2 and Q3 group, while in Q4 group, it was negatively correlated.Multivariate linear regression analysis showed that LAP could enter the equation in group Q1 and group Q4 after adjustment of age, sex, systolic blood pressure, diastolic blood pressure, low density lipoprotein-cholesterol,and high density lipoprotein-cholesterol(all P<0.05).With the increase of LAP,pancreatic β-cell secretion activity increases compensatorily,then decreases to decompensation and finally to the process of weakening secretion.

Objective To investigate the characteristics of peroperative blood pressure and heart rate in patients with normotensive incidental pheochromocytomas in order to provide the basis for peroperative treatment. Methods This retrospective study collected the data of 104 patients with a pathological diagnosis of unilateral pheochromocytoma at PLA General Hospital during January 2011 to December 2016. They were divided into normotensive incidental pheochromocytomas(NIP) group (n＝50) if the patients were normotensive and HIP group ( n＝54) if the patients were with hypertension. The clinical features, imaging features and peroperative hemodynamics were analyzed. Results ( 1) The age, urinary norepinephrine, daily dosage and duration of phenoxybenzamine in NIP group were less than those of HIP group (all P<0.05). (2) Preinduction blood pressure, maximum blood pressure, and total fluid intake in NIP group were lower than those in HIP group(all P<0.05). The blood pressure range, heart rate range, increased blood pressure, minimum mean arterial pressure, vasoactive medication were without statistical significance between these two groups. ( 3) The times and rate of intraoperative systolic blood pressure more than 30% baseline, 200 mmHg (1 mmHg＝0.133 kPa), 180 mmHg, 160 mmHg, intraoperative tachycardia, bradycardia, intraoperative hypotension and postoperative hypotension were without statistical significance between these two groups. (4) Stratified analysis of age (50 years), phenoxybenzamine (40 mg/d), tumor diameter (50 mm) and preinduction blood pressure (130/80 mmHg) showed that intraoperative blood pressure and heart rate were without statistical significance between these two groups. ( 5) There was no correlation between phenoxybenzamine ( daily dosage or duration ) and peroperative hypotension. Applying phenoxybenzamine or vasoactive medication was not correlated with peroperative hypotension in NIP group. Conclusion The peroperative blood pressure and heart rate of patients with NIP are similar to those of patients with HIP. Adequate peroperative treatment should be applied to NIP to avoid hemodynamic instability.