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 explore the effects of home-based exercise rehabilitation on cardiac structure, valvular function, and exercise capacity in patients with severe aortic stenosis (AS) after transcatheter aortic valve replacement (TAVR). Methods 49 patients with severe AS who underwent TAVR at Zhongshan Hospital, Fudan University, from January 2024 to February 2025 were enrolled. They were divided into an exercise group (n＝25) or a non-exercise group (n＝24) based on participating or not in home-based rehabilitation after TAVR. The exercise group received 12 weeks of home-based exercise training (aerobic exercise plus resistance training every week); the non-exercise group received routine care. Transthoracic echocardiography (TTE) was used to assess cardiac structural parameters before discharge (T0) and after 12 weeks of exercise (T1). Functional outcomes including the 6-minute walk test (6MWT), Duke Activity Status Index (DASI), and Short Physical Performance Battery (SPPB) were compared between the two groups. A linear mixed-effects model was used to analyze the effect of home-based rehabilitation on echocardiographic parameters. Patients were stratified by baseline 6MWT (＜240 m as low-function subgroup, ≥240 m as high-function subgroup) to compare exercise-related outcomes between subgroups. Results At T1, the exercise group had a longer 6MWT distance than the non-exercise group (P＝0.012). The linear mixed-effects model showed that after 12 weeks of exercise, the left ventricular end-diastolic diameter (LVEDD) decreased in the exercise group but slightly increased in the non-exercise group, with a significant difference in changes over time between the two groups (P_interaction＝0.030). The exercise group also showed greater improvement in effective orifice area index (P_interaction＝0.028) and effective orifice area (P_interaction＝0.042) than the non-exercise group. Subgroup analysis revealed that in the low-function subgroup, the exercise group showed greater improvement in the 6MWT (P_interaction＝0.035) and the effective orifice area index (P_interaction＝0.046) compared to the non-exercise group; in the high-function subgroup, the exercise group showed greater improvement only in LVEDD compared to the non-exercise group (P_interaction＝0.046). Conclusions Home-based exercise rehabilitation improves exercise capacity, optimizes left ventricular remodeling, and enhances valvular function in patients with severe AS after TAVR, with greater benefits observed in patients with lower baseline 6MWT.

Inflammatory bowel disease(IBD)is a group of chronic non-specific intestinal inflammatory diseases with unclear etiology.Its pathogenesis may be related to the intestinal immune imbalance caused by the interaction of multiple factors such as environment,genetics and intestinal microecology.Macrophages,as an important component of the immune system,can maintain a balance between pro-inflammatory and anti-in-flammatory responses in the intestine.Macrophages can be divided into two polarization types:classical activa-tion(Ml)and alternative activation(M2)according to the different phenotypes and cytokines secreted by macrophages.The polarization of macrophages plays a key role in the subside of intestinal inflammation and the healing of mucosa.In the intestinal immune system of IBD,the imbalance between pro-inflammatory and anti-inflammatory factors caused by macrophage polarization imbalance can lead to sustained progression of intestinal mucosal inflammation and impairment of barrier function,playing a key role in IBD.The changes in macrophage polarization levels may affect the therapeutic effect of IBD.Therefore,targeting macrophage po-larization may be an important target for the treatment of IBD.This article summarizes the role of intestinal macrophage polarization in IBD and the impact of regulating macrophage polarization in IBD treatment to pro-vide reference for studying the new treatment methods for IBD.

Objective:To explore the characteristics and typology of self-care behavior among patients with chronic heart failure (CHF), and analyze their influencing factors.Methods:A cross-sectional study was used. A total of 318 patients with CHF who were hospitalized in the Heart Center of Zhongshan Hospital, Fudan University from November 2022 to July 2023 were selected by continuous enrollment method. The General Information Questionnaire, Heart Failure Self-care Index Scale, Brief Illness Perception Questionnaire, Self-efficacy for Managing Chronic Disease 6-item Scale, Perceived Social Support Scale, Atlanta Heart Failure Knowledge Test-V2 and Self-Care Confidence Scale were used to investigate. Latent profile analysis was utilized to delineate the characteristics and subtypes of self-care behaviors in CHF patients and examine the influencing factors.Results:A total of 291 patients were included in this study, including 190 males and 101 females, aged 67 (61, 74) years old. The analysis identified three latent categories of self-care behaviors among CHF patients: 26 cases in high self-care group, 131 cases in moderate self-care with deficiencies in maintenance and symptom perception group, and 134 cases in low self-care group.Ordered multicategorical Logistic regression analysis revealed that age ( OR=1.023, 95% CI 1.001-1.046, P<0.05), self-care confidence ( OR=0.859, 95% CI 0.817-0.904, P<0.01), and social support ( OR=0.966, 95% CI 0.940-0.993, P<0.05) were the factors influencing the potential categories of self-care behavior in CHF patients. Conclusions:The study identifies distinct categorical characteristics of self-care behaviors in patients with CHF. Healthcare professionals can leverage these findings to identify the self-care behavior characteristics and influencing factors for each patient category at an early stage, thereby providing personalized and precise support strategies to help patients enhance self-care behaviors.

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 analyze the gaps between the allocation of nursing human resources and the workload of emergency department and intensive care unit in Zhongshan Hospital, Fudan University in Shanghai in the past five years, so as to provide basis for the formulation of optimal countermeasures for the allocation of nursing human resources.Methods:Based on the data from January 2016 to December 2020, a retrospective study was used to analyze the trend and correlation between the allocation of nursing human resources (educational background, professional title and years of work experience) and the workload of emergency department and intensive care unit(emergency rescue, 120 vehicle pick-up, triage of level-1 patient, extracorporeal membrane oxygenation, central venous catheter intubation, organ transplantation, blood purification and endotracheal intubation). So as to explore the change trend of human resources and the workload of emergency department and intensive care unit in the past five years.Results:By the end of 2020, the proportion of the nurses with bachelor′s or master′s degree had reached 61.44% and the proportion of nurses with professional titles of nurse in charge and above reached 73.85% in emergency department. The structure of working years was relatively stable, and there was no obvious change trend. At the same time, the proportion of the nurses with bachelor′s or master′s degree has reached 57.62% and the proportion of nurses with professional titles of nurse in charge and above reached 63.42% in intensive care unit. The number of nurses who had worked for more than 5 years had shown an upward trend. However, the proportion of nurses with master′s degree or above was still small both in emergency department and intensive care unit. The workload of acute and critical care for nurses was increasing year by year. The average annual growth rates of nursing workload for triage of level-1 patient, blood purification, organ transplantation, central venous catheter intubation and extracorporeal membrane oxygenation were 8.94%, 9.06%, 11.07%, 18.50% and 28.32% respectively.Conclusions:The allocation of nursing human resources for emergency department and intensive care unit in Zhongshan hospital is changing towards personnel quality improvement and structure optimization, but there is still a shortage of high-level nursing personnel. And the workload of nurses in relevant departments is increasing year by year. Hospitals should actively explore the innovative way for the reform of the allocation of nursing human resource to ensure the balanced development of "quantity" and "quality" of nursing human resources for emergency department and intensive care unit.

Objective The objective of this study was to investigate the relationship between the molybdenum target imaging features and clinical signs of mammography,and the expression of HER-2 receptor in breast cancer patients with positive receptors of estrogen and progesterone. Methods One hundred and eleven patients with estrogen and progesterone receptor-positive breast canc-er who were admitted to our hospital from July to September 2017 were examined with mammography before operation. Immunohisto-chemical analysis was performed on breast cancer tissues. Pathological features and features related to mammography were analyzed af-ter operation. The relationship between clinicopathological features and mammography-related signs,and HER-2 expression was al-so analyzed statistically. Results Of the 111 patients,34 were HER-2 positive patients. There were significant difference between the observed indicators and the over-expression of HER-2(P<0. 05). These indicators included lymph node metastasis,calcifica-tion of the mass,margin of the mass,the shape of calcification,and the blood status of vessels. The mammography of patients with tri-ple positive breast cancer is more likely to manifest as lymph node enlargement,mass with calcification or simple calcification,margin-al burrs,granular calcification,and vascular thickening. Conclusion The expression of HER-2 in breast cancer patients with posi-tive estrogen and progesterone receptors can be reflected to some extent by lymph node metastasis,tumor with calcification,tumor mar-gin,calcification,calcification morphology and peripheral blood vessel thickening. In terms of clinical conditions,The biological behav-ior and characteristics of tumor can be inferred based on the clinicopathological features of the patient and the imaging findings of the mammography,providing a direction for the treatment and evaluation of prognosis in breast cancer patients.

Objective To analyze the short-term complications and long-term outcomes of spleenpreserving distal pancreatectomy (SPDP) in pediatric pancreatic tumors.Methods A retrospective analysis was conducted on 43 patients with tumors of the body and tail of the pancreas in Beijing Children's Hospital from Jan 2007 to Jan 2018.Results There were 17 boys (39.53％) and26girls (60.47％),with a median age of 123 (80,141) months.The median maximum diameter of primary tumor was 7.60 cm.Diagnoses included solid pseudopapillary tumor (n =28),pancreatoblastoma (n =10),neuroendocrine tumor (n =4),and pancreatic cyst (n =1).Two cases (4.65％) received tumor enucleation,4 cases (9.30％) did distal pancreatectomy plus splenectomy,and 37 cases (86.05％) did SPDP.16 cases (37.21％) had short-term complications,including pancreatic fistula (n =13),delayed gastric emptying (n =3),abdominal infection (n =7) and postoperative bleeding (n =2).After a median follow-up of 46 (23,71) months,38 cases (88.37％) were disease-free;two cases (4.65％) with tumor recurrence;one case of pancreatoblastoma died of tumor recurrence.Two cases lost to follow-up.Three patients had long-term complications,including chronic fatty diarrhea (n =2) and hypoglycemia (n =1).Three patients underwent second operation for recurrent tumor (one pancreatoblastoma and two solid pseudopapillary tumor).Conclusions SPDP is safe and effective in the treatment of tumors of the body and tail of the pancreas in children.

OBJECTIVE To evaluate the clinical value of contrast-enhanced ultrasonography (CEUS) in diagnosing thyroid carcinoma.METHODS The clinical data of 129 patients with thyroid nodules,who were examined by CEUS and were operated in Xinhua Hospital between Jan 2014 and Aug 2015,were analyzed in order to compare the diagnostic results of CEUS to the postoperative pathologic findings,and to summarize its imaging features.RESULTS A total of 132 thyroid nodules in 129 patients were examined by CEUS.Among them,103 nodules were diagnosed as thyroid carcinoma,24 nodules were benign thyroid tumor and 5 nodules were thyroiditis.Compared with pathology results,the diagnostic accuracy,sensitivity and specificity of contrast-enhanced ultrasound is 88.6％,92.2％ and of 75.9％ respectively.The diagnosis of the CEUS in 31 cases was not consistent with the pathological results,in which 8 cases of thyroid carcinoma were misdiagnosed as benign tumor,3 cases of thyroiditis were misdiagnosed as thyroid carcinoma,and 20 cases of benign tumors were misdiagnosed as thyroid carcinoma.The malignant thyroid nodules mainly were papillary carcinoma,which was characterized by'low enhanced'and'slow in fast out'performance in the contrast-enhanced ultrasound examination.CONCLUSION The contrast-enhanced ultrasound examination in diagnosing thyroid carcinoma has much more specificity and sensitivity,the'low-enhanced'and'slow in fast out'signs of the CEUS were the important features of malignant thyroid nodules.