UNASSIGNED: Prior research suggests polyunsaturated fatty acids (PUFA) may prevent gallstones, but evidence on saturated fatty acids (SFA) and monounsaturated fatty acids (MUFA) is limited. This study aims to explore the associations between fatty acids and gallstones using a large sample of American population and Mendelian randomization (MR) methods.
UNASSIGNED: The cross-sectional study involved 6,629 participants from the National Health and Nutrition Examination Survey (NHANES) 2017-2020. Logistic regression and restricted cubic spline (RCS) analysis were conducted after stratifying by gender subgroups. Two-sample MR analysis was used to explore the causal relationship between fatty acids and gallstones without confounding factors.
UNASSIGNED: In females, higher SFA intake was positively associated with gallstone risk, while higher intake of n-3 and n-6 PUFA was negatively associated. No significant associations were found in males. No nonlinear correlations were found in any group by RCS analysis. MR analysis indicated that SFA, n-3, and n-6 PUFA could reduce gallstone risk.
UNASSIGNED: The influence of dietary fatty acid composition on gallstone development differs by gender, providing insights into dietary prevention and treatment of gallstones.

BACKGROUND: The chronic digestive condition gallstones is quite common around the world, the development of which is closely related to oxidative stress, inflammatory response and abnormalities of lipid metabolism. In the last few years, as a novel biomarker of lipid metabolism, the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) has garnered significant interest. However, its relationship with gallstones has not been studied yet.
METHODS: 3,772 people, all under 50, were included in this study, and their full data came from the National Health and Nutrition Examination Survey (NHANES) database for the years 2017-2020. Information on gallstones was obtained through self-reported questionnaires. Smoothed curve fitting multifactorial logistic regression was utilized to evaluate the connection of NHHR with gallstone formation incidence. Subsequently, subgroup analysis and interaction tests were applied. Finally, to create a prediction model, logistic regression and feature screening by last absolute shrinkage and selection operator (LASSO) were used. The resulting model was displayed using a nomogram.
RESULTS: In multivariate logistic regression that accounted for all factors, there was a 77% increase in the likelihood of gallstones for every unit rise in lnNHHR (OR 1.77 [CI 1.11-2.83]). Following NHHR stratification, the Q4 NHHR level was substantially more linked to the risk of gallstones than the Q1 level (OR 1.86 [CI 1.04-3.32]). This correlation was stronger in women, people under 35, smokers, abstainers from alcohol, non-Hispanic White people, those with excessively high cholesterol, people with COPD, and people without diabetes. After feature screening, a predictive model and visualized nomogram for gallstones were constructed with an AUC of 0.785 (CI 0.745-0.819), which was assessed by DCA to be clinically important.
CONCLUSIONS: In the group of people ≤ 50 years of age, elevated NHHR levels were substantially linked to a higher incidence of gallstones. This correlation was stronger in several specific groups such as females, under 35 years of age, smokers, and so on. Predictive models constructed using the NHHR have potential clinical value in assessing gallstone formation.

Spilled gallstones during laparoscopic cholecystectomy can potentially lead to serious complications in patients. We present a case of a patient with gallstone spillage during cholecystectomy who was found years later to have gallstones stuck in a difficult location, requiring robotic surgery. A robotic approach allows for greater visual angles compared to conventional laparoscopy. The patient tolerated the robotic procedure successfully, and no patient symptoms were reported during follow-up. This case addresses retained gallstones for difficult anatomical positions and confirms that a robotic abdominal approach is a safe, minimally invasive option.

BACKGROUND: Cholelithiasis is one of the more common complications following bariatric surgery. This may be related to the rapid weight loss during this period, although the exact mechanism of gallstone formation after bariatric surgery has not been fully elucidated.
METHODS: The present literature review focuses on risk factors, prevention options and the impact of the gut microbiota on the development of gallbladder stones after bariatric surgery.
RESULTS: A potential risk factor for the development of cholelithiasis after bariatric surgery may be changes in the composition of the intestinal microbiota and bile acids. One of the bile acids-ursodeoxycholic acid-is considered to reduce the concentration of mucin proteins and thus contribute to reducing the formation of cholesterol crystals in patients with cholelithiasis. Additionally, it reduces the risk of both asymptomatic and symptomatic gallstones after bariatric surgery. Patients who developed gallstones after bariatric surgery had a higher abundance of Ruminococcus gnavus and those who did not develop cholelithiasis had a higher abundance of Lactobacillaceae and Enterobacteriaceae.
CONCLUSIONS: The exact mechanism of gallstone formation after bariatric surgery has not yet been clarified. Research suggests that the intestinal microbiota and bile acids may have an important role in this.

UNASSIGNED: Morphologic changes in the gallbladder and gallstones are common in cirrhotic patients, but their associations with outcomes of cirrhotic patients are unclear.
UNASSIGNED: We retrospectively enrolled 206 cirrhotic patients and measured their gallbladder length and width, gallbladder wall thickness, presence of gallstones, and gallstones\' length and width in axial contrast-enhanced computed tomography (CT) images. X-tile software was utilized to calculate the optimal cutoff values of these parameters for evaluating survival and hepatic decompensation events in the cirrhosis group. Their associations with survival were explored by Cox regression analyses and Kaplan-Meier curve analyses. Their associations with hepatic decompensation events were evaluated by competing risk analyses and Nelson-Aalen cumulative risk curve analyses where death was a competing event.
UNASSIGNED: Cirrhotic patients with gallbladder length < 72 mm had a significantly higher cumulative survival rate than those with a length of ≥ 72 mm (P = 0.049 by log-rank test), but gallbladder width, gallbladder wall thickness, presence of gallstones, and gallstones\' length and width were not significantly associated with survival (P = 0.10, P = 0.14, P = 0.97, P = 0.73, and P = 0.73 by log-rank tests, respectively). Cirrhotic patients with gallbladder wall thickness < 3.4 mm had a significantly lower cumulative rate of hepatic decompensation events than those with a wall thickness of ≥ 3.4 mm (P = 0.02 by Gray\'s test), but gallbladder length and width, presence of gallstones, and gallstones\' length and width were not significantly associated with hepatic decompensation events (P = 0.15, P = 0.15, P = 0.54, P = 0.76, and P = 0.54 by Gray\'s tests, respectively).
UNASSIGNED: Changes in gallbladder length and gallbladder wall thickness, rather than gallstone parameters, may be in parallel with the long-term outcomes of cirrhotic patients.

UNASSIGNED: Adrenal Lipoma (LA) is a benign very rare tumor that accounts for 0.7 % of primary adrenal tumors and 4 % of adrenal fatty tumors. They are asymptomatic and discovered accidentally by a CT scan or the US.
METHODS: This case report describes an incidentally discovered giant adrenal lipoma in a 45-year-old Asian woman with no prior medical history, presenting with episodic blood pressure fluctuations and abdominal pain attributed to coexisting gallstones. Imaging revealed a heterogeneous, well-demarcated adrenal mass measuring 17 × 14 × 11 cm with a 2 × 3 cm nodular density. Histopathological examination confirmed a 15 cm lipoma with ischemic changes, devoid of atypical features. This case underscores the importance of thorough investigation for adrenal masses, even in asymptomatic individuals.
CONCLUSIONS: This case report details a rare instance of a giant adrenal lipoma (17 × 14 × 11 cm, 870 g) co-occurring with gallstones in a 45-year-old woman experiencing chronic abdominal pain. Computed tomography revealed a characteristic homogenous fatty lesion, prompting open surgical resection due to the tumor\'s size. Hormonal evaluation confirmed a non-functioning tumor. This case emphasizes the challenges in diagnosing and managing giant adrenal lipomas, advocating for comprehensive investigation of adrenal masses, particularly with concurrent hypertension.
CONCLUSIONS: Giant adrenal lipomas (LAs) are rare, benign tumors often presenting asymptomatically. This report documents the fifth largest and third heaviest LA reported, notably co-occurring with gallstones. While laparoscopic resection is ideal, delayed diagnosis due to insidious presentation can lead to increased tumor size, potentially precluding minimally invasive approaches.

Impacted gallstones in the stomach and the duodenum lead to a rare presentation of gastric outlet obstruction known as Bouveret syndrome. Diagnosis and management is often challenging because of lack of streamlined protocol. However, when a diagnosis is made, there is an extensive toolkit available to endoscopists and surgeons to ensure favorable outcomes for the patient. In this article, we present a challenging case of Bouveret syndrome that required multidepartmental coordination and intervention.

BACKGROUND: The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are novel inflammatory indicators that can be used to predict the severity and prognosis of various diseases. We categorize acute pancreatitis by etiology into acute biliary pancreatitis (ABP) and hypertriglyceridemia-induced acute pancreatitis (HTGP).
OBJECTIVE: To investigate the clinical significance of NLR and PLR in assessing persistent organ failure (POF) in HTGP and ABP.
METHODS: A total of 1450 patients diagnosed with acute pancreatitis (AP) for the first time at Shanxi Bethune Hospital between January 2012 and January 2023 were enrolled. The patients were categorized into two groups according to the etiology of AP: ABP in 530 patients and HTGP in 241 patients. We collected and compared the clinical data of the patients, including NLR, PLR, and AP prognostic scoring systems, within 48 h of hospital admission.
RESULTS: The NLR (9.1 vs 6.9, P < 0.001) and PLR (203.1 vs 160.5, P < 0.001) were significantly higher in the ABP group than in the HTGP group. In the HTGP group, both NLR and PLR were significantly increased in patients with severe AP and those with a SOFA score ≥ 3. Likewise, in the ABP group, NLR and PLR were significantly elevated in patients with severe AP, modified computed tomography severity index score ≥ 4, Japanese Severity Score ≥ 3, and modified Marshall score ≥ 2. Moreover, NLR and PLR showed predictive value for the development of POF in both the ABP and HTGP groups.
CONCLUSIONS: NLR and PLR vary between ABP and HTGP, are strongly associated with AP prognostic scoring systems, and have predictive potential for the occurrence of POF in both ABP and HTGP.

Introduction Laparoscopic cholecystectomy has long been the cornerstone of gallstone treatment. Both monopolar cautery and ultrasonically activated scalpel (UAS, also known as harmonic scalpel) have been employed in the dissection of the gallbladder from its fossa during laparoscopic cholecystectomy. Material and methods The prospective study was conducted in the Department of Surgery at Vivekananda Institute of Medical Sciences including 200 patients equally divided among the monopolar cautery and harmonic scalpel group. Patients were observed for 48 hours post-surgery, during which temperature and pain assessment were done. Acute phase reactants were measured during this period and compared with preoperative values. On the seventh day ultrasonography was done to look for the inflammatory changes. Results In a study involving 200 patients, the majority fell within the age bracket of 31 to 50 years, with females constituting the predominant demographic. Notably, patients who underwent surgery with a harmonic scalpel exhibited a reduced need for analgesics. Furthermore, the use of harmonic scalpels led to noteworthy alterations in acute phase reactants, including a significant decrease in the total leucocyte count (TLC) (p=0.03), neutrophils (p=0.005), and lymphocytes (p=0.02). Additionally, patients in the UAS group experienced a significantly lesser increase in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values (p=0.0001). Conversely, ultrasound imaging conducted on the seventh day post-surgery did not reveal any significant differences between the two groups. Conclusion Laparoscopic cholecystectomy performed with a harmonic scalpel is associated with a reduced tissue response and less tissue damage compared to the monopolar group.

BACKGROUND: Studies have indicated that monocyte-to-high-density lipoprotein cholesterol ratio (MHR) can be a reliable indicator of various diseases. However, the association between MHR and gallstone prevalence remains unclear. Therefore, this study aimed to explore any potential association between MHR and gallstone prevalence.
METHODS: This study used data from the National Health and Nutrition Examination Survey (NHANES) 2017-March 2020. MHR was calculated as the monocyte count ratio to high-density lipoprotein cholesterol levels. Multiple logistic regression models, Cochran-Armitage trend test, and subgroup analyses were used to examine the association between MHR and gallstones.
RESULTS: This study included 5907 participants, of whom 636 (10.77%) were gallstone formers. The study participants had a mean age of 50.78 ± 17.33 years. After accounting for multiple covariables, the multiple logistic regression model showed a positive linear association between MHR and gallstone odds. The subgroup analyses and interaction testing results revealed that the association between MHR and gallstones was statistically different across strata, including sex, smoking, asthma, and hypertension.
CONCLUSIONS: Gallstone prevalence positively associated with elevated MHR, indicating that MHR can be employed as a clinical indicator to assess gallstone prevalence.