Bidirectional associations among gallstone disease,non-alcoholic fatty liver disease,kidney stone disease

BACKGROUND A body of evidence has suggested bidirectional relationships among gallstone disease(GSD),non-alcoholic fatty liver disease(NAFLD),and kidney stone disease(KSD).However,the results are inconsistent,and studies on this topic in China are relatively few.Our goal is to explore the bidirectional associations among these three diseases through a multicenter study,systematic review,and meta-analysis.AIM To explore the bidirectional associations among these three diseases through a multicenter study,systematic review,and meta-analysis.The results may help to investigate the etiology of these diseases and shed light on the individualized prevention of these three diseases.METHODS Subjects who participated in physical examinations in Beijing,Tianjin,Chongqing in China were recruited.Multivariable logistic regression was employed to explore the bidirectional relationships among GSD,KSD,and NAFLD.Systematic review and meta-analysis were initiated to confirm the epidemiologic evidence from previous observational studies.Furthermore,trial sequential analysis(TSA)was conducted to evaluate whether the evidence was sufficient and conclusive.RESULTS Significant bidirectional associations were detected among the three diseases,independent of potential confounding factors.The pooled results of the systematic review and meta-analysis also corroborated the aforementioned results.The combined evidence from the multicenter study and meta-analysis was significant[pooled odds ratio(OR)=1.42,95%CI:1.16-1.75,KSD→GSD;pooled OR=1.48,95%CI:1.31-1.67,GSD→KSD;pooled OR=1.31,95%CI:1.17-1.47,GSD→NAFLD;pooled OR=1.37,95%CI:1.26-1.50,NAFLD→GSD;pooled OR=1.28,95%CI:1.08-1.51,NAFLD→KSD;pooled OR=1.21,95%CI:1.16-1.25,KSD→NAFLD].TSA indicated that the evidence was sufficient and conclusive.CONCLUSION The present study presents relatively sufficient evidence for the positive bidirectional associations among GSD,KSD,and NAFLD.The results may provide clues for investigating the etiology of these three diseases and offer a guideline for identifying high-risk patients.

Burden of gallstone disease in the United States population:Prepandemic rates and trends

BACKGROUND Gallstone disease is one of the most common digestive disorders in the United States and leads to significant morbidity,mortality,and health care utilization.AIM To expand on earlier findings and investigate prepandemic rates and trends in the gallstone disease burden in the United States using national survey and claims databases.METHODS The National Ambulatory Medical Care Survey,National Inpatient Sample,Nationwide Emergency Department Sample,Nationwide Ambulatory Surgery Sample,Vital Statistics of the United States,Optum Clinformatics®Data Mart,and Centers for Medicare and Medicaid Services Medicare 5%Sample and Medicaid files were used to estimate claims-based prevalence,medical care including cholecystectomy,and mortality with a primary or other gallstone diagnosis.Rates were age-adjusted(for national databases)and shown per 100000 population.RESULTS Gallstone disease prevalence(claims-based,2019)was 0.70%among commercial insurance enrollees,1.03%among Medicaid beneficiaries,and 2.09%among Medicare beneficiaries and rose over the previous decade.Recently,in the United States population,gallstone disease contributed to approximately 2.2 million ambulatory care visits,1.2 million emergency department visits,625000 hospital discharges,and 2000 deaths annually.Women had higher medical care rates with a gallstone disease diagnosis,but mortality rates were higher among men.Hispanics had higher ambulatory care visit and hospital discharge rates compared with Whites,but not mortality rates.Blacks had lower ambulatory care visit and mortality rates,but similar hospital discharge rates compared with whites.During the study period,ambulatory care and emergency department visit rates with a gallstone disease diagnosis rose,while hospital discharge and mortality rates declined.Among commercial insurance enrollees,rates were higher compared with national data for ambulatory care visits and hospitalizations,but lower for emergency department visits.Cholecystectomies performed in the United States included 605000 ambulatory laparoscopic,280000 inpatient laparoscopic,and 49000 inpatient open procedures annually.Among commercial insurance enrollees,rates were higher compared with national data for laparoscopic procedures.CONCLUSION The gallstone disease burden in the United States is substantial and increasing,particularly among women,Hispanics,and older adults with laparoscopic cholecystectomy as the mainstay treatment.Current practice patterns should be monitored for better health care access.

Pathophysiology of severe gallstone pancreatitis:A new paradigm

Severe gallstone pancreatitis(GSP)refractory to maximum conservative therapy has wide clinical variations,and its pathophysiology remains controversial.This Editorial aimed to investigate the pathophysiology of severe disease based on Opie’s theories of obstruction,the common channel,and duodenal reflux and describe its types.Severe GSP might be a hybrid disease with pathology polarized between acute cholangitis with mild pancreatitis(biliary type)and necrotizing pancreatitis uncomplicated with biliary tract disease(pancreatic type),in which hepatobiliary and pancreatic lesion severity is inversely related to the presence or absence of impacted ampullary stones.Severe GSP is caused by stones that are persistently impacted at the ampulla with biliopancreatic obstruction(biliary type),and probably,stones that are either temporarily lodged at the duodenal orifice or passed into the duodenum,thereby permitting reflux of bile or possible duodenal contents into the pancreas(pancreas type).When the status of the stones and the presence or absence of impacted ampullary stones with biliopancreatic obstruction are determined,the clinical course and outcome can be predicted.Gallstones represent the main cause of acute pancreatitis globally,and clinicians are expected to encounter GSP more often.Awareness of the etiology and pathogenesis of severe disease is mandatory.

Optimization Design of the Multi-Layer Cross-Sectional Layout of An Umbilical Based on the GA-GLM

Marine umbilical is one of the key equipment for subsea oil and gas exploitation,which is usually integrated by a great number of different functional components with multi-layers.The layout of these components directly affects manufacturing,operation and storage performances of the umbilical.For the multi-layer cross-sectional layout design of the umbilical,a quantifiable multi-objective optimization model is established according to the operation and storage requirements.Considering the manufacturing factors,the multi-layering strategy based on contact point identification is introduced for a great number of functional components.Then,the GA-GLM global optimization algorithm is proposed combining the genetic algorithm and the generalized multiplier method,and the selection operator of the genetic algorithm is improved based on the steepest descent method.Genetic algorithm is used to find the optimal solution in the global space,which can converge from any initial layout to the feasible layout solution.The feasible layout solution is taken as the initial value of the generalized multiplier method for fast and accurate solution.Finally,taking umbilicals with a great number of components as examples,the results show that the cross-sectional performance of the umbilical obtained by optimization algorithm is better and the solution efficiency is higher.Meanwhile,the multi-layering strategy is effective and feasible.The design method proposed in this paper can quickly obtain the optimal multi-layer cross-sectional layout,which replaces the manual design,and provides useful reference and guidance for the umbilical industry.

Association between triglyceride-glucose index and colorectal polyps:A retrospective cross-sectional study

BACKGROUND Colorectal polyps(CPs)are frequently occurring abnormal growths in the colorectum,and are a primary precursor of colorectal cancer(CRC).The triglyceride-glucose(TyG)index is a novel marker that assesses metabolic health and insulin resistance,and has been linked to gastrointestinal cancers.AIM To investigate the potential association between the TyG index and CPs,as the relation between them has not been documented.METHODS A total of 2537 persons undergoing a routine health physical examination and colonoscopy at The First People's Hospital of Kunshan,Jiangsu Province,China,between January 2020 and December 2022 were included in this retrospective cross-sectional study.After excluding individuals who did not meet the eligibility criteria,descriptive statistics were used to compare characteristics between patients with and without CPs.Logistic regression analyses were conducted to determine the associations between the TyG index and the prevalence of CPs.The TyG index was calculated using the following formula:Ln[triglyceride(mg/dL)×glucose(mg/dL)/2].The presence and types of CPs was determined based on data from colonoscopy reports and pathology reports.RESULTS A nonlinear relation between the TyG index and the prevalence of CPs was identified,and exhibited a curvilinear pattern with a cut-off point of 2.31.A significant association was observed before the turning point,with an odds ratio(95% confidence interval)of 1.70(1.40,2.06),P<0.0001.However,the association between the TyG index and CPs was not significant after the cut-off point,with an odds ratio(95% confidence interval)of 0.57(0.27,1.23),P=0.1521.CONCLUSION Our study revealed a curvilinear association between the TyG index and CPs in Chinese individuals,suggesting its potential utility in developing colonoscopy screening strategies for preventing CRC.

Mental health and insomnia problems in healthcare workers after the COVID-19 pandemic:A multicenter cross-sectional study

BACKGROUND Healthcare workers(HCWs)are at increased risk of contracting coronavirus disease 2019(COVID-19)as well as worsening mental health problems and insomnia.These problems can persist for a long period,even after the pandemic.However,less is known about this topic.AIM To analyze mental health,insomnia problems,and their influencing factors in HCWs after the COVID-19 pandemic.METHODS This multicenter cross-sectional,hospital-based study was conducted from June 1,2023 to June 30,2023,which was a half-year after the end of the COVID-19 emergency.Region-stratified population-based cluster sampling was applied at the provincial level for Chinese HCWs.Symptoms such as anxiety,depression,and insomnia were evaluated by the Generalized Anxiety Disorder-7,Patient Health Questionnaire-9,and Insomnia Severity Index.Factors influencing the symptoms were identified by multivariable logistic regression.RESULTS A total of 2000 participants were invited,for a response rate of 70.6%.A total of 1412 HCWs[618(43.8%)doctors,583(41.3%)nurses and 211(14.9%)nonfrontline],254(18.0%),231(16.4%),and 289(20.5%)had symptoms of anxiety,depression,and insomnia,respectively;severe symptoms were found in 58(4.1%),49(3.5%),and 111(7.9%)of the participants.Nurses,female sex,and hospitalization for COVID-19 were risk factors for anxiety,depression,and insomnia symptoms;moreover,death from family or friends was a risk factor for insomnia symptoms.During the COVID-19 outbreak,most[1086(76.9%)]of the participating HCWs received psychological interventions,while nearly all[994(70.4%)]of them had received public psychological education.Only 102(7.2%)of the HCWs received individual counseling from COVID-19.CONCLUSION Although the mental health and sleep problems of HCWs were relieved after the COVID-19 pandemic,they still faced challenges and greater risks than did the general population.Identifying risk factors would help in providing targeted interventions.In addition,although a major proportion of HCWs have received public psychological education,individual interventions are still insufficient.

Insights from exploring the interrelated dynamics of gallstone disease,non-alcoholic fatty liver disease,and kidney stone disease

This article delved into the comprehensive study by Jiang et al,which meticulously examined the bidirectional relationships among gallstone disease,nonalcoholic fatty liver disease,and kidney stone disease through a multicenter study,systematic review,and meta-analysis.The study provides significant evidence supporting these associations,offering valuable insights into the etiology and potential prevention strategies for these interconnected conditions.The clinical significance of these bidirectional relationships is profound,as they underscore the importance of recognizing these conditions not only as isolated diseases but as part of a complex network that can influence each other.These results highlight the critical need for thorough screening and personalized prevention strategies for individuals with these interconnected conditions.Explicit implications for prevention strategies and early screening practices are crucial,as they can lead to early detection and intervention,significantly altering disease progression and outcomes.Furthermore,identifying potential therapeutic targets within these shared pathways may enhance treatment efficacy and patient outcomes,making this research highly relevant to clinical practice.By comprehending the common pathophysiological mechanisms and applying specific interventions,healthcare professionals can greatly enhance patient care and lessen the impact of these widespread diseases on global health.

Comparison of biliary protein spectrum in gallstone patients with obesity and those with normal body weight

Background: Obesity is a common public health issue and is currently deemed a disease. Research has shown that the risk of gallstones in individuals with obesity is elevated. This study aimed to explore the bile proteomics differences between cholelithiasis patients with obesity and normal body weight. Methods: Bile samples from 20 patients(10 with obesity and 10 with normal body weight) who underwent laparoscopic cholecystectomy at our center were subjected to tandem mass tag labeling(TMT) and liquid chromatography-tandem mass spectrometry(LC-MS/MS), followed by further bioinformatic analysis. Results: Among the differentially expressed proteins, 23 were upregulated and 67 were downregulated. Bioinformatic analysis indicated that these differentially expressed proteins were mainly involved in cell development, inflammatory responses, glycerolipid metabolic processes, and protein activation cascades. In addition, the activity of the peroxisome proliferator-activated receptor(PPAR, a subfamily of nuclear receptors) signaling pathway was decreased in the Kyoto Encyclopedia of Genes and Genomes(KEGG) enrichment analysis. Two downregulated proteins in the PPAR signaling pathway, APO A-Ⅰ and APO A-Ⅱ, were confirmed using enzyme-linked immunosorbent assay. Conclusions: The PPAR signaling pathway may play a crucial role in the development of cholelithiasis among patients with obesity. Furthermore, biliary proteomics profiling of gallstones patients with obesity is revealed, providing a reference for future research.

Cracking the silent gallstone code:Wait or operate?

The widespread availability of abdominal ultrasound has revealed the common occurrence of asymptomatic gallstones.While the treatment for symptomatic gallstones is clear,the benefits of minimally invasive laparoscopic cholecystectomy have sparked debate about the best approach to managing silent gallstones.The potential for asymptomatic gallstones to become symptomatic or lead to complications complicates the decision-making process regarding surgical intervention,as it's uncertain when or which patients might develop complications.Consequently,risk stratification appears to play a critical role in guiding decisions about silent gallstones.However,there is no definitive evidence to direct management,and a consensus-based on high-quality evidence is yet to be established.

Development and validation of a nomogram model for predicting the risk of gallstone recurrence after gallbladder-preserving surgery

Background:The high incidence of gallstone recurrence was a major concern for laparoscopic gallbladderpreserving surgery.This study aimed to investigate the risk factors for gallstone recurrence after gallbladder-preserving surgery and to establish an individualized nomogram model to predict the risk of gallstone recurrence.Methods:The clinicopathological and follow-up data of 183 patients who were initially diagnosed with gallstones and treated with gallbladder-preserving surgery at our hospital from January 2012 to January 2019 were retrospectively collected.The independent predictive factors for gallstone recurrence following gallbladder-preserving surgery were identified by multivariate logistic regression analysis.A nomogram model for the prediction of gallstone recurrence was constructed based on the selected variables.The C-index,receiver operating characteristic(ROC)curve and calibration curve were used to evaluate the predictive power of the nomogram model for gallstone recurrence.Results:During the follow-up period,a total of 65 patients experienced gallstone recurrence,and the recurrence rate was 35.5%.Multivariate logistic regression analysis revealed that the course of gallstones>2 years[odds ratio(OR)=2.567,95%confidence interval(CI):1.270-5.187,P=0.009],symptomatic gallstones(OR=2.589,95%CI:1.059-6.329,P=0.037),multiple gallstones(OR=2.436,95%CI:1.133-5.237,P=0.023),history of acute cholecystitis(OR=2.778,95%CI:1.178-6.549,P=0.020)and a greasy diet(OR=2.319,95%CI:1.186-4.535,P=0.014)were independent risk factors for gallstone recurrence after gallbladder-preserving surgery.A nomogram model for predicting the recurrence of gallstones was established based on the above five variables.The results showed that the C-index of the nomogram model was 0.692,suggesting it was valuable to predict gallstone recurrence.Moreover,the calibration curve showed good consistency between the predicted probability and actual probability.Conclusions:The nomogram model for the prediction of gallstone recurrence might help clinicians develop a proper treatment strategy for patients with gallstones.Gallbladder-preserving surgery should be cautiously considered for patients with high recurrence risks.

Analysis of Constitutional Factors in Patients with Gallstone Disease

Objective: To summarize the common constitutional types in patients with gallstone disease and analyze influencing factors. Research Hypothesis: Qi stagnation constitution may be a potential predisposing constitution for gallstone disease, whereas the Balanced Constitution and Yin deficiency constitution have a lower tendency towards the development of the disease;gallstone disease is more prevalent among young men engaged in mental labor. Methods: A retrospective study was conducted on 180 patients with gallstone disease who were hospitalized in the Department of Hepatobiliary Surgery, First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine (TCM), from July 2017 to July 2023. Additionally, 180 healthy individuals undergoing physical examinations at the Health Examination Center of the same hospital were selected as the normal control group. Both groups underwent general condition surveys, TCM constitution scales, Eysenck Personality Questionnaires, Brief Coping Styles Questionnaires, and Social Support Rating Scales to determine risk factors and common types. Results: Independent variables such as gender, Qi stagnation constitution, Balanced Constitution, negative coping scores, positive coping scores, and stressful life events were included in the model. The OR values for Balanced Constitution, gender, positive coping style, and overall social support were all less than 1, and the maximum value of the 95% confidence interval was also less than 1. After selecting the intercept into the model and analyzing the standardized regression coefficients, it was found that negative coping scores had a significant impact on the model, while stressful life events showed extremely high relevance to the study. Compared with the normal group, the frequency of Qi stagnation constitution in the study group significantly increased, with a significant difference (P χ2 = 11.109, P = 0.0009, indicating a significant difference (P χ2 = 4.0890, P = 0.0432, indicating a significant difference (P 0.05). However, when comparing mental workers with physical workers within the patient group, the frequency of Qi stagnation constitution in mental workers was significantly higher, with χ2 = 6.8467, P = 0.012, indicating a significant difference (P Conclusion: Qi stagnation constitution is a potential predisposing constitution for gallstone disease, whereas the tendency to develop the disease is relatively low for Balanced Constitution and Yin deficiency constitution. Gallstone disease is more commonly found in young male mental workers.

Association between Residential Greenness and Cardiometabolic Risk Factors among Adults in Rural Xinjiang Uygur Autonomous Region,China:A Cross-Sectional Study

Objective This study aimed to explore the relationships between residential greenness and cardiometabolic risk factors among rural adults in Xinjiang Uygur Autonomous Region(Xinjiang)and thus provide a theoretical basis and data support for improving the health of residents in this region.Methods We recruited 9,723 adult rural residents from the 51st Regiment of the Third Division of the Xinjiang Production and Construction Corps in September 2016.The normalized difference vegetation index(NDVI)was used to estimate residential greenness.The generalized linear mixed model(GLMM)was used to examine the association between residential greenness and cardiometabolic risk factors.Results Higher residential greenness was associated with lower cardiometabolic risk factor prevalence.After adjustments were made for age,sex,education,and marital status,for each interquartile range(IQR)increase of NDVI500-m,the risk of hypertension was reduced by 10.3%(OR=0.897,95%CI=0.836-0.962),the risk of obesity by 20.5%(OR=0.795,95%CI=0.695-0.910),the risk of type 2 diabetes by 15.1%(OR=0.849,95%CI=0.740-0.974),and the risk of dyslipidemia by 10.5%(OR=0.895,95%CI=0.825-0.971).Risk factor aggregation was reduced by 20.4%(OR=0.796,95%CI=0.716-0.885)for the same.Stratified analysis showed that NDVI500-m was associated more strongly with hypertension,dyslipidemia,and risk factor aggregation among male participants.The association of NDVI500-m with type 2 diabetes was stronger among participants with a higher education level.PM10 and physical activity mediated 1.9%-9.2%of the associations between NDVI500-m and obesity,dyslipidemia,and risk factor aggregation.Conclusion Higher residential greenness has a protective effect against cardiometabolic risk factors among rural residents in Xinjiang.Increasing the area of green space around residences is an effective measure to reduce the burden of cardiometabolic-related diseases among rural residents in Xinjiang.

Impact of metabolic disorders on gallstone disease and perioperative recovery after laparoscopic cholecystectomy

Background:Gallstone disease(GSD),nonalcoholic fatty liver disease(NAFLD),metabolic dysfunctionassociated fatty liver disease(MAFLD),and metabolic syndrome(MetS)are common medical disorders worldwide.This study aimed to ascertain how NAFLD,MAFLD,MetS,and other factors affect the development of GSD,and how the GSD-associated factors influence patient recovery after laparoscopic cholecystectomy(LC).Methods:We included 200 patients who were diagnosed with GSD and underwent LC between January 2017 and February 2022.A total of 200 subjects without GSD and“non-calculous causes”during the same period were also included as controls.We compared the metabolic disorder differences between GSD patients and controls.Furthermore,we sub-grouped patients based on the comorbidities of preoperative NAFLD,MAFLD,and MetS,and compared the impacts of these comorbidities on short-term post-LC functional recovery of the patients.Results:The prevalence of NAFLD and MetS were higher in GSD patients(P<0.05).Based on multivariate logistic regression analysis,hyperglycemia[odds ratio(OR)=2.2,95%confidence interval(CI):1.4–3.4,P=0.001]and low high-density lipoprotein cholesterol(HDL-C)level(OR=1.8,95%CI:1.1–3.1,P=0.048)were linked to GSD.NAFLD and MetS linked to liver enzymes after LC(P<0.05).MetS also linked to the levels of inflammatory indicators after LC(P<0.05).The obesity,hyperlipidemia,low HDLC level,and hyperglycemia linked to liver enzymes after LC(P<0.05).Hyperlipidemia,low HDL-C level,and hypertension linked to inflammation after LC(P<0.05).Conclusions:The prevalence of GSD may be linked to NAFLD and MetS.Hyperglycemia and low HDL-C level were independent risk factors of GSD.

Biliary microbiome and gallstones: A silent friendship

With increasing evidence,the biliary tract and the gallbladder mucosa are no longer considered sterile environments devoid of bacteria.Rather a profound biofilm of resident bacterial flora is associated with the mucosal surface.The bile too harbors a resident flora.It is when a dysbiotic process ensues,that this bac-terial flora either becomes opportunist or is replaced by a pathogenic one that has a strong ability to survive the challenges of the biliary environment.Although once believed a metabolic problem,recent evidence indicates a complex intera-ction between different species of bacteria and gallbladder mucosa and bile which may culminate in calculus formation.The resident microbiota and its several enzymes dictate the type of gallstone by the mere interplay of the constituting type of bacteria in the biofilm,even without any evidence of infection.Dysbiosis is often mediated by either intestinal dysbiosis or less probably by oral dysbiosis.The gallstones,in turn,provide a haven for the resident microbiota in which they can form their own defined niche enriched with the biofilm that can resist the biliary defense mechanisms and survive the hostile biliary environment in the background of biliary stasis and local infection.However,this process of silent friendship is more complex than said,and further research is needed to define the relationship between the two.

Wideband radar cross-section reduction by a double-layer-plasma-based metasurface

Reduction of the radar cross-section(RCS) is the key to stealth technology. To improve the RCS reduction effect of the designed checkerboard metasurface and overcome the limitation of thinlayer plasma in RCS reduction technology, a double-layer-plasma-based metasurface—composed of a checkerboard metasurface, a double-layer plasma and an air gap between them—was investigated. Based on the principle of backscattering cancellation, we designed a checkerboard metasurface composed of different artificial magnetic conductor units;the checkerboard metasurface can reflect vertically incident electromagnetic(EM) waves in four different inclined directions to reduce the RCS. Full-wave simulations confirm that the doublelayer-plasma-based metasurface can improve the RCS reduction effect of the metasurface and the plasma. This is because in a band lower than the working band of the metasurface, the RCS reduction effect is mainly improved by the plasma layer. In the working band of the metasurface,impedance mismatching between the air gap and first plasma layer and between first and second plasma layers cause the scattered waves to become more dispersed, so the propagation path of the EM waves in the plasma becomes longer, increasing the absorption of the EM waves by the plasma. Thus, the RCS reduction effect is enhanced. The double-layer-plasma-based metasurface can be insensitive to the polarization of the incoming EM waves, and can also maintain a satisfactory RCS reduction band when the incident waves are oblique.

Spilled gallstone mimicking intra-abdominal seeding of gallbladder adenocarcinoma: A case report

BACKGROUND Gallbladder rupture is common in laparoscopic cholecystectomy because the gallbladder is usually in acute or chronic inflammation status.The gallstones may sometime be spilled into the peritoneal cavity,resulting in intra-abdominal ab-scess if the gallstones were not retrieved.The diagnosis of intra-abdominal ab-scess caused by unretrieved gallstone can usually be correctly identified in the routine imaging studies,such as abdominal ultrasonography or computed tomo-graphy(CT).Here we present a case of abscess formation from unretrieved gall-stone following laparoscopic cholecystectomy,which mimics the imaging findings of metastatic gallbladder ade-nocarcinoma.CASE SUMMARY This case described a 78-year-old man who received laparoscopic cholecystectomy and gallbladder adenocarcinoma was diagnosed after surgery.After adjuvant chemotherapy,the following up abdominal CT showed several small nodules at right upper abdomen and peritoneal carcinomatosis is considered.Repeated laparoscopic surgery for the excision of seeding tumor was conducted and the pathological diagnosis of the nodules and mass was inflammatory tissues and gallbladder stone.CONCLUSION Spilled gallstones are a common complication during laparoscopic cholecystectomy and some gallstones fail to be retrieved due to the size or the restricted view of laparoscopic surgery.For spilled gall bladder stones,surgeons may consider regular computerized tomography follow-up,and if necessary,laparoscopic examination can be used as a means of confirming the diagnostic and treatment.

Classification of anatomical morphology of cystic duct and its association with gallstone

BACKGROUND Gallstones are common lesions that often require surgical intervention.Laparo-scopic cholecystectomy is the treatment of choice for symptomatic gallstones.Preoperatively,the anatomical morphology of the cystic duct(CD),needs to be accurately recognized,especially when anatomical variations occur in the CD,which is otherwise prone to bile duct injury.However,at present,there is no optimal classification system for CD morphology applicable in clinical practice,and the relationship between anatomical variations in CDs and gallstones remains to be explored.AIM To create a more comprehensive clinically applicable classification of the morphology of CD and to explore the correlations between anatomic variants of CD and gallstones.METHODS A total of 300 patients were retrospectively enrolled from October 2021 to January 2022.The patients were divided into two groups:The gallstone group and the nongallstone group.Relevant clinical data and anatomical data of the CD based on magnetic resonance cholangiopancreatography(MRCP)were collected and analyzed to propose a morphological classification system of the CD and to explore its relationship with gallstones.Multivariate analysis was performed using logistic regression analyses to identify the independent risk factors using variables that were significant in the univariate analysis.RESULTS Of the 300 patients enrolled in this study,200(66.7%)had gallstones.The mean age was 48.10±13.30 years,142(47.3%)were male,and 158(52.7%)were female.A total of 55.7%of the patients had a body mass index(BMI)≥24 kg/m2.Based on the MRCP,the CD anatomical typology is divided into four types:Type I:Linear,type II:n-shaped,type III:S-shaped,and type IV:W-shaped.Univariate analysis revealed differences between the gallstone and nongallstone groups in relation to sex,BMI,cholesterol,triglycerides,morphology of CD,site of CD insertion into the extrahepatic bile duct,length of CD,and angle between the common hepatic duct and CD.According to the multivariate analysis,female,BMI(≥24 kg/m2),and CD morphology[n-shaped:Odds ratio(OR)=10.97,95%confidence interval(95%CI):5.22-23.07,P<0.001;S-shaped:OR=4.43,95%CI:1.64-11.95,P=0.003;W-shaped:OR=7.74,95%CI:1.88-31.78,P=0.005]were significantly associated with gallstones.CONCLUSION The present study details the morphological variation in the CD and confirms that CD tortuosity is an independent risk factor for gallstones.

Dyslipidemia in Adults with Type 2 Diabetes in a Rural Community in Ganadougou, Mali: A Cross-Sectional Study

Dyslipidemia is a disorder where abnormally lipid concentrations circulate in the bloodstream. The disorder is common in type 2 diabetics (T2D) and is linked with T2D comorbidities, particularly cardiovascular disease. Dyslipidemia in T2D is typically characterized by elevated plasma triglyceride and low high-density lipoprotein cholesterol (HDL-C) levels. There is a significant gap in the literature regarding dyslipidemia in rural parts of Africa, where lipid profiles may not be captured through routine surveillance. This study aimed to characterize the prevalence and demo-graphic profile of dyslipidemia in T2D in the rural community of Ganadougou, Mali. We performed a cross-sectional study of 104 subjects with T2D in Ganadougou between November 2021 and March 2022. Demographic and lipid profiles were collected through cross-sectional surveys and serological analyses. The overall prevalence of dyslipidemia in T2D patients was 87.5% (91/104), which did not differ by sex (P = .368). High low-density lipoprotein cholesterol (LDL-C) was the most common lipid abnormality (78.9%, [82/104]). Dyslipidemia was associated with age and hypertension status (P = .013 and.036, respectively). High total and high LDL-C parameters were significantly associated with hypertension (P = .029 and .006, respectively). In low-resource settings such as rural Mali, there is a critical need to improve infrastructure for routine dyslipidemia screening to guide its prevention and intervention approaches. The high rates of dyslipidemia observed in Gandadougou, consistent with concomitant increases in cardiovascular diseases in Africa suggest that lipid profile assessments should be incorporated into routine medical care for T2D patients in African rural settings.

Cross-section distortion and springback characteristics of double-cavity aluminum profile in force controlled stretch-bending

3D elastic-plastic FE model for simulating the force controlled stretch-bending process of double-cavity aluminum profile was established using hybrid explicit−implicit solvent method.Considering the computational accuracy and efficiency,the optimal choices of numerical parameters and algorithms in FE modelling were determined.The formation mechanisms of cross-section distortion and springback were revealed.The effects of pre-stretching,post-stretching,friction,and the addition of internal fillers on forming quality were investigated.The results show that the stress state of profile in stretch-bending is uniaxial with only a circumferential stress.The stress distribution along the length direction of profile is non-uniform and the maximum tensile stress is located at a certain distance away from the center of profile.As aluminum profile is gradually attached to bending die,the distribution characteristic of cross-section distortion along the length direction of profile changes from V-shape to W-shape.After unloading the forming tools,cross-section distortion decreases obviously due to the stress relaxation,with a maximum distortion difference of 13%before and after unloading.As pre-stretching and post-stretching forces increase,cross-section distortion increases gradually,while springback first decreases and then remains unchanged.With increasing friction between bending die and profile,cross-section distortion slightly decreases,while springback increases.Cross-section distortion decreases by 83%with adding PVC fillers into the cavities of profile,while springback increases by 192.2%.

Prediction of(n,2n)reaction cross-sections of long-lived fission products based on tensor model

Interest has recently emerged in potential applications of(n,2n)reactions of unstable nuclei.Challenges have arisen because of the scarcity of experimental cross-sectional data.This study aims to predict the(n,2n)reaction cross-section of long-lived fission products based on a tensor model.This tensor model is an extension of the collaborative filtering algorithm used for nuclear data.It is based on tensor decomposition and completion to predict(n,2n)reaction cross-sections;the corresponding EXFOR data are applied as training data.The reliability of the proposed tensor model was validated by comparing the calculations with data from EXFOR and different databases.Predictions were made for long-lived fission products such as^(60)Co,^(79)Se,^(93)Zr,^(107)P,^(126)Sn,and^(137)Cs,which provide a predicted energy range to effectively transmute long-lived fission products into shorter-lived or less radioactive isotopes.This method could be a powerful tool for completing(n,2n)reaction cross-sectional data and shows the possibility of selective transmutation of nuclear waste.